Chronic Illness: Jeffrey Bland’s Four R’s

I started my Fall clinic shifts today – very exciting! I will see patients from 9-5 on Tuesdays at Bastyr Center for Natural Health in both Patient Care and Physical Medicine. Today during my shift preview, my supervisor brought up Jeffrey Bland’s Four R’s when treating patients with digestive/gastrointestinal complaints. Here are the Four R’s:

Remove Phase: This phase involves the removal of allergy producing foods, the most common being grains containing gluten and diary. A low allergy diet focuses on rice based products, legumes, fruits, vegetables, fish and poultry.

Replace Phase: Digestive enzymes are key in proper digestion of food. The best indication of this is when a person can have a meal without complaints of bloating, gas or reflux. If these are present, digestive enzymes should be taken along with a meal.

Reinoculate Phase: Reinoculating refers to bringing back good bacteria. This can be done through the use of well researched and medically documented probiotics. This will improve intestinal immunity and essentially improve whole body function.

Repair Phase: The repair phase focuses on promoting the proper repair of the intestinal lining. Supplements that aid in repair are L-glutamine, pantothenic acid, zinc citrate, omega-3 fish oils, mixed tocopherols and glycine.

The Four R’s are part of the Functional Medicine Model which addresses the underlying causes of signs and symptoms that accompany disease. In contrast, the Pharmaceutical Model manages the signs and symptoms with different classes of drugs. There are a vast variety of problems that can come from chronic health problems, the most common signs and symptoms are fatigue, pain and inflammation. The following disorders are examples of medical conditions associated with fatigue, pain and inflammation:

  • Chronic fatigue syndrome
  • Fibromyalgia (muscle pain and fatigue) 
  • Irritable bowel syndrome- Chronic headache
  • Arthralgias (arthritis symptoms)
  • Metabolic Syndrome (pre-diabetes)
  • Allergies- Environmental/Chemical Sensitivities
  • Hypertension (high blood pressure)
  • Dyslipidemias (elevated cholesterol)
  • Prostatitis (prostate irritation)
  • Fibrocystic breast disease
  • Dyspepsia and gastrointestinal reflux disorder (digestive problems)
  • Sleep apnea
  • Cognitive impairment (short term memory)
  • Eczema and rosacea 

All of these conditions can lead to more serious diseases if not corrected early. The idea is to address the root cause of the disease, early to prevent future issues. Functional Medicine is a fascinating field, and one that I feel really uses a naturopathic approach.

Institute for Functional Medicine 
Chronic Illness: What Works?


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