The 5 R Approach
Since I still have two weeks of preparation for my Functional Medicine specialty board exam I will spend some time reviewing the 5 R approach to a healthy gut. The hose of our gastrointestinal system that runs from our mouth to our anus with a few extra-pouches and organs involved, such as the stomach, liver, gallbladder, pancreas and rectum is lined by a wall that is typically one layer thick. That’s actually all that separates the outside world from the inside world. If that layer of cells becomes compromised or “leaky” then things that are supposed to be kept out of the inside world get in.
Another very important thing is that 90% of a person’s immune system sits right behind the lining of the gut wall and so if things are getting in that are not supposed to, the immune system is going to react and attack the “foreign” invaders. This reaction causes inflammation and excess immune irritation that can lead to autoimmune disease, hypertension, anxiety, depression, hormonal imbalances and many other problems.
With this scenario in mind, it is easy to understand why and how the gastrointestinal system or the gut is the core system to initiate either healing or disease in a multi-systems approach to human health. And, if you think about the typical Standard American Diet (SAD) of mostly white and brown colorless foods that have been processed and packaged, irradiated, and filled with additives and sugars to try and add back flavor; it does not take much of a leap to see the connection again between health and disease!
So, if you eat a typical SAD diet and have been feeling fatigued with brain fog or joint pain, anxiety, depression or you have irritable bowel syndrome, heartburn, difficulty losing weight, bloating, gas, chronic pancreatitis, ulcerative colitis, or crohn’s disease you are going to want to read on and implement aspects of the 5 R approach to gut health.
The first “R” stands for REMOVE
First and foremost people need to remove the processed, packaged, irradiated and sugar layden foods from their everyday intake. Eat real foods filled with phyotonutrients. The fruits and vegetables from nature of all the colors of the rainbow: red, green, orange, yellow, purple, and blue are what should be eaten.
Remove foods that cause irritation and inflammation and leaky gut. This may be different for each individual, but the gold standard test to determine what categories of food are causing a person trouble is to do a Comprehensive Elimination Diet. The categories that are typically eliminated for 3 weeks are: gluten, dairy, eggs, soy, alcohol, processed foods, sugar, caffeine, peanuts, and shellfish. Once 21 days of elimination are done; then each item or category is added back systematically one at a time to assess for a negative reaction; such as, headaches, bloating, gas, bowel upset, rash, joint pain, etc…… If any of these symptoms occur during the re-challenge and they were gone during the elimination then it means the food item caused the reaction and it must be eliminated for another month before challenging it again. Sometimes, the gut will heal with more rest and avoidance of a food and you will eventually be able to tolerate it; but in many certain foods will always be an irritant. Every individual is different. But again, the Gold Standard Test to determine foods that a person is sensitive to is to do a 3 week comprehensive detox or elimination diet and Remove the triggers from your gut environment! (over the last 6 weeks I blogged on the adverse effects of wheat and explained that I have created a Detox Plus Program that is available on my website: tmurraywellness.com, which is a 5 week course that explains and supports a person through the comprehensive elimination diet)
Another aspect of the Remove approach is to remove bad bugs from the gut
Humans live in a symbiotic relationship with microbes or bacteria. We would die without bacteria in our colon. But, we want the good bacteria on our team and not the bad bacteria. Lactobacillus and Bifidobacteria are the two major types of good and beneficial bacteria and you typically find these in manmade probiotics. But, there are many other forms of bacteria and also yeast, like candida that can become more populated in our gut and cause dysbiosis or dis-ease in our gut environment. It is these bad guys that we want to remove if they are leading the pack and promote the good guys to be the main gang running the neighborhood.
The best way to know whether you have dysbiosis or not is to do a comprehensive stool analysis that can culture the bugs in your stool and report which bacteria are present and to what quantity or degree. Once this test is done, then different treatments can be done if needed to Remove the bad guys and promote the good guys. This treatment could involve antibiotics, antimicrobial herbs, supplements, and of course different foods or diets to optimize and support the good guys and Remove the bad guys.
Remove Irritating Medications When Possible:
Finally, Remove also involves removing medications that may be promoting an unhealthy environment in a person’s gut. Anti-inflammatory medications like ibuprofen or other NSAID’s can promote intestinal permeability or leaky gut and should be removed or limited as much as possible. Another example are antacids. They are not meant to be taken for long periods of time and the stomach is supposed to have an acidic environment. The pH of the stomach is supposed to be around 2.0 and if it is not the valve will not open properly at the end of the stomach to allow the contents of the stomach to progress into the small intestine. If this is occurring there is no wonder that the contents starts to regurgitate back up the esophagus and cause heartburn or gastroesophageal reflux disease (GERD).
So, removing irritating foods like alcohol, caffeine, dairy (lactose), carbonated drinks; and optimizing stomach acid by drinking a dilute drink of apple cider vinegar or lemon juice prior to meals, are a more functional approach to healing one’s gut then being on an H2 blocker or a proton pump inhibitor for years and years. However, one must understand that the functional medicine approach to healing the gut does not happen overnight and it is never recommended that a person should remove any medication right off the bat. Instead, changes in diet should be done first and foremost and removing bad bugs, then as things improve antacid removal may be possible as the gut function is optimized.
So, as you can see, the functional medicine approach to gut health is multifactorial and today I have reviewed the first step in the 5 R approach which involves Removing things that are blocking optimal function of the gut. Stay tuned for next week when I discuss the second R, which stands for Replace.