The 4Rs Protocol For a Healthy Gut Skip to main content

🔴 Rated Top El Paso Doctor & Specialist by ✔️ RateMD* | Years 2014,2015,2016,2017,2018,2019

Chiropractic Podcast



❇️ CareCredit® Patient Financing

The 4Rs Protocol For a Healthy Gut

Do you feel:

  • Like you have been diagnosed with Celiac Disease, Irritable Bowel Syndrome, Diverticulosis/Diverticulitis, or Leaky Gut Syndrome?
  • Excessive belching, burping, or bloating?
  • Abnormal distention after certain probiotics or natural supplements?
  • Suspicion of nutritional malabsorption?
  • Do digestive problems subside with relaxation?
If you are experiencing any of these situations, then you might be experiencing gut problems and might have to try the 4R Protocol.

Food sensitivities, rheumatoid arthritis, and anxiety have one thing in common. These various conditions have all been associated with impaired gastrointestinal health. These conditions can happen from a poor diet to excess stress and many factors that can negatively impact the digestive function. It can potentially be the result of increased intestinal permeability, systemic inflammation, and the development of certain health conditions. The 4R protocol can be utilized to restore optimal digestive health and involves the four steps, which are: remove, replace, reinoculate, and repair.

Intestinal Permeability

The intestinal tract is the body’s primary physical barrier from the outside world. It protects the body from potentially harmful environmental factors that are passing through the digestive tract. It can be either toxin, pathogenic microorganisms, and other antigens that can harm the digestive tract causing problems. The intestinal lining is consisting of a single layer of epithelial cells that are separated by protein complexes known as tight junctions. In a healthy gut, the tight junction regulates the intestinal permeability by selectively allowing the transport of substances like water, electrolytes, and nutrients from the gut lumen, traveling across the intestinal barrier, while also preventing the absorption of harmful substances.

Certain environmental factors can damage the tight junction, and the result is that it can increase the intestinal permeability, which is referred to as intestinal hyperpermeability or leaky gut. Contributing factors to increased intestinal permeability include dietary excesses (saturated fats and alcohol), nutrient deficiencies (vitamin D and fiber), stress, and infections (Helicobacter pylori and bacterial infections.)

With an increased intestinal permeability, it can enable antigens to cross the gut mucosa into the systemic circulation. This is resulting in an immune response and a low-grade inflammation. Intestinal hyperpermeability has been associated with certain gastrointestinal conditions like IBS (irritable bowel syndrome), ulcerative colitis, and Crohn’s disease. It can also trigger certain autoimmune conditions like celiac disease, type 1 diabetes, and rheumatoid arthritis, causing harm to the body.

What are the 4Rs?

The 4Rs is a four-step protocol that healthcare professionals advised individuals to use when they address digestive conditions and to support gut healing.

Step 1: Remove

Food allergies

The first step is to remove pathogens and other inflammatory triggers that are associated with increased intestinal permeability. Triggers like stress and chronic alcohol consumption can do much harm to an individual's body. So targeting pathogens may involve treatment with pharmaceutical medication, antibiotics, or antimicrobial herbal supplements and removing inflammatory foods from the diet is advised, including:
  • Alcohol
  • Gluten
  • Food additives
  • Refined starches and sugar
  • Saturated and trans-fatty acids
  • Food sensitivities, which may be identified through the elimination diet

Step 2: Replace

The second step is to replace dietary nutrients that can help reduce inflammation and support digestive health. Anti-inflammatory food that is nutritious include:
  • High-fiber foods
  • Omega-3 fatty acids
  • Extra virgin olive oil
  • Mushrooms
  • Anti-inflammatory herbs and spices


Certain dietary supplements can also be used to support the digestive function by assisting in the digestion and absorption of dietary nutrients. The digestive enzymes assist in the breakdown of fats, proteins, and carbohydrates, while also benefiting individuals with an impaired digestive function, food intolerances, or having celiac disease. Supplements like bile acid supplements can also assist in nutrient absorption by emulsifying lipids. Studies have stated that bile acids have been used to treat the conditions of the liver, gallbladder, and bile duct. Bile acids have been shown to prevent gallstone formation following bariatric surgery.

Step 3: Reinoculate

The third step is to reinoculate the gut microbiota with beneficial bacteria. Studies have been shown that probiotic supplementation has been used to improve the composition of the gut microbiota by restoring the beneficial Bifidobacterium and the Lactobacillus bacteria species. With probiotic supplements, they can help improve the gut by enhancing the secretion of anti-inflammatory substances, supporting the immune system, altering the microbial composition, and reducing the intestinal permeability.


Probiotics are found in fermented foods like yogurt, fermented vegetables, fermented soy products, and kombucha. Foods that have probiotics in them are considered as transient as they do not persist in the gastrointestinal tract. Surprisingly, they may still have an impact on human health by producing vitamins and anti-microbial compounds by influencing the gut microbiota diversity and function.

Step 4: Repair


The last step is to repair the gut. This step involves repairing the intestinal lining with specific nutrients and medicinal herbs. These herbs and supplements have been shown to decrease intestinal permeability and inflammation. Some of these herbs and supplements include:
  • Aloe vera
  • Chios mastic gum
  • DGL (Deglycyrrhizinated licorice)
  • Marshmallow root
  • L-glutamine
  • Omega-3 fatty acids
  • Polyphenols
  • Vitamin D
  • Zinc


Since many dietary and lifestyle factors can adversely affect the digestive system and can be the contributor to several health conditions. The main goal of the 4Rs protocol is to minimize the factors that can lead the gut to have an increased intestinal permeability and inflammation, as well as introducing the beneficial factors that can promote gut health and healing. Some products are here to help support the gastrointestinal system by supporting the intestines, improving the sugar metabolism, and targeting the amino acids that are intended to support the intestines.

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues as well as functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or chronic disorders of the musculoskeletal system. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 .


De Santis, Stefania, et al. “Nutritional Keys for Intestinal Barrier Modulation.” Frontiers in Immunology, Frontiers Media S.A., 7 Dec. 2015,

Ianiro, Gianluca, et al. “Digestive Enzyme Supplementation in Gastrointestinal Diseases.” Current Drug Metabolism, Bentham Science Publishers, 2016,

Mu, Qinghui, et al. “Leaky Gut As a Danger Signal for Autoimmune Diseases.” Frontiers, Frontiers, 5 May 2017,

Rezac, Shannon, et al. “Fermented Foods as a Dietary Source of Live Organisms.” Frontiers in Microbiology, Frontiers Media S.A., 24 Aug. 2018,

Sander, Guy R., et al. “Rapid Disruption of Intestinal Barrier Function by Gliadin Involves Altered Expression of Apical Junctional Proteins.” FEBS Press, John Wiley & Sons, Ltd, 8 Aug. 2005,

Sartor, R Balfour. “Therapeutic Manipulation of the Enteric Microflora in Inflammatory Bowel Diseases: Antibiotics, Probiotics, and Prebiotics.” Gastroenterology, U.S. National Library of Medicine, May 2004,

Zaremba, Karolina. “The 4Rs: How To Heal The Gut Naturally.” Fullscript, 24 Sept. 2019,

Testimonies & Case Studies

Today's Chiropractic

Trending: Back Pain Insights

Location Near You


Legal Disclaimers & Scope Of Practice