5R: Getting the Gut in Balance

Healthcare practitioners may find their patients benefit from the 5R protocol. We sat down with Mark Kaye, DC to discuss the use of the 5R GI restoration program.

What is the 5R protocol?

The 5R protocol is a means of helping to restore the natural balance of the gastrointestinal (GI) system. The GI system can become compromised even through typical lifestyle patterns. The GI system is a very complex environment because it is the main means of communication that our body has with the outside world. It’s a very complex organ system. There’s a couple of pounds of bacteria in the gut. There are digestive enzymes that have to break down foods. So it’s a means of taking each of the different functions of the gut and to try to bring them back into balance.

How did the 5R program come about?

One of the first topics discussed as a Functional Medicine parameter was GI restoration. However, we can go back literally hundreds of years if you think about how traditional food patterns utilized components such as fermented foods, that was part of the health process of many traditional food patterns. The integrative medicine model took much of its influence from the naturopathic profession. In the naturopathic model, gut health overlies many aspects of systemic health. How healthy the gut is, is a reflection of how healthy the body is.

What are the five elements of the 5R program?

The first of the 5Rs is remove, which is removal of any type of undesirable organisms that may be residing in the gut. Part of that dysbiosis may be undesirable bacteria, undesirable fungi, which are impacting the health of the GI tract.

In addition would be removal of irritants from the diet. Wheat and gluten may be an example of one. Other common allergens such as fish may be of concern in some individuals, or tree nuts. These are all healthy foods, but in some individuals they contribute to immune dysregulation, irritation, and damage to the gut.

The second phase of 5R is replace. A key function of the GI tract is digestion, taking complex foods and breaking them down into their individual components so that we can properly absorb fats, properly absorb carbohydrates for energy, but also to break down proteins so they can be absorbed and used for the normal building and maintenance process of the body. That requires quite a few different types of digestive enzymes including hydrochloric acid in the stomach, pancreatic digestive enzymes, and certainly bile.

The third phase of the 5R GI restoration program is reinoculation. Again, there are literally trillions of bacteria that reside in our gut that are part of a so-called normal flora or the microbiome of the GI tract. These can be negatively impacted by many different factors in our environment. From stress to diet to lifestyle, patients who may not get sufficient rest, as examples. Reinoculation is bringing a few desirable species and strains of bacteria back into the system and allowing the GI tract to be a hospitable environment.

The fourth phase of the program is regenerate. The GI wall is a tube that has desirable compounds, nutrients that need to be let in, but undesirable compounds need to be kept out and eliminated through the feces. It’s constantly turning itself over. The cells are regenerating and repairing themselves. That regeneration process requires both macronutrients such as proteins and specific fibers as well as micronutrients, which work to keep that cell wall healthy and to keep it from becoming a leaky tube that allows undesirable compounds to be absorbed.

Last but not least is retain. Once you’ve taken that patient through this entire process of GI restoration, they have to be able to maintain that normal GI environment, so that’s going to require a healthy diet, proper vitamin and mineral intake, appropriate protein intake, and again, maintaining a healthy diet means staying away from things that are potentially harmful.

How does the program work?

This is a GI restoration program. It’s asking the practitioner to determine what is most important in this individual. Not everyone is going to require each step of the 5R program. For example, a patient may have very effective digestion, sufficient hydrochloric acid, good bile production in the liver, appropriate pancreatic enzyme release, so the replacement phase of the 5R program would not be required for that individual.

Let’s look at the first phase: remove. That patient and practitioner may have already determined what specific foods are problematic for that patient or what specific lifestyle factors have been impacted, so they may not need that individual phase. There may be specific things that may be needed in an individual patient, or a patient may be able to bypass that phase completely.

Can two or more 5R elements be undertaken simultaneously?

Very appropriately! For example, if we talk about removal, part of that removal would be a strategy to remove undesirable bacteria from the gut. Anytime you’re removing undesirable bacteria in the gut, you want to replace that with something else, or reinoculate. So the removal and reinoculation phases can often go together. What’s very important is to continue the reinoculation phase a couple of weeks at least after stopping the removal phase.

The same thing with the regenerate. Since the health of the GI tract is highly nutrient-dependent, you have to feed that gut well and make sure you’re getting the baseline nutrient requirements for that patient.

Outside of diet, are there any lifestyle changes that you recommend while patients are undergoing the 5R program?

Just anything that’s related to a healthy diet. So proper exercise is certainly very important. Certainly we understand the use of fiber as part of that and other dietary components. But exercise stimulates intestinal function. Gravity is important for intestinal function. So get up and go! We’re far too sedentary.

Very similarly with stress, we look at emotional or physical stress on the body; it changes our chemistry, so anything that reduces stress. One of the best ways we can help to reduce stress is proper sleep. The 5R program is not simply a GI restoration program; it’s a GI restoration program as part of a comprehensive diet and lifestyle intervention in patients.

How would a patient get started on the 5R program?

Find an experienced practitioner who understands the 5R program and can assess whether a 5R program would be appropriate. A practitioner can help the patient to discover the triggers for different diet and lifestyle habits that have led to the problem. I think anytime we’re dealing with any type of chronic illness, anytime we’re ready to make a major dietary lifestyle change where we’re ready to eat healthier, find a healthcare professional who can help us through it. Don’t do it on our own.