How The 4R Approach Can Heal Your Gut

Updated: 3.2026

Are you wondering if too many antibiotics have affected your gut health and digestion?

I remember calling the doctor, begging for antibiotics for yet another UTI, as a young adult.

In the end, the antibiotics never helped my UTIs; addressing my gut health and healing with herbal medicine did.

By the end of this post, you'll understand how the 4R approach, now called the 5R approach - taught by a functional medicine doctor, can help heal Clostridioides difficile {a.k.a. C. diff.}, leaky gut syndrome, and unwanted digestive issues you may be experiencing from too many antibiotics.

We know antibiotics destroy the good and the bad bacteria in your gut.

We all have Clostridioides difficile bacteria, but when we kill off too many of the “good guys”, digestive issues happen, and even Clostridioides difficile, which is life-threatening.

If you don't replace these good bacteria, it can lead to something called leaky gut syndrome. 

What is leaky gut syndrome?

Leaky Gut Syndrome

• Leaky gut syndrome (LGS) is when fragments of protein and bacteria cross the tight junctions of your gut wall, and your body recognizes these fragments as invaders and mounts an inflammatory response to your immune system.

• Envision the tight junctions of your digestion, like fingers. Spread your hand out, and notice the gaps between your fingers.  This is what it looks like when the junctions open.

• Food and medications that irritate your gut

  • Have you noticed Advil or Tylenol bother your stomach? This is a sign to heal your gut.

• Antibiotics and medications

  • Think about diarrhea after a round of antibiotics

10 Signs You May Have "Leaky Gut Syndrome."

1. Digestion problems- i.e., bloating, constipation, and/or diarrhea

2. Food intolerance-i.e,. avoiding meat, dairy, and/or gluten

3. Seasonal allergies

4. Skin complaints: acne, skin rash, etc.- your back, your tush, and the back of your arms included

5. Autoimmune disorder

6. Tired/ poor concentration

7. Anxiety & depression

8. Candida overgrowth

9. Cannot lose weight

10. Your joints ache

So, how do you “heal your gut”?

It’s called The 4R Approach, or sometimes the 5R Approach

What is the 4R approach?

• It's a method created by functional medicine doctors to address the underlying causes of gut imbalances and restore harmony, helping alleviate symptoms and maybe even disease.

The program suggests you: Remove> Reinoculate> Repair> Reintroduce> Rebalance

Step #1: Remove

• Take out what inflames you. 

• Remove the top allergens: wheat, corn, eggs, dairy, peanuts, and soybeans. {If you can't give up dairy...goat cheese and goat milk may be easier on your digestion}

• Add in whole grains (like quinoa and rice), organic vegetables, fruit, and healthy fats. 

• Remove allergens for 4-6 weeks, or it may take up to a year to heal your gut with an autoimmune disease.

• Encourage whole, organic foods if able, and consider shopping the perimeter of the grocery store.

• Ayurvedic Kitcheri recipes are often suggested to reduce inflammation.

Step #2: Replace

• After 2-4 weeks on the Elimination diet, introduce a good-quality digestive enzyme containing protease, lipase, amylase, and pepsin. 

  • This is safe for pregnant and breastfeeding women, too. I like Digest Gold by Enzymedica.  If you log in to my supplement store, you'll receive 15% off the suggested products.  Look under gut health for my suggestions. 

• Adding bitters, like  Urban Moonshine Bitters, will trigger the digestive system to produce digestive enzymes, secrete bile, and balance HCI levels in the stomach.  

  • Take bitters 10-15 minutes before your meal.

• If you have a lot of nausea with meals or when you take supplements, you might also need some additional stomach acid in the form of a supplement called Betaine HCL, or try 1 Tbs. of apple cider vinegar in water with your meals. 

Step #3: Reinoculate

• Wait 2 weeks for the elimination diet or up to 6 weeks. 

• Keep in mind that adding a probiotic can give you gas and bloating if you do not remove the allergens first.

• Add a good-quality probiotic to restore your gut flora.  I like Klair probiotics. There is also an infant formula for babies and young children struggling with dairy allergies. 

  • You want it to have a minimum of 10 billion CFU in each dose, and a good range of Lactobacillus and Bifidobacteria species.

    • Also fermented foods such as miso, sauerkraut, and kimchee can be a helpful advantage to your gut, add it to your diet 3-4x week. Although very delicious, kombucha can be high in sugar, so consider using it sparingly.

Step #4: Repair your Gut

Include the following supplements for 6 weeks or more to repair your gut. The following supplements can be taken for up to 6 months to help to heal the intestinal lining:

• Turmeric

• Aloe vera

• Marshmallow root powder

• DGL licorice (aloe and licorice are not for internal use during pregnancy; these are fine for children) are some of the most effective herbs for healing the gut lining.

  • They are best taken in capsule or extract form, though turmeric can also be added to foods.

  • DGL or diglyceride licorice is a great alternative to Tums and does not raise your blood pressure.

  • DGL licorice is available as chewable lozenges.

  • Zinc

• Dosing: 25-40 mg/day for older children and adults.

  1. Take zinc with food to prevent nausea.

  2. Caution: Too much zinc WITHOUT copper can affect your iron levels.

Fish oil:

• I prefer Carlson's fish oil

• Fish oil is essential for general health in pregnancy and breastfeeding, too.

• L-glutamine powder: 5- 10 gm of powder twice daily for one month.

Step #5: Rebalance

• Newly added. We’re addressing your overall lifestyle; looking at what’s inflaming your gut, your exercise, your sleep, your hormones, and blood markers.

Here are examples of other practitioners using the 4R approach for healing

• The Chopra Center

• Amy Myers

• Constipation & children Sheila Kilbane, MD

• Dr. Axe

Conclusion

If you're struggling with digestive issues and find you're avoiding foods, there is hope.  The 4R approach (also called the 5R approach) is more than an elimination diet for 4-6 weeks or sometimes up to a year with autoimmune disorders.

Practicing this yearly can heal your digestive tract and reduce bloating, gas, diarrhea, and constipation for years to come, and you may be able to enjoy gluten and dairy once in a while after you heal!

xo

Tara

See the products I love that are safe while breastfeeding

• https://www.taragregorio.com/blog/how-i-healed-postpartum-anxiety-by-addressing-my-gut-health