Dr. Rakel discusses the four best ways to keep the intestinal tract healthy.
The four-R approach is a therapeutic modality that actually was coined by my naturopathic colleagues. They have been talking about this gut immune interface for a long time, and the first R is to remove. Remove those things, like a stressor, emotional stressor that could be causing that disruption or a chronic antibiotic that you might not need for acne, that some people use, oops…sorry. So what can we remove that could be blocking that body’s ability to heal in the GI tract.
And number two is replace. I don’t use this one as much because I find that it’s not often necessary but sometimes we don’t have enough acid and we see this with people who use proton pump inhibitors or H2-blockers which suppress acid for prolonged periods of time. And we forget that we need acid for a reason we need acid to absorb key nutrients, vitamin B12, iron, calcium, and if we suppress acid for too longer a period of time it actually worsens our digestive ability.
Sometimes we will give people enzymes, just for a short period of time to help them digest their food until we improve that eco system but then we need to take those away because we want our own pancreas to do its job. We want our own pancreas to create those enzymes.
Replace is the third R. We want to replace the healthy bacteria to create that ideal ecosystem so sometimes we will actually use some probiotics or prebiotics, often we use both. We have the patient change their diet to include those prebiotic foods which are asparagus and bananas and onions and garlic to help create that environment where those bacteria can grow.
And the last R is repair. So what do we need to repair that dysfunctional GI lining that results in an increased intestinal permeability, and often we will use some key nutrients like viscous fiber for the mucus, the healthy mucus along the GI tract, and viscous fiber means it absorbs water so that’s like psyllium or guar gum or ground flaxseed - those are viscous fibers.
We might use a little zinc. Zinc is needed for repair of the intestinal tract. We might use an amino acid called L-glutamine, just for a short period of time, just to make sure the GI tract has what it needs to repair itself and we often will use omega-3 fatty acids, as well.
About Dr. Rakel, M.D.:
Dr. David Rakel, M.D., attended medical school at Baylor College of Medicine in Houston, Texas, and completed a family practice residency in Greeley, Colorado. He spent the next five years in rural practice as one of two physicians staffing a 14 bed hospital in Driggs, Idaho. As medical director for Grand Targhee Ski resort in Wyoming, he developed an interest in sports medicine and received his Certificate of Added Qualification in 1999.
Dr. Rakel completed a two year fellowship in Integrative Medicine at the University of Arizona from 1999-2001. He joined the University of Wisconsin Department of Family Medicine in 2001 where he teaches and practices, and is the medical director for the University of Wisconsin Health Integrative Medicine. Dave is board certified in family medicine, holistic medicine and sports medicine. He is also certified in Interactive Guided Imagery.