The 4 "R" Program

Four R Program, brainchild of Dr Jeffrey Bland, was developed by the Institute of Functional Medicine in Gig Harbor, Washington.  This testing and treatment  process takes a number of months and requires testing and professional guidance.   IFM seminars provide the best guidelines for physicians.   The steps described may occur simultaneously, though they are described individually below.

Remove: The first step is to remove the problem,  usually unhealthy bacteria, yeasts and/or parasites. This phase is guided by results of stool testing. Some practitioners use herbal treatments, others prescription medicines.   Removal phase can take from several weeks to several months.

Repair: Damaged mucous membranes lining the digestive tube allow microscopic bits of food can leak into your bloodstream.  This is thought to be a factor leading to autoimmune diseases. Repair involves providing the nutrients that the membranes need to regenerate.  Some of the best nutrients for repairing the lining of the gut include L-glutamine, a type of amino acid found in cabbage juice, aloe vera gel, deglycyrrhizinated licorice root extract, and arabinogalactan, a starchy substance derived from the inner bark of Western larch trees. The repair phase generally takes one to two months.

Replace: This phase is guided by testing, and involves providing the digestive enzymes and/or stomach acid that are found to be missing.  Both digestive enzymes and hydrochloric acid have important roles in early stages of digestion and replacing them improves the chances of full digestion and absorption of nutrients. Replacement will last several weeks to months.  Some people, especially elderly, have chronic needs for replacement.

Reinoculate: Once the harmful bacteria or parasites or yeast are removed, healthy bacteria need to be reintroduced.  Good bacteria compete with bad for food and space in the colon.  Just as weeds can choke out grass in your garden, pathogenic or bad bacteria and parasites can outcompete good bacteria for food.  In this phase, probiotics, good bacteria, are taken daily for several months.  After the first three months, the dosing can be decreased.  In this instance, it is best to use a very potent probiotic, one with billions rather than millions of bacteria per capsule.  These are sometimes difficult to find on the shelf at the pharmacy.  My patients can order them at the doctor price directly from the lab.  I do NOT put a mark-up on any supplements, nor do I sell them in my office.

Once the health of the digestive system is restored, maintenance involves eating adequate fiber and drinking adequate water to keep the digestive process moving. A goal is at least one bowel movement daily. For most people, this involves at least 20 grams of fiber and at least eight full glasses of water a day.  Even with a healthy diet, it can be hard to get adequate fiber.  Flax meal, unsweetened psyllium  husks or wheat bran all contain significant amounts of fiber.  Both magnesium and vitamin C can also help keep bowels moving regularly. 

Learn more about digestive health
4R Program:
Typical Patient with Digestive Imbalance