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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.

5,877 Comments

  1. Swati 3 weeks ago

    Hey Dr Nemechek
    My son just turned 10 last dec. We have been on your protocol since March last year. Currently on 1/2 tsp inulin twice a day, 10 ml oilve oil, 5 ml fish oil.
    We saw alot of gains past few months. Everything was going really well.
    But past weeks have been really tough. He is back to hitting , spitting and very hyper aggressive. Do i need to reduce/ increase the dosage??
    Thank you so much

    • Patrick Nemechek, D.O. 3 weeks ago

      Makes me wonder if he has sustained a new injury (inflammatory, physical or inflammatory)

    • swati pandey 3 weeks ago

      He did undergo a small surgery in Dec . though he was not on any antibiotics but we did stop the protocol for two days.

  2. Katerina 3 weeks ago

    Hello, doctor. A son is 4,5 years, epilepsy. I want to make attempt Your protocol, wanted at first to specify: whether he befits to the babies with cramps. Beforehand enormous thank you.

    • Patrick Nemechek, D.O. 3 weeks ago

      Yes, the inulin often will make the cramps stop.

    • Nikhat 3 weeks ago

      Dr.Nemechek,

      My heartfelt thanks to you for your contribution towards this field.
      I have a 6.5 yrs old son, autistic with severe speech delays. Active and healthy otherwise. On your protocol for 8 months now…on same dose since beginning (20 ml of EVOO +cooking in EVOO, Inulin gummies 3-4, fish oil 1200mg omega 3 ( 625mg EPA+ 425mg DHA). Never noticed any awakening or may be it was subtle…. although he has become more aware of his surroundings and understanding things better, being more independant…. but every month passing by, his stimming has worsened, gone down on his verbal attempts (his articulation was way better before). Since two months the new stims he has started is flapping his hands and tightening his hands and legs not knowing where they are in space or how to control his emotions, secondly pushing the corner of his eye (at lacrimal gland location) ,when redirected he started seeing from corner of his eyes. Recently Cholesterol levels reading came out 207…last year was 204 . Rest assured healthy home-made fresh food diet with no lactose, no gluten, no other supplements, single strain plain yoghurt once a while. Just worried,8 months on protocol and seeing not much of verbal gains, most importantly worsening of stimming behaviors is concerning me….anything I need to add or change in his protocol or diet? Otherwise, Do you think he could be a fit for VNS.Please advise. Thanks.
      Nikhat

    • Patrick Nemechek, D.O. 3 weeks ago

      Try cutting back on the inulin or just using the plain NOW Foods inulin.

  3. Anonymous 3 weeks ago

    Hi,
    I am 42 yrs and facing anxiety from last two years ,now due to this reason one more symptoms appeared that is eye twitching. May this problem resolved this issue.

    • Patrick Nemechek, D.O. 3 weeks ago

      It can go a long way toward reducing it.

  4. Sskl 3 weeks ago

    Hi Dr ,
    Do we need to limit carbohydrate intake for this protocol to be successful?
    Does rice worsened the bacterial overgrowth? Asian foods are mostly rice everyday , off course with vegetables and meats. But Rice is there almost everyday in every meal .

    • Patrick Nemechek, D.O. 3 weeks ago

      No, carbohydrate restriction is not necessary.

  5. Sush 3 weeks ago

    Dear Dr ,
    I started the protocol for my 3.3 yr old son on 1st Jan 2019.he has been taking fish oil since dec 2018. the very first day we administered 1 tsp evoo directly and he showed aversion. So from 2nd day we started adding evoo in his food generously. May be it got too much . Since then he has been saying vomit. Could it be related to too much evoo?
    Last three days he has been vomiting, doc said it’s gastroenteritis. We have stopped the protocol for last 3 days as he is not able to keep anything down. His vomiting has stopped (May be due to medicines given by doc) but the nausea feeling still persists. He keeps saying vomit vomit. We notice that it has started since we started evoo. Could it be related?
    Thank you dear Dr Nemechek.

    • Patrick Nemechek, D.O. 3 weeks ago

      Sounds like a viral process with maybe a little too much EVOO as well.

    • Sush 3 weeks ago

      Thank you so much Dear Dr. I want to tell you something: I really really want to meet and talk to you one day. People like you don’t exist on this earth anymore. Autism has become an industry for greedy people. Me and my husband run pillar to pillar to get effective treatment for my son and everyone out there is greedy for money. All our income is going for my son’s treatment (ABA , other therapies) . But you are doing it for no cost. I don’t have words to thank you dr. Wishing you and your family the best always.

    • Patrick Nemechek, D.O. 3 weeks ago

      You are very welcome.

  6. Dacia 3 weeks ago

    Hi Dr. Nemechek,
    My 2.4 year old has been fighting a C Diff infection. He’s on his third attempt at treatment with a pulse/taper of Vancomycin over a two month period. This all came about just as we were getting ready to start the protocol in November. I decided to wait until he completed treatment to start. He’s scheduled to complete vanco treatment February 28th. So my question is, how long should I wait before starting the protocol? Or should I wait? It was interesting that after his first dose of Vanco, my non verbal child immediately began talking and interacting with us and having normal bowel movements. He went from needing an ASD eval to no longer qualifying for one. I’m eager to get him healing on the protcol, but don’t want to jump the gun.

    • Patrick Nemechek, D.O. 3 weeks ago

      I would ask the infectious disease specialist handling your child’s case about the appropriate timing to start this protocol.

  7. Anonymous 3 weeks ago

    Are there any theories as to why inulin doesn’t work after rifaxamin?

    • Patrick Nemechek, D.O. 3 weeks ago

      In regards to autonomic recovery, I was unable to get recovery using inulin. I need rifaximin for ANS recovery

    • Pragya 3 weeks ago

      How do I know if I / my child need ANS recovery?

    • Patrick Nemechek, D.O. 3 weeks ago

      Take the autonomic quiz on this website and see how you score.

  8. Colleen Baker 3 weeks ago

    Hi Dr. Nemechek,
    My 12-yr-old son has PANDAS and antibiotics aren’t working for him. His doctor just started him on Prednisone. I’d like to start your Protocol but should I wait until he’s done with the steroid? He already takes fish oil capsules and I gave him a tbsp. of EVOO this morning.

    • Patrick Nemechek, D.O. 3 weeks ago

      I’ve successfully treated many kids who had been diagnosed with PANDAS by other docs. I think these docs are often misguided with their diagnoses of PANDAS (i.e., can’t see the forest for the trees).

  9. baskaran 3 weeks ago

    Dear dr nemechek

    thanks so much for your protocol and your response to all question .Our 5 year and 9 month boy is on your protocol almost 1 year 2 month , he have some gain but still he is non verbal and sensory issue . We gave him 2.8 gram inulin ( before around 2 month we gave him 6 Gramm inulin and then according to your reply we alter it to 2.8 Gramm ) , 1000 mg Nordic natural pro omega 3, and 7.5 ml olive oil without any supplements. Before 3 month we did check for vitamin d and iron , and result is negative, while he have 16 ng vitamin d , then our pediatrician gave vitamin d3 drop and iron supplements, but after gave him supplements his Stimming behavior is increased and he have urinary tract problem . So now we don’t gave him vitamin d3 or iron. now we like to give him nordic natural cod liver oil , while he have vitamin d deficeny and cod liver oil is natural product. but question is cod liver oil for serving one tea spoon include 1000 mg omega 3 and 1000 iu vitamind d3 , but already we gave him 1000 mg pro omega3 per day , when we give him cod liver oil one teaspoon per day, then he will get 2000mg omega 3 per day. could you recommend me please how much high dose omega 3 is safe for him? how to break omega 3 and cod liver oil per day? further last two weeks he become more craving for food. is that mean bad gut bacteria growth or leptin deficency( our diet include more grains ans simple carbohydrate and not much fat)

    thanking you

    faithfully
    baskaran

    • Patrick Nemechek, D.O. 3 weeks ago

      Whether its traditional fish oil or cod liver oil, just dose them with the same omega-3 equivalent amounts.

  10. Ja 4 weeks ago

    Hi
    Dr Nemecheck.
    I have got question regarding spitting. In 11 months journey for 4 year old its on nd off process .we have 2 months of spitting nd then it stops for 5-6 weeks nd starts again.
    Lowering inulin didnt help at all.
    So is it kind of Ans dysfuntion which need more time / oil to heal or missed stage ??
    Thanks lot

    • Patrick Nemechek, D.O. 4 weeks ago

      Yes, it will recover with a little time

  11. Gaurav 4 weeks ago

    Hi Dr.,
    My kid 4 years old is on NP since July,2018. In second week of January , she was on vacation with her mother and her supplements got lost and we couldn’t give it for five days.
    Now since past one week , I am seeing a relapse. I have read the chapters related to relapse but I am not clearly able to make it off if it is Propionic or Inflammatory relapse or both. In either case , I am maintaining the same doses. Need your advice if I need to make some changes and how long will it take the things to be normal
    Inulin – 1tsp
    FO – 1000 mg
    EVOO – 1tbsp

    Thanks

    • Patrick Nemechek, D.O. 4 weeks ago

      No supplements leads to relapse. This is a good lessen to all – take your supplements with you when traveling.

  12. Anonymous 4 weeks ago

    Hi Dr.,
    Not a question but a request. Please plan a visit to India or other countries where there a lot of kids needing to see you. I know you are a very busy physician but please think about it. Parents with kids on spectrum want to meet you personally but its just impossible to come to US.
    I am sure if you plan one week visit , you will be fully occupied.
    Thanks

  13. Jen 4 weeks ago

    Good evening:
    Thank you so much for sharing in your knowledge to us. My son is four and has ADD, he was on you protocol for two months and was doing better overall until I doubled his fish oils. As it also turns out they have artificial coloring which I didn’t realize since they are the Nordic naturals brand, and based on your comments that could throw off his healing path. One more thing, he is also a child that gets sick easily- can I give him a vitamin C that comes from cherrys? Thanks so much for any advice. Blessings to you.

    • Patrick Nemechek, D.O. 4 weeks ago

      He shouldn’t need any supplements to recover from a cold.

  14. Juan 4 weeks ago

    My 5 year old is doing GREAT on your protocol, has never stopped progressing after 1 year and is well on his way to become neuro typical. On month 9 of the protocol he was still having stool impactation and encopresis, our pediatric GI prescribed Liquid Senna and Lactulose, he is now going every 2-3 days instead of every 10 days (the goal is getting rid of Senna/Lactulose after he starts going daily).

    There have been discussions about your opinion on Senna and Lactulose saying that you have changed your mind about them and that you were not recommending them anymore. Since my son has never stopped getting better on your protocol, I wanted to clarify if, is still ok to keep giving him Senna/Lactulose? Thank you for your time

    • Patrick Nemechek, D.O. 4 weeks ago

      They are both fine.

  15. Balaji 4 weeks ago

    Hi Dr.,
    My son is 4.5 years .I started giving my son “Inulin” from last 4 days with small quantity.I saw noticeable difference on 3rd day itself ,he is little hyper.At the same time, I noticed ‘mouth ulcers’ .I would like to know if it is normal.If not, what alternates I should provide him to get rid off ‘mouth ulcers’.
    Thanks,
    BG.

    • Patrick Nemechek, D.O. 4 weeks ago

      Mouth ulcers are not normal and possible just a reflection of the shifting bacteria. Continue with you increases of inulin and they should resolve.

  16. Antonia Pavlidou 4 weeks ago

    Hello Dr. Nemechek,
    My 6 year old asd son has been on protocol for six months. He has been taking 1 tsp inulin, 2 caps NOW and about 30 ml olive oil. There have been improvements in speech and in other areas, but I haven’t seen any reduction in stimming. He is also a bit hyper. I thought that I should decrease the fish oil to 1 capsule NOW dha. Would that cause a relapse or lose any gains that he has had so far?
    Thank you in advance.

    • Patrick Nemechek, D.O. 4 weeks ago

      Just make sure you’ve eliminated other supplements and probiotics and be a little more patient. The stimming will stop soon.

  17. Sarah Khalid 4 weeks ago

    Hi dr nemechek
    I’ve been on the protocol for almost a year for my son who is now 9 years old. He was a verbal HFA kid. I have seen many improvements and increased understanding in him since the protocol. He is on one tsp of Now Inulin, one tablespoon California Evoo and 2 tablets of dha 500. Should I increase any of the doses?
    He Used to do a lot of humming(his stimming) and now he will make stories constantly verbally without realising. And when I ask him to write them down he says he likes making stories out loud. And he still doesnot make friends and has selective mutism at school.
    Kindly guide me if he needs a dose of rifaximin? Or any upping of existing doses.
    Thank you!
    (Ps we live in Pakistan!) and have recommended your protocol to many people I know.

    • Patrick Nemechek, D.O. 4 weeks ago

      Your doses are fine.

  18. Margarita 4 weeks ago

    Hello, dear Dr. Nemechek,
    I am the mother of twins, Who suffer from autism. They are 6 years old. My children are hardly verbal. They hardly speak, only syllabic speech. In December they had nootropic treatment. Then I’ve learned about protocol . We stopped giving them Omega 6 at once. Since the 2nd January we have started protocol. Now they are taking Now Food, certified organic inulin, pure powder 1/8, California Olive Ranch, Arbosana, extra virgin Olive oil 7,5 ml. Now they have awakening period. One of the Boys during the hysterics has urination. That is not involuntarily, he makes it deliberately as a culmination of hysterics. If I near him, he goes to another room and does it there. I worry, because it is getting more often. Two weeks ago it could happen only once or twice a Day, now he can do it even in the street, when we go for a walk right into trousers. What can cause it? What can I do to stop it? How long can it last?

    • Patrick Nemechek, D.O. 4 weeks ago

      Yes, strange behaviors like this can be a part of the awakening and reflect the underlying developmental instability that is now visible since the suppressing effects of propionic acid are now gone.

      Cutting back on the dose of inulin and going up more slowly can help him (and you) through this.

      Watch out YouTube video about The Modified Protocol with Anxiety and Aggression.

  19. Jennifer Finley 4 weeks ago

    If blood results indicated positive HHV6 PCR and high HHV6 IgG, would you treat?

    • Patrick Nemechek, D.O. 4 weeks ago

      I high IgG titer for nearly any viral test is meaningless. Just indicates past exposure/infection and the high amounts generally occur with systemic source of inflammation.

      PCR testing is prone to lots of error as well depending on the virus tested and clinical circumstances.

      Best to have an infectious disease specialist help you with this question.

  20. Rafia 4 weeks ago

    Hi dr nemechek. My son is 4.5 yr old autistic
    I just started biomedical treatment for him 2 week ago and then I heard about ur treatment and join fb group I find it v effective. So my question is it ok to start ur treatment along with biomedical ?? Cz my son showing huge improvements already.

    • Patrick Nemechek, D.O. 4 weeks ago

      No, do not do both at the same time.

  21. Olivia 4 weeks ago

    What can we do with the vagus nerve stimulator without moving around your office, just with a Skype session, because it’s too expensive to move around thanks

    • Patrick Nemechek, D.O. 4 weeks ago

      No, I’m, sorry. It is against U.S. regulations.

  22. Olivia 4 weeks ago

    my daughter cringes a lot of teeth, she is on the protocol for 11months, according to you what is that cause? thank you

    • Patrick Nemechek, D.O. 4 weeks ago

      I’m not certain but most likely this is due to her underlying autonomic and developmental imbalance.

      This will eventually stop.

  23. Anonymous 4 weeks ago

    Hi Dr
    Can autism stunt growth? My 4yr old doing well 1 yr on protocol but is small in height and weight.
    Any views or experience with this issue in kids?

    • Patrick Nemechek, D.O. 4 weeks ago

      The bacterial overgrowth (SIBO) that is essential in trigger autism can also stunt growth through a variety of effects.

      Reversal of SIBO with inulin or rifaximin helps increase growth and normalize weight gain.

  24. Amal 4 weeks ago

    my son is diagnosed with autism is also tdha he is 14 years old
    I started your protocol for two weeks with him it takes just 1/8 ts of inulin and I stopped all omega 6 and just 1ts of olive oil but it is very tired
    what does that mean
    his fatigue worries me
    I still do not give him omega 3 because it increases for him the stimings

    • Patrick Nemechek, D.O. 4 weeks ago

      Doesn’t mean anything worrisome.

      I would add the fish oil, even in a smaller than necessary dose and slowly increase with time.

  25. Susan Smith 4 weeks ago

    please doc is their any kind of formula that has what my grandson need sin it? He is not consuming anything right now except carnation instant breakfast and milk and maybe rice cakes or chips( crunchy and salty foods). I am afraid he will not drink it if we add the supplements to his drink.

    • Patrick Nemechek, D.O. 4 weeks ago

      No there are not.

      Why not give it to him separate from the carnation instant breakfast?

    • Anonymous 4 weeks ago

      because other than mixing things with a fluid ,holding him down and squirting it in his mouth he will not take anything. He has sensory food issues and they are getting much worse.

  26. Gaurav 4 weeks ago

    Hi Dr.,
    This is question as well as observation. I switched to strawberry flavour fish oil from lemon based and gave to my daughter for one month. I think she has regressed clearly. I am kicking myself to think that more DHA could benefit her and hence I switched. I am pretty sure the regression is due to strawberry flavour.
    Doctor – How long would it take to undo the effects . I have started her back on lemon flavour.

    • Patrick Nemechek, D.O. 4 weeks ago

      Thank you for sharing your experience.

      Kids seem to regain their losses within a month

  27. Evelyn 1 month ago

    I have just purchased 5 bottles of Californian Olive Ranch evoo. However it is different to the last one and is labelled ‘destination’. The oil is certified to be extra virgin, but, is produced from more than one country and bottled in California.

    Can I use it or will it harm/disrupt the protocol for my daughter?

    • Patrick Nemechek, D.O. 4 weeks ago

      The problem with the Destination blend of California Olive Ranch is that the oil does not go under the same rigorous testing as the COOC-certified process. I personally would not use it.

  28. Cassie Solis 1 month ago

    Hello Dr. Nemechek,
    My son is 3 years old and we are fixing to start the protocal, he has been diagnosed with autism. My question is, he was a 1 pound premature baby in the NICU for 8 months because he got necrotizing collitous (medical nec) 3 times. He had to have a section of his small intestines removed along with a section of his colon because it died. Since he is missing a portion of these, should I start him on a lower dose of the evoo, fish oil and inulin, or should I stick with the reccomended doses in your book? For his age? Thank you so much we are super excited to get this rolling but want to do it right.

    • Patrick Nemechek, D.O. 4 weeks ago

      He needs the doses of each for his age but because of the smaller than average intestinal length, you may want to increase the dosage of the oils over 2 months to give the gut ample time to adapt and increase its capacity to absorb the oils.

  29. Lorena 1 month ago

    Hello Dr.Nemechek!
    Is corn polenta (corn flower) and baken allowed in your Protocol?

    • Patrick Nemechek, D.O. 1 month ago

      Yes

  30. Anonymous 1 month ago

    Is high fructose corn syrup allowed on your Protocol?

    • Patrick Nemechek, D.O. 1 month ago

      Yes

    • Manuka 1 month ago

      Hi Dr Nemechek,
      I started your protocol on our 12 yr old daughter and bought your book and have read halfway through. She is on carnosine, vitamin E and enhansa( turmeric). Do I need to stop these or can continue??
      I am giving her 1/4 inulin, 1 cap now DHA and 1 tsp EVOO and today upped to1/2 inulin and she had lot of stools ,some loose. I have upped inulin before too once to half spoon once a day and she had lot of BM and I went back to 1/4 teaspoon inulin.
      She is a very constipated child even with 1/4 cap inulin . Goes once in 3 days.. so though I am delighted but worried BM are not well formed. Should I continue at 1/4 inulin or stay at 1/2 inulin??

    • Patrick Nemechek, D.O. 4 weeks ago

      There is more information in the book as well as on our YouTube videos to answer these questions.

  31. Noelle 1 month ago

    My daughter is on this protocol for about 3months. Just to confirm if this millet/oat milk powder which contains Organic millet powder (USDA certified), Organic oat powder (USDA certified), DHA, Lecithin, FOS&Fructose, is okay to continue drinking while doing your protocol.thanks

    • Patrick Nemechek, D.O. 1 month ago

      Sounds fine. As long as it doesn’t have prohibited high 0mega-6 oils or probiotics you are OK.

  32. Jennifer 1 month ago

    Hi Dr Nemechek.! Thank you so much for the wonderful work that you’re doing. My question is related to ADHD. Have you ever found that any of your ADHD patients did not recover because their underlying issue was not autonomic damage? Or is it always autonomic damage?

    • Patrick Nemechek, D.O. 1 month ago

      If a general chemistry, blood count and thyroid panel are normal and there are no overt heart problems, ADD is almost always in large part autonomic.

  33. Martha 1 month ago

    I really wish there was a way to find your VNS in Europe… From the little I’ve researched, all available options here are transcutaneous…

    • Patrick Nemechek, D.O. 1 month ago

      Mine is transcutaneous as well.

  34. Saritha 1 month ago

    Hello dr
    I have a doubt you told homeopathic medicines not allowed. But if its a prescribed medicine such as if its helping anxiety stress and all like adhd medicine which other doctors giving can we continue that.

    • Patrick Nemechek, D.O. 1 month ago

      Yes but just be aware that if there is minimal recovery that you may need to try stopping it or switching to another medication.

  35. Pragya 1 month ago

    Dear Dr Nemechek,
    First of all , I want to thank you for giving hope to millions of parents across the globe. You are an angel sent by God to help the parents in distress and hopelessness.
    My 3 year 2 month old son has been showing ASD symptoms although he has not been diagnosed yet. I’m sure that he had digestive issues since he was young, so we are very hopeful that your protocol will help him. My concern is his frequent diaper rash (he is potty trained) which run up to his penile shaft. Doctors here prescribe us steroid cream for application each time we see them. Could this be due to SIBO? Will your protocol help this condition as well?
    Many thanks

    • Patrick Nemechek, D.O. 1 month ago

      I’ve never seen SIBO do this. Chronic rashes in that area can be from allergic reaction to soap or certain fibers in undergarments, eczema and psoriasis. Sometimes from candida but I doubt this since he is potty trained.

    • Pragya 1 month ago

      Thank you so much Dr. for your reply. Will your protocol still be beneficial if it’s not SIBO? I’m a little confused as psoriasis and I believe eczema too is an autoimmune condition. I have read many people seeing benefits on NP but I’m not sure. We have just started him on inulin on 10th January, so I thought that the recent flare up could be a sign that it’s working.
      Thank you again!!

    • Patrick Nemechek, D.O. 1 month ago

      Hsrd to say what the flair is from exactly but there is a growing amount of evidence that virtually everyone with an autoimmune disorder has SIBO to one degree or another.

    • Pragya 1 month ago

      Thank you so much dear Doctor. I really want to meet you one day.. I hope it’s not for my son’s medical needs.. just a casual meet where I can extend my heartfelt gratitude to you. . May God bless you and your family always. Thank you!!

    • Patrick Nemechek, D.O. 1 month ago

      You are very welcome and I hope we meet someday as well.

  36. Animesh K 1 month ago

    Dear Dr Nemechek.
    My son 6.5 year old, mild ASD, non verbal is on full protocol since past 8 months. Dosage: 2 tsp NOW inulin, FO,: 1.5 softgel NOW DHA and 25-30 ml EVOO. All approved brands, no probiotics, no supplements. We have not seen any gain in speech and awareness.He makes only irritable sounds /shouts..since past one year(before protocol irritable sounds were there..but less)
    We are desperately looking for gain in speech and awareness
    There are no negative impacts of inulin or FO. His body is tolerating them ineffectively. How do i know whether SIBO/propionic acid levels are being reduced or not?
    Is it right time to give him Rifaximin?
    Thanks

    • Patrick Nemechek, D.O. 1 month ago

      Occasionally when a child under 10 have little to no improvement and there was little to no sign of an awakening, I will recommend a 10-day course of rifaximin.

  37. Liz 1 month ago

    Hi dr Nemecheck!
    We are in the protocol since august 2017.
    We are presenting a plateau.. we have 6 months with no Advance. We are considering double the dosis of fish oil.
    But my question is “double” means jump in to the next age level? Or just add the same amount into the dosis?
    Thanks in Advance!

    • Patrick Nemechek, D.O. 1 month ago

      Double the starting dose for that age group.

  38. Kiki 1 month ago

    Hi Dr N My 11 yr old non verbal and high functioning was OK to deal with until later starts to pull his genitals and crying profusely. He seems to be in a bubble that will last btw5 to 15 mins. Will hit himself and looks as if he has a spasm. Just being on the protocol for 3 wks. Just wondering what it is and if we are likely to get gains from the protocol. He has been xrayed twice to see if any underlying issues but nothing seen

    • Patrick Nemechek, D.O. 1 month ago

      Probably some anxious behavior from the awakening.

      If so, it should lessen some by lowering the inulin dose and increasing more slowly

  39. RAMYA 1 month ago

    HELLO Doctor,
    my son is 7 years old.has heterozygous mutation for mthfr both genes.should i consider giving 5htp with your protocol?will it make a difference?

    • Patrick Nemechek, D.O. 1 month ago

      I would only give it if your neurologist thought is was necessary.

  40. Jennifer 1 month ago

    Hello Dr. Nemecheck, I was just hoping to ask you a question. We purchased your book and just started our 2.5 year old son. We want make sure we have everything correct. We purchased Nordic Naturals children’s dha Xtra. It says ages 1-6 and says great taste with a picture of grapes on the bottle. We know that you recommend no flavors, however we looked online, ultimate omeagas have pictures of lemons on them. We couldn’t find one that didn’t have a picture of a fruit on them. We just wanted to ask you if these are ok?

    • Patrick Nemechek, D.O. 1 month ago

      Well, we’ve only are suspicious about the strawberry flavoring and thousands of kids are doing well with the lemon flavored NN fish oil.

      Haven’t heard anything about berry good or bad.

    • Ella 1 month ago

      Why strawberry flavoring is suspicious?
      I am using it for my son. should I stop?

    • Patrick Nemechek, D.O. 1 month ago

      We had a few kids relapse after switching from lemon-flavored Nordic FO to strawberry-flavored Nordic FO.

    • Jennifer 1 month ago

      Thank you so much for your reply Dr. Nemecheck. My husband and I are planning to make an appointment with you for our son if we need to in the future. A big thank you from Pennsylvania.

    • Patrick Nemechek, D.O. 1 month ago

      Your welcome (from Arizona)

    • Jennifer 1 month ago

      Hi Dr. Nemechek, I just wanted to tell you something about the strawberry I think I just discovered. I watched your YouTube video on fish oil (twice), to better understand the differences between the dha/epa and decide if we should switch to the lemon one for our son. We then went online to buy the lemon and compared the ingredients with the berry one we have. They were exactly the same word for word. The berry one we have is a new product and has a good dha/epa ratio. I then pulled up the strawberry one to compare the ingredients. I noticed that one was made from cod liver oil and had a few other differences. The berry and lemon are from anchovies and sardines, and you were talking about that in your video. I just thought I would tell you or anyone else having problems with the strawberry flavor. Thanks for your time.

    • Patrick Nemechek, D.O. 1 month ago

      I don’t think the issues is with the constituents of the fish oil per say but instead lies with the varieties of chemicals used to create a strawberry scent. The fruit flavoring in the fish oils are from a wide variety of chemical compounds and not from the fruit itself.

      I wonder if one of the chemicals used to re-create the scent/flavor of strawberry is to blame. Mere speculation at this point.

  41. Deborah Djanie 1 month ago

    Hello Doctor Nemechek,
    My son whohas is 2.7 years has been on the protocol since August. We had an awakening at 1/4 plus 1/16. We have had good gains so far. I increased the inulin to 1/2 teaspoon in anticipation of other gains such as potty training but I have noticed some bad behaviors coming back. Should I go back to my previous dose or keep pushing. Thank you

    • Patrick Nemechek, D.O. 1 month ago

      Keep pushing and be patient.

  42. Olivia 1 month ago

    Hello doctor
    on the protocol since February 2018, I had encouraging gains, my daughter must see the dentist because she has several quarrymen, what put the fillings in her teeth can harm it remains that it is metals and I am not not very comfortable with that?

    • Patrick Nemechek, D.O. 1 month ago

      I personally have amalgam filings and I don’t worry about it.

      But if you are concerned, there are porcelain and other options that can be used.

  43. Deborah Djanie 1 month ago

    Hello Doctor Nemechek,
    My son , 2.7 yrs who doesn’t have an ASD diagnosis yet but has some delays had an awakening on 1/4 +1/16 inulin three months ago . I increased his dosage to 1/2 teaspoon in anticipation of more gains such as being potty trained. But I have noticed he has some old behaviors like opening and closing doors back and generally defiant and whining a lot. Is He experiencing another awakening or should I go back to my previous dose.

    • Patrick Nemechek, D.O. 1 month ago

      Doesn’t sound that bad. Might be a little more awakening or from a minor injury.

      Either way he should recover out of it

  44. Olesya 1 month ago

    My 6 year old child with ASD and speech impairment was on protocol for 6 months, with speech and occupational therapies for over a year. Recently started to have outbursts – screaming hysterically, crying. He became more verbal, his articulation got better. The only change in his routine was adding brain training program. I cannot find answers. If this becoming highly emotional is related to new addition or as a result of being on protocol.

    • Patrick Nemechek, D.O. 1 month ago

      The protocol won’t cause this kind of reaction. There are a wide variety of brain training programs so its hard to comment if this could do this.

      Sounds more like a injury (physical, emotional or inflammatory) might be responsible. Also, addition of other supplements and especially probiotics could trigger something like this.

  45. Hopeful Mom in New England 1 month ago

    Just another positive update: son continues on recommended doses of approved products. He said “help me” tonight when he didn’t want to leave the mall. Took our breaths away. Huge development for us. Is more interested and mimicking sounds we ask him to make. Stimming now reduced by around 20% from baseline after a two day uptick for him. Interesting is that he is choosing more visually intricate objects to flap (that is how he stims) such as jewelry instead of the usual (measuring spoon sets). He also seems to be making some more deliberate hand movements during stimming and looking more at the objects he is holding.

    Thank you.

    • Patrick Nemechek, D.O. 1 month ago

      Nice to hear of his improvements.

      Stimming comes in every imaginable form.

  46. Anupama 1 month ago

    Hello Doctor, My son now aged 5 has been on the protocol since an year with very slow improvements. He has socio communication disorder. He is on 2 tsp inulin since a long time with no real gains. I am wondering if I could put him on Rifaxamin since i cant see inulin helping him even with max does? Can you please let me know your thoughts. Thank you so much!

    • Patrick Nemechek, D.O. 1 month ago

      Fish oil and olive oils are also needed for recovery.

      Please read the protocol. A copy can be purchased at https://autonomicrecovery.shop

  47. Frosina 1 month ago

    Hi, I would like to ask about lactose intolerance and fructose intolerance, should the protocol be excluded from products that contain these substances or it is not necessary, my son has 6 years and on the protocol is 2 months, 1\2 tsp inulin and 1 capsule omega DHA DPA 500, 30ml fish oil plus cooking, we go slowly and he is doing fine.
    Lactose and fructose do not make him any problem when he consume them, so I wonder if he needs to fully avoid them and can this protocol resolve the problem whith intolerance? Thank you…regards

    • Patrick Nemechek, D.O. 1 month ago

      I routinely discontinue dietary restrictions after the children are on adequate doses of inulin or after using the rifaximin.

  48. Jasmine 1 month ago

    Hello Dr. Nemcheck,

    First of all, thank you so much for your help. My son has been on your protocol for 5 months with good gains. I saw the post about leucovorin. My son also got FRAT positive through a blood test, but we stopped after starting your protocol. Do you think he’ll need to start that again?

    Thank you

    • Patrick Nemechek, D.O. 1 month ago

      Probably not

  49. Kristina 1 month ago

    Dr. Nemecheck,

    My son still doesn’t spit out toothpaste. All fluoride free toothpaste has either xylitol or sorbitol in there. Which are both no-no’s for your Protocol. Is it okay on toothpaste? Does such a unicorn toothpaste exist? What do you suggest as far as toothpaste that won’t interfere with your protocol? Thanks!

    • Patrick Nemechek, D.O. 1 month ago

      Don’t worry about the toothpaste. It won’t prevent recovery.

      He’ll be spitting it out soon enough.

  50. Anonymous 1 month ago

    Hello Doctor,
    My son 6 year old is on the protocol since 1 month.He had little incremental gain in language and perception of his surroundings. Since 2 days his verbal stimming and hand flapping behaviour is high comparatively but he is not seeming confused or aggressive like before protocol.
    His dosage is olive oil cooked with curries just more than 2 ml, inulin morning 1/8th and evening 1/8th,2.5ml fishoil. Please guide me whether he is on right pathway.
    Thanks

    • Patrick Nemechek, D.O. 1 month ago

      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.

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