The 4R Program To Promote Gastrointestinal Health

The 4R Program to promote gastrointestinal health, developed by Jeffrey Bland, Ph.D., and his associates at the Functional Medicine Institute, is an extremely effective way to address and treat gastrointestinal dysfunctions and promote gastrointestinal health. It is a simple four-step program, and it is what I use with my patients:

The program simplifies the complex interactions in gastrointestinal health by asking four questions:

  1. What needs to be REMOVED?
  2. What needs to be REPLACED?
  3. Does one need to RE-INOCULATE with probiotics?
  4. Does the intestinal lining need to be REPAIRED?

Step 1: Remove

  • Toxins in food
  • Gastric irritants (e.g., caffeine, alcohol, and non-steroidal anti-inflammatory drugs)
  • Food allergies, sensitivities, or reactions
  • Chronic low-grade infections in the gut (e.g., yeast and parasites)

Step 2: Replace

  • Stomach acid (or stimulate stomach acid with bitters)
  • Digestive enzymes

Step 3: Reinoculate

  • Restore beneficial bacteria to reestablish a healthy balance of microflora in the gut.

Step 4: Repair

  • Provide nutrients to heal the gut wall or lining.
  • Support the immune functioning of the gut.


For Dr. Frank Lipman, health is more than just the absence of disease: it is a total state of physical, mental, emotional, spiritual and social wellbeing. Dr. Lipman is a widely recognized trailblazer and leader in functional and integrative medicine, and he is a New York Times best-selling author of five books, How To Be Well, The New Health Rules, 10 Reasons You Feel Old and Get Fat, Revive and Total Renewal.

After his initial medical training in his native South Africa, Dr. Lipman spent 18 months working at clinics in the bush. He became familiar with the local traditional healers, called sangomas, which kindled his interest in non-Western healing modalities.

In 1984, Dr. Lipman immigrated to the United States, where he became the chief medical resident at Lincoln Hospital in Bronx, NY. While there, he became fascinated by the hospital’s addiction clinic, which used acupuncture and Chinese medicine to treat people suffering from heroin and crack addiction. Seeing the way these patients responded so positively to acupuncture made him even more aware of the potential of implementing non- Western medicine to promote holistic wellbeing. As a medical student, he was taught to focus on the disease rather than the patient, and now as a doctor he found himself treating symptoms rather than the root causes of illness. Frustrated by the constraints of his training, and the limitations in helping his patients regain true health, he began a journey of discovery to search for the path to meaningful long-term health and wellness.

He began studying nutrition, acupuncture, Chinese medicine, herbal medicine, functional medicine, biofeedback, meditation, and yoga. Dr. Lipman founded the Eleven Eleven Wellness Center in 1992, where he combines the best of Western medicine and cutting edge nutritional science with age-old healing techniques from the East. As his patient chef Seamus Mullen told The New York Times, "If antibiotics are right, he'll try it. If it's an anti-inflammatory diet, he’ll do that. He’s looking at the body as a system rather than looking at isolated things."

In addition to his practice, Dr. Lipman is the creator of Be Well, an expanding lifestyle wellness brand he founded in 2010 to help people create, sustain and lead healthier lives.