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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. Patrick Nemechek, D.O. 12 months ago

    If everything has stopped improving over the last few months, he may have inulin failure and require rifaximin. If other aspects continue to improve except the speech, then he needs a vagus nerve stimulator.

  2. Kristy L 12 months ago

    Hi Dr Nemecheck
    We are 8 months into the protocol with amazing gains. My son is nearly 4. He’s on 1/8 inulin, olive oil on food and drinks and also the correct dose fish oil. I’ve never missed a dose. My only struggle is constantly looking if he is having gains or not. I would probably say things have plateaud slightly after an explosive start…

    I would say he is maybe saying a new word every week and maybe trying to put two words together occasionally, he’s still scripting constantly in his own world but that’s the only ASD symptom he has, along with his speech. My question is do I stay on the current doses with this minimal gains??
    I am fully aware of not being impatient I just struggle with what is still gains and what’s not

  3. Colleen 12 months ago

    Hi Dr. N., I’m trying to get a doctor to prescribe Rifaximin for my 12-yr-old son who has PANDAS. One doctor flatly refused, saying it wouldn’t help with PANDAS kids. Another wants more info about this before he would prescribe it. I don’t see anything in your book on how it would benefit kids with PANDAS. Could you respond with some info that would convince him to prescribe it? Thank you.

  4. Maayan 12 months ago

    this is not a typical question, but you all need to know about this Dr. N protocol that saved our little boys life! he started speaking 4 days after we start at december 2018. 4 days!!!!! from non verbal to digging my had all day long.
    we on our way to get full helling (still have some sansory issues).
    we are sooo gratfull. Dr N you are our favorit persone on this erth!
    Thank you its will never be enugh!

  5. John 12 months ago

    Hi Dr. N,
    I am curious; have you ever had a diagnosed autism patient (that didn’t have some other major complication) under your direct care who did not respond or recover at all using your protocol, even with tVNS? Trying to decide on bringing my son to see you, been on the protocol strictly nearly a year but receptive and expressive language still lacking any significant or steady gains. Not trying to put you on the spot, I know there are no guarantees, just trying to decide if I should continue to wait or not. Thanks in advance for your dedication to helping our children recover from this, you can’t imagine how refreshing it is.

  6. Najaiha 12 months ago

    Hi Doctor,

    I started off with the protocol about 2 weeks ago with my Level 3 ASD daughter. I am seeing minor positive changes in her behavior.
    She is 3yr 10 months and dos/age is 1/8inulin, 2ml NN fish oil and evoo in food.
    She has Vitamins C (14 umol /L) and D (30 nmol/L) deficiency.
    Should I give her C and D supplements? I am afraid they might interfere with the protocol. Please suggest.

    Thank you for the protocol..we are glad that we started. 🙂

  7. Diana 12 months ago

    Hello Dr. Nemechek, greetings from London. My 26 month old son with asd non verbal is on the protocol for a little more than a month. (1/4 inulin, 2.5ml fish oil, and food cooked with EVOO) My question is he seemed much more alert the first week we started, then his eye contact decreased, still better, but not what it was the first week. Was that the awakening itself?

  8. Parent 12 months ago

    Hi dr nemechek, my son is on protocol for a year now he has had massive gains in all areas. I will be forever thankful for that!!!! He is very loving and has never been aggressive in his life. From June every day he is lashing out hiting, biting, screaming. This is so unlike him and is tearing our family apart. The only change is the NOW inulin. I’ve checked my account and a week after he started the new inulin this all started. I know NOW have said that the inulin itself hasnt changed it’s just the way it’s manufactured but this can’t be a coincidence. I have tried to ride it out but it’s going on 3 months. He is currently on 1/4 should I bring it down to 1/8? Or should I try a different brand?

  9. Ashley Felts 12 months ago

    Dr. Nemechek,

    If my 14 year old son only has ADHD, will only using the oils work or do I have to use Inulin or Rifaximin? He gets super hyper with even tiny amounts of inulin.

  10. Elito.p 12 months ago

    My 6 years son has an autism and he is on the protocol since 2 years. The I st year I gave 1 tea spoon of INULINE and 5ml omega 3 and 5ml olive oil, the second year I was giving 1 /2 INULINE and 6/7/8 ml omega 3 and 10 ml olive oil.
    My son woke up after the first month. He started to be more curious and interested. He still doesn`t speak and has stereotype activities and periods of isolation. 2 weeks ago, he relapsed and had a manifestation of “pica sindrom”. trying to eat uneatable things.
    Can I give more inulin, or to try a round of rifaximin?
    Thank you!

  11. Mary Johns 12 months ago

    Hi Doctor, my son is 8 and has been on the protocol for months. ( He used to be on vsl 3 probiotics and magnesium )
    I haven’t seen any improvement in him other than the fact that he would normally do terrible off his vsl 3 and magnesium so that is great.
    But now laughing episodes are happening the last week he is also more defiant and aggressive. I usually contribute this to yeast overgrowth. (He was on amoxicillin a little over a month ago) what can I do? Whenever he gets this way I usually give a little extra probiotic and magnesium, pray and wait for it to run its course. I can’t do that on the protocol and I can’t take this cycle!!! Is it really yeast? How can I get to the bottom of it? It’s like it he’s a different child when he gets this way! We have done Azols in the past from a Dan doctor. With good results but one time he went off the deep end behaviorally. It lasted months and I never thought he would snap out of it. Thankfully the did. Bit like I said I don’t know what to do. This cycle had to end! Please help! Please

  12. Covie 12 months ago

    Dear Dr Nemecheck, thank you for taking the time to answer my question.
    In your practice, when there is inulin failure and you prescribe Rifaximin to a young toddler, do you give the full dose as set out in your book or do you adjust for age/weight?
    Thank you so much for helping!

  13. Jenny 12 months ago

    Hi! I just finished your book. I loved it. What do you think about the present levels of Propionic Acid used in gluten and dairy as a preservative / mould inhibitor? Do you think it is possible that excessive consumption of foods laced with Propionic Acid could further contribute to the amount of Proprionic acid in the small intestine? I was wondering if perhaps one of the reasons people who go gluten -free and dairy-free have some additional success is due to the fact that they are unknowingly reducing Propionic Acid levels in their system. It seems like many new studies that have come out this year are further proving the validity of your views on PA and other gut pathogens. Thanks for the awesome book!

  14. Najam 12 months ago

    Hello doctor,

    My 2.10 year is on protocol since January with minimal gains. She is throwing tantrums a lot now a days, also she is having severe meltdowns at playschool and home as well.

    Present dose – 1/8 inulin(Stopped 10 days back due to aggression issue)

    1100mg of epa+dha nordic naturals(550mg before but i doubled recently)

    Cooking in evoo+2ml cooc evoo orally(7ml cooc evoo orally till now, but started cooking in evoo 2 days back)

    With no promising gains in last 7 months, i am becoming concern if i am dosing her correctly. When should i add inulin back?

    Diagnosis – Severe speech delay(non verbal), global developmental delay.

  15. Olivia 12 months ago

    on the protocol since February 2018 for my 5 year old daughter I give 1 / 4INULINE and 3ml omega 3 and 5ml olive oil, she relapsed these days, eats toilet paper, shouts a lot, too much opposition as before, she is not sick, do I have to lower inulin, is it a second awakening? please enlighten me?

    • Patrick Nemechek, D.O. 12 months ago

      If a little more inulin doesn’t help then she probably has inulin failure and needs a round of rifaximin.

    • Olivia 12 months ago

      Merci beaucoup docteur pour votre réponse

  16. Hayden Chew 12 months ago

    Hi Dr.Nemecheck, firstly would like to thank this protocol help alot of childs in the world.
    My Son 7yrs old had been full protocol about 1year & 3Months. He was getting better & better.
    He can reading, writing and understanding instruction now. Before NP he is non verbal child, and less eye contacts.

    But… yesterday he start some bahavior come out, he jerking head & blinking eyes. is this Stimming / Awakening / Tics ?
    What should i do for him now ? Decrease or increase dose ??

    Current Dose :-
    2ml NN Ultimate Omega Oil
    15ml EVOO
    1/2tsp NOW Inulin

    Thank You
    Hayden Chew

  17. Chetna 12 months ago

    Hello Dr.

    What is your take on ATSAS EVOO? Appreciate your response.


  18. Mat 12 months ago

    Hello Dr Nemechek. My son has been doing well on the protocol. Slowly improving. He is 3 years old and we have been on the protocol for 3 months. We use 1/2 teaspoon Inulin. 2.5ml NN fish oil and 5ml olive oil. My problem is he has been having a really hard time going to sleep. Stays awake till 2am. He has always had a hard time falling asleep but its much worse bow. Also he gets super hyperactive at nightime. Running pacing and making so much noise. It seems lile he has lost his mind a little. He’s also been biting his nails to the point of hurting himself. He’s coming along ok. He’s still not social and he does not understand simple instructions yet but I’m hopeful

  19. Nat 12 months ago

    Hello Dr Nemechek. First of all I want to say thank you so much for everything. May God continue to bless you. I started my 3 year old son on your protocol 3 months ago. He went from being in his own world to responding to his name. Singing songs out loud. Finishing songs i started. He still has a way to go but I am so happy with where he is at the moment. However he still not social with other kids, still doesn’t follow simple instructions and he can get super hyperactive at nighttime. Like making noise running and all that. I just wanted to ask if you know why that is happening. It mostly happens at night. Should i increase his fish oil or just stay the course. I think he is slowly getting there but worried about the pacing running and noise. Thank you so much

  20. Samar 12 months ago

    Hi Doctor N,
    I Have below questions for you

    1. Are you doing research on restoring Microbiota as well ?
    2. I am a vegeterian and never had fish in my life. How is my Omega 3 and Omega 6 balance maintained.

    • Patrick Nemechek, D.O. 12 months ago

      1. No I am not working on gut restoration. Its too technical and expensive for me top do research on.

      2. It is very difficult for vegetarians to get enough DHA. The is a conversion pathway from ALA to DHA but some evidence suggest this pathway does not function well because of the excessive linoleic acid in the food supply chain.

  21. maayan 12 months ago

    Hi Dr, Nemechek,
    Would like to ask your advice on EXOME testing came back with a change in GNAO1 gene,
    Can Inulin have any effect on some of the symptoms?
    can it help improve signs, is it worth the try or can it be harmful?

  22. Antonia 12 months ago

    Hello Dr. Nemechek! Thank you for spending your time and answering all the questions here, please help me identify what would be the right decision. My son, 3,3 ASD, nonverbal, has been on your protocol for a year now. Prior the protocol he had 0% receptive speach, no poiniting, no social skills, no eye contact, no responds to his name or any other reaction to whats happening around him. As of now, he has a beautiful eye contact, interested in everything that goes around, paying attantion to his sister, animals and birds, having fun in playing with us, started pointing what he wants, knows colors, shapes and animals, started to understand some simple instructions, 90% of the time responds to his name. However he has no improvement in speach, no babbling even, also no functional play, and somewhat little imitation here and there, lots of stimming. During that time we have tried increasing the inulin up to 1tsp, 500mg FO, 1,5 tsp of Olive Oil, At 1stp of inulin he had not much success in any additional gains, but got sleeping issues, and mood swings. Deceased the inulin to 1/4, the overall begavior got better, more attention, and less stimming, but no significant imrovements for over two months. Decided to start all over again with small doses :now he gets 1/32 of inulin and we have good concentration, nice awareness, perfect eye contact, and reaction, more interest in toys, but still stiming a lot, and poor reseptive speach, still no babbling and words no imitation and poor understanding. . Should I change the doses of inulin, increase it to 1/16 may be, or double the FO as there is a plateau in gains for over two months? I know you advice vns if one o two areas do not improve, and refaximin in case of inulin failure. I am confused how to asses my situation, is it considered to be tha case of no significant gains? Thank you.

    • Patrick Nemechek, D.O. 12 months ago

      Sounds like he needs vagus nerve stimulation

  23. maayan 12 months ago

    Hi Dr,
    Can the Protocol benefit children with Genetic Disorders?
    in one case-
    a child with microcephaly, global development delay (and some doctors says also ASD)
    EXOM test came back inconclusive with no actual observation,
    in second case-
    a child with global development delay, had Giardia infection, now EBV
    and recent EXOM found change/mutation in GNAO1> GLU246LYS
    Can the INULIN do any difference? and also important- can it do any HARM?
    Maybe you have some advise for us?
    Thank you so much in advance

    • Patrick Nemechek, D.O. 12 months ago

      I’ve seen improvements in a variety different scenarios such as these.

      All the ingredients of the protocol are very safe

  24. Sana 12 months ago

    Hello doctor! My daughter is 3.10 years old..We did hyperbaric oxygen therapy, MB12 shots, with no improvement in speech & toe walking and then got to know about your protocol so stopped all supplements and other biomedical treatment & started full protocol since February -2019 with 1/2 tsp inulin, 1 tsp UU fish oil & 1 tbsp approved cooc seal oil….seeing gains like receptive language got better, learning things, waving for hi-bye, good eye contact,started nodding head, pretend play, reduced stimming etc but no improvement in speech and toe walking, not ready for potty training yet so my question is ‘do we need VNS for these two areas?! Total 6 months on protocol.

    P.s: we have been doing chiropractic adjustments & oestopathic treatment before and after tongue tie procedure along with the protocol since April.
    Thank you!

    • Patrick Nemechek, D.O. 12 months ago

      There is a good chance the speech will still come along without VNS but if no gains at all in 3 more months, then yes I would recommend VNS.

  25. Michal 12 months ago

    Hello, my son is 8 years old. On olives like needed and 1/128 tsp of inulin since December 2018 (for a couple of weeks had only olives because of agression).
    Having small gains. Each time I try to go up with inulin he is going crazy and aggressive.
    I wonder weather I should stay in this amount (1/128) or to go up drastically to 1/8.
    I wonder if the small amount is what is doing the troubles or is he just need this 1/128.
    Thanx and all the best.

    • Patrick Nemechek, D.O. 12 months ago

      You might want to consider discontinuing the inulin and treating with rifaximin.

    • Michal 12 months ago

      Is it common that kids that doesn’t tolerate inulin will be better with rifaximin?

  26. Simon Ttaylor 12 months ago

    Hi Dr Nemechek,
    Thank you so much for a great book and protocol. Our son is ASD non verbal 4.6 years old and we feel has had SIBO since birth and CBI since 18 moths old. He has been on protocol since July 11 2019 with
    1/4 tspn Inulin
    EVOO in food
    2.5mL Fish Oil (Australian Brand Ethical Nutrients where 5mL 947mg DHA and 1.9g EPA. It is a highly respected brand in Australia).
    The fish oil was under the advice of a local nutritionist and to be honest I wasn’t into the protocol at that stage so I didn’t think anything of it. I have since read the book and am really focused on it now.
    We saw the awakening three weeks in but had to take Paromomycin for parasites a few days later. The antibiotics are finished and we are waiting recovery from relapse, should be a few days away.
    My question is about the fish oil. The dose is around double the NP dose for his age. Do I:
    1. Reduce it down to the recommended dosage
    2. Change brands to Nordic Naturals and reduce to recommended dose
    3. Change brands and keep it at the high dose.
    4. Keep it the same given he seems to be tracking well
    It is hard to know if the fish oil is having an effect given we are in the awakening., but it was a very clear and defined awakening.
    Thank you so much

    • Patrick Nemechek, D.O. 12 months ago

      I think you need to read and follow the protocol and get a second opinion the next time someone suggest your child has a problem with parasites or yeast.

    • Simon Taylor 12 months ago

      Thank you so much. We have definitely seen a relapse with the antibiotics. They were finished on Tuesday July 13, before which he was in the awakening for 4 days. We have kept inulin, EVOO and fish oil constant at pre-relapse levels according to Protocol. No other supplements.

      Should we see a return to the awakening in the coming week or so? Keep Protocol at same amounts? It says to increase inulin a bit if needed. When would we need to do that? If he doesn’t improve two weeks after the end of the course on antibiotics?

      Sorry for all the questions, we are just getting started. Thanks for all your help.

  27. San Zaf 12 months ago

    Hello Dr. N,
    After 8 month of inulin, my 4 year ASD son stopped responding to Inulin. We gave him Rifaximin 3 weeks ago. First two weeks, were great, trying to talk more, communicate with one word , saying he wants to go to potty. We are at end of week 3 and he is starting to zone out, stopped saying potty, pooping again in nappies, lost in his own world. So we put him back on 1/2 teaspoon inulin( before rifaximin he required 1+1/4 teaspoon). He is still not saying or asking things,, not requesting to go to potty. Did we loose the potty trained skill? Just devastated with this new behavior. Please advise.
    FO – 5ml since long time
    EVOO ON FOOD AND 3 teaspoon during day.

    • Patrick Nemechek, D.O. 12 months ago

      Sounds like he has relapsed again (as long as their is no obvious other event).

      Retry the rifaximin

    • San zaf 12 months ago

      Thank you for your reply Dr. Nemechek:)

  28. Rose 12 months ago

    What is your opinion on colon hydrotherapy?


    • Patrick Nemechek, D.O. 12 months ago

      Not necessary

  29. Kanika 12 months ago

    Hello Dr. My son is 3.9 yrs old and from last week he is on protocol , my question is to be on protocol he need to be on gfcf diet and we have done some of his allergy test as well and he is allergic to almost all the things which we eat even some gluten free food also should I do any food restrictions or just follow ur protocol without food restrictions.

    • Patrick Nemechek, D.O. 12 months ago

      The food testing results are very inaccurate when there is bacterial overgrowth. In all but the most severe cases (anaphylaxis from peanuts) I only trust food challenges for food allergy determinations.

      I do not start anyone on food restrictions and if they are on them, I recommend stopping them (they become unnecessary) 2-4 weeks after either starting inulin or finishing their round of rifaximin.

  30. Davinder 12 months ago

    Hi Dr,
    My 5 year nonverbal, asd 18 months on protocol has started doing hand nd vocal stimming along with aggression.
    On other hand
    We are having slow nd steady gains nd seeing improvement in babling nd some sound productions.
    Dosage- 1/2tsp inulin
    1.50 ml nnuo
    7.5ml cooc approved olive oil.
    My question do we need to increase anything at this point or wait bit longer to pass .
    No case of illness or constipation etc. Dosage are same from last 5 months.

    • Patrick Nemechek, D.O. 12 months ago

      Just be patient, this will go away.

  31. Valeri 12 months ago

    Hello Dr. Nemechik! Could you help me to find a solution, please? A boy, 6 years, has autism. He’s been on the protocol since September 2018. His dose is 1/2 inulin, 1 drop of DHA and 1 spoon of olive oil. All stems have disappeared, but he is constantly blowing. Could it be a sign of low blood pressure? And what can I do with this? Thanks a lot in advance.

    • Patrick Nemechek, D.O. 12 months ago

      What do you mean by “blowing”?

  32. Fir Ali 12 months ago

    Hello Dr. N,
    We’ve been on your protocol for 8 months for my 4 year old son. He was doing great, when he developed sibo flare and we had inulin failure. So we gave him one round of rifaximin 3 weeks ago. First two weeks he did great, but this week his response is decreasing, so is eye contact and he seemed to be zoning out. He still doesn’t have signs of sibo (bad breath, white tongue) but we are worried if we are getting there or is this part of recovery and we just live this phaseout? Or do we gradually start introducing inulin again? Last week he had bit of runny nose so we gave him zyrtec and he was doing very well on it. We stopped it three days ago and he has been waking up in night crying, holding his crotch tight and crying, which we think is low BP problem. Salt water doesn’t seem to be working, so yesterday we gave zyrtec again and he slept through out the night, less hyper behavior to stimulate blood flow to brain. Do you think the anti-histamine is helping regulate blood pressure?

    • Patrick Nemechek, D.O. 12 months ago

      That recent could (runny nose) might be enough to throw him off temporarily. What and he should come out of it. If not, try another round of RIF

  33. Michelle Gibbons 12 months ago

    Please can someone send me links to peer reviewed research to support this.
    I am looking into all alternatives for my son.

    • Patrick Nemechek, D.O. 12 months ago

      There are numerous references listed in the book.

    • Michelle Gibbons 12 months ago

      So I have to buy the book.
      You cant name a single research or review I can go read.
      Well then that has answered my question I guess.
      I found another hack who cant help my son and just wants to make money off desperate people.

    • Patrick Nemechek, D.O. 12 months ago

      I’m post the references just so people can see how much verbal abuse I have to endure to try to answer these questions for free when someone can buy a book that will transform their child for only $9.99 on Amazon (less than the cost of 2 latte’s)

      Autonomic Dysfunction:
      • Bjørklund G. Cerebral hypoperfusion in autism spectrum disorder. Acta Neurobiol Expo (Wars). 2018;78(1):21-29.
      • Goodman B. Autonomic Dysfunction in Autism Spectrum Disorders (ASD). Neurology April 5, 2016 vol. 86 no. 16 Supplement P5.117.
      • Anderson CJ et al. Pupil and Salivary Indicators of Autonomic Dysfunction in Autism Spectrum Disorder. Developmental psychobiology. 2013;55(5):10.1002/dev.21051.
      • Goodman B et al. Autonomic Nervous System Dysfunction in Concussion. Neurology February 12, 2013 vol. 80 no. 7 Supplement P01.265.
      • La Fountaine MF. et al. Autonomic Nervous System Responses to Concussion: Arterial Pulse Contour Analysis. Frontiers in Neurology 7 (2016): 13.
      • Amhed K. Assessment of Autonomic Function in Children with Autism and Normal Children Using Spectral Analysis and Posture Entrainment: A Pilot Study. J of Neurology and Neuroscience. 2015. Vol. 6 No. 3:37.
      Bacterial Overgrowth:
      • Adams JB et al. Gastrointestinal flora and gastrointestinal status in children with autism — comparisons to typical children and correlation with autism severity. BMC Gastroenterology. 2011.
      • Wang L. Hydrogen breath test to detect small intestinal bacterial overgrowth: a prevalence case control study in autism. Eur Child Adolesc Psychiatry. 2017 Aug 10.
      • Hsiao EY et al. The microbiota modulates gut physiology and behavioral abnormalities associated with autism. Cell. 2013;155(7):1451-1463.
      • Cryan JF et al. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci. 2012 Oct;13(10):701-12.

      Cumulative Brain Injury:
      • Cunningham C. Microglia and neurodegeneration: the role of systemic inflammation. J Neurosci. 2013 Mar 6;33(10):4216-33.
      • Wager-Smith, Karen, and Athina Markou. Depression: A Repair Response to Stress-Induced Neuronal Microdamage That Can Grade into a Chronic Neuroinflammatory Condition?Neuroscience and biobehavioral reviews 35.3 (2011): 742–764.

      • Kellow NJ et al. Effect of dietary prebiotic supplementation on advanced glycation, insulin resistance and inflammatory biomarkers in adults with pre-diabetes: a study protocol for a double-blind placebo-controlled randomized crossover clinical trial. BMC Endocrine Disorders. 2014;14:55.
      • Hopkins MJ, Macfarlane GT. Nondigestible Oligosaccharides Enhance Bacterial Colonization Resistance against Clostridium difficile In Vitro. Applied and Environmental Microbiology. 2003;69(4):1920-1927.

      Microglia and Neuroinflammation:
      • Petrelli F, Pucci L, Bezzi P. Astrocytes and Microglia and Their Potential Link with Autism Spectrum Disorders. Frontiers in Cellular Neuroscience. 2016;10:21.
      • Norden, DM et al. Microglial Priming and Enhanced Reactivity to Secondary Insult in Aging, and Traumatic CNS Injury, and Neurodegenerative Disease. Neuropharmacology 96.0 0 (2015): 29–41.
      • Calabrese, F et al. Brain-Derived Neurotrophic Factor: A Bridge between Inflammation and Neuroplasticity. Frontiers in Cellular Neuroscience 8 (2014): 430.

      Omega Fatty Acids:
      • Madsen L, Kristiansen K. Of mice and men: Factors abrogating the anti-obesity effect of omega-3 fatty acids. Adipocyte. 2012;1(3):173-176.
      • El-Ansary AK et al. On the protective effect of omega-3 against propionic acid-induced neurotoxicity in rat pups. Lipids in Health and Disease. 2011;10:142.
      • Chang, P et al. Docosahexaenoic Acid (DHA): A Modulator of Microglia Activity and Dendritic Spine Morphology. Journal of Neuroinflammation 12 (2015): 34.
      • Patterson E et al. Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids. Journal of Nutrition and Metabolism. 2012;2012:539426.
      • Harvey, LD. et al. Administration of DHA Reduces Endoplasmic Reticulum Stress-Associated Inflammation and Alters Microglial or Macrophage Activation in Traumatic Brain Injury. ASN Neuro 7.6 (2015): 1759091415618969.

      • Ponziani FR et al. Eubiotic properties of rifaximin: Disruption of the traditional concepts in gut microbiota modulation. World Journal of Gastroenterology. 2017;23(25):4491-4499.
      • Gao, J et al. Rifaximin, gut microbes and mucosal inflammation: unraveling a complex relationship. Gut Microbes. 2014 Jul 1;5(4):571-5.
      • Yao CK. The clinical value of breath hydrogen testing. J Gastroenterologists Hepatol. 2017 Mar;32 Suppl 1:20-22.
      • Ghoshal UC et al. Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with orocecal transit time. Indian J Gastroenterol. 2006 Jan-Feb;25(1):6-10.
      • Muniyappa P et al. Use and safety of rifaximin in children with inflammatory bowel disease. J Pediatricians Gastroenterol Nutr. 2009 Oct;49(4):400-4.
      • Pimentel M, Cash BD, Lembo A, Wolf RA, Israel RJ, Schoenfeld P. Repeat Rifaximin for Irritable Bowel Syndrome: No Clinically Significant Changes in Stool Microbial Antibiotic Sensitivity. Digestive Diseases and Sciences. 2017;62(9):2455-2463.

    • Gunjeet Parmar 12 months ago

      For someone looking for scientific research as proof, you are surely quick to judge a person’s intentions or character. The road to recovery is long and winding. Keeping you cool will surely help, as will using your words carefully and seeking help with humility and gratitude. There is a whole community of Nemechek followers out there at various stages of recovery. Reaching out will get you some testimonials as well.

    • Kelsey 12 months ago


    • Michelle Gibbons 12 months ago

      All I asked for was proof. Scientific proof. It makes little sense to me how a stomach is connected to a genetic condition.
      I asked for that and the reply was that I should fork out MORE money on a book.
      So yes, I get angry. And I have read other comments. This is not something that had worked for all the children. I am also more interested in what other independent scientists say. Why are there more saying this doesn’t work than the few that say it does?

    • Gunjeet Parmar 12 months ago

      I hear you and am sorry that life has brought you to a point where doubt overshadows everything else. You can research all four aspects of the protocol separately and find numerous researches, across the world supporting them.
      Dr Nemechek answers so many questions, almost daily, for free and the book costs a pittance. I am not sure where you were made to spend money on this protocol. Families, even in third world countries are benefitting from this protocol, where following this protocol is not only costs much lesser than the prevalent alternatives(inspite of the import costs), but showing tangible benefits. Living in a developed country and especially in the USA, would mean the protocol is coming to you, more or less for free. Give it a chance, search Facebook groups for followers of this protocol. There are numerous groups for children as well as adults. If nothing else, it will give you a better perspective about a potentially life changing formula.

    • DS mommy 12 months ago

      Wow!! As a grateful parent I think I’d better speak up here as you obviously have not a clue what you’re talking about. But if you truly want healing yet, cannot afford 14 bucks for a paperback life-changing, healing book that recommends 3 inexpensive items available in grocery stores YET INCLUDES an extensive and comprehensive explanation of an expert physicians theories based upon decades of clinical experience and education… I suggest you put a few bucks into a savings account weekly in order to afford this. You will not regret your decision to save up. In addition, the research articles supporting this protocol are referenced in the back of the book. Wonderful work Dr. Nemechek! We are so grateful to you for all you do !!

    • Esther 12 months ago

      That is very rude. Dr. N is the only doctor in the world who answers questions for free in his blog.

    • Carla 12 months ago

      Michelle- my family has been hugely helped by the protocol. It is amazing that Dr. N answers the questions he does. He is so busy. He has a website, the book, and there are support groups on FB that often post articles that support the protocol.

  34. AnnMarie 12 months ago

    Hello Dr.,

    My 10yr old daughter has experienced big reductions in anxiety, and behaviors since starting Protocol (1.5 months). Her doctor prescribed Monteleukast for a simple allergic rhinitis. My question is, can Singulair negatively affect my child’s immune system and gut microbiome?

    Please let me know your thoughts and if you would give this medication to your child for a simple stuffy nose (no asthma). If not, I can have the doctor prescribe nasal sprays instead.

    Thank you so much for your opinion!!

    • Patrick Nemechek, D.O. 12 months ago

      Compared to antihistamines or nasal sprays, I don’t think Singulair is very effective for sinus allergies.

      That being said, I don’t think Singulair will negatively affect the gut biome.

  35. LESKITA 12 months ago

    Hi Dr, thank you so much for your support, our 25-month-old son has been in his 100% protocol for 7 months, since he was born with diarrhea, his stool has never been formed, many advances are coming but no intestinal health arrives for our son, diarrhea 2-3 smelly daily, ruled out parasitism and other germs by his gastroenterologist, with a gluten-free and casein-free diet, without supplements or probiotics, we have an appointment to meet him next July, currently 1/16 Inulin NOW, 1 ml FO and cooking with COOC, please some harvests on how to improve our child’s intestinal health or just wait. Thank you

    • Patrick Nemechek, D.O. 12 months ago

      Why worry so much about the loose stool at this stage if he has been evaluated by a gastroenterologists?

      Stay focused on recovery of neurological function and the intestinal issues often resolve on their own.

      Too many parents get over-focused on what I call “loose ends” (diarrhea, constipation, some tic or other particular behavior). The parents often resort to needlessly modifying the protocol doses or adding some other supplements and it often ends up in confusion and more problems with recovery.

      “Better is the enemy of good enough”.

    • Leskita 12 months ago

      thank you very much for your advice

  36. Fo123 12 months ago

    Hi dr Nemecheck, I have twin boys. Ages 3 years and 4 months.Both of them are autestic. We are on Nemechek protocol from January 2019. One of my boy has improved a lot. And starting to say some words. On of them (twin one )not improve at all. I’m very thankful from you . But I don’t know what to do now. I have an appointment with you on jun 22th ,2020. I try to lower his doses from 1/2 to 1/8 from last 2 weeks. He is more calm but still on his own world. Teeth
    His doses now .and not supplement
    1/8 inulin
    10 ml olive oil
    1000 Nordic cod liver oil
    I dabbled his oils when I didn’t see any improvement.
    I need your advice please.

    • Patrick Nemechek, D.O. 12 months ago

      If I don’t see any substantial recovery after 6 months, I consider it inulin failure and use Rifaximin instead of inulin.

  37. Simon Ttaylor 12 months ago

    Hi Dr. N, our 4 year old son has been on the protocol for almost 4 weeks. We feel like he came through the awakening after 3 weeks with increased hyperactivity, awareness and more anxiety. He is on 1/4 tspn inulin, 1mL fish oil and EVOO in cooking and 1/4 tablespoon in yogurt. He still takes Incremin for low iron. We have stopped all other supplements.

    Speech is the major concern. His speech was a few words picked up then lost since 2 years old. The number increased a little with ABA therapy started in April to around 10-20 words, but still often said only a few times then never again. We increased the therapy from 8 hrs/week to 20 hrs/week and after a couple of weeks he only said No. So we dropped the therapy back to 8 hrs/week. He has said on rare occasions bye, hi, bin and poo since . We have also noticed what looks like him really trying to talk with hand gestures, mouth movements, and a sort of hissing sound. What does this mean physically? Is it damage to the Vagus nerve? I assume we just keep going and be patient.

    Thank you so much

    • Patrick Nemechek, D.O. 12 months ago

      Speech is a major concern for all parents and often takes much longer to recover than most other issues.

      You’re only 4 weeks to go and theres a lot that needs to happen before he recovers his speech.

  38. Anonymous 12 months ago

    hello Doctor Nemechek, my friends mother has alzheimer’s, 2 years now, would there be a benefit from using the protocol at this stage. 74 year old woman. thank you kindly T

    • Patrick Nemechek, D.O. 12 months ago

      Yes, it can help

  39. Zahra 12 months ago


    I had started my son with ASD on your protocol in May of 2018, in April of 2019 he got severe allergy from antibiotic and had to receive IM steroids and I stopped inulin. When I restarted inulin in May 2019 he started to become aggressive and started to hit himself. As a result I stopped inulin and continued fish oil and EVOO. However, since then his sib related injuries have not decreased and after re reading parts of your book I decided to restart him on inulin. He is currently 5.5 year old. I have started him on 1/8 tsp of inulin. However, your book states to give any where from 1/8-1/2 tsp once to twice daily. My question is how often am I supposed to increase the inulin dose and wait for how long to see the changes. Also he is taking 5ml of ultimate omega which is >2000 EPA+DHA, should I reduce this dose. Can increased quantity of fish oil cause problem with inflammation , he has no gi symptoms from this dose of fish oil. Please let me know.

    Thank you

    • Patrick Nemechek, D.O. 12 months ago

      The allergic reaction may of given your child a small inflammatory concussion.

      You may need to just try even lower doses of inulin

    • Zahra 12 months ago

      Thank you for your reply. Should I also decrease the dose of ultimate omega fish oil. Currently he is taking 5 ml which is about 2400 epa+dha and per the book he should take 500-1000. Please let me know. Thank you

    • Patrick Nemechek, D.O. 12 months ago

      Maybe so, that is a bit much

  40. HoneyBon 12 months ago

    Hi Doctor,
    Firstly my sincere thanks to you from bottom of my heart. Thank you wouldn’t be sufficient.
    My son is who is 5 years old is on your protocol from past 6 months. Currently he is on following doses
    NN ultimate omega 2 ml (doubled it after reaching a plateau)
    EVOO 1/2 tablespoon
    Inulin 1/2 + 1/8 teaspoon (from past three weeks)
    He was bit calm and sometimes repeating words . But from past one week he is walking continuously all the time and his hand flapping has increased ( doing it wantedly) and also has vocal stimming. Is there any reason for this restless walk and increased hand flapping.
    Thanks in advance
    God bless you and Jean for your wonderful work.

    • Patrick Nemechek, D.O. 12 months ago

      You’ll find you answer in the chapters on relapses.

  41. Maayan 1 year ago


    My  daughter is 4yo and has high function autism, she has been on the protocol since nov.  2018. 

     fish oil dose 2/3 now. She gets  COOC approved EVOO with food and 1/4 tsp inulin.

    I have tried to increase her dose of inulin and I saw more awareness for a few days and lost it.

    Then, I dropped inulin to 1/16 tsp where I saw  awareness that lasted for a few days.

    It seems that everytime I change the dose ( up or down) awareness increase then she loses this gain and we go back to old behaviour… less eye contact less responding.

    • Patrick Nemechek, D.O. 12 months ago

      The real question is, “Are you seeing significant gains since November?”

      If not, maybe she need Rifaxaimin

  42. Annie 1 year ago

    Hello Dr Nemecheck,

    We did PET SCAN for my son who is 6 yr old and the findings include mild cerebellum hypoperfusion, he constantly wiggles his fingers on left hand, has anxiety , drooling, attention and other learning issues. I would like to know if the protocol will help treat these issues and if I need to add pinch of salt in the drinking water to help keep increase blood pressure/oxygen supply ? we are currently on 1/8th inulin, 5 ml EVOO and Ultimate fish oil (approved protocol supplements).


    • Patrick Nemechek, D.O. 12 months ago

      Yes, it should help

  43. Kathryn H. 1 year ago

    Dear Dr. Nemechek,

    Thank you so much for sharing your protocol to the world! My 11 year old son has been on the protocol for over a year with inulin. I’ve recently started him on Rifaximin and may have messed up his doses for the last 5 days. I’ve been giving him 2 – 550mg at the same time each day instead of spreading them out 1 morning and 1 evening. Would this have botched any effectiveness or the meds? I haven’t seen any signs it has bothered him other than more and quicker emotions. Should i restart the 10 day course? Thank you again for improving our lives and giving our ASD families hope!

    • Patrick Nemechek, D.O. 12 months ago

      Its hard to say.

      Wait and see if things improve. If not consider repeating the Rifaximin

  44. Seema Seth 1 year ago

    Hello Dr Nemechek,

    My 4.11 years old son has been on the Nemechek Protocol since December 2018. We made good improvements in fading away his sensory issues, lesser obsessions gut is better, sleep is also great. But he did not gain much in understanding and the saddest part is that since February (this year) he lost all the sounds, words he had before protocol. We are on recommended inulin and oils. His current dosage is 1/4tspn inulin , 2 ml NN Ultimate Omega, 5 ml Olive Oil. Not sure where are we going wrong.

    • Patrick Nemechek, D.O. 1 year ago

      Very unusual. Conceptually we do not think you can lose developmental gains.

      What can happen is that anxiety or poor focus increase so much that kids are excessively distracted and are unable to access these developmental skills.

      Try boosting BP with salt and fluids are decreasing the inulin a little (or both). these should help both of these issues

  45. Senthilpriya 1 year ago

    Dear Dr. Nemecheck, thank you so much for your wonderful protocol. We are seeing great improvements
    In various areas like :
    – imitation skills which was 0 before protocol and now it’s almost equal to a neurotypical,
    – improved receptive language,
    – uses 2 to 3 word sentences, started to understand simple explanations.
    – Expressive language is developing slowly but I’m sure he will catch up steadily.
    – Getting flexible day by day and food tolerance is getting better every day.
    One of the main areas not addressed is he does not understands social cues. When other people around him say “No” or warn him he becomes defensive and tries to hit them. At that time he does not understand what people around him mean. I’m not sure if this is aggressive behavior because he does not hit anybody without a reason . Also he is not bothered when somebody talks to him. Appears socially blind.
    He is 4.4 years old and doses are inulin -1 tsp, fo – ultimate omega 2ml(started putting words together after this dose).California evoo – on his food. 11 months on protocol. Should I go down on his inulin level? If I go down will the gains still be retained? Sorry for the long post. Thanks in advance..

    • Patrick Nemechek, D.O. 1 year ago

      I wouldn’t change anything and just work on being more patient.

      With these gains you just need more time.

  46. Lusine 1 year ago

    Hello, Dr. Nemechek. First, I want to thank You for the protocol, as this is the only treatment that helps us. We started the protocol with my son in February of this year. At the moment ,I give my son inulin 1 teaspoon per day (started with 1/4 teaspoon of inulin, gradually brought to 1 teaspoon). It was on 1 teaspoon of inulin that I saw positive changes. My son is 11 years old. I have been giving 1 teaspoon of inulin for 2 months already, I give the olive oil ,Omega-3 in recommended doses. All brands are recommended by protocol. I have the following question: inulin is a prebiotic, which means in time it will normalize the intestinal microflora, therefore, over time it will be
    necessary to lower the dose. Do you think I need to gradually lower the dose of inulin or not? Thanks for the answer.

    • Patrick Nemechek, D.O. 1 year ago

      Inulin only helps balance intestinal bacteria but will not lead to an increase in missing species.

      If he is doing well, leave the dosage where it is.

  47. Parent 1 year ago

    Hi dr nemechek, have you seen full recovery in children who aren’t on double fish oil? Any recovery stories I read about, all children are all taking double the amount you recommend. My child is making minor gains but cannot cope with double fish oil (he gets a lot of tummy pain if I double it) people are constantly saying for their children to be conversational they needed double fish oil. What are you thoughts on this?

    • Patrick Nemechek, D.O. 1 year ago

      If they are making gains, then your inulin and fish oil doses are adequate. More will not speed anything up

  48. Susette 1 year ago

    Hi Dr. N. What’s your thought on treating SIBO using Manuka Honey?


    • Patrick Nemechek, D.O. 1 year ago

      Will not help SIBO

  49. Aruna 1 year ago

    Hello Dr,

    My 4.5 year old has been on the full protocol (2 philips inulin gummies, 2 fishies, and evoo in cooking) since June 9. He is high functioning and verbal, but since the age of 2, we’ve struggled with explosive meltdowns which can last 1-2 hours! He is extremely hyper, rigid, and anxious all the time.

    With regards to the protocol, we’ve had one amazing gain – he is having regular BMs! Prior to starting the protocol, he used to be constipated and would only have a BM 1-2 times per week. However, we haven’t noticed any improvement in his behavior and we’re almost at the 2 month mark. Do we 1) stay at current dose for a bit longer, 2) decrease inulin, 3) increase fish oil, or 4) look into medication to increase brain blood pressure as you’ve mentioned in your posts?

    • Patrick Nemechek, D.O. 1 year ago

      Stay at present doses.

      Try boost BP with salt and water – the summer heat can cause a lot of increased aggression due to the drop in BP.

      In the end, the protocol will help the brain repair this issue

  50. Covie 1 year ago

    Hi Dr Nemecheck, can teething cause an inflammatory relapse or PA relapse or both? My son is teething and being hyperactive, anxious and agitated, laughing inappropriately and also much less interactive. Thank you so much for your kind help!

    • Patrick Nemechek, D.O. 1 year ago

      Not that I’m aware of.

  51. Robert 1 year ago

    Hi Dr. N, my son is 12 and has been doing your protocol for PANDAS since February. He’s taking 1 tbsp. EVOO, 3 DHA500 capsules, and 1/2 + 1/8 tsp. inulin. We just increased the inulin a few days ago, haven’t seen much improvement yet. Seems like every time we increase, he improves for a few days, then it subsides.

    My question is, should we continue increasing the inulin to see if there’s any improvement, or should we go right into Rifaximin, given his age?

    • Patrick Nemechek, D.O. 1 year ago

      Probably needs rifaximin

  52. Sussy das 1 year ago

    Hi Dr. Nemechek,
    I need to check for my 3.5 year old son .His speech is delayed and have max 30 words.
    His expressive and reception is not good .But say few words
    Not much socialisation. he can follow simple instruction.
    He didn’t start jumping and not yet potty trained 100 %
    No yet diagnosed.

    I have just started on protocol 2.5ml Nordic Naturals, Ultimate Omega, Lemon, 2,840 mg, 8 fl oz and 3ml of EVOO
    i am planning to start 1/8 inulin after 3 weeks
    Please check if that my dose of oils is too much .
    should i start inulin and continue if his behaviour is ok.

    • Patrick Nemechek, D.O. 1 year ago

      Please read the protocol. You’ll find my recommendations to your questions there.

  53. Shweta 1 year ago

    Hello doctor…

    First of all heartful thanks for your efforts to save our kids…. God bless you … My question is I have been doing protocol since October 2018… She went from being a non verbal child to now verbal though not conversational … We are seeing huge gains all around …just noticing some aggressive behaviours and increased stimming..we never saw improvement in eye contact at even 1 TSP inulin but when we increased ,UO from. 1 ml to 2 ml , we did …… Current dose : 1/8 TSP inulin , 2 ml UO , 7.5 ml evoo direct…

    .she is 4 …. The other thing is , Dr suspected an ear infection and prescribed Amoxicillin antibiotic for 6 days..

    Should I stop the protocol during this time ??

    • Patrick Nemechek, D.O. 1 year ago

      The infection is cause her other symptoms. Continue the protocol while taking the antibiotics

  54. Nikhat 1 year ago

    I cant cook in evoo as it is quite expensive for us in India, we import it from u.s
    So, how much dose of cooc evoo shall we give my 2.9 year old orally, to do protocol correctly.

    • Patrick Nemechek, D.O. 1 year ago

      Please read the protocol. You’ll find your answers there.

      Copy can be purchased at

  55. Mommy 1 year ago

    Dear Dr Nemecheck, thank you for all your help.
    Can Fish Oil cause low blood pressure and also low brain BP? If so, do I just reduce the dose?
    Also, should one be concerned with the amount of vitamin E in the NN ultimate omega fish oil liquid or is it negligible?
    My son has, since recently, low energy and is pale so I am just thinking of all possibilities.
    Thank you kindly!

    • Patrick Nemechek, D.O. 1 year ago

      You are over thinking what must be the simplest and most powerful protocol in the history of medicine.

      Keep simple simple.

      FO does not lower brain BP and do not be worried about the Vitamin E.

      Why would I recommend both if I might think there was a problem?

  56. Sabeeha 1 year ago

    Hello doctor,

    My child is 2.9 year now. On protocol since Jaunary 2019. Started with only inulin 1/8(no oils) and 5th day i saw pointing finger once.

    Then I started full protocol, she started to imitate on rhymes. But only for few days i saw these gains and then all gains stopped.

    Its been 7 months now with 0 gains.

    Current dose 1/4 inulin, 1 teaspoon cooc evoo(cooking in ghee), 2 nnuo (1100mg epa+dha).

    Doubled FO recently.

    Does she need Rifaximin?

    • Patrick Nemechek, D.O. 1 year ago

      I would have stayed at the lower dose of inulin.

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