The 5R programme to make your gut a happier home
Our digestive system is a complex network of organs that is far more complex than just breaking down our food, absorbing nutrients and eliminating wastes, it is a critical player in immune and mental health as well as supporting mood regulation. When working optimally we don’t often think about our digestion system perhaps only when we get a bit of transitory bloating or gas. However, when it becomes compromised, it can lead to a wide range of common ‘local’ symptoms such as excess gas & bloating, abdominal cramps, constipation and/or diarrhoea, acid reflux/ heartburn, and Inflammatory bowel diseases (Crohn’s, Colitis etc). The 5R programme is a functional medicine approach designed to restore optimal gut health.
The gastrointestinal tract
Beyond digestive symptoms, compromised gut health may also manifest in seemingly unrelated conditions such as skin complaints, fatigue, headaches/migraines, frequent colds, histamine reactions, inflammation, hormonal imbalances, food intolerances, or allergies. One of the main contributory factors for the range of the body-wide symptoms can be linked to the gut or the gastrointestinal tract (GIT) as it is also referred to and can be caused by increased intestinal permeability or ’leaky gut’.
The GIT is considered the largest immunological organ in the body. Its intestinal barrier covers a surface of about 30-40 m2 (the size of half a badminton court!) and requires approximately 40% of the body’s energy expenditure.[i] This barrier is an important structure that acts as a physical and immunological shield, protecting us from the daily insults that we are exposed to. It is made up of a protective mucous layer, immune cells, a diverse community of microbes and epithelial cells that are joined together by protein structures called tight junctions that have selective absorption.
‘Leaky Gut‘
Under normal conditions, our intact barrier helps prevent the transport and absorption of pathogens into our internal environment, whilst preventing the loss of water and electrolytes and allowing the absorption of nutrients from our diet.[ii] If the important tight junctions become damaged or weakened, they can no longer effectively block harmful substances. As a result, larger particles, such as toxins, undigested food, and bacteria, can “leak” through the gut lining and enter the bloodstream which can lead to a host of symptoms that are body-wide, not just local to the gut.
The intestinal barrier can be damaged by many factors such as food insults (gluten, casein, etc), environmental toxins, viruses, infections, past antibiotic use, certain medications as well as lifestyle factors such as stress that can alter the permeability of this important intestinal protection. This can lead to common symptoms that are associated with this barrier dysfunction such as IBS (irritable bowel syndrome) and more.
The 5R programme
Protecting the gut lining is, therefore, an important strategy in the prevention of many complex diseases and symptoms associated with its breakdown. The 5R programme is a functional medicine approach designed to restore optimal gut health which stands for Remove, Replace, Repopulate, Repair and Rebalance.
Whilst working towards the removal of the many factors that can contribute to leaky gut, we need to address the ‘replace’ step that focuses on essential components that may be needed such as HCl and other digestive support that can support the breakdown of food and the absorption of crucial nutrients. We may also need to add in herbs that can help soothe the GIT such as marshmallow root which helps to form a protective layer by increasing the production of mucin that supports the lubrication of the epithelial lining to help trap pathogens and protect the gut.
The repopulate stage refers to increasing the levels of beneficial bacteria from our diet, namely fibre from the diet and choosing a good quality probiotic. Studies have shown that Lactobacillus Rhamnosus GG can help maintain intestinal barrier function by increasing mucin production, supporting immune modulation, lowering inflammation and encouraging the growth of other beneficial bacteria that help maintain intestinal integrity and transit.
Many nutrients play critical functions in repairing and regulating gut homeostasis such as Vitamins A and D. One of the most researched nutrients to support intestinal health is L-glutamine which is the most abundant amino acid in the blood and other fluids. [iii] L- Glutamine is found in many foods, we also produce it naturally, however, we may not produce enough for our needs when there is a greater than normal demand for it such as illness, infections, stress, inflammatory bowel diseases and more. Glutamine is a major substrate used by the intestinal cells, which are renewed every 4-5 days, helping to regulate the important tight junction, reduce inflammation and maintain intestinal integrity.[iv]
A holistic approach to healing the gut also involves the rebalance phase which refers to the gut-brain axis, the vital communication pathway between our digestive system and brain, that links our emotions to gut function. Stress, anxiety and psychological pressures can negatively impact our gut and contribute to various digestive issues. Practices such as mindfulness and medication can help restore balance as well as taking time to sit, relax and enjoy our food instead of grabbing quick meals and eating on the go!!
5R Summary
Think of the 5Rs as removing bad tenants, replacing them with reliable helpers such as digestive enzymes, repopulating the neighbourhood with friendly helpful residents (microbes), and repairing the old property (healing the gut lining). Finally, we can help rebalance with new house rules such as stress management and mindful eating.
References
[i] Helander HF, Fändriks L. Surface area of the digestive tract – revisited. Scand J Gastroenterol. 2014 Jun;49(6):681-9. doi: 10.3109/00365521.2014.898326. Epub 2014 Apr 2. PMID: 24694282.
[ii] Holtmann G, Shah A, Morrison M. Pathophysiology of Functional Gastrointestinal Disorders: A Holistic Overview. Dig Dis. 2017;35 Suppl 1:5-13. doi: 10.1159/000485409. Epub 2018 Feb 8. PMID: 29421808.
[iii] https://www.healthline.com/nutrition/glutamine#TOC_TITLE_HDR_2
[iv] Kim MH, Kim H. The Roles of Glutamine in the Intestine and Its Implication in Intestinal Diseases. Int J Mol Sci. 2017 May 12;18(5):1051. doi: 10.3390/ijms18051051. PMID: 28498331; PMCID: PMC5454963.
