I recently wrote an article about what activities inhibit MMC function and I wanted to build on that article by covering what activities will improve MMC function.
Migrating motor complex deficiency is seen in 70% of patients who have SIBO. This deficiency in MMC activity creates an environment in the small intestines that is ripe for an overgrowth. High relapse rates in many SIBO patients can be a result of failing to address MMC deficiency. No amount of herbs or pharmaceutical antibiotics will keep the small intestines clear if you have poor MMC function.
So what exactly is the migrating motor complex? The MMC is a cyclical pattern of electromechanical activity that is observed in the smooth muscle of the GI tract between meals. You can think of the MMC as a broom that sweeps the small intestines clean between meals.
In a healthy individual, these cleansing waves come every 1.5-2 hours, but someone with SIBO has more infrequent MMC activity. With an MMC deficiency, SIBO patients have food, bacteria and waste sitting in their small intestines for longer periods of time. The inefficiency of the MMC will lead to the development of SIBO. Relapse is inevitable if the MMC is not addressed during treatment.
I came up with 8 key factors that are important to increasing MMC function. Lets dive in!
1. Fasting between meals
You have to be in a fasted state to produce MMC activity. As a SIBO patient with a MMC deficiency, grazing and snacking can be problematic, because you are not giving yourself enough time between meals to allow the MMC to work its magic and clean the intestines. Optimally, you want at least 4 hours between feedings.
Some of my SIBO clients do well with intermittent fasting and sticking to just 2 meals a day. But, adrenal and thyroid function should be considered before embarking on any periods of extended fasting. As with everything in the SIBO world, one size does not fit all with treatment.
2. Good Blood Glucose Control
High blood sugar can damage nerves. Individuals with diabetes often have motility disturbances like gastroparesis due to this nerve damage. But, you don’t have to have diabetes to experience blood sugar swings.
In fact, many of my SIBO clients have blood sugar issues. Usually this is related to adrenal/thyroid problems, but can also be a result of the imbalances in the gut causing metabolic endotoxemia. I discuss ME in more depth in this post, but it’s essentially when endotoxins seep into the bloodstream leading to systemic inflammation and insulin resistance.
Balancing your meals with enough protein, fat and carbs at each meal is a good first step to keeping your blood sugars under control. Blood sugar issues are going to be more prevalent in under eaters due to increases in cortisol. Sometimes just making sure you are adequately nourished can make a huge difference in blood sugar balance.
Physical activity can also be beneficial for optimizing blood glucose. Going on a short walk either before or after your meal will blunt blood sugar spikes. But be careful not to go too hard, sometimes intense exercise can actually increase cortisol leading to blood sugar instability.
When someone has lots of blood sugar instability, it also may make it hard to go even four hours between meals. Sometimes you may need to take a gradual approach when reducing feeding frequency while addressing your hormones and increasing stress management.
3. Vagus Nerve Exercises
People with IBS have been shown to have low vagal nerve tone. Like a muscle, the vagus nerve needs to be exercised to remain toned and strong to have optimal digestion, motility and MMC function.
These exercises including gagging, gargling, singing and humming. I discuss the importance of repairing the vagus nerve in this blog post.
4. Meditation and Stress Management
Stress management goes hand and hand with vagus nerve function. I see many patients who are stuck in sympathetic (fight or flight) state. Chronic stress will raise cortisol levels which shuts down digestive processes.
Employing stress management techniques like meditation can retrain how your body responds to stress and can help you find a more parasympathetic (rest and digest) state. Meditation like the exercises listed above help to build vagal tone and can shrink the fight or flight center of your brain. Not only will mediation make you feel like a zen master, but you will also notice better digestion and motility!
If meditation is not for you, there are also a lot of other stress management techniques that you can incorporate into your day instead.
5. Raising levels of good gut bugs (Bifidobacterium)
Many SIBO patients have dysbiosis in their large intestine bacteria. MMC function has been shown to be dependent on bacterial composition in the gut in animal studies. Bifidobacterium seem to be especially important in MMC function (not to mention intestinal barrier function).
What can be really problematic when trying to repair MMC function is the LOW FODMAP diet. This diet has been shown to reduce Bifidobacterium levels in the gut. If these diets are maintained for too long, you can really deplete Bifidobacterium levels.
To regain MMC function, diets need to be broadened and fermentable fibers need to be reincorporated. Probiotics and prebiotics can also be helpful tools to increase Bifidobacterium levels.
6. Lion’s Mane to regenerate damaged nerves in the GI tract.
Many people who have had a history of food poisoning, IBD or intestinal inflammation may have sustained damage to the nerves lining their GI tract. These are the same nerves that produce MMC activity. Damage to these nerves will inhibit MMC function.
Lion’s Mane to the rescue! Lion’s mane is derived from mushrooms and can help regenerate nerves that have been damaged by inflammation and past food poisonings.
7. Optimal thyroid levels
Thyroid hormones play a role in nervous system activity in the gut and has been shown to modulate smooth muscle and MMC function in the gut.
Having adequate levels of the active thyroid hormone (T3) is important for efficient motility and MMC function in the gut. Many SIBO patients can be hypothyroid due to a number of reasons: inflammation caused by the SIBO, going too low carb, nutrient deficiencies and Hashimotos. Thyroid issues need to be addressed for optimal MMC function.
8. Prokinetic support
Most SIBO patients are familiar with prokinetics. They can be a great tool to support optimal MMC function, especially in conjunction with some of the other MMC boosters we have discussed in this post.
Prokinetics are both pharmaceutical or supplemental agents that help stimulate motility and MMC function in the GI tract. These should be added in following the clearance of the overgrowth with antimicrobials.
The pharmaceutical options that are used a lot are resolor, erythromycin and low dose naltrexone. Resolor is the strongest and is only available in Europe and Canada. I used erythromycin for a couple months and found it helped in conjunction with other MMC focused strategies. LDN is the weakest but has some additional immune modulating benefits that can be helpful in many SIBO patients.
There are also supplements like Iberogast, Motil Pro, Motility Activator and ginger caps that can serve as prokinetics. They are not quite as powerful as the pharmaceuticals, but when used in conjunction with other strategies they can still be effective!
A multifaceted approach to boosting your MMC function will help you beat SIBO and prevent relapse.