Digestive Difficulties

Resolving Digestive Difficulties with the 4 R Program

4 r program digestion gut health Aug 22, 2023

The “Digestive Difficulties” presentation from Middle Path Medicine has been one of our most helpful educational tools for over a decade now. It is a PDF comprised of the 4 R Program, an approach to GI healing that has been used in functional medicine settings for decades. If you have a digestive symptom you just can’t figure out, from “heartburn” to diarrhea to anywhere in between, the understanding and delivery of a comprehensive, systematic approach succeeds while so many other attempts at treatment have failed.


The 4 R Program compares analogically to the famous acronym for healing a sprained ankle, RICE (Rest, Ice, Compression, Elevation), but instead applied to your “sprained intestines” RRRR (Remove, Replace, Reinoculate, Repair). If you have a bad sprained ankle you must do all components of RICE to heal; similarly, if you have a severe sprained intestine, you must apply all components of RRRR to get better.



  • Stress from eating, everyone knows “fight or flight” - sympathetic response helps you figure things out, but literally turns down and ultimately off your digestive capacity. Parasympathetic “rest and digest” turns on your digestive tract, which, really, makes sense if you think about it! Blessing your food, moments of silence, candlelight while turning off all distractions improves the enjoyment of eating while activating digestive capacity, improving every known digestive problem.
  •  Irritants/Sensitivities -  Paleo diets specifically eliminate the known direct toxins to your intestine:  gluten, other glutenoids found in other grains and starchy legumes, as well as processed foods that are also directly toxic. Of course many medicines, alcohol, and supplements can fit into this category. Intelligent 2 week eliminations of common irritants can help when added to other approaches. Consider Food Sensitivity Testing - like ALCAT to help you discern your food sensitivities.
  • Pathogens/Dysbiosis - For persisting symptoms consider comprehensive stool testing like GI Effects test to pick up on potential parasites, yeast, pathogenic bacteria and the most common problem, an abnormal balance of normal bacteria seen in SIBO (Small Intestinal Bacterial Overgrowth) and Dysbiosis (similar to SIBO, but in the colon)


  • Digestive Enzymes - Everyone has a certain digestive capacity based on pancreatic enzyme function, the health of their stomach and stomach acidity and the health of the “brush border” or lining of the small intestinal tract. When what you eat, even if it is a “good food” exceeds your capacity to digest it, toxicity and imbalance ensue. When starting a digestive healing program, it sure makes sense to improve digestive capacity while helping symptoms instead of harming digestive capacity while treating symptoms (all antacids). Digestizym V 1-3 caps taken at the beginning of each and every meal to assist the digestion of each meal can change people’s lives!


  • Probiotics - The health of our microbiome, the over 100 trillion organisms that make up 99% of our genetic diversity affects everything from inflammation levels to our mood to, of course, our digestive health. That microorganisms can come into our  body help stabilize our digestive tract and then leave is a more accurate statement than “reinoculate”. Thousands of scientific articles exist on the use of probiotics to prevent and treat many diseases, their primary role however is the stabilization of fluctuating “storms” in our intestinal tract. A monthly rotation of good probiotics has even become a part of our “Basic Nutritional Protocol”. My most useful probiotics include, but are not limited to: OrthoBiotic (OrthoMolecular), MegaSporeBiotic, ProbioMax Plus DF, and Douglas Labs MultiProbiotic.


  • Similarly to so many systems in the body, under conditions of stress or damage to the intestines, specific nutrients become “conditionally essential” and can speed the healing of the rapidly repairing intestinal tract. There are two repair formulas that can provide enormous benefits when combined with the above approaches
  • Upper GI Healing - gastritis, GE Reflux, upper abdominal pain. GlutAloeMine (Xymogen) or Glutagenics (Metagenics) 1 scoop three times daily between meals. The Xymogen product includes the prebiotic larch arabinogalactan which confers additional benefits with our prebiotics. Both combine the miraculous amino acid glutamine with aloe and DGL (DeGlycyrrhizinated Licorice) which speeds the repair of the GI tract while aiding the mucopolysaccharide coating.
  • Lower GI HealingSBI Protect (OrthoMolecular) 2 scoops twice daily has become my favorite when dealing with SIBO, Leaky Gut Syndrome, and most all diarrheal illnesses. Formerly a well studied drug, now available without prescription. The Serum-derived Bovine Immunoglobulins work far better than any colostrum product I have recommended in the past. It has healing, anti-viral, anti-parasitic and more activities!


When combined, the 4 Rs allow your intestinal tract to heal usually within weeks, and you taper the treatments as tolerated.


Your Journey to Health & Healing, 

Gary E. Foresman MD

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