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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.

A TESTIMONIAL

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.

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Dr. Nemechek
Dr. Nemechek

Please use the search feature on this blog to find answers to your questions. Many of the questions that are being asked have been answered repeated by me (Dr. N) in the past.

Thank you.

Bee
Bee

Hello Doctor!
My 2 year old autistic kid has been diagnosed with metabolic acidosis since birth. May I go ahead with this protocol or her M A worsens?
Many thanks!

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

With a problem as serious as metabolic acidosis, I don’t think you should ever go ahead with any new protocol without first discussing it with your child’s physicians.

Inulin fiber and fish oil is safe for most children but in this circumstance please run it by your local physician.

Chris Mak
Chris Mak

My son is taking 500mg Azithromycin for Lyme disease. Can this antibiotics replace Rifaximin? Do you recommend to start inulin now or wait till after the antibiotics is finished? Is Krill oil ok?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Azithromycin and Rifaximin are completely different in scope, targeting and tissue penetration. They are not interchangeable. And please do not mix Rifaximin with another antibiotics unless specifically told to do so by your physician.

The real question is does your son have Lyme Disease or Autism? If he truly has Lyme’s then you shouldn’t need Rifaximin. If he has bacterial overgrowth there’s a good chance he doesn’t have Lyme Disease. If someone is claiming he has both, I think the odds are greatly against that happening. Although I’ve never seen the 2 together, it’s not impossible.

Kala
Kala

Thanks for your reply Dr. Before going ahead with the antibiotic, have a question.
Elsewhere in this blog you mentioned that sibo can return too. So once a ten day rifaximin is done, how to protect the gut?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Relapse is most likely a function of low biodiversity, acidification of the small intestine, intestinal dysmotility from autonomic dysfunction, exposure to antibiotics as well as other unknown factors.

ALthough probiotics, anti-SIBO diets, etc may have some appeal they seem to be ineffective, and unproven to “prevent” SIBO.

Anonymous
Anonymous

I read your blog post about vaccines indicating your belief that with a healthy gut vaccines should be low risk. My son has thus far been fully vaccinated and is due for his 5 year (MMR, DTP, Varicella, and polio boosters) in 3 months. Do you typically have a general recommendation/rule of thumb for a certain amount of time on your protocol before having vaccines? In my son’s particular case he never seemed to have any bad reaction to vaccines in the past.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

For a heathly child I think it would be a few months but no one knows for certain

Anna C.
Anna C.

We started this protocol 3 weeks ago, are on full recommended dose now for 1 week (of inulin and fish oil, still working on the olive oil since we have very limited diet). We have not yet seen any changes in behavior, but I am amazed that he now tolerates 3 tsp of fish oil without difficulty when previously even 1 tsp would cause diarrhea! I guess that is gut healing at work!!! and now daily, soft but formed stools. I am eagerly awaiting the behavioral benefits!

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The gut functions much better once bacterial overgrowth is reduced.

Kala
Kala

Rifaximin blows out sibo only right? But how does stomach lining, inflamed colon get treated? Do we have to add anything more?
Please advise.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The lining of the intestinal tract quickly repairs itself (10-14 days) after the offending agent (medicine, bacterial overgrowth) are removed.

Anonymous
Anonymous

Can your protocol help with speech apraxia?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes, I’ve seen it help a lot in patients under my care.

jamee
jamee

I would love to hear more about this as my daughter was just diagnosed with apraxia.

Anonymous
Anonymous

Do you have any examples/case studies of younger children gaining autism reversal? Thanks Dr Nemechek!

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

There is an example in the article of recovery of a 23 year old non-verbal autism young woman.

There are also several testimonials through this thread about how the commentors children have recently improved.

Humaira Noo
Humaira Noo

hello, thank u for sharing ur protocol. my non verbal 3 yo is taking cod liver oil and other supplinents like iron, folic acid, pyridixine, Zn, Ca, vit E,C and n acetyl cystine. also he takes biokult probiotic. we recently started giving him inulin powder. my question is should we stop probiotic? should we give him something else for omega 3? at the moment we use sunflower oil in cooking, hoping to change it to EVOO. would u please tell me if we should change the suppliments also? none of these are much available in our country Bangladesh, but we… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

As I state in my article, I generally recommend stopping all probiotics, digestive enzymes and supplements as these can be a source of side effects after stabilizing the intestinal tract with inulin.

Aussie Mum
Aussie Mum

He is 19 years old!! Happy birthday! We have been on the treatment road for 15 years on and off with successes here and there and yes he has made gains over the years, but nothing has ever been as simple as your protocol with such significant gains so quickly . Imagine the gains he will make once the fish oil is added? Exciting! I will update again in coming weeks//months. Thank you

Aussie Mum
Aussie Mum

My 19 year old Severe Autism, non verbal, PANDAS, OCD, ODD, Agoraphobia,severe anxiety etc etc etc is on week 3 almost 4 of inulin alone. Most days he has a table spoon and has handled it well. We have had success with high dose fish oil over the years to control the OCD and Tics but in recent months have had trouble getting it into him as he cannot swallow pills and will not take the omega fishies either! However on inulin alone he is settled, calm, loads of babbling, huge amounts of interaction, concentration and interest, he is happy!!!… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Oh my gosh. Reading this brings tears to my eyes.I

I’m going to consider your son’s improvement my birthday gift!

How old is your son?

Anonymous
Anonymous

Is rifaximin available as oral medicine too? Please advise.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes, it is used all over the world, and is relatively inexpensive.

Kala
Kala

My kid has IBS and symptoms are worsening with inulin. Gas retention, mucous in stool etc is what we are observing. Do you have any alternative to this, Dr N?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Make sure your child is not still getting probiotics or digestive enzymes. If not, you might need to stop the inulin and start at a lower dose or consider discussing with your physician about using Rifaximin.

Jaffa
Jaffa

Is elevated levels of serotonin addressed in this protocol?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

No but I don’t worry about such test results. Alteration in serotonin levels is a reflection of cellular dysfunction which resolves after using the Nemechek Protocol. The resiliency of a child’s brain is proving to be much great that anyone could of every imagined. I have several patients who is spite of their severe neurological dysfunction seem to be on the potential path for a complete recovery. Patience is key. As I’ve said on this thread several times, the brain recovers about as fast as hair grows. Day by day it doesn’t seem as if much is happening but then… Read more »

Citadines
Citadines

Trying the protocol for two weeks for an 8 year old partially verbal (1 teaspoon inulin, 1000mg Nordic Naturals Omega 3, both in mornings), main changes thus far are a reduction in separation anxiety (actually preferring own space) and an increase in visual stimming. The visual stimming is quite stressful as its done with saliva, is this a pass through phase or is there any other way to counteract?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I’m sorry I can’t provide a specific recommendation but generally there are pass through phases and as long as it doesn’t seem to be harmful to the child I stay on the treatment course.

I recommend following your child’s overall progress closely, and discussing any adverse changes with your physician.

Adebayo Oluwatoyin Rashidat
Adebayo Oluwatoyin Rashidat

Thanks so much dr for responding, I sure will get the inulin asap, but can other brands aside that of the NOW and Nordic Natural be used as it takes long before I get shipment from amazon, I live in Germany. If I can go ahead with other brands, then I can start right away by getting it over the counter here. Thanks in advance.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I generally think other brands are fine.

My article was originally written for a U.S. audience and I had no idea it would spread internationally.

Anonymous
Anonymous

Hey Dr N
Greetings. Don’t you have your patients undergo Organic acid s test before advising this protocol? It reveals many other biological imbalances based on which we may need to customize this protocol. Don’t you think so?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I don’t believe we are capable of correctly interpreting those tests.

Again, the children I’ve treated have done without worrying about such tests.

Violet
Violet

Hi Dr. Nemechek, love your blog! My daughter has Lennox Gastaut Syndrome. She has always had digestive problems and silent GERD. I started with 1/8 tsp inulin and 1/2 tsp fish oil since she is so sensitive. I am surprised that she is tolerating it better than I expected. I have noticed seizures are changing – a little more frequent, but shorter and less intense, in addition to some improvement in her chronic apnea. I wonder if you have any short-term recommendations for constipation, any brand of magnesium or vitamin C that has worked for your patients in the meantime… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

For the constipation, I generally recommend a non-fiber supplement such as magnesium (Milk of Mag) or MiraLax. The constipation will go away. Vitamin C only helps constipation when it causes a toxic reaction in the gut – doesn’t sound like a good option to me.

Don’t worry about the white tongue. Thrush does not grow on the tongue. It appears on the tonsillar pillars or posterior pharyngeal wall way in the back.

Anonymous
Anonymous

Hi Dr, my son is 6years, autistic with saliva drooling, I am eager to start the protocol. He has been on cod liver oil which has omega 3 fatty acids, vit b complex, b6, Gabapentin, risperidon, medikinet retard and melatonin. Can I start him on the protocol and still use all these? And for the drooling, what do you advise please.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Sounds like all you’re missing is the inulin.

The drooling usually recovers with the improvement in motor function that often accompanies the first month.

Anonymous
Anonymous

Day 11 of the protocol and my daughter keeps plugging her ears and becoming very anxious. She is often bought to tears. She is normally fairly easy going and placid. Is this to be expected?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Very usual. Maybe have someone check her ears just in case.

Alan
Alan

Dr. Nemechek, your protocol sounds too good to be true. I start my seven years old 85 pounds on 2000 mg Omega 3 and ordered inulin through Amazon. I will start my son on two spoons inulin once it comes. I will mix it with Prune juice and give it to him at nigtht before sleep. Please, know that if this works and my son got better, i promise to take a trip to your office, pay the consultation fee and give you a big hug. I promise you and i swear if he got better, i would work to… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Alan, Please stay in touch, I’m excited to hear about his progress. Generally on the dosing, I recommend starting at lower doses and working your way up over a week or 2. Within the first 2 weeks parents will see their child “wake up”. The child becomes more alert of people and their surrounding, often are less anxious. Loose or frequent stools are reduced and sometime replaced with constipation – this is not a bad sign, just normal progression of the recovery phase. Remember, recovery happens about as fast as hair grows. It may not seem like much is happening… Read more »

Sam
Sam

There are some algae Omega oils available now with the same DHA + EPA content. Do you recommend them ? Is there a minimum dosage of inulin to start with?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

There are some algae omega-3 oils but I have no experience with them.

Vas
Vas

Hi Dr N
Can we use lime juice while on this protocol? Do you think this will interfere with your protocol? Inulin creates an acidic environment whereas lime alkalizes the stomach. So Any food restrictions?
My kid is unable to combat the acidity generated by inulin.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I do not restrict any foods when I treat my patients other that severe allergies (peanuts, etc) and obvious intolerance (milk causing diarrhea, etc)

Samantha
Samantha

Hello, thank you for sharing your protocol with us. My daughter is diagnosed with dravet, a catastrophic Form of epilepsy. She does have some delays, with no sign of autism. The results of some testing, showed heavy metals, bad gut bacteria. Her propionic (longer word on test, I assume it’s the same?) was only slightly elevated. She shows many nutrient deficiencies. I assume it’s Bc of a bad gut balance. Anyway, I have some questions. I understand you don’t feel the need to address heavy metals? I am curious as to why, When we know that heavy metal load on… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I don’t worry about heavy metals because I don’t trust many of the labs performing the testing. Secondly, when I treat autism and other developmental issues I don’t need to address the heavy metal issues and they still recover. I have no idea how heavy metals may be affecting your child in particular.

I use inulin because it has consistently worked for me but that is not to say other forms or mixtures of fibers might not work as well.

Anonymous
Anonymous

In your article (which i have read many times!) you say a child could start speaking again. My child has never spoken and is minimally verbal at 4. Have you known children to gain age specific speech during your protocol treatment?
Have you ever had children that are non responders?
We are so very worried that the protocol may not work for her……

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Many children under my care have started to speak even after 10-20 years of being non-verbal.

There may be non-responders but usually it seems the parents are patient enough, quit my protocol and move on to other avenues of treatment despite obvious neurological improvement. Sometimes the recovery of speech may occur later than the recovery of other areas of funtioning.

Anonymous
Anonymous

I’m sorry, Dr. Nemechek. I need clarification. Are you saying to go ahead with the protocol, as is? Or should I have her treated separately for the impaction first, then go ahead with the protocol?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I can’t tell you exactly what to do without formally being your daughter’s physician.

I recommend discussing it with them.

Anonymous
Anonymous

Dear Dr. N,

My friends son is 2.5 years old and ASD. Can they take inulin and omega-3. Could you please suggest the dosage.

Thanks
Sudhakar

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The doses I use in children are discussed in the article.

Oluchi
Oluchi

I began wrongly with Nemechek protocol. i started my son on fish oil for a day and added inulin on the second day. His stool became soft. Today is the third day and i gave him only 1/4 teaspoon of inulin but his stool has gone berserk. They have mucus like substances. Was it the fish oil? or the Inulin powder? Should i stop entirely or redose? TIA

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

If there are ever any problems I start with low doses of inulin and after a week or then slowly add in the fish oil.

Anonymous
Anonymous

I am wondering what your suggestion is in how to proceed if the child has an impacted colon. Would the protocol be the exact same or would the impaction have to be dealt with first? Thank you.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I have used inulin to successfully treat several children with severe constipation.

Anonymous
Anonymous

Hi doctor…Any side effects with rifaximin? What dosage for 4.5 year old? My child is not so strong to even face oral antibiotics. Do you think he can tolerate the side effects of this injection?
And If this does the required job, why do you insist inulin first…Any special reason?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I start with inulin first because it is very gentle, reversible, inexpensive and its very effective in reversing the effects of autism in young children when combined with fish oil.

Anonymous
Anonymous

Will your protocol eventually make my child neurotypical and reverse asd traits? We have a non verbal 4 year old….. what is the typical time scale in young children? Many thanks.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I’ve covered these topics in my article.

Please re-read.

Megan
Megan

Just in case there’s some other Australians reading, I contacted Cobram and they said their extra virgin olive oil averages 73% Oleic Acid. Any other suggested foods with oleic acid?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Thanks for the info.

Olive oil is one of the highest containing oleic acid foods in the world

A little of the olive oil every day is all that’s needed.

Anonymous
Anonymous

Thankyou doctor.
Do you discourage probiotics even for short term usage.. I mean as short as a couple of months? And do you discourage natural probiotics too such as fermented foods? My child could not even tolerate quarter tsp inulin last month. Can we start as low as few pinches or is there a minimum amount?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes I do. If I can’t control overgrowth with even small amounts of inulin, then I consider using Rifaximin.

You might discuss this option with your physician.

Anonymous
Anonymous

Dear doc,
Is the intestinal inflammation only because of sibo or can it be due to other reasons such as excessive dehydration etc? If this is possible, I shall only give omegas. My child almost always have stomach issues and has excess acids too. He doesn’t like to drink water at all. So little worried to give two supplements that too both that tend to be acidic.
Is it okay to give him these supplements since his digestive system is already acidic as per what the tests revealed? Is there a test to check for inflammation?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The inflammation is mainly from th e bacterial overgrowth. The upper small intestine is a naturally acidic environment. Some worry they have too much acid because of issues like heartburn of acid reflux. These are really problems with not being able to empty the stomach and not from excessive acid production per say. Fixing intestinal bacterial balance in kids often resolves most of their “acidic” symptoms.

Angela C
Angela C

I’ve seen some slight improvement in OCD but it got to a point where it stopped changing. I’m concerned that this might not be “enough” to treat PANDAS/PANS as I keep finding out just how complicated it can be… We’ll see, but I’m afraid to delay much longer. A few more weeks of inulin and omega -3 and we will have to make a judgement call – autoimmune diseases really spook me. I’m trying to also be patient and note the slow and steady perspective. Tourette’s like movements are still present. I’m optimistic that they might be easing up. Fingers… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Patience and persistence are essential for autism recovery.

If there are any new changes that concern you, always discuss them with your physician.

Anonymous
Anonymous

Dear Dr. N,

Thanks a lot for sharing your knowledge, God bless you. We are on second week of inulin but dosing very less as he gets stomach cramps not sure is it acidity or bloating, but managing with essential oils. Certainly we are seeing overall gains. I have a question, once we platue on this do you think anyone would require chelation or hbot or GAPS diet etc.

Thanks
Prashanthi

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Prashanthi, I’m glad to hear things are progressing. If you read in the post, if there is a plateau I increase the omega-3 fatty acids from fish oil and then if necessary, add vagus nerve stimulation. I would absolutely avoid chelation, and GAPS simply address bacterial overgrowth the inulin takes care of, and the anti-inflammatory effects from HBOT should not be necessary if omega-3 dosing is high enough. Remember progress is slow. The brain recovers as fast as your hair grows. You don’t notice much day-by-day but suddenly you realize it’s grown so much you need a haircut! Please keep… Read more »

Angela
Angela

Dear Doctor, I was wondering if a different type of fiber might be used in our case. My daughter’s stool test came back positive for candida tropicalis, a strain of candida that assimilates inulin. Please see Table 5 in this study: http://www.biotech-asia.org/vol13no2/prevelance-of-bacteria-and-candida-oral-colonization-infections-among-dialyzed-patients/ All of the other types of candida tested do not assimilate inulin, but candida tropicalis does. Would the candida compete with the good bacteria for the inulin? Should we use a different fiber? Thank you very much – I just want to make sure it’s okay before starting.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The candida you are reporting is typically that found in a stool specimen – in other words a sample from the distal colon.

Modern studies of the microbes within the small intestine show that children with autism have very little yeast (candida is a type of yeast), and no more than children without autism.

The positive effect from inulin is how it rebalances intestinal bacteria within the small intestine and not the colon.

anonymous
anonymous

We are following your protocol. Our child is 4.5 and around 20kg. We are using half a teaspoon of inulin and 600mg omega 3 (nn). We are cooking with extra virgin olive oil and drizzling it on her food.
Is this enough? Can we be doing any other dietary changes to help her? Many thanks Dr N ! X

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

No, just observe and be patient.

The brain recovers about as fast as hair grows. Everyday your hair looks the same length until in 4 weeks or so, you suddenly notice the change and realize you need a hair cut.

The same pace of change will occur in your child.

Lindsay
Lindsay

Is there a multivitamin that you would recommend to compliment this protocol? My son is 7, been on the protocol for a week and we’ve exchanged our large daily dose of supplements/probiotics for just the omega 3 and fiber well gummies. Eating very clean as well. Adding olive oil in this week.
Thank you so very much for sharing this with us, I can tell you have a genuine heart for healing our kiddos. I’ll continue to post progress as it comes.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I’ve had many cases where the supplements were complicating the picture by causing their own problems. Vitamins minerals, digestive enzymes, probiotics can all easily have a negative effect. Some are just a bit more subtle and difficult to detect. As a rule, I don’t recommend them to my patients, young or old unless they have a traditional deficiency (B12, iron, etc) whose tests are measured in a recognized, CLIA-registered laboratory. Many patients show me reports claiming a wide-array of nutritional, enzymatic problems. These are often produced by labs that run tests in an unorthodox manner, and produce results with interpretive… Read more »

Anonymous
Anonymous

My son started pooping on the potty on day 1. And has been doing it almost every day since. With only 2 or 3 accidents. We are on day 11.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Nice. Good news for both him and you!

Thanks for the update, please keep us informed of his progress.

Anonymous
Anonymous

We are day 10 into the protocol. We are getting better sleep and more awareness. We are hearing lots of Babbling but no clear words. Our daughter is 4.5. Do these signs sound promising?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes it is. Day 10 is only the beginning.

Radhika
Radhika

Hello Dr. N
We have started on the protocol but our son has heavy metals issue. If there are heavy metals in the brain, will this protocol help.?
Thanking you in advance.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Please ask who ever suggested your child may have heavy metal problems.

Raghu
Raghu

Is bloating and intestinal gas issue forever? My kid has been waking up in the night frequently due to above said issues. Will they get resolved on their own?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Bloating, cramping and gas are often a result of an imbalance of the autonomic nervous system, and yes will over time resolve themselves. Autonomic imbalance and dysfunction is a common occurrence in children and adults after their brains have been injured. Autonomic damage is very repairable and the Nemechek Protocol.

Holly
Holly

Is taking the Omega’s 6&9 via fish oils an issue if you’re child eats ZERO processed foods? We make everything from whole/raw foods. Also, we only cook in duck fat, beef tarrow, extra virgin olive and coconut oils. Would giving the Omega 6 and 9 be beneficial then or still shouldn’t give?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I can’t make any judgement about the particulars of your diet.

With the high degree of fraud in the labeling of meats and fish, oils and supplements,

I still hold to my recommendation of restricting all omega-6 fatty acids from the diet

Jay
Jay

Hello Doctor
My kid was born normal but regressed in between due to malnutrition. He lost social connections and cognition during that phase.
With this protocol is it possible to re-make the lost connections and continue pruning process?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I would think so yes depending on the cause of the malnutrition.

Noel
Noel

Hi Dr..Have an interesting observation. My kid has dev. delay with no ye contact, speech etc. So far we have been told it’s autism disorder. I just happened to start him on Omega 3s alone seeing this blog, since inulin was not readily available. Within days I could see he is paying more attention and eye contact to me with reduced hyper activity. Could it be possible that he was not giving eye contact all these days purely due to inflammation in the brain? Does it mean that children who don’t give eye contact may not be in ASD ???Of… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The vast majority of children with autism have developmental delay, the developmental delay in large part is due to inflammation (elevated pro-inflammatory cytokines) within the brain.

Fish oil lowers brain inflammation and inulin lowers brain inflammation as well as reduces the production of propionic acid.

Good luck and let us know how your son does.

Anonymous
Anonymous

My kid is having ulcerative colitis and with developmental delay. Can I still go-ahead with inulin or does it worsen the colon ulcer?
Can omegas reduce only brain inflammation or does it help reduce anywhere else?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

In adults, bacterial overgrowth is more of an issue in Crohn’s and less so with Ulcerative Colitis. Less in known about the role of bacterial overgrowth in these 2 cases in children.

Any source of inflammation can impair neuronal pruning and normal development. I believe omega-3 fatty acids are universally beneficial to kids especially thise with any developmental issue.

Supplementing with omega-3 fatty acids from fish oil and nuts or flax will help to normalize inflammation control mechanisms, and can result in a decrease of inflammation in any part of the body.

Anonymous
Anonymous

I am giving
NN Pro EFA 369
1270mg Omega 3
500 mg Omega 6
500mf Omega 9

Is this okay?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Please read my other comments concerning Omega 369

Beth
Beth

We do have to continue to give him Allegra due to the hives and today had to give Zantac for the H2 blocker. Does giving the Allegra (and Zantac when needed) effect the clearing out of the bacteria overgrowth? Could the probiotic have been stopping the inulin from clearing out the bacteria overgrowth? Is the histamine release part of the process of getting the bacteria overgrowth under control?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Children with autism and most developmental disorders would be expected to have some underlying autonomic dysfunction. The autonomic nervous system normally controls the inflammatory response in the tissue surrounding the small intestine., and if the ANS is damaged, excessive inflammation including histamine release can result. With time, the autonomics will recover and the inflammation and histamine release should stop.

Until then, dual histamine blockage is a standard approach to controlling the symptoms.

Beth
Beth

My on has been on both fish oil and inulin for awhile but we recently stopped all other supplements including probiotics. He has battled hives for 4 plus years and the last few days he has been itchy (no actual break out of the hives). This morning his skin on his legs was burning. He does seem to have a very faint raised bumpy rash on his torso and thighs. But his skin is so fair and sensitive it isn’t uncommon for him to have bumps (which never both him). Wondering if his body is detoxing. Would activated charcoal help?… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Most of the itching and hives I see in patients, the source if the intestinal tract. The itching and hives are often a manifestation of histamine release from mast cells, a specialized form of white blood cell. Mast cells are predominantly found in the GI tract, brain and respiratory tract. So as long as a patient doesn’t have significant respiratory issues, the histamine induced itching is coming from gut inflammation. Bacterial overgrowth is a major source of histamine release, and it is not a detox phenomena. If one has an allergic reaction to inulin or fish oil, it would most… Read more »

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