Four pendulum balls hanging still while a fifth pendulum ball is about to hit them

Best Prokinetics for SIBO: Herbal and Pharmaceutical

Are prokinetics for SIBO helpful? If so, which one should I choose? What even is a prokinetic anyway? Before we get too far in, let’s talk about why we would consider using a prokinetic for SIBO.

We’ve talked about what SIBO is (see my blog post “What is SIBO?”), the types of SIBO and treatments for SIBO. If you haven’t read these blog posts yet, I suggest you do, as the information in this post builds on those. Not required, but helpful.

Since we know that SIBO is a result of something else, you may think that it stands to reason – unless we can manage the underlying cause, SIBO can come back. And you would be right. The truth is, even then, SIBO can come back.

If you’re a SIBO sufferer, this may make you feel somewhat hopeless but don’t feel that way. First of all, treatments for SIBO can be implemented time and again as needed. If you need another round of treatment here and there, then you need another treatment here and there.

Other than the symptoms you experience, no harm no foul with this. Per Dr. Mark Pimentel, SIBO researcher, Rifaximin is FDA approved as a pulse medication and multiple rounds of this is safe. Both herbal antibiotics (done under the supervision of a qualified practitioner), and the elemental diet can also be used this way.

A woman sitting up in bed with a stomach ache

BUT, what if we don’t WANT SIBO to come back? It is certainly not pleasant and can be a hassle to undergo multiple treatments. So what can we do to help prevent it?

Prokinetics

While there are many different approaches to preventing a SIBO relapse, we will focus on prokinetics today. These may not work for everyone depending on the underlying cause of their SIBO, but they do help for many.

Our GI tract is full of muscles that help it contract and “squeeze” food downstream if you will. These contractions happen repeatedly throughout the day and night as we sleep.

For some people, these contractions aren’t happening as often or as strong as they should. This alone can cause SIBO and is actually a very common contributor. So food does not pass through the GI tract at the rate that it should or as completely as it should. This can cause bacteria to populate the small intestine creating SIBO.

The word prokinetic means to promote movement. A prokinetic in this respect refers to an agent that helps increase the frequency or strength of these contractions… to get the gut moving. For many people, starting a prokinetic after their SIBO treatment ends, is key to preventing it again. It may not be the only prevention measure needed, but certainly helps.

Herbal Prokinetics for SIBO

One very basic herbal prokinetic is simply ginger root. Though ginger root has been shown to be effective, one con of this option is that it may not be as strong as some folks need. For many, however, it works wonderfully.

There are other herbal combination supplements available over the counter. Many of these contain ginger as well. Some examples include Motil Pro, GI Motility Complex and Prokine.

Whole ginger root sitting on a counter top

One herbal combination supplement that does not contain ginger is Iberogast. This also works very well for many. Some take this in combination with ginger root.

Many people may feel more comfortable using herbal remedies when possible. It is important to remember, however, that there can be side effects with even with herbal treatments.

Another thing to consider with herbal treatments is that, barring ginger root, they can be pricey. In addition, health insurance often does not cover them which can be a big down side for some.

Pharmaceutical Prokinetics for SIBO

There are several different options for pharmaceutical prokinetics that are commonly used for the prevention of SIBO. Some examples include Prucalopride, low dose Erythromycin and low dose Naltrexone.

One upside to pharmaceutical interventions is that insurance will often cover, or help cover, the cost as opposed to herbal therapies. That said, insurance coverage varies widely, as we all know, so this is always a bit of a question mark.

A woman about to take a pill with a glass of water

Of course with any type of pharmaceutical intervention, there can be side effects so it is important to have a detailed discussion with your healthcare provider about this.

Final Thoughts

Most often, prokinetics are taken before bed as many of our GI contractions happen while we are sleeping at night and not eating. Do remember, however, the importance of getting specific dosing, timing, etc. recommendations from your qualified healthcare provider with any of these prokinetic options.

Usually, a trial taper of the prokinetic is recommended at 3 months to see if it can be discontinued completely. The reason to trial a taper and not discontinue it cold turkey is that, this way, a recurrence of symptoms can be caught quickly.

Again, prokinetics for SIBO may not be the magic bullet for everyone. BUT they help to keep the gut moving and grooving the way it should, thus helping to prevent stagnant bacteria from populating places it should not!

Thanks for reading!