The Chain of Gastrointestinal Recovery; Remove-Replace-Reinnoculate-Repair
Remove,
Replace, Reinnoculate, Repair, the 4R Program, is a strategic sequence of
therapies designed to help re-establish normal gastrointestinal function.
*The first component, Removal
of pathenogenic organisms (e.g., parasites, allergens, dysbiosis)
supports a normal intestinal environment, removes a primary source of metabolic
toxins, and aids the efficacy and comfort of subsequent steps.
*As the second component of
the 4R Program, Replacement of necessary digestive factors (such as
pancreatic and intestinal enzymes, hydrochloric acid, intrinsic factor, and
bile) and gradually increasing fiber intake support normal digestion.
Cranial
respiratory faults must be evaluated and corrected if present, because of their
capacity to shut down the normal acid production in the stomach through
diminished nerve signal through Cranial Nerve X. This lack of stomach acid production reduces
the pH necessary in the small intestine to signal the pancreas to release
digestive enzymes.
*After Removal of metabolic
toxin sources and Replacement of digestive factors, the digestive tract may be Reinnoculated
with beneficial flora to re-establish a more functional environment. Not all flora are alike, however.
To
be considered a probiotic, an organism should be able to:
Survive
host defenses like bile salts, digestive enzymes, and digestive acids; adhere
to intestinal mucosal cells (inhibiting colonization by pathogens).
Produce
substances that help maintain a healthy microbial balance (such as organic
acids and peroxides). Among the few organisms confirmed to have these three
qualities are Lactobacillus acidophilus strain NCFM®, L. casei strain Shirota,
and L. rhamnosus
strain GG (“Lacto GG”, formerly L. casei).
In
addition, probiotics produce beneficial short-chain fatty acids in the
intestines, and may stimulate specific and
non-specific host immune responses. The term “symbiotic” has been recently
applied to co-administered probiotic and prebiotic substances.
Stabilized
human probiotic strains like L. acidophilus strain may support immune function
in healthy as well as hypersensitive individuals. In contrast, phagocyte
receptor expression increases in non-dairy-sensitive individuals receiving this
strain. A recent study of atopic infants found symptomatic improvement and
lower inflammatory marker levels in treated infants. Though confirmatory
studies are needed, lactic acid bacteria (lactobacilli and some bifidobacteria)
have shown diverse effects on intestinal immune function. These include beneficial effects on microbial
balance, decreased intestinal permeability, and improved lactose tolerance.
*The fourth step of the 4R
program is Repair of the digestive system lining, or gut wall. The enterotrophic effects of glutamine are
well known, but recent evidence shows that it may help reduce intestinal
permeability among those using nonsteroidal anti-inflammatory drugs (NSAIDs).
Subjects pretreated with high doses of glutamine or given multiple doses of
glutamine near the time of NSAID administration retained greater intestinal
barrier function than those given only the NSAID. Subjects given a synthetic
prostaglandin in addition to glutamine and NSAID did even better.
Another
study suggests that, in protein-deficient guinea pigs, supplemental zinc helps
normalize intestinal barrier function and hypersensitivity to cow’s milk.
Malnourished animals show greater intestinal oxidation and sensitivity in
response to cow’s milk, and supplemental zinc may support intestinal barrier
function in these animals.
Supplemental
fiber (Ultrabalance Herbulk- a Metagenics Product) may also be needed by the
gut during the Repair phase, as intestinal fermentation of soluble fibers
produces butyric, propionic, and acetic acids, providing key nutrition for
enterocytes and colonocytes. In animals, fiber supplementation may help restore
barrier function of the small intestine and colon after chemotherapy. Enteric
nutrition alone did not preserve intestinal structure and function in
chemotherapy-treated animals, but those additionally given fiber showed less
bacterial translocation, less intestinal atrophy, and lower intestinal
permeability.
Each
serving of UltraClear Sustain® provides glutamine, zinc, inulin, fructooligosaccharides,
and other dietary fibers for specialized dietary support of enterocytes and
colonocytes. For further product information: Glutagenics combines glutamine
with standardized aloe leaf extract and concentrated deglycyrrhizinized
licorice extract.
Glutamine
is the major free amino acid in the body, and it is a preferred fuel by
enterocytes and many types of immune cells. It is additionally used for
acid-base balance, gluconeogenesis, and synthesis of nucleotides, glutathione,
histidine, Krebs cycle intermediates, and amino sugars.
Skeletal
muscle can ‘donate’ glutamine as a nitrogen source for connective tissue
healing or metabolically exchange it for branched-chain amino acids, which are
skeletal muscle’s preferred fuels. Glutamine availability is particularly
crucial during healing, acidosis, inflammation, chronic stress, steroid use, or
other increased metabolic demand, during which it may become essential.
Glutamine depletion after strenuous exertion is strongly linked to greater
immune susceptibility.
Glutamine
may have even more specialized roles in controlling the life cycles of
epithelial and immune cells lining the digestive tract. It
‘nurses’ immature epithelial cells, supporting their early growth and
differentiation, and depriving enterocytes of glutamine results in their
premature death. Glutamine may also support normal cell life cycles in
stressed intestinal cells, as irradiated rats given glutamine maintain better
intestinal barrier function and villous structure than those not given glutamine.
Because
ammonia is a common conversion product of glutamine, glutamine supplementation
may not be suitable for those with compromised kidney or liver function.
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L, Isolauri E, Lilius EM, Nuutila J, Salminen S. Probiotic bacteria
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