Balance gastrointestinal health and the 4 R protocol. Gut heath is strongly linked to immunity. Approximately 70% of cells contributing to the immune system are found in the gut.
The microbiome (the beneficial microbes we find in our gut) is in constant communication with the immune system, ‘teaching’ it how to respond to toxins and pathogens. Maintaining a heathy gut is therefore especially important at the time of a new viral threat.
There are many factors that can lead to a disturbance in gut function, so maintaining gut health and alleviating related symptoms can be challenging.
Symptoms can vary from constipation, diarrhoea (or alternation of the two) to flatulence and bloating. Identifying possible food sensitivities play a big role in gut health and any nutrition advice needs to be personalised.
The Four R protocol:
The four R protocol (Remove, Replace, Re-inoculate, Repair) provides a structure to address specific underlying causes of gut imbalances.
When we have a consultation, I will first determine the best approach for your particular situation and symptoms; then, if appropriate, move through these four steps. This process takes time, commitment and perseverance and its interpretations vary substantially.
Remove (problem foods, gut pathogens)
The first step is to remove the factors that negatively impact the gastrointestinal (GI) tract and may be contributing to your symptoms such as food sensitivities, bacterial overgrowth/infection, fungal overgrowth/infection, stress, parasites, bowel toxins and chemical pollutant exposure.
Some bacteria use carbohydrates as their energy source and ferment them to gases; therefore, a low carbohydrate diet can directly reduce symptoms by decreasing the amount of gas produced. Reducing carbohydrates may also be linked to a decrease in the overall microbial load.
In patients who have no celiac disease, non-celiac gluten sensitivity (NCGS) may exist, involving an inflammatory immune response that can contribute to digestive symptoms.
In addition to gluten, other foods can create digestive symptoms such as dairy (particularly if containing lactose as many people become intolerant with age) eggs, soy, nuts or shellfish.
Elimination diets often focus on the removal of those foods for a period of time (ranging from a couple of weeks to months) with the gradual introduction of one food at a time after this period to determine which may be a triggering factor. This also may include foods which are high in histamine or histamine-releasing foods (see box).
Multi-herbal formulas containing grapefruit seed extract, caprylic acid, berberine and oregano may help with bacterial overgrowth and infection. Oil of oregano is also a well- documented botanical that directly inhibits the growth of intestinal microbes and high potency caprylic acid contribute to the reduction of yeast overgrowth.
Anti-parasitic compounds include berberine, grapefruit seed, wormwood and black walnut.
Psyllium bark, apple pectin and activated charcoal can be helpful in removing bowel toxins.
Replace (support digestive function)
In this step, we will replace all those factors that may be missing or lacking such as insufficient stomach acid, digestive enzymes and nutrient deficiencies.
The body may have inadequate digestive secretions because of genetics, a recent gut bug, medication use or other chronic conditions such as celiac or pancreatic disease. Digestive or pancreatic enzymes or supplemental bile may improve digestive symptoms.
Vegetarian digestive enzymes (bromelain from pineapple and papain from papaya) assist in the breakdown of food particles. This can help to reduce fermentation in the gut, reducing bloating and flatulence.
Ginger and bitter herbs might also be needed to support the migrating motor complex, a peristaltic gastric movement that happens between meals and helps get rid of undigested food. Hydrochloric acid, a key component if stomach juices, facilitates the digestive action of enzymes and may need to be supported if stomach acidity is low.
Vitamin B6 and zinc can also be used as useful cofactors in the natural production of stomach acid.
Re-inoculate (restore healthy gut flora)
In this phase I will offer advice on how to re-inoculate your gut with good bacteria via probiotics in order to regain a healthy balance.
Prebiotics also help by feeding and promoting the growth of the right organisms thus limiting proliferation of pathogenic microbes. Asparagus, onion, garlic and leek contain a natural prebiotic fibre known as inulin. This insoluble fibre travels through our bodies from the small to large intestine where it acts as a food source for beneficial microbes.
However, introducing prebiotics too early can act as a fuel source for bad bacteria.
Yogurt or kefir contain friendly bacteria from the strains lactobacillus, bifidus and acidophilus, but I recommend a thorough check and reading of ingredients as they often have added sugar which feeds the bad bacteria in your gut.
Following a course of antibiotics, extra strength lactobacillus acidophilus NCFM and Bifidobacterium lactis can contribute to bacterial balance.
Repair (repair leaky gut that could be the source of intolerances/allergies)
The fourth and final step in this process is to repair the lining of your gut.
Damage to the gastrointestinal mucosa can occur with pathogens or an imbalance in the microflora due to alcohol use, food sensitivities, allergies or other inflammatory and immune-mediates conditions.
Inflammation and damage in the gastrointestinal tract have an impact on the local tissue but it can also affect the body systemically as increased intestinal permeability (leaky gut) allows toxic metabolite, products of bacterial die-off and potentially larger allergenic molecules to pass through the junctions between the cells (which, in a healthy state, are tightly connected and do not allow such transport).
As a consequence, the gut mucosa flora is affected and that can impact the immune system function. Many enzymes are activated or even produced in the cells and mucosal brush-border lining of the gut, and when this becomes damaged, the ability to break down substances such as lactose and histamine diminishes.
For some individuals with significant damage to the gut mucosal barrier, probiotics may be poorly tolerated until the health of the gut lining is improved.
Quercetin, which also exerts anti-histamine action, improves the integrity of the tight junctions in the gut. Additional botanicals that support healing of the gut include slippery elm and chia seeds.
Your diet will play a big role in this step, along with some supplementation that may be recommended to help repair the intestinal tract lining such as L-Glutamine, Vitamins A, C and Zinc together with deglycerized liquorice.
A healthy diet and lifestyle and a structured stress and anxiety reduction are fundamental to preventing disease recurrence. Milk protein hydrolysate and theanine have both shown to help support the body’s normal response to stress.
Much of our overall health depends on the health of the intestine. Given the large number of patients suffering from intestinal symptoms and the amount of drugs prescribed, it is useful to propose a more structured intervention capable of tackling the problem at its root. The 4R program represents a valid and complete intervention protocol that can help restore optimal gastrointestinal function.
High Histamine Foods
Alcohol, pickled or canned foods, matured cheeses, mushrooms, smoked meat products, fish, beans and pulses, dried fruit, seeds and nuts, chocolates and other cocoa products, vinegar, ready meals, yeast extract, yeast, additives (benzoate, sulphites, nitrites, glutamate,
Food dyes. Fruits : bananas, strawberries, tomatoes, pineapple, mango, raspberry, grapefruit, avocado, tangerine
Vegetables : spinach, pumpkin, aubergines
Green and black tea not recommended as they block the diamine oxidase enzyme, also known as histaminase, that metabolises histamine
Low Histamine foods
Fresh meat, freshly caught fish, egg yolk, fresh fruits (except the ones listed above), fresh vegetables (except the ones listed above), grains, dairy alternatives, cooking oils, organic flaxseed oil, leafy herbs, herbal teas (peppermints, ginger, fennel)