Natural prokinetic herbs and supplements are something I wish everyone knew about. Prokinetics have done wonders as part of a holistic treatment protocol for digestive issues like constipation, reflux, and/or small intestinal bacterial overgrowth (SIBO) in my functional nutrition & clinical herbal medicine practice!
In this article, I’ll teach you the fundamentals of my favorite natural prokinetic herbs and supplements for optimizing gut motility – aka the healthy downward movement of food/waste (and in some cases, the sweeping of unwanted debris) through and/or out of your gut.
Disclaimer: This article was written for informational and educational purposes, to make you more aware of the different options available to you in functional nutrition and herbal medicine. Please don’t take this as medical advice!
Consult a qualified functional dietitian, holistic nutritionist, naturopathic doctor, functional medicine doctor, and/or a clinical herbalist to get customized recommendations on the best prokinetic herbs or supplements for your individual needs.
What’s a prokinetic agent?
A prokinetic agent is any type of herb, nutraceutical supplement, or pharmaceutical which stimulates and promotes gut motility, either in the upper or lower gastrointestinal tract.
Prokinetics are rarely if ever used as a stand-alone protocol; it’s best used in conjunction with other interventions. Prokinetics are also usually more of a secondary level of intervention, exclusively for those who aren’t responding to fundamental dietary/lifestyle changes for addressing slow gut motility.
When do you need a prokinetic agent?
The following are examples of cases in which you can likely benefit from prokinetic herbs as part of a holistic treatment plan:
- Slow gut motility / a long digestive transit time (more than ~24 hours)
- Delayed gastric emptying
- Constipation-predominant irritable bowel syndrome (IBS-C) not responding to foundational interventions (i.e. fiber, fluids, movement, probiotics, etc.)
- SIBO (all types)
These symptoms and conditions usually occur secondary to an event or series of events which alter your enteric nervous system in a way that slows your gut’s natural motility.
Understanding your root causes is important! Make sure you’re addressing your issues at this level, since prokinetics are usually only a small component of a holistic, multi-dimensional protocol.
Signs and symptoms of slow gut motility
Constipation (Bristol Stool Chart #1’s and 2’s, and/or a digestive transit time longer than ~24 hours) is the most obvious sign of slow motility.
- You can easily find out your own unique transit time via the “beet test”. You can read more about the beet test here!
However, you may also have poor gut motility if you’re dealing with any of the following symptoms:
- Gas
- Bloating
- Burping
- Heartburn/reflux
- Nausea
What slows gut motility?
The following are some examples of triggering events that usually lead to dysregulated/slow gut motility, for one reason or another:
-
- Chronically high stress levels
- Mental/emotional trauma
- Concussion / traumatic brain injury
- Parkinson’s disease
- Gastric surgery
- Zinc deficiency (inhibits taste/smell)
- COVID-19 (inhibits taste/smell)
- Gastric surgery
- H. pylori infection (may induce autoimmune gastritis)
- Medication side effects
- Snacking all day
- Drinking sugar-free beverages between meals all day
- Methane-dominant SIBO
- Neurologically, methane gas (produced by microbes in the small intestine) mimics a neurotransmitter which inhibits your Migrating Motor Complex (MMC), slowing down gut motility.
How it works: Any combination of the above types of scenarios can inhibit the activity of your Migrating Motor Complex (MMC) – a key player in your “rest and digest ” enteric nervous system response, which regulates your gut motility.
Most of the above scenarios are pretty self-explanatory – but what’s up with the zinc deficiency and COVID-19?
Loss of taste and smell can slow down your gut motility. Taste and smell play a key role in the cephalic phase of digestion (which is supposed to begin before you even take your first bite!).
- When you initially smell or taste food, it triggers the secretion of gastric juices and enzymes which then signal your gut motility or “peristalsis” at the beginning of a meal.
- If you can’t smell the aromas of what you’re about to eat, your nervous system won’t receive those very important initial signals to start preparing for that meal!
Now that you have some context on when and why you might benefit from a prokinetic agent, let’s deep-dive into the types of prokinetics you can work with.
Types of prokinetic agents
- Natural: herbs and nutraceutical supplements which can be prescribed by a qualified registered dietitian, holistic nutritionist, clinical herbalist, doctor, or nurse who is trained in functional nutrition and herbal medicine.
- Pharmaceuticals: medications which must prescribed by a doctor, and which usually have more side effects than natural prokinetics
For the purposes of this article, we’ll stay within my scope of practice and zoom in on the two main branches of natural prokinetic agents:
- Prokinetic herbs: medicinal plants which naturally stimulate activity and motility in the stomach, intestines, and/or colon
- Nutraceuticals: supplements made up of a specially formulated proprietary blend of medicinal constituents naturally occurring in certain functional foods and herbs
Deep-dive into prokinetic herbs
Below is a list of my favorite natural prokinetic herbs for gut motility, which I work with most often in my private practice.
(You might recognize lots of these herbal prokinetics from my list of bitter herbs for digestion, which tend to stimulate digestive secretions in the stomach, thus activating the Migrating Motor Complex responsible for gut motility!)
Artichoke leaf (Cynara cardunculus)
Artichoke leaf is a special herbal ally that I have benefited from first-hand (as a former sufferer of IBS-M) and one which I work with a lot in my clinical practice, to this day.
I’ll often recommend artichoke leaf extract as part of a next-level intervention for my clients with stubborn constipation that isn’t responding to fundamental dietary interventions.
Artichoke leaf is extremely bitter (due to a constituent called cynaropicrin), so it makes a great addition to a digestive bitters formula for people looking to optimize digestion or stomach acidity.
This herb also acts as a natural alterative in that it helps to protect and promote optimal liver function (1, 2), so it can be taken to help to reduce/prevent symptoms of “die-off” when taking herbal antimicrobials which kill off harmful microbes (such as in cases of SIBO, candida, or dysbiosis).
A 2015 study tested Prodigest (a standard blend of artichoke leaf and ginger root extracts) on participants with delayed gastric emptying, and found that it made a significant difference! (3)
A German study from 2015 also confirmed the prokinetic activity of artichoke leaf extract, independent of ginger. (4)
How to take it: Artichoke can be taken as an herbal tincture, blended into a digestive bitters formula, or it can be blended with other prokinetic herbs. (I don’t recommend trying artichoke leaf as a tea, due to the extreme bitterness. I learned this first-hand!) 😉
A standard dose of artichoke leaf extract in tincture form is ~30 drops, ~15-20 minutes – usually before meals.
Artichoke leaf extract is also included in prokinetic herbal blends like Prodigest and MotilityPro, or MegaGuard, which can be taken in capsule form after meals or before bed.
Contraindications: Consult a practitioner for a customized protocol, and avoid artichoke leaf extract if you’re pregnant/nursing, on medication, or if you have gallbladder issues such as gallstones. Artichoke leaf has also been said to sometimes cross-react with ragweed pollen, a common allergen. Proceed with caution if you have an allergy to ragweed!
Gentian root (Gentiana lutea)
Gentian root is another very popular bitter herb – and it’s meant for more than just cocktails!
Research has confirmed that gentian roots contain special constituents that stimulate gut motility by altering serotonin receptors in the gut. (5)
How to take it: Gentian root (like artichoke leaf) is best taken as an herbal tincture or digestive bitters formula (30 drops beforoe meals).
I’ve also seen Gentiana lutea added to certain natural prokinetic herbal formulations like Prokine.
Ginger root (Zingiber officinale)
A 2022 Molecules review uncovered that ginger, like gentian root, contains special constituents that seem to activate and suppress multiple types of receptors in the gut, to promote downward motility via the Migrating Motor Complex. (5)
As it turns out, ginger also has lots of other digestive benefits and it’s often used in conjunction with other herbs for settling the stomach, optimizing stomach acid secretions and promoting healthy motility.
How to take it: The most simple way to reap the prokinetic benefits of ginger root would be to make a basic ginger tea infusion, by steeping a piece of fresh peeled ginger root in hot water for about 5 to 15 minutes.
- The perks of this route: it’s very cheap and easy, and you can control how strong or weak you make the tea – depending on how long you steep it for. Some honey and fresh lemon juice go a long way to make this tea more palatable and enjoyable, too.
Ginger is powerful, so it’s often diluted by getting used in conjunction with other herbs (versus taking straight ginger root capsules).
Since ginger is one of the most well-researched prokinetic herbs, you’ll notice it’s added to almost every prokinetic herbal formulation mentioned in this article.
Contraindications: Ginger can stimulate the gallbladder to contract, and it’s sometimes hit-or-miss in cases of acid reflux, heartburn or ulcers (it can help or hurt, and varies from one person to another.) Consult your doctor before taking ginger if you’re pregnant or nursing, or on medication.
Licorice root (Glycyrrhiza glabra)
While licorice root is well known in Traditional Chinese Medicine and western clinical herbalism for being a wonderful demulcent herb and adrenal ally, few people are aware that licorice also acts as a natural prokinetic – making it a great ally for constipation and other issues related to slow motility!
A 2017 study from SOJ Pharmacy & Pharmaceutical Sciences found that licorice root had a prokinetic effect on delayed gastric emptying in rats. (6)
The 2022 Molecules review did a deeper investigation on the underlying mechanisms of various herbs for digestion in humans (in vitro and in vivo), and uncovered that licorice contains multiple special constituents that promote gut motility through interacting (directly or indirectly) with serotonin receptors.
How to take it: Licorice root can be helpful on its own or in combination with other herbs. It can be taken in tincture or capsule form, as long as it’s safe for you to take.
- I take 1 organic licorice root capsule daily, in the morning (with my coffee, before breakfast) Monday through Friday, for digestive health and to nourish and support my adrenal glands.
Contraindications:
- Avoid licorice root if you have high blood pressure and/or are on oral contraceptives.
- Licorice is also a demulcent herb, which, while gut-healing for most people, can sometimes worsen symptoms for people with SIBO.
Peppermint leaf (Mentha x piperita)
Peppermint is well established to be a potent prokinetic herb in that it contains special constituents (like menthol) which stimulate receptors in the gut to help promote motility. (5)
How to take it: You can enjoy peppermint leaf tea infusions before/after meals to settle your stomach and stimulate motility – or you may benefit from supplementing with peppermint leaf capsules or peppermint oil capsules such as IBGard a few times daily, 15-30 minutes before or right after meals.
Contraindications:
- Proceed with caution if you’re prone to heartburn/acid reflux, ulcers, positive for H. pylori, or if you’re pregnant.
Amla (Phyllanthus emblica)
Amla, aka “Indian gooseberry”, is one of the three Ayurvedic herbs which makes up a popular herbal trio known as “triphala” which is often used for treating constipation.
While triphala isn’t well studied for its prokinetic activity, a 2013 Phytotherapy research study concluded that amla berries have “prokinetic and laxative activities” in mice. (7)
While more research is needed to figure out the underlying mechanisms and to conduct human studies in vivo, amla berries could potentially make a great ally if you’re seeking natural constipation relief without unwanted side effects!
How to take it: consider trying a tea infusion made with amla berries, or take a standard dose of amla tincture or amla capsules a few times a day after meals.
Bitter candytuft (Iberis amara)
This is a medicinal flower which is used for remedying nausea and bloating, as well as to stimulate the gastrointestinal tract as a promotility agent.
How to take it: the most common way to reap the benefits of bitter candytuft is via Iberogast®, a natural prokinetic herbal supplement – since the whole is greater than the sum of its parts. (More on this below!)
Natural prokinetic supplements
In functional nutrition, we also work a lot with natural prokinetic supplements, or “nutraceuticals” – aka specially formulated proprietary blends which consist mainly of herbs and constituents from herbs, nutrients, and/or foods.
Below you can check out each of my favorite types of prokinetic herbal blends and nutraceutical supplements.
(Don’t buy herbs or supplements on Amazon. Third party sellers were very recently caught diluting and adulterating Amazon supplements with unsafe / potentially harmful ingredients.)
Feel free to purchase these through my private online dispensary, FullScript, for 15% off, or you may also find them at a local health food store, or through each corresponding company website!
Iberogast®
This prokinetic herbal blend is a liquid extract, made up of the following 9 herbal extracts:
-
- Bitter candytuft
- Angelica root
- Caraway fruit
- Chamomile flowers
- St. Mary’s milk thistle fruits
- Lemon balm leaves
- Peppermint leaves
- Licorice root
It’s generally very safe, gentle, and usually well tolerated by most people. It’s also a great kid-friendly prokinetic herbal blend.
- Adults & children over 13 years: 20 drops (1 mL), 3 times a day before or after meals
- Children 6–12 years: 15 drops (0.75 mL), 3 times a day before or after meals
- Children 3–5 years: 10 drops (0.5 mL), 3 times a day before or after meals
Contraindication: The main contraindication of Iberogast is that it contains licorice root, which may not be the best fit if you’ve got high blood pressure and/or are taking oral contraceptives (which interact with licorice root).
Licorice and and SIBO: While licorice root is a demulcent herb, it’s diluted with 8 other herbs in Iberogast. For this reason, Iberogast doesn’t usually trigger adverse reactions in people with SIBO – and it can actually make a wonderful ally for SIBO sufferers (when used in conjunction with SIBO eradication protocols).
MotilPro (Pure Encapsulations)
This is a nutraceutical made up of a proprietary blend of vitamin B6, ginger root, amino acid acetyl L-carnitine, and 5-HTP (serotonin precursor) which gets converted to serotonin, to get things moving.
General recommended dose: 1-2 capsules ~20 to 30 minutes after meals, or 2 capsules at night, before bed
Contraindications:
- Avoid MotilPro if you’re on an antidepressant medication SSRI or if taking St. John’s wort (due to 5-HTP) so you don’t get “serotonin syndrome” (an excessive amount of serotonin in your system, which leads to lots of problems).
- This supplement could also potentially worsen symptoms of reflux/heartburn so proceed with caution if you think you have acid reflux or an H. pylori infection.
Motility Pro (Orthomolecular)
This herbal prokinetic capsule is made up of proprietary extracts of artichoke leaf and ginger root, for stimulating the upper gastrointestinal tract.
General recommended dose: 1-2 capsules ~20 to 30 minutes after meals, or 2 capsules at night, before bed
Contraindications: Proceed with caution in cases of a ragweed allergy, and avoid in cases of gallstones or a bile duct obstruction, since this herbal blend has a tendency to stimulate gallbladder contractions.
Motility Activator (Integrative Therapeutics)
This is a clinically studied proprietary blend of artichoke leaf and ginger root extracts, very similar to Motility Pro.
General recommended dose: 1-2 capsules ~20 to 30 minutes after meals, or 2 capsules at night, before bed
Contraindications: Proceed with caution in cases of a ragweed allergy, and avoid in cases of gallstones or a bile duct obstruction, since this herbal blend has a tendency to stimulate gallbladder contractions.
GI Motility Complex (Enzyme Science)
This is a similar formulation containing artichoke leaf and ginger root extracts, much like MotilityPro and Motility Activator – but it also contains apple cider vinegar powder, for reducing stomach acid pH.
General dose: 1 capsule after each meal, or 2 capsules before bed
Contraindications: GI Motility Complex activates gallbladder contractions, so avoid in cases of gallstones and proceed with caution in cases of a ragweed allergy since artichoke leaf cross-reacts with the ragweed family. Avoid in cases of hiatal hernia and proceed with caution if you have acid reflux.
Prokine (Vita Aid)
Prokine is a nutraceutical blend of B vitamins, bitter herbs (chamomile, gentian root), prokinetic herbs (gentian root, ginger, peppermint extract), a serotonin precursor Griffonia simplicifolia, and carminative herbs (ginger, cinnamon).
It’s very potent, containing the equivalent of ~15 grams of dried ginger and ~2.4 grams of dried peppermint) – so while the “serving size” says 3 capsules, that may be too much for most people!
While Prokine can help, there are lots of potential safety concerns and interactions associated with this prokinetic. Consult your practitioner for a custom recommendation.
General recommended dose: 1 capsule after each meal
Contraindications: Avoid taking Prokine if you’re:
- Taking an SSRI (antidepressant medication or St. John’s wort)
- Have gallstones
- Have Parkinson’s and take Carbidopa / “Lodosyn”
- Have scleroderma
- Have or suspect ulcers
- Have acid reflux or heartburn
- Are pregnant/nursing
- Have a bowel obstruction
Megaguard (Microbiome Labs)
This specific nutraceutical is propriety blend of licorice root, artichoke leaf extract, and ginger root extract. Megaguard is a great option if you’re dealing with nausea or fullness caused by gastritis-related delayed gastric emptying.
It can even be used in protocols if heartburn and acid reflux and/or /H Pylori infection is co-occurring, because of the protective mucilage in the licorice root.
General recommended dose: 1 capsule 2-3x a day, each ~15-30 minutes before meals
Contraindications: Proceed with caution in cases of a ragweed allergy, and avoid in cases of gallstones or a bile duct obstruction, since this herbal blend has a tendency to stimulate gallbladder contractions.
Gutgard®
This is a patented extract of certain constituents from licorice root. It’s been third-party tested and proven in multiple studies to be clinically effective for stomach acid balance, gastritis and motility for the upper gastrointestinal tract.
A major perk of taking this is that the gut-healing and prokinetic constituents of licorice root are extra concentrated, and you can still take this prokinetic herbal supplement without a gallbladder.
General recommended dose: 150 milligrams/day
Contraindications: Licorice root contains mucilage which can potentially trigger symptoms of gas and bloating in people with SIBO. Licorice can also potentially raise blood pressure in some people.
SIBO-MMC (Priority One)
This doctor-formulated prokinetic is unique in that it contains a combo of vitamin B6, chinese red dates, flax oil, ginger, and an herb called Griffonia simplicifolia – a natural herbal source of 5-HTP (precursor to serotonin), which will all work synergistically and neurologically together to help to activate your Migrating Motor Complex.
General recommended dose: Take 3-6 capsules at bedtime, or 3 capsules in the morning and 3 capsules in the evening (away from food or with only carbohydrates such as fruit – no fats or proteins).
Contraindications: This nutraceutical prokinetic contains 5-HTP, a precursor to serotonin. Avoid this supplement if taking an antidepressant SSRI or St. John’s wort.
Frequently asked questions
Prokinetic vs laxative herbs – what’s the difference?
Prokinetic herbs (unlike laxative herbs) can safely be used with diarrhea on an as-needed basis, particularly in treatment protocols addressing hydrogen-dominant SIBO and hydrogen sulfide SIBO.
Laxative herbs, on the other hand, induce excessive movement in the colon. Laxatives are more likely to lead to unwanted symptoms of diarrhea or even incontinence.
Is triphala prokinetic?
There are currently no direct research studies investigating whether or not triphala is prokinetic.
However, it’s safe to assume that amla (one of the three Ayurvedic herbs making up triphala) has prokinetic activity in the gut, based on a 2013 clinical study. (7) Still, lots more research is needed before we can make this claim.
There’s also a lot of research supporting claims around the use of triphala for constipation (8, 9) so it wouldn’t surprise me if triphala is also prokinetic!
Are there any contraindications of prokinetics?
Potential contraindications / interactions taking prokinetics include, but aren’t limited to:
- Bowel obstructions
- Pregnant/nursing
- No gallbladder (depends on the supplement)
- Heartburn/reflux (depends on the supplement)
- Gallstones (depends on the supplement)
- Taking SSRI herbs/medications (depends on the supplement)
- High blood pressure (depends on the supplement)
More resources
The world of gut health and herbal medicine is a fascinating and complex one! Needless to say, I’ve got lots more to share on these topics which are near and dear to my heart.
If you’d like to learn more, feel free to check out the following articles on herbal medicine and gut health:
- What is Small Intestinal Bacterial Overgrowth (SIBO) and How Do You Know If You Have It?
- What is Irritable Bowel Syndrome (IBS) and How Do You Know If You Have It?
- What is a Leaky Gut, and How Do You Know If You Have One?
- 39 Best Herbs for Leaky Gut and Digestive Health
- How to Get Started with Bitter Herbs for Digestion
- Turmeric for IBS & Leaky Gut: Does It Work?
Final thoughts & next steps
There’s a wide array of natural prokinetic herbs and supplements to choose from, if you’re looking for extra support improving gut motility.
However, prokinetic herbs aren’t usually enough as a stand-alone intervention for slow gut motility. They also aren’t usually a first-level intervention.
Before diving head-first into the world of prokinetic herbs and supplements, make sure you’ve already begun making foundational lifestyle changes like:
- Balanced food choices
- Adequate hydration
- Regular movement
- Good quality sleep
- Stress reduction
Always make sure to consult a qualified practitioner so you can receive customized recommendations tailored to your individual needs.
If you’d like hear more about what I have to say on all things food, herbs & gut health, download a copy of my free gut health nutrition guide:
5 Diet Mistakes to Avoiod When Healing Your Gut!
XO – Jenna
