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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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Alina
Alina

Hi Dr.
Does ionic foot bath interfere with the protocol?

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

Not that I’m aware.

Ella
Ella

Hi Dr. N
Is it ok to use Zyrtec for a 3.9 years old while on protocol?

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

Yes

Michael
Michael

Hi Dr. Nemechek. I have a two and a half year old autistic son. I just started the protocol three days ago but just noticed on the bottle of Nordic naturals children’s dha Xtra that it has a berry flavor. I went online to look at other Nordic natural products for him but they all seem to have some sort of flavoring whether it be lemon etc… If the berry flavor is not good, is the lemon ok? Is there something that you could recommend that maybe I have overlooked? Thank you

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

I’m uncertain about the berry flavor. I certainly advise to avoid the strawberry and many, many child are recovering with the lemon flavor

Vithal
Vithal

Hi Dr.N, First of all I thank you so much for this amazing protocol.We saw lots of improvements. My son is 3.10 years old.Is it okay to give melatonin inmedicine while on protocol it is prescribed by his psychiatrist for sleep .Also my son has D vitamin deficiency and some other deficiency..His pediatrician prescribed multivitamin syrup for him. is it ok to give d vitamin supplements or the multivitamin syrup? We are on protocol since 3 months. We saw Lots of gains.But no speech (he is non verbal).I am giving him 1.15 ml Evoo on food, 2 ml NN omega… Read more »

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

I’m sorry but I cannot give specific recommendations for your child on the blog.

As a general rule, if you are using doses in the upper ranges I use in my protocol and sticking with the approved brands, my experience is the answer would lay more in the VNS rather than rifaximin.

Vithal
Vithal

Thanks Dr.N

Is it okay to give Melatonin and the vitamin deficiency supplements prescribed by the doctors?

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

I recommend following your physician’s specific advise about supplements.

Some kids really need iron or B12 for instance for these deficiencies.

April
April

Hi Dr. Nemechek, We’ve had our 4 year old son on the protocol since July with a month off in September for surgery to remove tonsils and adenoids per doctor’s orders. Within 4-6 weeks he was speaking. He only had 4 words before starting the NP and now he will use phrases and even sings songs sometimes (he likes the Baby Shark song). My question is this: He has had sinus infections off and on since October. Mostly we’ve used OTC medications and it will go away, but then came back. This last one was since the 17th of December.… Read more »

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

I’m sorry but I cannot give specific recommendations for your child on the blog.

As a general rule, if you are using doses in the upper ranges I use in my protocol and sticking with the approved brands, my experience is the answer would lay more in the VNS rather than rifaximin.

Ramina
Ramina

Good evening, Mr Nemechek! My son is on protocol since 6th of December, 1tsp of inulin, 7.5 ml of evoo, 2.5ml of fish oil. I give him antispasmatic because of epileptic symptoms. Now there are some red spots on his back. They don,t look like alergic, they are gainy. Should I go on protocol? Is this appearance of spots because of protocol?

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

I would think this is from the protocol.

If you are concerned, have your physician look at the the rash

elceejay
elceejay

Hi Dr N. My 3 yr old son (he will be 4 in April) has been on the protocol for 10 months now. He is non verbal (suspected apraxia) and has autism. We do 1 Tbs of California Ranch EVOO; 3 capsules of NN Ultimate Omega and 1 Tps of Now inulin in Yoplait yogurt (that’s been his dose now for about 4 months). He’s a very picky eater and eventually i’d like to not do yogurt but I haven’t seen much change in his eating habits. We have seen gains in focus, eye contact and following simple instructions but… Read more »

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

Either way (relapse or awakening) it represents underlying developmental issues.

If it is too intense try decreasing the inulin dose a little.

Priya
Priya

Hello Dr N, I started protocol one week ago, my son is going through awakening. He is extremely hyper, jumping, stimming, doing lots of finger movements nearby eyes, screaming, running here there, lots of mouthning, teeth grinding got more worse. We have noticed little awareness but negativity is far more than awareness. He is 4 year and getting 1/8 Inulin, 1 ultimate omega capsule, 12-15 ml EVOO. Should I need reduce Inulin to 1/16 to manage the negativity? We are very scared to see his behavior. Pls advise.

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

Yes reduce inulin. Watch our YouTube video about aggression and Anxiety

Thankful & Hopeful Mother in New England
Thankful & Hopeful Mother in New England

I am 3 days into the protocol with our beautiful son who has “severe” ASD. He is almost7, has only ever said a few words, is in a special school, and is considered severe to the point where SIB created a true safety risk and we were encouraged to leave him at a residential facility for a 6 week evaluation (we declined and moved heaven and earth to give him as much support and help as we personally could). Through ABA however, we were able to get his SIBs to be all but non-existant. We love him more than anything… Read more »

Amina Amir
Amina Amir

Dearest Doctor Patrick Nemechek.i need your help .i want to know if ultimate omega 2840 is given to kid 6.10 year old since 3 months near .Can the children dha 530 given for few days because of non availability of ultimate omega?actually ultimate bottle is broken accidentally and now I have children dha 530 strawberry flavour .need to know both r same if dha plus epa same quantity given or affects the process of recovery ?need only your suggestion .

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

Do not worry about the DHA content for children, dose according to the total omega-3 amount.

I would avoid using strawberry flavoring in the future be I have some concerns it may of prevented recovery in a few cases.

Amina
Amina

Thanks great I am so much worried.thanks a lot . I had given children dha strawberry flavour at starting of protocol two full months and saw awakening and few gains also .i try my best to give ultimate omega as soon as possible .pray and hope recovery not stop due to strawberry flavour till .

Anita
Anita

Hi Dr. Nemechek, Thank you very much for effective protocol and all your answers to the block has been very much helpful! My son is 6.5 yrs old and it’s been nearly 2 weeks he has been on the protocol. We have seen dramatic increased in his language and awareness, understanding, engaging etc. Using 1/2 tsp inulin( just increased to 1/2 tsp )Nordic ultimate omega fish oil 2840 mg. Total omega3 2840mg, EPA 1460mg, DHA 1010mg. And 1tbsp EVO. Before the protocol he had never had constipation or diarrhea problem he was always normal textured , color and regular. But… Read more »

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

I would split up the treatment and maybe just slowly increase the inulin over a few weeks. After he seems to be tolerating this, then add in the fish oil.

José Ignacio Ganboa
José Ignacio Ganboa

Estimated Dr. Nemechek. Bacteria have several mechanisms to become resistant to antibiotics. Our children may have bacteria resistant to Rifaximin or they may become resistant after several cycles with the antibiotic. In that case there would be no effect or the effect of the antibiotic would decrease with the number of cycles. For example, there are described resistances of Clostridium Difficile to Rifaximine. Have you found any cases like this in your clinical experience? What to do if resistance arises and they do not respond to antibiotic treatment? Could any difficulties in recovery not be due to the presence of… Read more »

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

The incidence of bacterial resistance to rifaximin is much, much lower than other antibiotics. There is a 30-year history of patients with hepatic encephalopathy being on rifaximin continuously throughout the year but with a very rare occurrence of resistance.

The practical reality is the kids I treat do not relapse very frequently and at this point have not run across any cases suggestive of resistance.

Tatyka
Tatyka

Dear dr Nemechek, My 10 year old daughter has been on protocol for a full year and we have seen some steady gains. She is few years behind in many areas but progressing constantly. However she just started to receieve Growth Hormone due to very short stature but not GH deficient and I am very worried if it will somehow interfere with protocol or worsen SIBO. ( she has been suspected SIBO and now doing much better , no flatulence and similar) . I was wondering if you had cases like hers on protocol. She is also prescribed Vit d… Read more »

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

Unfortunately I’ve never had a patient under these circumstances.

If she is on inulin, her SIBO won’t relapse during treatment. If she has been treated with Rifaximin, you just may need to occasionally retreat her if any symptoms suggestive of SIBO (see my YouTube video on SIBO Fingerprint) arise.

Tatyka
Tatyka

Dear Dr Nemechek,
Thank you for your reply! She has been only on inulin but I was just considering Rifaximin. Since you mentioning it I suppose it is safe to give her Rifaximin while on GH therapy which will last for years.
Maybe someone out there on protocol and under similar circumstances will see this and share experience. All the best to you and your team!

Arianne
Arianne

Thank you Dr Nemechek, you are what we needed. I read stories everyday of all the little children getting better it makes me happy for them but I am also sad as we are stuck, my 5 yrs old non verbal. 1 tsp inulin agave based. 3 fish oil NOW DHA 500. 10 mls of OO (Best trusted brand I could find). Progress: stopped stimming, aware, understand 70% what is said to him, uses pecs, toilet trained, generally happy, amazing bowel movements, sleeps well, eats generally well for a 5 year old. Tries to copy sounds. We still don’t have… Read more »

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

Jean and I are very frustrated with the lack of availability of VNS for all the families around the world.

Your doses are good. Maybe you can scratch out a little more improvement by pushing up the inulin a bit.

Mom
Mom

Hi! One more question. We Are scheduled to come to get vns over the summer. My son has been on the protocol 1.5 year increased awareness and great Eye contact. Although some Improvement Has come mostly due to him being more aware no speech or understanding. So my question is should I try RX? Could he benefit from RX? Or continue with inulin until we get vns? And then have RX as a last resort
He is 4 Years old mild autism

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

I’m sorry but I cannot give specific recommendations for your child on the blog.

As a general rule, if you are using doses in the upper ranges I use in my protocol and sticking with the approved brands, my experience is the answer would lay more in the VNS rather than rifaximin.

Mom
Mom

Ok. Thank you. Yes we Are using upper doses recommended brand. 2 tsp and 1/2 tsp NN ultimate omega ( 1500 EPa dha). I tried upping omega but he gets very irritated. I will wait for the vns if that does not do the trick I will try antibiotic.

Rachel
Rachel

My 3 yr old son is on the ketogenic diet for epilepsy (Dravet Syndrome), so he has been taking many supplements as prescribed by the neuro. In some cases we know there is a deficiciency (levocarnitine, sodium bicarbonate, vit D), but for others we don’t (multivitamin, calcium). We have been on the Protocol for a couple months now. I have not noticed any big change, but I know it is like growing hair. (He is not autistic, so no awakening to look for). Also, I am just not sure how much his genetic disorder can be overcome. But is it… Read more »

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

It possibly might help but I would eliminate anything without running it by the neurologist.

First choice would be to get rid of the supplements being used “just in case”, and continue those which there are demonstrable low levels.

The addition of vagus nerve stimulation can also be of help in recovery. In your son’s case, the implantable units would be the preferred method. Our transcutaneous unit might not be potent enough.

Anonymous
Anonymous

Okay, many thanks!!

Rachel
Rachel

Okay, I certainly feel comfortable stopping the “just in case” ones for a few weeks to see how it goes. Thank you!

Anonymous
Anonymous

Good evening, dear doctor! We cannot find evoo California anymore. What label do you recommend now?

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

Go to the COOC.com website and you will find a long list of COOC-certified olive oil producers. Most of the ship direct to the consumer.

Paul
Paul

Dr N you owe every parent following your protocol a free course of rifaximin for all the stress and axiety the awakening has caused us (haha). Was just wondering why new stims emerge? We passed the awakening a few months but our 5 year old has just started waving fingers infront of face. Started two weeks ago. We are giving max dose inulin already. Im not too concerned about it, but could it be from a minor head injury he had around about the time it started?

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

We all need more than rifaximin to get through these ups and downs for sure. 🙂

I can say why, but we see things come as the kids recover – stims, laughing fits, obsessions. Might be another manifestation of neurological imbalance and different circuits are coming back on line or possibly the manifestation of minor, unrecognized injuries.

The good news is they seem to pass as soon as they appear.

Anonymous
Anonymous

Hello! My 5 years old daughter is on the protocol since 30.11.2018, 7.5 ml of Evoo, 1 teaspoon of inulin, 1 capsule of fish oil. The genetic test showed us a deficit of folic acid. Should we add this acid ? We don,t use any medicine now. Thank you

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

You don’t diagnosed folate (folic acid) deficiency, one should use a blood test called RBC Folate level.

PRATIMA
PRATIMA

Can Rifiaximin be given to a 6 year old if Inulin is not working?

6 months on protocol Mild ASD Non verbal kid. Reached 1+3/4 tsp NOW Inulin already. 2 softgels Now FO and 30 ml EVOO. All approved brands. No Prebiotics, no supplements. No improvement in awareness. No major gains/changes since starting protocol.

Kindly advise. Thanks for all you do.

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

YEs it can. If there was an awakening but no progress after that point, the next treatment needed in vagus stimulation.

Bronagh McCann
Bronagh McCann

Thank you doctor for replying to my1st post I am following the full protocol but not cutting out any foods as she doesn’t eat much anyways I live in Ireland and my 7 year old autistic daughter is addicted to ice lolly’s ice pops I don’t know what you call them wherever u live I know there full of sugars and things but I could NEVER get he off them I think they keep her alive as she eats them constantly but will she recover if she is eating them so much I am giving her more evoo to make… Read more »

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

Don’t worry so much about the foods when starting – stay focused on getting the fish oil, olive oil and inulin right.

She is probably craving the sugar in the ice pops (called popsicles in the U.S.) because the boost blood pressure and oxygen delivery to her head.

Low brain blood pressure is a common side effect of the autonomic dysfunction occurring from cumulative brain injury. This is also what drives a lot of hyperactivity, hunger, thirst and anxiety. It will calm down and eventually go away as her brain repairs itself.

Bronagh McCann
Bronagh McCann

Thank you so very much doctor I have never heard that ever before about the low brain pressure as the doctors where I am from a little town in Belfast (falls road) aren’t really updated in the world of autism and as Ireland is 20 years behind the us. Thanks a lot means the world for your response

Scott
Scott

About the start the Protocol next week (as stated previously). I see that the Nordic naturals Ultimate Omega only has 225mg of DHA per 1000mg pill. Does that mean I need to take 13 pills a day to hit 3000mg of DHA as a 48 year old adult? Is there other recommended ways of getting this dosage? Also, should I WAIT until I’ve taken the Rifaximin course for ten days before I start the DHA supplement? And if you are looking for a Guinea pig, I enjoy problem solving and would love to assist in furthering your work. Thanks.

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

For adults wanting to use Nordic Naturals brand, I recommend the NN DHA Extra – it has about 500 mg of DHA per capsule so you’ll only have to take 6 per day.

The Now Foods DHA-500 is similar (6 per day to hit the 3,000 mg of DHA mark) and is generally less expensive and works well.

Fatima
Fatima

Hi, My daughter has chromosome 14 deletion, developmental delay and Seizure. I am going to start protocol, I know it is OK to continue her seizure medicine (Keppra) what a bout B6 and B12 ( she gets these to reduce Keppra side effects)?
Is it possible that seizures may increase when starting the protocol? She is 2 years old
Thanks

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

If those were prescribed by the neurologist then I would continue them.

Paula
Paula

Good morning Dr.! My son 2.9 has been on the protocol since the end of October, a lot of gains since then. A few days ago I increased the inulin from 1/4 tsp to 1/2 tsp, and we are experiencing an awakening, a lot of stemming, climbing furniture,crying for nothing, and less sleep, but also more sounds and trying to say words. Should I hang in there or decrease the inulin to 1/4 tsp. TIA!

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

Watch the YouTube video on Aggression and Anxiety

Danwine
Danwine

Hi Dr Greetings from Sunny South Africa 🙂 We have been on protocol for almost 10months now with no significant gains. He is 4 years old Non verbal ASD. Barely any understanding, no speech (regression at 1.5 years old), no social interaction etc. We are using all approved brands (For Maybe 8 of those 10 months). We are using a daily anti histamine called cipla actin. We are also using a CBD oil from a very trusted source. No other supplements/ hardly any yogurt. All food cooked in canola oil. He has futurelife cereal for breakfast Doses are: 2 heaped… Read more »

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

I am sorry but due to the large volume of requests, I am restricting my responses to those of a general instructive nature and will no longer give specific advise on dosages, etc.

Anonymous
Anonymous

Does anyone here have feedback using extra virgin olive oil grown in Australia? In particular Cobram estate oil.

Josna
Josna

Dear Dr N, Thank you so much for this protocol. My last post to you, you suggested a visit you to your office for a vns as my son has had improvements in all areas expect expressive speech. Been on the protocol for a year. Since I am based in India travelling to the US needs some time. Meanwhile I heard about safe and sound protocol which also seems to stimulate the vns. Do u think I could try that while I plan the visit to meet you. Please share your opinion as I do not want to mess with… Read more »

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

I have no experience with the Safe and Sound protocol.

G
G

Hello Dr N, we recently started your protocol for my 4.5 year old son who has autism nonverbal. We did blood testing and his b12 was very high according to blood test and OAT test says very deficient in b12. My map prescribed MB12 injection for my son. He mentioned high b12 in serum and low b12 in OAT test means b12 is floating in blood and not getting absorb properly. Will it be ok to use mb12 shots with your protocol? Also he is very deficient in Glutathione as per OAT test so we got prescribtion for transdermal glutathione.… Read more »

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

I believe the blood testing over the OATS testing (which is generally unreliable as this case shows).

Saritha
Saritha

Hello Dr, Last April i did protocol for 3mths for 11year old non verbal asd boy. He was cool boy without emotional outburst and all . His doese were Now dha500 2caps 1/2 teaspoon inulin 1tablespoon olive oil He was ok no change in any manner . May i increased fish oil to 3 caps. Still same june 10 i increased inulin to 1teaspoon. Frome june 26 he was crying screaming i cant do anything i stopped inulin and did modify protocol still nothing calmed. Finaly in aug i stopped protocol. And sep he was back normal. I waited again… Read more »

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

Watch our YouTube video on Aggression and Anxiety

Aisha
Aisha

Hi Dr Nemechek, Happy New Year. My daughter is 10 months on NP, she is 6yo , moderate autistic. No major gains so far. No expressive speech gains , receptive is even not that gained so far, low cognitive skills and crying anxiety behaviours. Her only gain I would consider is eating variety. Recently she is very high on her toes while walking though she was always toe walker. What can I do next ..Her dose 1tsp inulin, 2.5 ml NN ultimate omega and 10 ml EVOO all recommend brand. Im feeling defeated please help. Also I’d question can I… Read more »

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

Something is interfering with her recovery. Although she is 6, the inulin might not be working and she might be needing rifaximin.

That being said, the number 1 cause of this scenario are other supplements, probiotics or homeopathic remedies.

Gina
Gina

Hi my son is 5 years and he is the protocol since 4 months along with occuoational and speech thherapies. The gains have been better attention and responsiveness. But recently we good allergy testing done. His IgE levels against olive is 1.6 IU/ml. My doctor suggested against olives. Can you suggest a replacement for EVOO?

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

There is none. Don’t worry about the IgE testing. The real test for allergies is if a substance bothers someone when ingested or inhaled.

Aisha
Aisha

Thanks Doctor for the reply. I’m not done anything other than protocol , no added probiotics no supplements, no homeopathy. Initially when we started in March 2018, she shown some great awareness , last year she also started repeating words which wasn’t there before protocol.she don’t understand just repeats whatever been asked. I want to let you know September until Dec 1st week 2018 , she was sick many times with flu , fever cold cough , I treated her with Tylenol but no antibiotics as there were no ear or throat infections discovered. And she also went thru flu… Read more »

Autumn
Autumn

Hello. Our 3-year-Old son is very medically complex. He was diagnosed with autism at 2.5 years old, after a dramatic regression following his second birthday. Three months later he was diagnosed with Acute Lymphoblastic Leukemia. He is in remission but will need to stay on the treatment protocol for another 2.5 years to ensure complete remission. This involves many medications, including daily oral chemotherapy (Mercaptipuran) and Bactrim (antibiotic) every weekend. We started the Nemechek Protocol in August and we have seen gains. He also started at a full time ABA school in September. I know your protocol says to stop… Read more »

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

It is in appropriate for me to give any advice on such a complicated case without an in depth face-to-face visit.

sub
sub

Hello Doctor, Hope you are doing well and wishing you are a very happy new year. I want to thank you for such a wonderful protocol. My son, 3 year old now (assessed to be speech delayed) is on the protocol for 6 months. We have seen good gains with his speech(he was pre verbal prior). He is currently on 1/4 + 1/8 inulin, 5ml evoo and 450mg fish oil. He is on the same dose since 4.5 months. He learns verbs and action names quickly. He grasps and tries to use the words whatever we talk to him. But… Read more »

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

I think you need to increase you dosage of patience. 🙂

The dosages are proving they are adequate to start recovery.

sub
sub

sure doctor I’ll keep that in mind.

I would like to know about your view on using Nutritional yeast. I hear its a good source of B vits which our veg foods lack.

Thanks again.

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

I strongly advise using probiotics of any kind, bacterial or yeast/fungal.

Bronagh
Bronagh

Hi doctor I’m just a young woman who is trying to enjoy my 7 year old autistic child who has been on the protocol 7 weeks now and if I’m a little too honest it’s flipping hard work but I’m sticking to it as it’s also brilliant her eye contact and her wee sense of humour is amazing but she likes to listen ve in her room just runs up down the stairs whenever she wants something is this healthy I don’t know what to do but she seems to happy and contented like this

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

Sounds like you’ve had an awakening – increase eye contact and increased activity.

Things will improve, just hang in there.

Anonymous
Anonymous

Hi,
i want to switch natrual nordic to soft gels dha double strength for 4 yrs boy.should i start from one soft gel?

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

Just use an equivalent amount of omega-3.

Kimberly jeremiah
Kimberly jeremiah

Hi Dr. Nemechek! Thank you for all of your work! My daughter has been following the protocol since August and we have noticed slow but steady progress. We are extremely encouraged and plan to continue on the program 🙂
2 questions:
1) Is there any downside to just taking the rifaximin if you are not sure the inulin fiber is working?
2) is there such a thing as too much fish oil? Are there any medical side effects to an overly high dose and what would too high a dose be as we consider increasing?
Thanks!!! Kimberly J

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

1. Rifaximin seems generally safe but inulin provides a much more stable clinical course over time (no relapses).

2. Definitely yes, this is why I constant discuss staying within the guideline in my protocol.

Tia
Tia

Hi Dr. Nemecheck
Have you ever tripled the fish oil for anyone of your pts? After doubling the fish oil after 2 months can we then triple it. My 8 year old is on max doses of approved brands of everything nothing has happened
Does this mean she doesnt have autonomic nervous system dysfunction? Nothing good or bad for the past 2 months . I understand it’s still early but I mean nothing ?
Also do your pts gain weight on your protocol ? Thank you very much .

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

I’ve never needed doses beyond the maximums I discuss in my book.

Suri Fineberg
Suri Fineberg

Hello, Just want to say that I have a 19 year old son, who has autism (non verbal), Crohn’s disease, Celiac disease, chronic ideopathic constipation, IBS, and in the last 1.5 years has started with severe self injurious behaviors, one episode of which landed him in the hospital for 5 days with severe rhabdomyelosis. We have an appointment to see Dr. Nemechek on February 20th, and will be flying from NY. We started the protocol on 11/11/18, with all the recommended components for an adult, except the inulin (started it but then stopped – couldn’t decide if it was increasing… Read more »

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

HAng in there, your appointment is right around the corner.

Amanda
Amanda

In a post, I saw that you recommended the individual stop homeopathic remedies due to increased stimming, as they might be interfering with the protocol. Would you recommend stopping homeopathics while on the protocol regardless or only if there is a negative side effect?

Also, I’ve read that too much Omega 3s can have adverse effects. Would you say there is a limit to Omega 3 consumption where the supplement becomes counter productive?

Thank you.

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

Stop them regardless.

shrigi
shrigi

GM doctor Can I use below EVoo from Aldi as I visit the store regularly. Below are the details of oil. Aprreciate your response. Thanks. SimplyNature Mediterranean Extra Virgin Olive Oil. They can be spotted by the red seals on their packaging. This seal identifies them as North American Olive Oil Association (NAOOA) certified quality. Wondering what that really means? We’ll explain the NAOOA process and why it’s important! To be awarded the NAOOA Quality Seal, our olive oil must meet or exceed the standards of the International Olive Council (IOC). Think of the IOC as the authority on all… Read more »

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

I recommend only using COOC-certified oils. IF it doesn’t have that COOC seal, then I’ll tell you not to trust it.

Anonymous
Anonymous

Dear doctor we r 9 months on protocal i think we r seeing awakening behaviours when i increase inulin beyond 1.5 tspoon my son starts sneezing and say itchy skin when i cut back he stops sneezing i noticed this twice u think its dieoff reaction i heard inulin is immune modulater i gave 2 tspoon inulin for 20 days all these 20 days he was sneezing alot even in sleep he got fever after this after this i cut back to 1.5 tspoon he is not sneezing u think its dieoff reaction and liver is not able to flush… Read more »

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

1.5 tsp of inulin is usually more than enough for the majority of kids.

Amanda
Amanda

Hello. Two questions. #1 – My son has been on the protocol for 1 week. We started with 1/8tsp/day Inulin for the first 3 days and then moved up to 1/4 tsp/day. His poop is a little harder but he’s still pooping once a day. We haven’t noticed anything else yet, positive or negative. How long should we wait before we increase inulin again?

Second question. We get pasture eggs, but most pasture eggs are still fed a supplemental diet of grain or wheat. Is a supplemental amount OK as long as it’s not their main diet?

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

1# – be patient. Improvements come slowly.

2# – The eggs are fine.

Priya
Priya

Hello Dr Nemcheck, I Just started your protocol for
My 4 year old autistic nonverbal son. He is getting leucovorin as we got FRAT positive through blood test. Will it be ok to take while on Nemcheck protocol? Pls suggest.

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

Yes, continue the leucovorin.

Mona
Mona

Hello. My 7 yo daughter has Eosinophilic esophagitis (inflammation in esophagus due to allergies), she also has a stomach ulcer. She’s been on the protocol for a few weeks, just wondering if we should stop it to heal the ulcer or the protocol might actually help with the esophagus inflammation and ulcer. Thank you!

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

The protocol often helps heal the eosinophilic esophagitis.

Sue D
Sue D

When Nemecheck says awakening you better believe it. After 6 months of tears and an uncontrollable 4 year old, I have now ended up with a perfectly behaved and focused toddler who is just with us again and loving life. He also calls me “mum”, so many happy tears in this household. I cant believe the awakening you describe is this intense and REAL. I’m so glad I didnt give up. Please keep pushing through guys. Thankyou Dr Nemecheck.

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

Thank you for your feedback and the words of encouragement to all the others who read this blog.

Anonymous
Anonymous

Hello,
I know the “metals in the brain” idea is quite controversial and not accepted by most physicians. But I wanted to ask, IF there is mercury or aluminum in the brain, is there any reason to believe that the metals could actual have a chemical reaction to higher propionic acid levels in the brain effects?
Thank you for your consideration.that has negative

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

I have no idea.

From a pragmatic level it doesn’t matter if there is or isn’t heavy metals involved because children seem to recovery with my protocol without address this directly.

Maybe the bacteria can naturally chelate the metals – there is a little evidence suggesting this might be the case.

Valina
Valina

Hi Dr , I just want to update you regarding my daughter . regressed after camel milk. So the behaviours lasted for 2 weeks after i stopped camel milk. I actually pushed up the inulin a bit ( from 1 tsp to 1 1/4 tsp ). She is 6 y.o . I must say she is back on track now. But she is having difficulty pronouncing words. But i saw difference in that too , previously she talks without moving her tongue, now when she tries to talk, there is a movement of the tongue, but words are apraxic. She… Read more »

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

Its hard to say if she needs more inulin but I think 2 tsp would be the max for almost any kid.

Anita
Anita

Dear Doctor, I have read the book several times and my son is on the protocol for the last 1 and a half years ( 18 months) I do all the recommended brands and doses. Current dose 1.5 teaspoon inulin, 1 capsule of now DHA and 1/2 tablespoon of California ranch olive oil My question is that my son has made some progress like started chewing properly and little better in receptive language, however he cannot be considered recovered. He has always been mild ASD and the diagnosis is the same. He can’t even complain when kids hit him in… Read more »

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

The only thing I can say is that after this long on the protocol he probably needs vagus nerve stimulation.

I hesitate to say that because I understand how hard it is to get this type of help and for many, traveling to the U.S. is a financial impossibility.

Lisa Brizendine
Lisa Brizendine

My grandson is allergic to fish, is there alternative to omega 3’s?

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

Fish contain many different molecules other than omega-3 fatty acids that can cause allergies. Remember, our own cells are made up from the identical omega-3 fatty acids found in fish. Using highly purified fish oils such as Nordic Naturals will often allow those who are sensitive to fish tolerate the omega-3 supplementation. Secondly, I’ve had many people just be told they are allergic to something because of only a blood test. When there is bacterial overgrowth within the small intestine, these test results are often erroneous and I routinely ignore them. The true medical proof of allergic reactivity is when… Read more »

Charvi
Charvi

What could be causing excessive biting in a 3 year old kid , he is on np protocol for aggression from a month

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

The aggressive behaviors are from the developmental imbalance the brain is experiencing. Watch my video on Aggression and Anxiety and try tapering back off the inulin dosage a little.

Anonymous
Anonymous

Hi Dr Nemechek I hope you are keeping well and enjoyed your holidays. I have increased my sons inulin dose from half a teaspoon to one teaspoon over the last 3 weeks. We have not added the oils yet as he keeps having a overgrowth reaction to them so we wanted to heal his GI tract first. However, I have noticed that he is bruising more easily on his legs since the last increase of inulin to one teaspoon. Is this something u have seen before in your patients? Can this be caused temporarly by the shifting of bacteria? He… Read more »

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

Inulin does not cause bruising.

Amina
Amina

Dear Superb Doctor Nemechek .why chicory inulin makes kid less anxiety? Many people have experiencing it . Which chicory inulin is approved by you? (brand name please)
Secondly can we buy olives , make its oil (where it can be before us)and use evoo instead cooc seal evoo ?
Is cooc certified oil has other medically benefits ?if yes then what r those benefits?

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

I have not seen different forms of inulin make a difference in the patients I personally manage.

Of course, home pressed or locally grown olive oils are fine.

The concern is with the international olive oil market. If oils are imported, there is a high percentage that is fraudulent.

Amina Amir
Amina Amir

Thanks a lot for this

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