Dr. Alex Jimenez, El Paso's Chiropractor
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 - Cell 915-540-8444 Great Regards. Dr. J

The 4Rs Protocol For a Healthy Gut

Do you feel:

  • Like you have been diagnosed with Celiac Disease, Irritable Bowel Syndrome, Diverticulosis/Diverticulitis, or Leaky Gut Syndrome?
  • Excessive belching, burping, or bloating?
  • Abnormal distention after certain probiotics or natural supplements?
  • Suspicion of nutritional malabsorption?
  • Do digestive problems subside with relaxation?

If you are experiencing any of these situations, then you might be experiencing gut problems and might have to try the 4R Program.

Food sensitivities, rheumatoid arthritis, and anxiety have been associated with impaired gastrointestinal permeability. These various conditions can happen from many factors that can impact the digestive tract. If left untreated it can potentially be the result of dysfunction of the intestinal permeability barrier, causing inflammation, and severe health conditions that the gut can develop. The 4R program is used to restore a healthy gut in the body and involves four steps. They are: remove, replace, reinoculated, and repair.

Intestinal Permeability

The intestinal permeability helps protects the body and makes sure that harmful bacteria do not enter the gut. It protects the body from potential environmental factors that can be harmful and are entering through the digestive tract. It can be either toxin, pathogenic microorganisms, and other antigens that can harm the digestive tract causing problems. The intestinal lining is consisting of a layer of epithelial cells that are separated by tight junctions. In a healthy gut, the tight junction regulates the intestinal permeability by selectively allowing substances to enter and travel across the intestinal barrier and preventing harmful factors from being absorbed.

blog picture of doctor and elderly patient speak

Certain environmental factors can damage the tight junction, and the result is that it can increase the intestinal permeability, which causes intestinal hyperpermeability or leaky gut in the body. Contributing factors can increase intestinal permeability like an excessive amount of saturated fats and alcohol, deficiencies in nutrients, chronic stress, and infectious diseases.

With an increased intestinal permeability in the gut, it can enable antigens to cross the gut mucosa and enter the bloodstream causing an immune response and inflammation to the body. There are certain gastrointestinal conditions that are associated with intestinal hyperpermeability and if left untreated it can trigger certain autoimmune conditions that can cause harm to the body.

4Rs Program

The 4Rs is a program that healthcare professionals advise their patients to use when they are addressing disruptive digestive issues and help support gut healing.

Removing the Problem

The first step in the 4Rs program is to remove harmful pathogens and inflammation triggers that are associated with increased intestinal permeability. Triggers like stress and chronic alcohol consumption can do much harm to an individual’s body. So targeting these harmful factors from the body is to treat it with medication, antibiotics, supplements, and the removal of inflammatory foods from the diet is advised, including:

  • – Alcohol
  • – Gluten
  • – Food additives
  • – Starches
  • – Certain fatty acids
  • – Certain foods that a person is sensitive to

Replacing the Nutrients

The second step of the 4Rs program is to replace the nutrients that are causing the gut problems through inflammation. Certain nutrients can help reducing inflammation in the gut while making sure that the digestive tract is being supported. There are some anti-inflammatory foods that are nutritious. These include:

  • – High-fiber foods
  • – Omega-3s
  • – Olive oil
  • – Mushrooms
  • – Anti-inflammatory herbs

There are certain supplements can be used to support digestive function by assisting and absorbing the nutrients to promote a healthy gut. What the digestive enzymes do is that they assist in helping to break down fats, proteins, and carbohydrates in the gut. This will help benefit individuals that have an impaired digestive tract, food intolerances, or having celiac disease. Supplements like bile acid supplements can help assist in nutrient absorption by merging lipids together. Studies have stated that bile acids have been used to treat the liver, gallbladder, and bile duct while preventing gallstone formation after bariatric surgery.

Reinoculated The Gut

The third step is of the 4rs program to reinoculated the gut microbe with beneficial bacteria to promote a healthy gut function. Studies have been shown that probiotic supplements have been used to improve the gut by restoring beneficial bacteria. With these supplements, they provide the gut an enhancement by secreting anti-inflammatory substances into the body, help support the immune system, altering the body’s microbial composition, and reducing the intestinal permeability in the gut system.

Since probiotics are found in fermented foods and are considered as a transient since they are not persistent in the gastrointestinal tract and are beneficial. Surprisingly, they still have an impact on human health due to influencing the gut by producing vitamins and anti-microbial compounds, thus providing diversity and gut function.

Repairing the Gut

The last step of the 4Rs program is to repair the gut. This step involves repairing the intestinal lining of the gut with specific nutrients and herbs. These herbs and supplements can help decrease intestinal permeability and inflammation in the body. Some of these herbs and supplements include:

  • – Aloe vera
  • – Chios mastic gum
  • – DGL (Deglycyrrhizinated licorice)
  • – Marshmallow root
  • – L-glutamine
  • – Omega-3s
  • – Polyphenols
  • – Vitamin D
  • – Zinc


Since many factors can adversely affect the digestive system in a harmful way and can be the contributor to several health conditions. The main goal of the 4Rs program is to minimize these factors that are harming the gut and reducing inflammation and increased intestinal permeability. When the patient is being introduced to the beneficial factors that the 4Rs provide, it can lead to a healthy, healed gut. Some products are here to help support the gastrointestinal system by supporting the intestines, improving the sugar metabolism, and targeting the amino acids that are intended to support the intestines.

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.


De Santis, Stefania, et al. “Nutritional Keys for Intestinal Barrier Modulation.” Frontiers in Immunology, Frontiers Media S.A., 7 Dec. 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670985/.

Ianiro, Gianluca, et al. “Digestive Enzyme Supplementation in Gastrointestinal Diseases.” Current Drug Metabolism, Bentham Science Publishers, 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923703/.

Mu, Qinghui, et al. “Leaky Gut As a Danger Signal for Autoimmune Diseases.” Frontiers, Frontiers, 5 May 2017, http://www.frontiersin.org/articles/10.3389/fimmu.2017.00598/full.

Rezac, Shannon, et al. “Fermented Foods as a Dietary Source of Live Organisms.” Frontiers in Microbiology, Frontiers Media S.A., 24 Aug. 2018, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117398/.

Sander, Guy R., et al. “Rapid Disruption of Intestinal Barrier Function by Gliadin Involves Altered Expression of Apical Junctional Proteins.” FEBS Press, John Wiley & Sons, Ltd, 8 Aug. 2005, febs.onlinelibrary.wiley.com/doi/full/10.1016/j.febslet.2005.07.066.

Sartor, R Balfour. “Therapeutic Manipulation of the Enteric Microflora in Inflammatory Bowel Diseases: Antibiotics, Probiotics, and Prebiotics.” Gastroenterology, U.S. National Library of Medicine, May 2004, http://www.ncbi.nlm.nih.gov/pubmed/15168372.



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We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Rehabilitation Systems for all ages.

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We’ve been blessed to use our methods with thousands of El Pasoans over the last three decades allowing us to restore our patients’ health and fitness while implementing researched non-surgical methods and functional wellness programs.

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The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 Read More…

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*

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