Topics of Interest THE 4-R PROGRAM GENERAL INFORMATION We believe you may benefit from a treatment plan known as the 4-R Program. The following information is given so that you may understand more completely how the 4-R Program may be of benefit to you. THE FUNCTIONS OF THE GASTROINTESTINAL TRACT You have heard it said "you are what you eat." This has been changed by some practitioners to "you are what you eat, and then absorb." At Nature's Healthcare, we take it a step further in our belief that "you are what you eat, and then absorb, and then what you do or do not detoxify." What this means is that "you are what you eat" if it's all working OK. These homilies cut to the core of the functions of the gastrointestinal tract, and it is becoming increasingly recognized that disturbances in the functions of the GI tract can result in a number of symptoms and conditions. These range from symptoms such as fatigue, joint pain, muscle pain, and headaches, to medical conditions such as inflammatory bowel disease, allergies, asthma, autism, ADD, and chronic skin conditions. It is this association between GI function and ill health that the 4-R Program is intended to address. Those GI functions include: DIGESTION- This is the process whereby our food is broken down into smaller portions that are more easily absorbed by the intestines. ABSORPTION- This is the process whereby the digested food is taken up by the intestine and delivered to the body for utilization as energy, nutrition, and other cellular functions. EXCLUSION- This refers to the barrier function performed by the GI tract as it appropriately excludes substances from entering the body. DETOXIFICATION- This is the complex process involving the liver and GI tract whereby toxins are metabolized for elimination from the body. Toxins include such things as medication we take that must be metabolized, to pesticides, preservatives, dyes, and flavor-enhancers we ingest knowingly in our food, as well as the over 4 million chemicals present in our environment not intended for use in our bodies. ELIMINATION- After digestion has occurred, and the metabolic phase of detoxification is complete, the GI tract must then eliminate the digestive and metabolic wastes of these processes. Some refer to this as excretion. Each of these gastrointestinal processes has certain requirements and conditions that must be present in order to occur properly. Those requirements and conditions include: DIGESTIVE ENZYMES- Enzymes are the substances that participate in the process of digestion by breaking down our food into smaller components, so that they can be more easily absorbed. Production of acid by the stomach, though not technically an enzyme, is also required for this process. If digestion does not occur completely, it can result in the absorption of food particles that are larger than usual, which the body recognizes as "foreign." This can result in the production of an antibody to that "foreign" food particle, resulting in a food allergy. If this larger-than-usual food particle is not absorbed, this can result in a nutritional deficiency. BACTERIA- There are bacteria in the GI tract that are involved in digestion, as well as in detoxification and elimination. For these processes to occur, the proper bacteria must be present in the proper numbers. If these so-called "friendly bacteria" (such as Acidophilus, Lactobacillus, Bifidobacillus, etc.) are not present, digestion and detoxification will be effected. As well, if there is an overgrowth of other bacteria, so-called "unfriendly bacteria," these bacteria can produce substances not usually present that can have toxic effects, producing a variety of symptoms and conditions. When an imbalance is present in the bacterial flora, it is called "dysbiosis." This imbalance can be caused by a number of factors, including antibiotic use, dietary choices, altered immune function, and altered intestinal motility. AN INTACT AND FUNCTIONING INTESTINAL WALL- The intestinal wall, and the cells that comprise it, have several key roles in GI function. Those would include: acting as a barrier, to exclude selected substances from entering the body; secreting a variety of substances involved in digestion; facilitating the selective absorption of nutrients into the body; and participating in a number of immune functions. When these functions break down, and the intestinal wall loses its ability to properly balance exclusion and absorption, the absorption of substances ordinarily excluded can occur. This is referred to as to as altered intestinal permeability, also called "leaky gut syndrome," and is associated with a number of medical conditions. (See the tables at the end of this handout for a list of conditions associated with altered intestinal permeability.) GI MOTILITY- Motility refers to the muscular contractions of the intestinal wall that move the intestinal contents forward. If motility is impaired, a number of adverse consequences can result. Food and nutrients will not be delivered in a timely fashion for utilization by the intestines or the intestinal bacteria. The lack of nutrients needed by the friendly bacteria can result in an overgrowth of unfriendly bacteria, with its attendant consequences. Impaired GI motility, especially when associated with dysbiosis, has been linked to the development of altered intestinal permeability ("leaky gut") as described above. Motility can be effected by medications, the amount of physical activity we get, and our dietary habits, particularly dietary fiber. Unfortunately, the "typical American diet" (highly processed, low in fiber, high in animal protein) is not conducive to good GI motility. A FULLY SUPPORTED AND BALANCED DETOXIFICATION SYSTEM- Fully supported means having available all the nutrients required for proper functioning of the elaborate system of detoxification. Balanced means that the amount of material presented to the liver for detoxification (referred to as the "total load") does not exceed the capacity of the liver to process it. Understandably, anything that affects nutrition can effect the availability of nutrients required for proper detoxification. The total load can be effected in many ways: OTC and prescription drugs add to the total load; dietary choices can impact the total load if the dietary choices involve food additives such as dyes, preservatives, flavor enhancers, etc; exposure to environmental toxins can have a huge impact, depending on the degree of exposure, both in amount and duration; life-style choices can greatly add to the total load if those choices involve smoking, alcohol, drug use, etc.; and hormonal factors can play a part, as hormones are ultimately delivered to and processed by the detoxification system of the liver. In this regard, environmental and psychological factors have a role in so far as they effect the production of hormones as we deal with stress, anxiety, and depression, for example. THE ROLE OF THE 4-R PROGRAM Because of the far reaching effects of GI function on health, and because of the number of medical conditions being recognized as having a gastrointestinal component, the 4-R Program has been developed as a method of treatment. In brief, the 4 R's of the 4-R Program involve: REMOVE- This phase involves the removal of substances felt to be contributing to the problem, and can have several components. One involves a dietary component, generally in the form of an elimination diet, in which the goal is to eliminate from the diet food items thought to be reactive, or which may contribute to a food allergy or intolerance. The Remove phase also involves reducing the "total load" with regards to detoxification. This includes dietary changes to reduce/eliminate the intake of food additives in prepared and processed foods, lifestyle choices to reduce/eliminate smoking, alcohol, etc., and it can involve other changes to address other areas adding to the detoxification burden, such as the use of medication, environmental exposures, and the like. If pathologic gut bacteria have been found or are suspected, they would be treated at this time. REPLACE- The goal of the replace phase is to supply the GI tract with the elements required for proper digestion, such as hydrochloric acid and the various pancreatic enzymes. This should lead to absorption of properly digested and broken down food, so that absorption of larger and improperly digested molecules of food does not occur. In so doing, the allergic and inflammatory reactions to these larger molecules are reversed. REINOCULATE- The goal of the reinoculate phase is to restore to normal the bacterial flora of the GI tract. This will have two effects. The first is to restore to normal the involvement of the bacteria in the digestive process. The second is to reverse the overproduction of harmful and inflammatory substances being produced in excess by the abnormal bacterial flora that are present. The Reinoculation phase involves reintroducing not only the normal GI flora, but also the nutrients those bacteria require for proper metabolic function, the so-called probiotics such as fructo-oligosaccharides. REPAIR- This is the last phase of the 4-R Program. The goal of this phase is the healing of the gastrointestinal tissue, which involves supplying the GI tract with the components needed for cellular repair and function. By addressing these four areas, the goal of the 4-R Program is to accomplish the following: To address dietary and lifestyle issues, and to begin the process of dietary education and change. To normalize digestion and absorption. To normalize the balance of gastrointestinal bacteria. To promote a balanced system of detoxification. To promote gastrointestinal healing. Please be aware that, while we use the term "4-R Program," the design of any given 4-R Program is different, depending on the clinical condition of that patient and the therapeutic goals. For example, the 4-R Program of one patient may have heavier emphasis on detoxification, whereas another program may emphasize modulation of inflammation. As such, the composition of your 4-R Program will be individualized for your needs. A full 4-R Program takes approximately three months to complete. It is very important that you are prepared to implement the somewhat demanding dietary changes of the program, as without the dietary component you can not achieve anywhere near the maximum therapeutic benefit. Back to Top

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