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Diabetes is More Than Just Controlling Blood Sugar

Diabetes is More Than Just Controlling Blood Sugar
February 4, 2019 Patrick Nemechek, D.O.

The growth in our understanding about why people develop Diabetes Mellitus Type 2 (DMT2) is greatly out-pacing our present treatment strategy.

In the early 1900’s, the primary fear about getting DMT2 was from the very elevated levels of blood sugar (glucose in the 400-700 mg/dl range) that would trigger a deadly condition called diabetic ketoacidosis.  Diabetic ketoacidosis is very different than the mild ketoacidosis that occurs from restricting carbohydrates in the diet.

In 1921 insulin was discovered and the fatal complication of diabetic ketoacidosis was now, in many cases, avoided.

Now instead of dying from a diabetic coma, patients were living longer and their more common cause of death from DMT2 was the consequence of chronically elevated blood sugar within the blood stream. 

Atherosclerosis in DMT2 occurs when the blood sugar (glucose greatly than 137 or a HgbA1c level greater than 6.4%) is not enough to trigger the deadly ketoacidosis but it is enough to act as a toxic irritant to the surface of the blood vessels.  The chronic toxic nature of this concentration in diabetes of blood sugar damages the inner lining of the blood vessels and leads to blindness, kidney failure, amputations, and premature death.

In the more modern era, the development of additional blood sugar-lowering medications has given diabetics the ability to maintain their blood sugar HgbA1C levels less than 6.4%.  Keeping one’s blood sugar in this range greatly reduces the toxic complications of blindness, numbness in the feet, kidney failure and amputations, and greatly increases survival.

Today our understanding about DMT2 has grown even further.  There is overwhelming evidence that DMT2 is fueled by a chronic elevation of inflammation chemicals released by white blood cells.  Known as pro-inflammatory cytokines, these chemicals circulate throughout the blood stream and are capable of triggering a wide array of genetic disorders including DMT2.

These proinflammatory cytokines not only turn on the gene(s) that trigger DMT2, they also influence the level of abnormal blood sugar elevation.  The higher the levels of inflammatory cytokines in someone with a gene for DMT2, the higher their blood sugar level.  And conversely, the lower the cytokine levels, the lower their blood sugar.

These inflammatory cytokines also activate other genes leading to the development of cancer, hypertension, Alzheimer’s dementia, and can cause direct damage to the tissues throughout the body which leads to sensory neuropathy (numbness in the feet), osteoarthritis, heart disease, osteoporosis and most dangerously, damage to the autonomic nervous system. 

Unfortunately, the present goal of diabetes management of reducing blood sugars without also focusing on the elevated cytokine levels has led to continued high rates of sudden death, cancer, and Alzheimer’s in patients whose blood sugar levels are “under control”.

Insulin, metformin, and the ever-growing number of prescription medications that lower blood sugar do little to nothing to lower inflammation.  The toxic effects of inflammatory cytokines continue to damage the body and activate other dangerous genes continues unabated.

The persistent elevation of inflammation is why patients with controlled diabetes have a much higher incidence of cancer, strokes, and heart attacks than people without a diagnosis of DMT2.

Furthermore, the single most common cause of death in individuals with DMT2 is due to direct inflammatory damage of the autonomic nervous system; a condition known as diabetic autonomic neuropathy or cardiac autonomic neuropathy (CAN). 

Cardiac autonomic neuropathy is a profound weakened state of the parasympathetic branch of the autonomic nervous system and results in the instability of heart rate control.  Diabetics have other autonomic issues from parasympathetic dysfunction such as bloating, heartburn, constipation, widely fluctuating blood pressure, and gastroparesis.

In fact, the autonomic nervous system of a diabetic prematurely ages because of inflammation and often has a functional capacity of someone approximately 20 years older than a person the same age without diabetes.  Autonomic function is critical to maintaining good health and a prolonged lifespan because a healthy autonomic nervous system is required for your brain to properly control your heart.

Patients die from sudden cardiac death due to cardiac autonomic neuropathy because their heart rates will suddenly jump to 300 beats per minute, so they cannot maintain any blood pressure at this point, and then they die of cardiovascular system collapse.  In 2016, the SAVOR-TIMI 53 Trial determined that approximately 1/3 of deaths in persons with DMT2 were caused by sudden cardiac death.

There are no symptoms or warning signs as cardiac autonomic neuropathy silently develops.  It can be easily detected with a physician’s common electrocardiogram (ECG or EKG) through a measurement known as heart rate variability (HRV).  If it is detected death can easily be prevented by reversing the underlying inflammation or blocking the arrhythmia with medication but unfortunately most modern ECG machines do not provide physicians with that simple information.

The Nemechek Protocol® was developed with this condition in mind, and CAN was the reason why I became interested in testing and treating the autonomic nervous system.  Cardiac autonomic neuropathy can easily be detected by assessing the autonomic nervous system with a simple 17-minute test known as spectral analysis. 

Once detected, my patients are started on The Nemechek Protocol® and their cardiac autonomic neuropathy (CAN) is often reversed in 3 to 5 months.  During that time, patients are temporarily placed on a medication that greatly reduces the risk of sudden cardiac death from occurring while the protocol allows the autonomic nervous system to recover.

Over the last few decades we have witnessed DMT2 is occurring in younger and younger individuals.  This is because the abnormal elevation of chronic inflammatory cytokines is beginning at younger and younger ages as well.

If you have diabetes, there are several things you can do to prevent yourself from dying from CAN and sudden cardiac death.

First, ask your physician to refer you to a cardiologist capable of determine whether cardiac autonomic neuropathy exists.  Second, study and learn everything you can about chronic metabolic inflammation and how it affects your health.

And finally, start developing a program to lower your inflammatory cytokines. The Nemechek Protocol® is a great place to start.  Supplementing your diet with omega 3’s (fish oil), omega 9’s (extra virgin olive oil) and reducing your intake of calories, carbohydrates, and advanced glycation end products (AGE’s are abnormal molecules formed when food is cooked quickly and at high temperatures) all have an additive effect on lower inflammation and helping your autonomic nervous system to recover.

With time you will be able to detect the reduction of inflammation in your blood work.  Look for reductions in your fasting blood sugar, HgbA1c level, and your triglycerides.  Reductions in those numbers are all indications that your inflammation is declining.  Additional tests such as the highly sensitive C-reactive protein (hsCRP) will also decline once your inflammation is lowered.

The Nemechek Protocol® also encompasses the use of transcutaneous Vagus nerve stimulation to get substantial recovery of autonomic function.  This is a type of electric neuromodulation to the Vagus nerve which completely controls inflammation throughout the body.

Diabetes management is no longer just about taking pills to keep blood sugar levels low, because diabetes is never under control in a high inflammation environment.  Diabetes management must include a focus on inflammation control by the combined benefit of calorie reduction, carbohydrate reduction, AGE reduction, and improvement of autonomic nervous system health to prevent death from sudden cardia death. 


  1. Saima Abbasi 11 months ago

    Dr Nemecheck my 4.3 son is on the protocol almost 1 year. I noticed gains in his gross motor skills, and language too. But he is not conversational at all, he can not ride a bike, can not jump. My main concern is pinching, he recently started pinching alot…what can be a reason, what should i do. He is is on half teaspoon inulin, 1 ml nordic natural omega, and olive oil? need your help

    • Author
      Patrick Nemechek, D.O. 11 months ago

      Try bumping up the fish oil a bit and if this doesn’t help, he will probably need a VNS.

    • Saima Abbasi 11 months ago

      Thank you so much for a reply…I will increase fish oil. I really want to help my son he is 4 years. Here in Canada, they can label kids as Autistic with no hope. you are the only one who gives hope to many parents like me. For VNS I have to book an appointment?

    • Author
      Patrick Nemechek, D.O. 11 months ago

      Yes, an appointment is required for me to dispense a VNS.

  2. Gemma MacFarlane 1 year ago

    This may seem an unusual question but do you feel the Protocol could help with a brain tumour? I’m not looking for a cure just improved quality of life. Would the EVOO help with inflammation in the brain?
    I totally understand if you cannot answer.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      My protocol will help some but if the tumor is a glioblastoma multiforme, you need to seriously begin a very strict low carb ketogenic diet ASAP.

      Read this paper, Targeting energy metabolism in brain cancer: review and hypothesis, by Thomas N Seyfried

    • Gemma MacFarlane 1 year ago

      He is already on low carb as he also has diabetes. The cancer started in his kidneys and he had one removed. Since then has spread but recently to the brain and he is losing motor strength due to inflammation.
      The doctor is happy that he is currently stable but I wanted to see if the polyphenols in the EVOO would help.

  3. Susan mcgrath 1 year ago

    My son has type 1 diabetes, emotional dysregulation and SPD . Is it safe to try your protocol with type 1 diabetes? Thanks so much

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I think it is b ut I recommend running it by your endocrinologist before proceeding.

  4. Mohamed Nawshad 1 year ago

    Dear Dr. Nemechek,
    We are following NP for last 7 months for 7Y daughter, now my wife has conserved for second baby, she was followed pre-pregnancy protocol as you guid in the video (Refaximin +high DHA+olive oil for last six months).

    As we need to switch fish oil in to high EPA, i found NN brand which has 850mg EPA /200mg DHA in two capsules. is this ratio ok during pregnancy? (we are thinking of taking 5 softgels)

    Please need your advice whare i feel it is too low DHA,


    • Author
      Patrick Nemechek, D.O. 1 year ago

      I think during pregnancy the fish oil should remain EPA>DHA.

  5. Verna 1 year ago

    Hi Dr. N I have 2 questions:

    1. My asd 8 y.o. twins have been on full NP for a year since May 2018. The younger twin developed whitish almost skin colored pimples on his face February 2019. Could this be a side effect of NP?

    2. I lowered the dose of the boys’ inulin from 1/2 tsp to 3/8 tsp inulin hoping the older twin would stop stealing and being naughty and the younger twin would reduce is hyperactivity. It’s been 2 weeks. Should we wait another two weeks, because their activity level hasn’t changed.

    Thank you for such a wonderful protocol. Boys have improved so much through your NP and combined therapies!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      1. No
      2. I don’t think this dose of inulin will cause hyperactivity. They might need a VNS at this point if the hyperactivity has not improved much at all in almost a year.

  6. Verna 1 year ago

    Hello. I’ve been doing the NP for my twin 8 y.o. asd sons for a year now and it has been successful. I’m thinking about trying it with my dad who’s 89 y.o. he’s a very bright man and very hardworking. Still drives and still does things on his own, but within the past year his memory has gotten worse, and he sometimes is in denial that his memory is worsening. I don’t want to start inulin or rifaximin (sp?) On him. Can I start nordic naturals dha or now dha on him and cooc approved evoo, and if so is there a dosage chart I can consult for an adult? If I give it to him do you think it’ll help with his memory? Any side effects? Thanks for all you do.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      The dosages for adults with autism where developed over 10 years for adults without autism. They are the same.

  7. Zaira Vicioso 1 year ago

    This is our success journey. I just want to know what I can do for this testimonial to reach Dr. Nemecheck

    Dear Dr. Nemecheck, I don’t know if this testimonial will reach your eyes, but I sure hope so. By the time he was 2 years old, my little boy was presenting all the symptoms of Non-Verbal Autism, Sensory Processing Disorder, Apraxia, GERD, Global Developmental Delays, Food Intolerance, Food Allergies and severe aggressive behavior.

    I cannot count the numerous times he injured me with his aggressive tantrums. Those injuries included Black eyes, Swollen nose, bloody lips, scratches and black&blues everywhere.

    We heard about the protocol through a support group on Face Book. I did research, bought the book, read it twice, and ordered all the approved products.

    We embarked on this journey full of hope and faith. My little boy has been on the protocol since July 2018 and I have tears in my eyes at being able to say he does not injure me anymore. He is not aggressive, he actually sits at the toddler table to learn through his Speech, Physical and Occupational therapy sessions which is something he was not able to do before we started the protocol.

    My son also has been having cognitive explosions, for example, he is learning sign language, he learned to recognize all the letters and numbers, colors and shapes… His stimming has reduced by 75%.

    Thank you so much Dr. N for giving us our child back. With my heart on my hands I tell you that I have shared the knowledge of your protocol with my child’s therapists and other parents of children on the spectrum in hopes that I can help save another child from the awful aggressive spiral that Autism Spectrum Disorder can bring to so many families.

    You deserve to win the Nobel Prize. This protocol is so simple and easy to follow, that it would be a shame not to shout it from the roof tops! I prayed and prayed to God to help my little boy.

    I feel like you are an angel placed on earth to help so many children that so desperately need it. I hope from the bottom of my soul, in the name of Jesus Christ, that this protocol can reach as many people in the world as possible because it does help, it does work, I HAVE SEEN IT WITH MY OWN EYES. Amen.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      You are very welcome.

  8. sara 1 year ago

    Hello Dr. Nemechek!
    My son has been on the Nemechek Protocol for 8 months. He has had some incredible gains. He is so calm and focused with NP. But now he has been wetting the bed for about a month. I’m 99% positive it is the inulin causing it, which I figured out through process of elimination. If I stop the inulin, the bed wetting stops. If I restart the inulin, the bed wetting starts again that same night. I have done this 4 times now to see if there was truly a correlation. No other changes have been made. I believe he NEEDS the protocol badly to continue to improve and function. What should I do??? Thank you!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I don’t know why inulin would cause the bedwetting after using it for many months without bedwetting.

      Maybe you’ve upped the dose of inulin too much. Many parents keep increasing the dosage of inulin even after they notice improvements and they are running into problems like this.

  9. Klaudia Rystwej 1 year ago

    Dear Dr. Nenechek. Could you please confirm that all childeren even under age of 10 (i am Talking about childer age of 3 to 6 for example) suppose to use xifaxan in dose of 550mg twice Daily(1100mg per Day in Total) ? Or should the dose be lower for smaller kids? Tia

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Proper dosing of Rifaximin in small children needs to be determined by the prescribing physician. Do not do this on your own.

  10. Marianne D. 1 year ago

    Does your protocol work for estrogen dominance in women? I have tried many things to relieve hot flashes, mood swings, and even PMDD so bad that it results in psychosis for 1 week out of every month. My alternative health doctor said my estrogen is causing this, but all the medications I have tried failed to help. Does inulin have some anti-estrogen effects, or is it more the omega-3 and omega-9 oils which can do this?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      My protocol helps with symptoms associated with PMS and PMDD.

  11. Joe 1 year ago

    Dr. N, you say that: “patients are temporarily placed on a medication that greatly reduces the risk of sudden cardiac death”. Which medication are you using for this? I bought your book but didn’t find the name of the medication in it. Also, will your protocol work without the fish oil, so just inulin and olive oil… can it still produce improvements?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      The protocol does not improve autonomic function without fish oil.

      Cardiac autonomic neuropathy can be controlled with carvedilol.

  12. Riddhima 1 year ago

    Hello Dr. Nemechek, my 5 yr old son’s stool test came back positive for Dientamoeba fragilis parasite. I tried searching on this blog and FB group, but can’t find any answer. Do you think your protocol will help in killing/decreasing those parasites? Or, should I do the parasite cleanse along with your protocol? Please advise.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Dientamoeba fragilis requires a specific antibiotic for this organism, not a cleanse.

      In the U.S. we use iodoquinol. Outside of the U.S. secnidazole and ornidazole are used. Get advise from a licensed physician in order to appropriately deal with this.

    • Riddhima 1 year ago

      I am in the U.S. I will get that antibiotic. Thank you so much.

  13. Rose Smithson 1 year ago

    Dr Nemechek, about extreme instability in a child: My son with autism cycles between “stable” normal days, and extremely bad days, without any apparent reason. We’ve tried many approaches, diets, supplements over the years. All supplements produced very bad side-effects, like even B-vitamins produced some strange behavioral reactions that don’t make any sense. Even a simple food, like eating a food like banana or apples, will make him agitated, sweating, and confused (even though he doesn’t test positive on classic food allergy tests). But even with a diet which is exactly the same every day, he may have 2 good days followed by 2 very bad days. We can’t seem to get any stability. Have you heard of such a thing in autism or other disorders? Is there a way to achieve long-term stability, so we can plan for the future?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      With all other obvious issues being constant, I think the swings you describe would most likely be coming from bacterial overgrowth (SIBO).

      The gut bacteria can change with stress (physical and emotional) as well as exposure to mild asymptomatic viruses and other bacteria.

  14. Vincent Finlay 1 year ago

    Dr. Nemechek – I believe I’m in a more advanced stage of autonomic dysfunction. I’ve tried to schedule an appointment, but I was told you don’t have anything available until February 2020. I feel I may need the vagus nerve stimulator, but I can’t purchase unless I see you in person first. My health is steadily declining. I don’t know if my body can hold off until next year. I’m willing to be put on your waiting list, but there’s no guarantee I’ll be able to get anything sooner. Are there any other doctors that you are aware of who incorporate your protocol into their patients’treatment plans? And any who are licensed to sell the vagus stimulator? Do you have emergency appointments? Please help me!

    Kind regards,

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Sorry but I do not know of anyone else who has advanced as far as I have with these techniques.

  15. Nimya 1 year ago

    Dear Dr,

    In some blog, have read about cookie test. My son used to response for cookies before we start NP. Last Aug 2018, we have started the full protocol with approved brands. He is in 4 years and 8 months. We started Now Inulin with 1/16 tsp and increased to 1 tsp by last Jan 2019, along with California Olive oil and 1 ml Ultimate Omage FO. But we never see any progress. From Last Feb 2019, onward, after reading some blogs , have reduced the inulin slowly and now we are with 1/4 tsp. After reduced to 1/2 tsp, he was little different, his stemming increased and some time he jumped like anything for a week. but that is only for 3 to 4 days. Now he is with 1/4 tsp, but no major awakening.

    My question here is,

    1, If a kid is responding for cookies, then we have to stick those dosage right? But if the kids responding before this NP for cookies, how to consider that he is ok with those dosage?

    2, Now am with 1/4tsp inulin, can i increase the inulin to 1/2 tsp slowly ? or continue with 1/4?

    Kindly advise doctor. Thanks in advance.


    • Author
      Patrick Nemechek, D.O. 1 year ago

      If a child is fairly alert to begin with, just keep the inulin at the starting dosage.

    • Nimya 1 year ago

      Thanks a lot Dr.

  16. Rose Smithson 1 year ago

    Hello Dr. Nemechek. 2 questions. What is your opinion on “LDN” (low dose naltrexone), for autism and other neurological conditions, for children and adults? Is it OK to combine your protocol together with LDN?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      In my testing of adults with chronic autonomic dysfunction from cumulative brain injury, LDN (low dose naltrexone) was not useful in recovery of autonomic function as measured by spectral analysis.

  17. Renalda 1 year ago

    Hello Doctor, My daughter 3 years old has multiple food intolerance, By multiple I mean more then 150 in red zone. We are 4 months following your protocol and recently have repeated Food intolerance test and nothing change. Could you please share your opinion regarding that? When we could see improvement in for those intolerance? I know healing takes time, I just want to be sure we are going in right direction. Time is precious for all of our kids. Thank you so much!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      The best and only true test for food intolerance is how a person feels after eating a food. The next most accurate is skin testing . by a qualified allergy/immunologist.

      Blood testing for food intolerance is so prone with error that it should not even be performed. And in my experience, the majority of food testing greatly exaggerates the true incidence of intolerance.

  18. Verna 1 year ago

    My son’s doctor recently prescribed retinin a for my 8 y.o. asd son’s white spots on his face. Will this interfere with protocol? Thank you.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I would not think so.

    • Verna 1 year ago

      Thank you!

  19. Geri 1 year ago

    as per ONE Test done one month prior to beginning protocol showing very low levels in both proprionic acids , in fact one type barely traceable , in my 8 year old boy , might adding inulin affect him negatively? in other areas where the body requires having proprionic acid for other functions. thank you !

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Those tests are not reliable for management of your child.

    • Geri 1 year ago

      thank you for that. have a good day

  20. Marco S 1 year ago

    Hello Dr. Nemechek
    We started the protocol (ASD) several month ago, strictly following the book’s raccomandations. The awakening came very quickly, in less than a week. All the family was amazed to see our 5 yo child completely transformed and able to communicate so well. Unfortunately it all lasted 4 days then he fall back into his own world, very sad to see. We kept the protocol, slowly increasing the inulin (we started at 1.5 grams/day gradually up to 10 grams/day) but the “awakening” we saw at the beginning never came back in the following 2 months.
    Then we completely stopped the inulin for one week (but keeping the omega3 and the olive oil).
    After one week we reintroduce the inulin and bang! he quickly came back “awake”, talking and interacting again, this time for 3 days, then the dark came again.
    After one month we tried again: one week off the inulin then back on and, no surprise he has been “awake” for 3 days.
    We did the same last week and again he has been “awake” for 2-3 days, but now he is staring at his spinning wheel again all day.
    To make a long story short the inulin seems to work very well but only for few days, no matter the dosage, then not at all for the following months.
    May be this happened to someone else before, but I did not find similar comments in the blog.
    Con you give us some directions?
    Thank you in advance and my compliments for your work.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      You may want to consider rifaximin in this rare case.

    • Marco S 1 year ago

      Good morning Dr Nemechek,
      Following your advise, we went to our pediatrician and we got our Rifaximin prescription, as follow:

      Spiraxin 200 mg – 1 pill every 6 hours, for 10 days.

      As the dosage of Rifaximin available here in Spain is different that the 550 mg (twice a day) that you suggest in the book, I would ask if the prescription that we got still fits the Nemechek Protocol. (By the way, my son weights 22 Kg and is physically very healthy, almost bulletproof and is not taking any other drugs)
      Thank you for your kind answer.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I’m sorry but I cannot comment on the specific dose of Rifaximin for your child.

  21. L. B. Dahle 1 year ago

    I have Ehlers Danlos-hyper mobility type. Now in my sixties and have had a partial knee replacement. I have been using supplements to control the breakdown of my joints and muscles, and to counteract my inability to form collagen. Also have POTS and Mast cell. We learned about the NP and I began the full protocol in early October 2018. Felt like it was helping. However, in the past few weeks I have gotten progressively much worse, even though I eat very healthy and have stayed 100% on the protocol. On my second Rifaxamin round it was like I was having a flare. Gut issues, nausea, followed by pain every joint. My previous shoulder pain returned. My “good knee” throbbed. Then the other. Neck, TMJ, insomnia, you name it. Total body joint & muscle pain. Several weeks now. I was supposed to have another partial knee replacement next week, but I feel I’m not strong enough to rehab, so I’m planning to postpone it. I’m just wondering — is this a flare? A reaction to the protocol? Or rather an awakening? Or a healing crisis or healing reaction? I’m still on the protocol 100% but wondering why I hurt so bad everywhere and if this is a normal progression and just to endure? Please advise?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      This is not a normal progression. Something else is going on.

  22. Mimi 1 year ago

    Hello there, Dr. Nemechek!

    I have taken Rifaximin several times in the last yr but am still burping (since end of April 2018) with increased heartburn all the time. I’ve since been on herbal “antibiotics” & the excess hunger has improved 40% in the last 2 wks but the burping & heartburn continue (& left side back of neck pain). Inulin makes it worse & makes the SIBO appear or reappear. I’m already barely eating carbs or sugar so that’s not the issue. On top of that multiple Rifaximin causes severe yeast overgrowth & vaginal streptococcus issues/discharge, etc. My questions are:

    1. Is there a suggested NATURAL alternative or herbs to Rifaximin to eliminate SIBO, strep, heartburn & burping? I’m thinking that the Rifaximin (also took Flagyl & Penicillin last yr with no improvement – plus may make SIBO worse) must not kill all bacteria types from the small intestines and Inulin aggregates it.

    2. Rifaximin can cause yeast overgrowth & increase step issues in the body. What do you suggest for yeast overgrowth from the multiple rounds of antibiotics without any improvement in the burping, heartburn & hunger (the hunger did improve some)? Rifaximin also caused my underarms to start to smell during the 1st time I used it & it hasn’t gone away.

    Thank you, kindly!


    • Author
      Patrick Nemechek, D.O. 1 year ago

      1. Heartburn and burping are often from autonomic dysfunction and not necessarily from SIBO.

      2. Your comment, “Rifaximin can cause yeast overgrowth & increase step issues in the body.” is incorrect on both accounts.

  23. Verna 1 year ago

    Hello. I am the mother of twin ASD 8 y.o. boys. They’ve been on protocol since May 2018. Prior to protocol they just completed Brain balance and had made lots of progress (more awareness, swimming, etc). Recently, my younger twin has been smacking his head on the floor, table and per teacher on the corners of chairs but not too hard and maybe averages 4 to 5 times an hour. This has been happening for a month. His older twin brother was almost potty trained November 2017 then kind of lost some of those gains June 2018 shortly after beginning protocol. Plus, he’s gotten more sneaky stealing markers from school. Overall though, they’re doing better in school. The twins mastered most of their goals on their IEPs. The older twin is sometimes keeping dry and sometimes poops in the potty. Plus, the younger twin is continuing to follow directions and while is still kind of hyper is better than before. I believe your protocol enhanced a lot of the work I had accomplished with Brain balance; however, I saw some old behaviors return.

    Twins are on 1/2+1/8 tsp now inulin
    About 1 to 2 tbs ca evoo in food (make sure don’t cook food above 425 degF-can’t take evoo straight).

    Older twin on about 1200 mg DHA nn gummies
    Younger twin on about 1420 mg ultimate omega (if I’m lucky to get it in.)

    Increasing Brain Balance sensory exercises especially for younger twin since I observed a majority of head banging is sensory seeking and some frustration.

    Should I reduce inulin for the younger twin or should i consider a lot of this just growth. We increased their doses from 1/2 tsp to 1/2+1/8 tsp inulin on Jan. 25. Younger twin was sick with flu first week of January. Thanks for everything you have done for our kids!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I’m sorry I cannot give specific dosing recommendations.

  24. Fernandez 1 year ago

    Dear Dr. Nemecheck,
    First of all I would like to thank for your protocol, my daughter (7Y) in the protocol for last six months. Last week we changed our fish oil brand (earlier Nordric Natural- 450DHA/650EPA and changed to NOW 500DHA/250EPA).

    We see unusual hyper active on her since this change, is their any relation to hyper active and combination of EPA&DHA?

    (current dose ½+ tsp Inulin, 15 mil EVOO and 500DHA/250EPA).


    • Author
      Patrick Nemechek, D.O. 1 year ago

      I have never seen altered behavior I would attribute to the brand of fish oil if switched.

    • Fernandez 1 year ago

      Dear Dr. Nemecheck,
      Thank you very much for the reply, but i’m really sorry to say that my english understanding is poor, i,m not able to catch your second statement (“I would attribute to the brand of fish oil if switched”).
      Just to clarify further, in this case do we need to switch back to original brand? or is this hyper active is a sign of improvement?
      Thank you very much for your time

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Yes, I would stay with the original fish oil.

  25. Anonymous 1 year ago

    My son is 3.6 year old he is dignose with autism i purchase inulin now fish oil and olive oil can u tell me the dose….?

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I recommend reading the protocol before proceeding.

      There is a lot more to it than just feeding your child the 3 supplements.

      A copy of the protocol can be purchased at

  26. Georgia 1 year ago

    Dear Dr Nemechek,

    Hello again, it’s Georgia (27) from Australia here. I thought I’d give you a quick update as you and your amazing Protocol have completely changed my life for the better. I have now been formally assessed and diagnosed with quite severe Autism.

    I am so deeply grateful to finally understand myself, and to be healing my brain and body every day! My Autism is reversing, and it seems my Hyperhidrosis is also healing (I now believe this is a symptom of my Autism). It’s all falling into place thanks to you. I’m studying to be an Opera singer (I’ve been told I’m very good and could become a Coloratura Soprano!), and I finally believe that I will actually achieve this. Thank you so very much.

    I have a couple of quick questions regarding hemp seeds thanks. I’ve just discovered these beauties and since consuming them the protocol seems supercharged. I’m guessing this is the ALA. Anyway, I’m wondering if hemp seeds are interchangeable for nuts and other seeds on the Protocol?

    I also noticed they contain mega amounts of omega 6, which believe we should avoid on the Protocol (all those nasty Vegetable oils etc). So would you please tell me if you think they’re ok to consume?

    Kind regards,


    • Author
      Patrick Nemechek, D.O. 1 year ago

      Don’t bother with hemps. Stick with the protocol.

      “Better is the enemy of good enough.”

  27. Nawshad 1 year ago

    Dear Dr. Nemecheck,

    My daughter (7Y) in the protocol for 5 months, there are some gains but she is playing with her fingers regularly, this was started 2.5months before when we switch the Inulin dose 1/2tsp to ½+1/8 tsp. We thought that it is a part of awakening, but now it is more than two months which is worrying since she is not concentrating in school works indeed focusing on fingers.

    Please need your advice (current dose ½+1/8 tsp Inulin, 15 mil EVOO and 1180mg fish oil).

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Maybe too much inulin.

  28. Minisha 1 year ago

    We have been following your protocol from past 4.5 months. I do see gains but not much in Speech. She is preverbal but non conversational. we give 1/2 teaspoon inulin, 1ml ultimate omega FO, 7.5ml EVOO. I read on faceook that some people are using supplement DMG with your protocol for Speech. Should I use it ? If yes then how much ? Currently I don’t do any supplements. My 4 year old sometimes holds her heads ,doesn’t pay attention. She is often lost in her imagination(sings songs and seems like she is role playing something but doesn’t listen to us). ALso I will be seeing you in July end. Please help.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      You aren’t on my protocol if you are using DMG

  29. Linda 1 year ago

    Hi Dr Nemechek, I’m writing to you from South Africa, my son is 13 years old, he started the protocol early in January this year, he’s on the dosages recommended in your book for the olive oil and omega and 1/4 tsp of inulin. We have kept him at that dosage of inulin, not much has changed, (I realise it’s early) he’s still extremely anxious (this is the reason why we started the protocol and for digestive issues, bloating and loose stools). Should we wait longer on 1/4 tsp of inulin, more than happy to do so, or, should we increase it?
    I really appreciate your time, thank you.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I wouldn’t go above 1/2 a tsp of inulin and if that doesn’t work sometimes kids his age need rifaximin.

    • Linda 1 year ago

      Thanks Dr Nemechek, we reduced the inulin right down to try and alleviate the anxiety and slowly went back up to 1/4tsp, the 1/4tsp dose gave some great improvements after a few weeks, much calmer, and happier, better bowel movements and less emotional upset generally but the anxiety was still there. We went up to 1/2tsp a few days ago but we have had quite intense behaviour, increased anxiety, intense fluctuations of emotions and a lot of bloat and tummy discomfort also he feels too alert.. If we can’t get Rifaximin, do we see how this 1/2 tsp dose goes or do we revert back to the 1/4 tsp? Many thanks for your time.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Why did you go up further? Maybe at a 1/4 tsp when things were better and he was awake the only next ingredient needed was more time.

    • Linda 1 year ago

      Hi Dr Nemechek, thanks for your response, because of his age (13) and anxiety, it was recommended on the group to increase the inulin. There has been such a great change though, since I wrote to you, earlier this week. He is now calm, rational and when he wakes up in the morning, he is happy (usually he is very irritable in the mornings), his anxiety is also way down and he is handling situations with a level head, previously he would spiral into an anxious meltdown. Now we can sit and have a discussion/conversation and he seems way more mature in his reaction, understanding and response. This is wonderful. We will definitely not increase the dose and it has been so lovely to see him coping better with life than he ever has. Thank you so much.

  30. N. Panayotova 1 year ago

    Hello dr Nemechek! Should I avoid walnut oil in your protocol? It contains polyunsaturated fatty acids (72% of total fats), particularly alpha-linolenic acid (14%) + linoleic acid (58%), oleic acid (13%) and saturated fats (9%). Also I have not found information about avoiding or not gamma linolenic acid GLA, which is an omega-6 fatty acid but also can reduce inflammation in brain cells. Thank you in advance!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      I would generally limit its use

  31. Serene 1 year ago

    Hi Dr Nemechek,
    My son is only 8 months old. He is currently constipated. PD has prescribed him with lactulose. Is it okie to use it to treat constipation during protocol? If not is magnesium citrate safe for a 8 month old kid and what is the dose to give? Thanks

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Yes, it is OK to treat constipation during the protocol.

  32. Rohma 1 year ago

    Hello. My 4 year old daughter is on protocol for 5 months now. Alot of gains but one thing bothers me alot. Wheneevr she sits to study or write she would yawn constantly. If this period is extended for more than 20 mins she would have water coming out of eyes due to yawning. I dont understand why. What do i need to do to fix this? Please help. I understand gaining more concentration would take longer time. Thanks alot!!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      This symptoms is low blood pressure to the brain due to autonomic dysfunction. This will resolve with more time.

  33. Bill 1 year ago

    Hi Doc,
    For the adult protocol, can I take the fish oil pills maybe 2 at a time spread throughout the day? Getting close to starting and worry taking 6 at the same time might be sort of a gut bomb. Thanks.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Yes, its fine to spread them out. I personally take 3 in the Am and another 3 before I go to bed.

  34. Katie McCollum 1 year ago

    We are scheduled to come see you in August. (SO excited) We just got my son’s genetic test back and his results showed a huge mitochondrial dysfunction. His mitochondrial are functioning so low that his current dr. thinks he may have mitochondrial disease (cirtrate synthase 25%, RC-IV 336%, RC-I 34%). Now, I know your views are that mitochondrial dysfunction is a downstream effect of the ANS dysfunction, however, in my son’s case, I think his low functioning mitochondrial may be causing the majority of his issues. My son has been on the protocol for 1.5 years and I would think if it were an ANS issue, then his mito functioning test results would have been better after a year and a half of healing the ANS. So, I’m wondering if this issue is outside the scope of the protocol. Thank you!

    • Author
      Patrick Nemechek, D.O. 1 year ago

      Other than severe genetic mutations, almost all mitochondrial issues are related not to autonomic dysfunction but to systemic inflammation

  35. Rosita 1 year ago

    Thank you Dr. I believe we need to visit you for the VNS machine. Can one VNS machine be used for the entire family? Thanks.

    • Author
      Patrick Nemechek, D.O. 1 year ago

      While the device we use is adaptable more you and old and a wide variety of medical conditions we treat, I can only prescribe its use for the individuals that are formally under my care.

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