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Reversing Autism with The Nemechek Protocol – Update 2017

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

March 23, 2017 –  An Addendum on Recovery

My Experience with Autism Recovery:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hope this helps.

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


  1. baskaran yogarajah 1 year ago

    Dear Dr Nemechek

    thanks so much for your protocol and your answers. our 6 years old boy is on your protocol since december 2017. he have improvements but still non verbal . at moment we gave him 1/4 tsp now Inulin , 1500 mg nordic natural pro oemga 3, 1 Tbsp California evoo. earlier we try with 2.8 gr(1tsp), 1.4gr Inulin but we have seen increased stimming behaviours and no improvemnets , so since last week we try to reduce as 1/4 tsp(0.7gr). he understood many words and his bowel movement get normal after your protocol. but since january his sensory issues got worse and he always try to put small sticks and some time leaf inside his outer ear canal, and almost 3 times got sleeping tablets to remove those object in Hospital. doctor please guide us to solve this issue , is it sensory issue or audiitory issue or does he try to stimulate vagus nerve inside outer ear canal , or is that any Mineral deficency ? what could we do in this Kind behavior.

    thanking you


    • Patrick Nemechek, D.O. 1 year ago

      I happy to hear of your improvements to date. You seem to be spot on with the doses so I presume no other supplements or remedies have been added since January.

      If this were due to an injury, he should have recovered within a few weeks. I would look for a chronic infections such as a mild sinus infection or true parasite infection one might get from tainted water as an aggravating source. If none are found, he very well would need VNS to recover.

  2. Aruna 1 year ago

    Hello Dr N. I just started the protocol for my 4 year old with ASD. He has been having constipation, bloating and stomach pain for several months now (even before protocol). I always had a feeling that his symptoms were gut related. I read online that there are 2 types of SIBO – hydrogen vs methane SIBO. It looks like he might be having methane SIBO which causes constipation. Will inulin be ok for this type of SIBO or will it make his constipation worse?

    • Patrick Nemechek, D.O. 1 year ago

      Inulin helps both types but the combination of bloating, stomach pain and constipation together is actually suggestive of autonomic dysfunction as the source of the problem. Fortunately the protocol helps autonomic dysfunction. If things do not begin improving within a month or 2, be sure to have him examined by a physician.

  3. M oharr 1 year ago

    Hi doctor nemechek. My son is on protocol for 10 months and has had amazing results. This past month he is having histamine reactions that he never had before. Why is this?

    • Patrick Nemechek, D.O. 1 year ago

      If he is responding, these abnormal reactions would not be from histamine. They are from something else.

  4. Jen Dunning 1 year ago

    Hi. My son is 3. On days we are out and about, not cooking in olive oil at home, how much evoo should I supplement to him?

    • Patrick Nemechek, D.O. 1 year ago

      I spell out the doses I recommend in my book

    • Jen Dunning 1 year ago

      I bought and read the book, however the only reference to 3 year old dosing amounts I can find is to cook in evoo. We often travel and have all day appointments, etc. I have tried to find consistent answers on the facebook support group, but answers vary widely. I guessed and have been giving him a teaspoon or slightly more via medicine syringe, and praying it’s enough, but not too much.

  5. Rob 1 year ago

    Hi DR, do you have a recommendation for EVOO brands which can be found in Europe/UK? Is it essential that it is Californian as that is extremely hard to find here.


    • Patrick Nemechek, D.O. 1 year ago

      I understand the difficulty. Because of the loss of certification of one of the major California brands, I have recommending people contact the small growers themselves and have it mail ordered. I’m sure there must be some fantastic olive farms along the mediterranean you can order from.

    • Lili 1 year ago

      Hello Dr. N. Just wanted to share that I found a Cooc certified o.o at walmart . The brand is Bari. Thanks and GOD BLESS!!!

  6. Maria krashias 1 year ago

    hello doctor. my son is 10.5 years old and he have cerepla palsy. we started the protocol on 2/26/2018 with 3 ml N.N. fish oil 1/2 taplespoon olive oil and 1/4 teaspoon of inulin. we gradually increased the dose. after 8 months, we received 1 dose of rifaximin. after rifaximin I did not give inulin. we have not seen any major improvement. I need to do a second dose of rifaximin? I dont know what to do

    • Patrick Nemechek, D.O. 1 year ago

      With the cerebral palsy, you might need the assistance of VNS

  7. Noelle McNally 1 year ago

    Hello from Ireland. My son has been on the protocol 14 months, age 4. He has had gains with speech, potty trained, can cycle a bike, understanding and following instructions has improved.
    Still no gains in social interaction…on 1/4 inulin, evoo in cooking and 2ml fish oil. We did have a Skype call in sept’18 and we tried higher inulin dose but left him stimming a lot so we decreased back down.
    Should we make an appt for a visit for VNS?


    • Patrick Nemechek, D.O. 1 year ago

      If there is no improvement in socialization, then yes the VNS would be the next step.

  8. Aimee Hanrahan 1 year ago

    Hi Dr,
    My 12-year-old son has been following the protocol for 10 months now and doing quite well . He is very high functioning and his main diagnosis is ADHD although he has some ASD traits. He’s on all approved brands and doses yet he continues to have times where he is laughing to himself and does a lot of self talk . This makes them stand out more and not look so typical .

    • Patrick Nemechek, D.O. 1 year ago

      After this period of time, if a single component of development is failing to recover I generally recommend VNS.

  9. Janine David 1 year ago

    Hi, my 2 year old Asd son has been on the protocol for 3 months. After what I would think was a tough time with the awakening he started to show signs of receptive understanding and even started to imitate which I still can’t quite believe. Because of issues with pica he we were advised to give him multivitamins by a private nutritionist. Over the last week his stimming behaviours have increased, eye contact is still ok. But the head banging, shaking spinning have all returned (he’s been on multivitamin for 1 month) he also has eaten a lot of chips the last week which we hoped would be ok. Is he having a second awakening or is has the food or multivitamins interrupted his journey? Any advice would be much appreciated.

    • Patrick Nemechek, D.O. 1 year ago

      There is no such thing as a second awakening, and the behaviors are very likely from the vitamins.

  10. Tina johnson 1 year ago

    Good Morning from the U.K. firstly thank you for all that you and Jean have done for our children (hope she got home safely last night) I watched your FB live video last night and I am looking forward to getting my hands on the new version of your book … my question is inulin relate, we lowered my 6 yr olds inulin from 2 tsp to 1/2 tsp due to aggression and hyperactivity (secondary to constant spitting for last 6 months) the aggression and hyperactivity have lessened the spitting is still full force …. it has been a month at the lower dose ….. would you stay the course at 1/2 tsp or lower again ? Thank you for your time xx

    • Patrick Nemechek, D.O. 1 year ago

      Its difficult to actually know – you’ll have to experiment with the inulin dose.

  11. Hussey 1 year ago

    My son , is 5 year 7 months old , have been using NP for over 16 months now .
    we got some gains , but there is nothing amazing yet . I have been reading NP book, blogs , and testimonials . And almost all the testimonials have amazing gains after the awakening , which hasn’t happened for us .

    the inulin dose is currently 1 1/4 tspn. and I believe as per the book , after 2 tspn you have suggested to go with Rifaximin. My major worry is , having such a high dose of inulin, we still have no speech at all . it feels my son has no motivation to speak. What do you suggest in this regard.

    • Patrick Nemechek, D.O. 1 year ago

      My doses in the book at 1/4 to 1/2 tsp of inulin.

      Please re-read the book.

    • Hussey 1 year ago

      thanks , Also, I read on this blog you suggested someone to get VNS done , can you please suggest where to get it done , as I have no clue who will be able to do it .

    • Patrick Nemechek, D.O. 1 year ago

      VNS is performed either by surgical implantation or by a transcutaneous approach at the each or the neck.

      The implantation device is done just for severe depression and severe epilepsy. The neck device is approved for migraines and requires a doctor’s prescription.

      The VNS device I am is discussing is a device we have designed and built that uses the phone to power and control it. This device can only be obtained after an in-office visit with me.

  12. Chandra 1 year ago

    Hello Dr. Nemechek,
    We started the protocol on my 2yr 8 months old son 4 weeks ago and we noticed that he is not sweating at all. Here in Mumbai its very hot and humid but still he is not sweating and his body is getting very warm. Is it related to his underlying ANS dysfunction or something else?
    Thank you

    • Patrick Nemechek, D.O. 1 year ago

      Yes from autonomic dysfunction. This will recover wiith time on my protocol but until then be careful of heat exhaustion with him.

  13. Billie 1 year ago

    Hello dr Nemechek,
    We are 1 year and 8 months on the protocol. During this time a non verbal child learned to speak so that we can communicate, he is able to form simple sentences. The other that knew few words, we can say, is speaking.
    Regarding stimming, I understand, it is not a big issue if a child is improving in all other areas, but still… Can the stimming be a result of pruning and language development? It must be stressful for a child. We had the problem with freshness of fish oil, and I replaced it again with the fresh one , but the stimming is still present even after a month. Before that the stimming disappeared completely for almost a year. I don’t understand why. Also, is it possible that ADHD resolves before SPD? Their attention is good, and they both can sit still and do the work. Thank you. Greetings.

    • Patrick Nemechek, D.O. 1 year ago

      I know of no precise explanation for stimming, mostly everyone is just guessing. Sometimes the kids seem in distress and sometimes it seems to be a soothing reaction for them.

      I just keep the focus on overall recovery and most of all of these things recover with just fish oil, olive oil and balancing the gut in kids less that 10 or so. The older they get the more likely they need VNS to assist in full recovery.

    • Billie 1 year ago

      Thank you very much for your answer. Yes, I have noticed the stimming is present anyway, regardless of how he feels. Sometimes it looks like he does it just out of habit. The other twin is doing really well. At almost 7 he is on kindergarten level, around 5, but I am more than happy with that progress. If he continues like this, in a year he’ll be on his age level. I’m very grateful to you.

  14. Alberta 1 year ago

    Thanks so much for your time in answering us. Recently increased my son’s inulin to finally get to a teaspoon. We hav been on a since August. Since increasing by 1/8 to get to a teaspoon, he now constantly sings songs, zoned out, complete lack of response to name. But the greatest improvement is good sleep without waking till morning. Please do I take the 1/8 increase off or wait for a few more days to see outcome if he will come out of his world.

    • Patrick Nemechek, D.O. 1 year ago

      Give him a little time to see if he progresses out of it.

  15. Shan 1 year ago

    Dear Dr Nemechek,

    My 9 year old son with autism and ADHD has been on the protocol since January last year and has progressed well.

    He had severe constipation for a long time and was on movicol and senna. Due to increased constipation (his intestine diameter was 4.5cm instead of normal 1.8cm) , he has started on bowel irrigation recently using water and the Peristeen system. This seems to help with the constipation, however, I am finding that his behaviours have gone up – lower concentration, jumpiness and tiredness.

    Is there anything I should be doing while he is on bowel irrigation.

    Many thanks

    • Patrick Nemechek, D.O. 1 year ago

      I do not recommend bowel irrigation systems such as this.

      Constipation is predominantly a neurological issue stimming from autonomic dysfunction. This will recover on its own if given more time

  16. Brigitta 1 year ago

    Hello Dr. Nemechek, my nearly 3 years old has gluten/dairy and soya intolernce. I just worried his calcium intake however he eats lots of fruit, gluten free grains, veg and meat. Is Calcium supplement allowed with the protocol?

    • Patrick Nemechek, D.O. 1 year ago

      He shouldn’t need additional calcium with the diet he is on.

  17. Kiran 1 year ago

    Dear sir my sister son now 8 year age,he born 8 month pre matured uptoo now no brain development but physically fit but unable to sit and stand a to z serve for parents,he is only speech father and mother only 2 to 3 words only and not sign to urine or toilet only sleeping area please suggest what I can do,my mob number is 8838818415 watsup number also please help

    • Patrick Nemechek, D.O. 1 year ago

      I suggest you read the protocol, share it with your parents and if they agree, you can help them start your sister on my protocol.

  18. Hasnain 1 year ago

    Hi doc,
    Thanks for the protocol. My son is 5 year mi this now
    My son was fully social and verbal to an extent at the age of 2 and then by 2.5 years, he suddenly regressed and slowly by age 3lost all skills and went completely mute. I have been on NP for 16 months now with full on ABA. Current inulin dose is 1 1/4 tspn
    1) my son still is lost a lot of times why is that
    2) he is still having the drunken sailer moments, is this expected
    3) he has 0 speech still, do you reckon it can still come back
    4)there hasn’t been any quantitative improvement but qualitatively he is better, which can be NP and ABA both. I am unable to differentiate any significant changes like a lot people. I really need motivation from you to have my goals straight and see results. Can you please enlighten me where I m doing wrong.

    • Patrick Nemechek, D.O. 1 year ago

      If there is little to no recover in all aspects that are problematic, then I believe the inulin is not effective. MAke sure you are using the NOW Foods brand and if so, then consider stopping inulin and treating with rifaximin.

  19. Andy 1 year ago

    Hello. My 2 year old had colic for 5 months since birth, did not have bowel issues as she was exclusively breast fed for 17 months, however upon weening on to foods (8/9 months) my little one became subtly constipated. Since she used to always cry we did not know any different, and the doctors just said all babies are constipated. It was when she was 18 months, we started to see she would cry and shiver in pain trying to have a bowel movement. She was a late crawler and also a late walker (20 months). She seems to be hyper at times, but calm at times, we suspect she has gut issues (constipation was one give away), will your protocol help with her issues? Her emotions are so drastic, she could be crying 1 second and snap out into a laugh. She is not talking, says a few words however makes a lot of attempt to blabber away like she is talking to us and does seem to understand us on some things. She loves other kids and is not shy in trying to explore and is very aware of her surroundings and calling her name etc We are currently using laxido and senna to help her with going, I really want to stop this and provide her with a natural approach. By reading your book it is clear that she could have got the issue from both parents, as we do feel we have had gut issues all out lives albeit very different ones. Many thanks!

    • Patrick Nemechek, D.O. 1 year ago

      Yes, the protocol will help this.

      I recommend reading the book before starting. There is much to learn about the stages of recovery and the little problems you might encounter along the way.

    • Andy 1 year ago

      Thanks for the response Patrick, i have read the whole book and we are well on our way to helping my little one. Constipation has really helped with the fish oil/ olive oil, she is off the senna (bowel stimulant) which my partner and i are really happy about, we still use laxido but hoping to reduce this over time. Other benefits, my childs much better through the night and also her attempts to talk are massively increased since the use of your protocol, thank you!

      I have 1 question and it is regarding the pregnancy side of this protocol. You go into detail of using inulin during pregnancy and to use fish oil (high in EPA than DHA), are you able to recommend a brand to me? I understand my wife can revert back to the high dha version after she has given birth. I really think the inulin will help with her digestion issues but more importantly we want to provide the best omega 3 for our unborn child. Many thanks again!

    • Patrick Nemechek, D.O. 1 year ago

      Stick with NOW Foods and Nordic Naturals.

      They seem to be very reliable in helping people to recover.

  20. Delia Knight 1 year ago

    Dear Dr Nemechek, my son is 6 years old and been on the protocol for 6 months now with great progress in: eye contact, understanding, following instruction, independent play, gross motor skills (can now ride a bike without stabilizers, ride the kids bump cars, be on a zip line), improved fine motor skills, initiated imitation, more curious, better behaviour, stools are much better. He speaks in one word though – park, apple, banana, bike..etc. and he is stimmy – although it has reduced a lot. We were told his left side of the brain is not good as the right side of the brain, he suffered from oxygen lack when he was born (emergency C-section), plus vaccine/antibiotic injured. Do you think we should add the VNS to increase his language? He is currently on 1/4 heaping tsp inulin, 7.5mL EVOO, 4 ml Nordic Omega 3 (1560mg), cooking in EVOO (all homemade GF/DF food).
    Thanks for your amazing work. We are truly blessed to have you helping us.

    • Patrick Nemechek, D.O. 1 year ago

      If one of his developmental issues fails to recover in spite of recovery in other regions, then he most likely will need a VNS to help all areas recover.

    • Delia Knight 1 year ago

      Thanks Dr Nemechek, I will book a face to face visit then. Delia

  21. Mushabir Zaki 1 year ago

    Hello Doctor! My daughter 6 yo, diagnosed with ADHD and IDD, was seizure free for 2 years. I started protocols after reading the book in Dec 2018. 20 days back she had sudden repetitive seizures after every 2 – 3 hours. Took her to hospital emergency and the doctor after administering diazpam had to put her on daily epival (sodium valporate ‘ 4ml 2 times daily). Her blood tests now revealed moderately higher levels of glycine (570) and alanine (95). Would the protocol be effective for her?

    • Patrick Nemechek, D.O. 1 year ago

      Seizures can occur more frequently with increased inflammation.

      My protocol is very effective at lower inflammation and may help in this way

  22. Parent 1 year ago

    Hi Dr Nemechek i have Started your protocol 6 months on my daughter who is showing signs of being on the Autism Spectrum. She has shown many gains. There have been many ups and downs. One thing that hasn’t improved is her stimming. Shall i amend the doses or wait it out. She is currently on 5ml of omega 3 NN 1560mg, 1 teaspoon of inulin and 1 tablespoon of EVOO.

    I would like to start the protocol on my 9 month old son he is currently on formula milk that contains GOS with no added inulin. Can i start him on inulin and can i also give him vitamin d as an extra supplement as he is eating more food than milk. I already give him nn fish oil and EVVO in his meals.

    • Patrick Nemechek, D.O. 1 year ago

      With your daugther, I would probably ait it out. Another option is to go down a little on the inulin and see if that helps

    • Parent 1 year ago

      Thank you so much for responding. I will try lowering the inulin. With my son shall I wait until he is 1year to start the inulin ?or shall I start with a very small dosage? Also is hemp milk fine to drink while doing the protocol.

    • Patrick Nemechek, D.O. 1 year ago

      Inulin has proven safe in even newborns in many studies.

  23. Covie 1 year ago

    Hello Dr Nemecheck, thank you for all you do, I have read your chapter on Potential Prevention and also the section in chapter 7 on ‘The other children in the family’ . If one is planning a pregnancy in 6 months to a year in future, is rifaximin or inulin preferred as potential prevention where one has ample time ahead of a pregnancy to prepare?
    Thank you so so much!

    • Patrick Nemechek, D.O. 1 year ago

      Inulin is always preferred in adults.

    • Covie 1 year ago

      Thank you Dr, from your book I understood that Rifaximin is preferred in adults, not inulin?

    • Patrick Nemechek, D.O. 1 year ago


    • Covie 1 year ago

      Thank you kindly Dr, is your statement above that ‘INULIN is always preferred in adults’ a typo or do you mean that the rifaximin should be followed up with inulin? Thank you so much for your time.

    • Patrick Nemechek, D.O. 1 year ago

      Yes, thank you – a typo.

      Meant to say Rifaximin is always preferred in adults, and I never follow-up inulin after rifaximin. It doesn’t help prevent relapse on causes cramping and flatulence.

  24. Ayesha 1 year ago

    May i use Kefir with protocol?

    • Patrick Nemechek, D.O. 1 year ago


  25. Jasmine 1 year ago

    Hello Dr. Nemechek,

    I have a 4yo son with ASD. What’s the reason for major tantrums? He is having at least two episodes of non-stop crying for 30~40 minutes a day. Been on the protocol for 9 months… He is driving us nuts 🙁

    1/4 tspn Now inulin, 1000 mg NN FO, 1~2 tspn EVOO

    • Patrick Nemechek, D.O. 1 year ago

      Tantrums are often due to difficulty with transitions or a transient drop in brain BP and oxygen delivery – both are autonomic in origin and often recover with time.

      The low b BP issue can improve with increase in water and salt intakes.

      If there is no lessening of either in 6 months, then a VNS is most likely required.

  26. Aparna Anantha Narayanan 1 year ago


    Please let us know the best and safe way to deal with constipation.

    I gave 10 ml milk of magnesia for my 8 yo. After using milk of magnesia, she is troubled, loss of appetite and very aggressive for about a week.

    I have been using glycerin suppository as well, but doesn’t seem to flush out her bowels entirely.

    Please advise, this constipation is really impeding her wonders with Nemechek protocol.

    Recently reduced from 1/2 to 3/8 inulin.


    • Patrick Nemechek, D.O. 1 year ago

      I would just try a different variety of magnesium laxatives and give some everyday, not just when she gets way behind.

    • Sadhana 1 year ago

      Sir can we give peg polyethylene glycol for constipation
      Would that disturb the nemechek protocol

    • Patrick Nemechek, D.O. 1 year ago

      Yes you can.

  27. Sskl 1 year ago

    Hi Dr,
    My 6 y.o daughter is 1 year on protocol. Small small gains is there, no wow yet.
    Her receptive improved . I have tried to go up till 1 tsp inulin but she got hyper..
    I reduced it to 1/4 tsp inulin 2 months ago.
    Lately i found she getting more thinner, having vitamin deficiency due to malabsorption. The doctor said she could be having inflammatory bowel disease..
    What should i do with inulin? Increase or stay put?
    2 cap NN UO, 10 ml EVOO.

    • Patrick Nemechek, D.O. 1 year ago

      Stay put and follow-up with a gastroenterologist to be certain she doesn’t have IBD.

  28. Mag 1 year ago

    If rifaximin did not eliminate frequent and loose stools, could you use inulin to improve this?

    • Patrick Nemechek, D.O. 1 year ago

      It might but I would consider looking at some other potential cause such a inflammatory bowel disease, a real parasite such as giardia or an pathogenic bacteria such as salmonella.

  29. Maryam 1 year ago

    Doctor I want to start with my son .it is ok if my son take melatonin for help sleep

    • Patrick Nemechek, D.O. 1 year ago

      Yes, melatonin is OK

  30. Noelle 1 year ago

    Hi doc, do we need to do SIBO test before we give inulin/Rifaximin for spectrum kids?thanks

    • Patrick Nemechek, D.O. 1 year ago

      No, the SIBO tests are extremely inaccurate and are correct only a little more frequently than they are wrong.

  31. Anonymous 1 year ago

    Hello Dr.Nemcheck,
    Thank you for the protocol.My 6 year old son is in protocol since 6 months. He improved in understanding and motor skills. He is laughing many times for no reason. Is this a symptom of Autism or Recovery.How can I know what is happening with him. Do we have to stop this inappropriate laughing.Please suggest.

    • Patrick Nemechek, D.O. 1 year ago

      Many parents refer to this as the “drunken sailor” phase. Don’t be alarmed, it will go away with continue use of the protocol.

  32. Lori 1 year ago

    Do you see any benefit for older adults? My son is 33 been on prescription medications since he was 12 and been on CBD oil for 6 months. He has diagnoses of Autism, Tourette’s Syndrome and seizure disorder.

    • Patrick Nemechek, D.O. 1 year ago

      Yes, this can help adults with autism.

  33. Dorot 1 year ago

    Hello Dr N, my daughter is 14 years old, Has been on the protocol for 17 months . Her doses are 1/4 of inulin twice a day; 1 tablespoon of olive oil , 4ml FO. Unfortunately, she started to react badly to oils ( a lot of cursing, spitting). Her blood test showed too much vitamin E . So i stopped oils to repeat the blood test. And Her behaviuor improved. What should i do now about vit.E? Secondly, I am aware that she need rifaximin at this point, but how much if her weight is 36 kg. Thank you so much for your help and the protocol.

    • Patrick Nemechek, D.O. 1 year ago

      Reaction to fish oil or olive oil like this indicates the gut is still unbalance in site of the inulin.

  34. Ayesha 1 year ago

    Dr. may i use apple cider vinegar with your protocol?

    • Patrick Nemechek, D.O. 1 year ago


  35. Sehar 1 year ago

    Hello Dr N
    I am new and planning on ordering the book soon to learn more. I was wondering if this protocol can help reverse vaccine damage in adults where the vaccine has caused chronic pain and neuralgia in the body?
    Thank you for your amazing work!!
    I look forward to your response.

    • Patrick Nemechek, D.O. 1 year ago

      Yes, it can help a wide variety of neurological injuries in adults.

  36. Aisha 1 year ago

    Hi dr Nemechek,we start our ASD 3,5 years old daughter with protocol all recommended brands,1/8 inulin 1ml ultimate omega and 5 ml evoo on food,but we didn’t see any change and we increase to 1/4 inulin and she start have head tics all day long and vocal stiming is so scary because I think we lost her now is in her world and she is more autistic and doing things what she never does,hand flapping,walking on tip toes,stop understand us,stop have eye contact but the worst is head tics what we should do ?

    • Patrick Nemechek, D.O. 1 year ago

      If you think things are worse, then stop the protocol.

  37. DS mommy 1 year ago

    Thank you Dr Nemechek for this wonderful protocol. My son is 7.5 with Down Syndrome and has seen many gains in the past 16 months using it. I feel we have had several relapses and possibly inulin has begun to fail and wonder if it’s time to look at rifaximin and/or vns. Do we need to meet with you in person for these prescriptions or is a Skype appt necessary?
    Thank you again we are very grateful for your research and hard work.

    • Patrick Nemechek, D.O. 1 year ago

      That would require an in-person appointment.

  38. Olivia 1 year ago

    Passer à la langue suivante : français
    on the protocol for 15months, my 5-year-old daughter better understand some instructions but still no language, do you think she should have rifaximin?

    • Patrick Nemechek, D.O. 1 year ago

      She may need VNS.

  39. Covie 1 year ago

    Hello Dr N, thank you for your book and protocol. I ignorantly took a popular probiotic while I was pregnant with and breastfeeding my asd son (almost 1 yr) which contained a very high dose of streptococcus thermophilus strain. I have sadly now read it is a strain that enhances propionic acid bacteria. As he would have received this strain in abundance from me into his gut, will inulin still reverse the PAB overgrowth? Or does he need rifaximin? Thank you Dr (I have booked a consultation with you but it is still many months away.)

    • Patrick Nemechek, D.O. 1 year ago

      No one knows the answers to your questions but I believe probiotics or not, you child has an excellent chance for recovery

  40. Andrea Mora 1 year ago

    Hello Doctor!
    Would it be safe to add Coseva TRS-Toxin Removal System to this protocol. My understanding from what I’ve read is that TRS is a zeolite, which is a mineral. So I assume it would be safe to use since it is not a supplement? Is that correct? My son 4.6 has been on protocol since Sept 2018 . We were up to 1.5 tsp+1/8 tsp of inulin, 2 gummies of FO per day (600 mg. total) and 1/2 tbsp. of EVOO a day and we have seen very minimal gains. I know you advise us not to use any other supplements in the book, but wanted to see if TRS is considered a supplement? Thank you and God bless you for the work you do.

    • Patrick Nemechek, D.O. 1 year ago

      It will interfere with recovery

  41. Ash 1 year ago

    Hello doctor Nemechek my son is 3 year and 6 months old. We started your protocol November 2018. His is taking
    Inulin 1/4 +1/8 teaspoons
    NNFO 1/4 teaspoons
    EVOO in Cooking
    All recommended brand
    He is looking into our eyes
    Singing songs his vocabulary is growing but he can’t talk
    He started to grind his teeth a lot today.
    No recently sickness or any other changes. Plz help where am I wrong. I think I am fallowing 100 protocol. He did have good gain I see him changing slowly slowly but what is this new behavior plz help.

    • Patrick Nemechek, D.O. 1 year ago

      Just be patient and the teeth grinding will ultimately resolve.

  42. Ujunwa 1 year ago

    My almost 4yrs old ASD has been on modified protocol for 6 weeks and 3days due to aggressive behavior and hyperactive,1ml ultimate omega and 5ml EVOO all approved brands. I have not noticed any calmness since I started this protocol but last week his behavior became worse like biting his teachers and siblings, hitting, kicking, scratching himself and other and tantrums .pls what should I do

    • Patrick Nemechek, D.O. 1 year ago

      He also needs some inulin

  43. Anonymous 1 year ago

    In your video presentations you highlight case studies about treating adults with PTSD, in which you mention using 4,500mg of DHA, which is 1.5 times higher than the 3,000mg normally recommended as an adult dose for your protocol. When using the protocol for a child with PTSD, not autism, do you use a similar slightly higher fish oil amount for them as well?

    • Patrick Nemechek, D.O. 1 year ago

      I only use 3,000 mg of DHA/d when treating PTSD

  44. LESKITA 1 year ago

    Hi Dr, thank you very much for your work, our 23-month-old son has been in NP for 4 months, he has had some gains but anxiety and hand flapping are not regulated every day worse, my son with nothing forbidden of what you are talking about in your book, taking the protocol with the recommended brands, inulin now 1/8 + 1/16, FO-NN1ML and cooking with certified oil, some advice for us like lowering inulin or just recommend us to wait? Thank you.

    • Patrick Nemechek, D.O. 1 year ago

      Be patient and let him recovery out of this. He just needs more time.

  45. Kalyan 1 year ago

    My kid 6.5 yrs is on Nemecheck protocol last 3 months, I live in India, would like to store both EVOO and NN Ultimate Omega for next 6 months. Temperature here is around 104F. Kindly advice if it’s recommended both (EVOO and Fish oil) to be refrigerated or can be kept outside after opening. Please advice.

    • Patrick Nemechek, D.O. 1 year ago

      With those temperature I would recommend refrigeration.

  46. Mother 1 year ago

    Dear Dr Nemechek
    My son 5y and 4months old (on Autism Spectrum) has been recently diagnosed with nephrotic syndrome! He is on steroids prednisone and another medication cellcept!
    Before he was diagnosed , he was on the nemechek protocol for about a year and was having amazing results!
    What would you recommend? Should i continue with the protocol? With steroids he has got lots of emotional imbalances! Sometimes it seems that the progress he has made with this lovely protocol is reversing now! Im alot worried! Kindly suggest me! Thankyou very much!

    • Patrick Nemechek, D.O. 1 year ago

      Yes continue but be sure to keep your nephrologist informed

  47. Anonymous 1 year ago

    My son on the protocol since Aug 18- he has been getting what appears to be geographic tongue on and off – I think it’s inulin related. Do you recommend trying Rifaximin instead of inulin to see if it subsides?

    • Patrick Nemechek, D.O. 1 year ago

      Ignore the geographic tongue. Its harmless and chasing after some treatment for this could jeopardize his recovery

  48. leigh 1 year ago

    Hi Dr Nemechek. Thank you for your excellent work. I have read your book more than once and I understand why you don’t recommend probiotics – basically not wanting to introduce foreign bacteria into an already delicate environment. But can you please explain what happens after ‘bad bacteria’ are reduced after either inulin or Rifaximin. If a child is lacking in ‘good bacteria’ to begin with, how does the gut actually rebalance itself by building up levels of good bacteria it has never had. I’m dedicated to your protocol, but I would like to understand more about the mechanics! Thank you so much.

    • Patrick Nemechek, D.O. 1 year ago

      There are 2 basic problems with the gut bacteria in kids.

      Normal bacteria living in the wrong place (SIBO) and a permanent loss of species overall (low biodiversity).

      Inulin and rifaximin help with SIBO but there is at present we do not know if fecal transplants (FMT) are safe or improve the recovery rate in kids with autism.

  49. Saroja 1 year ago

    Hi Dr.Nemechek, would like yo thank you for all the information you share through your videos and this blog to help all kids.

    We have been on the protocol for 11 months. His awareness, vocabulary improved.. his eye contact improved when we reduced his dose from 3/4 th tsp to 1/2 tsp due to hyperactivitiy and increased hunger. When we look back and check we see lot of improvements in him.. but we are not seeing much improvements in his stimming, hyperactivitiy / fidgity and hunger.

    His socialization is one more big concern. With family/therapist he is working , he will be interactive and we all feel that he is making progress. But in school no one except his class teacher knows that he can talk and he is fine at his academics. He will never look at any kid or talk and play with them. In school gatherings, when he see lot of patents and group gatherings , i feel like he is just like he was prior starting the protocol. And after coming home he will be fine after sometime.

    What makes him do this? We always feel depressed looking at him in group gatherings. Are we doing something wrong in the protocol?

    Do you think that he need VNS? We are scheduled to meet you in october. Please advise..

    He is 5.6 yr old.. taking 1/2 tsp inulin.
    7.5 ml – 10 ml oral EVOO + cooking
    2 ml ultimate omega . All approved brands. No supplements.

    • Patrick Nemechek, D.O. 1 year ago

      Socialization with peers is one of the last groups the children become comfortable with. Give him time to recover more.

  50. Parent 1 year ago

    Hello Dr,
    We started our 3.5 year old son on modified protocol in March – 1 ml NNUO, 1 tsp COOC EVVO on food. He had good vocabulary before starting the protocol. He started to use few two three word sentences on modified protocol. Started with 1/16 tsp inulin two weeks back. He has been affectionate towards new born in the family, trying to pacify her and kiss her. Whenever he hears her cry he is there to stroke her hand and pacify her. Is this awakening? Also he started screaming for fun and hitting us playfully which he never did. He seems to be very emotional these days. Is the inulin dosage okay? Please suggest

    • Patrick Nemechek, D.O. 1 year ago

      Yes, this is the awakening.

      Just sit tight and enjoy the recovery

    • lycca 1 year ago

      dr.nemecheck i am the stupid person in the world to trust my son’s nanny we started the protocol following 2ml of omega-3 evoo on food and 1/8 of inulin ,mistakenly instead of giving 1/8 tsp she gave my 2.9months son 1/8 cups of inulin, on the 4th day he starts to vomit and have fever ,i already bought him to the pedia and doctor said that he got tonsilitis,given antibiotic my i notice my son become more sensitive and cry for no reason …now he dont have fever anymore but still taking antibiotic…should i worry about him taking so much inulin he took it for 3days really worried pls help me .thank you so much i stop the protocol for now, my son is diagnosed gdd …im so worried that it might affect after few more weeks once i return to the protocol thanks you

    • Patrick Nemechek, D.O. 1 year ago

      Since your pediatrician has already seen the child, I know there is nothing significantly wrong other than the pharyngitis.

      Do not worry, the inulin has not caused any lasting damage.

  51. Missi 1 year ago

    Would a fluoride treatment from the dentist interfere with the protocol?

    • Patrick Nemechek, D.O. 1 year ago

      Most likely not.

  52. Parent 1 year ago

    Hello Dr. Nemecheck

    Thank you for your book, I have purchased and read and reread it. Since February 2019 I’m cooking with Evoo, trying to eliminate bad oils from my autistic son diet who is 3½ years old. We also are booked to visit you on September and I’m planning to start the protocol during this month. However, my child has been taking 14 different supplements for about 1 year prescribed from a well-known doctor in New York, but he did not have any progression. Some of them were different vitamins and the others for healing the gut and the brain. Four weeks ago I stopped all these supplements. It’s been almost three weeks I’m giving my child Camel Milk due to the fact that I have read and heard from different doctors that have good impact in this category of children. As I mentioned above I’m planning to start the protocol now and I also have purchased the Inulin and Pro Omega (1460 EPA/1010DHA) direct from the manufacturer, NP Starter Pack, 10 years or younger. But still my concern is that it is this the right dosage for my 3½ years old child? Do I have to stop giving my child the Camel Milk while he is on the protocol or do they interfere with one another? Please advice. Thank you.

    • Patrick Nemechek, D.O. 1 year ago

      You need to simply follow the advice in the book without alteration.

  53. Mitra kariyat 1 year ago

    Hi Dr N,
    My daughter is 9 years old (looks like 15-16 with a height of 5′ and weight of 125lbs). We started the protocol in June 2018 and slowly increased inulin from 1/4tsp to 1tsp. She was much aware and less hyperactive. But I have always noticed that she has good gains when I increase inulin but that will subside in 2-3 weeks. That is why I increased inluin from 1/4 tsp slowly to 1 tsp. But when I tried to increase above 1tsp she got very aggressive. started crying /screaming/hitting. So I reduced it slowly to 1/2tsp. She is calm now. But looks like she is somewhere else. If I ask her to do something she will do…but she looks very sad and not interested in any of the activities with her friends at school. She was not doing good with inulin in the beginning when I started the protocol. After 1/2 tsp she was always bloated. I am giving her 15ml EVOO and 3.5 now DHA capsules. Can you advise if we need to try rifaximin for her. I have an appointment scheduled about which we are very excited. But that is after several months only. If we need to try Rifaximin we can actually start next month when the school closes for 3 months. Please please advise.

    • Patrick Nemechek, D.O. 1 year ago

      I wouldn’t try rifaximin just yet

      I would wait longer.

  54. Deb 1 year ago

    My 4yr 10 months old daughter is in NP from last 10 months. We have seen gains with her sensory issues, eating habits, sleeping and constipation. All these are almost at par with NT kids of her age. Her stimmings has reduced to great extent. We are also observing some gains with socialisation in last 1 month. She is trying to reach out to other kids. Also she now acknowledges if any outsider comes to our home and greets them. She is following simple commands. One of the biggest gain is that she got potty trained two months back. Accidents do happen sometimes, but quite manageable.
    However, she is not able to gain speech. She says a few words randomly. Also she is still not able to label things. Her response to name is still very poor. She was diagnosed with ASD and ADHD. Her present dosage is 2.5 ml NN OU, 2 tsp inulin and 2 tbsp certified EVOO. Also her mother was in depression during her last trimester in pregnancy.
    My question is do I need to change any dosage or in her case tVNS is a requirement?
    Or should I continue with same dosage and wait for more 3 – 6 months for speech?

    • Patrick Nemechek, D.O. 1 year ago

      The requirement to start VNS does not necessitate a change in any doses.

  55. Mommy 1 year ago

    Hi Dr Nemecheck, thank you for the work that you are doing. I have just started my 7month old boy on your protocol 9days ago, using NOW and NN, but he has developed severe, audible, painful gas which is waking and keeping him up at night. He has also started flapping his arms. What do you recommend?
    Thank you kindly in advance!

    • Patrick Nemechek, D.O. 1 year ago

      Read the protocol and double check the starting doses.

      You’re giving too much of something.

    • Mommy 1 year ago

      Thank you Dr.

      Is the gas produced by the ‘fish bacteria’ in the small intestine? Does the excess gas mean that the inulin is not working for him or feeding bad bacteria?

      Or do I just try to reduce the inulin to a level where he is comfortable?

      Thank you so much

    • Patrick Nemechek, D.O. 1 year ago

      The colonic bacteria can generate gases from inulin in either part of the intestinal track.

      Excess flatulence is a sign you might be giving too much inulin.

  56. Shem Mandela 1 year ago

    Hello Dr Nemecheck.
    My almost three year old autistic nephew has been on omega 3 supplements, cod liver oil and recently we added Dimethyglycine (DMG) to the regimen.
    If i were to start the Nemecheck protocol, should i still continue with the above mentioned regimen?

    • Patrick Nemechek, D.O. 1 year ago

      No. You need to read the complete protocol and not guess at what to do.

  57. Parent 1 year ago

    Hi Dr Nemechek, I have been told by my doctor to give multivitamins to my 4 year old. The brand I have is Children’s Mindlinx® Multinutrient from Biocare UK. It has fructooligosaccharides (Chicorium intybus Root) in the ingredients.
    Will this add to the 1/2 now inluin I already give…or will it not make a difference?

    Please help.


    • Patrick Nemechek, D.O. 1 year ago

      No an approved brand and I don’t recommend vitamins unless there is specific B12, folate or iron deficiency

  58. Ally 1 year ago

    Dear Dr Nemecheck
    Thank you for your book which I purchased and read. My 6 month old son has visibly regressed into autism after a CMV virus, antacids and PPI for reflux and numerous vaccines. We have just started your protocol. He has not been on antivirals for the CMV (the dr said he would recover without), Would you recommend that we commence antivirals to treat the CMV in addition to your protocol?
    Thank you so much in advance.

    • Patrick Nemechek, D.O. 1 year ago

      It is very rare that anyone needs antivirals to recover from CMV.

    • Ally 1 year ago

      Thank you Dr N.
      I just saw that his infant formula contains GOS. Will it interfere – should I change brands?
      (I have already taken him off a formula that contained probiotics. ) Thank you so much.

    • Patrick Nemechek, D.O. 1 year ago

      The formula issues should be discussed with your pediatrician

  59. Dusan 1 year ago

    Hello Dr. Nemecheck!
    First of all I’d like to thank you for your work! Protocol is amazing for many many people..
    My son will be 9 this year, he is on protocol for nearly 2 years. He started talking, not very clearly but we can understand him and he isn’t so much frustrated now.. He is getting 1 TBSP EEVO, 2x 500-DHA, and we reduced
    inulin to 1/4tsp. And probably we will need to reduce it to 1/8 or less.. He is hitting his head sometimes when he sees a baby crying on youtube, or when our dog takes some of his toys.. He also bites gently his hand and cries.. Mostly he behaves like that when he is hungry or tired, but sometimes could be everything ok and he is crying and hitting him self for unknown reason.. ( mostly he says that he is afraid of something that something bad can happen… like bulb might burn when he will play with a switch or other nonsenses)
    7 years ago he started lying on his belly and stretched his arms and legs and kicking with his foots. That relaxes him and makes him tired..
    Should we change something in his dosages?
    Thank you very much

    • Patrick Nemechek, D.O. 1 year ago

      If the head banging, etc is relatively new, it might be from an emotional, inflammatory or physical trauma.

      If not recovery with time or lower inulin, at this age you can sometimes have inulin failure and then need to bump up to rifaximin.

  60. Anika 1 year ago

    Hi Dr. Nemechek, I’m grateful for the amazing protocol , my daughter has come a long way on it in a year. We’re 13 months on NP. She has shown wide gains in eating variety , gross motor skills, understanding, fine motor skills, core strength and repeating words ( no functional speech yet). Her current dose
    Inulin – 1/2 tsp , reduced 6 weeks ago from 1 tsp
    Omega3 – 3.75 ml NN ultimate omega 3, upped 4 days ago she was at 2.5 ml
    Evoo – 7.5 ml
    No bad oils
    Our major concern is her anxiety, getting fussy when we put demands.,Transition challenges, her functional speech and cognitive skills. It’s already close to 14 months on NP . And journey so far was with ups and downs. She is 6 years old and has autism. Any further suggestions on it. Many thanks

    • Patrick Nemechek, D.O. 1 year ago

      She sounds like she is recovering nicely. It just may take longer than you are hoping for.

  61. Aswini 1 year ago

    Hello Dr. Nemechek, I started my 2.5 yr old son on the protocol.. I started with 1/8th of inulin and found that he is very anxious that he doesn’t even want to enter into any closed space even our house. So I waited for a few days without inulin and started 12 days ago with 1/64th of inulin. Now he is not anxious but all the old behaviours started, like hyperactivity, uncontrollably excited if someone comes home, screaming loud, etc. Can this be considered as awakening?If this is awakening, do I need to stick with 1/64th inulin itself? If we are seeing awakening at 1/64th does this mean his ANS is more dysfunctional?

    • Patrick Nemechek, D.O. 1 year ago

      Make sure you are using only recommended brands and discontinue any other supplements, probiotics or vitamins that might also be contributing to this. I can’t believe that small of an inulin dose is causing this.

    • Aswini 1 year ago

      Thank you Dr.Nemechek for your reply. We are giving him all approved brands.1/64th Now Inulin, 1 capsule Now DHA500 and 5ml Arbasona COOC olive oil. Apart from this he drinks raw milk so that he doesnt get constipated. Is raw milk considered as probiotics? Should I stop giving him raw milk?

    • Patrick Nemechek, D.O. 1 year ago

      Raw milk is not a probiotic (unless it’s spoiled).

  62. Trupti 1 year ago

    Hello Doctor!
    My Son is 16 years old and pre-verbal. we have been on this protocol since october 2018. I was giving him i tablespoon olive oil , 6 capsules fish oil, twice a day for 10 days rifaximin. i gave him . i need your suggestion for further treatment. I noticed he is getting angry and hitting me when he gets mad.

    • Patrick Nemechek, D.O. 1 year ago

      The protocol shouldn’t cause him to become angry unless this is part of his awakening and it started within the first week or 2 after Xifaxan.

      Otherwise, sometimes medications for anxiety such as guanfacine can end up increasing anxiety and anger as they recover. Guanfacine is a blood pressure lowering medication.

    • Sharon Jenkins 1 year ago

      Dr Nemechek, the above situation applies to my 23 yr old also. Do your comments regarding guanfacine also apply to Propranolol please?

    • Patrick Nemechek, D.O. 1 year ago

      Yes it does.

    • Nadyia 1 year ago

      I came across this and guanfacine has been on my mind. I’m wondering you have any patient cases that have specifically discontinued guanfacine and seen positive results after starting the protocol. Trying to determine if the protocol or guanfacine is causing newfound agitation.

    • Patrick Nemechek, D.O. 1 year ago

      Usually with the protocol, the kids will have recovery of their autonomic nervous system, improvement of brain blood pressure levels and then are able to taper off the guanfacine.

    • Trupti 1 year ago

      Hi Dr Nemechek. After Rifaximin, is there a ‘maintenance’ strategy that you recommend to prevent SIBO from returning? I know to avoid Inulin but is there anything else to be done?

    • Patrick Nemechek, D.O. 1 year ago

      I have not found any way to avoid relapses after rifaximin other than to limit the use of antibiotics.

  63. Glenn 1 year ago

    Dr. Nemechek,

    First of all, I would like to thank you for taking the time to answer questions. My son has been on your protocol for the past 10 months. Good gains in the beginning, but I believe he is going through major relapse right now. We haven’t seen any gains in the past 3 months. I’m not sure if it’s a propionic or inflammatory relapse (He had a cold/asthma and flu in February and March). He used to have constipation issues, but that has been resolved. However, we’ve been noticing hyperactivity, emotional outbursts, defiance, and visual stimming since February. He started saying a few words, but haven’t noticed any improvement since February. Please advise… thank you!

    3.11 yo
    2 fiber choice gummies
    900 mg NN cod liver oil
    2~3tspn EVOO

    • Patrick Nemechek, D.O. 1 year ago

      You might try shifting to low dose NOW Foods inulin and see if that helps. If not the he may have inulin failure and will need rifaximin.

  64. Iva 1 year ago

    Hi Dr Nemechek. My 9 year old (ASD, ADHD) started taking Rifaximin 3 days ago. We have a 10 day course. His behaviour is completely different to when he was on Inulin. Then it was lots of angry aggressive behaviour even on 1/16 tsp, which is why we took him off it. Now he is doing strange things like standing on his toes and swaying or standing and hopping around on one leg for very long periods of time. Maybe you’ve seen this before. What do you think is happening – is this another type of awakening and why is it so different to the Inulin awakening do you think?

    • Patrick Nemechek, D.O. 1 year ago

      The bacteria are causing this as they rebalance. Remember, rifaximin does no appreciably get into the blood stream.

      As long as you do not see any symptoms suggestive of a severe allergic reaction, finish out the rifaximin dose.

  65. Mushabir Zaki 1 year ago

    Hello Doctor! My daughter 6 yo, diagnosed with ADHD and IDD, was seizure free for 2 years. I started protocols after reading the book in Dec 2018. 3 days back she had sudden repetitive seizures after every 2 – 3 hours. Took her to hospital emergency and the doctor after administering diazpam had to put her on daily epival (sodium valporate ‘ 4ml 2 times daily). My question is now can I continue with the protocols plz? I know that it would interfere but I’m at a lost please advice!

    PS: I was really starting to see gains.

    • Patrick Nemechek, D.O. 1 year ago

      Look for some other eason for the seizure. Fish oil, olive oil and inulin do not precipitate seizures.

  66. Parent 1 year ago

    Hi Dr nemechek, my nearly 2 year old has been on 1/2tsp inulin for 6weeks, (after decreasing from 1tsp as he was very hyper and falling over easily, then increasing from 1/8, then 1/4 with no improvement), he is still spinning sometimes, opening closing doors, spinning toys. However he is pulling my hand when he wants something. Trys to copy action songs rarely. Still doesn’t respond to name when someone calls him. Still no babbling talk.
    What do you suggest?


    • Patrick Nemechek, D.O. 1 year ago

      Give him more time. Keep the doses as they are.

      Remember, he may not want to respond to you yet.

      If he gazes into your eyes and responds if you ask him if wants a cookie (or some other sweet treat), then he is awake.

  67. Keisha Williams 1 year ago

    Hello Dr,I started my son who is 3 years old on the protocol. 1/2 of inulin 3.5ml of fish oil. An olive oil on foods. All reccomeneed brands you suggested. He has had some gains which I am grateful for. However hes stimming a bit like constantly stamping his feet and being quite hyperactive. Would this be the awakening ? or should I reduce inulin to 1/4 . Many thanks for any advice

    • Patrick Nemechek, D.O. 1 year ago

      Either a little less inulin or a little more time (or both) will help you get past this.

  68. Nathan 1 year ago

    Hi Dr Nemechek. After Rifaximin, is there a ‘maintenance’ strategy that you recommend to prevent SIBO from returning? I know to avoid Inulin but is there anything else to be done?

    • Patrick Nemechek, D.O. 1 year ago

      The only thing I can sense that limits relapses after treatment with Rifaximin is to limit the use of antibiotics, probiotics, antacids as much as possible.

      Avoiding sugar or other foods does not seem to prevent (or trigger is eaten in excess) SIBOP relapse.

      Once the autonomics fully recover (this often takes up to a year in adults), relapses tend to become very infrequent.

    • Nathan 1 year ago


  69. Krys h 1 year ago

    When we first started the protocol we were using NN Cod Liver Oil. We saw gains and awakening but decided to switch the fish oil to your recommended NN Ultimate Omega. Looking back, I am realizing that a lot of the bad behaviours came after this switch like Major AGGRESSION, head banging, hitting etc. Recently, after he became aggressive again, I took him off of the fish oil completely and his mood has greatly improved. Do you think that the Ultimate Omega was not a good fit for him and if so, would you recommend that I go back to the Cod Liver Oil. Over a year on protocol. 4 year old ASD.

    • Patrick Nemechek, D.O. 1 year ago

      The type of fish has nothing to do with the issues you are discussing.

  70. Kelly M Langan 1 year ago

    Hi Dr. Nemechek!
    My son is 5.8 years old with ASD. We’ve been on the protocol for 18 months now! We’ve never missed a day! We’ve seen great gains in overall engagement, clarity, decreased stimming, participation, and receptive language. But we still do not have expressive speech! He can say very simple words, mom, dad, baby, blue, boo, toe, two, etc. When asked and these are words we’ve worked on repetitively! When I ask him to say other words, he attempts the words, however mostly unrecognizable. My main question, do you think speech will come? True, real, conversational speech! I’m starting to worry, as he is almost 6 and I feel like we’re running out of time. Thank you for your continued support!

    • Patrick Nemechek, D.O. 1 year ago

      True, real, conversational speech will come.

      It just always takes longer than our patience can accept.

  71. Missi 1 year ago

    Me and my two kids have started the protocol. My 10 year recently got diagnosed with autism. My 12 year is diagnosed with ADD.
    With the protocol do I do inulin everyday for all of us or only the one diagnosed with autism?
    Also, is the attention piece generally that last to recover?

    • Patrick Nemechek, D.O. 1 year ago

      Please read the book

    • Missi 1 year ago

      I have read and re read the book. I also carry it with me wherever I go. I believe inulin will be part of the daily routine to maintain healthy intetestial balance for all of us. Just wanted to make sure I was totally understanding.
      Just a scared parent making sure I am following the protocol to a T.
      Thank you and most appreciated of your posts and reaching out to helping to follow your wonderful protocol.

  72. Monica 1 year ago

    Hi Doctor,
    We started your profile with my 18 month old on April 9. She has no diagnosis but we suspect ASD, ADHD, possible CP, possible dystonia and possible verbal apraxia. She has shown great gains over the last month. More sounds, better gross motor control, a few word approximations. We had issues with the agave inulin and switched to chicory root inulin. She lost her words immediately but the gross motor skills improved. Last night I increased her inulin very marginally. She was on 1/16 and I added 1/32nd. She soon after developed a nosebleed. She has never had one before. Is this concerning? I ask because as inulin improves vitamin absorption, I read it caused iron overload in someone which can lead to organ damage and may present through nosebleeds. Obviously this is rare (but so far we’ve found everything rare to show up in my daughter), is this a possibility? Or do u think it will pass? How would you proceed? Thank you.

    • Patrick Nemechek, D.O. 1 year ago

      Stick with you originally dosing and quit overthinking everything.

  73. Naushad 1 year ago

    Hello Dr Nemechek:
    I purchased your book yesterday and while reading the section on Fish Oil and recommended dosages, you mention that your protocol focuses on DHA portion of Omega 3 and EPA percentage is not very relevant. Based on this information in your book, would you recommend using Nordic Naturals DHA XTRA supplement versus their Ultimate Omega supplement?
    NN DHA XTRA contains 960mg of DHA and 410mg of EPA as compared to Ultimate Omega which contains 450mg of DHA and 650mg of EPA. Even NN Ultimate Omega XTRA has only 425mg of DHA and 850mg of EPA. So for the fish oil component of your protocol, shall we start with NN DHA XTRA fish oil (using the dosage charts outlined in your book ) vs Ultimate Omega or Ultimate Omega XTRA? Thanks.

    • Patrick Nemechek, D.O. 1 year ago

      The DHA content is only particularly important in adults

  74. Caroline 1 year ago

    My son has been on your protocol for 10 months and was doing really well. I believe his issues were primarily caused by multiple rounds of antibiotics for ear issues starting around 4 months and continuing until he was 4.5. He will be 8 later this month. 12 days ago he had his first positive strep test. The doctor prescribed 10 days of amoxicillin. The only strep symptom he exhibited was out of control OCD. OCD/rigidity is his worst issue and the one we’ve yet to see improve on your protocol. We continued your protocol while he did his full course of antibiotics. However, the ramped up OCD/rigidity has not subsided with amoxicillin treatment. School is reporting he is very “off”…he’s back to scripting and stimming…things that had greatly improved over the last 10 months. He is yelling and very angry. Is this normal? Could he need another round of antibiotics? Would the strep cause this or is the regression from the antibiotics he was forced to take? It’s so discouraging to watch. I feel like I need to be doing something. Thank you for your recommendations. We’ve never seen him regress from illness until now.

    • Patrick Nemechek, D.O. 1 year ago

      In spite of what other doctors are saying, strept does not cause OCD.

      The source for the OCD is either an injury that he should recover from within a few weeks and if not then I would consider inulin failure and treat with rifaximin

  75. Shireen 1 year ago

    I started my son only oils for first 2 months and he was on NOW fo capsule, and did it for 1 month.

    But changed to nnuo capsule as i was not seeing gains with NOW and he became hyperactive on NOW and his poop always smelled like FO.

    He started showing gains on nnuo capsules. Then i added inulin.

    On oils 2 months
    Full protocol 2 months

    Age 2.5 years

    Inulin 1/8
    Nnuo 1 cap lemon flavour(550mg)
    Evoo on food 5ml
    Cooking in mustard oil and coconut oil

    My concern – He is always sick on and off after i started protocol (fever, cold, cough, diarreah etc)

    This time he is having high fever since 6 days and now having rashes on body. Doctor has prescribed anti histamine for 3 days.

    Could FO be causing his illness?
    Could he be allergic to FO?

    P.s his gains are good till now. But his sickness is making our life tough.

    • Patrick Nemechek, D.O. 1 year ago

      Oil in the stool is either from too much oil at one dose or poor absorption because of bacterial overgrowth (SIBO).

      FO is not trigger the illnesses

  76. Sujatha 1 year ago

    Hi Dr NemeCheck
    We started protocol 1month back on my 2yrs (yesterday he turned 2)old boy …
    diagnosed with asd (no constipation ,no diarrhea but little eczema )……..when he was 17 months ….i saw him how he lost all senses(hearing,watching,name responding)…all gone one after other…finally he regressed for 3-4 when he was 23 months…..

    after that with therapy & GFCFSF diet from us ….
    His daily diet is green homemade juice (organic),eggs ,chicken rice ,fruits ,Indian curry ,…70./. Organic food ….
    he slowly started responding to name …then pointing & eye contacting for requesting things(toys&food) …….
    then I came to know about your protocol ….i started with fish oil NN omega 1.5ml …improved eye contact ,name responding,environment awareness all in one week then I added EVOO 2-3ml &cooking with canola oil ….then his receptive language improving & cognitive skills improving
    but showing insomnia daily before we go bed……but his afternoon nap is good…….and also showing all of the sudden aggression (if something goes wrong toy or food)…2-4times a day ……and i feel like his no of stools a day decreased ….before I start protocol he used to go poop right after each meal … max 2times a day
    ……I started inulin yesterday onlywith 1/16 spoon ….babbling very little

    My questions are the above doses good enough for his symptoms ?

    And iam still breastfeeding (only in night timings )i chose to breastfeed to avoid MSG in almond milk &coconut milk ….is my milk good to feed (I had seizures in my childhood until 13yrs……I stopped medication 10 yrs back for seizures now iam 33…no seizures till now)
    My elder son (7yrs)had only speech delay ….he started talking fluently in 4yrs……..iam so worried am I the root cause for both sons speech &asd

    Please respond to my questions
    Iam really sorry for very long query

    Thank you so much for your protocol …..iam seeing lots of gains in short period

    • Patrick Nemechek, D.O. 1 year ago

      I do not respond to questions asking about specific doses for a specific individual

  77. IRENA 1 year ago

    Hello, Doctor! Thank you for your work. I have a question. We live far from America. How do you feel about laser stimulation of the cerebral cortex!

    • Patrick Nemechek, D.O. 1 year ago

      Potentially helpful with comes with a lot of risks.

  78. Martha 1 year ago

    Dr. Nemechek, my son Philip (almost 9 years old) has been in the protocol for 14 months now. We started seeing some overall improvement during the past 5 months after we stopped inulin and gave him Rifaxamin. ( we are seeing improved behavior, less stimming, overall progress at school). There is however no speech.. He tries sooooo hard, but he has serious difficulties. I read somewhere that kids with MTFHR mutation should take leucovorin, which is supposed to help them with speech and social skills. What do you think?

    • Patrick Nemechek, D.O. 1 year ago

      No, just hang in there. If he is trying, he is pruning his brain. It will come soon.

    • Martha 1 year ago

      Thank you

  79. Missi 1 year ago

    My 10 year old son got a Late diagnosis of ASD in August. He is verbal, but socially withdraws and has limited joint attention with no behavior problems. One of his main issues is insomnia. His doctor has prescribed a scheduled 5ml of melatonin nightly. I started the protocol 8 days ago and eliminated the melatonin. His insomnia has returned. My husband, an MD, believes we should stick to the melatonin because he believes it resolved his sleep issue as he has sleep through the night since we started the melatonin 7 months ago. Does melatonin interfere with the protocol? Is melatonin acceptable in the protocol? The past two nights he has not fallen asleep until 4 am and wakes up for school by 7am.

    • Patrick Nemechek, D.O. 1 year ago

      OK to continue the melatonin for a little while.

      Soon his sleep will improve on its own and then you can stop it.

    • Missi 1 year ago

      Thank you.

  80. Pragyan 1 year ago

    Hi Dr.Nemecheck, we live in India the temperature here is 106f, I have stocked up some olive oil, is it safe to leave it at this temperature or can I store them in the fridge(not freezer). I have kept 2 bottles in the fridge, the oil has turned semi solid, is it safe to use on the protocol?

    • Patrick Nemechek, D.O. 1 year ago

      It is OK to store EVOO in the fridge. This is better than getting too hot.

    • Noelle 1 year ago

      I usually mixed EVOO with milk powder dissolved in just boiled water. Is that okay?

    • Patrick Nemechek, D.O. 1 year ago


  81. Christy 1 year ago

    According to the protocol, how much daily COOC should I give my 2 year old daughter via gtube? Thank you!

    • Patrick Nemechek, D.O. 1 year ago

      Please read the book

    • Christy Naughton 1 year ago

      I have but I just wondered if it was ok to give the oil alone directly in her gtube?

    • Patrick Nemechek, D.O. 1 year ago

      Yes it is.

    • Christy Naughton 1 year ago

      Thank you!

  82. Chandra 1 year ago

    Hello Dr. Nemechek, I am following your protocol for 2.5 yr old son who has Autism. After starting the protocol, we saw gains in terms eye contact and name call response. However his hyperactivity didn’t reduce even after 9 weeks on protocol. Some people on FB wrote that it’s because of Now DHA-500. I am giving 1 capsule per day. Should I switch to NN ultimate omega or wait and see with Now DHA-500?

    • Patrick Nemechek, D.O. 1 year ago

      The type of fish oil is not responsible for this.

      Maybe too much inulin?

  83. IRENA 1 year ago

    Hi Doctor! Thanks for your work. I have a question. How do you feel about the point laser stimulation of the cerebral cortex!

    • Patrick Nemechek, D.O. 1 year ago

      Too risky

  84. Ekaterina 1 year ago

    Hello Doctor Nemechek
    I’ve read in one parent group about use of “Speak” (which is Omega 3, D, E, and K vitamins), have you heard of this product. Would you say it is possible to incorporate this into the Protocol as the “FO” component? Thank you very much!

    • Patrick Nemechek, D.O. 1 year ago

      If you are using other supplements you are not on my protocol and run the risk of poor progress

    • Ekaterina MATAMOROS 1 year ago

      Thank you. We re NOT using anything other than in the Protocol. We will read it as Fish Oil is not substitutable by anything other then the indicated supplements. Thank you!

  85. Leigh 1 year ago

    Hi Dr Nemechek. My 8 year old son with ASD and ADHD had a hydrogen breath test 2 years ago which showed SIBO. He was given Metronidazole and another antibiotic to take concurrently which seemed to help gastro issues. He hasn’t had any antibiotics since then. We’ve been on the protocol for 6 months with some gains but have had to come off inulin as lowest dose was still causing some behavioural problems. My question is whether, given his background, we should now take Rifaximin since we are no longer on inulin and gains seems to have plateaued. Would you always recommend Rifaximin where no inulin is being taken regardless of whether obvious SIBO symptoms or not?

    • Patrick Nemechek, D.O. 1 year ago

      Yes, a significant drop in the rate of previous gains might be a sign that another round of rifaximin is needed.

  86. Anonymous 1 year ago

    My son is a 33 weeker 17 weeks (4months) old 10 weeks adjusted. He Never do eye contact in upright position but do while laying in crib, diaper changing table etc. I think he does not have eye sight problem as he tracks me while I am moving around. I have searched a lot on this topic and the results shows Autism everywhere. My Dr. said you cannot diagnose autism before 1 year you have to wait till then, babies develop differently especially preemies. I am really worried as anyone in the family hold him he doesn’t see in the eyes looks right and left. The point is I want to start this protocol should I start with full protocol or moderate just the oils?


    • Patrick Nemechek, D.O. 1 year ago

      Interesting. People with ADD are more able to focus when laying flat that when upright. Sounds a little similar to your child. This condition is called orthostatic intolerance.

      I only recommend starting the complete protocol if trying anything.

  87. Magda 1 year ago

    Hello, is it possible to take blockers h1 and h2 after rifaximin while the histamine reactions do not calm down? Will it not cause a relapse?

    • Patrick Nemechek, D.O. 1 year ago

      H1 and H2 blockers are not known to trigger relapses of SIBO

  88. Honey Bon 1 year ago

    Hi Doctor,
    Thanks for your protocol which we were following for our kid.
    I am suffering from migraine from past 8 years. I wanted to try your protocol for relief of migraine. In your protocol it is specified that Rifaximin 550 mg should be taken twice for 10 days and stop after that. If I get migraine again and if it’s a little headache,then do I need to take Rifaximin again for 10 days?? How long do I need to take this medicine?
    Please reply Doctor. Thanks in advance

    • Patrick Nemechek, D.O. 1 year ago

      Just follow the protocol and over a few months most of your headaches will resolve.

  89. Kashif 1 year ago

    Hi dr
    We have been using Nemechek protocol for our 4 year old son for last two years as describe in your book . He has shown no improvement . He has scripted speech only three word he speak. He is also diagnosed for celiac decease after that we have put him on total gluten free diet. He has cramping or constipation most of the time .he has so much anxiety’ .i believe his anxiety (he does lot of stimming because of anxiety) is not letting him speak .is there anything we should do to control his anxiety .

    • Patrick Nemechek, D.O. 1 year ago

      If there is no improvement of any sort after several months on the protocol, I believe the inulin has not reversed any of the overgrowth and would recommend rifaximin.

      Discuss this option with your managing physician.

    • kashif 1 year ago

      Thanks for your Reply Dr nemechech
      what mg rifaximin we should do and for how long?

    • Patrick Nemechek, D.O. 1 year ago

      Please read the book.

  90. Brigitta 1 year ago

    Good morning, I have been told many times that EVOO is not suitable for cooking as it burns at higher temperature and it is not safe …I have just started to read your book and would like to ask this from you.many thanks Brigitta

    • Patrick Nemechek, D.O. 1 year ago

      EVOO is not harmed or turned into an unhealthy substance by cooking.

      It may burn at a higher temperature that coconut oil but this is simply a reflection of its chemical properties and not evidence it is unhealthy.

      I would also like to add that I enjoy cooking and have never had my olive oil burn or smoke. 🙂

  91. Angela 1 year ago

    Hi Dr. Nemechek, I recently had a stool test done for my 6 year old son. He’s been on the protocol for 13 months and while his gut inflammation has GREATLY decreased (thank you!!), his zonulin levels have significantly increased. His strep levels and also candida are now within “high” ranges, though they were mostly normal when we did the same stool test about 16 months ago. We have been diligent with the protocol, he gets 2 fiber choice gummies, 2 tsp of approved EVOO, and 1/4 tsp NN fish oil daily. I would appreciate your thoughts on how to deal with the candida, strep, and zonulin given that these things have seemed to pop up even after he’s been on the protocol for a while. Thank you for helping my son.

    • Patrick Nemechek, D.O. 1 year ago

      I suggest you focus more on your son’s health and less on lab tests. I have never needed zonulin, strept or candida tests to help my patients. Focus on administering the proper doses I recommend and be patient.

  92. k h 1 year ago

    Over a year on this protocol for my now almost 4 year old ASD non verbal son. After intiially seeing gains we have been at a stand still for months. Absolutley no gains for months and some of the gains he had at the beginning have also disappeared. Annd worst of all, still zero words. Why is this not working for my son? What would you suggest?

    • Patrick Nemechek, D.O. 1 year ago

      I always suggest being sure to use approved brands, discontinuing other supplements as looking for other issues that limit recovery (recurrent infections, emotional trauma).

      If there still isn’t any recovery, they a follow-up appt with me is probably necessary to sort out the issues and even consider starting a vagus nerve stimulator.

  93. Patrick Nemechek, D.O. 1 year ago

    Inulin dosage might be too high or behaviors might be from other supplements or even another source of relapse. Please review the chapters on the book on this topic.

  94. Lisa 1 year ago

    Hi Dr. Nemechek,

    First of all, thank you for all your help. I’m a big believer in your protocol and have been following your protocol for the past 9 months. My son (3.10 yr) initially made some gains in the first six months (awareness, constipation, reduced symptoms of sensory issues, cognition), but he is not making any progress in the past 3 months. I see a high level of visual stimming and other sensory issues. He was sick in early February (asthma and fever) and hasn’t been the same kid since then. Prior to this protocol, he was nonverbal, so we were very excited when he started saying a few words back in January, but it pretty much stalled after he got sick. Do you have any suggestions? Does he need rifaximin or VNS to reduce his inflammation?

    • Patrick Nemechek, D.O. 1 year ago

      I wouldn’t change anything in the protocol but look for other causes such as other supplements, other forms of stress (school or home emotional stress), etc.

  95. Brigitta 1 year ago

    Hello Dr Nemechek, Just ordered your book and would like to start your protocol.
    My son is 2.5 years old who has autism signs however his diagnose is Global Developmental Delay. He has several allergy issues such as dairy, soya and gluten. He started to get Bioray detox drops, CBD oil , fish oil and probiotics for 6 months now and showed big improvement.
    Could you tell me how I should continue as I want to try your protocol. Just drop all of the above and only start using inulin? Thank you

    • Patrick Nemechek, D.O. 1 year ago

      Read the book and you’ll have your answer.

  96. Sarah M 1 year ago

    Hi my son has Down syndrome, he doesn’t have any focus or attention issues so has no propionic acid production (I’m guessing) would you still recommend inulin in this instance?

    • Patrick Nemechek, D.O. 1 year ago

      Yes, it is still useful for helping with recovery from developmental issues and cumulative brain injuries.

  97. Landon 1 year ago

    Hi Dr. Nemechek,
    Thank you so much for the Protocol. It is working so well on my 9 year old asd son. We have seen huge gains over the past 8months with the exception of hyperactivity and sporadic anxiety issues. I know you have been recommending a decrease in inulin in certain circumstances and we tried this with no luck. Thank goodness for the Facebook group because one of the admins (J) suggested I try upping the EVOO a tad bit or giving it direct to try and lower the inflammation more. His diet isn’t that great at the moment. Well it worked and my sons hyperactivity and random anxiousness are so much better now. I am so grateful for your protocol and the parents out there that are able to help us across the globe.

    Thank you again and god bless

  98. ibrahim Omer 1 year ago

    Hi Dr
    Thank you for your help with the Protocol. My 4 years old son is in Autism disorder and he is following your protocol. But now my concern is before one month he started laughing a lot and in inappropriate situations and we can not stop him laughing. Is there any thing we can do to help him. He takes 2 ml Inulin, 5 ml NN fish oil and 10 ml EVOO all right products as mentioned in your book. thanks sir

    • Patrick Nemechek, D.O. 1 year ago

      These laughing episodes have been referred to as “the drunken sailor” by some parents. I’m uncertain what causes it but it will resolve on its own without any changes in protocol.

  99. Natalya 1 year ago

    Hi, dr. Nemechek! My daughter is 11 years old. She started a rifaximin course. On the fifth day, she developed vomiting from rifaximin. What should we do? Stop rifaximin and try the next round after some time? How often can rifaximin be repeated?

    • Patrick Nemechek, D.O. 1 year ago

      How do you know it was the rifaximin that caused the vomiting?

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