The 4 R’s protocol has been used successfully for years in functional medicine. It involves removing anything that is making you sick, replacing anything you are deficient in, re-inoculating the gut with probiotics and repairing any damage to the intestinal lining.
The first of the 4 R’s involves removing any allergenic foods, chemical irritants, medications or pathogenic microorganisms which may be causing gut inflammation.
Common foods which promote leaky gut include gluten, dairy, soy, corn, sugar, and GMO’s. Other irritants might include coffee, alcohol and irritants in processed foods. (For further guidelines on how to maintain a healthy diet, click here.)
Pathogenic microorganisms such as yeast, bacteria and parasites must be eradicated. A comprehensive stool analysis may be necessary to look for these various harmful organisms.
Anti-inflammatory medications such as ibuprofen should be removed. To the extent possible, try and reduce your stress level as stress can promote gut inflammation or leaky gut. Always try and eat only when you are in a relaxed state.
The second R – replace – consists of adding back and replacing anything that will aid in normal digestion or might be lacking because of your poor digestive health. For example we need adequate amounts of hydrochloric acid and digestive enzymes to break down and extract the nutrients from our food.
We need to replace any vital nutrients which may become replete as the result of our leaky gut. These nutrient deficiencies can in turn lead to neurotransmitter imbalances which can cause mood disorders. For example, vitamin B-6 is a cofactor for converting the amino acid tryptophan to the neurotransmitter serotonin. Serotonin deficiency can lead to anxiety and depression.
The third R – re-inoculate – involves reintroducing good bacteria or probiotics into the gut to establish a balanced gut flora. We need to reestablish a normal terrain or microbiome. This can be accomplished by taking a good probiotic supplement or eating fermented foods such as kefir, sauerkraut, kombucha tea, kimchi or miso.
Prebiotics are foods that help to feed and nourish the good bacteria in much the same way natural fertilizers help your garden grown.
For more information on proper supplementation, click here.
Lastly, the fourth R – repair – consists of taking specific nutrients which help support and nurture a normal gut lining. To name a few these supplements might include: glutamine, deglycyrrhized licorice (DGL), zinc and quercetin. In summary, the 4 R’s is a time tested approach to repairing your leaky gut. Although applying components of the protocol may give you some partial benefit, the best results will be seen when all 4 R’s are addressed simultaneously.
About the Author: Dr. Gerard Guillory, MD is Board Certified in Internal Medicine and has published two books on Irritable Bowel Syndrome (IBS). In 1985, he opened The Care Group, PC. Today, his clinic is a Primary Care facility that is a hybrid of functional and traditional medicine treating patients with digestive disorders, autoimmune disease, and other conditions. You can learn more about Dr. Guillory here.