How to improve your digestive health – The 5R approach
What I am going to introduce to you today is a concept known as the 5R protocol for gastrointestinal health. It’s something I have been using for a number of years now since I was first introduced to it when I overcame my own health challenges back in 2010, although I think it was the 4R approach back then. Ultimately the 5R protocol is a framework to allow for a more holistic approach to addressing your digestive issues.
The complexity of digestive health protocols are person dependent and there is no one size fits all protocol for gut health, but there are some similarities that I have found need addressing, particularly when addressing ongoing chronic symptoms where perhaps only the symptoms are currently being considered.
The diagnosis of IBS is an umbrella term used to categorise a number of symptoms, however it does little to determine the underlying cause in the majority of cases. That is where a combination of nutrition, lifestyle and functional medicine can come in. Couple that with the 5R protocol and we have a very successful process for addressing chronic and often frustrating digestive issues.
What is the 5R Program?
Imagine building a house with no scaffolding or any architectural plans. Can you imagine how that house might look or how many errors might occur during the build, not to mention what the end product might look like and the stress it might create during the build?
The 5R program is like supplying plans and creating a structure for that build. It allows for a systematic process to take place increasing the likelihood for success.
What are the 5R’s?
The 5R’s follows this particular flow:
Lets take a look at each one now to give an overview of what each one means. Remember everyone is different and not all of the 5R’s may be required to get your digestive health back on track.
What does REMOVE mean?
First of all you might ask the question, what might someone need to remove that might be upsetting someone’s digestive health?
Some of the most common issues you will see with more chronic digestive issues are that of chronic exposure to the following:
- Problematic Foods
- Problematic Bugs
- Problematic Toxins
- Problematic Thoughts
The remove process looks to investigate and where possible helps with the removal of any of the above contributing factors.
We may use methods such as stool testing, elimination diets/food sensitivity testing, environmental toxicity testing and just general investigation into your lifestyle and significant stressors.
As you can see already just the removal aspect of the 5R can be quite complex and hopefully you can see that a holistic approach has to be taken when addressing digestive health because there are so many contributing factors that are more often than not overlooked, hence the significant prevalence of chronic and unresolved digestive issues.
What does REPLACE mean?
On a very basic level, replace is just adding the good stuff back in. This might be replacing acids/enzymes that are perhaps low, thus impacting your ability to digest and absorb foods.
In some cases it might be replacing nutrients and fibers that are important for proper digestive health, growth of beneficial bacteria and the health of our intestinal lining.
What does REINOCULATE mean?
At this point we start to look at what we can do to help establish a healthy microbiome or balance of bacteria in our digestive tract.
Most people are unaware that we have more bacteria in our body than our own cells. In fact around 10 times the amount. Our relationship with these bacteria is symbiotic, in that we rely upon one another for survival and optimal health.
The reinoculate phase simply looks at how we can address an imbalance of bacteria or support low levels of specific strains of bacteria whether through diet or supplementation. This step is crucial for the longer-term recovery of the gastrointestinal tract and so often a step missed out in conventional treatment, which is generally only concerned with the removal phase and not the work that needs to come afterwards.
Research has clearly demonstrated that just a single course of antibiotics can have a profound effect on the populations of bacteria in our gut for up to a year, and if those antibiotics are taken in our infancy it can have even a life-long effect.
Likewise only focusing on probiotics can be an error as well as probiotics only have metabolic activity as they move through the gut and do little to colonize the gut, thus having little lasting impact on the micro biome.
The most effective way of influencing the balance and diversity of bacteria is actually from the type of food and variety of food that we eat. Check out some of these natural prebiotic and probiotic foods.
In some more extreme cases of infection, particularly with severe acute Clostridium Difficile infection, fecal matter transplant may be required to elicit a swift and complete change in one’s microbiome. This treatment while very promising is unnecessary for the majority of digestive symptoms.
What does REPAIR mean?
This step looks at what is required for you to support the health of the intestinal barrier. The lining of the gut is only 1 cell thick but separates us from the material in our digestive tract and the inner workings of the body.
Perhaps there has been significant inflammation from infection, overgrowth or problematic foods or high stress causing your intestinal lining to become compromised, something referred to as leaky gut or intestinal permeability.
Certain nutrients, compounds and herbs can be very useful in addressing this issue, but on the most part the triggers have to be removed first, hence step 1 (remove), otherwise its like trying to fill a bucket with water when it has holes in the bottom.
What does REBALANCE mean?
So here is the big one. The one that is often overlooked by most healthcare practitioners. What happens if you go through the first 4Rs everything seems hunky dory and you then return to your previous behaviours?
Well unsurprisingly a lot of people will have a return in symptoms. Chronic digestive issues rarely develop as a result of one single factor, unless perhaps your symptoms first started with an acute infection like a specific food poisoning incident or picking up a bug whilst travelling etc.
The majority of issues are the result of chronic mismanagement of nutrition and lifestyle.
Rebalance is working together to address those previous imbalances that may have lead to the issues in the first place.
For many this will be a combination of education and action steps towards a sustainable diet, proper stress reduction or reframing, appropriate exercise and relaxation and addressing underlying emotional issues that might be present. In some cases past symptoms have lead to a lot of emotional stress and finding a practitioner to support you on that level can be important to help you integrate back into your community and past relationships once again.
There you have a quick overview of a functional approach to digestive issues. Unfortunately on the most part digestive issues are not resolved with one magic recommendation, pill or protocol. It requires time to address underlying causes and time to rebalance and restore normal functioning again.
If this process resonates with you and is something you are interested in then please feel free to get in touch using the form below or check out the digestive health or functional medicine pages for more info.
- Langdon, A, Crook, N, Dantas, G (2016) The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation, Genome Med, 8:39
- Zaura Et Al (2016) Same Exposure but Two Radically Different Responses to Antibiotics: Resilience of the Salivary Microbiome versus Long-Term Microbial Shifts in Feces, Nov (3) Yassour et al (2016) Natural history of the infant gut microbiome and impact of antibiotic treatment on bacterial strain diversity and stability, Science Translation Medicine, Jun, Vol 8:343, pp343
- Dethlefsen L, Huse S, Sogin ML, Relman DA (2008) The Pervasive Effects of an Antibiotic on the Human Gut Microbiota, as Revealed by Deep 16S rRNA Sequencing.
- Dethlefsen L, Relman DA (2011) Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc Natl Acad Sci
- Jernberg C, Löfmark S, Edlund C, Jansson JK (2007) Long-term ecological impacts of antibiotic administration on the human intestinal microbiota. ISME J 1: 56–66.
- Antunes LCM, Han J, Ferreira RBR, Lolic P, Borchers CH, Finlay BB (2011) Effect of Antibiotic Treatment on the Intestinal Metabolome. Antimicrob Agents Chemother 55: 1494–1503
- Cox LM, Yamanishi S, Sohn J, Alekseyenko AV, Leung JM, Cho I, et al. (2014) Altering the Intestinal Microbiota during a Critical Developmental Window Has Lasting Metabolic Consequences. Cell 158: 705–721
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