Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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The 4R Gut Rebuilding Program Summary

Discussion in 'The Gut: De Meirleir & Maes; H2S; Leaky Gut' started by caledonia, Oct 10, 2013.

  1. The 4R Gut Rebuilding Program was first developed by the Institute of Functional Medicine, and this seems to be the best way to go about healing the gut.

    Unfortunately there is no good single source online that I can point you to, and everyone seems to have their own slightly different way of doing it, so I've come up with this summary of research about the program. (attached)

    A functional medicine doctor, naturopath or holistic doctor would be the kind of doctor to help you with this. You should interview them first to see if they do testing and what kind, and do all the steps, not just some of them.

    New version posted 9-11-2014 - fixed broken article link for the
    Liska / Lukaczer article reference.

    Attached Files:

    Last edited: Sep 11, 2014
    Hilary, CedarHome, MissCB and 12 others like this.
  2. Gestalt

    Gestalt Senior Member

    Thanks for putting that together.

    the metametrix guide link does not work in the pdf fyi
  3. Gestalt Thanks for the heads up on the link not working. I checked into it - this is weird. Sometimes the link works, and sometimes it doesn't.

    You can also try going to and clicking on the "Interpretive Guide" link in the right hand column. Again, sometimes it works and sometimes it doesn't.

    You can also cut and paste the links into your browser. Again, it may work, or it may not.

    This seems to be some sort of glitch on the part of the Metametrix website, and hopefully, it will clear up eventually.


    Edited 7-2-2015 to add a better link:
    Last edited: Jul 2, 2015
  4. Soundthealarm21

    Soundthealarm21 Senior Member

    Dallas, TX
    I just saw a Functional medicine doctor yesterday and the first thing we're starting on is the 4R Gut rebuilding program. Switching to this Paleo diet is going to be a challenge as it's so incredibly restrictive. I'm on day two of elimination and it's not been too bad. We'll see how it goes over the coming months. I believe this will be very helpful before I get methylation pumping. Gotta support the gut and the cells.
    ljimbo423 and caledonia like this.
  5. Christopher

    Christopher Senior Member

    Whenever I eat carbs, I tend to get bloated and then have an increase in neurological symptoms. Whatever pathogens I have in my gut, carbs feed it and make my symptoms worse.
  6. Soundthealarm21

    Soundthealarm21 Senior Member

    Dallas, TX
    I'm just gonna post a little update on my diet.

    It's pretty much strictly Paleo (There are a few things my doc allows that I don't believe fit Paleo/ ex: Brown Rice)
    There was a noticeable difference within a week. I felt great, my mood relaxed, my body relaxed and all was well. Then I went through a rough detox period (no new supplements) for a few days just from the diet alone.

    Several weeks in the food was starting to get bland until I learned just how important fats are to the diet! We've all been brought up to believe low fat, no fat, fats are bad. After reading "Grain Brain" and dozens of studies and just basic biochemistry I realized how important and essential fats are and that one can eat them and eat plenty of them. So now my food is great and I don't really miss the carbs at all (Bread every once in a while). I eat plenty of eggs, bacon, sausage, nuts, grass fed meats w/ fat, etc.

    About 2 weeks ago I added in Phosphatdylcholine (2 capsules 3x day) and also the probiotic VSL3 (2 caps 3x day) plus eating raw sauerkraut and Kombucha tea. Hopefully it is doing its thing.

    I started taking Body Bio's Cal-Mag Butyrate and that has absolutely kicked my butt. So I have backed off of that and will start it again at a lower dose and do it every other day.

    Along with that I got my Yasko and 23andMe results back (SNPs listed below in signature) and am now waiting for my doctor to let me know she has the other tests in (ZRT Saliva test, Stool Test, Fatty Acid Profile, etc.) and we can proceed from there.
    ljimbo423 likes this.
  7. JalapenoLuv


    It's a mistake to say "remove all GMO foods from the diet." The problem isn't that foods are GMO but that some conventional GMO crops are sprayed with roundup pesticide, people eat this pesticide and it destroys their intestinal bacteria.

    A better way is to avoid the dirty dozen high pesticide foods as well as US wheat and corn.

    I've heard that GMO regulations are different in the UK so someone else can comment whether roundup (glycophosate) contaminated produce is a problem there.
  8. liverock

    liverock Senior Member


    (Part 2 is available to click on at the end of part 1)

    The health of the gut determines the health of the body. This is a well-known fact. There are roughly 100 trillion cells inside our bodies, yet the there about 10x as many cells of bacteria living on our bodies. This mass of bacteria lives in harmony with us (most of the time) and helps make sure our immune system is functioning and we are able to digest our food. Without these bacteria in our gut and on our skin, we wouldn’t survive long.

    That is all good news but what happens when these bacteria become imbalanced? What are the implications to our health when we have an overgrowth of bacteria in the gut? As we will see, when the small intestine is overwhelmed with bacteria (diagnosed as Small Intestine Bacterial Overgrowth – SIBO) it can have major impacts on our methylation cycle…it can make methylation problems much worse!

    As a quick reminder, those of us with MTHFR, PEMT, MTR, MTRR, etc. have defects in how well we recycle homocysteine and how well we convert folic acid into folate. Many of you are aware of Dr. Lynch and his concept that folic acid is a toxin for those with MTHFR. While there is still some debate about this issue, Dr. Lynch is right on when he points out that having too much folic acid can impair the methylation cycle. Here is how it works:

    1) Folic acid comes from fortified food AND from gut bacteria. Yes, you heard that right…folic acid is a NATURAL by product of the metabolism of bacteria that live in our intestines, mainly the colon. Every person on earth gets some folic acid into their bodies from the action of our gut bacteria.

    We get in trouble when the bacteria in our colon grows and moves into the small intestine. Normally only a small amount of bacteria is found in the small intestine, but when the digestive system becomes imbalanced the population of bacteria in the small intestine can increase, creating a condition of SIBO.

    2) Folic acid and folate both enter the cell through the same receptor. If there is an excess of folic acid, it is harder for the folate to get into the cell. The more folic acid you have inside your blood stream, the less often folate will get to the receptor. In other words, there is competition between folic acid and folate, and when folic acid is elevated, it wins the competition to enter the cell.

    3) In a person WITHOUT MTHFR issues, this poses zero problems since folic acid is rapidly converted to folate in their methylation cycle. For the rest of us however excess folic acid makes it harder for us to create methyl donors. Since MTHFR is often slowed down along with MTR, MTRR, BHMT and other SNPs, having high doses of folic acid may slow down the methylation cycle. This is why folic acid in high amounts can be a problem.

    There is new research that shows that the bacteria involved with SIBO actually poop out large amounts of folic acid (yes the dreaded folic acid!) and we absorb that folic acid into our bodies. Many individuals with MTHFR C677T/A1298C, MTR, BHMT, etc. may have symptoms of under- or overmethylation due solely to the excess folic acid from improper gut bacteria and digestion. An imbalance of the gut bacteria, namely in the small intestine, is a major reason WHY an individual has elevated unmetatoblized folic acid. If we are going to balance methylation pathways, we need to control how much folic acid gets into the system. – we have to control the gut!

    In other words, until the gut infection is properly taken care of, the methylation cycle is at the mercy of what is happening in the gut. The same is true of important vitamins like choline, B12, vitamin D, protein, etc…the gut imbalance makes it very difficult to absorb these vitamins. Side effects from vitamins are most commonly due to an untreated gut problem.

    When someone has SIBO, or an overgrowth of “non-pathogenic” (aka normal species of gut flora) bacteria in the small intestine, the bacterial infection can produce EXCESS AMOUNTS OF FOLIC ACID! Too many bacteria in your gut, can lead to way too much folic acid being released and absorbed. This can lead to high blood levels of folic acid, which as Dr. Lynch and other researchers have shown, can impair the methylation cycle in people with MTHFR and other genes. What I have just discovered is that one important and often-overlooked source of this increased, UNMETABOLIZED Folic Acid is a raging Gut Infection!

    This gut infection, aka SIBO, is an infection made up of non-infectious bacteria. Meaning, its not an infection in the traditional sense, its an overgrowth of something that should normally be there, only exists in way too high of a quantity. This is a problem since the bacteria down there can produce folic acid while at the same time causing all kinds of other digestive issues.

    As I will show in the next video, SIBO can be caused by antibiotics, proton-pump inhibitor drugs, chronic leaky gut, ileocecal valve dysfunction, and chronic stress. All of these triggers make it easier for the bacteria that normally lives in the colon, to make its way up into the small intestine where it doesn’t belong. In fact, those individuals who have been on long-term antibiotics and/or proton-pump inhibitors often have the most challenging methylation issues. The reason is that those drugs – antibiotics and acid reflux medication – make is much more likely to get a Small Intestine Bacterial Overgrowth. And with SIBO comes excess folic acid, low b12 and a host other malnutrition/methylation issues.

    Common health issues associated with SIBO include:

    • Low B12
    • High Folic Acid
    • Low Iron
    • Low Vitamin A, D, E, and K
    • Low Omega 3’s and other fatty acids
    • Difficulty gaining weight / failure to thrive
    • Gas
    • Diarrhea
    • Bloating
    • Abdominal Pain
    • Food in stool
    • Fat in stool
    • GB disease
    • Acid reflux
    • Malabsorption
    • Difficuly losing weight / obesity
    • and much more…
    Many patients with methylation issues are dealing with the symptoms I’ve just listed above. The take away point is to realize that in order to heal the methylation cycle, you have to heal the gut. Every supplement you take, every food, every beverage interacts with the bacteria in your gut. If the gut is imbalanced and you have too much bacteria in the small intestine, you are likely going to have luke warm results until you treat the gut problem. If someone is suffering from a digestive problem like SIBO with symptoms like the ones I’ve listed, it is going to be very difficult to fix the methylation issues until the gut is working better.

    Because the bacteria in the small intestine have the ability to produce folic acid, many patients are suffering because their body is full of folic acid and they don’t have enough folate. Dr. Lynch demonstrates that because folic acid can starve the cell of needed folate (L 5-methyltetrahydrofolate) it can weaken the methylation cycle. And since the SIBO infection continously produces folic acid, I’m not sure taking more folate is the answer.

    In our office we have learned to treat the gut first, making sure to clear out the gut infection before embarking on supporting methylation. Through trial and error we have learned that until the gut bacteria is working properly, there cannot be methylation balance. The research discussed in the videos above also supports this idea as well. We all know having too much folic acid can create an imbalance. I believe the many patients with digestive symptoms like bloating, reflux, gas, and abdominal pain of a chronic nature are suffering from some form of SIBO. I also believe that unmetabolized folic acid is a SIDE EFFECT of a gut infection. Even if someone avoids fortified foods and high doses of folic acid, just having SIBO means they can still be absorbing folic acid directly from the gut itself.

    If you or someone you know is dealing with digestive issues and is concerned about methylation problems, then please contact my office. We have developed effective, safe, and natural approaches to clear the gut infection quickly to make way for the more long-term healing methylation support. Once the gut has been restored and is working properly, the body will be able to heal much more effectively and the methylation cycle can then be addressed.

    Yours In Health,

    Dr. Rostenberg
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  9. @liverock Very interesting - thanks for posting. This is yet another reason why you should always start with treating the gut first before diving into methylation.
    NK17 and liverock like this.
  10. jepps

    jepps Senior Member

    In this link Chris Kressers explains a potential strategy to treat SIBO:
  11. JalapenoLuv


    GMO roundup is anti-microbial. How about just eating Captain Crunch, pasta and Prego tomato sauce for a few days to sterlize the gut? It's cheaper.
  12. Peyt

    Peyt Senior Member

    Has anyone actually been to Dr. Rostenberg? I have SIBO and appreciate the fact that he has made a video series on it, but not sure what I can expect if I become a patient. I called his office a couple of months ago and they said he charges by the minute(on the phone) ... Never made the appointment. would love to read some reviews. Thanks so much.
  13. CedarHome


    RE: Gut Rebuilding Program Summary
    Okay, just when I was thinking I had a bare beginning of understanding methylation protocols, and could begin to think about gut rebuilding....but where to start?!

    @ Caledonia to the rescue AGAIN!! :angel::nerd::balloons:
    caledonia likes this.

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