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Reversing Autism with The Nemechek Protocol – Update 2017

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

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

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

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

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

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

A TESTIMONIAL

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

March 23, 2017 –  An Addendum on Recovery

My Experience with Autism Recovery:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hope this helps.

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

6,858 Comments

  1. Sama 1 year ago

    Hello Dr Nemechek, Daughter got 2 really really bad viral infections – 4 months back and once again 1 month back. I continued the inulin and we continued to see gains in other areas. Except she developed a severe severe OCD flare following the first viral which got worse with the 2nd. She was put on erithromycin by our regular doctor but had to stop it within a day as she reacted to it. My question is : since she continues to have this ‘flare’ for the last 4 months now, is it a good idea to use some strong anti viral herbs until the issue clears up. I fear stopping the inulin as she has great gains with it! But the OCD has been around since 4 months now which is worrying! Thanks a million for your protocol!!

    • Patrick Nemechek, D.O. 1 year ago

      The viral infection is gone (they tend to be self-limiting and resolve within a week) but she is sufferring from the inflammatory effects from the infection.

      This will improve in a little more tome. Try increasing her salt and water intakes.

  2. Julie 1 year ago

    Thank you

  3. Gunjeet Parmar 1 year ago

    Greetings Dr Nemechek,
    My daughter 5 years and 4 months old , has been on the protocol for approx 14 months now. Her current dosage is –
    3 NN Fishies
    7-10 ml COOC olive oil sprinkled over food(cooked in EVOO available in India)
    1/4 TSP Now inulin(reduced from 1/2 TSP a week ago)

    She has been showing steady gains in many areas like language, communication as well as social behaviours.
    She has however never stopped tip-toe walking and tends to breathe heavily whenever excited.
    Since last few days she has been having more and more pee-in-the pants accidents. They did happen initially for a few months when we started the protocol, but tapered off eventually. She had a short viral flu episode a couple of weeks ago, but no anti- biotics were involved.
    Is this indication of a relapse or something to do with recently reduced dose of inulin?
    Please help! Her teachers at school are much distressed due to the peetox incidents.

    Many thanks

    • Patrick Nemechek, D.O. 1 year ago

      Could be from the inflammatory stress from the infection, should clear up.

      Tell the teachers to focus on all the gains rather than the temporary setbacks.

    • Gunjeet Parmar 1 year ago

      Thank you so much.

  4. Malkochan Oksana 1 year ago

    Hello, Dr. Nemechek .. My son, 15 years old, had an individual intolerance to inulin, even at the lowest dosage of 1/64, there was nausea, vomiting, pain and cramps in the stomach, bloating and allergy .. I bought antibiotic rifaximin 200 mg at the pharmacy .. I started taking with 2 tablet 2 times a day. The child has side effects: from the gastrointestinal tract: nausea, vomiting, diarrhea, bloating and abdominal pain, from the genitourinary system: frequent washing in small portions every 3-5 minutes, from the nervous system irritability, aggression, insomnia .. On the third day, the dosage was reduced by 1 tablet 2 times a day, the condition worsened .. The antibiotic intake on day 5 had to be stopped and given a sorbent … Tell me please what to do in this situation? if inulin and rifaximin are not suitable … Or is the protocol not suitable for everyone? Maybe there is another antibiotic? Thank!! Looking forward to your reply…

    • Patrick Nemechek, D.O. 1 year ago

      Very unusual response.

      Stop the fish oil and olive oil and retry at a higher dosage

  5. Sabiha 1 year ago

    Hello doctor,
    My child is 2.8 year now. On protocol since Jaunary 2019. Started with only inulin 1/8(no oils) and 5th day i saw pointing finger once.

    Then I started full protocol, she started to imitate on rhymes. But only for few days i saw these gains and then the gain lost.
    I restarted the protocol after 2 months as i thought i have missed the awakening…( at that point of time i was giving her 1/2 tsp of inulin, 1 now fish oil and 1 tbsp of olive oil)

    Its been 7 months now with 0 gains.

    Current dose 1/4 inulin, 1 teaspoon evoo(cooking in ghee), 2 nnuo 550mg capsule.(its been 1 week since i have double the fish oil)
    Am on right track
    Sinnce last 5 days she is crying and rolling on the floor very difficult to handel her..i got the same complain from her playschool too

    • Patrick Nemechek, D.O. 1 year ago

      Maybe too much fish oil.

      That dose is very high

  6. KSA 1 year ago

    Hello Dr. my son was diagnosed with mild Autism symptoms at the age of 2. He is non verbal, with low eye contact and no response on calling BUT his IQ is very good and learning is quick. we heard alot about protocol and interested to start aeap. Pls can you guide us on dosage for him, he is now 2 yrs and 5 months.
    what precautions should we take during the protocol?
    Thank you very much for all your support and advises for all the parents.

  7. Nikhat Equbal 1 year ago

    Hello Doctor,
    In book you have mentioned that intestinal parasite can also contribute to long term relapse.
    Also, intestinal infection from parasites can push the bacterial blend into autism mode.

    So, in India it is advisable to do deworming every 6 months(using anti biotic).

    My question is that will this interfare with protocol? Or should i go ahead with it?

    My child is 2.8 year
    4 months on NP
    Is mostly irriated and food demand a lot(sign of intestinal parasite).

    • Patrick Nemechek, D.O. 1 year ago

      I also say only treat for parasites after stand stool for O&P testing shows their presence.

  8. Divya 1 year ago

    Hello Sir – i started the protocol for my daughter (4 years 7 moths old ) on 10/7/2019 with 1/16 tsp now inulin , 2/3 capsule Now dha 500 and evoo approved in her food ! No gains no awakening or changea in behaviours of any sort

    Increases inulin to 1/8th on 20/7/2019 still no gains on the eye contact , awareness etc.
    Instead find she is making unnecesary movemets , blinking eyes ( she used to blink eyes before also but had completly gone off)
    Staring morw at the colored led lights !

    Diagonosed as global developemnt delay
    Still not verbal
    Babbles most of the times
    Is able to repeat certain words but with no much clarity some words re clear but most of them are not

    Pls help

    • Patrick Nemechek, D.O. 1 year ago

      Give her a little more time. Leave the doses where they are.

  9. Sandeep 1 year ago

    Hi Dr Nemecheck, Thank you very much for your protocol. My son is currently 4.9 years old, he was doing very good until 2.2 years with clear words and few sentences. But slowly reduced his speech had a speech regression when he was at 2.3 years old. My son has been speaking only one word for past 6 months.
    We have started your protocol 8 weeks ago starting with 1/8 + 1/8 tsp (twice daily) of NOW Inulin, 1/2 tbsp of COOC certified olive oil and 1 tsp of Nordic naturals children DHA 530 mg (255 DHA + 170 EPA). We have been giving the same quantity till date with no other medicine or probiotics except homemade yogurt made with A2 milk. We are using organic cold pressed Sesame oil for deep fry items.
    My son was having little screaming earlier but for past 2-3 days he has been screaming with too much loud noise for every few seconds (most of the time in a day) and sometimes crying along with loud screaming and keeps moving around. Last night he was crying with loud screaming and hitting walls and jumping on the bed which he never done before in the past. We are not giving any other supplements apart from the protocol measurements mentioned above. No speech improvement so far.
    Kindly advice if we need to change the dosage.

    • Patrick Nemechek, D.O. 1 year ago

      Never change doses of anything because of a short term behaviors.

      And when you do, most improvements take longer that a few days to be noticed (inulin -1-2 weeks, fish oil/EVOO 3-4 weeks)

      This should pass without doing anything

  10. Rupam 1 year ago

    My daughter has autism
    And she is 2.9 year old. she is non verbal, only babbles. We are doing np from 3.5month, but she is constantly sick, and we didn’t see any significant gain.
    Less eye contact
    Less name response
    Don’t follow commands
    Understanding level is not that much.

    We are on the 1/4 inulin about 3month and her sleep is horrible since last 1month. Now I stopped inulin(suddenly her stimming reduced) and will restart inulin after 1week. plz suggest me, what should I do?
    I am giving melatonin for sleep.
    1/4 inulin(stopped now)
    5ml evoo on food
    1 nnuo 550mg FO

    • Patrick Nemechek, D.O. 1 year ago

      Less inulin

  11. Kelly Stephens 1 year ago

    I have two questions – my son was put on digestive enzymes long before we started your protocol. He has obvious food intolerances to gluten, egg, and soy (diarrhea and insomnia) even after treatment with Flagyl for SIBO and taking inulin consistently for many months (as well as the rest of the protocol). I have tried to stop the digestive enzymes because you recommend stopping all other supplements, but every time I try, he is awake all night. Thoughts?

    Also, I would like to increase his salt intake to combat his cerebral hypoperfusion and excessive stimming/scripting, but I am unsure what is an appropriate amount for a five year old. Is there a certain amount of table salt we should be aiming for a day? Is Gatorade appropriate to use daily? Thanks!

    • Patrick Nemechek, D.O. 1 year ago

      Often, the food intolerances resolve within a month or 2 after starting inulin or treating with rifaximin.

      Flagyl is not a good alternative for SIBO.

  12. Parent 1 year ago

    Hi dr nemechek, my son is 3 on nemechek nearly a year. We’ve had amazing gains for first 8 months but Hit a plateau for last few months. I have tried doubling ultimate omega from 1ml to 2ml but he cannot handle this. His sensory issues go into over drive. Even if I increase it to 1.25ml he still has sensory issues and as soon as I bring it down to 1ml these go away. I’ve tried cod liver oil too but again he cannot handle anything over 3.5ml of clo. Any suggestions?

    • Patrick Nemechek, D.O. 1 year ago

      If everything has stopped improving, he has inulin failure and needs to be switched to rifaximin.

      If only a 1-2 aspects have stopped improving, he’ll need a vagus nerve stimulator.

  13. Ayesha 1 year ago

    Hi . Our doctor Patrick Nemechek.i want to know what should be the right doses of 8 year old boy if he is autistic non verbal and less cognition .my son had Diarrhea very often and smelly stools before your protocol but after your protocol,stool once daily or few time a gap of one day . Very perfect after np .its great . I am not seeing more gains since two months . Dosing inulin 1/2 teaspoon ,proomega 2840 is one teaspoon full after doubling since one week, evoo 15 ml .
    Should I change doses ?

    • Patrick Nemechek, D.O. 1 year ago

      The prescribing doctor needs to decide this

  14. Equbal 1 year ago

    Hello doctor,
    You have adviced in book to give salt water in case child is hyperactive, demanding more food, anxious, poor concentration etc.
    So, should we use table salt(white) or Himalayan salt? Also does the quantity matter or should we just give 1 pinch?

    • Patrick Nemechek, D.O. 1 year ago

      Your need sodium chloride (table salt) regardless of the origin.

  15. Lynne Susanne 1 year ago

    Dear Dr. Nemechek,

    I wanted to bring up something for possible insights for future treatments and deeper understanding. I wanted to send you a more private email, but I think this was the only way for me to reach you.

    Thinking about the appendix and the digestive tract, I recently read that people and mammals have an appendix. That for quite sometime scientists did not understand the function of it. Recently it has been hypothesized that the appendix is there to replenish the good bacteria if the person/mammal had all of the good bacteria flushed out of their system with an illness. This made sense to me.
    It also on the other hand might be a source of bad bacteria and relapses, possibly why bowel disease is so very hard to treat.

    My daughter, 18 years old now, used to have terrible frequent debilitating migraines which always seemed to be related to foods and her stomach. At age 16, she had appendicitis and an appendectomy and antibiotics at the same time. Since then she has been well and without migraines. I am in no way recommending or suggesting an appendectomy for everyone, but there could possibly be a connection to be examined between the appendix and possible treatments.

    My son, 16 now has severe autism and we are using your protocol to try to help him. We have an appointment in January to see you. I only wanted to share my thoughts about the appendix and theories in hopes that it might give more insight or help someone.

    You do not have to publicly post this on your blog, but you can.

    Thank you for all you do.

  16. Equbal 1 year ago

    My child is so anxious, irriated, hyper, stimming, he need food after 1 min of finishing his meal or else he cries. There are good gains but i feel gains are kind of plateued since 1 months and he is very less interested in any activity, he just want to munch on snacks or watch tv. He has been sick recently and was on anti biotic, now he is fine.

    Age is 2.8 year. 3 and half month on NP.

    Doses 1/8 inulin, 1 ultimate omega 550mg capsule, 3ml evoo on food(cooking in coconut oil).

    Will doubling Fo help him?

    • Patrick Nemechek, D.O. 1 year ago

      Stop the inulin.

      If things get better, restart with a lower dose.

    • Equbal 1 year ago

      Thank u!

    • Elizabeth 1 year ago

      Some of us are confused by this.. Just so we understand fully, how do you know this isn’t relapse that will resolve if the child stays on the protocol? Do you think the issue may be the result of his illness and the antibiotics, in which case he’d actually need the inulin in order to bring back gains?

    • Patrick Nemechek, D.O. 1 year ago

      Typical relapses resolve in a few weeks

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

    That decreasing attention span might very well be increase anxiety due to excessive inulin.

  18. Annie 1 year ago

    Hello Dr Nemecheck, My son’s naturopath asked us to supplement him with B-complex and nicocinamide (B3) his theory is even if he is not deficient in these areas which are hard to determine my son being diagnosed with micro deletion (William syndorme) may not get/absorb enough nutrients hence he thinks supplementing this for long term will help him. please let me know if you see any issues continuing this?

    • Patrick Nemechek, D.O. 1 year ago

      With that logic then one should supplement him with every possible supplement known to man just in case he might develop a deficiency.

      Better in the enemy of good enough

  19. Nikhat 1 year ago

    My 2.8 year old on full protocol for 3 and half month. Doses inulin 1/8, evoo 2.5ml, 1 capsule 550mg of ultimate omega.
    He gained a lot during short time(finger pointing, sitting and playing appropriately, calling mumma and papa, follow command etc)
    But, very less speech gain(2-3 words).
    He have not improved in hyperactivity, anxiousness, stimmimg and food demand(always need something to snack on).
    Also, he is falling sick more often now.
    I cook in coconut oil.
    Do i need to increase his fish oil to double?

    • Patrick Nemechek, D.O. 1 year ago

      It sounds like he is recovering and waiting is the best option. Do not fiddle with the doses.

  20. Sorted 1 year ago

    Dear Dr Nemechek,

    On 13 November 2017 at 9:05 pm, you had responded to a question raised by an ‘Agata’ on whether ‘Made in India’ rifaximin could be used. Your response is quoted as follows (sorry, I can’t seem to attach a pic or a link for your easy reference. Hence, the inclusion of time and date for your ease of reference) “All the Rifaximin I’ve seen coming from India is manufactured by Dr Reddy’s Pharmaceuticals. They produce high quality medications that meed FDA standards and are sold in the US.”

    In relation to the above and based on my findings, Sibofix is the trademark name by Dr Reddy’s Pharmaceuticals whilst Rifagut (which was stated in your book) is the trademark name used by Sun Pharma Laboratories, which is the market authorisation holder but is manufactured by Lupin Ltd. I am afraid I am a little confused because both names are mentioned in the book whose copyright is also in 2017 but you remarked only on sibofix. May i please ask if you have a preference for as I understand it, there are a huge number of generic rifaximin brands out there and some doctors as well as some hospitals actually have a preference as to the brand due to its efficacy, quality and side effects? Could you please advise on this?

    Thank you.

    • Patrick Nemechek, D.O. 1 year ago

      My responses are not intended to be all encompassing especially in regard to the entire pharmaceutical industry in India which is quite substantial.

  21. Dennis 1 year ago

    Hello Dr. N. My son has been the protocol for more than a year. Began: June-2018.Started of with 1/4 tsp NOW Inulin reached already 2tsp on the 3rd month. Fish oil of Nordic Natural Ultimate Omega reaching 5ml with California EVOO around 5ml to 10ml. First 6 months was mostly hyperactive, vocal stimming, nursery rhyme,tic/side glancing, awareness was increased but not much response to name calling.

    Continued with the dose till Jan-2019. With not much gain in comprehension and language. Reset the dosage back to square one.
    This time using Nordic Natural Omega-3, reaching 5ml(800mg DHA/EPA), still NOW inulin reaching 1tsp, Cobram EVOO since unable to get California Olive Ranch.Till July 2019 ,
    Still vocal/stimming, TIC, drunken sailor, very very hyperactive, short attention span and with behavior of a incoming 2 yrs old. He’s turning 4 this end of july. Doing OT and SPED.

    Question: Do i need to increase or decrease a component like inulin? Or change to Chickory? Up at Fish Oil? Or remove VCO/MCT?

    • Patrick Nemechek, D.O. 1 year ago

      He is showing signs of low brain blood pressure (hyperactivity, low attention span, anxiousness). Too much inulin can cause this but so can cumulative brain injury to the autonomic nervous system.

      Dropping inulin to lower range (1/8 tsp/d ?). If no improvement in a few weeks, consider getting medicatin to boost blood pressure such as midodrine or Adderall.

      FO and EVOO are OK. Stop coconut oil.

  22. Meerim 1 year ago

    Hello Dr. Nemecheck!
    Thanks for amaising book you are helping us.

    My story of our son is below if you could advise.

    Our son will be 6 yo this September. He was born with C section, he got fetal destress.
    All vaccines got according calendar. He was very social boy, then at 9 month I have noticed he started to change, however till age 2 he used to repeat words but after everything has gone.

    At the age 3 he became hyperactive, creating sounds, jumping not hearing and answering.

    At the age 4 we have done MRI and our Doctor confirmed the diagnosis of encephalopathy (minor hemorrhage and the presence of gliosis) so we found this thing very late however it happened during labor.

    The encephalogram showed epiactivity. Our son was treated with Depakin and the missing look was gone. Excellent hearing was confirmed by Doctor as well.

    At the moment he is still hyperactive, he is looking sideway at items or looking very close.
    Most of the time he is massaging his chin.

    How do you think Doctor can we follow Protocol to help his brain. how to restore brain cell death???

    I am worried too much about his future!

    Thank you very much!!!

    Yours Meerim

    • Patrick Nemechek, D.O. 1 year ago

      If you want to help your son, you need to just follow the simply instructions in the book.

  23. Caroline 1 year ago

    My son was on a full round of Rifaxamin 2 months ago. We got through the awakening and he was doing great. Then he just got an abscess on a tooth that required immediate treatment with amoxicillin. He also had to undergo about 25 minutes of anesthesia to have the tooth pulled by an oral surgeon. We already see a decline in behavior and a return of things like screaming and scripting (he is still on the antibiotic). My question is whether Rifaxamin is always necessary after antibiotics/anesthesia or is this decline sometimes just temporary and he could possibly rebound without another course of Rifaxamin? How long can we safely wait to out before we know he needs Rifaxamin? I tried using the search feature and double checked the book but couldn’t find a specific answer to this question. Thank you!!!

    • Patrick Nemechek, D.O. 1 year ago

      Probable relapse. If your doctors cannot find any other explanation such as a side effect from a medicine, etc then I expect this is from a SIBO relapse.

  24. Salaha begum 1 year ago

    Hi doctor , my mother is suffering from vericose veins since 25 yrs back and now she is 55 years of age…. can I start this protocol with her, can this protocol helpful for her.pls suggest me.

    • Patrick Nemechek, D.O. 1 year ago

      Yes it can.

    • Salaha begum 1 year ago

      I appreciate your reply thank you doctor we love you so much and wish you always with good health.

  25. Janet Ng 1 year ago

    Hi Dr N, my son is 4.5yo, ASD, verbal but delay. We’re in NP since May, started off with 1/8 tsp inulin, 1ml FO and 1/2tbsp EVOO. We got good gains, better eye contact, better speech, better mood. So after 1 month, in June we gradually increased inulin, until now in July we give total 1/4 daily. Since we increase, for the past 3 weeks my son got more hyperactive, attention got worse, and began to stutter. All ABA tutors, OT, ST observe the change. My son is so aware of his stuttering because he didn’t have it before NP. He would even cover his face with his mouth wide open when words don’t come out. Do you suggest we change our doses, like reduce inulin back to 1/8 or increase more inulin or oil to overcome the bacteria overgrowth? The stuttering is really bothering him. He’s not sick or stressed, we started summer holiday he’s always in quite good mood. Appreciate if you can advise, thank you.

    • Patrick Nemechek, D.O. 1 year ago

      Here is message for everyone starting the protocol.

      If you get an obvious awakening with your initial dose of inulin, DO NOT INCREASE the the dose further.

      You only increase your chances of having negative side effects due to low brain blood pressure.

      If you did raise the dose and you have the increased side effects, drop back down to the original dose of inulin.

      Also, do not fiddle with the olive oil and fish oil doses or brands.

      Keep simple, simple. The more you fiddle, the bigger a mess you’ll have.

      There is no alternative for patience. There are no short cuts.

  26. Anonymous 1 year ago

    Good morning Dr. N

    Have a traveling question and hope it’s not silly. But when traveling by plane, how do you suggest we carry the olive oil? I haven’t flown in years and just want to make sure supplements remain in tact.

    Thank you

    • Patrick Nemechek, D.O. 1 year ago

      I transfer the oil into a plastic camping flask that is designed to not leak.

      Put the flask with oil in a ziplock bag and put that in my checked luggage.

      I’ve never had it leak.

  27. MRmom 1 year ago

    Hi Dr. Nemechek, my 3.3years old son has been on the protocol for 11 months now, we saw a few gains like from Nonverbal to now saying some of his ABCs and some animal names and sounds but no functional language. His awareness has improved, his receptive language has improved too but he has become very hyper, his poop is very loose, his eczema has flared up, lots of vocal stimming, he is fussy, tantrums and whines all the time. He is not social with his peers, he is happy to play by himself, he barely respond to his name. Lately he has a very low appetite. His dosages are 1/4tsp Now inulin, 2mL Ultimate NN FO, and 1/4tsp of EVOO in his morning juice. What do you think?

    • Patrick Nemechek, D.O. 1 year ago

      The loose stool and flair of eczema indicate is gut bacteria has been thrown off balance.

      Viral infection vs supplement issue vs. inulin failure.

  28. Gemma MacFarlane 1 year ago

    Hi Dr N
    I just opened my new bottle of Now inulin and the consistency has changed from like creamy and powdery like baby formula to grainy and white like sugar. Should I be worried about this and change my bottle?

    • Patrick Nemechek, D.O. 1 year ago

      The bottle was probably overheated in shipping.

      Contact the manufacturer.

    • Gemma MacFarlane 1 year ago

      Thanks. I managed to email them and was told they have changed the spray dryer so this is what it looks like now.

  29. Vandita Malhotra 1 year ago

    Hello Dr,

    I’ve been following the protocol since 6th March 2019 for my 4 year old son. Initially we did see some improvement like Better Eye Contact and few Random words but from the last 2 months, I’m not seeing any gains…His sensory issues have gone up and he has become a very reluctant speaker. We are in a typical regression phase post awakening.
    Our current doses are 1/4 tsp Inulin, 2.5 ml NN FO (1560 mg) and 5-10 ml EVOO all approved brands.
    Pls advise

    • Patrick Nemechek, D.O. 1 year ago

      I’ve never heard of the concept, “a typical regression phase post awakening”. No such thing.

      If he is acting anxious, the inulin might be too much for him.

  30. deb 1 year ago

    Hi..my daughter, now 5, is on NP from last 1 year with some gains. As there was little improvement in eye contact even after 11 months on inulin, I gave her 1 dose of rifaximin. Eye contact improved after rifaximin. She used to have foul smelling morning breath before giving rifaximin. After rifaximin, bad breath completely reduced with no smell at all. However after 1 month her foul smelling morning breath is coming back. Does this signifies her SIBO is growing back and I should give her 1 more round of rifaximin?

    • Patrick Nemechek, D.O. 1 year ago

      Yes, I would interpret the return of bad breath as a return of SIBO.

  31. Tom 1 year ago

    Dear Dr. NEMECHEK,

    My son is on the protocol for 2 months and he started to show brilliant gains however he has weird moments . He started to look up more and making eye contact then sometimes he is not responding in the same situation then after 2 min he smiles again.
    When he is tired he has the moments then before , not focusing then next day he is a different little man …. His brain function is up and down.

    • Patrick Nemechek, D.O. 1 year ago

      Its hard to understand these types of events. The good news they generally calm down with more time on protocol..

  32. Alexandra Dunnison 1 year ago

    My son is 25 with a complicated gut history but no cognitive difficulties. Been on the protocol for about a year. Not completely consistent. 3 rounds of rifaximin. Still feeling pretty cruddy a lot of the time (gut pain). Should we add curcumin and L-Carnitine? We have an appointment to see you for next May so just trying to figure out what to do to improve outcomes in the meantime. Impacting his ability to work and have a full life.

    • Patrick Nemechek, D.O. 1 year ago

      The question is does he do well for a month or 3 and then relapse? If so he needs more frequent dosing of Rifaximin.

      If not, then the gut symptoms (bloating, heartburn, cramping and constipation) are from underlying autonomic dysfunction and will most likely need vagus stimulation.

    • Alexandra Dunnison 1 year ago

      Thank you for the reply. Hard to tell as I know we haven’t dosed him frequently enough with Rifaximin. But he does have a diagnosis of dysautonomia from a GI, so that we know! Yes, expect we need the VNS. I know curcumin and L-Carnitine are for inflammation and were in your dementia protocol and probably wouldn’t help much for ANS dysfunction, but just checking. Look forward to meeting you when we get there. On the wait list! No need to reply to this.

    • Patrick Nemechek, D.O. 1 year ago

      Curcumin and L-Carnitine are needed for autonomic dysfunction recovery.

    • Alexandra Dunnison 1 year ago

      Thanks for that. We will add in then!

  33. Timea 1 year ago

    Hi. We are doing the protocol for over a month with great results and thank you so much for this. My 3 year old has high tolerance for dairy but loves yoghurt so I found Alpro. Within the ingredients listed : yoghurt cultures (s thermophilus L bulgaricus)
    I’m superconfused, please help. Does it mean it has probiotic?

    Also is sacharoomyces boulardii a probiotic? Or should it be rather avoided with the protocol?

    Thank you so much for your help!!!

    • Patrick Nemechek, D.O. 1 year ago

      Standard yogurts are acceptable with the protocol.

  34. Anonymous 1 year ago

    Hello Doctor,
    Thank you for the protocol. My son is 7 year old moderate ASD. We are following the protocol since
    8 months. Gains are very slow better in certain skills but his stimming and anxious behaviour increased than before. We are following gfcf diet along with protocol.The dietician is suggesting Magnesium L-Threonate and Taurine to improve his cognition and reduce his anxious behaviour. Can I use them along with the protocol.

    • Patrick Nemechek, D.O. 1 year ago

      You’ll know my response if you’ve read the protocol.

  35. Chetna 1 year ago

    Hello Dr. Nemechek,

    I started protocol for my son age 2 years and 5 months old on July 1st 2019. Have not notice any gains (not that I expect this soon) but he had few random nights where he woke up in the middle of the night. Some of his behavior also got worse (not too much worse but like we can say 20% increase) like not using speech for requesting things rather crying, more tantrums, more vocal stimming (repeating nursery rhymes over and over)
    I am using all approved brands and I started Inulin with 1/8 tsp and after 5 days I increased to 1/4 tsp because before NP we were giving him Culturelle Kids which contains Inulin.
    So his current dosage are
    Inulin 1/4 tsp
    EVOO in food (mostly just in dinner)
    Fish oil 1 ml

    Please suggest if I am not right track or not. Thank you so much.

    • Patrick Nemechek, D.O. 1 year ago

      Yes you are on the right track. Continue the protocol and be patient.

      Improvements will come.

    • Chetna 1 year ago

      Thank you Doctor for reassurance. On the FB group of Nemechek ( not affiliated to you) I was advised to reduce his Inulin dosage to 1/8 tsp.

  36. Kirthi 1 year ago

    Hi sir ,Thank you so much for your protocol iam doing it for my 4years old daughter with speech delay for past one month I read your book and slowly increase it the inulin dosage my current dosage is 1/3 tsp in the morning and evoo 5ml and fish oil all recommended brand by you and recently I met a doctor for her and he confirmed she got mild autism and he prescribed l-carnosine 100 mg morning and evening 100mg in liquid form 5ml each . I told that doctor about ur protocol and he said it’s ok to give this medicine with the protocol so for past one week I’m giving her this medicine but for past 3days she is not sleeping in nights in day just2hours of sleep I’m worried could u please tell me how can I adjust the dose or stop L-carnosine I’m confused please help me sir even lot of new symptoms like she never did flapping and closing her ears and much irritated for small small things , thank u

    • Patrick Nemechek, D.O. 1 year ago

      Try stopping the l-carnosine. If the sleep improves, notify your physician.

    • Kirthi 1 year ago

      Thank u so much sir, I stopped l-carnosine and her sleeping pattern is normal now and I haven’t stop Nemecheck protocol and she is showing improvements I’m so happy

    • Patrick Nemechek, D.O. 1 year ago

      Great to hear. Thanks for the feedback.

  37. Marianne Keith 1 year ago

    Do you ever recommend Rifaximin for children under the age of 10?

    Our son is 6. On Protocol for a year – huge overall gains. Constipation still an issue. We’ve noticed over the past month that he’s more anxious (daily) and down than usual. He also seems to be back in his own world after many months of alertness and more interest in his little sister and some peers.
    Prior to switching from gummies to powder inulin, he was on a WAY high dosage (4 gummies) bc he had been taking them for a long time before beginning Protocol for constipation. When we switched to powder, we saw another awakening so then stuck with this dose of 1/4tsp. (also 2 NOW DHA capsules & 10mL approved EVOO)

    • Patrick Nemechek, D.O. 1 year ago

      Occasionally the inulin seems to quit working.

      The child will have several months of continued improvement and then lapse for weeks or months back to no eye contact and no further gains.

      Yes I use Rifaximin in kids younger that 10

  38. LESKITA 1 year ago

    Hello Doctor Nemechek, my 24 month old son is in protocol 5 months ago with many advances Inulina Now 1/8 + 1/16, when he had 4 months of protocol started with liquid diarrheas 2 or 3 frequencies and a lot of mucus, we suspend fish oil As recommended in his book and we went to the gastroenterologist indicating for my child stool culture and the result has been negative, but my son does not improve, continues with diarrhea with mocus and all his earnings with his protocol are going, I have read his book and suggests stopping inulin for 1 week when there is mucus in the stool, but in case of diarrhea and mucus do not know what to do doctor, I can assure you that my son is NOT in any supplement, probiotic or digestive enzymes in their food. Please advise me we need your help. Thank you. God bless you and your family

    • Patrick Nemechek, D.O. 1 year ago

      Since the source is not obvious, I would try stopping everything just to see if the diarrhea stops and then add them back one-by-one to find out which might be bothering your child.

  39. Gaur 1 year ago

    Hello Dr N, thank you so much for the protocol. My son just turned 7 yesterday, he has ASD , adhd we started the modified protocol in January with 1 now DHA cap and 1/2 tbs of evoo he was also taking guanfacine and within a months we saw major gains he was non verbal and he started talking so we stopped his guanfacine.
    he behavior was worse after a month he started hitting his head he was hyperactive and became aggressive and was not focusing at all like he became a difficult kid. We did not start the inulin yet. So after reading on Face book the Now dha could be overstimulating for some kids so we changed that to NN.
    So now he is getting 2 NN Fish oil and 1 tbs evoo and 1/4 inulin started last week. We are not seeing any gains in him from last few months .

    Pls suggest do I need to adjust his dose? Thank you so much

    • Patrick Nemechek, D.O. 1 year ago

      You need to start either inulin or treat with rifaximin if you are afraid to use inulin.

  40. Carra 1 year ago

    I have been reading about higher polyphenol evoo’s and that they have more medicinal qualities than the one recommended for the protocol. However, with such a huge market I understand that it would be impossible to screen every single evoo and approve them for the protocol. I know that in your video you stated that for people unable to access the COOC they would need to do their own research as to what is the best choice in the region where they are from and even encourage them to press their own.. Would pressing their own evoo’s be of a higher quality than using the gold standard for their region and any COOC approved evoo and how can we ensure its quality? With your knowledge of evoo’s would you say that there is more of a benefit using one with higher polyphenols rather than COOC approved ones and what is the basis for your evidence?

    • Patrick Nemechek, D.O. 1 year ago

      Please re-read the EVOO post.

  41. Afsheen 1 year ago

    Hello thank you so much for wonderful protocol my son is 3 year and 6 month old on the protocol since November 2018. Inulin 1/4+1/8 teaspoons now brand.
    Evoo coco cooking with it . And ultimate omega NN 1/4 teaspoons. He is making good gain. He is not talking but his vocabulary is amazing. He look little hyper some time and still not listening to his name he is also grinding his teeth is been more then one month. He also eating things from the floor. Plz give me some suggestions.

    • Patrick Nemechek, D.O. 1 year ago

      You’re on a good path, just don’t change anything.

      Give him more time to fully recover.

    • Afsheen 1 year ago

      Ok thank you so much your words are everything for us….. we will keep everything same

  42. Robert 1 year ago

    Hi Dr. N., have you seen older children (12 and over ) recover with inulin? Or would you automatically go right to Rifaximin and not experiment with inulin?

    • Patrick Nemechek, D.O. 1 year ago

      Occasionally but I generally start with rifaximin at this age if it is available.

  43. Rozanne Van Jaarsveld 1 year ago

    Hi, we’ve been following the protocol for 2 months and I’ve recently moved my daughters onto lactose free milk (cows milk with lactase enzyme added into it). Is this allowed? Will the enzyme affect the protocol? Stools have improved but stimming has increased and eczema for the other daughter but both have also had a slight cold so it’s hard to tell. My main worry or question is will the enzyme lactase that’s in the lactose free milk affect the protocol. Thank you and thank you so much for this incredible protocol!

    • Patrick Nemechek, D.O. 1 year ago

      Lactose-free milk is allowed.

    • Rozanne Van Jaarsveld 1 year ago

      Thank you that’s great!

  44. Heather 1 year ago

    Hello!
    Our doctor, who is not wholly familiar with your protocol, was kind enough to give my 18-year-old a 10-day prescription for Rifaximin. Should the rest of the protocol be implemented while taking the Rifaximin or afterwards?
    Thanks a lot!

    • Patrick Nemechek, D.O. 1 year ago

      You can start them together or one-by-one. Shouldn’t make any difference..

    • Heather 1 year ago

      Hello again, Dr. Nemechek. I’m so disappointed to report that our insurance won’t cover the Rifaximin, and it costs way too much for us to pay cash. By any chance is there a somewhat comparable alternative for us to use with my 18-year old son? Thank you for your time…

    • Patrick Nemechek, D.O. 1 year ago

      I do not recommend using any other antibiotic.

  45. Jenn J Remick 1 year ago

    Hi Dr. N – Do you ever use (or recommend) cranial osteopathic manipulation on your (younger) patients to help correct vagus nerve damage or do you mostly just recommend the tVNS treatment? Thanks so much.

    • Patrick Nemechek, D.O. 1 year ago

      I just recommend tVNS since the treatment is required daily to get a sustained, maximal response

  46. Martha 1 year ago

    Hi Dr. Nemechek,
    We ‘ve been following strictly your protocol for 17 months now…. but my son (9 years) continues to have hives every time we try to reduce XOZAL. There are no allergies, food intolerances, nothing that can explain this..
    All I know for a fact, is that he has MTHFR mutation and that he has high levels of heavy metals (especially lead = 38 μg/g / Method: ICP-MS / Provocative agent: CAEDTA). I know what is your opinion about heavy metals, but what if in his case, there is some need for heavy metal detox i.e. zeolite? In his case lead exceeds three times the upper expected limit per the reference population.
    P.S. We ‘ve seen some progress since we gave him Rifaxamin six months ago, but still we fail to see the progress we should be having after so much time in the protocol.I’m really at loss here. What should I do?

    • Patrick Nemechek, D.O. 1 year ago

      Just leave him on the Xozal

  47. Nat 1 year ago

    Dr Nemechek. Hope you are having a lovely day. I just wanted to ask. You said that there might not be a chance of recovery for a child who has been autistic from birth. So can this protocol help them at least have a better chance at independence and speech. Have you witnessed it?

    • Patrick Nemechek, D.O. 1 year ago

      Yes, the protocol can help them a great deal.

  48. Holly 1 year ago

    Hi Dr Nemecheck,
    I am going to be starting my 8 year old daughter on the protocol in a couple of weeks. Is it okay for her to be on the protocol while also taking risperidone & laxido??

    Many Thanks

    • Patrick Nemechek, D.O. 1 year ago

      Yes, the protocol is compatible with these medications.

  49. Ambika Pant 1 year ago

    Dear Dr Nemecheck, if my child (17 year, non verbal, on full protocol for 13 months) has firm stools but 3-4 times a day, would that indicate that SIBo is resolved? He has never suffered from constipation. We have done 3 rounds of rifaximin over the last year. I am wondering if constipation is an essential part in the progress of recovery? Thanks!

    • Patrick Nemechek, D.O. 1 year ago

      If the child is improving in many respects, then the gut is adequately balance and you do not need to worry about SIBO.

      The constipation will ultimately take care of itself.

  50. Vinay 1 year ago

    Hi doctor,
    My daughter is 4.3 years old and non verbal.. we are on gluten free and ceasin free diet since one year and going for speech therapy. But she still doesn’t talk . She has speech and she will keep on singing ryhmes. We are very much worried about her. Reading your book we got a hope that she will get normal.. but confused with the dosage. Please tell us the dosages of fish oil, inulin and olive oil. How to use olive oil.. if there are some deep fry items which oil to use..
    thank u
    Vinay

    • Patrick Nemechek, D.O. 1 year ago

      Follow my dosage recommendations in the book.

      Do not follow other advice on the internet.

  51. Liza 1 year ago

    Hi Dr Nemechek,
    We have started the Nemechek Protocol today with our 8,5 yr old daughter, who has ASD, ADD, mild learning difficulties and epilepsy. She has been diagnosed with epilepsy in Sept 2018 and since then she is on medication (Keppra solution 2×5 ml/day). She hasn’t had any seizures luckily since 09/18. My question is that is it safe to introduce all 3 elements of the protocol as I have noticed that a few people experienced issues with their seizures as they may have increased.
    I have started with less than 1/8 tsp inulin powder and was planning to slowly increase this amount to 1/2 tsp over a month.
    Thank you in advance if you can share any information on this. We are very excited to see some progress in our darling daughter.
    Kind regards,
    Liza from London

    • Patrick Nemechek, D.O. 1 year ago

      Most people with epilepsy who start the protocol have a reduction in seizures

  52. Vinay 1 year ago

    Hi Doctor,

    My daughter is 4.3 years of age and non verbal. We are planning to start NP. We are already following gluten free and Caesin free diet and speech therapy . But there is no change. Reading your book we got a hope that she will get normal but confused with the dosage. Kindly advise us with dosage of Inulin, fish oil and olive oil

    Thanks in advance

    Regards,
    Vinay

    • Patrick Nemechek, D.O. 1 year ago

      The dosages I use in my patients are outlined in the book.

  53. Parent 1 year ago

    Hi,

    I see in your blog you talk about plastic bottles being an issue. In your Facebook group they are promoting a company that stores their olive oil in plastic bottles and also sells some of the larger oils in plastic containers. What are your thoughts on this?

    • Patrick Nemechek, D.O. 1 year ago

      Its not my Facebook group.

  54. Vijay 1 year ago

    Good Morning Dr N,

    Hope you are doing well 🙂

    We are planning to start the NP for my son who is 4 years old. I have couple of question to clarify

    What is the key difference between FOS and Inulin?

    I heard that FOS doesn’t feed bad bacteria. Is it true?

    If yes, then can we use FOS powder instead of inulin as part of protocol?

    Appreciate your valuable suggestion and earliest response

    Regards
    Vijay

    • Patrick Nemechek, D.O. 1 year ago

      The isn’t much difference other than we do not know if a general brand of FOS will do the same thing as approved brands on inulin.

      Don’t over think the protocol. Just follow it with fiddling up and down with the doses and you’ll have a good chance of success.

  55. David McCrea 1 year ago

    I tried the protocol last year with my autistic son and had good progress. After 4 months it all went pear shaped. Early wakening, defiance, extreme meltdowns etc. We tried reducing inulin, upping inulin, doing oils only but it didn’t improve so stopped. Most of the gains were lost. Fast forward a year we started again and again saw some good improvements with speech, awareness, anxiety improved. However the really bad behaviours have kicked in again after 3-4 months…defiance, irritability, OCD, controlling beyond belief. What should we do? He takes fish oil, cook with EVOO and 1/8tsp inulin

    • Patrick Nemechek, D.O. 1 year ago

      Sounds like inulin failure. It seems to quit working after a few months.

      I’ll often stop the inulin for good and use rifaximin.

    • David McCrea 1 year ago

      Thanks for replying. We cannot get rifaximin in UK

  56. Tai 1 year ago

    Good morning Dr N. First of all I just wanted to say thank you for giving us some hope when everything was bleak. I just started my beautiful boy on NP. My question is will NP help a child who might have been autistic since birth. Will they be able to recover from your protocol even though theu did not develop some milestones and lose them.

    • Patrick Nemechek, D.O. 1 year ago

      Yes it can

  57. Aseretro 1 year ago

    Dear Dr N,
    My son 3.7 years old, diagnosis mild ASD, has been in your protocol since Sep 2018. We have seen awesome gains really fast in almost all aspects. His awareness has improved greatly, he is starting to speak. BUT he is still hyper, stimming alot, running back and forth, jumping all the time and covering his ears. He has been on vacation from school for about a month and since then he is more hyper, less focused, aggressive, impatient and does not follows direction or commands at his therapies (NOT AT HOME though ). He has been on the same dosage for more than 5 months. At the moment he is on 2tsp Now Inulin, 2ml Ultimate Omega, 1tbs EVOO. Should I decrease Inulin or what should I do?? I have so much faith in this protocol. Please help!!

    • Patrick Nemechek, D.O. 1 year ago

      I rarely ever need more than 1/2 tsp of inulin

  58. Smita 1 year ago

    hello sir,

    Its been 3 months now I have started the protocol for my 5 years old boy. I am on 1/8th Inulin,2.5 ml of Olive oil and 2.5ml of ultimate omega Fish oil .Earlier his bowel movement were really good on regular basis , from past few weeks I am seeing my son had constipated,his bowel movement is not regular, its every alternate days.
    Would you be able to let me know what changes needs to be done. I am giving inuline and fish oil at night before going to bed because during day time he used to be in school.
    I used to feed him raw olive oil 2.5 ml also because in India cooking in olive oil is bit expensive for me but instead for cooking I am avoiding all the oil which you mentioned in the book and cooking food in mustard oil.

    Please help ,what needs to be done.

    Thanks and Regards,
    Smita
    Hyderabad,India

    • Patrick Nemechek, D.O. 1 year ago

      The development of constipation means the loose stool that is associated with bacterial overgrowth has resolved.

      The constipation is an autonomic issue and will resolve on its own. It does not need to be treated with magnesium is there is no discomfort, etc.

  59. Mary 1 year ago

    Hi doctor my 8 year old son has been on the protocol 3 months. We are up to half teaspoon inulin. But I haven’t gotten the full 15ml of olive oil in him because he is gagging. He has been getting less than 10 months per day. I haven’t seen any big improvement. Do you think it’s because it’s not enough olive oil? I’m going to try harder and maybe the rest in the afternoon but I forget with his busy we are….. Another thing is that I took him off gluten free diet and we have been eating fast food more. Do I have to take him off all other oils? Please help! I want this to work so bad!

    • Patrick Nemechek, D.O. 1 year ago

      He’s getting enough olive oil. You can also add it to food and cook with it.

  60. Kim 1 year ago

    Dear Dr N,
    Our 11yr old son has high functioning ASD & ADHD. We started on 1/8 tsp Inulin x 2 daily and built up over 2 wks to 1/2 tsp Inulin x 2 daily, along side 4 tablets NOW DHA and 1 tbsp EVOO. The first 2 wks he was very hyper, unsettled and hard work. We needed to give him an antihistimine every bedtime and sometimes in the morn.
    From Wk 4 we continued to up the Inulin to a max. of 1tsp x 2 daily.
    At Wk 5 his teachers spoke to us about ‘really lovely days’ & ‘indepth conversations’. He was being thoughtful, alot calmer and sleeping better. He asked (quite unbelievably) to use his birthday money to buy a keyboard as he wanted to learn an instrument?!! He has never had any major interests beyond playstation/ipad.
    Sods law…in the next 3 days he suffered 2 head injuries, including a major fall on his head from play equipment.
    He relapsed (he was hyper, less focused, rude and impatient). At Week 8, I dropped the Inulin back to 1/2 tsp x 2 daily as, on reflection, I could see the wk 5 gains were a result of the smaller dose. I also reduced the NOW DHA: 2 tablets AM and 1 at PM. EVOO stayed at 1tbsp daily.
    Wk 12 & he is showing ‘hair growing’ improvements, greater maturity overall, but is not as calm, easy going and thoughtful as wk 5 – but to be fair there is lots of ‘off timetable’ activities with only 3 weeks of primary school left and he has a cold. We are also experiencing less histamine issues, despite having a much higher pollen count now, than 3 mths ago.

    Late July brings us 6 weeks of summer holidays and he starts High School at the start of Sept. We have appts to see you in April 2020.

    Should we continue with 1/2tsp x 2 daily Inulin in belief that the “hair will continue to grow” and “Better is the enemy of good enough….” until such time things become noticeably worse for no other apparent reason e.g. such as an increase in demand on him when he starts High School? Or, should we bite the bullet and give him Rifaximin (which we only now have to hand)?

    Thank you ever so much for your truly amazing work.

    • Patrick Nemechek, D.O. 1 year ago

      You need to re-read the protocol because your inulin dosage is too high.

  61. Bridget 1 year ago

    Hello Dr Nemechek, My son is 35 months old and he showed lots of autism traits , he has global developmental delay diagnoses. We started the protocol 7 weeks ago. On the first two things he started to lose traits but new things like covering his ears came up. Then he almost lost all of his traits, like side viewing, covering his ears. All of the sudden he started to finger point to the objects he wants to reach, and tries to self feed himself which is a new thing him to do. there is more copying than before.
    He slightly improved with listening and follows orders however his attention slightly improved. When we talk to him he looks up but does not focus on people when we say something or when someone on the road say hi there is no respond from him at all.
    Some days it looks like he socilizes with kids then next day there is no connection to anyone.
    When we sing he loves that, and I try to follow his leads but he still loves to play on his own and being alone.
    At the moment he gets 1/4 inulin, cooking with EVOO and 1ml fish oil (Superhero) Do you think I should increase?s

    • Patrick Nemechek, D.O. 1 year ago

      Why increase when things are going so well. Follow my instructions in the book, not what someone else might say on the internet.

  62. Ally 1 year ago

    Dear Dr Nemecheck, thank you for your book, research and this discussion page!
    I increased my asd son’s inulin to a 1/4tsp and he is making eye contact (overjoyed, thank you!) but he has become tired and fatigued, zones out when sitting and often leans forward. I read in your book about hypoperfusion and also searched this comments section on this topic and read that the inulin could also lower brain BP sometimes in some kids (it seems my son is one of them).

    My questions are, should I decrease the inulin and risk the bacterial overgrowth getting worse again (and losing eye contact) or do I just give it some time? Does this (presumably, mild) cerebral hypoperfusion cause lasting brain damage? (I am trying to ascertain which does more harm to him, the awful propionic acid or the mild hypoperfusion?)

    I cannot thank you enough for helping Dr!
    Ps. We have a consult booked with you next year, we are from Cape Town, South Africa

    • Patrick Nemechek, D.O. 1 year ago

      In your case I think the low brain BP is from CBI and not inulin. Wait and give him more time to recover.

      Increasing salt and water intake can boost his pressure during these moments.

  63. Lim 1 year ago

    Dear Dr. Nemechek , I have a 6 years old daughter with developmental delays, anxiety, social and emotional delays and probably ASD. She is verbal and pretty high functioning. I read your book very thoroughly and started her on protocol about 3 weeks ago: 600 mg omega 3 NN, 2 gummies of Inulin and 5ml of EVOO. Her weight is around 38 pounds. It looks like most people use inulin powder and not gummies. Does it matter? How do I know if I need to adjust/increase the dose? She seems to be tolerating all the doses well right now. I am just not sure if it’s effective as it is. Can’t really tell if there is an awakening going on yet. Thank you so much in advance!

    • Patrick Nemechek, D.O. 1 year ago

      If she does well with the gummies, stick with the gummies.

      Follow my instructions and stay with what works for her.

  64. Caroline 1 year ago

    Hello, I have an appointment scheduled with you for January next year, for my 9 year old ADHD daughter. She started the protocol 18 months ago, when she was 7 (all approved components, at suggested doses, and no additional supplements), and we still have seen no real gains. I am tempted to take her to a MAPS doctor before our appointment to start her on Rifaximin, but now am wondering whether we should wait to see you first and instead try VNS first. I’d love to hear your thoughts. (Note that we adopted her, and her birth mother used methamphetamines, which we believe, along with a genetic predisposition, may have been responsible for her ADHD.) Thanks so much.

    • Patrick Nemechek, D.O. 1 year ago

      At that age, if there is no improvement, she has inulin failure. In my practice I would treat her with rifaximin.

    • Caroline 1 year ago

      Thank you, doctor. We started the protocol when she was seven, though. Do some patients that young succeed with Rifaximin when they haven’t with inulin? My worry is that the inulin failure in a 7 year old suggests that SIBO may not be causing her issues. Or do you see children that young who have no gains with inulin but then improve on Rifaximin? Also, willt VNS help her if SIBO isn’t the issue (or if Rifaximin doesn’t lead to gains?)

  65. Casey 1 year ago

    Are there peer reviewed documents you can provide that explain the negative effects of probiotics? Thank you!

    • Patrick Nemechek, D.O. 1 year ago

      Yes there are. As a caution, most of the probiotic research is of very low caliber.

      I posted a study showing the damaged caused b y probiotics when prescribed along with antibiotics – its on my autism FB page.

  66. Terry Skehan 1 year ago

    Hi Dr N! Thank you for what you do! We have an in office apt with you for my 6 yr old Asd Level 3 son in August but in the meantime I have an opportunity to see the top doctor involved in brain balancing and integration of primitive reflexes. This would become our major component of step 5 of your protocol. It’s very expensive. Do you believe in the idea of retained primitive reflexes and integrating them as a modality for treatment?

    • Patrick Nemechek, D.O. 1 year ago

      We don’t need these modalities to get kids to recover.

  67. Colleen 1 year ago

    Hi Dr. Nemechek, my son has PANDAS and we have been doing the Protocol since February. He is currently taking 1 tbsp. EVOO, 3 capsules NOW DHA-500, and 1/2 tsp. inulin. Last week I increased inulin to 1 tsp. and he flipped out with rages and unsafe behavior, so we went down to 3/4. He was still doing poorly, so we’re back at 1/2.

    He is still having PANDAS symptoms (brain fog, slurring, age regression) and it’s only been a week so I know I have to be patient to see how he is doing at this dose. But given his age (12), at what point does he take Rifaximin instead? If he is having reactions to inulin (albeit bad), does that mean it’s working and we just have to find the correct dose? Or does he just ditch the inulin and go right into Rifaximin?

    • Patrick Nemechek, D.O. 1 year ago

      Sometimes inulin just doesn’t work at this age.

  68. Rachael Havern 1 year ago

    I have just bought the book the inulin powder and the omega three but how do I give my child evoo ? Through cooking with food? And should diet be changed completely in terms of him living pancakes and cereals thanks Rachel

    • Patrick Nemechek, D.O. 1 year ago

      Yes, it can be added to food, mixed in smoothies or just dosed straight away

  69. Edwin Krisnadi 1 year ago

    Dr Nemecheck, My son is 5 years old non verbal – severely autistic. We have started the NP almost 3 weeks now.
    1/8 tspn inulin, 2 ml fish oil and 1/2 tbspn evoo.
    So far we have not seen any gains, but I am very hesitant to increase the inulin since my son seems very fatigue for the last few days. Is this something to worry about? Do I need to increase the inulin dose to 1/4 tspn?
    THANK YOU!

    • Patrick Nemechek, D.O. 1 year ago

      Just wait a little long before changing things. The brain recovers slowly.

  70. Jim 1 year ago

    Have had great success following your protocol over the past 9 months. Over past 2 weeks my child has developed constant burping, severe nausea, grey appearance & has fainted twice. No improvement as yet & now not able to attend school due to weakness. Would you advise to stop/adjust the protocol or keep pushing through? Thank you.

    • Patrick Nemechek, D.O. 1 year ago

      Continuing the protocol will not hurt but she should see your pediatrician because of the passing out

  71. HoneyBon 1 year ago

    Hi Doctor,
    Recently bought a new bottle of NOW brand Inulin powder. On the front side label it is specified as “PREBIOTIC INTESTINAL SUPPORT ” ( from Blue Agave) where as on the back side label ( at the top) it is specified as “PROBIOTICS / ENZYMES /DIGESTIVE “. Can I use this Inulin powder?? Please clarify doctor

    • Patrick Nemechek, D.O. 1 year ago

      If it doesn’t have anything new added to it then yes. Call the manufacturer if you have any concerns about the product you received.

  72. Esmeralda Galvan 1 year ago

    Hi Dr. Nemechek,
    My 5 y/o son has ASD/ADHD, was born with imperforate anus (corrected 2/2017) TOF (corrected 11/2015), PRS jaw distraction 3/2014.. he has a GTUBE and only drinks elecare Jr through sippy cup but gets supplemental feeds through feeding tube for lacking calories. He has been in and out of the hospital on and off anitbiotics and chronically constipated his entire young life. He had speech of around 20 words at 18 mths before his open heart surgery at 22 mths old and he is now nonverbal but we have taught him sign language. He takes lactulose 10mL BID and loratadine daily. I tried the inulin 1/2 tsp daily, 600 EPA and DHA mg fish oil for two weeks and he became severely constipated. Due to history of chronic constipation, do I need to raise the dose of the inulin or is this something I should stop trying for him? would a treatment of rifaximin be more appropriate for him? I want to give our son the best and am willing to travel to have you evaluate if necessary. Thank you in advance for your response.

    • Patrick Nemechek, D.O. 1 year ago

      With all that is going on I recommend to things.

      Start all the supplements at the low end of the dosage recommendations and inform you managing physicians of you intention just so they can be aware of any changes (good or bad) they may see in your son.

  73. Nicole 1 year ago

    Dr N, my son is about to start the ketogenic diet for seizures. He has had small gains on NP but no help with seizures over the last 6 months. One of the admins on the FB group posted today that Keto and NP are not compatible. Is this so, it’s the first time I have read this?

    • Patrick Nemechek, D.O. 1 year ago

      The Nemechek Protocol and ketogenic diet are absolutely compatible.

      A note to everyone. When you are talking to a moderator on Facebook or any other forum that might use my name in their title, we are not affiliated with them in any way. We do not train or necessarily support their opinions. They in no way, shape or form are an official extension of my medical practice or any business entity I may be affiliated with.

  74. San Zaf 1 year ago

    Hello Dr. N.
    Thank you so much for this protocol. My son is 4 yr 3 month old, asd .We are on protocol since Nov 2018. He has shown great improvement with great eye contact, responding to us, starting to get social. He was on 1+ 1/2 tspn inulin , 7ml fish oil( he was on 5ml for a year before we started np, so he showed gains at 7ml) and two teaspoon evoo. However last month he fell ill and developed tics, food aversion and we were given PANDAS diagnosis. When he received amoxicillin and brufen for this, he changed overnight. He got potty trained, starting asking for things with one word, acknowledging things like moon and showing to us etc. once we finished course I have been on steady doses, but the previous symptoms are slowly creeping back like jumping and shouting aggressively. Do you think the antibiotics treated a little bit of SIBO and now its growing back. Please i am very desperate, do you think I should go up on his inulin by 1/4 tspn to get better control of SIBo?

    Please do reply.

    • Patrick Nemechek, D.O. 1 year ago

      Yes, the amoxicillin treated some SIBO (I do not believe PANDAS exists) and that’s why they seem to improve.

      Sounds like the inulin has quit working. In these cases, I treat children with rifaximin.

  75. Covie 1 year ago

    Dear Dr Nemecheck, thank you so much for your book and kind assistance!
    Could too much inulin cause a propionic acid relapse?
    If so, should I just reduce the dose?
    Thank you kindly Dr

    • Patrick Nemechek, D.O. 1 year ago

      No. Too much inulin seems to sometime drop cerebral (brain) blood pressure and leads to anxiety, increased thirst or hunger and hyperactivity.

  76. jalaja 1 year ago

    Hello Dr. we are from India. My daughter who is 3 yrs has the inverted circadian rhythm (smith magnesis syndrome) We are giving her Melatonin at night and she sleeps from 9 to 5, However she still feels sleepy during the day. The only other option is giving the beta blocker to stop release of Melatonin in the morning. We dont want to consider the beta blocker yet due to all the side effects. She had global development delays… however is beginning to thrive as a wonderful little person.
    We have started the protocol 2 month back… (she still is not able to tolerate the fish oil, so we have cut it back to few drops) Would the protocol help in setting right her circadian cycle. .. Thanks so much!

    • Patrick Nemechek, D.O. 1 year ago

      The protocol lowers inflammation and allows the brain to prune synapses and repair neurons as it should.

      If her circadian issues are due to something along these lines then Yes I think it should help her.

    • jalaja 1 year ago

      Thank you so much for your reply! She has a deletion in the 17.2.p chromosome… the gene area includes the RAI1 gene… which regulates sleep. It is a genetic issue… i was hoping it could help.

  77. lesya 1 year ago

    Dear Doctor, thank you very much for this protocol. My son 3 years and 7 months old with speech delay and motor tics. we started protocol this April. His speech improved dramatically and tics were almost gone until today. His tics for some unknown reason came back today and also his anxiety is up. Please help.
    He is using 1/16 of inulin, 5ml of California EVOO and 1ml of NN omega 3. Please help!!!Thank you very much and waiting for your response.

    • Patrick Nemechek, D.O. 1 year ago

      Don’t chase symptoms from day to day. Symptoms are going to wax and wane often without any obvious reason why.

      As long as things are improving, any little regression will resolve itself.

      A big mistake many people do is to change an effective dosing regimen just because of a new symptoms.

      Sit tight and wait out these little moments and you’ll do fine.

    • lesya 1 year ago

      Thank you very much!!!

  78. Sue 1 year ago

    Hi Dr, thank you so much for this protocol. My granddaughter age 3.10.has made so many gains with eye contact, interaction with others, understanding and some speech and best of all constantly happy. However, she has been in a irratible mood for last few weeks, whinging,punching herself, banging head on floor. No illness. She is on 1/2 teaspoon of Now inulin, 10 to 15ml of californian evoo, 3 ml of NN omega 3. It’s really upsetting as she was making so much progress. Thank you awaiting your valued opinion.

    • Patrick Nemechek, D.O. 1 year ago

      If she has been on fixed doses of NP, look for another cause. If the inulin was recently increased or another supplement added, re-assess these.

    • Sue 1 year ago

      Thank you for your quick reply dr. We took your advice and cut back on inulin. It seems to be working. We are 10 months into the protocol making slow steady progress. Can’t thank you enough for helping so many children .

  79. Leona 1 year ago

    Hi dr nemecheck, my daughter 4 years old this month, diagnosis asd, has been on your protocol since October 2018 we have seen great gains, slow but steady, she is on 1 tsp inulin split morning/night 2ml nn ultimate omega split morning/night food cooked in evoo and 3ml drizzled over food daily
    Her awareness has improved greatly, she’s is starting to speak, she is calmer than she was but is still extremely hyper, stimming a lot, vocally, visually and running back and forth, flapping, should I just be patient or do you think I should tweak anything? She did relapse so I’ve just been holding ground on doses so she could recover, we’re in the process of booking a in person visit with you, we are coming from Ireland, but as your so busy this is some time away
    Thank you for your time, your protocol and hope
    Leona

    • Patrick Nemechek, D.O. 1 year ago

      If the hyperactivity and stimming worsened with the increase in inulin, I suggest trimming back the dose. Otherwise, you’ll need to wait it out for her to recover.

  80. Olivia 1 year ago

    Hello doctor
    What does your protocol help children with intellectual disabilities? It seems that this is difficult to remove! !!thank you

    • Patrick Nemechek, D.O. 1 year ago

      Intellectual disabilities can improve a great deal as well.

  81. Priya 1 year ago

    Hi Dr Nemechek, my 4.5 year ASD nonverbal son is doing good on your protocol. He is getting 1/8 tsp Inulin from 5 months. I tried 1/4 tsp Inulin for 4-5 weeks in between then I found he was doing more good on 1/8 tsp Inulin. He gets more stimmy on 1/4 tsp. Is it possible to get recovery on 1/8 tsp Inulin only. We are seeing gains in all area like receptive language gains, motor skills, more aware, learning more etc just his stimming and no single word yet.

    He gets 2 Now DHA and 15 ml olive.

    • Patrick Nemechek, D.O. 1 year ago

      Yes, its possible to recover on 1/8 t of inulin daily.

  82. Samar 1 year ago

    Hi Doctor,
    We started the protocol per the book around 6 months ago for my 5 year old son.His Sleep and speech have improved a lot. Though the bloating still haunts him every now and then.

    Our major concern is that since 3 months he starated making humming sound (never before) and started to pull my hair. Even with multiple therapies we are not able to stop either humming or hitting behaviour.

    Please let us know, if should we stop the protocol for a while.

    Dosage: 5 ml NN Fish oil, 7.5 ml EVOO,1/2 tsp Inulin

    • Patrick Nemechek, D.O. 1 year ago

      Continue with the protocol and try lowering the inulin a little.

  83. Tamila 1 year ago

    hello doctor, please tell me after 4 months food allergy persists on the dose of inulin, is it possible for me to assume that inulin needs to be raised, since I did not solve the problem of 1/8 (boy of 3.8 years is autistic

    • Patrick Nemechek, D.O. 1 year ago

      Sometimes food allergies have nothing to do with gut bacteria and will not resolve with rebalancing of the gut.

  84. Ash 1 year ago

    Greetings dr. Nemechek , I read your book and it makes sense and I have started my 7 year old ASD when he was 6 yrs and 9 months 3 months ago. He had some awakening and sleepless nights but doing better on 1/4 tsp inuline which I ll increase now in summer vacation and see how he does . He gets aggressive on 1/2 tsp so after reading your comments had to decrease if for few days . He is showing some gains . Has few new words also. My question is is inluline safe to take in pregnancy as now I am pregnant 26 weeks now and I want my next baby to safe and not have any of the probelms. ? I am taking fish oil 583mg and hardly can tolerate that. Anything I can do maybe I should take some inuline but I am not sure if it’s safe to take ?

    • Patrick Nemechek, D.O. 1 year ago

      There are sevral studies showing inulin is safe to take during pregnancy. I recommend asking you obstetrician as well

    • Ash 1 year ago

      Thank you for replying dr. N . God bless you. Thanks for your research and writing the book for parents who are looking for hope.

  85. Suyash Chaturvedi 1 year ago

    Hello Doctor, my daughter, 3.3 years has been on protocol since Jan 2019. All approved brands and dosages recommend in the book. Her dosage are 1/4 + 1/6 Now Inulin, 3 ml NN Omega 3, all food cooked in domestic evvo plus 5 ml COOC evvo. We have seen amazing gains, mainly in receptive language, command following, bit of imitation, better sleep, better intake of different food etc. However her behaviour is becoming very aggressive, more specifically for last 3 weeks. She has been cranky all day, not following the way she was, hitting and biting in irritation. She had mild cold and was taking an antiallergic for 4 days. But the symptoms above have persisted even post phasing off. Would lowering down inulin help? Kindly suggest.

    • Patrick Nemechek, D.O. 1 year ago

      Symptoms are probably from the underlying infection. Get the cold resolved but keep her on the same doses and she’ll continue to recover out of this.

  86. Leann Cussary 1 year ago

    Hi Dr. Nemechek,

    My 16 month year old daughter has Juvenile Rheumatoid Arthritis (polyarticular). We’ve been doing your protocol for 2 weeks. I know every child/case is different, but at what point do you think we will see results?

    • Patrick Nemechek, D.O. 1 year ago

      You might see some improvement in her joint inflammation and pain.

  87. Paola 1 year ago

    Hello Doctor, my name is Paola, I’m from Argentina. We have a little boy of 7 years old, he has autism; we are in the protocol for 10 months with great results, thank you so much for the researching and pls, continue helping us.
    Since aprox 6/8 weeks the hiperactivity has been increasing and he has been less patient and the agresive has increased as well, last 10 days much Worse with autoagresive situations, mainly in the head. We are so worried, his pediatritian does not find any explanation, next tuesday we will have an appoinment with the neurologist, we need to know what is happening. We have cancel the daily ingesta of inuline, he is with the oils.
    Could you pls let me know if maybe it is relative to the protocol?
    Thanks in advance for your help and best regards!
    Paola

    • Patrick Nemechek, D.O. 1 year ago

      If this doesn’t decrease after decreasing the inulin it is not from the protocol.

    • PAOLA DE LA VEGA 1 year ago

      Hello Dr, we have had 10 days without inulin and for 4 days ago our child has been fantastic. This morning I´ve read about levesl of noradreanline, maybe all this situation was for the reduction of cerebral blood pressure? thanks in advance for your real help and best regardssss

  88. Anamika 1 year ago

    Hi Doctor, I’m glad that I found this protocol. It’s been giving me hope that my daughter will improve one day. But my journey so far was very bumpy. She’s 6 yo, moderate Autistic , and on NP for 15 months. She has improved in fine motors, eating variety, receptive communication but I don’t see much gains in cognitive skills and expressive communication, her defiance and anxiety were never resolved in-fact got even worse. I’m not able to figure out what to change and how to gain in these areas. Her present dose are- inulin 3/4 tsp, fish oil – NN ultimate omega, evoo – 7.5 ml and I avoid bad oils. Had really rough journey, messed up with inulin by raising it until 1 tsp , then since last 2-3 month reduced it to 3/4 tsp. Now she’s much calm but gains in communication, cognitive skills are not coming. Do you think sound and safe protocol can help. Please advise. Many thanks

    • Patrick Nemechek, D.O. 1 year ago

      At his point I think VNS is needed.

  89. A mother 1 year ago

    Hello nemechek,
    Thanks for your protocol.And it is a miracle to our life’s. We have started protocol for my 5 year boy in nov 2018. Immediately we saw awareness ,gains ,vocabulary has increased but zero development in social communication.Recently we went for stem cell therapy after that we are seeing lots of negatives like vocal stimming ,less attention ,less eye contact.is that a relapse? Or do i need to change his doses are 1/4tsp inulin 15 ml evoo and 5 ml NN fo. We have booked appointment with you in November and very happy to meet you soon.
    Thanks
    A mother

    • Patrick Nemechek, D.O. 1 year ago

      Don’t change doses. He’ll recover out of it.

      This is a negative effect from stem cells. This happens more than people think.

  90. Fan 1 year ago

    Hi Dr. Nemechek,
    Is DHPPA (Dihydroxyphenylpropionoc Acid) the propionic acid you are talking about in the book, as there are different abbreviations listed)?
    Thank you!

    • Patrick Nemechek, D.O. 1 year ago

      It is one form of propionic acid that can be released by the bacteria.

  91. Evelyn 1 year ago

    Hi Doctor ny child is 4. But apart from her developmental delays, she also cant see. Is it ok for her to be on the protocol and if it will help her vision as well? Thanks.

    • Patrick Nemechek, D.O. 1 year ago

      There are many reasons for blindness in a child but the protocol is very safe and might help in some way.

      A patient I care for regained hearing at the age of 33. She was deaf since birth.

    • Betty 1 year ago

      Dear Dr Nemechek

      It is amazing to read this. I’m 33 and deaf from birth too.
      I started with the oils and I am waiting for Rifaximin.

      Could you please share how long it took this patient to recover her hearing?
      I understand not everyone is the same and what happened to her might not happen to me, but like to know more.

      Sincerely
      Betty

    • Patrick Nemechek, D.O. 1 year ago

      6 months but I cannot tell you how precise or clear the hearing is.

  92. Emily Molenaer 1 year ago

    Dr. Nemechek. I started my Autistic, Down’s syndrome, 26 yr old, tube fed son on Xifaxin for 10 days because GI doc said he has SIBO. He has had GI and constipation, malabsorption, leaky gut issues his entire life. He has a double copy of MTHFR — will that hinder this protocol? While on the Xifaxin, I found your protocol. He is on his second week. I started him on Inulin for a few days and took it away because it made him anxious and edgy. The EVOO is fine– I add it to his organic tube feed formula. My problem is finding DHA in 3000 mg liquid version– he’s currently on Nordic Naturals 1000 mg DHA. Where can I get 3000 mg that can go into his tube feed? I will say that his stemming increased immediately– but I think that’s a good thing according to your comments in your book– until he balances out. Due to the constipation he’s been on Digestacure (aloe formula) and Magnesium Citrate and Vitamin C. He also takes Nutrivene D, which is a multivitamin for Down’s. I would appreciate your input– on the DHA and whether his current supplements will hinder this protocol.
    Thank you, Emily

    • Patrick Nemechek, D.O. 1 year ago

      If you are asking me this you clearly need to read the protocol.

    • Emily Molenaer 1 year ago

      I am halfway through your book and purchased the NN DHA through your website. I have since removed him from the Vitamin C but not the Digestacure, and with much trepidation, I removed the Nutrivene D—I was hesitant on this one because it’s made specifically for Down’s syndrome, and as you know, they produce too much SOD and they metabolize things differently —I guess what I’m asking, is have you had success with others who are Down’s and are on the bare bones protocol?

    • Patrick Nemechek, D.O. 1 year ago

      Yes we do.

    • Emily Molenaer 1 year ago

      Thank you

  93. Katya 1 year ago

    Dear Dr Nemechek,
    My son has been on the protocol for 2,5 months and nothing but good things to say.
    Current dosage:
    Age 7
    Inulin 1/16
    FO 4ml
    EVOO 7,5

    We saw the awakening pretty soon, we started inulin very low but saw the awakening along with first signs of improvement and brain “filling in the gaps” very soon.

    Reading stories and comments of fb, we did not have a rough, rude, aggressive or challenging awakening.. so the question is:
    Are we one of the lucky ones to have quiet awakening or did we not reach our sweet spot?
    General consensus on fb is that we should go up to at least 1/8 (we re relying on the book), but we re not certain, as we keep seeing gains almost daily. And when we tried to go up by as little as 1/64 there was increase in “bad” moments…

    Thank you!! And congratulations on the patent for the protocol for adults! It was great to hear!

    • Patrick Nemechek, D.O. 1 year ago

      If you saw an awakening, leave the inulin dosage where it is, give the proper dose of fish oil and olive oil and wait.

  94. Debjyoti Mitra 1 year ago

    Hi Dr. N. My 5 yr old daughter is unable to gulp the rifagut 550 tablet. Can I ground the tablet into powder and mix it with 30 ml Pepsi to and give it her to drink? I hope Pepsi won’t interfere with working of the medicine.

    • Patrick Nemechek, D.O. 1 year ago

      Crushing the rifaximin is fine.

  95. Tracy 1 year ago

    Hi Dr Nemechek. I have read your book numerous times and I would really appreciate some clarification around VNS. In the book you mention that, once recovery has started, VNS doesn’t speed up or enhance recovery. What would you usually look for as the obvious signs that recovery has started? Would it be an increase in speech (in a child with limited but some language) or something else?

    • Patrick Nemechek, D.O. 1 year ago

      There are many aspects that need recovery in the children – receptive/expressive communication, speech, socialization, emotional control, motor control, etc.

      If the gut has been rebalance you will see a broad degree in many of these areas and no further alteration in the inulin or dosing of rifaximin needs to be performed.

      VNS is additional required if after 6-12 months if there is no improvement what-so-ever in 1-2 developmental areas. If some areas seem to be improving slowly, you just need to wait because rate of improvement will not increase with VNS.

      VNS will only help those areas that are not improving in any way

  96. Bonnie Roberts 1 year ago

    Hi Dr. Nemecheck,
    Thank you so much for what you have given our children. My 10 yo son has been on the protocol since April 3rd, and has had an improvement in his severe reflux, chronic stomach pain, and developmental gains in socializing, communciation, less meltdowns. My question: he has been on allergy shots for almost 2 years that were started due to allergy induced respiratory & asthma issues that were frequent. His respiratory issues are so much better. What are your thoughts on allergy shots? Can they affect recovery? Thank you again so much!
    Bonnie

    • Patrick Nemechek, D.O. 1 year ago

      I would continue the shots if he seems to be recovering on the protocol.

  97. Sekhar 1 year ago

    Hello Sir,
    My son is 5 years old with ASD, we are going for therapies for ABA and OT, however he is not yet started speaking. Still have few behavioral problems like corner looking, addiction to color toys, laughing alone. Could you please help to suggest do we need to use any medication for him.

    • Patrick Nemechek, D.O. 1 year ago

      Try being more patient and giving him time to recover.

    • Sekhar 1 year ago

      Thank you very much for prompt response. We have just started namecheck protocol.

  98. Ramina 1 year ago

    Hello, doctor! First of all thank you for your book and examinations that help us to struggle against our problems. Using the protocol we saw that feces of our child became too light in colour and there is too much oil in it. I suppose that fish oil and evoo was not absorbed. Should we use the oil of krill for better absorbation?

    • Patrick Nemechek, D.O. 1 year ago

      No, I would suggest double checking the amount of oils being used and split it into 2 doses

  99. Elizabeth 1 year ago

    Hello Dr. N, I’ve been following the protocol faithfully for 16 months with my now 9 year old daughter with minimal gains. Recently I’ve been looking at Dr. Adams’ work in healing the microbiome, and see he’s successfully using GOS. Which made me wonder, considering the low biodiversity in many of our kids, whether in some people, the bacteria inulin feeds are not prevalent enough to force out SIBO, and it might be worth trying a different prebiotic which might feed the “birds” that actually are prevalent enough. With non-responders, do you think it might make sense to try adding GOS, or mixing both FOS and GOS? Or even testing the microbiome to see which prebiotic might be most likely to succeed?

    • Patrick Nemechek, D.O. 1 year ago

      I don’t think there is a substantial difference in FOS vs GOS to make a practical difference.

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