In order to treat a patient with dysbiosis, many functional health practitioners follow what is called the the 4R approach to systematically address potential causes and triggers of gut dysfunction.  The R’s stand for remove, replace, restore and repair. 

Remove

To remove, we want to remove foods that are antigenic, commonly gluten, lactose, eggs, and nuts, and an optimal way to do this is to implement an elimination diet where common antigens are removed from the diet for a period of time, perhaps 4-6 weeks, and then one by one each type of food is added back into the diet slowly to evaluate and track and signs and symptoms in an attempt to identify the specific types of foods that may impact you. This also gives the gut a period of rest and may assist in healing intestinal permeability and resultant inflammation. 

Replace

To replace, we want to replace enzymes, amino acids, bile salts and other intrinsic factors that may be lacking in the gastrointestinal tract to improve digestion and absorption, including improving fat absorption and liver clearance of non-beneficial substances.

Restore

To restore, we add in probiotics, if appropriate, fermented foods and prebiotic foods to restore the natural gut flora.  Probiotics are not always a cure-all because they do not remain permanently and do not actually reinoculate the gut with beneficial bacteria. Additionally, they are strain specific, which means that only certain probiotic strains are effective on specific signs and symptoms.  Prebiotic foods are important because they are used to provide food to grow beneficial gut bacteria and release other beneficial compounds. Prebiotic foods include foods containing inulin like garlic, onions, asparagus and chicory root, as well as nuts and seeds.

Repair

To repair, we may consider certain targeted supplements that can provide energy to enterocytes, the cells of the gut lining, to heal and restore its integrity and to address any nutrient deficiencies, which is common with dysbiosis. Also certain other foods can be recommended to provide an energy source for beneficial bacteria to support the gut flora, such as resistant starches. 

The 5th R!  Rebalance

Some practitioners also implement a protocol with a 5th R, called rebalance, where you seek to achieve balance in your life by adopting an anti-inflammatory diet and regularly engaging in physical activity, stress management and social connection.

Please reach out to me if you’d like guidance on addressing gut issues and to see if I can help you rebalance!