The 4 R’s of gut health
by Ian Craig
in Blogs

Gastrointestinal (GI) dysfunction is the number one complaint that I receive from my clients on a daily basis. For example; this morning I’ve had two clients so far - the first was a guy who’s been working with me on constipation and ‘gassiness’ for the past couple of months and the second was a lady with some hormonal issues - her gut is okay at the moment, but when she first came to see me a year ago, she was struggling with constant bloating and alternating constipation and diarrhoea.

GI health is linked to what we eat and drink, who we got our genetics from, who we hang out with, how much we sleep, what type of exercise we do, and of course patterns of stress. The gut-brain axis, which I prefer to call the brain-gut axis, is incredibly powerful and, as a practitioner, when I’m not making progress with physiological measures, I turn to the mind for an added therapeutic lever.

We’ll start, though, with physiological methods of improving GI health. Something I like using, and refer to a lot in my practice, is called the 4R Functional Medicine approach. I’ll sequentially go through each of the R’s and give you a bit of a commentary as to what I’m looking for at each stage.

1st R - remove

Remove refers to two things that potentially should be removed from our body. The first is the foods that we eat and in particular; food sensitivities. I’ve already written a whole blog on this one subject, so I’ll give you a quick synopsis, and here is a link to that blog for more information. Basically, some common foods, in particular wheat and dairy, can be hard for some people to completely digest, meaning that our gut-based immunity becomes irritated by regular consumption of these foods. It is possible to test for these sensitivities via IgG testing at specialist labs and/or by elimination and challenge testing. I also wrote a whole chapter on this topic in our book Wholesome Nutrition.

Another thing we might want to remove from our body is ‘bugs’. The gut is a hotbed of microbial activity, to the point that if we were to sterilise our GI tract, most of us would lose 1-2 kilos in weight, although our life wouldn’t last too much longer if we were to do this! Opportunistic microorganisms are many and can include bacteria, yeasts, viruses, and parasites. Small amounts of very evasive bugs and large amounts of less evasive bugs can be enough to throw the GI tract into an inflammatory state, potentially causing all sorts of problems. Specific and specialised anti-microbial strategies are available to clear out the bad guys…

2nd R - replace

I actually prefer to start with this R. Many of my clients will have been given a handout called ‘Pre-eating Strategy’ - it is a preparation for eating and it includes the use of lemon juice or apple cider vinegar and/or a digestive enzyme, combined with a religious or non-religious ‘thanks’ for your food, plus a great deal of mindfulness around the eating of your food.

When we are not mindful of our food when we eat it, we generally don’t produce enough salivary enzymes, stomach acid, digestive enzymes and churning of our stomach. Pop the term ‘cephalic phase of digestion’ into Google and you’ll find a description of this vitally important anticipatory phase of digestion.

3rd R - reinoculate

Not surprisingly, I needed to get to probiotics at some stage of this discussion. There has been a huge amount of research on the human microbiome over the past decade and researchers are beginning to wonder if we’re actually more human or more bug. We are beginning to discover that rural people living an old-fashioned lifestyle actually have much higher GI microbial diversity than us stressed-out city dwellers. Microbial diversity is considered one really vital component of our health.

Here at the Nutritional Institute, we put a lot of focus on our gut flora: I use probiotics in my nutrition practice, but what I believe to be much more powerful than that, is Rachel’s passion for fermented foods. I, for one, have never experienced such good gut health since I’ve been eating Rachel’s sauerkraut and her ginger kefir. If you browse this website, you’ll find a lot of Rachel’s writing on this topic. You may also have heard of prebiotics, which form another layer of nutritional GI health - read here for Rachel’s article on this topic.

4th R - repair

With all of the gut stress you may have experienced by eating too many of the wrong foods and being subject to minor or major microbial infections, you could be sitting with a leaky gut. This means that the cells of the intestinal membrane become damaged and separated, contributing to the inflammatory situation described earlier. See below for an illustration (from page 66 of Wholesome Nutrition).




Certain foods are capable of healing the gut lining. These include: prebiotics and probiotics, fermented foods, homemade stocks, butyric acid (from proper country butter), l-glutamine (an amino acid) and aloe vera. There are some excellent gut repair formulations on the market that combine some of these ingredients. However, my first ‘go-to’ is fermented food and homemade stocks from grass fed bones and joints!

For some more gut information, here’s a blog that I previously wrote on IBS: