Dysbiosis and the Many Roles of the Gut Microbiome
An ever-growing body of scientific research demonstrates the importance of the gut microbiome for digestion and overall health. The gut microbiome, which is defined as the population and its genome of the microorganisms that live in the ecosystem of the human gastrointestinal tract, mediates proper immune function, metabolizes drugs, eliminates toxins, and creates vitamins.
Dysbiosis is a term to describe the state of an imbalanced microbial population; for example, when there are too many harmful bacteria and not enough beneficial bacteria.
- Genetic mutations
- Diet (processed foods, high fat, high sugar)
- Early life exposure, i.e. C-section, bottle feeding
- Food allergies
- IBD (Crohn’s disease, ulcerative colitis)
- Cardiovascular disease
- Chronic fatigue
Truly the gut microbiome, directly and indirectly, affects overall health and quality of life. So what are the steps that you can take to restore balance and health to your patients’ gut flora?
The 4 R Approach, originally developed by Dr. Jeffrey Bland, may be an effective way for you to treat dysbiosis and get your patients feeling well again. It consists of Remove, Replace, Repair and Re-inoculate.
Step 1: Remove
The first step is to remove any food allergens or causes of inflammation. High-fat diets, the standard American diet and excess sugar are known to increase inflammation and damage gut microbiota communities. Additionally, some of the most common food allergens that may need to be eliminated are: 
Step 2. Replace
After allergens have been removed, it is important to replace the necessary elements for healthy digestion. This may include digestive enzymes (protease, lipase, and amylase). Digestive enzymes can increase nutrient absorption and be beneficial for multiple different digestive disorders. Hydrochloric acid supplements to increase stomach acidity are also commonly used.
Step 3: Repair
The repair step involves healing the damaged intestinal tissues. Glutamine, vitamin A, and zinc are all known to improve nutrient absorption and the integrity of the epithelial barrier. In fact, a double-blind placebo-controlled study showed that glutamine supplementation significantly improved epithelial barrier function in malnourished children.
Step 4: Re-inoculate
To restore optimal gut microbiome health it is important to re-inoculate the gut with beneficial bacteria. Probiotic supplements can be a great way to reintroduce healthy bacteria including Bifidobacterium sp., Lactobacillus sp., and bacillus spore-forming species. Fermented foods are another highly effective way of getting probiotics. You might suggest that your patients eat:
- Unsweetened yogurt
- Unsweetened kefir
So remember: Remove, Replace, Repair and Re-inoculate! Following the 4 R’s may help in cultivating a healthy gut microbiome, and thus, a healthy mind and body!
Help Your Patients Find a Clear Path to Wellness
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 Ghaisas op. cit.
 Alenberg & Wu op. cit.
 Round & Mamanian op. cit.
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 Ghaisas op. cit.
 Cani PD, Possemiers S, Van de Wiele T, et. al. (2009). Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability. Gut, 58(8): 1091–1103.
 Boyce JA, Assa’ad A, Burks AW, et. al. (2010). Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol, 126(6): S1–58.
 Ianiro G, Pecere S, Giorgio V, et. al. (2016). Digestive Enzyme Supplementation in Gastrointestinal Diseases. Current Drug Metabolism, 17, 187-193
 Lima AAM, Anstead GM, Zhang Q, et al. (2014). Effects of glutamine alone or in combination with zinc and vitamin A on growth, intestinal barrier function, stress and satiety-related hormones in Brazilian shantytown children. (2014). Clinics, 69(4): 225–233.