Prokinetic Herbs: Herbal Medicine for Gut Motility

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There are many herbs that act to improve motility in the digestive tract. In this article we will explore the top prokinetic herbal medicines that assist digestion by keeping things moving through the gut. 

In my clinical practice I use herbal prokinetics every day. Many of my patients are struggling with poor gut motility and slow gut transit time. What is interesting is that most of these patients have a bowel movement everyday and are shocked when we test their gut transit time and find that it is delayed by 4, 5 even 6 days!

Motility in the Gut

For most of the digestive tract, good forward movement is crucial for health and balance. In a healthy gut it isn’t until the remnants of what we consumed – now called chyme – reaches the large bowel that things start to slow down. There are many factors at work to keep things moving forward including peristalsis in the fed state and the migrating motor complex in the fasted state. 

As a quick overview (1)

  1. Peristalsis – This action moves everything that you have consumed forward, or rather down the gastrointestinal tract. Smooth muscle, controlled by specialised cells called interstitial cells of cajal (ICC for short) act almost like a heartbeat and facilitate the contraction above and the relaxation below the food bolus, propelling it down the digestive tract. 
  2. Segmentation – This smooth muscle action mixes the contents of the gut to facilitate breakdown and digestion but doesn’t contribute to forward movement.
  3. The migrating motor complex (MMC) – In the fasted state the MMC is kicked into action by a polypeptide called motilin manufactured by endocrine cells in the small intestine. Starting in the stomach the migrating motor complex sweeps through the small intestine clearing excess bacteria and remnant chyme.   

We won’t spend too much time diving into the physiology of the gut but it is important to understand that these processes are crucial for good gut health. Insults to the gut that impair gut motility can set the stage for gut imbalances such as small intestinal bacterial overgrowth, gastroparesis or oesophageal spasms.


Symptoms of slow gut motility

The first symptom of slow gut motility is constipation. That’s pretty straight forward. 

What isn’t so clear to most people is the fact that you can have slow gut motility even when you have a quality bowel movement every day.

Some symptoms I frequently see in the clinic in patients with slow gut motility are

  • Bloating 
  • Burping 
  • Reflux 
  • Nausea  
  • Abdominal pain 

I prefer to test rather than guess and ask every single one of my patients to track their gut transit time as we work together.

Herbal Medicine For Gut Motility

Prokinetic agents are things that enhance gastrointestinal motility. As a herbalist I rely on pants to help get things moving in the gut.

Lets cover the different herbal prokinetics. 

Herbs for Gut Motility #1: Ginger 

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Herbal prokinetic numero uno is ginger. 

Ginger is one of the top 10 herbs that I use everyday in my clinical practice.

It is inflammation modulating, anti-viral, helps to stimulate circulation and, possibly my top use, helps to stimulate motility in the digestive tract. 

Ginger, Zingiber officinale, has been used to treat digestion for some time. As with many herbal medicines we are still trying to figure out how they do what they do. The mysteries of nature.

This spicy rhizome – a fancy word for root – contains a range of phytochemicals including terpenes and phenols. The volatile oils are responsible for the flavour of ginger and include gingerols and shogaols. 

With ginger we have good data showing that it can help to increase or accelerate gastric emptying (2, 3) – perfect for patients suffering from gastroparesis. 

Summary – Ginger appears to have the most impact on the stomach and can help to speed up gastric emptying. 

Herbs for Gut Motility #2: Globe Artichoke

globe artichoke as a herbal gut motility agent prokinetic SIBO treatments herbal medicine for gastroparesis natural motility

Herbal prokinetic number two would be globe artichoke.

Globe artichoke, Cynara scolymus, is another prokinetic herb that helps to increase digestive tract motility. It is frequently formulated with ginger. This herbal medicine couplet has been well studied. 

Globe artichoke is used to increase bile flow, is hepatoprotective, can reduce serum cholesterol and has antispasmodic effects. 

Where ginger acts on the stomach, globe artichoke appears to work on the small bowel motility. The thinking here is that the increase in bile acids helps to increase gut motility in the small intestine (4).

Herbs for Gut Motility #3: Iberogast 

Iberogast is a mix of 9 different herbal medicines that work synergistically to improve a range of underlying dysfunctions common in many digestive health imbalances. It is another top herbal prokinetic in my clinical practice. Some patients notice big differences using iberogast whereas others feel it may help but isn’t powerful enough. 

Image taken from: Evaluating the Multitarget Effects of Combinations through Multistep Clustering of Pharmacological Data: the Example of the Commercial Preparation Iberogast

In the image below (5) we can see the effects of iberogast on the digestive tract including

  • Anti-inflammatory and mucosal protection on the oesophagus 
  • Increased lower oesophageal sphincter pressure
  • Improved stomach motility 
  • Normalises hyperacidity in the stomach
  • Enhanced mucosal production  
  • Lowering gastrointestinal inflammation 
  • Decreases visceral hypersensitivity 
  • Intestinal motility normaliser
Image taken from: Evaluating the Multitarget Effects of Combinations through Multistep Clustering of Pharmacological Data: the Example of the Commercial Preparation Iberogast

Focusing on the motility enhancing properties of iberogast we can see in in-vitro studies showing that iberogast is amphoteric meaning that it acts to normalise rather than exacerbate. This appears to be the magic of combining multiple herbs into one formula.

Iberogast can increase basal contractile tone in a gut that is hypomobile. On contracted muscles it acts as a spasmolytic and helps to relax. 

“STW 5 (iberogast) contracts atonic muscles but relaxes precontracted ones”

Bitter candytuft and caraway appear to be the herbal medicines that increase intestinal smooth muscle tone whereas peppermint, angelica and licorice act more as spasmolytics, relaxing over toned intestinal smooth muscle (5).

As much of the above data comes from pre-clinical studies (in-vitro or animal studies) the real question is, how effective is iberogast at increasing gut motility in people? 

One randomised clinical trial assessed iberogast against a prokinetic drug. The study found that iberogast and the prokinetic had similar efficacy and both improved patients 80% above baseline on average (6).

At least 2 other clinical trials comparing iberogast and pharmaceutical prokinetics showed similar promising results (7).

Image taken from: A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia

Herbs for Gut Motility #4: Chinese Herbal Formulas 

Chinese herbal medicine has some powerhouse formulas that have been proven for centuries, time and time again, in the clinical setting. There is also a plethora of research on Chinese Medicine’s herbal formulas and its effects. 

One important note here is that each of these formulas have indications and contraindications, something that we have to take into account when thinking about applying these herbs in clinical practice. 

One herbal formula da cheng qi tang keeps coming up time and time again when reviewing the literature for gut motility or herbal prokinetic herbs.

This herbal formula comprises a mix of the following.

  1. Turkey rhubarb root
  2. Immature bitter orange peel
  3. Magnolia bark 
  4. Sodium sulphate 

One study found that da cheng qi tang could ‘increase plasma motilin, enhance gastrointestinal motility, improve gastric dysrhythmia, and reduce gastroparesis after abdominal surgery.’ (8).

Another study found that da cheng qi tang could ‘significantly improve the post operational EGG disorder, elevate the amplitude and time of migrating motor complex (MMC) phase III, prevent gastrointestinal reversed peristalsis, increase the blood level of motilin, decrease the orocecal transit time, and promote the recovery of gastrointestinal motility.’ (9).

Digging into the science we can see that emodin, an isolated compound from turkey rhubarb, can increase small intestinal peristalsis in-vivo by increasing motilin and decreasing somatostatin (10).

Magnolia bark, containing two active constituents magnolol and honokiol, has been shown in animal studies to speed up intestinal transit, increase circular muscle contraction, and ameliorate the morphology changes of interstitial cells of Cajal (ICC) in animals stimulated by LPS, a potent bacterial endotoxin (11).

Magnolol and honokiol, two active constituents of magnolia bark. Image taken from: Insights on the Multifunctional Activities of Magnolol

Magnolia bark was shown in rats to improve gastrointestinal motility by increasing the concentration of

  • L-glutamate
  • L-tryptophan
  • serotonin 

It also was shown to protect the gastrointestinal barrier (12).

Finally Immature bitter orange peel was shown in-vitro to speed up intestinal peristalsis. The research concluded that the flavonoids found in the orange peel were the real movers and shakers when it came to speeding things up in the gut (13).

Herbal Prokinetics In Clinical Practice

We have covered a number of possibilities to choose from when considering herbal medicines to speed up your digestive tract. Whether you are suffering from gastroparesis, small intestinal bacterial overgrowth or post-surgery dysmotility you must be wondering which ones to start with. 

It is a hard question to answer and many times I choose different prokinetics depending on the patient, their history and their presenting symptoms. Sometimes I combine more than one to get things moving smoothly. 

My number one recommendation would be to find the root cause of your stuck bowels and work on treating that at the same time. The end goal is intestinal motility without herbal medicines to keep things moving down and out and without treating the root cause this will be difficult. 

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References and Resources

  1. Gut Movements: A Review of the Physiology of Gastrointestinal Transit
  2. Effect of ginger on gastric motility and symptoms of functional dyspepsia 
  3. Ginger in gastrointestinal disorders: A systematic review of clinical trials
  4. The effect of ginger (Zingiber officinalis) and artichoke (Cynara cardunculus) extract supplementation on functional dyspepsia: A randomised, double-blind, and placebo-controlled clinical trial
  5. Evaluating the Multitarget Effects of Combinations through Multistep Clustering of Pharmacological Data: the Example of the Commercial Preparation Iberogast
  6. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia
  7. Modulation of gastrointestinal motility beyond metoclopramide and domperidone
  8. Da-Cheng-Qi-Tang promotes the recovery of gastrointestinal motility after abdominal surgery in humans
  9. Effect of dachengqi granule on human gastrointestinal motility
  10. Effect of emodin on small intestinal peristalsis of mice and relevant mechanism
  11. Insights on the Multifunctional Activities of Magnolol
  12. Insights on the Multifunctional Activities of Magnolol
  13. Anti-coagulative and gastrointestinal motility regulative activities of Fructus Aurantii Immaturus and its effective fractions

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