4Rs approach

The 4Rs denote the four steps in the management of digestive dysfunction and are as follows:

REMOVE, REPLACE, REINOCULATE, REPAIR.

Remove

This stage involves the removal of foods from the diet which may be contributing to symptoms emanating from within an individual’s gastrointestinal system. This will often include sugar, refined carbohydrates and alcohol, as well as proteins. It also makes sense to remove those foods which can produce an inflammatory response; common foods which fall into this category are gluten, dairy, soya and eggs. One way in which these potentially inflammatory foods can be identified is with the use of food intolerance tests, which identify elevated levels of food specific IgG antibodies. In addition, if an individual is suffering from chronic infections, or gut parasites, then these should be treated and any exposure to toxic chemicals or metals such as mercury should also be eliminated. This phase is aimed to help decrease the load upon the gastrointestinal tract, thus preventing further inflammation of gut tissues.

Replace

This begins with the replacement of any "problem" foods which have been removed from the diet, with others that can provide similar nutrients and therefore ensure that the individual is not missing out on any vital nutrition due to their dietary change. The other component within this phase of the 4Rs approach is regarding the digestive process itself. Digestive enzymes present within the GI tract are fundamental to the proper digestion, absorption and assimilation of the nutrients from any food consumed. If an individual has digestive enzyme deficiency/insufficiency, their food can’t be broken down correctly and although they may have improved their diet through step one, they won’t fully absorb the valuable nutrients contained within the food that they ingest. This replacement is done utilising digestive and brush border enzyme supplements.

Re-inoculate

Individuals with chronic conditions will often have depleted levels of beneficial gut flora. This imbalanced microbiome (gut flora environment) can be due to a variety of factors, including the use of antibiotics and other medications, excess sugar, a poor diet, alcohol, chronic internal inflammation, stress and a lack of sleep. In this case, an individual’s balance of beneficial bacteria needs to be improved, whilst adjusting lifestyle factors to prevent further proliferation of pathogenic bacteria. This can be achieved with the consumption of food and supplement based prebiotics and probiotics. Prebiotics are specific food fibres that act as food sources for the beneficial gut flora to grow and multiply within the intestinal tract, whilst probiotics are the live healthy bacteria themselves.

Repair

This is achieved by additional nutrient supplements and foods to promote the proper repair of the gut lining, more specifically the mucosa of the gastrointestinal tract. A variety of different supplements can be utilised for this purpose within this phase including L-Glutamine, zinc and omega 3 fish oils. Additionally, foods such as bone broth, yams and sweet potato can also be extremely beneficial for this purpose.

 

Elimination diets and the use of supplement should be conducted under the guidance of a professional healthcare practitioner.