How to heal leaky gut syndrome - part 3

How to heal leaky gut syndrome - part 3

Welcome to the final instalment of my three-part leaky gut blog series! In this series, we’ve been exploring everything you need to know about leaky gut syndrome. So far, we have uncovered the causes and signs of a leaky gut in part 1 of the series, and took a closer look at the impact a leaky gut can have on both your physical and mental health and wellbeing in part 2. In this third and final article, we will be pulling all this information together, discussing the practical steps you can take to heal leaky gut, using the 5-R protocol. This is the approach I learnt when receiving my training at the Institute for Functional Medicine, and I use it with all of my clients who are struggling with hormone imbalances and inflammatory issues.

What is the 5-R protocol?

The 5-R protocol is a comprehensive system used by Nutritional Therapists and Functional Medicine Practitioners to help restore optimal gut function, supporting conditions such as irritable bowel syndrome (IBS), inflammatory bowel diseases (IBD) and small intestinal bacterial overgrowth (SIBO), as well as conditions related to leaky gut such as autoimmune conditions, hormonal imbalances, arthritis, obesity and depression.

How do I follow the 5-R approach?

There are five key steps to the 5-R approach – Remove, Replace, Reinoculate, Repair and Rebalance – all of which are important for repairing and restoring gut functionality, resulting in improvements in both gut and systemic symptoms. Let’s take a look at the steps in more detail:

1. Remove

The first step is to remove anything that may be irritating the gut, causing it to become leaky. This may include removing items such as food additives and sweeteners, alcohol, caffeine, processed foods and any foods you have a specific sensitivity to (for example for some people, gluten can trigger a sensitivity). You may also want to consider non-food irritants, such as medications, infections or bacterial overgrowth. Of course, we are all unique and irritants may differ from person to person, so removing the key gut irritants listed above is a useful first step (1).

2. Replace

Digestive enzymes, bile salts and hydrochloric acid are all extremely important for proper digestion and functioning of the gut, but can be compromised by factors like poor diet, medication and bacterial overgrowth. Therefore, this step aims restore the digestive capability of the gut by replacing those enzymes and acids to reduce inflammation and restore function. This can be achieved through replacing vitamins and minerals you may be deficient in, keeping hydration levels in check and increasing protein-rich foods to support regeneration of the gut lining (1).

3. Reinoculate

As a healthy gut microbiota is vital for the health of the gut, this stage focuses on repopulating and increasing the gut flora to help the gut flourish. Consuming foods high in fibre is a great way to do this, as the microbes use fibre to create short chain fatty acids which support gut health. Adding in prebiotic foods, such as asparagus, chicory root, garlic, onions and oats will ensure your microbes have the fuel to thrive. Eating foods containing probiotics (live beneficial bacteria) or probiotic supplementation is also advised at this stage. Kimchi, sauerkraut, kefir, live yoghurt and sourdough bread are all good sources of probiotics (1).

4. Repair

Step four is all about repairing and healing the gut to restore its proper function. Remember those tight junctions we spoke about in the last article? Now is the time to focus on restoring them. This may include adding in foods or supplements which provide specific proteins or nutrients that the cells of the gut need to repair and regenerate, including bone broth, collagen powder, L-glutamine, antioxidant vitamins (A, C, E) along with anti-inflammatory omega-3 polyunsaturated fatty acids (or fish oils) (1) and curcumin which help to protect the gut lining by reducing inflammation and support the growth of healthy bacteria in the gut.

5. Rebalance

The final step in the 5-R approach moves away from diet and shines a spotlight on your wider lifestyle choices. Poor sleep, high stress and a lack of exercise are all known to cause imbalances of the gut microbiome and contribute to leaky gut, so in this stage we look at ways to improve these lifestyle factors. Meditation, yoga, movement and other stress management techniques, alongside good sleep hygiene practices are key areas that can be explored at this stage to help rebalance and realign both mind and body to support future gut and holistic health (1).

How do I start?

Firstly, let’s consider whether you have a leaky gut. While there are currently no specific tests available to confirm leaky gut syndrome, stool and/or zonulin tests may be a useful tool for identifying bacterial overgrowth or increased zonulin levels, which both point towards a leaky gut – though it is important to be aware that these tests may not accurately detect gut permeability (2). However, if you suffer with gut issues or inflammatory conditions such as those mentioned above, it suggests you are experiencing a leaky gut to some degree and you may find adopting the 5-R approach useful for improving your symptoms.

I understand looking at all five steps as a whole may feel overwhelming (so many changes to make – eek!) - but it doesn’t have to be. Work through them a step at a time and gauge how your body responds. While they are designed to be followed one after the other, each stage is a step in the right direction to improving the health of your gut so even just trying one will help. Why not pick the step that feels most achievable and begin with that? You can then decide whether to continue or move onto the other stages – what is most important is using the approach that is sustainable and works for you. Another option is to look at working with a Nutritionist, who can help you uncover the root cause of your symptoms and support you implement the 5-R protocol in a way that suits your wants and needs – this can be particularly useful if you have a lot of complex health issues.

Have you tried the 5-R protocol to help manage your inflammatory symptoms? I would love to hear about your experiences. Drop me a comment below.

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  1. The Institute for Functional Medicine. 2020. 5R Framework for Gut Health. Available at: (Accessed: 13th July 2020)

  2. Ajamian, M., Steer, D., Rosella, G., Gibson, P.R. D’Auria, S. 2019. Serum zonulin as a marker of intestinal mucosal barrier function: May not be what it seems. PLoS ONE, 14 (1), e0210728