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Reversing Autism with The Nemechek Protocol – Update 2017

Reversing Autism with The Nemechek Protocol – Update 2017
March 20, 2017 Dr. Patrick Nemechek and Jean Nemechek

Nemechek Autonomic Medicine Autism 2017There is growing scientific evidence that an imbalance of intestinal bacteria called SIBO (Small Intestinal Bacterial Overgrowth) along with excessive inflammation within the brain are responsible for the features associated with Autism as well as ADD/ADHD, mood disorders, and developmental delay in children.

Bacterial overgrowth occurs when large numbers of bacterial that predominantly live in the colon migrate upwards, and increase the number of bacteria within the small intestine by 10,000 to 100,000-fold. This added bacterial load in the small intestine has two consequences that contribute to Autism.

First, the bacteria often tend to be of a clostridium species which can produce propionic acid in massive amounts. Propionic acid is a short chain fatty acid that is normally produced in small amounts within the intestine but the higher concentrations are being linked to some of the behavioral aspects of autism.

In animal studies, high propionic acid leads to the development of antisocial behaviors, increased sensitivity to sound, light, and touch, as well as gait abnormalities. In human studies, children with autism have very high concentrations of propionic acid within their tissues.

Secondly, the increased concentration of bacteria within the small intestine causes leakage of pieces of bacteria into the large concentration of immune cells that surround the small intestine and triggers the inflammatory reaction referred to as leaky gut.


Hello! Just wanted to share that I started my Autistic/Apraxic 3 year old son on your protocol almost a month ago. He had about 10 words before this, averaging 1 new word a month prior. He has since, in that short time had an explosion of speech. He has been saying now about 1 new word a day, said 3 new words just yesterday, and has even spoken a few 3 word sentences. I felt hopeless before trying your protocol and cannot believe the large gains we are seeing so quickly! Thank you thank you thank you!!!!!!!   –   A Mom on Facebook

Leaky gut causes an increase in peripheral pro-inflammatory cytokine levels and allows for the inflammatory priming of a specialized form of white blood cell known as microglia within the central nervous system.

The combined production of inflammatory cytokines and activated microglia are primarily responsible for the developmental issues, seizures, sensory issues, mood and attention disorders commonly associated with autism.

A child is born with approximately 100 billion neurons and over the ensuing 18 years, needs to prune these neurons down to 50 billion in a process referred to a synaptic pruning. Excess inflammation from leaky gut, microglia priming and omega 3:6 imbalances prevents otherwise healthy microglia from pruning fast enough, and results in developmental delay.

The priming effect from the bacterial overgrowth causes many microglia to shift into the M1-phenotype, and results in the brain being less able to fully repair itself from commonplace physical (falls and bumps to the head), emotional (fear, abuse, neglect) and inflammatory (surgery, infections, vaccines) brain injuries.

A small residual amount of damage will remain after each injury, and each new injury leaves residual damage upon the prior injury in a process referred to as cumulative brain injury. The abnormal neurological functioning from cumulative brain injury can occur slowly over time and or rapidly depending on the intensity of the brain injury. Damage to different portions of the brain will result in different outward symptoms such as ADHD, chronic anxiety or gait abnormalities.

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The elevated inflammatory cytokines are also able to turn on certain genes that are linked with autism and may be responsible for certain features or more severe forms of Autism.

And finally, the excessive inflammatory environment in the brain reduces the seizure threshold and make seizures more likely to occur. The drop in the seizure threshold from inflammation is seen when young children without Autism develop febrile seizures with the fever and inflammatory reaction that occurs with simple upper respiratory viral infections or middle ear infections.

My understanding of the bacterial and inflammatory features in Autism have opened the door for me to provide groundbreaking treatment. The bacterial overgrowth increases propionic acid levels that cause kid’s brains to function differently, almost like a chemical impairment or slight intoxication, and at the same time the inflammation prevents normal neuron pruning and development as well as inhibits normal brain injury repair.

My approach to reverse the key components in Autism is straightforward. To provide the brain with a healthy, non-inflammatory environment to function more normally and to allow microglia to correctly prune and repair the brain, we need to reverse bacterial overgrowth and suppress the production of inflammation cytokines that are produced from a variety of sources.

By applying a logical understanding of science, I have focused application of The Nemechek Protocol™ medical consultation and treatment services on Autism, and have reversed the key features of Autism in many children.

The Nemechek Protocol for Autism uses a prebiotic fiber called inulin to reverse and control bacterial overgrowth, and high doses of omega-3 fatty acids to normalize microglial function and normalize the inflammatory state within the brain.

Cooking with domestic extra virgin olive oil also helps reduce brain inflammation resulting from linoleic acid, an omega-6 fatty acid found in in high concentration in cooking oils and processed foods.  Inulin is a natural fiber found in onions, garlic, artichokes, agave, chicory root and many other plants.

When buying powdered inulin, I avoid ones that also contain probiotics or digestive enzymes as these ingredients can makes some aspects of Autism worse.  (See my post on probiotics for more info on this topic.)

I find that 2-4 inulin gummies or 1/2 to 1 teaspoon of powdered inulin daily can reverse bacterial overgrowth enough to allow an autistic child (2-8 years of age) to become much more aware and interactive with their environment within a few weeks. And depending on the amount of underlying developmental delay, children will often start speaking within a few weeks to a few months.

Remember this is a simple plant fiber found in foods we eat every day, and is safe in children. If children get a little gassy or bloated, I recommend cutting back on the dose. Inulin is heat-tolerant and can be mixed or sprinkled over any form of liquid or food.

To help reduce the inflammation within the brain and normalize the behavior of microglia, my autistic patients are placed on omega-3 fatty acids (EPA and DHA) from fish. A recommended starting dose for small childrens is about 600 mg of omega-3 (the total of EPA plus DHA) per day.  DHA is particularly important as it is the main omega-3 in the brain.  (Read this post for more information on DHA as brain food.) Omega-3 fatty acids may be given in the forms of simple fish oil mixed in their food or drinks.

I don’t recommend fermented fish oil.  And when dosing I tend to increase the dose of omega-3 is the children are older (specific dose for varying ages of children can be found in The Nemechek Protocol for Autism and Developmental Disorders)  When in doubt, I favor a high dose.

If children have difficulty with diarrhea or prior problems with fish oil causing diarrhea, I have the kids start inulin fiber alone for 2-3 weeks in order to let the gut bacteria balance out, and then slowly increase the dose of fish oil and usually the tolerance is much better.

Whether the parents use Nordic Fishies or or another brand of liquid fish oil, I recommend they buy a high-quality brand as there is a very high level of fraud in the supplement industry.

All families are asked to cook their foods in domestic extra virgin olive oil (EVOO).  EVOO contains 70% oleic acid, and oleic acid reverses the underlying inflammation coming from excessive linoleic acid toxicity.  (Watch my screencast for more information on the benefit of olive oil.)

Linoleic acid is most commonly found in the unnatural vegetable oils added to the foods we purchased.  (See my other post about omega-3/omega-6 rebalancing for more information on this topic.)

The bigger, older children with autism require more effort and higher doses of inulin.  To gain better control of SIBO in older children I often treat with a 10-day course of Rifaximin (Xifaxan in U.S.).  Rifaximin is a non-absorbable antibiotic that is only used for other bacterial overgrowth conditions (hepatic encephalopathy and IBS with diarrhea).

Follow-up use of inulin after Rifaximin is sometimes used if intestinal symptoms are still present.  If inulin does not make any significant difference as a follow-up therapy, I stop it.  I never add probiotics after resetting with Rifaximin because probiotics can easily make things worse even if they helped prior to the use of Rifaximin.

The reversal of bacterial overgrowth with inulin results in a drop of propionic acid and can result in a sudden improvement in function within a few weeks.  But many children do not fully return to normal because they still have underlying developmental delay (some quite severe) as well as ADD, ADHD, sensory issues, seizures, as well as chronic depression, anxiety or aggressive behaviors. ( Watch my screencast about how leakage of LPS from bacterial overgrowth prevents the brain from fully recovering from injuries.)

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These remaining conditions take longer but week by week things can slowly improve.  If there is no significant improvement within 2 months, I generally increase the dosage of omega-3 fatty acids. If things still do not improve or seem to plateau after a couple months, I now add bioelectric Vagus Nerve stimulation to the Nemechek Protocol with good results.  (See my screencast about vagus nerve stimulation.)

The brains of older kids that have experienced prolonged bacterial overgrowth and inflammation as well as more brain injuries that occur over time, generally take longer to show improvement but I have seen significant progress in older kids as well.

I care for 2 teenage non-verbal autistic boys (14 and 16 years of age), and although they showed signs of continual improvement, they took about 4-5 months to begin speaking.

More recent is a remarkable case of a 23-year-old non-verbal autistic girl with frequent seizures. Within 8 months her seizures had reduced from 5-7 per day to 2-3 per week, and she can now write her name and converse in both Spanish and English (she lives in a dual language family).

For autistic children, the Nemechek Protocol will need to be daily and possibly forever but the benefits are life changing. Inulin fiber, omega-3 fatty acids and olive oil are from natural sources, are commonly consumed by most of us every day, and are available without prescription.

I am a classically trained internal medicine physician (D.O.) from UCLA and my Internal Medicine and Autonomic practice is in the Phoenix area. My research background has been focused on the Autonomic Nervous System, brain metabolism, and metabolic inflammation.

I use all available scientific and medical tools to induce the nervous system and organs to repair themselves by normalizing inflammation control mechanisms, inducing natural stem cell production, and re-activating innate restorative mechanisms.

March 23, 2017 –  An Addendum on Recovery

My Experience with Autism Recovery:

Uniformly all the kids under my care (50-60 to date) seem to be improving in significant ways.

In terms of speech, some younger kids start speaking within a few weeks while kids in the teens might take 4-6 months.  Our 23-year-old patient didn’t start speaking until after 8-9 months of treatment.

Importantly, even the most severe cases have a noticeable improvement in their awareness of their surroundings within a week or 2.  I interpret this as a decline in the toxic effect of the propionic acids on their brains.  Parents report more eye contact, awareness or acknowledgement others have entered the room.  They also seem more tolerant of being touched or held, or are more willing to approach someone and be physically close to them.

After the first few weeks, recovery rates are highly variable, and I believe this is due to the degree of developmental delay underlying the toxic state.  If the inflammatory cytokine process has been going on since birth, there can be so much developmental delay as to be labeled mentally retarded.  But if the developmental delay is simply mild, kids may seem very functional quickly.

The important point to remember is that your child’s brain and an enormous capacity to continue the path of development once the inflammation is controlled.  Neuronal/synaptic pruning will re-initiate, and according to the developmental delay literature, they can catch-up about 2-3 months of development for every 1 calendar month.  In my estimation, it seems to advance this fast if not faster.

The underlying wild card is what gene has been activated by the inflammation and what might it do to the neurological impairment of your child’s brain.  The inflammatory environment that prevents normal synaptic pruning and recovery from brain injury also triggers the litany of genes being found in autism.

Inflammatory cytokines abnormally produced by the mother are affecting the child’s nervous system within the womb, and then the imbalance of intestinal bacteria of the child as well as high omega-6 food sources continue to fuel the inflammatory process within the child after birth.

These inflammatory cytokines are the primary process through which the genes within the DNA that had been dormant for 1,000’s of years in the child’s ancestors are finally activated, begin altering how cells function, and contribute to the overall variety of neurological, behavioral characteristics that manifest in autism.

Here’s the potential for recovery in the autistic brain. A 23-year old non-verbal autistic female (Lennox-Gastaut Syndrome), was having 6-8 seizures per day and had never held her parents gaze for her entire life.  She did not like to be held, could not color or write, and sat curled up in a chair most of the day rocking.

Within 2 months’ of starting our protocol (rifaximin, high dose omega-3 fatty acids, and mother cooking with California olive oil), her seizures had dropped to 1-2 a day, she would sit upright in a chair and she slept through the night.

At month 4 she started looking her parents in the eyes and holding their gaze, and was more able to be touched and hugged.

At her month 6 office visit, she started smile at me, her seizures had reduced to 1-2 per week, she could now write her name (although she had never been shown previously) and could draw objects that were recognizable.

At 8 months, she began speaking rudimentary Spanish and English (dual language household) but emotionally is behaving as if she is 3 years old.

At 18 months, she speaks very clearly in full sentences, her seizures have declined to 1-2 per month (despite discontinuation of 2 seizure medications), and her emotional maturity has risen to about that of a 4-5-year-old.

But don’t despair. No matter how badly the developmental delay has slowed brain maturation, the potential for an unbelievable recovery is present.  We are beginning to understand that once human genes are turned on by inflammation, they can ultimately be shut back off again once the inflammatory environment within the body is significantly reduced.

Do your best to be patient and give this approach a chance.  Because the path to recovery over all things medical is 3 steps forward, and 1-2 back, compare today’s behavior to last month’s, not yesterday’s. The neurons within the human brain, like your hair, can only grow and change only so fast.

Every month, your child’s brain has the ability to “catch-up” 2-3 months in development.  That means every calendar year, they may catch-up 2-3 years.  I believe once the inflammation is suppressed, all that is required for recovery is a good solid inflammation suppressing regimen and patience.

May 26, 2017 – Addendum on The Misconception of Feeding Bad Bacteria and Yeast

The conclusion that increased stemming, less sleeping or increased anxiety is from inulin feeding “bad” bacteria such as Klebsiella has been a concern of several commenters.

I’m not saying this is impossible but I do not believe that to be the case, and have never seen such a reaction in the many children I’ve worked with. There are several reasons for this.

First, inulin’s main effect is within the lumen of the small intestine where bacteria digest inulin through a process referred to as fermentation. The primary effect is the production of the healthy short chain fatty acid known as butyric acid. Only small amounts pass through to the colon.

Secondly, a significant increase in pathogenic bacteria, or overgrowth bacteria would almost certainly cause an increase in diarrhea, stool frequency, abdominal cramping, reflux and eczema. We do not see this, and in fact there in general a reversal of these symptoms with the use of symptoms with the use of inulin.  If the intestinal ( not neurological or behavioral) symptoms were to worsen on inulin, I would suggest the inulin be discontinued and would suggest using Rifaximin.

The development of constipation with the use of inulin is a sign of underlying autonomic dysfunction from developmental and cumulative injury that eventually reverse after a few months of fish oil.

Thirdly, propionic acid has a sedating effect on children, almost as if the children had been taking Valium or Xanax. Therefore, once inulin reverses the bacterial overgrowth and the propionic acid levels decline, the children will come out of their stupor. There behavior at this point is predicated but their pre-existing developmental abnormalities and cumulative brain injuries and not some toxic effect of inulin.

A fourth point is that the detection of pathogenic bacteria such as Klebsiella in the stool by no means suggests these bacteria are present within the small intestine where inulin has it’s main effect. Detection of pathogenic bacteria such as <em>Klebsiella pneuomiae</em> or <em>Clostridium difficle</em> are commonly in asymptomatic patients and are essentially harmless. Their growth is kept in check by a healthy balance of other bacteria which is further bolstered with inulin.

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And finally, some parents are worried about overgrowth of candida. I agree that candida and other yeasts/fungi inhabit the intestinal tract but more detailed studies demonstrate yeast/fungal overgrowth does not occur in autism. And while the observations of clinical improvement about reduction of sugars and etc. are correct (think GF/CF, FODMAPS, GAPS), they were misattributed to yeast instead of the bacterial overgrowth for which we have mounting evidence.

Because of this, I believe the use of potent anti-fungal drugs is unwarranted in the specific treatment of autism.

Hope this helps.

© 2017. Dr. Patrick M. Nemechek and Jean R. Nemechek. All Rights Reserved. Patent Pending.


  1. Martha 15 hours ago

    I really wish there was a way to find your VNS in Europe… From the little I’ve researched, all available options here are transcutaneous…

    • Patrick Nemechek, D.O. 6 hours ago

      Mine is transcutaneous as well.

  2. Saritha 20 hours ago

    Hello dr
    I have a doubt you told homeopathic medicines not allowed. But if its a prescribed medicine such as if its helping anxiety stress and all like adhd medicine which other doctors giving can we continue that.

    • Patrick Nemechek, D.O. 6 hours ago

      Yes but just be aware that if there is minimal recovery that you may need to try stopping it or switching to another medication.

  3. Pragya 2 days ago

    Dear Dr Nemechek,
    First of all , I want to thank you for giving hope to millions of parents across the globe. You are an angel sent by God to help the parents in distress and hopelessness.
    My 3 year 2 month old son has been showing ASD symptoms although he has not been diagnosed yet. I’m sure that he had digestive issues since he was young, so we are very hopeful that your protocol will help him. My concern is his frequent diaper rash (he is potty trained) which run up to his penile shaft. Doctors here prescribe us steroid cream for application each time we see them. Could this be due to SIBO? Will your protocol help this condition as well?
    Many thanks

    • Patrick Nemechek, D.O. 1 day ago

      I’ve never seen SIBO do this. Chronic rashes in that area can be from allergic reaction to soap or certain fibers in undergarments, eczema and psoriasis. Sometimes from candida but I doubt this since he is potty trained.

    • Pragya 21 hours ago

      Thank you so much Dr. for your reply. Will your protocol still be beneficial if it’s not SIBO? I’m a little confused as psoriasis and I believe eczema too is an autoimmune condition. I have read many people seeing benefits on NP but I’m not sure. We have just started him on inulin on 10th January, so I thought that the recent flare up could be a sign that it’s working.
      Thank you again!!

    • Patrick Nemechek, D.O. 3 hours ago

      Hsrd to say what the flair is from exactly but there is a growing amount of evidence that virtually everyone with an autoimmune disorder has SIBO to one degree or another.

  4. Animesh K 2 days ago

    Dear Dr Nemechek.
    My son 6.5 year old, mild ASD, non verbal is on full protocol since past 8 months. Dosage: 2 tsp NOW inulin, FO,: 1.5 softgel NOW DHA and 25-30 ml EVOO. All approved brands, no probiotics, no supplements. We have not seen any gain in speech and awareness.He makes only irritable sounds /shouts..since past one year(before protocol irritable sounds were there..but less)
    We are desperately looking for gain in speech and awareness
    There are no negative impacts of inulin or FO. His body is tolerating them ineffectively. How do i know whether SIBO/propionic acid levels are being reduced or not?
    Is it right time to give him Rifaximin?

    • Patrick Nemechek, D.O. 1 day ago

      Occasionally when a child under 10 have little to no improvement and there was little to no sign of an awakening, I will recommend a 10-day course of rifaximin.

  5. Liz 2 days ago

    Hi dr Nemecheck!
    We are in the protocol since august 2017.
    We are presenting a plateau.. we have 6 months with no Advance. We are considering double the dosis of fish oil.
    But my question is “double” means jump in to the next age level? Or just add the same amount into the dosis?
    Thanks in Advance!

    • Patrick Nemechek, D.O. 1 day ago

      Double the starting dose for that age group.

  6. Kiki 3 days ago

    Hi Dr N My 11 yr old non verbal and high functioning was OK to deal with until later starts to pull his genitals and crying profusely. He seems to be in a bubble that will last btw5 to 15 mins. Will hit himself and looks as if he has a spasm. Just being on the protocol for 3 wks. Just wondering what it is and if we are likely to get gains from the protocol. He has been xrayed twice to see if any underlying issues but nothing seen

    • Patrick Nemechek, D.O. 3 days ago

      Probably some anxious behavior from the awakening.

      If so, it should lessen some by lowering the inulin dose and increasing more slowly

  7. RAMYA 3 days ago

    HELLO Doctor,
    my son is 7 years old.has heterozygous mutation for mthfr both genes.should i consider giving 5htp with your protocol?will it make a difference?

    • Patrick Nemechek, D.O. 3 days ago

      I would only give it if your neurologist thought is was necessary.

  8. Jennifer 4 days ago

    Hello Dr. Nemecheck, I was just hoping to ask you a question. We purchased your book and just started our 2.5 year old son. We want make sure we have everything correct. We purchased Nordic Naturals children’s dha Xtra. It says ages 1-6 and says great taste with a picture of grapes on the bottle. We know that you recommend no flavors, however we looked online, ultimate omeagas have pictures of lemons on them. We couldn’t find one that didn’t have a picture of a fruit on them. We just wanted to ask you if these are ok?

    • Patrick Nemechek, D.O. 4 days ago

      Well, we’ve only are suspicious about the strawberry flavoring and thousands of kids are doing well with the lemon flavored NN fish oil.

      Haven’t heard anything about berry good or bad.

    • Ella 4 days ago

      Why strawberry flavoring is suspicious?
      I am using it for my son. should I stop?

    • Patrick Nemechek, D.O. 3 days ago

      We had a few kids relapse after switching from lemon-flavored Nordic FO to strawberry-flavored Nordic FO.

    • Jennifer 3 days ago

      Thank you so much for your reply Dr. Nemecheck. My husband and I are planning to make an appointment with you for our son if we need to in the future. A big thank you from Pennsylvania.

    • Patrick Nemechek, D.O. 3 days ago

      Your welcome (from Arizona)

    • Jennifer 2 days ago

      Hi Dr. Nemechek, I just wanted to tell you something about the strawberry I think I just discovered. I watched your YouTube video on fish oil (twice), to better understand the differences between the dha/epa and decide if we should switch to the lemon one for our son. We then went online to buy the lemon and compared the ingredients with the berry one we have. They were exactly the same word for word. The berry one we have is a new product and has a good dha/epa ratio. I then pulled up the strawberry one to compare the ingredients. I noticed that one was made from cod liver oil and had a few other differences. The berry and lemon are from anchovies and sardines, and you were talking about that in your video. I just thought I would tell you or anyone else having problems with the strawberry flavor. Thanks for your time.

    • Patrick Nemechek, D.O. 1 day ago

      I don’t think the issues is with the constituents of the fish oil per say but instead lies with the varieties of chemicals used to create a strawberry scent. The fruit flavoring in the fish oils are from a wide variety of chemical compounds and not from the fruit itself.

      I wonder if one of the chemicals used to re-create the scent/flavor of strawberry is to blame. Mere speculation at this point.

  9. Deborah Djanie 4 days ago

    Hello Doctor Nemechek,
    My son whohas is 2.7 years has been on the protocol since August. We had an awakening at 1/4 plus 1/16. We have had good gains so far. I increased the inulin to 1/2 teaspoon in anticipation of other gains such as potty training but I have noticed some bad behaviors coming back. Should I go back to my previous dose or keep pushing. Thank you

    • Patrick Nemechek, D.O. 4 days ago

      Keep pushing and be patient.

  10. Olivia 5 days ago

    Hello doctor
    on the protocol since February 2018, I had encouraging gains, my daughter must see the dentist because she has several quarrymen, what put the fillings in her teeth can harm it remains that it is metals and I am not not very comfortable with that?

    • Patrick Nemechek, D.O. 4 days ago

      I personally have amalgam filings and I don’t worry about it.

      But if you are concerned, there are porcelain and other options that can be used.

  11. Deborah Djanie 6 days ago

    Hello Doctor Nemechek,
    My son , 2.7 yrs who doesn’t have an ASD diagnosis yet but has some delays had an awakening on 1/4 +1/16 inulin three months ago . I increased his dosage to 1/2 teaspoon in anticipation of more gains such as being potty trained. But I have noticed he has some old behaviors like opening and closing doors back and generally defiant and whining a lot. Is He experiencing another awakening or should I go back to my previous dose.

    • Patrick Nemechek, D.O. 4 days ago

      Doesn’t sound that bad. Might be a little more awakening or from a minor injury.

      Either way he should recover out of it

  12. Olesya 6 days ago

    My 6 year old child with ASD and speech impairment was on protocol for 6 months, with speech and occupational therapies for over a year. Recently started to have outbursts – screaming hysterically, crying. He became more verbal, his articulation got better. The only change in his routine was adding brain training program. I cannot find answers. If this becoming highly emotional is related to new addition or as a result of being on protocol.

    • Patrick Nemechek, D.O. 4 days ago

      The protocol won’t cause this kind of reaction. There are a wide variety of brain training programs so its hard to comment if this could do this.

      Sounds more like a injury (physical, emotional or inflammatory) might be responsible. Also, addition of other supplements and especially probiotics could trigger something like this.

  13. Hopeful Mom in New England 6 days ago

    Just another positive update: son continues on recommended doses of approved products. He said “help me” tonight when he didn’t want to leave the mall. Took our breaths away. Huge development for us. Is more interested and mimicking sounds we ask him to make. Stimming now reduced by around 20% from baseline after a two day uptick for him. Interesting is that he is choosing more visually intricate objects to flap (that is how he stims) such as jewelry instead of the usual (measuring spoon sets). He also seems to be making some more deliberate hand movements during stimming and looking more at the objects he is holding.

    Thank you.

    • Patrick Nemechek, D.O. 4 days ago

      Nice to hear of his improvements.

      Stimming comes in every imaginable form.

  14. Anupama 7 days ago

    Hello Doctor, My son now aged 5 has been on the protocol since an year with very slow improvements. He has socio communication disorder. He is on 2 tsp inulin since a long time with no real gains. I am wondering if I could put him on Rifaxamin since i cant see inulin helping him even with max does? Can you please let me know your thoughts. Thank you so much!

    • Patrick Nemechek, D.O. 4 days ago

      Fish oil and olive oils are also needed for recovery.

      Please read the protocol. A copy can be purchased at

  15. Frosina 1 week ago

    Hi, I would like to ask about lactose intolerance and fructose intolerance, should the protocol be excluded from products that contain these substances or it is not necessary, my son has 6 years and on the protocol is 2 months, 1\2 tsp inulin and 1 capsule omega DHA DPA 500, 30ml fish oil plus cooking, we go slowly and he is doing fine.
    Lactose and fructose do not make him any problem when he consume them, so I wonder if he needs to fully avoid them and can this protocol resolve the problem whith intolerance? Thank you…regards

    • Patrick Nemechek, D.O. 4 days ago

      I routinely discontinue dietary restrictions after the children are on adequate doses of inulin or after using the rifaximin.

  16. Jasmine 1 week ago

    Hello Dr. Nemcheck,

    First of all, thank you so much for your help. My son has been on your protocol for 5 months with good gains. I saw the post about leucovorin. My son also got FRAT positive through a blood test, but we stopped after starting your protocol. Do you think he’ll need to start that again?

    Thank you

    • Patrick Nemechek, D.O. 4 days ago

      Probably not

  17. Kristina 1 week ago

    Dr. Nemecheck,

    My son still doesn’t spit out toothpaste. All fluoride free toothpaste has either xylitol or sorbitol in there. Which are both no-no’s for your Protocol. Is it okay on toothpaste? Does such a unicorn toothpaste exist? What do you suggest as far as toothpaste that won’t interfere with your protocol? Thanks!

    • Patrick Nemechek, D.O. 4 days ago

      Don’t worry about the toothpaste. It won’t prevent recovery.

      He’ll be spitting it out soon enough.

  18. Anonymous 1 week ago

    Hello Doctor,
    My son 6 year old is on the protocol since 1 month.He had little incremental gain in language and perception of his surroundings. Since 2 days his verbal stimming and hand flapping behaviour is high comparatively but he is not seeming confused or aggressive like before protocol.
    His dosage is olive oil cooked with curries just more than 2 ml, inulin morning 1/8th and evening 1/8th,2.5ml fishoil. Please guide me whether he is on right pathway.

    • Patrick Nemechek, D.O. 4 days ago

      I’m sorry but I cannot give specific recommendations for your child on the blog.

      As a general rule, if you are using doses in the upper ranges I use in my protocol and sticking with the approved brands, my experience is the answer would lay more in the VNS rather than rifaximin.

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