I recently had the opportunity in the Lombard student clinic to create another treatment plan inspired by the 5R protocol, which is commonly used in functional medicine to address gut dysfunction. It is a clinical approach that addresses gut pathogens, digestive insufficiencies and imbalances in the gut microbiota. It helps restore optimal gut health and function. In order to make a customized treatment plan for the patient, I used information that I gathered during the full history, review of systems and physical exams. Additionally, I was able to review the results of recent blood work and a functional stool test, which made treatment plan recommendations even more specific to the patient’s needs.

I would like to share the backbone of the 5R protocol, which includes the following elements:

Remove – It is necessary to remove any offending foods that are causing reactions for the patient (i.e. gluten, dairy, specific foods unique to the individual). In the case of food intolerances or sensitivities, it is essential to remove these offenders from the diet so that the gut can begin to heal. Additionally, depending upon unique gut infections that are impacting the individual, various anti-microbial, anti-fungal, anti-parasitic, or anti-viral botanicals or natural agents may be appropriate.

Replace – in the case of maldigestion or malabsorption, it may be appropriate to support and restore healthy digestion by providing digestive support (ie. apple cider vinegar, herbal bitters, betaine HCl, pepsin, ox bile, pancreatic enzymes). Individuals with food reactions tend to have enzyme deficiencies, which negatively interfere with the proper breaking down of dietary proteins. These natural agents restore optimal digestion and absorption. 

Reinoculate – Recolonizing the gut with beneficial bacteria (i.e. various types of probiotics) promotes optimal gut health. This may also include recommending prebiotics. Beneficial bacteria consume prebiotics, encouraging their growth. The ultimate goal here is to rebuild and re-establish the gut microbiota.

Repair – The integrity of the gut mucosa is restored by providing various substances (ie. L-glutamine, deglycyrrhizinated licorice, bone broth, herbs, vitamins, essential fatty acids) that assist in repairing the gut lining. Immune support (ie. colostrum, immunoglobulins) also can help repair the integrity of the gut.

Rebalance – This includes addressing the health of the individual as a whole, so it includes a diverse set of lifestyle recommendations (ie. sleep, nutrition, physical activity, stress management) that help support health and prevent future gut dysfunction. Ultimately, these elements that build general health also help heal the gut.

For more naturopathic medicine nutrition topics, see Food-Based Medicine and Soup Season!