EP.187/ Four At-Home Ways to Boost Your Migrating Motor Complex If You Have Endo Belly or SIBO
Okay so today we’re talking about the all-important migrating motor complex.
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Let’s start with what the MMC, which is just what’s it usually abbreviated to for ease, actually is.
The migrating motor complex is a wave like emotion that occurs in the small intestine, not large, between meals and overnight. This wave motion clears out any old food debris and bacteria once food has already passed through into the large intestine, so basically, see the MMC as the washing up, once all the leftover food has been cleared off the dinner plates.
Now, the MMC is crucial for good gut health and when it slows down, we get a build-up of bacteria and old food, this means that not only is there a constant supply of food debris in the small intestine for bacteria to munch on, but every time food enters the small intestine, that food will be munched too.
So, why is this a problem?
Well, you’re not supposed to have bacteria in your small intestine – at least, not much at all. There should be a teeny tiny amount, but the large intestine is where you should be housing all your friendly gut bacteria. The small intestine is designed for absorbing nutrients, not for housing bacteria, so this excess of bacteria damages the small intestine and we end up having trouble absorbing nutrients. To top that off, the bacteria actually compete with us for our food.
If that wasn’t enough, the bacteria ferment the food, and create gases. These gases not only cause bloating (which could be the leading cause behind your endo belly) but also cause problems like diarrhoea, gas, acid reflux, burping, constipation, abdominal pain and sensitivity, brain fog, fatigue, histamine intolerance and full body pain to name a few.
If this sounds familiar, you’d be right. What I’m describing is small intestine bacterial overgrowth, also know as, SIBO.
And SIBO is arguably one of the leading causes of endo belly with endometriosis patients, in fact, current research estimates that 80% of people with endo have SIBO and the same study found that 100% of people with endo have an impaired migrating motor complex.
Now, SIBO or not, it’s important that we all have a healthy migrating motor complex as it keeps food and bacteria in the right place, and even if our MMC isn’t damaged to the point that SIBO can occur or may eventually occur, a sluggish MMC could result in bloating, like the endo belly.
In the case of SIBO, ensuring that your MMC is supported is the essential piece to preventing relapse once you get the all clear.
Now, unfortunately, sometimes the MMC is so damaged that recurring SIBO is going to be an issue for us, and we have to use natural supplements or pharmaceutical drugs long-term to keep it working as efficiently as we can. Post SIBO treatment, there is a process called the prevention of relapse, which lasts about 3-6 months, and requires these supportive drugs or supplements, known as prokinetics, during this time frame. If you relapse once weaned off them, it suggests that your MMC is very deficient and further investigations will need to be done.
However, there are also some at-home methods we all can use to support the MMC, now these won’t be strong enough alone to prevent a SIBO relapse, so a prokinetic agent is always, always required post-SIBO treatment, at least for the prevention of relapse stage, but these suggestions are nice add-ons and if you don’t have SIBO, try one or two of them and see whether your endo belly improves, because regardless, our MMC still needs some love.
Number one is ginger.
Ginger is actually a prokinetic that we use in SIBO treatment, during the prevention of relapse stage. Unfortunately, it’s not normally strong enough to prevent a SIBO relapse so we tend to combine it with another prokinetic to increase the effects. However, for some people with SIBO, it’s enough to keep them in remission and for those of us without SIBO, it helps give our MMC a nice boost and moves things along the digestive tract.
Because the MMC is turned off for two hours after food, you don’t want to take ginger during this time frame, as it’ll push your food through too quickly and your small intestine won’t have enough time to absorb it. Instead, you can take it two hours after food and overnight, again, making sure you take it two hours after dinner.
Fresh ginger won’t work here, it needs to be ginger root powder, 1000 mg, which you can take at night or twice a day – just don’t exceed 2000 mg a day and always check with your doctor first, especially if pregnant, though ginger is normally safe and beneficial during pregnancy at these doses.
Our second method is meal spacing. Now, this might be triggering for some of you, so just skip forward by a couple of minutes if so.
Meal spacing is another essential step used in the prevention of relapse stage of SIBO treatment, and it is the practice of spacing out meals with enough time between that we allow the MMC to work. When we’re constantly grazing and eating late into the night, we’re not giving our MMC enough time to do its job. Many people can get away with this if they tend not to eat overnight and leave around a 12-hour gap between eating (so say from 8pm to 8am) but for those of us with SIBO or with other IBS issues, we may need to give our MMC a little more support. I will say that some people leave an even smaller gap overnight, like 8 hours, and they’re okay because their MMC is strong, but generally those of us with gut issues tend to need longer.
So, what does that look like? The ideal time frame is 4 hours between meals and 12 hours overnight, as our MMC does most of its work when we sleep, so that’s the really crucial time.
Now this doesn’t mean you can’t snack and it doesn’t mean you have to practice meal spacing all the time or at all if you don’t fancy it, this is just an option you could try if you’re really struggling with the endo belly and you want to see if this can help.
If you can’t do four hours, aim for three, or two and a half, and if you can’t do that, then maybe you can manage meal spacing in the morning, but not the afternoon, or vice versa. Or maybe you can’t do meal spacing during the day at all, but you can manage 12 hours overnight, or perhaps in the beginning you start with 8 or 10 hours. If you find that you’re needing to eat before those two hours are up post meal, I would also focus on the meals you’re eating because it could be that your blood sugar is dropping soon after meals and you need to do a bit of work on them to leave you satisfied for a little longer.
For me, meal spacing did not come easy because I’ve really struggled with blood sugar in the past, BUT now my blood sugar is more stable than I think it’s ever been and my continuous glucose monitor readings are looking really optimal, I can actually do meal spacing almost without thinking about it – and when I do manage to do it, my gosh do I feel better! My gut feels so much lighter, I’m not heavy and weighed down in my abdomen and I’m not as bloated.
Now, a quick note before we move onto our next tip – anything that we eat or drink that expands the stomach or contains calories, will turn the MMC off. So that includes tea or coffee with milk. But water, black tea, herbal teas, and black coffee, sipped rather than gulped, is fine!
For me, I do like a decaf tea with milk either mid-morning or mid-afternoon, so I tend to only meal space one side of lunch and overnight, but even then, I feel better!
Finally, if this feels too much for you, don’t even worry about it – don’t even think about it! Try one of the other tips and don’t give this another thought. This is more something that is important for those of us treating SIBO, but it can help us all with our MMC, which is why I included it, but it’s not essential so please don’t stress.
Next up is vagus nerve support. The vagus nerve is a large nerve that travels from your brain all the way down to the base of your spine, to your colon. It controls multiple functions and is responsible for your ‘rest and digest’ response and plays a leading role in digestion. It also stimulates the migrating motor complex, which is why we’re talking about it today!
Now the vagus nerve can be damaged in a myriad of ways, including a bang to the head or spine and trauma or chronic stress. This affects its ability to regulate digestion and to stimulate the MMC, so what we want to do is support it and improve what we call the ‘tone’ of this nerve, basically we’re working it out like a muscle.
Now, normally, I find that people with endo and the clients I work with, have such an extensive history of trauma, that they need deeper vagus nerve healing and I talk about that in my course, The Endo Belly Course, but just an introduction to vagus nerve support, we can start with really simple techniques including –
· Gargling
· Gagging
· Singing loudly
· Cold water exposure
· Alternate nose breathing
· Meditation
· Yoga
· Qigong
· Tai Chi
Now, as I’ve said, many of us tend to need deeper vagus nerve support, but give one or two of these a good run. Try one or two on a daily basis for a couple of months and see if things improve with your digestion, endo belly or SIBO.
Finally, our last strategy is one you’re all going to be bored of hearing by now, and that’s abdominal massage. Yes, I sound like a broken record because I am such a big fan of this stuff.
Regular abd0minal massage can improve digestion overall, ease constipation and even begin loosening a frozen pelvis and adhesions, but when practised in the evenings before bed, it can help boost the MMC overnight, and it actually does this by stimulating the vagus nerve. When I am working with SIBO clients or clients with constipation or excessive bloating, I really encourage them to try to practice abdominal massage nightly if possible, or a couple of times a week.
A free massage you can try is the I Love You massage, which was actually designed for constipation, bloating and other IBS issues, and I’ve linked to that in the show notes.
Alternatively, you could try Arvigo massage, which is designed for gut health issues and gynae problems like endo. You can book in an online tutorial with a teacher and then after one session, you can go away and perform it on yourself, so whilst it’s not free, it’s a low-cost option. I’ve linked to my go-to Arvigo teacher in the show notes.
So that’s it! I really hope one or some of these tips help you to better support your MMC, and I hope that brings you some endo belly relief. I’d love to hear if you try any of these strategies and how you get on – please email me or reach out on Instagram and let me know. Don’t forget to share this episode with other endo warriors if you found it useful.
On March 28th I am running my second Endo Belly Challenge! In this 4-week challenge, you will learn the first steps to identifying the root causes of your endo belly and the initial tools to heal your swelling, gut issues and abdominal discomfort. Every Monday, you'll receive a new email with a little bit of endo belly education and an action to implement that week! This challenge is perfect for anyone who experiences abdominal swelling/bloating, gas, constipation, nausea, diarrhea/loose stools, acid reflux, indigestion or stomach cramps with their endometriosis - and it's entirely free. You can sign up here.
Show Notes
MMC
https://pubmed.ncbi.nlm.nih.gov/9660426/
https://www.siboinfo.com/mmc-videos.html
https://www.siboinfo.com/prevention-of-relapse.html
https://pubmed.ncbi.nlm.nih.gov/9660426/
Ginger
https://pubmed.ncbi.nlm.nih.gov/10442508/
Massage
Arvigo therapist Tara Ghosh interview
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