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Gut Dysfunction and Chronic Disease: The Benefits of Applying the 4R GI Restoration Program

Gut Dysfunction and Chronic Disease: The Benefits of Applying the 4R GI Restoration Program

A Summary

By DeAnn J. Liska, PhD and Dan Lukaczer, ND

The ability of the body to maintain healthy gastrointestinal (GI) function, and to heal the GI barrier when its integrity is compromised, is necessary for healthy aging and protection from many diseases and disorders. Research has shown an association between impaired GI function and various conditions, such as gastritis, peptic ulcers, colon cancer, inflammatory bowel disease, irritable bowel syndrome, rheumatoid arthritis, asthma, eczema, metabolic bone disease, allergies, nutrient malabsorption, and esophageal reflux.1-8 There are many factors associated with impaired GI function including food allergies, excessive stress, and the use of non-steroidal anti-inflammatory drugs and corticosteroids.9 GI complaints are presently the most common reason for hospitalization, with over 70 million Americans suffering from some form of serious GI disorder.

Fortunately, recent work has been carried out to define a systematic approach to support optimal GI function. Based on the concepts of Remove, Replace, Reinoculate, and Regenerate, the 4R GI Restoration Program promotes overall GI health by removing unhealthy bacteria from the intestinal tract and allergenic foods from the diet, replacing supportive stomach acids and digestive enzymes, reinoculating the intestine with healthy bacteria (probiotics), and regenerating the intestinal lining with targeted nutritional support.

GI Restoration and the 4R Program

Remove focuses on eliminating harmful bacteria, viruses, fungi, parasites, and other environmentally derived toxic substances from the GI tract. An oligoantigenic or ?elimination? diet is important to this step of the 4R GI Restoration Program, since foods to which a patient is intolerant or allergic can worsen GI dysfunction and stimulate negative immune and inflammatory responses.10-12

It is important to keep in mind that even a healthy GI tract may permit food proteins, gut bacterial breakdown products, and environmental toxins, such as pollutants and pesticides, to reach the circulation system. Therefore, removal of offending substances and microorganisms is a critical component in GI restoration.

Replace refers to the replacement of enzymes and other digestive factors lacking or in limited supply in an individual?s GI environment. These include crucial digestive enzymes, such as pepsin, proteases, lipases, and saccharidases, as well as hydrochloric acid (HCl) and intrinsic factor.

HCl is particularly important to consider, especially in individuals older than 60, since inadequate levels (hypochlorhydria) are often associated with GI dysfunction. HCl is necessary for proper digestion, nutrient absorption, and the breakdown of protein for further digestion in the small intestine. Furthermore, HCl has been shown to effectively kill harmful organisms in the GI tract?which results in the decreased likelihood and severity of certain bacterial and parasitic intestinal infections.

Nutritional deficiencies can also impact GI function, protection, and health. Extensive evidence suggests a strong association between Helicobactor pylori infection and vitamin C deficiency.13,14 H. pylori is a bacteria that can cause peptic ulcers and stomach inflammation (chronic gastritis). Since vitamin C may help eradicate H. pylori, this deficiency, when coupled with poor intake of vitamin C, may increase both the colonization of H. pylori and the threat to the GI tract. In addition, zinc deficiency is known to worsen inflammatory bowel disease, delay GI restoration, and cause a variety of functional problems, including interruption of protein synthesis and reduced cell-mediated immunity.15,16

Reinoculate refers to the process of reintroducing and supporting a healthier balance of desirable microflora in the GI tract with probiotics, such as Lactobacillus acidophilus and Bifidobacterium lactis. Probiotics are "friendly" bacteria that serve a variety of functions in the GI tract: they synthesize various vitamins, assist with intestinal cell growth and function, prevent colonization of harmful bacteria, and help break down toxins.

In addition to probiotics, prebiotics may also be useful in supporting a healthy bacterial balance. Prebiotics are non-digestible food ingredients that selectively stimulate the growth of friendly bacteria. Extensively studied prebiotics include fructooligosaccharides, rice fiber, some soy fibers, and arabinogalactans.17-20

Regenerate refers to providing support for the healing and growth of the GI mucosa. Part of the support for healing comes from promoting healthy microflora and removing impediments that continually re-injure or irritate the mucosa. In addition, appropriate nutritional support is crucial to overall health and responsible for reversing GI dysfunction and eliminating the chronic diseases associated with it. Important nutrients for support of GI regeneration include vitamins C and E and the carotenoids, for their antioxidant effects, and zinc and vitamin B5 (pantothenic acid), due to their roles in supporting the healing mechanisms.21,22 In addition, the following dietary factors are particularly helpful for the healing and regeneration of the GI tract.

Plantain Extract?Plantain extract is composed of protective lectins and flavonoids, which protect the gastric layer from damage by exogenous agents.23,24 Plantain extract assists the mucus coating in protecting against infestation by microbes such as H. pylori and has been used therapeutically as an anti-ulcer agent. 

Phosphatidylcholine?Recent studies show that consumption of phosphatidylcholine (lecithin) with potential ulcer-causing substances like aspirin or bile salts protects the gastric layer from damage and promotes healing.25-27

L-Glutamine?The amino acid glutamine is considered a preferred fuel for the rapidly replicating cells of the GI mucosa.28-30 Glutamine may promote production of glutathione (an important antioxidant) in the GI cells, which supports healing and provides additional protection from free radical damage during inflammation.31 Dietary glutamine is important for maintenance of GI mucosa during stress, injury, inflammation, and sepsis?a serious, severe illness caused by infection of the bloodstream.32 Furthermore, glutamine deficiencies are often associated with degenerative changes in the small intestine following intestinal injury, infection, surgery, or radiation.33

Lactoferrin and Lactoperoxidase?These proteins are found in milk and other secretions and play important roles in the intestinal immune system. They both have antimicrobial and antiviral properties, stimulate the immune system, and promote healing of the GI tract.34-36

Arabinogalactans?Arabinogalactans are non-starch polysaccharides found in many vegetables and grains. Considered a fiber, arabinogalactans have prebiotic functions that may stimulate immune activity in humans, promote healthy intestinal bacteria, and prevent the spread of cancer tumor cells in animals.37-40


GI function is a primary factor in overall health and can influence many conditions. Fortunately, the constant renewal of intestinal cells provides an opportunity for healing, but requires appropriate nutritional and probiotic support for assured GI integrity and function. While the overall concept of the 4R GI Restoration Program defines a basic approach, its use should be individualized to the needs of each person based on his or her own unique combination of GI factors.


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Advanced Nutrition Publications ©2002

More Articles:

Gut Dysfunction and Chronic Disease: The Benefits of Applying the 4R GI Restoration Program
Herbal Antimicrobials for Intestinal Infections: A Summary
Proven Therapeutic Benefits of High Quality Probiotics: A Summary
Harmful bacteria growth reduced by certain strains of Lactobacillus acidophilus
Probiotics support a healthy and balanced gut flora
Probiotics provide protection against various gastrointestinal diseases
Bifidobacterium promotes immune function in the elderly
Lactoferrin possesses antiviral activity
Lactoperoxidase kills Helicobacter pylori
Antibiotics increase functional abdominal symptoms
Lactobacillus acidophilus NCFM® shows strong adherence to the intestinal wall
The Problem of Antibiotic Resistance
The Effects of Antibiotics on Intestinal Microflora
The Effects of Probiotics on Antibiotic-Associated Diarrhea
The Importance of Probiotic Selection
Additional Substances that Support the Intestinal Microflora
Lactoferrin inhibits a wide variety of harmful microorganisms
The beneficial health effects of oligosaccharides
The anti-inflammatory actions of curcumin and boswellia
Probiotics shown to support gastrointestinal health

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