This approach to restoring a healthy gut-immune barrier includes four steps: 1) removing mucosal irritants, 2) replacing agents for digestive support, 3) reinoculating with friendly bacteria and the foods they need to grow, and 4) repairing the mucosal lining.

1. Remove mucosal irritants such as allergenic foods, alcohol, medications
   and stress.
   • Recommend an elimination diet
     • Start with gluten (wheat) and dairy
     • See handout on “Elimination Diet”
   • Remove medications if possible
     • Long-term antibiotics
     • Non-steroidal anti-inflammatory medications (Ibuprofen, Naproxen, etc.)
     • Prednisone
     • Prolonged use of acid-suppressing drugs (proton pump inhibitors, H2 blockers)
   • Reduce simple sugars, refined carbohydrates, saturated fat and red meat to adopt a diet that reduces inflammation.
     • See handout on Glycemic Index
     • See handout on Anti-Inflammatory Diet (clinician version)  (patient version)
   • Treat possible pathogens (c. difficile colitis, H. Pylori, parasites, etc.)
   • Reduce perception of stress and
     stress triggers
     • Suggest a Mindfulness Based Stress Reduction course
     • Refer patients to the following handouts:
       • Breathing Exercise. (Gastric
         acid secreted is stimulated by the vagus nerve. Deep breathing exercises can induce relaxation and proper acidity in the GI tract.)
       • Meditation for Health and Happiness (patient version)
       • Loving-Kindness Meditation
2. Replace agents for digestive support. (This step may not be necessary).
   • • • • Consider a short course of pancreatic enzymes and in some cases Betaine HCL if low acidity.
     • If needed, consider prescribing a product called Pancrease MT 10, 1-2 capsules before each meal for a short period of time until the digestive process improves. The patient should not need these enzymes for a long period of time (more than 3 months). They are used just until the GI mucosa has time to return to optimal state of health.
     • If more acid is needed, recommend Betaine HCL for a short period of time until symptoms resolve.

This commonly comes in a dose of 10 grains (648 mg). The patient can use 1-3 tablets with each meal. Direct the patient to start with one and increase to 3. If there is any burning sensation in the stomach, the dose should be decreased by one pill. As the stomach develops the ability to create its own acid, a warm feeling may develop that would signal the need to taper off this supplement. This supplement should not be used for longer than one month