There are many reasons why your gut may be imbalanced. A poor lifestyle (diet, stress, poor sleep), health condition (inflammatory bowel disease/IBD, colitis, Celiac), bacterial imbalances (dysbiosis), and infections (candida, SIBO or small intestinal bacterial overgrowth, parasites) can all lead to a damaged or “out of whack” gut. In the field of functional medicine, the plan for fixing it is the 4 R’s, which stands for Remove, Replace, Re-inoculate, and Repair. The goal of the 4 R’s is to not only fix the issues that are affecting your gut, it’s also to improve its function. That means being able to absorb the nutrients from food, no more gas and bloating, and an overall sense of better health (these and plenty more are covered in my Profile of a Healthy Gut). Let’s take a closer look into each of these R’s and get to know this powerful approach for healing the gut!

#1. Remove

The first step requires removing any offending foods, supplements, infections, overgrowths, and habits that may be wrecking your gut. During this step, you’ll test and search for the culprits behind your symptoms. (Expect to take an IgG Food Sensitivity, Organic Acids,  and comprehensive stool analysis test.)

Generally, this is what you’ll be told to remove. Alcohol, sugar, (recreational) drugs, caffeine, and common trigger foods like gluten, dairy, soy, and eggs all may be on hold for a while. What it also focuses on is proper stress management, as it’s known to interfere with digestion. (Which I go way into more detail in this post.)

Don’t be surprised if your particular situation is more complicated than most. A lot of times, gut problems are more than just infections. Sometimes, there are deeper causes, like thyroid or hormonal imbalances, autoimmune disease, or nervous system disorders. It’s very important that you work alongside one (sometimes more) doctors to help you get to the root of your problem!

Common Step 1 Tools: Elimination Diets (i.e., Low FODMAP, Specific Carbohydrate Diet, Elemental Diet, GAPS diet, etc.), anti-fungal/anti-parasite/anti-bacterial-supplements or antibiotics to target overgrowths

#2. Replace

Now that you’re working to remove the bad, it’s time to replace them with the good. This step is about raising your body back up to its full potential. It uses supplemental enzymes and foods like apple cider vinegar and ginger to improve digestion. In addition to these, you’ll also be fixing any nutrient deficiencies that may have come up during the testing part of Step 1.

Common Step 2 Tools: Multivitamins or individual supplemental nutrients to improve deficiencies (i.e., vitamin A, C, D, E, iron, zinc, etc.), digestive enzymes, ox bile, hydrochloric acid (HCL), herbal or Swedish bitters

#3. Re-inoculate (aka, Restore)

After you’ve eliminated the overgrowths/ infections and have started improving your digestion, it’s time to speed things up by adding in healthy bacteria. Fermented foods (kefir, yogurt, kombucha, pickles, sauerkraut, miso, etc.), fiber-rich foods (asparagus, leeks, onions, broccoli, flaxseeds, apples, etc.), and/or supplemental pro and prebiotics are used to help the beneficial bacteria in the gut to restore order and make sure that the bad guys don’t come back to mess things up again.

Common Step 3 Tools: Probiotics and prebiotics (both supplement and food form)

#4. Repair

Finally, this last step is all about repairing the damage that had been made. Whether it was due to an overgrowth or inflammation, the goal here is to fix things up and allow your body to heal. This step is known to take quite a while (some sources estimate up to six months). It depends on how well you followed the first three steps and how bad your case was. A simple yeast overgrowth may not have a long Step 4. But a stubborn bacterial overgrowth, combined with inflammation, could take much longer to heal. But don’t worry- no matter how long it takes, know that you’re making an effort to heal and are on the right path to recovery! Which is all the more reason why you should have a good relationship with your doctor. They will know how to adjust your plan as you go along together.

Just like with Step 1, you may have to continue supplementing with any vitamins or minerals that your body is lacking. During this final stage, you’ll be focusing on repairing and sealing the intestinal wall of the gut, which may have been damaged either due to inflammation, overactive immune function, or infection/overgrowth. (In functional medicine, a damaged gut wall is referred to as leaky gut or intestinal permeability.)

Common Step 4 Tools: Omega 3 fish oil supplement, L-Glutamine, soothing herbs (aloe vera, marshmallow root, licorice root, peppermint, slippery elm bark), collagen peptides powder, vitamins, and minerals to continue filling in nutritional gaps

Tips for the 4 R’s:

• Work with a qualified healthcare practitioner, not a “guru” or “expert” on the internet; make sure he or she is well-knowledgeable about the 4 R’s and/or functional medicine (to find a practitioner near you, use the referral network from the official websitefor the Institute for Functional Medicine)
• Accept any setbacks or mistakes; no one is perfect! What matters is that you keep going
• Consider opening a savings account for supplements, tests, and healthy whole foods
• Ask as many questions as possible to get a clear understanding of what’s happening in your body (and if something doesn’t feel right during your treatment, speak up)
• Don’t rush it; slow and steady wins the race, and not all problems are quick to resolve
• Be kind to yourself throughout the entire process, and don’t compare your wellness to someone else’s
• Join a local or online community to connect with fellow patients; you’ll no longer feel alone during your treatment and you may end up making new friends! Not only that, you’ll have a community to raise you up when going through struggles or setbacks

There you have it, everyone! A general overview of the 4 R’s of Gut Healing. I hope you found this gut-focused post very useful and would appreciate your questions and thoughts about future posts! Let me know if there’s anything about the gut that you would like to know, and I’ll cover it!

Sources and Further Reading:

[1] http://rmalab.com/four-r’s-gut-healing
[2] https://www.amymyersmd.com/2013/01/heal-your-gut-heal-yourself/
[3] https://www.thenutritionalinstitute.com/resources/blog/292-the-4-r-s-of-gut-health