The five-pillars for restoring gut health commonly used by functional medicine practitioners is called the 5R approach.  This is because it consists of 5 processes that start with the letter R.

  • Remove
  • Replace
  • Re-inoculate
  • Repair
  • Rebalance

Let’s review what each of these steps involves.


This is the first and most crucial step to healing the gut, and it involves removing things that are causing harm to the gut resulting in it not functioning well. The common culprits would be the type of food we eat, exposure to certain bacteria, parasites, or viruses, and the build-up of toxins in our body known as toxic burden.

As expected, an individualized assessment would be required to determine precisely what needs to be removed.

One of the common ways to remove potential food allergies, intolerances, or sensitivities would be the elimination diet. This can be personalized to your unique needs. This would also be an ideal time to add a detoxification protocol depending on a patient’s symptoms.

Fasting is a great way to detoxify the system. However, suppose you are dealing with metabolic issues such as type 2 diabetes, cholesterol abnormalities, heart disease, hypertension, etc. In that case, I highly recommend this be done under the supervision of a qualified healthcare professional such as myself. Or even prescribing antibiotics or plant-based botanicals capable of treating bacterial overgrowth.


In this part of the 5R protocol, we address what needs to be replaced for our digestive system to function correctly. This may involve digestive aids such as bitters, hydrochloric acid, bile stimulants, or pancreatic enzymes. Keeping a food diary for a few weeks is a valuable tool to help pinpoint how certain foods affect us.


This refers to introducing healthy micro-organisms into the gut. In part 2 of this series, “the gut microbiome- three things you need to know,” I covered the role of probiotics and prebiotics.


This involves completely healing the gut lining and repairing any signs of ‘leaky gut.’ Leaky gut is associated with inflammation in the gut lining. It can be caused by several things such as infection (parasites, viruses, or bacteria).

As you might imagine healing the gut is not a one-size-fits-all approach. But some of the steps a functional health provider would take would be to prescribe a diet that helps reduce inflammation. One of the common culprits of gut inflammation is gliadin in wheat. If you have an auto-immune condition or symptoms of a leaky gut, one of the first things your functional health provider would recommend is to eliminate all gluten sources from your diet.

Obesity also plays a role in gut inflammation. Particularly belly fat. This is because fat tissue contains inflammatory agents called cytokines that keep the cycle of inflammation going. So if you’re carrying a lot of belly fat, this could be causing gut inflammation and putting you at risk for metabolic diseases such as pre-diabetes or full-blown type 2 diabetes.


This is the final step in the 5R protocol. In this step, we teach our patients how to become aware of stress, for instance, has on gut health. Also, one’s relationship to food and also how we eat. You may have heard the term ‘mindful eating.’ Do you know, for instance, that it is essential to chew your food correctly and slowly, allowing the food to mix with the enzymes in the saliva, which starts the digestive process? Or that eating in a hurry activates the sympathetic nervous system, which shuts down digestion? The rebalance phase is all about using different techniques to bring the body back into balance.


Are you currently dealing with gut issues?

I always recommend that you start with a detailed evaluation by your healthcare provider. This may entail being referred to a specialist called a gastroenterologist. This is also a great opportunity to work side by side with a functional medicine practitioner. This allows you to get to the root cause of what is causing these gut issues.

If you would like to know what that entails click here to schedule a free no-obligation discovery call.