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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.

Anonymous
Anonymous

Have you seen autism remission in all of your young clients? On average what has been the approximate time scale and dose reached of omega 3? Thank you

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

We’ve seen complete remission in several of our clients. More commonly we’ll have children improving but the parents quit following-up after 2-3 visits. The main reason is that my office doesn’t accept private insurance and patients are paying cash. The parents simply opt to continue the regimen at home and save the money which I completely understand and respect. We have had a few patients that were clearly recovering in a variety of ways but because recovery of speech did not occur within the first 1-2 months the parents quit following-up with me. I have 1 case I can think… Read more »

Laura
Laura

Is yogurt/kefir/fermented veggies out?

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

Naturally, and traditionally fermented foods are acceptable.

Do not use products that have been boosted with an additional wide variety of probiotics.

Jas
Jas

We are on our tenth day with inulin. I have also started Fish Oil and Extra Virgin Olive Oil. My son is 10 years old and suffers from chronic constipation. Can we stop his usual constipation medicine? Also, would it be best to give him inulin on an empty stomach , or with food? For older kids, you recommend 2 teaspoons, is this to be given to him all at once? We are seeing small improvements, such as less obsessive compulsive behaviours.
Thank you for your help.

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

Every child is a little different.

Some require a little more or less inulin to get their intestinal function to improve or limit the gas and bloating.

The same goes for the fish oil. If there is a little improvement but it seems to plateau, I’ll often recommend doubling the dosage of omega-3 fatty acids.

Anonymous
Anonymous

We started the kid on your protocol a couple of weeks ago. With inulin quarter spoon his cramps are too high that the next day he would have 3-4 bowel movements. But one day later he is so relaxed and sleeps much longer and better. Another thing that I noticed is that on the day when we feed inulin his nostrils seem to be getting constricted during night.
Does abdominal cramping and nostril constriction get better over time ? We skip the protocol on the days when these both are high, is that okay?

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

Please see my response to the comment immediately after yours.

Jill
Jill

Dr. N, thank you so much for that quick reply. i forgot to mention that we have been giving him vitc, zinc and lil critters multivitamins along with your protocol. We will take this off and continue with – fish oil, inulin and will add olive oil to his diet. We’ll watch him closely for atleast a week and see if stimming decreases. We will post updates. If nothing changes would you suggest increasing dosage of fish oil or gummies? If so how much? Thank you so much for your time.

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

Please see my reply to Jas, 2-3 comments after yours.

Alan
Alan

Hello Dr. Nemechek,

It is the second day since i increased the dosage from half spoon of inulin to one teaspoon. I am giving him the inulin mixed with Prune Juice. Today, he is.very gasy and has dayheria. The strange thing as well is that he goes to the bathroom every two minutes to urinate. He urinating just drops. I am not sure whats happening. However, he is making bowel movement like never before in his whole life. His system is getting cleaned up, but the urination thing every two minutes is alarming.

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

Prune juice can have a laxative effect.
The combination may be too much.

Anonymous
Anonymous

Dr. N we are in week2 of your protocol and saw noticeable changes – he’s more verbal. But we noticed yesterday (2wks and 1day) that he went back to watching the washer/dryer spin, and today he was spinning tops. These stopped months ago but now it’s back. We are giving him fish oil and 2fiber choice gummies. We cut the the gummies as it makes him really gassy. Will this stop? Is this a phase? I really appreciate all the help you share for us parents. Thank you.

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

If I see anything that strikes me as regressive after a dose reduction, I tend to increase the dose. Maybe try a different form of inulin. The sugar in the gummies might of been enough to cause the side effects.

Nicolette Barrie
Nicolette Barrie

Please, I am currently chelating mercury with my daughter and I via Andy Cutler Chelation therapy. Although we are continually improving with the ACC protocol our cognitive issues, brain fog, head pressure, OCD, all of which have benefitted greatly from Rifaximin and high dose Vermox, always return. I have major food intolerances there isn’t a food other than rice that I can eat without affect, normally brain swelling and feeling very poorly for hours after a meal (am DfGfCfSf low thiol, low amine, no sugar etc). I have been like this for most of my life, am malnourished and my… Read more »

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

I’m sorry but there is no simple answer for such a complicated history.

You might want to consider visiting Arizona for a formal consultation.

Dominika
Dominika

Just bought for my daughter rew cod live oil I was giving to her past 3 days and today when I give her vitamins she got histamine reaction:( I have to add that last 3 week ago we did 6th round of chelation. Is possible to make Skype app with you ? Thank you

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

Please send request for consultations via the contact tab.

Katie
Katie

Thank you. Would painful bloating also mean lower dose? -‘ experimenting on myself with gut issues and chronic fatigue and mood issues before trying on kids and had hugely painful tummy and bloat on the prebiotic fibres FOS and larch

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

Generally yer or it could be the type of fiber you are using.

I prefer pure inulin fiber

Anonymous
Anonymous

Thank you. What about just painful bloating ? Does the mean less inulin required?

Katie s
Katie s

If one gets gas when taking prebiotics (larch or FOS) does this preclude the use of inulin and if not do you expect gas and bloating with inulin? Thanks

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

Generally the excess gas means excess inulin, and is a sign for dose adjustment.

That being said if the dose required for a positive neurological response also causes increased gas, I’d put up with the flatulence and hope it clears in time and allow the brain to recover.

Kim
Kim

Dr N,

Our son was doing much better on your protocol but regressed again after eating some Easter candy. Could this candy imbalance the gut again fit to feeding bad bacteria/yeast? Thank you!

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

Bacteria loved processed sugar.

I can see how excessive amounts of sugar or candy could overwhelm the effects of inulin.

The effect should just be temporary.

Anonymous
Anonymous

Can the ‘awakening’ period in the first few weeks cause anxiety and heightened sensitivity? Can such behavior mimic ‘drug’ withdrawal symptoms? We are experiencing such behaviours….

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

After reducing bacterial overgrowth with inulin or rifaximin, the propionic acid-induced stupor will fade away and the child will become more alert and interactive. Sometimes the child may seem more anxious or hyperactive, may wake earlier in the AM or have more difficulty falling asleep. Potentially this could mimic withdrawal symptoms but there is no evidence that withdrawal from propionic acid occurs. These changes are not “side effects” of the inulin fiber but are the true function of a child that was formerly sedated by propionic acid that is no longer exists. Continued reduction of pro-inflammatory cytokines will activate injury… Read more »

Anonymous
Anonymous

Dr, N I want to give your protocol a try, my son will be 4 soon, 4 days I have been giving him inulin only, 1/4 scoop twice a day ( he is only 32 lbs) I already see eye contact, more words, repeats everything I say, even small sentences, he also is playing with his sister more. I haven’t done the fish oil just yet because I have tried in past and made him severely hyper, like running around for hours across the kitchen table non stop. When is a good time to try the omegas again?

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

I’m glad you’re seeing the initial awakening with the inulin.

You may want to try waiting a few weeks and then increase the fish oil slowly.

CJ
CJ

Dear Dr. N,

Do you recommend Hyperbaric oxygen therapy with your protocol?
would it hasten the recovery?

I really appreciate how your answering all these questions for us parents. God bless you.

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

No I don’t.

Anonymous
Anonymous

Can classical homeopathy still be used during your protocol? Many thanks

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

I don’t know what that really means but if you are suggesting herbs and vitamins I don’t find they are necessary

Omar
Omar

Dear Dr. N, Greetings from Argentina. Before start with my question, I want to say THANK A LOT for your gratitude in put your protocol available and all the support you give us answering all our questions. Same as the testimony above, three week in protocol and after a promising start with improvementa in attention, mood and ncreasing babbling ….now we are seeing an increased repetitive behaviour, tantrums and also increased stimming. The underlaying anxiousness from the autonomic dysfunction you mentioned it will provably be corrected along the protocol progress ?? or you recommend some adjustment on dosage of Inulin… Read more »

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

Yes, the autonomics improve with time. The only things that might speed things up are doubling the fish oil or adding vagus nerve stimulation which is rarely available.

Anonymous
Anonymous

Hi Dr Nemechek. Thank you for you prompt reply to my post today about stimming, tantrums etc…

Shehas magnesium daily to help with sleep and ear sensitivity. We also do Epsom salt and magnesium baths. Sometimes I use Bach flower remedies. Her diet is healthy and we are limiting processed foods.
She had a severe epilepsy as a baby and has developed autistic traits.

Jothee
Jothee

Dear Dr N Firstly thank you for your generous sharing .. you are truly an angel sent from above. I have a 9 year old who was diagnosed with West Syndrome/infantile spasm at 5 months old. He was given ACTH injections to control the seizures and it worked but a few months later the seizures returned in the form of epilepsy. He went through many different stages of epilepsy and currently they look like absence seizures. He probably as like 15 to 20 a day but its hard to keep count as they so unnoticeable that you wont even know… Read more »

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

Like I’ve said before, the dietary issues don’t seem to matter after stabilizing with the inulin.

The precise dose of inulin can take some fiddling with depending on tolerance.

Anonymous
Anonymous

Three weeks into protocol. After a promising start We are now seeing increased repetitive behaviour, tantrums, clinginess and increased stimming. Help!!!

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

I always recommend being sure there are no other probiotics or herbal remedies being used.

The reason is I’ve seen some cause problems such as this a few weeks into treatment.

Yu can also be seeing underlying anxiousness from the autonomic dysfunction patients will develop due to the inability to repair the multiple minor injuries from their head injuries

Diana
Diana

Thanks for the information. I will start this protocol as soon as possible

Anonymous
Anonymous

Dear Dr. N,

We are into 2nd week of inulin and first week of omega-3, using 1/6 of spoon, seeing improvement in speech and overall good results. Thank you so much.

Are Mast cells part of pro-inflammatory cytokines.

Another question is, does Histamine alone can cause Autism .

Thanks
Sudhakar

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

Mast Cells are a form of white blood cell that leak out histamine during inflammatory stimulation. They can also produce inflammatory cytokines but it is a secondary process for them.

I do not believe histamine can trigger autism although its release occurs with the inflammatory process that is associated with autism.

Kaegan
Kaegan

Hi Dr Nemechek,
My son is 11 months old, has SPD and showing several red flags for ASD. No gesturing, lack of imitation, very fussy, repetitive and odd hand and body movements. Can he start your protocol now or do I have to wait until he’s older?
Thanks!

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

I think the protocol should be started at the earliest sign of autism. I would encourage you to have the pediatrician evaluate your child if you are sensing some developmental issues might be developing.

Anonymous
Anonymous

Firstly thank you Dr Nemechek for sharing your protocol. We are 13 days in. Our daughter is 4. She is tolerating the inulin and fish oil well. However, we are seeing trouble falling asleep (can take up to 2 hours! ), wanting constant attention and being generally quite difficult! She vocalising more and even shousing. We don’t have clear words yet, just intonated babbling. In your opinion is she a responder to your protocol and what do you predict the next few months will bring? Thank you

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

This early awakening period is a good sign and children will beginning recovering from developmental delay and the brain injuries they have suffered.

Slow but surely this goes away.

Sharon
Sharon

Hi Dr N, We have been using inulin and Omega 3 fishies since 1 Feb 2017. There has been noticeable changes with my daughter who is 4 years old and has ASD. There is certainly a lot of language and longer sentences, more comprehension . She is starting to ask questions. There is more awareness of people and social ability. She now plays with her younger sister. I am very pleased with the results and will keep going with the protocol. I will however increase the dosage of inulin from 1/4 teaspoon to 1/2 teaspoon as I wanted to start… Read more »

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

The most important aspect of omega-6 toxicity seems to be the relative balance between omega-3:omega-6 and not whether any particular food source contains any omega-6. Nuts in general are high in omega-3 and low in omega-6. Food of this nature (nut, ground flax or chia, fish oil) are very healthy. Olive oil contains an omega-9 that protects the brain from the excessive omega-6 fatty acids that slip into the diet from commercially prepared foods and from animal meats especially those fed grains. I have a screencast on this site that discusses the omega3:6 issue and the benefit of olive oil.… Read more »

Radhi
Radhi

Hello Dr. N
We have been 3 weeks into this protocol and have seen good eye contact. Currently we are doing 1/2 tsp inulin and 800 mg fish oils. Our son is however very bloated and flatulence seems to be a concern. I know this is a minor issue but he seems to be uncomfortable. Will this reduce over time? I am keen to continue this as it is a simple protocol and I believe he is responding. Thank you so much for this article.

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

Other than constipation (see previous comment), adjusting inulin dosages can help with problems such as bloating or increased flatulence.

Anonymous
Anonymous

Thank you for what to are doing do the autism community.

If a child is constipated, should we cut back dose? Will he eventually be able to tolerate more without getting constipated?

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

Since bacterial overgrowth tends to cause loose or more frequent stools, the development of constipation is a sign that inulin or rifaximin is controlling the imbalance.

In my adult patients, rebalancing of intestinal bacteria often results in some constipation. This seems to be a manifestation of the relative imbalance of their autonomic nervous system and improves with time.

I recommend a mild, non-fiber based product to manage the constipation and eventually things improve.

Anonymous
Anonymous

Dear Dr Nemechek, I live in NZ with my severely autistic non-verbal 15 year old son. We have been on the inulin powder for 10 days now and behaviourally I am noticing some really positive changes. Initially diarrhoea and very frequent loose, yellow, frothy stools but after reducing the inulin slightly that has now stopped. He is more relaxed, less anxious, more interactive and most significantly less aggressive. This is huge for me as I’m a single mum and he’s taller and weighs more than me so the hitting out was becoming increasingly hard to manage. Unfortunately the only negative… Read more »

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

I’m excited to hear your son has entered into the first stage of recovery. I think of this as coming out of a drug stupor, it’s just that the drug (propionic acid or a derivative of such) is being made by bacteria within the intestinal tract. Now at this point, your 15-year old son could potentially have a portion of his nervous system behaving in the range of a 3-year old, another portion operating at the level of a 9-year old and another operating at the level of a 12-year old. Fortunately it seems like all these areas will start… Read more »

Samantha
Samantha

I have questions regarding the olive oil. I thought I have always learned that olive oil was high in omega 6, so I had to go search it to make sure. You say that olive brings down inflimation caused by linoleic acid, but olive oils contains just that.

I also always read that olive oil is unstable especially when cooked.

Can you please clairity?
Thanks

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

Olive oil has a tiny little bit of linoleic acid but it’s benefit is that it contains 70% oleic acid.

Oils such as soy oil are about 50-70% linoleic acid.

Olive oil is stable even when cooked.

Chris
Chris

Thank you for your reply Dr. Nemechek. I will discuss this with our Dr, however, I am not sure that she will be as studied up on Inlulin as you are. You state here on your site that, “SIBO happens when colonic bacteria migrate up into the small intestine and cause symptoms.” If that is the case, is it possible that Klebsiella also migrate up to the small intestine? If so, and Klebsiella grows on Inulin – is it not logical to conclude that it would be dangerous to feed our daughter Inulin? I want to buy into your protocol,… Read more »

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

My protocol most certainly is not a catch all for all kids affected by autism. Every child with autism has unique issues, and this is why situations such as yours needs to be discussed with your physician.

Chris
Chris

What about recent studies that have shown that Inulin/FOS encourages the growth of Klebsiella, a bacterium implicated in Ankylosing Spondylitis and increased intestinal permeability? Our daughter has tested high in dysbiotic bateria Klebsiella – wouldn’t feeding her Inulin be dangerous?

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

I suggest you discuss this with the physician who ordered such testing.

And remember, stool testing represents a mixture of bacteria within the lower colon and does not accurately represent what is going on in the small intestine.

Shar
Shar

Many thanks! Our inulin and fish oil are arriving today, and I will definitely write about our progress after 2-3 months (he’s 10, but he is super skinny and 30th percentile in height so I hope this will show its effects sooner). God bless you for your work and your willingness to help people. The world needs more people like you!

Anonymous
Anonymous

Dear Dr. Nemechek,
My 10 year old son has not been diagnosed with ASD. He has suspected mitochondrial disorder (ut the doctors really have no explanation) which manifests as a developmental delay – probably about 2-3 years behind academically due to memory problems, inability to understand complex concepts, etc, in addition to social immaturity.
Do you believe your protocol benefits children such as these?
Thank you!

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

I believe many of the mitochondrial disorders/dysfunction that are observed are simply downstream effects of metabolic inflammation (elevated pro-inflammatory cytokine levels).

Reduce metabolic inflammation with this protocol and many abnormalities such as mitochondrial dysfunction and antioxidant depletion are reversed.

MARI
MARI

How do you test and monitor proprionic acid levels?

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

Although there are tests available that can measure propionic acid levels in the blood stream and urine, there are no set standards which we can use to determine if a level is too high or low. Furthermore, there are a variety of metabolic variants of propionic acid (3HHA, 3HPA, HPHPA) that have may actually be able to be used as a marker for autism. From a practical standpoint if a child under my care has any features resembling, autism, any spectral disorder, ADD/ADHD, a mood disorder or any form of developmental delay, I am going to initiate this simple and… Read more »

Kelly
Kelly

I currently give my son (4 years old , ASD) Culturelle every day. Should I stop giving him this?

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

I can’t specifically recommend what is best for your child and can only inform you about my general approach with my own patients. I discuss my feeling on probiotics in the article.

Kala
Kala

Dr N
If there is too much bad bacteria/sibo, the child will not be able to put on weight right.
1) So if the child is weighing at par but still showing autistic symptoms, is there a chance that he may have IBD and not sibo?
2) are there tests for checking GI inflammation, DHA levels in blood? It’s tough to convince my pead. about sibo and inflammation as he thinks my child has intellectual disability and not the gut or brain inflammation issues.

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

In my opinion, bacterial overgrowth is a potential cause of “failure to thrive” or impaired growth in children.

I’ve seen some dramatic improvement in the general health and nutritional status of children after improving their bacterial balance.

Anonymous
Anonymous

Dear Dr. N,

If kid has cold, cough or related fever should we take break on omega-3 and can we continue giving inulin.

Thanks
Sudhakar

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

There is no reason to stop either unless someones symptoms prevent them from swallowing or tolerating these products. They are very safe and actually help the body to function in a healthier manner.

Diana
Diana

Dear Dr N,

when following your protocol, is there any other supplements allowed?

such as any anti oxidants or mineral supplementation? eg calcium due to GFCF diet.
I have read through all the comments and I can only see that you have instructed to remove multi-vitamins/probiotics/enzymes.
Are there any single Vitamins that are allowed during your protocol? such as Vitamin C and E?

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

I just think taking supplements for the vast majority of patients is unnecessary unless they are bona fide deficiencies such as B12 or iron, and are being treated by a physician.

It’s not that they aren’t “allowed” its just that I personally have found no need for them to help my patients recover.

Anonymous
Anonymous

The specific antibiotics (uk doctors wouldn’t even consider prescribing for asd!) and vagus nerve stimulation aren’the available in the UK. What happens if these are needed to during the protocol?

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

I am aware teat the unavailability of rifaximin and vagus stimulation are the same for many parents around the world.

My #1 goal is to provide some insight on a regimen that is safe and very effective in the kids I treat. Parents need to work the program as much as they can, even using the inulin in older kids if necessary.

Maybe through autism networks within individual country’s, there may be a might be a way for other parents to refer each other to more open-minded physicians.

Anonymous
Anonymous

When you say you add vagus nerve stimulation to the protocol for some children are you referring to the implanted VNS devices used for epilepsy patients?

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

Similar but we use a model for transcutaneous stimulation via the auricular branch of the vagus nerve.

Katie
Katie

Would Rosita cod Liver oil be ok? And larch arabinogalactan instead of inulin as this is prebiotic too? Thanks

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

Any high quality fish oil should be fine. I can’t comment on the effectiveness of larch arabinogalactan because I’ve never used it.

If someone wants to maximize their chances of this working I would recommend sticking with inulin.

CJ CHEN
CJ CHEN

Dear Dr N, I am going to implement your protocol and have a try, but I would like to know if there are any other possible supplements that I can incorporate? my son is 2.5 years old and is on the GAPS diet, we have received our Organic Acids Test [OATS] test (NutrEval) from Genova. The test shows : he is lacking numerous vitamins, minerals and antioxidants. He has Gut dysbiosis / SIBO + low levels of Glutathione ,high oxidated stress markers, high toxic exposure markers, mitochondrial dysfunction markers and a need for methylation markers. his got high levels of… Read more »

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

Many patients will continue non-prescription supplements provided by their other providers, and by no means should a parent stop prescription medications for seizures or behavior issues without the guidance of their prescribing physician because some medications need to be tapered off slowly in order to avoid withdrawal.

My main points are that for the children I work with, even very severe children, I don’t need these supplements to help these kids rapidly improve. And I’ve often found the supplements to potentially be a source of symptoms as the children recover on their own.

Anonymous
Anonymous

Do you believe retained infantile reflexes hinder neurological development? I would value your thoughts. We are on your protocol.

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

I’m not a developmental specialist and don’t know enough about it to comment.

Anonymous
Anonymous

Dear Dr. N,

Do you think Lyme could be one of the cause behind autism. Should we have to undergo Lyme test to rule it out.

Thanks
Sudhakar

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

I believe you can’t get autism without intestinal imbalance, and system inflammation impairing neuronal pruning.

Contracting Lyme Disease is not necessary to manifest autism. But testing should be done for Lyme or any other disease if their is any clinical suspicion it may be present independent of the child having autism.

Chris Mak
Chris Mak

My son’s doctor said he has both autism and lyme. He was diagnosed with autism at the age of 2. He is 21. His recent lab tests show that he has Lyme. That is why we are doing the lyme protocol.

He was very colicky and was constantly sick at very young age. He had been treated with antibiotics each time he was sick. He regressed at about 2 year old and lost all of his language.

Do you think he is a good candidate for your protocol?

Thanks doctor.

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

I think my protocol is safe and effective for a large number of kids with autism independent of other issues such as Lyme Disease, Down’s Syndrome, ADD/ADHD, etc.

In my private practice I see a number of patients, young and old, misdiagnosis as Lyme Disease, and the antibiotic treatments they are exposed to for Lyme Disease are ineffective or just make the bacterial imbalance worse.

I would recommend an Infectious Disease consult with a physician if there are serious considerations a child has Lyme’s Disease

JN
JN

Dr. N, I wanted to leave an update for you and for the other parents following this page. I eagerly read the new comments each day so I thought I’d share my experience in hopes it helps other parents starting this protocol. My 3.5 year old son was just diagnosed with mild autism at the beginning of February. He is verbal-has lots of vocabulary, verbs and can make simple requests and answer many yes/no questions, but he’s not as functional as he should be and is far from conversational. He’s also scripts a lot. About 75% of his scripting is… Read more »

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

Jennifer, I’m so happy to hear about your son, and thank you for sharing your insights with the thousands of parents who read this article every day. Your comments about the emotional age of your son is an important perspective parents need to keep about their children as they recover. The parents may have an autistic child who is 6, 12 or 24 years old but behaves as if they are a 2-year old. All I can say is hang in their because in a few more months these children will behave as if they are a 3-year old. And… Read more »

Anonymous
Anonymous

Can I ask the approximate time scale of the inulin rebalanced the gut and the oils reducing the brain inflammation in a young child? When will the development accelerate after this point? We are two weeks into your protocol!

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

I usually observe some improvements within the firs few weeks of the inulin. The children become more aware and tolerant of their surrounding. The doesn’t need to be a large amount of behavioral change to be important, just a real shift in behavior that is observed. This represent a drop in the propionic acid level in their body. The developmental issues will then begin improving over the following 2 months. If there is no substantial improvement in 2 months, I consider using antibiotics to balance the gut if the initial improvement in the first 2 weeks wasn’t present. If the… Read more »

Anonymous
Anonymous

Dear Dr. N,

Is this omega-3 fine to give ‘Nordic Naturals, Ultimate Omega, Junior, 500 mg, 90 Chewable Soft Gels’, we are making him to swallow.

Thanks
Sudhakar

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

Any high quality brand of fish oil in liquid, gummy or gel cap form will suffice.

Anonymous
Anonymous

Dear Dr Nemechek, We have a four and a held year old daughter,who is non- verbal andhas now been on your protocol for two weeks. We have seen increased vocalisations and increased awareness which is most promising. Initially her sleep was much improved (although she still takes a long time to get to sleep) but the last few nights have seen her wake up in the middle of the night and then struggle to get back to sleep again. As per your advice to others we have now cut out all the other pro-biotics and supplements she was on but… Read more »

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

Thanks great to hear your daughter is having having success as well. The initial response is from a drop in propionic acids, and resolution of the stupor it causes in children. Now you enter the slow and steady process of recovery. I don’t think there is any problem continuing any form of OT/PT during the protocol. In fact, the PT/OT of any kind will stimulate neuroplasticity and accelerate her overall recovery. Remember, brain recovery happens about as fast as hair grows. Day by day it seems nothing happens until suddenly you realize you need a haircut. Please stay in touch… Read more »

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