The gut microbiome is a complex ecosystem of microorganisms that reside in the digestive tract. These microorganisms play a critical role in digestion, absorption, metabolism, production of key nutrients, immune function and help create neurotransmitters. Dysbiosis (or an imbalance in the gut microbiome) is linked to a variety of chronic illnesses, including inflammatory bowel disease, irritable bowel syndrome, obesity, auto-immune diseases and even mental health disorders.
The 5R process is a framework that functional medicine specialist utilize to restore gut health, balance the microbiome and improve the diversity and abundance of the microbiome. The 5R’s stand for Remove, Replace, Reinoculate, Repair, and Rebalance.
1. Remove: This is the first step of gut healing. It requires removing inflammatory food triggers such as food sensitivities and allergies, possible infections and or toxins. This process may involve an elimination diet, taking anti-microbials or anti-fungals. The latter treatment is usually based on a stool study or breath test.
2. Replace: This step replaces digestive enzymes or nutrients that may be lacking. Depending on your symptoms as well as the stool study, functional medicine specialist can use hydrochloric acid, bile salts, pancreatic enzymes or broad spectrum digestive enzymes, which can help with digestion and absorption. This step also includes replacing any critical nutrients lacking from malabsorption, such as zinc, magnesium, vitamin A, B, C, D, E, or K and iron.
3. Reinoculation: involves reintroducing beneficial bacteria into the gut with probiotics. Most providers will use broad spectrum probiotics with lactobacillus, bifidobacterium, and the beneficial yeast strain Sacchromyces Boulardii. Prebiotics are indigestible fibers that feed the beneficial bacteria. Each family of bacteria will use different prebiotics, so a rotation of prebiotics is critical. Postbiotics are metabolites produced by the beneficial bacteria, and are best utilized with patients on recurrent antibiotics, low beneficial bacteria, surgery, and steroid use history. They can be expensive, so most patients use them for 3-7 months and then switch to prebiotics (which are less costly).
4. Repair: This involves healing the gut lining, supporting and developing a thicker cell membrane on the lining, and promoting an increase of healthy cells. This involves taking supplements like L-Glutamine, GI Revive, SBI protect, colostrum, zinc and Vitamin A, which all help repair the gut lining and reduce inflammation. Adding polyphenols (which are plant compounds high in anti-oxidants and anti-inflammatory properties) can also promote a beneficial gut microbiome, improve the gut brain axis, and cognitive function. The polyphenols used in both studies are resveratrol, quercetin and DIM.
5. Rebalance: The final (and probably most difficult) step for patients is improving your lifestyle to calm the system down and promote a restorative path. This involves regular meditation, breath work, quiet time, sufficient sleep, and having grace and compassion for ourselves.
The Functional medicine approach to gut health has been instrumental in improving patients’ health. Personalizing this approach requires blood work and a stool study to better understand your unique needs.
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