SBIO & the MMC – Part IV: Drugs and Herbs
This is part four of a five part series, the parts are:
- What is the MMC and why we care
- What influences the MMC
- When things go bad with the MMC
- Healing with drugs and herbs
- Healing with lifestyle measures
Recap on the MMC
MMC stands for Migrating Motor Complex. The MMC is the housekeeper of your gastrointestinal tract. Your housekeeper cleans up the stuff that should not be there, moving stuff along when it is time for it to move along. Some people have poor housekeepers and then things go wrong, resulting in Small Intestinal Bacterial Overgrowth (SIBO) and other horrors.
The Bad News
Although much work on the MMC was done in the 1970s and 1980s, the last few decades have seen a rapid drop. Part of this seems that the focus moved elsewhere. The other part of it is to do with rats: the MMC is a bit different in rats making cutting them up and torturing them in the name of research more difficult and less useful. Bad news for sufferers, good news for rodents.
So despite this research gap – what is available today in terms of herbs and drugs for those of us with sorry sad MMCs?
Big Pharma Options
Erythromycin: is actually an antibiotic however at lower dosses (i.e. 50-62.5mg per day or about 1/20th of the antibiotic dose), it creates intermittent contractions in the stomach which move onto to the small intestine and are similar to the natural MMC. The fact that it empties the stomach might cause other problems as partially digested food is moved through too quickly. There seems to be some sort of magic dosing window, that may be individual and age dependent (Asai 1997). There are also some other potentially nasty side effects such as QT-prolongation (that means uncool stuff happening within your heart). Also uncertain is if the meds continue to work over the long term. There are also a number of derivatives of Erythromycin without the antibiotic proprieties.
Prucalopride (Resolor): A new generation drug that triggers multiple MMCs (to Erythromycins one). Not approved in all countries. Anecdotally I have seen peeps rave about Resolor and its ‘life changing’ properties in some health forums online. But I also see an academic article talking about concerns about cancer and heart dramas, eek (Talley 2003).
Somatostatin: Encourages phase III of the MMC, but suppresses stomach contractions, so should not be used in gastroparesis. Also it is injection only which seems a bit limiting does it not?
Zelnorm: Increases the action of serotonin in the small intestine. The rest gets tricky as one of my fav SIBO gurus mentions it being gentle enough to get the job done without nasty downsides. Yet webmd discusses how it has withdrawn from the market due to heart attack and stroke risk. Gee research is tricky.
Morphine: Don’t try this at home peeps. But in low doses it does seem to stimulate the MMC.
Selective Serotonin Uptake Re Inhibiters (SSRIs): SSRIs (used in depression and anxiety) improve gut transit time (Talley 2003). What this does exactly for the MMC or where in the gut transit time might improve – I don’t know.
Before moving on – this quote seems pretty important to reflect on, as many of the above are types of prokinetics.
“Prokinetics … have somewhat fallen into disgrace due to central nervous or cardiac adverse effects” (Melzer, Rösch et al. 2004)
So with that wee warning let’s consider some herbal options. Only legal ones sorry peeps.
Iberogast: is a range of herbs developed in Germany in 1961. It is also called STW-5. For a herbal remedy it has quite a lot of research behind it. It is used in functional dyspepsia and IBS. Both of which are functional gastrointestinal orders. It is of interest in the IBS/SIBO community due to its prokinetic effects, as well as minimal side effects (Melzer, Rösch et al. 2004). Here is a useful summary from the Canadian Society of Intestinal Research.
Ginger: High doses of ginger are shown to have natural prokenetic properties, helping gastric emptying and the MMC (Wu, Rayner et al. 2008, Hu, Rayner et al. 2011).
Motilpro: Made of ginger and something called 5-HTP. Careful there is a warning on the bottle not to take this with some antidepressants – the SSRI types – this seems to be due to the risk of something called serotonin syndrome.
Atrantil: A US gastroenterologist struggling in supporting his patients with SIBO (and resulting MMC issues) decided to do something unusual (and exciting in my view) for a gastroenterologist, he researched some herbs (Brown, Scott-Hoy et al. 2016) that might help and brought that product to market under the name Atrantil. Atrantil works mainly to lower the methane producing bugs in your small instestine (see the SIBO series for more on this). However it also has a role in improving gut motility. Interestingly this seems due to the fact that these bugs that should not be there slow motility, so reducing them can improve motility. Note last I checked you could not purchase it in Australia – but you can ship it from New Zealand from http://fxmed.co.nz/ I use them regularly and they are great.
Sometimes it’s snake oil and sometimes it just looks like it.
Here is a tweet from me recently, which I was super proud of getting within the tweet characters restrictions. Of course no-one liked it so perhaps it was not as clever as I thought. However it is important in this discussion.
“Great thing re poor regulations in natural health industry is anyone can get their ‘great idea’ to market fast. The bad thing = THE SAME!”
So – how can you tell which herbs to invest your precious money on? Unfortunately there is no easy way to tell. Fortunately some herbs have been studied and these are a great place to start. Otherwise you are limited to online/personal reviews or trial and error. My strongest piece of advice here is to keep good records, including daily symptoms and dosages. You can see how far I go on this topic here. There is the odd money back guarantee products that might be worth a shot.
Another issue with the naturals industry is no legal requirement to notify negative side effects, so just because they are not listed does not mean they do not exist. An even more terrifying issue is no quality checks that product labels match product contents. This was borne home to me in a terrifying way at a medical research conference recently, where I learnt chinese herbs readily available in Australia coantined, among other things, traces of methampetamine (now theres an awesome repeat business strategy for herbs, if you can sleep with yourself at night). Want to know more? Pour yourself a very strong drink, get a box of tissues – now read this.
Remember even trusted herbs are medicine too, so treat them as such i.e. monitor yourself, keep out of reach of children, tell doctors/hospital staff etc what you are taking. If they laugh at you for taking ‘herbs’ as happened to me recently, just laugh back at them – that will confuse them and get them off your back.
I am not a doctor. I am a spoonie and one of my many challenges is SIBO which tends to reoccur after treatment. So I am putting my research skills (I am a PhD student) in to finding out what I can to help improve my MMC and sharing that with others who also might have an unhappy MMC. However given my area is not medical research some of this is pretty tough going (because academics never learnt the ‘write for a 10 year old’ thing, actually some of them never learnt the ‘write for anyone at all’ thing).
Asai, T. (1997). “Erythromycin and motilin as gastrointestinal prokinetic agents.” European journal of anaesthesiology 14(01): 3-6.
Brown, K., et al. (2016). “Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract.” World journal of gastrointestinal pharmacology and therapeutics 7(3): 463.
Hu, M.-L., et al. (2011). “Effect of ginger on gastric motility and symptoms of functional dyspepsia.” World J Gastroenterol 17(1): 105-110.
Melzer, J., et al. (2004). “Meta‐analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast).” Alimentary pharmacology & therapeutics 20(11‐12): 1279-1287.
Talley, N. J. (2003). “Evaluation of drug treatment in irritable bowel syndrome.” British journal of clinical pharmacology 56(4): 362-369.
Wu, K.-L., et al. (2008). “Effects of ginger on gastric emptying and motility in healthy humans.” European journal of gastroenterology & hepatology 20(5): 436-440.