5R Gut Healing Protocol

This protocol was designed by IFM (Institute of Functional Medicine) that I have found highly effective at improving gut health.

The five “Rs” are;

1.     Remove

2.     Replace

3.     Reinoculate  

4.     Repair

5.     Restore

Please do not attempt to implement this protocol without direction from your health care provider.

This protocol is designed to be followed for 1-3 months. The beauty of this protocol is that we can design a custom protocol that works for your specific case. It can be repeated 1-2 times a year (or as needed) as a gut reset.

Repairing the gut lining is akin to gardening. Keep that in mind as you read through this.

Remove

This is the weeding of gardening.

Remove refers to removing primarily two things; bugs and triggers.

Removing bugs

• This includes both infectious gut pathogens (parasite, bacteria, fungus) and non-infectious overgrowth bacteria/fungus (SIBO, SIFO, etc).

• This can be done using herbal medicine or conventional pharmaceuticals.

Removing triggers

• Food allergies/sensitives and suspected triggering foods (corn/gluten).

• Common foods that can cause temporary intestinal permeability (“leaky gut”) include diary, red meat, refined sugar (not fruit), and gluten/wheat.

• Alcohol and NSAIDs (advil etc) are well known GI irritants and are best avoided during this time.

By far this is the hardest “R” to follow. My strong recommendation is to completely omit these foods during your gut healing protocol. At a minimum reduce them as much as possible. Remember it’s temporary - not forever (most things worth doing are difficult).

Replace

This is the soil amendment of gardening.

This includes replacing digestive secretions to help a struggling gut lining to adequately break down (digest) food. This prevents undigested foods from reaching areas of the GI tract where it can cause inflammation. It also helps release nutrients for absorption.

We replace things (typically based on stool testing results) such as;

• Digestive enzymes; individuals with low/suboptimal pancreatic enzyme production greatly benefit from enzymes.

• Bile salts: sluggish gall bladder presentations or cases of post-cholecystectomy syndrome.

• Betaine HCL (stomach acid): replacing stomach acid for those with low stomach acid (hypochlorhydria).

• Bitters; herbal medicine blends of bitter herbs that help naturally promote gastric secretions taken in small amounts before meals.

Reinoculate

This is the seeding (planting) of gardening.

A healthy gut is full of bugs. A rich diverse ecosystem of microbes that all contribute to overall health in a variety of ways. The microbiome is important for SCFA (short chain fatty acid) production, neurotransmitter synthesis (mind health), hormone balance, and the immune system.

The contribution of a healthy microbiome in overall health is backed by numerous research studies.

We reinoculate the terrain here with probiotics including both beneficial bacteria and beneficial yeast.

Prebiotics

We have to feed the seeds we planted to ensure a fruitful harvest.

Prebiotics are the food for the microbiome. While there are many prebiotic foods I will highlight only soluble fiber here as it is (in my humble opinion) the keystone food for gut health and overall health. Legumes (lentil, split pea, bean family) are rich in soluble fiber and high quality plant protein). Recommended daily fiber intake is set at 25-38 grams. While I would argue this is a VERY low bar, most Americans struggle to achieve this. Incorporating legumes into your daily diet will help you reach this goal. Minimalist Baker does a great job teaching people how to incorporate legumes into their diet.

There are also fiber supplement options you can discussed with your provider.

Repair

The repair category refers to replenishing nutrients that specifically support the enterocytes (the cells that line the gut). This incorporates nutrients (ex. L-glutamine) and herbs (ex. Marshmallow) to help support the regeneration of damaged enterocytes. This is also a category in which your provider may recommend you pursue in depth nutrient testing (D, Iron, B vitamins, Omega 3, etc).

Consult your provider for specific recommendations

Rebalance

For Americans who are “burning the stick at both ends” this R is of vital importance. I want you to think of a guy, stuck in rush hour traffic, late for a meeting, shoving a burger in his face. His autonomic nervous system is in the fight and flight mode, NOT in the rest and digest mode. His gastrointestinal tract’s ability to properly digest and assimilate that meal will be seriously compromised by his choosing to eat this way.

Are you this guy?

Most of us, at least at one time or another, have been him. Grabbing a quick something and eating in a rush while doing some other activity. When is the last time you sat down at a table and did nothing other than simply enjoy a meal and good company? And when I say nothing – I mean it, no phone, no TV, no distractions. This allows your autonomic nervous system to switch into parasympathetic (rest and digest) mode so that you can adequately digest your meal.

Talk to your provider about ways to increase your parasympathetic tone.

Once again, this protocol is meant to be followed 1-3 months and only under the care of your healthcare provider.

I enjoy working with clients on GI health as it’s often the underlying root cause of so many other body system issues. I also enjoy it because I love food. Looking at it, smelling it, touching it, tasting it, preparing it, sharing it, traveling for it, etc. The only way to truly enjoy good food is to have a GI tract that can handle digesting it and turning it into the energy and nutrients we need for optimal health.

Dr Panza