Why a Prokinetic?

by Valerie Polley | Aug 27, 2019 | 6 comments

 

Each year that I have been in practice, the more clients I see with small intestinal bacteria overgrowth (SIBO). When I opened my business over 3 years ago, SIBO was not a term in my vocabulary. I honestly don’t remember where and when I first heard about it. Now I have individuals reach out to me not only to help with diet, but if multiple rounds of Rifaximin didn’t help, what can they do? I have learned much about SIBO and how to help those struggling with it. This is a growing issue, where it is estimated that 60% of those with IBS actually have SIBO.

If this is the first time you are hearing this SIBO term, here is a short explanation. Our small intestines have some bacteria, but most of the bacteria resides in the large intestine/colon. With SIBO, there is more bacteria than normal in the small intestine. This makes it difficult to maintain a healthy gut environment. What happens? This bacteria in the small intestine begins fermenting the food being consumed causing multiple gut issues, including bloating, distention, gas, diarrhea, constipation, etc. Unlike irritable bowel syndrome (IBS), SIBO often needs further intervention above and beyond diet changes, either in the form of a prescription ordered by your physician or herbal supplements.

One aspect of SIBO that most clinicians agree on is the importance of maintaining that migrating motor complex (MMC). This cleansing wave is natural for everyone to have and occurs during a fasting state. Those with GI issues tend to have a more sluggish digestive tract, so it is important to help that MMC do its job more easily.

Two main ways to keep the MMC moving is to space meals 4-5 hours apart (no small frequent meals) and taking a prokinetic. The definition of a prokinetic is stimulating movement or motility, such as a drug that promotes gastrointestinal motility. The bottom line is that a prokinetic helps keep things moving throughout the GI tract. For those with SIBO this is important. Intestinal dysmotility plays a crucial role in the severity of symptoms and motility issues itself can be a cause of SIBO. Keeping that MMC going allows the bacteria to migrate towards the large intestine, effectively stopping accumulation of bacteria in the small intestine.

If you have SIBO and you are not on a prokinetic agent there are options. Your physician can prescribe a prokinetic drug, such as low-dose Erythromycin or Resolor® (Prucalopride). There are other options for prescription prokinetic drugs, but these are the two I see often. If you would rather not take a prescription, there are herbal prokinetic agents that many find to be helpful. Iberogast® and Motility Activator® are two of the herbal choices along with a handful of others.

If you have SIBO and have been through treatment, now is a good time to start a prokinetic agent. If you want a prescription, reach out and discuss it with your physician. If you lean towards herbals and you need help figuring out which type and dose, reach out to a dietitian or functional practitioner that specializes in treating SIBO.

The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.

 

With summer here, many people are getting excited about upcoming vacations. But for people with digestive issues, symptoms like constipation and bloating are often unwelcome travel companions. Traveling disrupts our body's natural rhythms and daily habits, which can lead to digestive chaos.

This article will help you understand how sudden changes in hydration, diet, and airplane cabin pressure impact the gut, as well as provide practical, evidence-based tips for keeping your gut happy on the road.

The Perfect Storm for Constipation: Fluid and Fiber Drops

One of the biggest contributors to digestive issues like constipation when you're traveling is a change in your normal hydration and fiber intake patterns. Here's how each affects your gut.

Inconsistent Hydration

Disrupted routines often lead to forgetting to drink water. Plus, strict airport security rules mean you can't carry a full water bottle through security checkpoints. Travelers often intentionally avoid drinking to skip using tiny airplane toilets or unfamiliar public restrooms. Finally, plane cabins are incredibly dry, which can quickly lead to dehydration.

The result: When the body is dehydrated, the colon absorbs more water from food waste, leading to hard, dry, and difficult-to-pass stools.

Reduced Fiber Intake

Most people in the United States don't get enough fiber at the best of times, and traveling only makes this worse. Convenience foods at airports, gas stations, and roadside stops are typically highly processed, high in sodium, and low in fiber. Experiencing local cuisines often means prioritizing rich restaurant meals over fresh fruits, vegetables, and whole grains.

Not getting enough fiber quickly contributes to constipation because fiber is essential for adding bulk to stool and keeps things moving through the digestive tract. A sudden drop in fiber stalls peristalsis (the wave-like muscle contractions in the gut), leading to less frequent bowel movements. 

The Combined Effect

The simultaneous drop in both fluid and fiber creates a "logjam" effect in the intestines. Not having enough fluid and fiber slows the movement of waste through your gut. This leads to more water being absorbed from the stool, resulting in hard, difficult-to-pass stool. The traffic jam effect makes acute constipation one of the most common (yet preventable) gut-related travel complaints.

Cabin Pressure and Bloating

Have you ever noticed that you get more bloated during air travel than other forms of travel? No, you're not imagining things. This is due to a law of physics called Boyle's Law. Simply put, this law of physics states that as atmospheric pressure decreases, the volume of a gas naturally increases.

Here's how that works with your gut and air travel. Airplane cabins are pressurized to simulate an altitude of around 6,000 to 8,000 feet. Because of this shift, the gas that's already present in your gut expands during flight. This rapid gas expansion stretches your intestinal walls, leading to pain, cramping, and bloating often referred to as "airplane belly."

Additionally, several common travel habits can aggravate this trapped gas. Drinking carbonated beverages before or during the flight, chewing gum (which leads to swallowing excess air), and remaining stationary for hours on end all trap and intensify the expanding gas.

Tips for a Happy Travel Gut

Fortunately, a few small tweaks to your travel routine can make a huge difference in whether you end up constipated and bloated while traveling.

Pre-Flight and In-Transit Tactics

  • Hydrate on the go: Bring an empty, reusable water bottle through airport security and fill it once you reach the departure lounge (most airports now have water bottle filling stations). Aim for consistent sipping throughout your journey to keep hydrated.
  • Be mindful of foods that can worsen bloating: Avoid fizzy drinks, heavy or fried foods, and gas-producing foods like beans, broccoli, and cabbage, for at least 24 hours before your flight. This can reduce the amount of gas present in your gut, which can reduce the bloating associated with a drop in cabin pressure.
  • Pack smart snacks: Since airport snacks are typically high in sodium and low in fiber, bringing your own high-fiber, travel-friendly snacks can help boost your fiber intake. Consider packing dried chickpeas, almonds, dried fruit, or on-the-go fiber supplements to bridge the gap.

On-Arrival Habits

  • Prioritize fiber: While there's nothing wrong with enjoying the local cuisine wherever you're traveling, try to prioritize fiber at your destination whenever possible. I recommend starting your day with a high-fiber breakfast, such as oatmeal with fruit, nuts, and seeds.
  • Get moving: Try to avoid being sedentary on arrival. Going for a leisurely walk helps stimulate intestinal motility and releases trapped gas (there's a reason a short walk after meals is commonly called a "fart walk"!).
  • Keep a regular sleep schedule: Vacation can throw a serious wrench into your routine, but wherever possible, try to maintain it. Gut issues can be worsened by poor sleep, so sticking to your routine can help support gut comfort on vacation.

Final Thoughts

Travel naturally changes our dietary habits and challenges our digestive system through abrupt changes in cabin pressure, but digestive discomfort doesn't need to ruin your vacation. By being mindful of your fluid and fiber intake, staying active, and making strategic changes in pre-flight eating habits to minimize the effects of cabin pressure changes, you can keep your digestion on track and enjoy every minute of your vacation.

If you're worried about an upcoming trip and need personalized strategies for managing your digestion on vacation, I'd love to help. You can get in touch with me at Blue Tree Nutrition to book your appointment with a registered dietitian.

6 Comments

  1. sylvia Miller

    Going to P/U xifaxan antibiotic for SIBO and would like to know if a prokinetic should be taken with it or after?
    17 YO son diagnosed with EoE earlier last year. He was prescribed PPI – I’m certain that caused his SIBO.

    Reply
    • Valerie Polley

      I have seen it both ways while taking Xifaxin. I would ask his physician what he normally likes to do. If he is scheduled for a follow-up breath after his Xifaxin course, I would just wait. You need to be off a prokinetic for a week prior to a breath test.

      Reply
  2. Kelly Allhands

    I’m just wondering how long a natural prokinetic takes to make changes in motility.

    Reply
    • Valerie Polley

      It depends on the person. It starts working right away, but the degree it helps will depend on the individual.

      Reply
  3. Judy Bradshaw

    How to treat sibo naturally and is Berberine used to help with sibo?

    Reply
    • Valerie Polley

      Judy,
      Thank you for asking. If you decide to go the herbal route, the supplement that is chosen depends on the gas that is elevated on a breath test and/or your symptoms. Berberine can be a good option for hydrogen gas, but there are also other options for hydrogen gas elevation. Please let me know if you have any other questions. You can also reach out to me directly at valerie@bluetreenutrition.com.

      Reply

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.