The Fantastic Four of Functional Medicine

Four Rs Infographic

The Four R’s is a powerful treatment program that helps sufferers with chronic health complications to quickly address and heal the root causes of their symptoms, regardless of their severity and duration of affliction. It tackles gut health, based on an understanding of the key role that the gut and gut lining plays in so many aspects of disease, after all, 80% of our immune system is located in the digestive system.

The idea of the four R’s originated from Dr Jeffrey Bland, the co-founder of The Institute for Functional Medicine, and he has actually said of the four R’s “If I had only one clinical tool to teach doctors how to become successful with, it would be this therapy.”

The four steps are as follows – REMOVE, REPLACE, REINOCULATE, REPAIR.

Step 1 – Remove
The patient must cut out their intake of everything that is harmful to the gastrointestinal system. This means foods which produce an inflammatory response such as gluten, dairy, sugar, refined carbohydrates, soy, eggs, nightshades, alcohol, legumes and natural probiotic foods. Medications which are harmful to the gut that are safe to come off can also be removed.
Existing infections residing in the intestines need to be removed, such as SIBO (small intestinal bacterial overgrowth) and candida yeast infections which attack the gut wall lining causing leaky gut – increased intestinal permeability allowing things like toxins, gluten proteins and undigested food to pass through the gut wall into the blood stream, resulting in immune response issues and inflammation.

Step 2 – Replace
Digestive enzymes present in the digestive system are vital for the digestion and assimilation of food and the absorption of nutrients, they are usually depleted in patients suffering chronic ill health so need to be replaced. If a patient doesn’t have enough digestive enzymes their food won’t be broken down properly, they may have improved their diet through step one but aren’t going to be absorbing the valuable nutrients. This replacement is done through the use of digestive enzyme supplements.

Step 3- Reinoculate
Patients with chronic conditions will have depleted levels of natural healthy bacteria in their gut, this will be as a result of a variety of reasons such as factors which caused their chronic condition, medications, bad diet and stress. So levels of good bacteria need to be increased by taking in prebiotics and probiotics in supplement form, usually powders or capsules. Probiotics are the live healthy bacteria, prebiotics are fibers which act as sources of food for the probiotics to grow and multiply. Natural sources of probiotics such as fermented foods are highly beneficial but need to be avoided until step one is complete as they can act as a prebiotic and provide nourishment for growth of any bad bacteria still present.

Step 4 – Repair
This is the use of nutrients to repair the damage to the lining of the gut wall, more specifically the mucosa of the gastrointestinal tract. Supplements are required, and a variety of different ones are used…

  • L-Glutamine
  • Zinc
  • Omega 3 Fish Oils
  • Magnesium
  • Liquorice Root
  • Pantothenic Acid
  • B Complex Vitamins
  • Quercetin

The steps are followed concurrently, not separately one after the other, and time is required to feel the full benefit of the process. Dr Bland recommends a 12 week implementation, throughout this period responses are monitored and adjustments made as required, depending on how the program is working for the patient. Everyone is different and the practitioner’s expertise enables effective evaluation to give the protocol a distinct, custom fit to the individual, thus maximising its potential.
While 12 weeks may seem a bit overawing and require a level of commitment beyond what patients may be used to or expect, there is a an attractive boost…rapid improvements to symptoms are possible, and common, within the 12 weeks. This is because gut cells renew at a speedier rate than other cells in the body, so everything implemented in the four R’s program becomes effective and produces beneficial results very quickly.

So, a patient applying the four R’s under guidance from their functional medicine doctor can expect significant progress in enabling the digestive system to rectify the imbalance and re-establish proper function of digestion, assimilation, absorption and elimination.

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