How to Reset Your Gut Naturally: A Guide to the “4 R” Approach

Guides to doing a “gut health reset” often promise to get your gut back on track in a week or less. While it’s true that following simple steps can help you feel better in the short term, truly healing your gut requires identifying the root of your symptoms and committing to a lifestyle of gut-friendly habits.

Your gut gets assaulted from multiple angles throughout your life. Ultra-processed foods, antibiotics and even environmental chemicals can change how your gut functions and create a cycle of inflammation, damage and symptoms that increasingly worsens. Damage that takes years to develop doesn’t go away in a few days, but with time, it is possible to eliminate triggers, stop the cycle and give your gut what it needs to heal itself.

Causes of poor gut health

Your gut is equipped with collections of immune cells called gut-associated lymphoid tissue (GALT). The GALT works with other parts of the immune system to identify, target and eliminate pathogens and antigens in the gut environment.

Inflammation is a natural part of this process, and it usually calms down once the invader is removed. But a constant influx of pro-inflammatory or allergenic foods can overstimulate your immune system and cause chronic inflammation that damages the intestinal barrier—a lining of cells that prevents food and microbes from escaping into your bloodstream.

Inflammation can cause tight junctions in the intestinal barrier to open up, a condition known as increased permeability or “leaky gut.” Large particles like bacterial toxins and partially digested proteins can leave the gut through these spaces and trigger immune responses and inflammation elsewhere in your body, leading to systemic symptoms.

Signs you may need a gut health reset

Symptoms like bloating, gas, constipation, diarrhea or abdominal pain are often the first signs of problems with gut health. As the cycle progresses and permeability increases, you may also experience:

• Fatigue
• Rashes
• Joint or muscle aches
• Food intolerances
• Recurring infections
• Unexplainable fevers
• Mood swings
• Confusion or fuzzy thinking
• Environmental cross-reactions
• Mouth sores or lesions
• Cracks in or around the lips
• Autoimmune reactions
• Unexplained weight changes

Having one or two symptoms isn’t likely a cause for concern, but multiple new, persistent or worsening issues could be a sign that you need a gut health reset.

How to reset your gut naturally

The term “reset” is a bit misleading; it suggests a quick process like rebooting a computer. A true reset is more like wiping your hard drive and starting fresh from the factory settings: it’s longer and more complicated, but it’s the best way to finally resolve longstanding problems.

Jeffrey Bland, Ph.D. and founder of the Institute For Functional Medicine developed a gut health program called “4 R” that’s still widely used among practitioners of functional medicine and integrative wellness. It progressively addresses the potential causes of gut issues in four steps:

• Remove
• Replace
• Reinoculate
• Repair

Bland recommends following this gut reset for a total of 12 weeks. Healing may take longer if your gut has been subject to repeated assaults.

Cautions and considerations before starting a gut reset

Ruling out underlying infections or conditions before doing a gut health reset is critical. If you’ve been experiencing gut problems for a long time or you recently developed abdominal pain or a change in bowel habits, consider testing for:

• Small intestine bacterial overgrowth (SIBO), a condition where too many microbes grow in your small intestine
• Helicobacter pylori, a bacteria that can cause bloating, stomach pain and ulcers
• Functional gastrointestinal problems, such as gastroparesis or hiatal hernia
• True food allergies that provoke immune reactions
• Active gastrointestinal infections

If you have one of these conditions, the 4 R approach could make your gut health worse instead of better. Other factors like stress, exercise and toxin exposure may also contribute to gut inflammation and should be addressed as part of your regimen.

Consult with your doctor or a qualified functional medical professional before starting the 4 R program, and check in with them regularly for support and symptom updates throughout the process.

The 4-Step Gut Health Reset

1) Remove irritating foods and chemicals

The first step in 4 R aims to remove known and potential causes of gut inflammation, including:

• Pathogens and parasites
• Internal and external toxins
• Nutrient-poor foods like refined grains and sugar
• Low-quality fats and oils
• Foods to which you’re allergic or intolerant

In place of these foods, focus on eating:

• Gluten-free whole grains like quinoa, millet and brown rice
• Fresh, frozen or lightly cooked fruits and vegetables
• Allergy-friendly seeds like pumpkin, sunflower and flax
• Proteins like beans, fish and poultry
• Mushrooms

You may use oils like avocado, flax and cold-pressed extra-virgin olive along with your favorite herbs and spices to cook and season your meals.

In her book, Digestive Wellness, Elizabeth Lipski, Ph.D., CCN, CHN, recommends following this process, known as an elimination diet, for two weeks to three months. You may need to exclude additional foods during this time if your symptoms are severe or you have multiple known food allergies.

2) Replace missing digestive aids

Step two supports healthy digestion by replacing or stimulating the things that help your body break down and absorb food, such as hydrochloric acid (HCl), digestive enzymes and bile. Several supplements can be helpful during this phase, including:

• Digestive bitters to support gastric secretions involved in digestion^†
• Digestive enzymes, with or without HCl, to make it easier for your body to process proteins, fats and carbohydrates^†
• Liver detox formulas to help remove pro-inflammatory toxins and compounds^†

Get tested to determine which, if any, of these supplements may benefit you. Take only what you need; overdoing it on enzymes or HCl can cause bloating, gas or heartburn.

3) Reinoculate the gut with healthy microbes

Following the first two steps should help your gut calm down and heal enough to be a good environment for the beneficial gut bacteria introduced in the third phase. In Clinical Nutrition: A Functional Approach, Bland cites several probiotic species commonly used to bring balance back to the gut:

• Lactobacillus acidophilus
• bulgaricus
• thermophilus
• Bifidobacterium bifidus
• longum
• breve

Re-introducing these beneficial bacteria may help regulate inflammation, support tight junctions in the gut barrier and promote the production of beneficial byproducts that support the healing process.

Adding prebiotic fiber feeds probiotic species and helps them thrive. You can find supplements that contain both, but the best way to support probiotic bacteria is to eat a high-fiber diet like the one you began in the Remove phase. Fermented foods also contain small amounts of beneficial bacteria, so if you can tolerate them without symptoms, you can try adding sauerkraut, kefir, yogurt or tempeh.

4) Repair damage and soothe irritation^†

In the final step, you’ll focus on supplements that support healthy immune responses, promote healing of the gut lining and provide nutrients that support good gut function, including:

• L-glutamine, an amino acid that fuels cells in the gut lining and supports healthy production of an antibody called sIgA, a GALT defense mechanism that protects the gut from toxins and pathogens^†
• Zinc carnosine, a form of zinc that acts as an antioxidant and supports healing of the gut lining^†
• Quercetin, an antioxidant that supports healthy immune responses^†
• Deglycyrrhizinated licorice, which soothes the gut and may promote healthy cell growth^†
• Ginger and turmeric, two herbs known for their anti-inflammatory and antioxidant activities^†
• N-acetyl-glucosamine to support the production of proteins called glycosaminoglycans (GAGs), which are essential components of gut tissue
• N-acetyl-cysteine to support detoxification, gut immunity and tissue health^†
• Vitamins A, C and E to support immune function, sIgA production and antioxidant activity^†
• Manganese to promote tissue healing^†

The exact combination of supplements you use will depend on your personal needs, such as the level of inflammation, severity of symptoms and extent of gut damage. You can usually find products that combine several gut health supplements so you don’t have to take dozens of pills every day.^†

What to do after your gut health reset

The final phase after finishing all four steps is sometimes called the fifth R: “Rebalance.” During this time, you’ll work on adjusting your diet to re-incorporate foods you can now tolerate while continuing to avoid pro-inflammatory foods, oils and additives. It’s also the time to develop habits like stress reduction and regular exercise.

Resetting your gut for long-term health means committing to an intense regimen for three or more months and sticking with a gut-friendly diet when it’s over. But it’s worth the effort if you can finally start feeling better.

Note that the 4 R approach is just one type of gut health reset. It doesn’t work for everyone, and it’s not meant to address serious gut issues like IBD. Remember to consult with a medical professional before starting this or any gut reset program.

For further reading on gut health and resetting your gut

• The Best Supplements For Gut Health: A Health Coach Shares Her Top Picks
• What is a Digestive Detox? A Gut Health Expert Explains
• Is Your Colon OK? Signs That Something May be Wrong (Plus, Tips for Everyday Care)
• Optimal Digestive Health: A Complete Guide, edited by Trent W. Nichols, MD & Nancy Faass, MSW, MPH
• Digestive Wellness by Elizabeth Lipski, Ph.D., CCN, CHN

^†These statements have not been approved by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent disease.