Laxatives, stool softeners and prokinetic agents
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Colopathy & prokinetics
SIBO could lead to MICI (immune reaction) if not well treated.
Short term solution when constipated
Most of us has already heard to eat a carrot salad (or bamboo shoots) to optimize the take of fiber (30 g) and to help carrying LPS toxins away from the intestines. Right but only once a day (chelation). And whenever the transit is blocked (2 or 3x/wk. pooping), an often advised laxative in urgency could be to saturate with magnesium or best with L-acid ascorbic (vitamin C). Right but only appropriate if used with common sense: aggressive for mucus, stressful for brain, time-consuming.
So, these ways of practicing are emergency and / or temporary solutions.In case of lazy bowels with constipation problems
Another one possibility would be to take triphala (a natural prokinetic) 1 capsule with each main meal, plus 2 to 3 capsules at bedtime, to see if after a few days/weeks, I notice a positive change in my symptoms (less GERD, gas, bloating, etc.) --> triphala will work by supporting your MMC during the day and also at night, to help your body properly cleanse your small intestine.
https://www.brin-d-herbe.fr/triphala-125-gelules-c2x26055158
NB: I would try to observe as much as possible a 4-5 hour inter-digestive space to give my body time to properly evacuate waste through colonic motility.Medium term option
If you fight against sedimentation by using laxatives and prokinetics during treatment, you will allow closer contact between the active substances and the biofilms. However, the acceleration of transit risks preventing the sustainability of the treatment since you send everything to the toilet. So, no accumulation effect of the active substances.
Here is what Dr. Antonello D'Oro says about it (*):Stimulating Intestinal Motility (ICM) with Prokinetics
ICM = Intestinal Contractile Motility. It refers to the coordinated contractions and relaxations of the muscles in the intestines, which are essential for mixing and propelling food along the digestive tract. These movements are crucial for digestion and a correct nutrient absorption.
There are natural substances or medications that stimulate the motility of our small intestine in its cleansing function; these are called prokinetics. As soon as antimicrobial treatment is completed, many nutritionists recommend taking prokinetics to prevent a recurrence from occurring too quickly. It is important to keep in mind that a laxative is not a prokinetic and that laxatives do not stimulate the ICM. Furthermore, a prokinetic can be given even during diarrhea, as SIBO with diarrhea is often due to an ICM deficiency that leads to diarrhea through fermentation in the large intestine. A prokinetic should be taken as soon as antimicrobial treatment is completed, i.e., the following night after stopping the antimicrobial treatment. The duration of prokinetic treatment will depend on several factors:
• Short-term (3 to 6 months), especially if symptoms are less than a year old or following initial treatment.
• Long-term if SIBO has been present for more than 5 years or if recurrence is rapid upon stopping antimicrobial treatment. Additionally, people with autoimmunity against their migrating motor complex (positive IBSCHECK) should take prokinetics long-term.
After a certain period, it is recommended to gradually stop taking prokinetics, for example, every other day, then every third day, etc. If symptoms gradually return, you can reintroduce the prokinetic at full dose, possibly preventing a SIBO relapse. There are natural and medicinal alternatives to prokinetics.
Source:
*) Preventing the SIBO from returning
https://www.lanutrition-sante.ch/partie-3-empecher-la-recidive-du-sibo-la-partie-souvent-oubliee/ -
Prokinetics and Intestinal Motility
Mechanism of prokinetics (Dr. d’ORO, Swiss Dr)
Prokinetics are products, either natural or medicinal, that stimulate and coordinate intestinal motility, making it more effective. They act on various receptors in the intestine, thus allowing varied mechanisms of action. Some prokinetics inhibit dopamine which acts as an inhibitor on the digestive system. (…) Other substances also act on acetylcholine receptors which is a stimulating neurotransmitter of the intestine, other substances act on antagonistic (5-HT3) or agonist (5HT4) serotonin receptors. Etc. Thanks to these combinations of action, prokinetics have the capacity to amplify and coordinate muscular contractions of the intestine. They can act on different sites of action, both on the upper part of the digestive system such as the stomach or the small intestine and on the colon. Prokinetics can improve gastric emptying by coordinating the closing of the lower esophageal sphincter and the opening of the pyloric sphincter while the stomach contracts. They are known for their ability to stimulate the migrating motor complex (MMC) to clean the small intestine of this waste. Certain prokinetics have the ability to improve intestinal transit and can be used for example during constipation. However, prokinetics should not be confused with laxatives. (…) We will see that there are natural or medicinal prokinetics.Note: I’ve used Resolor 0.5 gr as prokinetic (prucalopride)
Source of the Info on MMC (Migrant Motor Complex) (=> interprandial motility)
“The complexity of the relationships between motility, transit and absorption is mainly due to the numerous parameters which characterize an intestinal contraction and to the nature of the intestinal contents.” (1)- Role of motility in intestinal transit and absorption
J Fioramonti 1, L Buéno. Presse Med. 1989 Feb 15;18(6):249-54.
- Role of motility in intestinal transit and absorption
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Understanding MMC
The migrating motor complex (MMC)
MMC stands for migrating motor complex
MMC is an electrical and contractile activity of digestive motility which takes place in the inter-digestive periods (= interprandial phase) (between two meals), and interrupted by food intake. Each MMC is accompanied by an increase in gastric, pancreatic and duodenal secretions. They are thought to serve to evacuate contents in the small intestine between meals, and also to transport bacteria from the small intestine into the colon. An alteration of this phase notably favors the development of chronic bacterial colonization of the small intestine, a source in particular of bloating, diarrhea, or even steatorrhea, of the majority of food intolerances. When contractile activity is low, we then speak of lazy intestines. Support and rehabilitation is often necessary, with a prokinetic.
An ideal break time would be 4 to 5 hours between 2 food intake.
NB 1: I’ve used Resolor 0.5 mg, as prokinetic (1 tablet 1 mg cut into 2 pieces) which is classified as laxative but not used so).
NB2: When the gastro-intestinal problems last for more than 3 months, we have to suppose there is bacterial overgrowth or inappropriate colonic phyla in the second part of the colon. At his point, the need for antibiotic is required (with medical assistance).
Rifaximin is the most commonly prescribed antibiotic for small intestinal bacterial overgrowth (SIBO) and is considered a good option for addressing lazy transit and bacterial overgrowth in the second part of the colon. Rifaximin is often the first-line treatment for SIBO, with studies showing eradication rates of up to 84% (with assistance of a healthcare professional).
NB: Erythromycin, as a prokinetic drug, accelerates gastric emptying in both healthy individuals with normal gastrointestinal function and in patients with critical gastroparesis -
Which antibiotic?
Erythromycin and rifaximin both have potential roles in addressing a "lazy" gastrointestinal migrating motor complex (MMC), but they work through different mechanisms. Erythromycin, a prokinetic agent, directly stimulates the MMC and gastric emptying. Rifaximin, a poorly absorbed antibiotic, can improve symptoms associated with MMC dysfunction, particularly in cases of small intestinal bacterial overgrowth (SIBO) and related conditions like IBS-D, by reducing methane production and modulating the gut microbiota.
Erythromicin Mechanism
Erythromycin acts as a motilin receptor agonist, stimulating the MMC and promoting gastric emptying. It induces premature MMCs at lower doses (50 mg) and can prolong their cycle length at higher doses.
Considerations: Erythromycin can cause side effects like diarrhea and nausea. It may also contribute to antibiotic resistance if used in an inappropriate way and frequently.
Erythromycin, used at a low dose (namely +/ 50mg), acts as a motilin receptor agonist, which stimulates the migrating motor complex (MMC) and promotes gastric emptying.
Explanation:
• Motilin Receptor Agonist:
Erythromycin binds to motilin receptors, which are found in the smooth muscle of the stomach and intestines.
• Stimulating the MMC:
By activating motilin receptors, erythromycin can trigger the MMC, particularly the phase III contractions, which are the strongest and most effective at clearing contents.
• Promoting Gastric Emptying:
By stimulating the MMC and increasing the strength and frequency of stomach contractions, erythromycin helps to accelerate the emptying of the stomach's contents into the small intestine.
In simpler terms: Erythromycin acts like a "wake-up call" for the stomach, causing it to contract more forcefully and regularly, which helps move food through the digestive system faster.
Clinical Relevance: This effect of erythromycin is often used in the treatment of gastroparesis, a condition where the stomach empties too slowly.
Reference:
https://www.sciencedirect.com/topics/medicine-and-dentistry/motilin-receptor-agonistRifaximin Mechanism:
Rifaximin is a non-absorbable antibiotic that primarily acts within the gastrointestinal tract. It can reduce bacterial overgrowth, including methane-producing bacteria, which can be a factor in slow transit constipation.
Considerations: Rifaximin has a favorable safety profile with minimal systemic absorption and fewer side effects compared to other antibiotics.Which to Choose?
The choice between erythromycin and rifaximin depends on the specific underlying cause of the "lazy" MMC and associated symptoms:
• If delayed gastric emptying is the primary issue:
Erythromycin is a good choice as a prokinetic agent to improve gastric motility and emptying.
• If SIBO, dysbiosis, or IBS-D are suspected or diagnosed:
Rifaximin is a good option to address bacterial overgrowth and related symptoms.
• In some cases, a combination of both might be considered:
For example, erythromycin could be used to improve gastric emptying, while rifaximin addresses SIBO. -
*) How to treat SIBO / SIFO with prokinetics
The following info is based on the work of Drs. Bella Lindemans, Nirala Jacobi, Antonello D'Oro, Marc Pimentel, Allison Siebecker, Bruno Donatini.
I’ve dealt with this issue in this topic:
https://mirzoune-ciboulette.forumactif.org/t1990-comment-traiter-le-sibo-sifo-avec-prokinetique-et-he#29010Erythromycin in details
It is a very polyvalent macrolide antibiotic used in many infections, most often given at doses around 1.5 to 2 g per day. However, this antibiotic given at low doses (between 50 mg and 62.5 mg) has practically no antibiotic effect and becomes an excellent prokinetic. It will act mainly on the upper digestive tract (motilin receptors) by stimulating the motility of the stomach and small intestine. It finds a good indication during gastroparesis or during the prevention of recurrence of SIBO. Professor Pimentel, who is one of the best SIBO specialists in the world, has demonstrated that this prokinetic has the capacity to double the remission time of SIBO. This low-dose medication is well tolerated with very few side effects. However, it is necessary to highlight some rare contraindications, especially in people with heart problems (prolonged QT interval). On the other hand, there may be interactions with other medications due to its hepatic elimination by cytochrome P450 (3A4). For example, antifungals or berberine may interact with erythromycin, however, its elimination by the body is rapid (about 8 hours) and therefore another medication can be started the day after stopping.Prucalopride (Resolor) in details
This medication has a highly selective action on 5HT4 agonist receptors in the intestine, which is one of the reasons why it is very safe because it does not affect other receptors. It is a highly effective substance that acts on the entire digestive tract. It is considered the star of prokinetics and is often the first choice for many American gastroenterologists. It is usually used for the treatment of constipation at a dose of 1 to 2 mg taken at bedtime. The recommended dose as a prokinetic is 0.5 mg at bedtime, however, in cases of constipation, the usual doses can be used.Note: I’ve taken it 30-60’ before bedtime. The 1st 4 days, I had to delay going to bed for about 2 hours (contractions affecting transit in order to have a bowel movement).
to be continued on next post -
Recently, new properties have been discovered: prucalopride has neuroprotective properties (*), meaning that it protects the nerves in the intestine and even has the ability to regenerate damaged nerves. These findings are the result of recent research and are very interesting given that many chronic intestinal diseases are accompanied by damage to the intestinal nerves. This discovery is particularly interesting because this neuroprotective molecule could offer an additional advantage in terms of remission.
Source
*) doi: 10.1152/ajpgi.00036.2016
Prucalopride exerts neuroprotection in human enteric neurons. 2016 -
Useful links
*) Protocole du Dr. Antonello d’Oro en cas de SIBO.
https://mirzoune-ciboulette.forumactif.org/t1131-sibo-pullulation-bacterienne
*) SIBO : l’invasion des mauvaises bactéries dans votre intestin
https://mirzoune-ciboulette.forumactif.org/t1131-sibo-pullulation-bacterienne
*) Comment traiter un SIBO / SIFO avec un prokinétique et HE (essential oils)
https://mirzoune-ciboulette.forumactif.org/t1990-comment-traiter-le-sibo-sifo-avec-prokinetique-et-he?highlight=prokinetique -
*) Suspicion of FUT2 deficiency
If there is a metabolic deficiency (FUT2 gene), the mucus layer is defective/insufficient.
In the presence of insufficient mucus, the small intestine is not properly protected by the thickness of the mucosa. Mucus also serves to trap unwanted organisms and push them towards the colonic flora (microbiota), which serves as food for the good bacteria. There is then a risk of stagnation and the creation of a gastro-resistant biofilm, a future pothole, where friendly or unfriendly colonies may form.
At the beginning of the process, the friendly strains that develop in the small intestine are no longer friendly at all and will proliferate "live," benefiting from 100% of the nutrition (to the detriment of their host) and forming colonies that will ultimately be pathogenic and impervious to antibiotics. So, yes, at the beginning, we will have good feelings, then after 1 to 2 months it will start to go wrong without us understanding where it comes from.
