Gut Dysfunction and Chronic Disease: “4R GI Restoration Program”

Summary Article Review.

Renata Trister DO

Gastrointestinal (GI) symptoms are one of the leading causes for visits to the primary care physician and the emergency room.  Over 70 million Americans are suffering from some form of serious GI disorder.  Assessment and proper support of the gastrointestinal (GI) system may provide benefit for patients with a variety of chronic ailments.   There is an association between impaired GI function and some chronic 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 (GERD). Many factors are associated with impaired GI function including food allergies, excessive stress, and the use of non-steroidal anti-inflammatory (NSAIDS) drugs and corticosteroids.  Fortunately, the constant renewal of intestinal cells provides a great opportunity for healing.

Recent work has been compiled in order to define a systematic approach for the support and optimization 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.

It is important to keep in mind that even a healthy GI tract may permit pathogens, food proteins and environmental toxins 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 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. 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. 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.

Reinoculate refers to the reintroduction of desirable bacteria (or probiotics) into the intestine to restore the balance of the GI tract. Probiotics are “friendly” bacteria that serve a variety of functions in the GI tract.  For example, they prevent colonization by harmful bacteria and help break down toxins. Lactobacillus acidophilus and Bifidobacterium lactis are examples of 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 without supporting pathogenic flora. Some prebiotics include fructooligosaccharides, soluble rice fibers, some soy fibers, and arabinogalactans.

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. In addition, the following dietary factors are particularly helpful for the healing and regeneration of the GI tract.

Plantain Fruits The mucus coating in the GI system is important in protecting the body from microbes such as H. pylori and other ulcer causing substances (NSAIDS, alcohol) Plantains contain botanical phytonutrients that support the upper GI mucus layer.  Plantains contain lectins and flavonoids, which promote mucus thickening and protect the gastric layer from damage by exogenous agents. For these reasons plantains can be used therapeutically.

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.

L-Glutamine The amino acid glutamine is considered a preferred fuel for the rapidly replicating cells of the GI mucosa. 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. 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. Furthermore, glutamine deficiencies are often associated with degenerative changes in the small intestine following intestinal injury, infection, surgery, or radiation.

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

Arabinogalactans are non-starch polysaccharides found in many vegetables and grains. They are considered a fiber, but also have prebiotic functions that promote healthy intestinal bacteria, and can support the immune system.

Summary of the 4R GI Restoration program:

1. Remove any of the factors that may be causing GI dysfunction. Pathogens include “bad” bacteria, viruses, fungi and parasites.  Identify and remove foods to which the individual is sensitive.

Clinical approaches may include:

Elimination diet

Botanical antimicrobials and phytonutrients

1. Replace digestive enzymes and restore normal pH of the stomach.

2. Reinoculate with “good” bacteria or probiotics along with prebiotics.

3. Regenerate by providing nutritional support for healing and growth of normal GI mucosa.  Micronutrients especially important for GI support include

Vitamin C, Vitamin E and carotenoids for their antioxidant abilities

Zinc and Vitamin B5 for their roles in healing.

The key to successful regeneration is providing the nutrients necessary for the mucosal epithelial cells to proliferate.  A diet that is high in nutritional value and low antigenicity provides a basis for the regeneration of the GI tract.