A Book Review and the Four R's

When your digestion isn't functioning well, a comprehensive approach is needed to put it right. I have a wonderful book called "Optimal Digestive Health - A Complete Guide" that is packed with great information about digestion. It is a collaborative effort on the part of many experts in the field of nutrition and digestion and is over 550 pages long. You might want to look into getting it at your local bookstore on online at amazon. 

Explaining first How the Body Works, then providing a list of Tools for Evaluating Your Health, Finding New Strategies for Inner Health, Therapies for Mind-Body Medicine, to providing a List of Treatment Options for Specific Conditions, it is a great resource for anyone interested in improving their digestion. I wanted to share a section from the book written by Jeffrey Bland, Ph.D. that I find to be the core of not only the book, but of improving digestion. Something called "The 4R Support Program".

Here's what Dr. Bland writes:

"A comprehensive approach to normalizing gastrointestinal function, referred to as the "4 R's", involves four basic steps: Remove, Replace, Restore, and Repair. 

"Remove" focuses on eliminating pathogenic bacteria, viruses, fungi, parasites, allergens, and toxins from the GI tract. This is a crucial beginning step on the path to digestive wellness.

The second step is "Replace", replenishing enzymes and other digestive factors that may be lacking, such as pancreatic enzymes, hydrochloric acid (HCI), or intrinsic factor. 

The third step, "Restore", refers to restoring the beneficial bacteria that are commonly found in a normal digestive system, but may be missing from a dysfunctional one. It is an important step in restoring healthy function to the gut. A variety of supplemental resources may be considered helpful in this phase, including cultured and fermented foods and supplements containing live beneficial bacteria.

The fourth step in a 4R approach, "Repair", addresses intestinal permeability through the use of nutritional supplements known to be critical in intestinal function.

Step 1: Remove

• Common food allergies or sensitivities
• Bad bugs - candida (yeast) or bacterial overgrowth or parasites
• Problems from viruses
• Minimize environmental and digestive toxins

Step 2: Replace

• Betaine hydrochloride (hydrochloric acid)
• Enzymes (animal or plant-based)
• Bicarbonate (which enables the enzymes to work)
• Intrinsic factor

Step 3: Restore

• Probiotics - L. acidophilus and other probiotics
• Provide prebiotics if starches and sugars are tolerated. Nourishment for the beneficial microflora such as FOS (fructo-oligo-saccharides) and inulin
• Increase fiber and monitor the response. Soluble fiber such as oat bran increases butyrate and other essential fatty acids. Nonsoluble fiber such as cellulose is best tolerated by some people, but not others
• Increase resistant starch in the diet to reduce acidity, and raise fatty acids
• Monitor level of starches and sugars (carbohydrates are a common source of digestive upset)

Step 4: Repair

• Provide nutrients to heal the GI mucosa: vitamins A and C, B5 (pantothenic acid), B6 (pyrodoxine), the amino acid L-glutamine, and the mineral zinc
• Support the immune functions of the GI tract: vitamin A to nourish antibody production
• Continue to avoid allergens and irritants: certain drugs (such as NSAIDs), alcohol, and foods that trigger allergies."

In Step 1, finding out if you have these "bad bugs" requires testing, and usually not by a regular doctor. You might have to request these tests from a specialist. Some can even be performed by a specialized lab via mail. The book has a great list of resources throughout on where to go for help.

How to go about doing all these steps is outlined in the book, of course. Each section gets a well-researched and extensive list of suggestions to get well. Of course no one thing works for everybody, and it might take trial and error to find out what's really going on with your own digestion, but it helps to have a place to start from. I highly recommend this book. It has helped me immensely.

Regarding my own digestion, I have had much success avoiding lactose and doing the FODMAP Diet. While I sometimes still have low-lactose-containing foods, they still cause some discomfort and therefore must remain an occasional treat nad be eaten in small quantities. Onions and garlic are back in, and while eating them raw causes the most trouble, cooking them very well or adding them to foods during the cooking process and then removing them (and not eating them) helps tremendously.

Just like life, it seems, getting to know one's ever-changing body is a journey and a learning process. Learn by reading good books such as this one.