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Leaky Gut and 5 R Gut Protocol

A properly functioning digestive system is critical to good health. In fact, problems with the gastrointestinal (GI) tract can cause more than just stomach aches, gas and bloating or diarrhea. GI issues may underlie chronic health problems that seem unrelated to digestive health, including autoimmune diseases such as rheumatoid arthritis and type 1 diabetes, skin problems such as eczema and acne rosacea, and heart disease (just to name a few). 

In Integrative and Functional Medicine approach, we use a program that goes by the simple acronym of the ‘5Rs’: remove, replace, reinoculate, repair, and rebalance. When applied to various chronic health issues, the 5R program can lead to dramatic improvement in symptoms, and sometimes even complete resolution. The elements of the 5R program are described briefly below.

Watch this video for details on how to use food sensitivities report to heal the gut.

1. Remove - Trigger Foods

Remove stressors. Get rid of things that negatively affect the environment of the GI tract including allergic foods, parasites and potential problematic bacteria or yeast.

This might involve using an allergy “elimination diet” to find out what foods are causing GI symptoms or it may involve blood test which show positive results to food sensitivities. Most common foods which cause sensitivities are the ones containing large protein molecules such as gluten (in wheat, oats, barley and rye), casein (in dairy products), corn and eggs. People can have sensitivities to a variety of additional foods found on their lab testing. 

5 - R protocol requires removal of these foods for at least 3 - 6 months. 

2. Replace - with Digestive Enzymes

Replace digestive secretions. add back things like digestive enzymes, hydrochloric acid (do not use without professional medical advice), and bile acids that are required for proper digestion and that may be compromised by diet, medications, diseases, aging, or other factors. It is important to note that 

  • Digestive enzymes should be taken before meals specially if the meal contains any foods which show sensitivities

  • Good quality digestive enzymes contain broad spectrum enzymes such as amylase, protease and lipase.

  • Gas-X and beano are not the same as digestive enzymes. These usually contain one enzyme to break down carboyhydrates which is not enough for digestive support.

  • Reputable companies which make good quality digestive enzymes are Life extension, Pure encapsulations, Thorne, Zymedica, Orthomolecular, Integrative therapeutics, Klaire labs, designs for health etc. In addition, several companies make formulas. Look for pharmaceutical grade products.

  • Prescription digestive enzymes are an other option which may be covered by insurance.

3. Reinoculate - with Probiotics & Prebiotics

Help beneficial bacteria flourish by ingesting probiotic foods or supplements that contain the “good” GI bacteria such as bifidobacteria and lactobacillus species, and by consuming the high soluble fiber foods that good bugs like to eat, called prebiotics.

  • Probiotics are beneficial microorganisms found in the gut that are also called “friendly bacteria.” Use of antibiotics kills both good and bad bacteria. Probiotics in the form of supplements or food are often needed to help reestablish a balanced gut flora. Fermented foods, such as yogurt, miso, and tempeh are food sources

       of probiotics.

  • Prebiotics are food ingredients that selectively stimulate the growth of beneficial microorganisms already in the colon. In other words, prebiotics feed probiotics. Prebiotics are available in many foods that contain a fiber

       called inulin, including artichokes, garlic, leeks, onion, chicory, tofu, and other soy products. Grains such as barley, flax,               oats, and wheat are also good sources of prebiotics. However, these should not be used in case of sensitivity to wheat or             gluten. 

  • Look for diversity. Probiotic supplements containing just one strain such as lactobacillus is similar to just eating yogurt and does not provide intended benefit.

  • Look for at least 20-50 billion CFU (colony forming units). 

  • One brand name probiotic which has been studied and has scientific data to show efficacy is VSL#3. However, it can be quite expensive. An alternative to this is any reasonably priced probiotic formula which contains the same 8 strains which VSL#3 contains. Those are listed below.​​​

1. Bifidobacter longum

2. Bifidobacter infantis

3. Bifidobacter breve

4. Lactobacillus plantaris

5. Lactobacilus acidophilus

6. Lactobacillus casei

7. Lactobaccillus bulgaris

8. Streptococcus thermophilus

  • A few good examples of over the counter probiotics and prebiotics are Zebora and Holigos. Both are available on Amazon. Probiotics can worsen certain situations such as small intestinal bacterial overgrowth (SIBO) or a slow transit gut. These conditions need to be treated before starting probiotics. Check with your health care professional if you have any of these. 

4. Repair - the Gut Wall

Help the lining of the GI tract repair itself by supplying key nutrients that can often be in short supply in a compromised gut, such as zinc, antioxidants (e.g. vitamins A, C, and E), peppermint oil, fish oil, and the amino acid glutamine.

  • L-glutamine is an amino acid and should be taken either prior to or with a meal. Recommended daily dose is 5 grams. This can be taken as powder or capsule. Aloe vera jel. Look for ingestible jel instead of juice organic and preservative free products. A reputable maker is Lily of desert.

5. Rebalance

It is important to pay attention to lifestyle choices. Sleep, exercise, and stress can all affect the GI tract. Balancing those activities is important to an optimal digestive tract.

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