# Migrating Motor Complex: SIBO & the importance of fasting



## tummyrumbles

Migrating Motor Complex has been implicated with SIBO. Most gas-producing bacteria live in the colon, but in SIBO there are large quantities in the small intestine. Hydrogen and methane are the by-products of these bacteria, which can cause constipation and diarrhea respectively. IBS patients are typically methane or hydrogen producers. Methane slows intestinal peristalsis, while hydrogen speeds it up. Motility problems in the small intestine can lead to SIBO. The symptoms for both SIBO and IBS seem to be identical.

SIBO is thought to occur because of a deficiency in the Migrating Motor Complex (MMC). Migrating Motor Complex is a process of the small intestine. It is a cleansing wave that moves matter, including bacteria, from the small intestine and into the colon. This occurs every 90 to 120 minutes and only during fasting. The process is interrupted by feeding. A decrease in MMC is thought to be the major factor in IBS / SIBO.

Digestive processes of the stomach and small intestine can be digestive and interdigestive. The interdigestive state happens after digestion, 2 or 3 hours after a meal. The MMC starts in the stomach and works its way to the ilium (between small and large intestine). This peristaltic actions sweeps the lumen (the space inside the intestine) clean as it advances. MMC occurs during consciousness and sleep. It takes up to 2 hours for the MMC peristalsis to move from stomach to ilium. The time lapse between cycles is longer during the day than night.

These peristaltic cycles continue until food is eaten. Food in the upper digestive tract stops this motion in its tracks.

MMC and digestive motility are both mediated by the enteric nervous system. MMC seems largely responsible for clearing indigestible food particles from the stomach and plays a pivotal role in ridding bacteria from the small intestine.

MMC complements digestive motility. When food is present, digestive motility is "switched on" and takes over from MMC. The digestive motility is called segmentation as food is moved backwards and forwards in the intestine and mixing of enzymes and mucus occurs. These are peristaltic, circular smooth muscle movements that prevent food moving back into the mouth while longitudinal contractions move the food forward towards the colon.

https://www.inkling.com/read/medical-physiology-rodney-rhoades-david-bell-4th/chapter-25/small-intestinal-motility

Diet is an important control for SIBO / IBS. The gas from bacteria is caused by fermentation of undigested carbohydrates, namely high FODMAP vegetables and grains, starches and soluble fibre. Reducing these foods will help to starve off the microbes.

Anything that retards efficient digestion may result in SIBO / IBS symptoms. An adequate fasting period is crucial and grazing on food throughout the day is discouraged as this impedes the MMC process. Meals should be kept to 3 a day with at least a space of 3 - 5hours between them, and the evening meal should be eaten as early as possible to allow a long, overnight fasting period.

Antibiotics may not work as a long-term cure as bacteria can repopulate after 2 weeks. Long term medication use isn't advised as drug resistance can easily develop. Medications are never designed as a long-term measure, and should only be used for short-term symptom relief.

SIBOinfo.com

http://www.siboinfo.com/prevention.html

Small Intestinal Bacterial Overgrowth - What to Do When Unwelcome Microbes Invade

http://www.todaysdietitian.com/newarchives/040511p46.shtml

Mechanism of Interdigestive Motor Migrating Complex

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400812/

The SIGO saga: part II

http://alt-ternativeautoimmune.com/2014/03/the-sibo-saga-part-2.html

Mechanism of Interdigestive Migrating Motor Complex

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400812/

Is the cyclic nature of the migrating motor complex dependent on the sleep cycle?

http://www.hon.ch/OESO/books/Vol_5_Eso_Junction/Articles/art014.html

Gastrointestinal Motility

http://humanbiology.wzw.tum.de/fileadmin/Bilder/tutorials/tutorial.pdf

Uninvited Guests: The impact of SIBO on nutritional status

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/zaidelarticle.pdf


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## elycestefani

This is really interesting. I feel, for me at least, this is correct. Recently I tried to gain some weight, so I was eating a lot, constantly to be honest. Never have my symptoms been worse. I am sure the larger amount of food and fiber made me feel worse, but I am now wondering if this contributed to my constipation too?


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## tummyrumbles

Yes, definitely. The interdigestive process, Migratory Motor Complex, works only during fasting. But the digestive process, the fed-response phase, is after eating, so one process starts when the other process ends.

A study has shown that the duration of the digestive phase is related to food calories, where a larger meal results in a longer fed state.

"The duration of this phase is dependent on food calories and consistency."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714419/

So over-eating could mean that the fed response phase predominates over the MMC phase, at least during the day. The main thing though is the long overnight fast, so even if you do overeat during the day, as long as you have dinner as early as possible this gives the MMC more time to work. The MMC cycles are shorter at night at well.

If you're a methane producer, this gas can act like a neurotransmitter and slows gut motility, causing constipation:

http://ajpgi.physiology.org/content/290/6/G1089

Certain carbohydrates feed bacteria, such as fermentable complex sugars (FODMAPS), starches and soluble fibre. This is why a lot of people find that fibre makes their symptoms worse. If soluble fibre feeds bacteria, and if that bacteria produces methane, then fibre can cause constipation. I go every morning but didn't always. A few cups of tea helps, and I take my time. I try to have dinner as early as possible without getting hungry before bed. Meats and fats are filling and gentle fibre such as mashed potato and pumpkin are usually gentle on the system. I eat banana and yoghurt every day and I'm sure that helps too.


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## maxwell

how does the ingestion of simple sugars and branched chain or essential amino acids affect this MMC process?

Edit - can you clarify the difference between peristalsis, which is triggered immediately after eating, and MMC, and why I would want the latter and not the former to take place.

It is a common suggestion for IBS sufferers to have frequent smaller meals as well. Given that a person eats a set number of calories, do you suggest that a condensed feeding is indicated (such as people who do intermittent fasting would experience) or that it would be better to simply have the meals more spread apart? Keeping in mind that the larger meals delay the MMC response, wouldn't a smaller meal more frequently be the same as larger meals less frequently?


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## tummyrumbles

I'm no expert, I just find these things. I once had dinner very early at 4.30 pm after a busy day and went to bed early. Evacuation was very quick the next morning so I searched around for something that explained this. The migrating motor complex was the only explanation I could find. Regarding the sugars: The specific carbohydrate diet disallows simple sugars and polysaccarides, like potatoes, and allows some complex sugars, like legumes, whereas the FODMAP theory seems to think we all digest simpler carbohydrates OK but can't digest complex sugars so the 2 diets basically contradict one another. This is why so many people are disappointed just following one, particular diet. My problem is more with starches so I think there are aspects of the SCD worth noting but I follow the FODMAP diet as well because I also have a problem with complex sugars. High fibre is another problem so I try to follow a general IBS diet too. I just create my own diet from what works the best. I have no way of knowing how sugars affect the MMC or whether they affect it at all. What the MMC does is sweep bacteria towards the colon. Because the MMC is interrupted by feeding, it's believed that constant snacking during the day disrupts this process as it only runs every 90 minutes or so. However the shorter cycles are at night, and it might be the night-time MMC which is most important. We're supposed to have a dysfunctional MMC if we have IBS/SIBO symptoms but there's no proof for this. Maybe we just have a bacterial overgrowth and the MMC works fine, I don't know. I try to eat my dinner earlier to give bacteria and gas more time to work their way down to the colon to be evacuated, which is what I want. I seem to have less symptoms and less gas at work when I eat dinner earlier. It's the night time MMC that I'm more concerned with.


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## maxwell

Your improved BM the next morning could be improved by longer, better sleep, I find the same on the weekends. When I have more time to lounge around and relax, I have a natural urge to go to the toilet. When I wake up groggy after hitting the snooze button 5 times, I have trouble with BMs.

I do intermittent fasting fairly regularly and cannot note an improvement in BMs.

I sometimes get an "attack" where my stomach feels extremely uncomfortable, and for some reason I want to eat a lot. I am not sure what is happening (cramps? stomach acid?) but stuffing myself seems to help. Though that is not as good for weight gain.

I am of two minds on this. If fibre is bad in terms of bacteria growth, then it must be minimized. Having less fibre may result in worse BMs and cause food to stay still and allow bacteria to migrate upwards. Regardless of whether it migrates up down or sideways, I think the fact that you have bacteria in your gut, producing gas, it doesn't matter how far up or down it is, it is one single tube.


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## tummyrumbles

Yes, you could be right that it was just a longer sleep that improved evacuation the next morning. And I experience the same as you - easier evacuation when I don't have to get up early. But then what is it about sleep exactly that helps? Serotonin is an important neurotransmitter that regulates motility as well as sleep. Lower than normal levels of serotonin are implicated in constipation and higher levels with diarrhea.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1574906/

This study suggests that serotonin doesn't regulate the pacemaker that causes MMC.

http://aups.org.au/Proceedings/39/100P/100P.pdf

IBS/SIBO is extremely complex and we could have a lot of things wrong with us, not just bacterial imbalance. If we do have neural damage that might be impossible to cure, let alone identify. I suspect there is physical damage as well because normal people eat what they like and seem to evacuate OK. Everything we do is a workaround, including diet, but at least diet and bacterial imbalance is something we have some control over.

I agree with your take on fibre. It's contradictory. On the one hand we need fibre to push things through, on the other hand for a lot of us it causes gas and which also feeds bacterial overgrowth. And for me gas seems to cause constipation as well.

Eating dinner early helps a lot, whether it's due to the MMC or serotonin.

I'm inclined to think it's due to the MMC because my biggest problem is a gas build-up at work around mid-day. I'm pretty sure it's not incomplete evacuation and is just gas itself. If I do have SIBO, then the problem gas is generated in the small intestine. The MMC works from the stomach and small intestine to the colon. Anything that sweeps the contents from this area towards the colon would have to help with evacuating gas, preferably in the morning when evacuating, so a long over-night fast would have to help with this. Serotonin is important as a regulator of motility, but isn't specifically involved in clearing gas, not that I know of anyway. The real cure to all this is not eating gas-causing food in the first place, but because this is so hard to do, the next best thing is to completely clear your colon of gas as much as possible before you go out.


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## vanessa6801

Great thread! I think that there should br more discussions on this forum around sibo since it is responsible for most cases of ibs.

"Digestive processes of the stomach and small intestine can be digestive and interdigestive."

An individual who is deficient in the mmc may develop bacterial overgowth, which is responsible for either increased motility in the digestive process (diarrhea) or decreased motility in the digestive process (constipation).

Relationship between peristalsis and mmc (wikipedia):

https://en.wikipedia.org/wiki/Migrating_motor_complex

http://ibs.about.com/od/symptomsofib1/a/Motility.htm


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## doces

I just got diagnosed with SIBO today. I control my symptoms through a combination of diet, sleep, and exercise. I am looking forward to trying out some meds to see if that helps, however, as my diet is very restrictive. This is what I have found works for me:

*1. Food:*

a. Breaking my meals into 6 smaller meals. Symptoms are greatly reduced as long as I stay full. I have more pain & other problems when I space out the meals.

b. I feel better when I don't eat. I fast for 24 hours at least once a month to give my digestive system a break.

c. I cannot tolerate dairy or grains. Specifically, dairy & gluten are the worst. Grass-family grain-type stuff that bothers me includes corn, millet, sorghum, barley, rye, sugarcane, oatmeal, etc. I can handle other sugars fine (honey, granulated beet sugar, coconut sugar, etc.). I can also handle faux grains fine, as long as they're not in the Poaceae/Gramineae family of grasses, so stuff like buckwheat & quinoa is fine.

d. No eating two to three hours before bed.

*2. Sleep:*

a. Eating dairy or grains causes me pain, fatigue, weakness, and typically forces me into a nap. Eating clean, no naps & I'm fine when I wake up - no grogginess. Otherwise I'm completely wasted in the morning if I'm not careful about what I eat.

b. Require 7 to 8 hours of sleep. Do best going to bed super early (8 or 9pm). I tolerate the lesser annoyances better when I am consistent with good sleep hygiene.

*3. Exercise:*

a. Have to exercise daily, at least 15 minutes. 30 to 45 minutes of cardio is preferred. TMI: This basically helps compress the poop into a single, solid log. If I eat well, sleep well, and exercise daily, I consistent get a Type 3 on the Bristol Stool Scale: a large, long, single, solid log that sinks & doesn't leave residue. Bowel movements are over in seconds with no pain & no endless wiping a la IBS.

b. Exercise is nearly impossible if I've ingested any of my trigger foods. It's not too bad if I don't move much, but if I've eaten something on the no-no list & try to do anything physical, I immediately become drained. It's sort of a combination of what feels like limb bone bruises & increased gravity...an ache that pulls me down to laying down. I get completely zapped. Brain is also affected...if I try to study or do anything that requires actual thinking, my brain shuts off, straight into brain fog mode.

So for optimum health, my approach basically boils down to this:

1. Eat 6 small meals a day using safe food that I've cooked myself.

2. Go to bed early & sleep for at least 7 hours

3. Exercise at least 30 minutes a day (brisk walk, swimming, biking, indoor cardio machine, etc.)

My indicator is my bowel movements: no stomach pain with clean & instant bowel movements on pretty much a daily basis means my stomach is working well & my diet is good. The rules sound easy, but are difficult to do because I cave to crap food all the time & also because certain food items like corn are extremely hard to avoid (corn syrup, dextrose, and other special names - simply removing the corn protein doesn't work, if the source is corn, it bothers me - including pretty much all medicines as they use things like cornstarch for binders). I do not have a helpful GI, so I'm pretty much on my own for research & management, and this is what I've found to work for me so far. Very glad to have the SIBO confirmation (I'm not crazy! haha).


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## tummyrumbles

I have to agree with everything in the above post. I now basically disagree with my opening post. This shows that we shouldn't post things if we haven't actually experienced an improvement ourselves. I found out a few months back that I was overeating, just a chance comment my daughter made. Suddenly things made sense - not only the IBS symptoms I've had all my life, but GERD symptoms as well. The GERD seems to be mostly in remission. The IBS is controlled mainly by a low starch diet. Dr Pimentel has been instrumental in trying to help understand the causes of IBS but I think the migrating motor complex theory might actually be the opposite of what we should be doing, especially for overeaters. If you eat more than say 2 handfuls of food in one sitting, that could be overeating, according to Ayurvedic principles anyway. Westernised guidelines are more generous - 4 handfuls of food in one sitting. It's pretty hard eating small portions but overloading your digestion system is a sure-fire way to cause indigestion, which in turns causes mushy stool, gas etc which makes evacuation hard the next day. But I too have found that giving up grains and other high starch foods (potato chips etc), eating smaller meals and daily walking are about the best things you can do. If you have enough willpower to maintain this lifestyle long term in theory this should reduce the bacterial overgrowth, wherever it is.


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## doces

tummyrumbles said:


> I have to agree with everything in the above post. I now basically disagree with my opening post. This shows that we shouldn't post things if we haven't actually experienced an improvement ourselves. I found out a few months back that I was overeating, just a chance comment my daughter made. Suddenly things made sense - not only the IBS symptoms I've had all my life, but GERD symptoms as well. The GERD seems to be mostly in remission. The IBS is controlled mainly by a low starch diet. Dr Pimentel has been instrumental in trying to help understand the causes of IBS but I think the migrating motor complex theory might actually be the opposite of what we should be doing, especially for overeaters. If you eat more than say 2 handfuls of food in one sitting, that could be overeating, according to Ayurvedic principles anyway. Westernised guidelines are more generous - 4 handfuls of food in one sitting. It's pretty hard eating small portions but overloading your digestion system is a sure-fire way to cause indigestion, which in turns causes mushy stool, gas etc which makes evacuation hard the next day. But I too have found that giving up grains and other high starch foods (potato chips etc), eating smaller meals and daily walking are about the best things you can do. If you have enough willpower to maintain this lifestyle long term in theory this should reduce the bacterial overgrowth, wherever it is.


My GI appointment to get meds isn't until next month (they're super booked, but at least I know I'm positive for SIBO now!). From what I've read, they recommend 3 regular meals with no snacks inbetween. This doesn't jive with my experiences to date, but maybe the medication affects the cycle you're supposed to eat on. Guess I'll find out!


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## Rae7

Hi everyone, 
I follow low fodmap thru a low fodmap coach. I am advised to eat 5 times a day (portion controlled) 3 hrs apart.
Researching migrating myoelectric complexes at moment. Has anybody come across studies that talk about how far apart feeding should be for optimised MMC function?


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