Dr. David Rakel and his naturopathic colleagues has developed a four-R approach for healing of the GI tract. Removing stressors helps the GI tract to heal. Replacing the acid suppressed for too long by proton pump inhibitors allows the GI tract to absorb nutrients. Replacing healthy bacteria by using probiotics or prebiotics creates a healthy ecosystem. Repairing the GI lining with viscous fiber, zinc and omega-3 fatty acids contribute to the healing process as well.
(Transcribed from video interview)
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.