Digestive health: The Four R Programme

Digestive Tract, Woman

The digestive system

All disease starts in the gut. This is a common theory as so much relies on a healthy gastrointestinal tract, yet there’s a lot that can go wrong.

The gastrointestinal tract runs from the mouth, down the oesophagus, stomach, small intestines, large intestines and rectum. This is considered the outside of the body with a only few sphincters to separate. The gut can cover more than 400 square meters (200x time surface area of the skin).

The gastric epithelial layer covers the stomach as a mucousal protection from stomach acid. The stomach acid is not just used to break down food, but to also kill off any bacteria or pathogens which may attempt to invade from the outside environment.

We are more bacteria than human. The number of bacteria in the large bowel alone contains over 100 billion. They are responsible for vitamin synthesis, energy production, digestion, the immune system and is closely linked to the brain. If the microflora becomes imbalanced with bad bacteria and pathogens, than the effects on physiology can be many.

Stress is just one example that can cause stomach acid, micro flora and tissue integrity to fail. Once these go, digestion can be reduced, nutrients can’t be used, deficiency occurs and bacteria and viruses can invade a weakened immune system. Much can go wrong, so protecting and restoring this digestive system can be a necessary step to optimising health.

The Four R Programme:

This programme is designed to restore the entire gastrointestinal tract from top to bottom with strong villi, adequate stomach acid and rich in a diverse healthy flora.


The first stage is to remove from the diet any foods that can be contributing to the the cause if the symptom or condition. This will include allergens and intolerances. Testing might be beneficial to identify this quickly. Alternatively, elimination diets depending on symptoms and severity such as the low FODMAPs can be a useful identification tool.

We also remove any pathogenic bacteria, viruses, fungal overgrown, parasites and toxins, ultimately minimising the toxic load.

This can be done by including anti-virals, anti-bacterial’s and anti-fungals into the diet or via supplementation. Garlic, ginger, black walnut, golden seal, lemon balm, oregano, clove and grape seed are some examples used.

It is important to do this stage first, because if we were to reinoculate with probiotics first, bad bacteria might feed on them and continue to grow. If the repair stage was done first, then all the elements contributing to damage would just undo any progress obtained.


The second step is focused on introduction of tools that will start the process of recovery. This can include enzymes the body is lacking such as lipase, cellulase, protease and sacchridases. These may be needed to help the digestive process in the small intestines from insufficient pancreatic or brush border enzymes. Alternatively, digestive bitters can be utilised to help stimulate release of enzymes naturally via the vagus nerve. These can include gentian, artichoke and dandelion root.

It may also include adding in bile to help break down fats, pepsin for protein digestion and hydrochloric acid (betaine HCl) to help with stomach acid when it may be otherwise low.

If stomach acid is low, you could also increase zinc and vitamin B6. These are two important cofactors needed to help raise stomach acid.


The reinoculation phase begins when the remove and replace phase has wiped out toxicants that would prevent beneficial bacteria from colonising.

Microflora in the gastrointestinal tract is first taken from our mothers at birth and developed further via breastfeeding. Beneficial bacteria is required in greater proportion within the gut for the working of the immune system and digestion. Quantity and variety is important as different strains play a broad spectrum of different roles for health.

Reintroduction of beneficial bacteria can be done via the use of probiotic supplementation and fermented food products like suarkraut, kimchi and kefir.

Eating a variety of fruit and vegetables is required to continue the commensal bacteria diversity.


Repairing the structure of intestinal permeability or ‘leaky gut’ is next. This mucosal membrane is the barrier between the outside world and inside our bodies. In a healthy gut, the intestine’s junctions between cells would limit transport of molecules into the body. A leaky gut spills waste products, proteins and amino acids with antigen sites that can move into circulation. Re-tightening these junctions are crucial. Luckily, there are tools that we can use to repair this tissue which includes:

Direct nutritional support for the structure and function of the intestinal
wall structure:

– Zinc
– Magnesium
– N-acetylcysteine
– L-Glutamine
– Inulin and frutooligosaccharides (F.O.S)
– Collagen
– Vitamin C


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