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Reversing Autism with The Nemechek Protocol – Update 2017

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

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

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

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

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

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

A TESTIMONIAL

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

March 23, 2017 –  An Addendum on Recovery

My Experience with Autism Recovery:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hope this helps.

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

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Dr. Nemechek
Dr. Nemechek

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

Thank you.

Charvi
Charvi

Is FMT allowed while on your protocol?

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

FMT is not part of the protocol and has not proven useful for ASD

Huda
Huda

Dear doctor,
My son12 years old non verbal diagnosed with severe autism and low functioning,he’s under speech, OT and ABA therapy. Non of them work for him. Now we want to follow your protocol and already bought and read your book, but he’s under two medications because of behavioral issues(Aripiprazole Oral Solution 1mg/mL , Oxcarbazepine Oral Suspension 300mg/5mL) plus vitamin D.. should we need to stop all these medications when we start the protocol, since we didn’t get any improvement?

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

You need to read the book.

I never mention discontinuing prescription medications in the book.

Huda
Huda

Thanks for your quick reply! I have another autistic child his age is 6, we got so much improvement last two years when he started ABA now he’s in regular class, he’s more aware his social skills are awesome, he makes friends, just very tiny tiny behavioral issues, we never started the protocol with him because we never heard about it before! My question is: is this mean he’s getting the recovery?? and can I start with him the protocol , he never got any regress for two years, do you think he will regress when we start the protocol… Read more »

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

I think the protocol will improve recovery of both children over the next 12 months with or without ABA.

Becoming high functioning by whatever method certainly makes a child’s life a richer and more fulfilling experience of all. But helping a child to become a full functioning adult is the true goal we should aspire to.

RAGHUVEERA
RAGHUVEERA

Doctor – You recommended to pushing the doses of approved-supplements up to the high end and stop any other herbal or homeopathic remedies to help with high stimming.

We will make sure to stop homeopathic remedies and start approved supplements. Can you please let us know what kind of approved supplements we need to use

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

Yes, use the high end of dosing regimen for the stated age if there are problems.

The approved brands are outlined in the protocol. You can get an inexpensive copy at https://autonomicrecovery.shop

Ivana Vidakovic
Ivana Vidakovic

Dear dr. N, I am 32, and I have autoimmune thrombocytopenia and Hashimoto’s. I have had both conditions for a while, but have realized it only when I got pregnant. DUe to my own autoimmunity, I tested for SIBO and came back positive (breath test), though I new it even before the test. I will start the protocol shortly. My question is regarding my baby, who is now 10 months old. She has atopic dermatitis, and I was wondering if my SIBO could have been passed to her, and caused (or at least contributed to) her eczema. Do have any… Read more »

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

I think reading the protocol will answer all your questions.

I also just posted a YouTube video about Protocol Babies this morning.

RAGHUVEERA
RAGHUVEERA

My son is on protocol from June 2018.
I have seen lot of improvements. Thanks for the amazing thought. One long pending behaviour is stimming. He always wants to take stick or spoon or leaves from tree to stim. Because of this he is not concentrating in any activity. Foxus is not improving.

Please suggest also he is nonverbal. I heard that this protocol helps in speech. He can immitate few sounda but can not start word by him self.

Two issues doctor, stimming and expressing. Please suggest

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

I recommend pushing the doses of approved-supplements up to the high end and stop any other herbal or homeopathic remedies. These can sometimes interfere with recovery.

If your child is anywhere around 10 or older then consider a course of rifaximin.

Melanie
Melanie

Dear Dr Nemechek,

We are on the full protocol for7months now, my son now 8, responded really well from the beginning. This protocol has been nothing short of life changing and Ill be forever in debt. He relapsed end Nov/early Dec. Just as he was coming out of that one, one of our cats bit him and he relapsed again, real bad, he sort of came out of that relapse but its like he is stuck and not moving forward. He is on 2tsp inulin and I wonder if its time to move over to rifaximin.

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

Melanie, I’m delighted to hear the protocol has been helpful.

You might just need some more time, or maybe rifaximin or maybe its time to add the vagus stimulator.

Anonymous
Anonymous

Hello dr can i start riffaximin directly for 12 year old non vebal boy

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

I always recommend starting with the inulin first at this age.

Iva
Iva

Hi! I guess New year is making me think. My son has been on your proticol for s year and a half. He is four, and although I saw some gains and he has become so much more aware. He is still completly Non verbal and understands the bascis. I have Made an appointment to come on summer to America to get vns. But I am starting to get afraid, why is this happening? He has never been a severe case? We started before his third Birthday. I guess I am just tired of waiting. So much so, I am… Read more »

Sue Chan
Sue Chan

Dear Dr N,

My son is 11 years old. He has histamine issues and can get terrible headaches when there is a histamine surge. I am only about 2 weeks into your protocol. Can I continue to work on increasing his Neuroprotek Low Phenol which contains quercetin and luteolin at the same time implementing your protocol?

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

I recommend not using other supplements during my protocol because many of them seem to prevent recovery.

Scott
Scott

I am a 48 year old male (ADHD, depression, anxiety, low processing speed, poor reading efficiency, excessive “tapping foot”, and more!) and will be starting the protocol in January. I see that an adult book is forthcoming, and I have been reading the current book that is focussed on autistic children, but I’m very interested in standard dosing for adults if I could get that info from somewhere. (I also have an autistic nephew.)

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

Use the dosing for adults with autism. This regimen is actually my starting regimen for adults without autism and was later adapted for autism.

Don’t wait for the adult book to start.

Additionally, although you will experience substantial improvements, full improve generally requires a VNS at your age.

Since we are already book for new patient appointments in July, you may want to consider making an appointment to come to AZ and be outfitted with a VNS.

Scott
Scott

I re-read sections of the book last night and realized that once I’ve got the SIBO under control, I can stop the inulin powder. I’m assuming that at my age I will need Rifaximin to start, but I’ve started with Inulin regardless, as I won’t be seeing my Dr until mid-January. My therapist recommended your book, and we did discuss VNS. She has a few adult patients that are on the protocol and have had some dramatic results. Very excited to get going on this! Also, recommending the NP to anyone and everyone I know that has kids that might… Read more »

Amanda
Amanda

My 4 year old son loves salmon which we’ve sourced from a reputable company. A 4oz (113g) serving has 1.3g (1300 mg) combined EPA and DHA omega-3. Can he eat this in place of the Omega 3 supplement? Also, because this is twice your recommended dose, is it OK he eat a piece every other day? Or would you simply recommend a smaller portion daily?

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

Unfortunately a recent USDA investigation revealed that 50% of wild salmon sold in the U.S. is fraudulent and is actually farm-raised.

Farm-raised salmon is fed grains and has little omega-3 in the meat.

Stick with supplemental fish oil from the approved brands.

Gaurav Sharma
Gaurav Sharma

Hi Doctor, My daughter details Age :4 years On Protocol : Since July 2018 Dosage :- Inulin ( 1tsp Now brand) , FO (1000 mg of DHA + EPA combined- Nordic Omega) , EVOO (20 ml raw orally since we cook in Ghee) I believe we had our first awakening in month of September that lasted for a month and after that all behaviors indicative of awakening subsided. Since past 2 weeks , we are seeing another set of behaviors like mouthing , clinginess with mother, collecting hairs fallen on bed etc. My question is could this be another awakening?… Read more »

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

If the inulin is high er enough there shouldn’t be multiple awakenings unless you are really seeing occasional relapses from intestinal problems such as viral infections, tainted food, etc.

You might try pushing the inulin up to a max of 2 tsp per day to see if this helps as well as double check no other supplements or probiotics are being introduced.

Anonymous
Anonymous

Dear dr.N my son is 9 months on protocal we increased inulin to 2 tspoons from 1.5 tspoon he started sneeezing in the middle of night sleep it never happened before he sneezes usually after he wakes up in bed like 3,4 times can inulin cause this sneezing in the night and he is saying alot of itching im applying moisturizer still no help is it histamine issue or salycites issue from oil

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

I would think increase the inulin from 1.5 to 2 tsp would trigger sneezing.

I’d look for some other cause like a new stuff animal or sheets he is allergic to.

Anonymous
Anonymous

Hi Dr Nemecheck, I started the protocol about 4 weeks ago for my 5 year old High Functioning autistic son. He is much more aware, inquisitive and definetely more defiant. He’s never been agressive, he is totally sweet little boy, he wet the bed once and seems to be waking up through the night,could this be his awakening? He still scripts cartoons and play repeatedly some of the things he gets obssessed about. Could I increase the inulin to see if that helps with repetitive behaviours? He is currently on 1tsp inulin, 5ml of Nordic Naturals Strawberry for children anf… Read more »

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

Yes, these behaviors are the awakening.

Give him time to recover from these behaviors before pushing the dose of inulin up further.

I would also not use the strawberry-flavored NN fish oil. We’ve had trouble with that in the past – i think some of the flavoring agents might impeded recovery

Kimberly
Kimberly

Is the lemon flavored fish oil problematic or just the strawberry?

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

We have suspicions the strawberry flavoring might interfere with recovery.

Jenny
Jenny

Our 3yr old had a battery of tests done that were ordered before I learned of the Nemechek protocol. One test revealed very high quinolinic acid(QUIN). If we assume the results are accurate… would you supplement with anything to reduce QUIN? We are new to the protocol so I’m not expecting major healing for a while. Our dr shared some of the scary implications of high QUIN and suggested L-theanine. I’m wondering if it would be wise to use the L-theanine now to try & prevent more damage while we wait for the oils to start healing the brain.

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

I would get a second opinion on the test results.

I’ve never found it necessary to measure quinolinic acid to get my pediatric patients to begin recovering.

Marian
Marian

Hi, Dr. Nemecheck! I started the protocol for my 5 year-old daughter who was diagnosed with ASD when she was 3 and 7 months old. We were on NP for over a month when her mantoux test came out and it showed she was positive for TB bacteria. We were advised to start medication but i opted to delay it since i read that it would be too much for her if i combine both. By the way i just read about NP last August and started last Nov. 11 since i had to order the ingredients from the US.… Read more »

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

I do not see the TB treatment and NP being incompatible.

It is ok to start both at the same time.

Anonymous
Anonymous

Thanks for your reply Doc. I’m happy that it’s no way of a disadvantage. But i’m anxious because a momma who also advocates NP mentioned that its no good to to administer both because of Rifamixin that’s part of the TB treatment. If i give both, it’ll be too much for her. Is it true?

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

Rifaximin is not part of the TB therapy, they are confusing it with another drug called rifampin.

Amina
Amina

Dear doctor Nemechek.i am seeing much angry behaviour at 5 month of protocol of my 6.9 year old .i am still at one teaspoon of inulin since 3 months . Can’t increase because of behaviour issues.when a little increase (spoon full often ) I saw much restless impulsive behaviour.i also noticing isolation,less eye contact ,more angry ,more pee accidents,old habits like playing wheels ,throwing things .since December many bad days less good hours , flu diarrhea before and now these behaviours .i gave no antibiotics but few other medicine anti allergy,paracetamol and brufen 4 days .flu and diarrhea got better… Read more »

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

Stay on inulin dosing that makes the child’s behavior more tolerable from him and you and either be more patient or try to come to Arizona for a vagus nerve stimulator.

Amina
Amina

Thanks for replying. I have saw gains in 5 months some in cognition,play more then before , using toys ,swings in good days ,naughty ness ,focus etc. Can I come for vagus stimulator if no gains in December I saw and increase of inulin make him more anxious.

Anonymous
Anonymous

Can I use Nordic cod liver oil with DHA greater than EPA for the protocol.

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

Yes but the DHA specific dosing is only necessary for adults. Using fish oil with a EPA>DHA ratio is fine for children.

Aishah
Aishah

Dear Dr. nemechek, My 7 year old who has been off protocol for a few months, due to increasing OCD (I realise it was a mistake to take him off protocol)….developed extreme verbal and facial stims soon after giving him: methylfolate, b complex and digestive enzymes. I now realise that digestive enzymes are a big NO NO…could this have spiralled his behaviour? his behaviour months later continues to be silly, goofy, laughing, inattentive and huge verbal+facial stims. Something bad is happening in his gut I feel. He was SO close to full recovery on your protocol before OCD, I got… Read more »

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

Just go back to the prior doses and brands that he was successful on.

Aishah
Aishah

Thank you Doctor, I will

Anonymous
Anonymous

I am pregnant with second child, and a little hesitant taking chicory root (inulin) while pregnant, due to reading contradicting things about it being safe… so my question is, would you recommend I take a probiotic? What can I do to ensure I have the best gut health?

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

In my opinion probiotics are completely unsafe in pregnancy while small amounts of inulin (a fiber found in onions and garlic) are not.

I recommend not taking anything unless you consult your OB/GYN

Alemayehu Tetemke
Alemayehu Tetemke

Dear Dr. Nemechek do you think Coffin-Siris syndrome can be treated with your protocol..my daughter is 18 months old

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

I am unaware of anyone attempting to use my protocol with Coffin-Siris syndrome.

At its core, my protocol is very safe and has the ability to lower systemic inflammation enough that it might help toggle off some of the genetic traits associated with this syndrome.

Anonymous
Anonymous

Hi Dr Nemecheck

Thank you for your reply. Is there any amount of inulin you would recommend to push up to before adding in the fish oil in a low dose? My son is 3.7 years old.

Also could you just clarify for me, is an overgrowth reaction to the fish oil different to a histamine reaction to the fish oil or are they the same thing?

Thank you once again. I hope u have a lovely Christmas and a Happy new year.

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

Push up to 1-2 tsp per day, no more

Liza
Liza

Hello Dr. N, I have been giving my daughter simple goats milk (nothing added). Would that be considered supplement. As I read in one of post here someone was giving camels milk & child regressed. We are 5th month in NP with my daughter 6 years old. She started to have some good gains (aggressive behaviour which is improving now). But she has lost eye contact & regress in speech too. So I’m figuring out if it could be goats milk. She was ill for a week (so I didn’t worry when she regressed). On the other hand my father… Read more »

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

No, plain unadulterated milk is acceptable.

Anonymous
Anonymous

Hi Dr Nemecheck I hope u are keeping well and would firstly like to thank you for ur protocol and dedication to helping everyone. My son is in on 1/4 teaspoon inulin for 3 months now. If I increase to 1/2 teaspoon he becomes extremely aggressive and hyperactive. The problem that I am having is that every time I introduce the olive oil and fish oil he loses the awareness that he has gained from being in the 1/4 inulin. From previous posts I see that u speak about an overgrowth reaction causing this. I would like like some general… Read more »

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

Keep pushing up on the inulin and retry only the fish oil first and at very low doses.

sarath
sarath

Dear doctor, I am from Australia. my daughter is 17 years old non verbal diagnosed with severe autism and intellectual disability. we have done all the treatments available around us for her. such as biomedical, chelation therapy, HBOT therapy, and last year stem cell therapy. non of them did not work for her. Now we want to follow your protocol and already bought and read your book. as you explain in the book at first we want to give her antibiotic but our GP refuse to prescribe it for her. we kindly request you, could you explain us where we… Read more »

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

I’ve heard some patients get there rifaximin from mail order pharmacies but do think that option may not be available in Australia.

Any Australian residents out there that can offer some advice?

Anonymous
Anonymous

Hi Sarath,
Try different GPs. Someone will understand this protocol and will prescribe you. We are from Tasmania, Australia. And we tried different GPs and finally one agreed.

Olivia
Olivia

my daughter of 5 years and on your protocol since 10months she is gluten free milk sugar I thought that her intestines were better then I allowed gluten and sugar except that we were faced with episodes of atrocious crises that even the professionals n could not manage, I currently give the maximum amount of inulin (2c) and 8goutes d omega 3 twice a day, do I have to do something else?

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

I find myself wondering if she has experienced any other physical, emotional or inflammatory trauma.

I serious doubt that something that sounds this bad is simply from some gluten or milk.

Don’t get over focused on these items, look for another cause such as a mild sinus or middle ear infection.

Ivan Milutinovic
Ivan Milutinovic

Hi Doctor,
My son is 5.6 yo, autism, nonverbal, on protocol 3 months, he takes: 2.5 ml inulin, 1200mg (EPA+DHA), 10 ml EVOO.
Let’s say we saw awakening and some improvements, he is more active, less fears, better understanding of commands, but he still has sometimes that strange movements of his fingers in front of his face and eyes. Whether this means that propionic acid level is still high enough and causes this? Then should we increase dose of inulin?
Regards,
Ivan

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

There is still more room to increase the inulin but this could just be from some underlying issues that will still require just more time.

Yasemin
Yasemin

Dear Mr Nemechek,
We are on the 30th day of your protocol for my 3 years old son with Nordics 600 mg fish oil and half teaspoon Now Inulin. Last 6 days he started to bang his head and hitting us, also stereotypical sounds. Can it be allergy to fish oil or die off?

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

This is due to the awakening. My guess is you’ve been slowly increasing the inulin dose and you’ve just increased into a more significant inulin dose range.

Watch our YouTube video on Aggression and Anxiety to understand this more.

Lucy
Lucy

Dear Dr, We have been on the protocol for 5 weeks now. We have seen some nice gains. Not taking vitamins or prebiotics. However without antihistamines she has daily nose bleeds lasting up to an hour each day. Frightened to stop them for this reason, so she is still taking daily antihistamines. Today she has woken up with swollen puffy eyes and a few hi es around her eyes too. Is this because she is still on antihistamines? She’s refusing not to take them due to nosebleeds. Not sure what to do. Really don’t want the poor thing to have… Read more »

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

I’ve never said you can’t use anti-histamine or any other necessary medications especially if prescribed by a physician.

Lucy
Lucy

Ok, we will continue with the anti-histamines. Thank you for clarifying. I was concious I didn’t want to interfere with the protocol. Thank you for your answer.

Anonymous
Anonymous

Hi,
I and few of my friends has claimed that as inulin has introduced /increased need of taking every object in mouth and teeth grinding has increased.please help in this regard ?why this happened?how to handle it?

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

This is increased anxiety due to the awakening.

Back off on the dose a little bit and wait for more recovery before increasing again.

Amy
Amy

Hi Dr, We are 7 months in protocol, at 1 tsp inulin, i saw good progress , words coming, apraxia improving, getting more social with brother.. and i did a huge mistake, i regret of doing it. I gave her camel milk to drink, 10 days and she regressed terribly.. became terribly apraxic, forgot her words, understanding reduced, withdrawn. I stopped her camel milk. Hw long will it take for her to bounce back? Do i have to increase her inulin? She is 6 y.o. I regret my decision.. you are right, any addition of supplement is going to cause… Read more »

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

Don’t fear, she will recover but it might take a few weeks.

There is no need to alter any dose of the protocol.

Swati
Swati

Dear Dr Nemechek
Thank you so much for this protocol. God bless you.
My question is regarding which olive oil should we use now?? The old one is not cooc anymore . We are almost out of stock and i will need to place an order soon.
Thank you so much

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

See the blog post I put up yesterday on this site. I also posted it on my NAM and Autism FB pages.

Jim
Jim

Good night doctor, thanks for all the effort helping us with our kids, I have one question, I can give my boy who is in the protocol right now, the 4lifetransfer factor? It could interfere with the protocol? I am thinking on giving it to him because it helps her sister to stay healthy last year.

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

Many supplements seem to interfere with the protocol. This one might also.

Why risk it when so many kids to remarkably well without it.

Anonymous
Anonymous

Hi, My son is 6 year old with moderate ASD. He says many words but poor comprehension and syntax. He is always in his world with very few limited interests. He is in special needs class but not adjusting there too. Aggressive behaviour is high in the class. I started inulin, olive oil and Nordic fish oil since last week.His aggressive behaviour was high last year when I used fish oil alone. Since one month I am also using Vitamin B( Nutri B 50),vitamin C, Calcium and Magnesium. Since 6 months he is on gfcf diet also all this we… Read more »

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

You need to read the full protocol to answer these questions.

The book provides you with much guidance on this and other issues you are going to face in the future.

A copy can be purchased at https://autonomicrecovery.shop

Sherri DeCorby
Sherri DeCorby

Hello there,
I am wondering if in your studies you have looked at your protocol with Auditory processing children. APD? I have a nine year old boy with it and a seven year old girl with a milder case. I am at a loss and no one seems to know anything to improve it. My nine year old is extremely bright and his output does not match his IQ. He is continually frustrated as he is very aware of it. Thank you for your time and Merry Christmas.

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

Yes, the protocol seems to help a wide variety of sensory issues including auditory

Renee
Renee

After the max dose of inulin has been reached, and the awakening has subsided, should we continue to see more awareness? It has three months at 2 tsp inulin, and I can’t say her awareness has increased much in these three months. 5 yrs, gene mutation

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

The further recovery is driven by the fish oil and olive oil.

Anonymous
Anonymous

Dear Dr N,
We have been on the protocol since a year now and my son has had many gains except his speech area. He has been potty trained and increased awareness and even beginning to show interest in learning. Just to rule out any deficiencies etc my doc here ran some tests and his alkaline phosphate level came at 223 and his tsh is at 6.5 . running further tests on the thyroid front before starting any medication. Will the protocol help with this? Will using inulin with alkaline phosphate being high cause any trouble in your opinion. Thanks

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

Alkaline phosphate enzyme levels are often an indication of biliary drainage irritation and should be evaluated by a gastroenterologist. Inulin will not cause this.

The general recommendation is not to treat hypothyroidism with a TSH less than 10.0.

Neither of these are related to the speech delay. You may want to consider a follow-up in Arizona for get a vagus nerve stimulator if this continues. It generally will drive the speech forward.

Hannah Erraine Bueno Cartano
Hannah Erraine Bueno Cartano

Hi Dr.Nemechek, My 5 yr old son had the Augmentin for 10 days and back doing the protocol but for 2 days now. He had fever and cough so the GP prescribed it. We continued the protocol and stopped for 5 days and back again. I noticed that his tongue has turned white. We’ve been doing the protocol for 16 months already and saw a lot of gains. This white tongue is worrying me, it’s the first time that this appear after 16 month in the protocol. I have no plan of stopping the protocol but I’m worried the white… Read more »

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

Don’t worry about the white tongue, this is not necessarily yeast and can be simply due to shifting bacteria within the mouth.

Sskl
Sskl

Good Day Dr ,
Thank you for this protocol . I just want to re confirm , there are 2 types of SIBO, hydrogen dominant SIBO associated with diarrhea and methane dominant SIBO – associated with constipation.
Does this protocol works for both SIBO or favours one over the other ? Does methane dominant SIBO have poorer outcome?
I am fascinated with your work. I am a general practioner in my country . Do you have any training for others like me?

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

Yes it works for both.

I’m sorry we are not planning any formal training at present but we hope to have our book focused on adults done within a few months.

Valina
Valina

Hi Dr .
Do the kids need to have some baseline good bacteria’s in them, so that the prebiotic- inulin can work?
Will these work regardless of the composition or ratio of good /bad bacteria?
sorry , i am just trying to understand the concept of this protocol. I have read your book and just wondering about this .

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

They already have good bacteria in them, you just need to help redistribute them correctly with the inulin.

valentina guerrini
valentina guerrini

Hello doctor
I have heard you are going to suggest a new EVOO? is happened yet’? not sure if I have missed it, there was a talk about it on internet few days ago

thank you

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

Yes we are aware and are working on a variety of solutions and will post this on our web page soon.

Anonymous
Anonymous

As I reflect on what a year it has been I cannot help but to think of your protocol. So….merry holidays to you and your family and I hope you have a very safe & happy 2019.
I hope you can take some time out to recharge your sweaty brain Dr Nemecheck!

13 months in & all I can say is Thank you
Thank you Thank you.

Aussie mum

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

You are more than welcome.

Umme Mahad
Umme Mahad

Hi Dr. Im a mom of a 3 yo severly autistic boy..we have been on the protocol since 14th September 2018.since we’ve started his stimming (arms movement ) has increased and he SCREAMSA alot..very loud and its alllottt . What could be the reason. How could i control it. It started last year but our naturopath started givibg him zinc because his zinc was quite low.and the screaming immidiately gone. Do i need to start zinc again? Please explain. Hoping high to hear from you

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

He’s having the awakening we discuss in the book. You’ll need to lower your inulin dose for a while.

Re-read the book and maybe watch my YouTube video on Aggression and Anxiety.

Anonymous
Anonymous

Hi doctor we r 9 months on protocal now we r at 2 tspons of inulin we havent seen any gains i want to start inulin dose again from low dose fro1/8 th my son is just out of fever is it bad idea to reduce inulin and restart again because of fever im expecting relapse can i stil reduce inulin if he is having relapse thanku

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

No need to reduce inulin after having a fever.

lisa
lisa

Dear doctor:
I am a mom in China.My son is 7 years old. He has severe autism and non verbal.Can we get your treatment. Please help me!Than kyou!

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

You need to read the protocol. It is quite simple and our book spells out exactly what to do.

A copy can be obtained at https://autonomicrecovery.shop

Rgat
Rgat

Hi everyone my daughter she’s 2 year .I want give here..
2, oil&pudr
But I don’t know..how much I give here.pls same one con helpmi.
Thanks

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

You need to read the protocol. It is quite simple and our book spells out exactly what to do.

A copy can be obtained at https://autonomicrecovery.shop . and there are a variety of different translations.

Eva
Eva

My little girl (6) is now only one year behind her peers. However her social skills are nearly 3 years behind. Will she catch up?

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

Yes, she can

Mylene
Mylene

Can my 7year old son with autism have the vaccine like HepaB, DTaP and IPV?
His in 2 months in protocol..
Thank you

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

This is a very complicated question and I think you are best to read the section about vaccinations in the Prevention chapter of my book.

A copy can be purchased at https://autonomicrecovery.shop.

Anonymous
Anonymous

Hi dr.my daughter is 3 and she statturing in speech, can we started protocol, can protocol heapl her in stuttering.

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

Yes, it tends to stop stuttering rather quickly

Animesh
Animesh

Dear Dr N,

We are religiously on protocol since Aug 2018 for my son 6 year old non verbal asd. Current dosage 1 +1/4 NOW inulin, 1 Softgel NOW DHA and 25 ml EVOO. Till now no gains seen. No discomfort or awakening even on increasing dosages.
What should we do next.. change inulin brand? Change FO or try rifaximin? Pl guide.
Regards
Animesh.

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

I’m sorry but due to the high volume of requests, I’m restricting my response to those involving a broader level of explanation and am refraining from providing individual dosage advice.

I believe the answer to your questions can be found in our protocol. A copy can be purchased at https://autonomicrecovery.shop.

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