SIBO Begone: 5 Easy Ways to Keep Your SIBO From Coming Back
One of the things I always warn every SIBO patient about is the tenacity of SIBO and its cousin SIFO (small intestine fungal overgrowth). If you’re dealing with chronic constipation, diarrhea, gas and bloating, you may have gotten a diagnosis of Irritable Bowel Syndrome or IBS. However, studies are showing that one of the major causes of IBS is Small Intestine Bacterial Overgrowth or SIBO.
SIBO is when there are too many bacteria in the small intestine. Contrary to what you may be thinking, we’re actually talking about the good, friendly bugs that we love – just too darn many of them. This overgrowth of bacteria, and sometimes fungus, can lead to all the symptoms of IBS.
While we have great treatments for SIBO/SIFO, a vital part of holistic SIBO/SIFO care is doing everything we can to keep these overgrowths from coming back. Let’s get into five easy ways to do just that!
The Migrating Motor Complex
Motility is Everything
One of the first things I think about as a cause of SIBO is slow digestive or gastric motility. Gastric motility refers to the movement of food, bacteria and toxins through the GI tract and out of the body as stool. Often, when we have slow motility, there can be problems with the Migrating Motor Complex (MMC). Not supporting the MMC is a major reason that SIBO recurs.
What is the Migrating Motor Complex and Why Does It Matter?
The MMC, more properly known as Migrating Myoelectric Complex, is thusly named for the series of electrical waves in the gut. The MMC is the housekeeping motor of the gut; it sweeps out the stuff we don’t want in there and moves it down to the colon where it can be excreted.
Phases of the Migrating Motor Complex
The MMC is usually divided into four different phases. Each of these phases plays a role that is important for the next phase of the process.
One MMC starts in your stomach and travels through the small intestine. The second MMC starts at the duodenum and moves down to the ileocecal valve in the large intestine, which is at the end of the small intestine where it meets the colon or large intestine. The process plays a critical role in digestion.
This cycle gets started between two meals, as well as during sleep. When you eat the MMC process is interrupted1. If the MMC doesn’t get a chance to do its job, food and bacteria can back up. This leaves you feeling heavy, like your food doesn’t move after you eat it (because it doesn’t). This also sets the stage for bacterial and fungal overgrowths, as the food left in the intestines is perfect food for bacteria (ewww).
Signs of MMC
That rumbling in your tummy when you’re hungry is caused by the MMC – say hello and thank you the next time you hear it! It’s a good thing and it’s helping you out. A lot of folks with SIBO never hear their tummy make noise!
The MMC is different from peristalsis, which starts when you eat, taste or think about food. Fasting is the trigger for the MMC, which occurs in the stomach and small intestine. Dealing with diarrhea? Don’t be scared of stimulating your MMC – the movement stops at the end of the small intestine and doesn’t move into the large intestine
Why is Slow Digestion an Issue?
Without a properly functioning MMC, gastric contents, the stuff we eat may stay in the stomach and small intestine longer than is healthy. This can feel really lousy; you’ll feel a heaviness after eating, too-full feeling even if you only have a small meal. Again, a slowed MMC leads to bacteria and fungus staying in the gut, or GI tract, for too long, leading to bacterial or fungal overgrowth3. Hormone imbalances can be sparked by a slow MMC as spent hormones need to be moved along and pooped out too.
Studies have shown that people with IBS tend to have disruptions to their MMC. Science doesn’t know yet just how these changes happen. Some theories point to food poisoning or other bacterial infections leading to changes in the gut microbiome2, which then messes with how the flora signal the MMC to start and stop. Eating inflammatory foods or foods you’re sensitive or allergic to can cause nerve damage in the gut. Subsequently, these nerves then can’t signal the MMC properly.
Triggers for a Slowed MMC
Stress, trauma and elevated cortisol can also do a number on the MMC. Finally, the old story that we need to eat every hour or two to “regulate our metabolism” can keep the MMC from moving things along.
Regardless of why your MMC isn’t working appropriately, getting it back on track is vital for beating SIBO, IBS, depression, anxiety and other mental and physical health concerns
How to Support a Healthy Migrating Motor Complex
1. Reduce Your Stress Levels
Studies show that stress messes with digestion. Stress can slow digestion down leading to constipation and a slowed MMC. Stress can also speed digestion up, like when you have the jitters before a big conversation. You may get looser stools, which doesn’t mean you’re having a full MMC sweep-out of the small intestine. This can also mean less absorption of nutrients from your food.
Psychological stress may also impair the function of the Migrating Motor Complex and can lead to a higher risk of complications like bacterial overgrowth3.
How to Combat Stress
Meditation and other relaxation techniques such as deep breathing or yoga are really helpful for supporting gut health and MMC function. These ancient techniques can help in reducing the amount of cortisol circulating in the body and may improve MMC function.
Our adrenals produce a stress hormone called Cortisol. While normal levels are vital for survival (like not getting hit by a car,) too much cortisol can thin the gut lining leading to more leaky gut and more digestive troubles.
2. Most Grown Ups Shouldn’t Snack
Remember that the MMC cycle is activated by having an empty stomach and naturally occurs every 90-120 minutes. It then takes about 1 hour 45 minutes for the MMC to go through all 4 its phases. This process is interrupted as soon as you eat something.
To give your MMC the best chance to do its housekeeping job, it’s optimal to wait a minimum of at least 3 hours 45 minutes between meals – that means no snacking between cleanings!
To be safe, I give my digestion 5 hours between eating. This means no snacks, coffee with creamer or sugar – just herbal teas and water.
Note that babies and children need to eat much more often because they’re growing, so this advice applies only to grownups who are not pregnant. If you’re pregnant, eat what you need to, and think about the MMC later. Folks with diabetes may also need to eat more often as they work to balance their blood sugar.
Hungry Between Meals?
If you feel the rumble and want to munch between meals, work backwards. Instead of snacking, make each meal really count! Make sure you’re getting enough fat, protein and a healthy vegetable carbohydrate and fiber-containing vegetables at each meal. Just having grains (like toast or oatmeal) will leave you hungry throughout the day and much more likely to reach for a snack. Fiber and fat keep you feeling full, so make sure to enjoy them with every meal.
Incorporate these into your meals to keep you full:
- avocado and some eggs on your morning toast (if you’re eating grains)
- a smoothie with protein powder, nuts, and whole fat coconut milk instead of just fruit
- sweet potato and a big salad with lots of yummy extra virgin olive oil or coconut oil with your steak or chicken
3. Overnight Fast (don’t panic! this isn’t scary)
A 12-hour (minimum) fast overnight allows the digestive system to take a break from constantly having to digest and process food. This gives the MMC a chance to work more effectively without being interrupted constantly.
Start with finishing eating at 7 pm or 8 pm and don’t eat while you’re asleep (chocking hazard and whatnot). Wait to break your fast until 7 or 8 am the next morning. 12 hours! Boom.
Other Benefits to Fasting
Overnight fasting can also help you connect in with your hunger better. Are you eating later at night because you’re actually hungry or is it a habit that may not be great for your health longterm?
Fasting has also been associated with several useful health benefits, ranging from improvements in heart health to improved metabolic balance (keeping diabetes at bay) and reducing cancer recurrence, which is pretty amazing.
4. Vagus Nerve Support
The Vagus nerve is the longest nerve of the cranial nerves and runs from the brain throughout your body. In addition to having an effect on organs like the lungs, heart, liver, gallbladder, and even the pancreas, this nerve is also known to affect the MMC’s functionality. I’ve noticed in the last decade that my patients who put the effort in the support their Vagus nerve are often those who are most likely to beat SIBO and IBS and to not having it come rearing back.
Viva la Vagus
There are many simple, free and easy ways to activate and support the Vagus nerve. While you may or may not inherently feel changes from supporting your Vagus, your cells and nerves will totally feel the difference.
Deep breathing, meditation, yoga, probiotic supplements are just a few options to consider4 for nerve support.
Learn more about simple things you can do for free, at home to support your Vagus nerve here.
There are many supplements and herbals that may assist in supporting the MMC. These are called prokinetics, and there are drugs that do a similar thing.
I recommend that my patients start these as soon as they’ve completed SIBO treatment and should be completed for a minimum of 6 months after treatment. Remember to speak with your own licensed healthcare provider before starting any supplements or other treatment plan!
Some good options options include:
- Medicinal bitters: herbs that stimulate the bile system and start digestion. Typical dosing: 30 drops of Swedish Bitters or similar before bed.
- Artichoke (Cynara cardunculus) 6-11: stimulates flow through the liver/gallbladder and digestion. Typical dosing: 1 dropperful of tincture before meals and with dinner or right before bed.
- Acetyl-l-carnitine: Supports a healthy neurotransmitter balance and motility nerve signaling, and healthy levels of acetycholine. Typical dosing: 500 mg before bed
- Ginger (Zingiber officinale)6-11: modulates serotonin signaling, supports gastric emptying, motility in the good, and is soothing to the upper GI system. Can be used as a tea, 1-2 tsp powder in your smoothies or in a motility blend. Best when taken with lunch and dinner.
- 5-HTP: stimulates neurons in the gut and is converted to serotonin, which helps with gut motility. Typical dosing: 50 mg with lunch and dinner*
*NOTE: please do not use 5HTP if you are on antidepressant (SRRI) drugs. This can be very dangerous. Also note that prolonged use of 5HTP (beyond 6 months) needs to be balanced with the amino-acid L-tyrosine the next morning.
The MMC plays a vital role in ensuring undigested foods and other substances, including bacteria, can be moved through the gastrointestinal tract and out of the body, where they belong. This helps to keep toxins and bugs from hanging out in the gut too long, which can lead to serious symptoms, like bloating, gas, constipation, diarrhea, IBS and SIBO.
Ready to finally beat your SIBO once and for all? Make sure you’re taking good care of your Migrating Motor Complex!
1. E. Deloose, P. Janssen, I. Depoortere, J. Tack. The migrating motor complex: control mechanisms and their role in health and disease. Natures Reviews: Gastroenterology & Hepatology. 27 Mar 2012. https://www.ncbi.nlm.nih.gov/pubmed/22450306
3.T. Takahashi. Mechanism of Interdigestive Migrating Motor Complex. Journal of Neurogastroenterol Motility. Jul 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400812/
4 .T. Takahashi. Interdigestive migrating motor complex – its mechanism and clinical importance. Journal of Smooth Muscle Research. 21 Mar 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137267/
5. V. Albina. Hack Your Vagus Nerve to Feel Better: 14 Easy Ways. Victoria Albina – Functional Medicine & Life Coach. 5 Jul 2018. https://victoriaalbina.com/2018/07/vagusnerve/
6. Giacosa A, Guido D, Grassi M, et al. Effects of Ginger (Zingiber officinalis) and Artichoke (Cynara cardunculus) Extract Supplementation on Functional Dyspepsia: A Randomised, Double-Blind, and Placebo-Controlled Clinical Trial. Evid Based Complement Alternat Med. 2015;2015:915087.
7. Micklefield GH, Redeker Y, Meister V, et al. Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther. 1999 Jul;37(7):341-6.
8. Holtmann G, Adam B, Haag S, et al. The effect of artichoke leaf extract in the treatent of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther. 2003 Dec;18(11- 12):1099-105.
9. Lazzini S, Polinelli W, Riva A, Morazzoni P, Bombardelli E. The effect of ginger (Zingiber officinalis) and Artichoke (Cynara cardunculus) extract supplementation on gastric motility: a pilot randomized study in healthy volunteers. Eur Rev Med Pharmacol Sci. 2016;20(1):146-9.
10. Ghayur MN, Gilani AH. Pharmacological basis for the medicinal use of ginger in gastrointestinal disorders. Dig Dis Sci. 2005 Oct;50(10):1889-97.
11. Kirchhoff R, Beckers C, Kirchhoff GM, et al. Increase in choleresis by means of artichoke extract. Phytomedicine. 1994 Sep;1(2):107-15.
^ These statements have not been evaluated by the Food & Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
Victoria Albina, NP, MPH is a licensed and board certified Family Nurse Practitioner, herbalist and life coach, with 20 years experience in health and wellness. She trained at the University of California, San Francisco, and holds a Masters in Public Health from Boston University and a bachelors from Oberlin College. She comes to this work having been a patient herself, and having healed from a lifetime of IBS, GERD, SIBO, fatigue, depression and anxiety.
She is passionate about her work, and loves supporting patients in a truly holistic way - body, mind, heart and spirit. A native of Mar del Plata, Argentina, she grew up in the great state of Rhode Island, and lives in NYC with her partner. A brown dog named Frankie Bacon has her heart, and she lives for steak and a good dark chocolate.