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The 5R Blueprint for Gut Health

January 7, 2025 - 12:28

The 5R Blueprint for Gut Health

The 5R blueprint is a comprehensive guideline to support optimal gastrointestinal (GI) health and function through five phases: Remove, Replace, Replenish, Revive, and Rebalance. The 5R program has been updated from the initial 4R program that was introduced by the Institute for Functional Medicine and outlined in its Textbook of Functional Medicine in 2010. This blueprint is designed for those with occasional GI complaints, conditions, disorders, unbalanced GI microbial environments, or issues with normal GI absorption. Depending on individual circumstances, the 5R program can occur in either sequential order (i.e., Remove first, then Replace, etc.) or with overlap. The length and outcomes of each phase may vary depending on individual patient responses. 

Each aspect of the 5R blueprint will briefly be discussed, followed by general recommendations for dietary, lifestyle, and supplemental intervention strategies. Please note that working closely with a health-care practitioner is strongly recommended to develop a personalized 5R blueprint that considers each patient’s unique goals, abilities, and desired outcomes.  

Remove

The Remove aspect of this program is typically the first phase and involves removing potential triggers in the diet or environment that may affect an individual’s health. These triggers include any source of inflammation to the GI tract, including inflammatory foods, pathogenic bacteria, yeast, fungi, or viruses. In addition, any exposure to environmental toxins or pathogens should be identified and removed to the best of one’s ability. Finally, lifestyle habits are assessed; poor health behaviors, such as smoking and sedentary behavior, are identified; and proper help to reduce, avoid, or support these behaviors is prioritized. 

  • Dietary strategies:
    • Oligoantigenic diet – a dietary strategy that focuses on foods with little risk of an allergic reaction. This diet is also known as a restricted elimination diet or hypoallergenic diet. Foods considered the most inflammatory are removed for a specified amount of time. 
    • After elimination, foods are reintroduced, one at a time, to assess individual responses and to create a personalized, allergen-free dietary strategy. 
  • Lifestyle strategies:
  • Possible supportive supplements:

Replace

The second step includes replacing what the body may need to support optimal digestive capacity. During occasional periods of altered digestive capacity, replacing enzymes and other digestive factors, such as proteases, lipases, amylases, hydrochloric acid, bile acids, and pepsin, may support a comprehensive breakdown of foods and food particles. Also, poor lifestyle habits should be replaced with healthier ones. 

  • Dietary strategies: 
    • Replace nutrient-poor foods with whole foods. 
    • Thoroughly chew foods to help support normal digestion and absorption.
    • Use bitter foods, like arugula, Brussels sprouts, kale, dandelion greens, artichoke, and radicchio, to help promote optimal digestion.
  • Lifestyle strategies: 
    • Replace sedentary behavior like sitting with walking or light jogging.
    • Current smokers may start a smoking cessation program.
    • Practice stress-management techniques. 
  • Possible supportive supplements:

Replenish

Replenish is a step that involves reintroducing bacteria and prebiotic fiber to help promote the proliferation and diversity of beneficial bacteria in the GI tract. When considering the Replenish phase, the mnemonic consisting of the three P’s of gut health is helpful: probiotics, prebiotics, and polyphenols. Polyphenols are compounds found in plant foods that give them their characteristic colors, tastes, and unique functional characteristics. Beneficial compounds called short-chain fatty acids (SCFAs) are produced from specific bacteria after they consume prebiotics and polyphenols. SCFAs, like butyrate, are essential to support mucosal strength and integrity. 

  • Dietary strategies:
    • If tolerated, adding probiotic-rich foods like sauerkraut, kimchi, kombucha, pickles, kefir, and yogurt may support microbial replenishment.
    • Plant variety, which includes adding as many plants as possible to the diet per week. Aiming for 20 to 30 plant-based foods each week is a great starting place.
  • Lifestyle strategies: 
    • Aiming for seven to nine hours of restful sleep each night.
    • Engaging in more calming and restorative activity rather than stimulating.
    • Drink plenty of fresh, filtered water.
  • Possible supportive supplements:

Revive

After the Remove, Replace, and Replenish phases, Revive is next. The Revive phase involves supporting the GI mucosal strength and integrity through supportive dietary and supplemental strategies. A healthy gut barrier supports optimal digestion, bowel movements, immune health, and healthy GI microbial environments. 

Rebalance

The Rebalance phase is a time for reflection and integration. This phase combines everything learned from the first four phases and continuously integrates it within a new routine. It primarily focuses on broader lifestyle factors to rebalance gut health in the long term. This phase involves practicing stress-reduction techniques, like meditation, breathwork, or journaling, engaging in enjoyable exercise, maintaining seven to nine restful hours of sleep each night, having work/life balance, and fostering supportive and loving relationships. 

  • Dietary strategies: 
    • Involves continuing with the dietary strategies that the individual feels best on. This may include long-term avoidance of foods discovered to contribute to symptoms. 
    • A food reintroduction phase may be implemented to support expanding the individual’s diet as much as possible to avoid nutrient deficiencies or inadequacies. 
    • Including plant variety and practicing plant rotation as best as possible.
      • Working with a health-care professional with a background in nutrition or dietetics may be helpful to increase patient compliance with dietary recommendations.
  • Lifestyle strategies:
    • Replace sedentary behavior like sitting with walking or light jogging.
    • Current smokers may start a smoking cessation program.
    • Practice stress-management techniques. 
    • Aiming for seven to nine hours of restful sleep each night.
    • Engaging in more calming and restorative activity rather than stimulating.
    • Drink plenty of fresh, filtered water.
  • Possible supportive supplements:
    • Once the 5R program is completed, the individual’s progress will need to be assessed. Testing can be a great strategy to understand which markers improved and which may still need additional support. 
    • A gut assessment that reviews digestive capacity, microbial balance (or imbalance), and the gut-immune interface may help refine the direction of future treatment. Markers that may be assessed in these tests are listed below. 
      • Steatocrit
      • Elastase-1
      • Secretory IgA 
      • Zonulin 
      • Anti-gliadin antibody

The 5R blueprint offers a structured and personalized approach to supporting gut health by addressing key phases: Remove, Replace, Replenish, Revive, and Rebalance. This comprehensive program emphasizes the elimination of potential triggers, restoration of essential digestive components, promotion of beneficial gut bacteria, reinforcement of mucosal integrity, and integration of sustainable lifestyle changes. By combining targeted dietary, lifestyle, and supplement strategies, the 5R framework serves as a valuable guide for individuals with varying gastrointestinal needs. Collaboration with a qualified health-care practitioner is strongly recommended to tailor the program to individual goals and circumstances, ensuring optimal and lasting results.

To learn more about gut health: 

L-Glutamine: Promoting Gut Barrier Health

The Latest on Saccharomyces boulardii and GI Health 

Understanding Inulin

 

By Bri Mesenbring, MS, CNS, LDN

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