The 5R Protocol

Question 1

The 5R protocol

Answer 1

The 5R protocol adopts a structured approach to GI dysfunctions by asking a client with GI-related complaints 5 questions:

Remove - What may need to be removed to support healthy GI function? (e.g., offending foods or pathogenic bacteria).

Replace - What may need to be replaced to support healthy GI function? (e.g., digestive enzymes, bile salts, stomach acid).

Reinoculation - What may be needed to reestablish a healthy balance of microflora? (e.g., reinoculation with pre- and / or probiotics)

Repair - What may be needed to regenerate and repair a healthy mucosal layer? (e.g., specific nutrients / phytonutrients).

Rebalance - What lifestyle changes may be needed to support gut healing? (e.g., stress reduction, addressing work / life balance).

Question 2

The 5R Protocol: Remove

Answer 2

• Foods may be the most important offending agents.

– Remove dietary irritants; i.e., processed food, food additives, sugar, alcohol, caffeine etc.

– Personalised diet; i.e., remove food allergens / foods that trigger an intolerance (e.g., dairy, gluten), low FODMAP, low histamine, specific carbohydrate diet etc.

• Avoid toxins; i.e., pesticides (eat organic), plastic / tinned packaging, non-filtered / distilled water, chemically-laden beauty products.
• Avoid unnecessary drugs; (e.g., NSAIDs) which can damage the GI mucosa / function.
• Eliminate potentially pathogenic bacteria, viruses, fungi and parasites using antimicrobials specific to the infection:

– Anti-microbial herbs (i.e., broad spectrum) berberine (a phytochemical found in barberry bark and goldenseal), garlic, oregano, uva ursi.

– Anti-bacterials — e.g., oregano oil, berberine, garlic, neem.

– Anti-parasitics — e.g., black walnut hulls, wormwood, oregano, neem, clove buds, pumpkin seeds.

– Anti-fungals — e.g., caprylic acid, grapefruit seed extract, garlic.

– Anti-viral — e.g., olive leaf extract, nano silver, elderberry

Question 3

The 5R Protocol: Replace

Answer 3

Replenish digestive factors that may be lacking.

• Stomach acid secretions — e.g., digestive bitters, betaine HCl.
• Pancreatic support — e.g., bitters, pancreatic enzymes, plant-based enzyme formulas, less frequent meals.
• Bile support — e.g., choleretics / cholagogues, ox bile

Question 4

The 5R Protocol: Reinoculate

Answer 4

Help beneficial bacteria flourish.

• Probiotics: Cultured vegetables, fermented foods and drinks (such as sauerkraut, kimchi, kefir), probiotic supplements e.g., Lactobacillus and Bifidobacterium spp.
• Prebiotics: Foods rich in fructans, fructooligosaccharides (FOS), inulin e.g., chicory, leeks, onions, Jerusalem artichokes.

Question 5

The 5R Protocol: Repair

Answer 5

Regeneration of the GI mucosa.

• For epithelial and tight junction support:

L-glutamine, N-acetyl glucosamine, quercetin, zinc, EFAs (incl. EPA / DHA), B vitamins, vitamin A, collagen, bone broth, aloe vera (↑ fibroblast collagen synthesis and inhibits COX).

• Supporting the mucous barrier: Demulcent herbs rich in mucilage. slippery elm, liquorice, marshmallow root, meadowsweet. Fibre. Polyphenols (↑ keystone bacterial species = ↑ mucin + SIgA).
• Increase SIgA where needed (e.g., S. boulardii) and reduce inflammation (e.g., curcumin).

Question 6

The 5R Protocol: Rebalance

Answer 6

Paying attention to lifestyle choices.

• Address stress; breathing exercises, nervines and adaptogens, e.g., passionflower, ashwagandha, etc.
• Practise good sleep hygiene.
• Undertake regular exercise.

Question 7

The 5R Protocol: Timings

Answer 7

The order, duration and timing of the 5Rs is dependent on your naturopathic summary and can be done in any order / overlapped. Some key points:

• Parasites or worms often need a second phase of antimicrobials to prevent eggs hatching. Either do 10 days on, 10 days off, then repeat or hold out the treatment for a whole 4 weeks.
• SIBO / strong dysbiosis may need 4 weeks of anti-microbials and also a repeat.
• Deficient microbiomes will take time to repair / re-inoculate, so do for a minimum of 4 weeks.
• Food intolerances need the gut wall to be repaired before reintroducing; a minimum of 6-week intervention is often needed.