What is the 5-R Protocol for Digestive Health? - Sara Kahn Nutrition (2024)

The 5-R Protocol developed by the Institute of Functional Medicine is the approach I use for healing digestive conditions such as IBS, SIBO, GERD, celiac disease and IBD (Crohn’s and ulcerative colitis) for good.

This protocol also helps to alleviate symptoms related to gut-health such as acne, anxiety, autoimmune conditions, brain fog, fatigue, joint & muscle pain, chronic headaches & migraines and more. Since your digestive tract is where most of your immune cells are and where you absorb your nutrients, it makes sense that improving gut health can improve health across the whole body.

The 5-R Protocol is a systematic and comprehensive method that not only improves symptoms but it helps heal so you get lasting results. So what’s involved?

1) Remove

We want to remove anything that could be irritating to the gut such as:

• Food – We want to remove any type of gut irritant such as alcohol, caffeine, processed food and food additives. You may have a hard time digesting certain type of carbohydrates. Or you may have food intolerance, sensitivity or food allergy. This is where a gut-healing diet comes into play.
• Medications & Supplements – Over-the-counter medications such as heartburn medication and NSAIDs (like aspirin and ibuprofen) are known to cause digestive dysfunction. We also want to consider the potential side effects of prescription medications that could be discontinued under the advice of your physician. And even though you can purchase supplements over the counter, that does not necessarily mean they are benign. There are many supplements that can cause digestive symptoms.
• Stress – It’s not just a feeling. Stress causes a biochemical reaction by releasing a hormone called cortisone into your blood stream. Too much cortisol can cause inflammation in the digestive tract.
• Infections, bacteria, parasites and pathogens that may require treatment

2) Replace

Depending on your health condition and symptoms, you may be lacking certain elements that are key to digestion such as stomach acid, bile and digestive enzymes. You also may be deficient in nutrients. Part of your gut-healing plan may include:

• Supplements to replace the missing elements such as betaine HCL, bile salts, and enzymes that help digest fat, lactose, carbohydrates and protein
• Foods containing nutrients that help the body produce these elements. For instance, bitter foods can help stimulate stomach acid and digestive enzymes.
• Foods and/or supplements to address nutrient deficiencies. Digestive conditions can affect the absorption of nutrients such as B12, iron, calcium, magnesium and zinc.

3) Repopulate

Remember, elimination diets are not forever diets. Once symptoms have improved significantly, it’s time to reintroduce foods that will help rebalance the microbiome. This is the term for the collection of good gut bacteria that play a role with immune, digestive, and metabolic health. It’s important to keep these bugs happy!

We may reintroduce the following types of foods:

• Prebiotic foods – This term describes the type of food that gut bacteria love to eat. They include carbohydrate such as onions, garlic, leeks, asparagus, apples and bananas to name a few. We also want to reintroduce or increase the variety of grains like oats, barley and seeds like flax.
• Probiotic foods – Probiotic describes foods that are rich in bacteria beneficial for our digestive system. While we can take probiotics as a supplement, we may want to reintroduce fermented foods like yogurt, sauerkraut, kimchi and kombucha.

4) Repair

At this stage we want to create an environment that supports gut-healing and long-term relief. We encourage repair of the intestinal cells and mucosa, reduce inflammation and help our microbiome find a happy home within our digestive tract. We may include:

• Foods high in vitamins A, C, D, & E as well as the mineral zinc
• Foods rich in amino acids such as bone broth
• Supplements such as L-glutamine, collagen, aloe vera, marshmallow or slippery elm

5) Rebalance

Our lifestyle habits have enormous influence on our digestive system and health. During this phase, we want to address:

• Stress management
• Improving sleep
• Moving more (or less, if necessary)
• Improving relationships

While this is presented as a step-wise approach, we may be working on multiple phases at the same time. For example, removing irritating foods, compounds and pathogens from the digestive tracts is the first step, it also initiates the repair phase. And if you’re only getting 6 hours of sleep a night, your gut-healing diet can only take us so far.

Every single client is on their own personalized 5-R protocol. If you found minimal improvement on your own, feel free to reach out to learn more about my approach to your case.