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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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Juliana
Juliana

Hi Doctor!

An 8-year-old child who has high HPHPA level, can use riflaximin?

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

Yes but I would try the inulin first.

Monica
Monica

We have been on the full protocol only 18 days and modified protocol since last summer. Since starting inulin 18 days ago, have run into several issues. My daughter is 18 months but no diagnosis. Suspected ASD and possible speech apraxia. We started with 1/8 tspn and she broke into a fever and diarrhea. I dropped to 1/16. Fever was only one day and diarrhea slowly improved back to baseline over 14 days even with some conscription in there now. Additionally she started having some very concerning motor movements- – cocking head to the right, walking with arms straight out… Read more »

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

This is very abnormal. I would stop everything and follow your neurologists advice. It most likely has nothing to do with the protocol and is just a coincidence.

Renee Gray
Renee Gray

Hello! I’m curious why dosing is done by age vs weight? For example my daughter has Cerebral Palsy and Lennox Gastuat Epilepsy. She’s 11 years old but tiny weighing in at only 50 lbs… much smaller than the average child her age. Does she still need the recommended dose for her age?

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

This is obviously and extreme weight issues and some accommodation of the guidelines can be made.

For instance, no one really knows if fish oil should be dosed by weight or age.

Jadzia
Jadzia

Hey. I have hashimoto,sibo, ibs, gerd and mast cell disorder. I am after giving birth and I can not put on weight. Should I do a low-carbohydrate diet outside the protocol?

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

Low carb dieting while safe can worsen low brain BP symptoms early in the course of treatment. I generally have adults wait until they have been on NP for 3-5 months before starting a carbohydrate reduction of 100 grams or less.

Children do not need specific low carbohydrate reduction

Anne
Anne

My son has been on the protocol for almost a year now with almost no cognitive gains, though he doesn’t get sick as much and we are grateful for that. We cook a lot with EVOO, but I stopped giving him his extra tsp dose because it was giving him uncontrollable diarrhea. He is on 2 tsp of inulin and 1 soft gel of NN ultimate Omega. He has a diagnosis of global apraxia and autism. Any advice that may help us see more cognitive gains? Thank you!

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

If there are no gains what-so-ever after a year (or even 6 months), I recommend stopping the inulin and treating with Rifaximin.

Magdalena Czyż
Magdalena Czyż

Hello, What can be caused by loose stool a few days after finishing rifaximin?

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

Rifaximin can but it ttypically resolves within a week or 2 as the bacteria re-establish a new equilibrium

Salma
Salma

Hello Dr , My son 7 years old with a rare eplipsey disorder ESES/landeau kleffner usually it is misdiagnosed as autism , this eplipsey affects kids with same traits of autism.He is taking Valium and vimpat to treat his seizures.When i read proponic acid effect is simar to valium , i get worried as my son is taking valium.Will valium affect his recovery? -He has milk allergy that was severe from 4 years ago leading to bleeding and esinophilic enteritis. His allergy is under control with milk free diet. -He is very senstive we started protocol many times before and… Read more »

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

You might want to just start with rifaximin and see if this gets you past the problems of inulin intolerance.

Sudha
Sudha

Hello doctor
My son is 11 years old .He is highly verbal with obsessive behaviors.He has been on protocol for 6 months.I started with 1/8 of inulin and increased to 1/4 to 1/2 to 3/4 but still with no change in behaviors.so tried rifaximin from India but on the second dose he developed fever of 100.8 .I am concerned .please advise .I stopped antibiotics and fever was gone.

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

The determination if the fever is from an allergic reaction needs to be made between you and the child’s pediatrician.

Pearl
Pearl

Hi Dr Nemechek. I would really value your advice since I’m a big believer in your protocol, but we are having some issues. After several months of following the protocol religiously and the development of unmanageable behaviour (aggression, anxiety, OCD) from my 7 year old who has ASD and ADHD, I have now stopped the inulin on your advice to another parent. I had hoped it was just an awakening but it wasn’t getting any better – even on a small amount of 1/16th tsp daily. His behaviour has already improved after three days of no inulin. Do you now… Read more »

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

The lack of any improvement leads me to believe the inulin was not at all effective and in this case rifaximin might be beneficial.

Just a note to other parents reading this: This is a completely lack of recovery. Treating a child with rifaximin who is already showing recovery with rifaximin will not speed up the recovery.

Mushabir Zaki
Mushabir Zaki

Hi Doctor! If, after taking any or all 3 protocols (Inulin, FO, EVOO), the child vomits within 30 minutes after intake, are we required or can we re-give the same dosage? TIA.

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

It’s a hard call. Depends on how much vomit, is there oil or capsules in the vomit, etc.

If the child is very ill from a virus, etc, you might just skip the day and let them recover before trying again.

Smunch
Smunch

Hello Dr Nemechek!

I am writing to ask about rifaximin for my child who has been on your protocol for 7 months. I have concluded that I will need rifaximin for my child’s recovery due to the age being 12. However, I understand that there can be situations relapses can occur post-rifaximin.

– Will a child regress if we are unable to procure additional rounds of rifaximin?

– Are there situations where rifaximin is insufficient to clear the field and relapses recur more frequently?

Thank you.

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

Q1 – Some children will relapse with or without reason, so additional rounds of rifaximin might be required.

Q2 – Frequent relapses are often not due to the effectiveness of rifaximin but due to slowing of the intestinal track due to autonomic dysfunction. This improves after a few to several months on the protocol. Intestinal motility drugs do not help this.

M k
M k

Hello, we’re booked in to see you in June. Next week I’ve been referred for a gastroscopy and colonoscopy (fun). Is there anything extra I should be doing on top of the nemechek protocol to help repopulate my gut after such a clear out?

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

2 points: 1. These procedures will not cause any loss of bacterial species. 2. The procedures might worsen or temporarily improve bacterial overgrowth. I know of nothing that can reliable influence what might happen.

Alexandra Dunnison
Alexandra Dunnison

I am a cognitive consultant focused on neuroplastic interventions and one of the things I follow is neuromodulation devices. As well, my son and I are both on NP. For these reasons I am interested in the benefits of the VNS and am aware of importance of the vagus nerve in terms of its impact on all our organs, inflammation, etc. . My question is in regards to the eTNS. You are probably aware of the eTNS developed by NeuroSigma that has just been approved. by the FDA. It is said to be beneficial for some learning, attention, and several… Read more »

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

The amount of research concerning trigeminal stimulation is very limited compare with VNS.

The thoughts about the linkage between the trigeminal and vagus nerves is speculative at best. Each nerve has its own function and purpose from a functional neurological perspective. n other words, they are clearly not the same.

Ella agbettor
Ella agbettor

Doc what is your thoughts on stem call therapy, I have tenagee am helping on the protocol and he is not making much progress and wondering what next, thanks

My younger son on the other hand has done remarkably well on np

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

The primary benefit of the NP is that by reducing inflammation, it activates stem cells.

The Nemechek Protocol is endogenous stem cell therapy.

lesya
lesya

Dear Doctor, My son 3.5 years old have some speech delay and a few months ago developed tics. He has stomach issues since birth and vomiting a lot. We have purchased your protocol but started him by taking Omega -3 DHA 550.Also we added Olive oil 1 teaspoon daily. He also taking Vit Complex B, Magnesium and calcium. Please correct us if we doing anything wrong. We will begin inulin in a couple days.
Do you recommend natural remedies – TIC TAMER- to relive his tics?
His speech has improved. Please help!!!Thank you very much!!!

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

The advice I give is you need to actually read the protocol and follow my instructions as written.

Shoba
Shoba

Hello Dr. Nemechek, Thank you for your immense guidance and support to the special needs community. I have a 16 year old daughter who had birth hypoxia (oxygen deprivation at birth due to umbilical cord wrapped around her neck). She has overcome a lot of her gross motor delays. However, her speech has been impaired significantly. We would like to start the protocol for her. Can you suggest the best plan for us to get her started? Should we start with Inulin (1/4 tsp) for the first two weeks and then add the fish oil and then the Olive oil?… Read more »

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

Please read the protocol before starting. It will instruct you on how I would dose a child such as yours under my care.

Tatty
Tatty

Dr. Nemecheck,
My son had some labs done and it showed him having Enterobactor bacteria, which explains behaviors in him. My question to you is will Inulin take care of this?
My doctor know about the protocol and no probiotics suggested 2 supplements to take care of this bacteria. What should I do, please advice? Thank you,

Tatty

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

There is no scientific evidence the Enterobacter species are responsible for any specific symptoms.

Stick with the protocol as written and that means avoiding other supplements

Ramina
Ramina

Hello, Mr Nemechek! We know that there is a video, where you were talking about different kinds of recommended olive oil. Someone says, that you don,t recommend california olive ranch of all harvests at all. Can you comment this? Thank you

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

I don’t recommend California Olive Ranch’s new “Destination Blends” because they no longer have COOC certification

lesya
lesya

I am looking for more information. My son is 3.5 years old and developed tics. Need help. Thank you!!
He also has speech delay. Dear DOCTOR, please proved any information to help me. I have started him on omega-3 DHA 550 and 1 teaspoon of olive oil. Please help. THANK YOU!!!

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

You need to buy the protocol and read it. It will answer many of the questions you’ll have.

You can purchase a copy at https://autonomicrecovery.shop

Nicole Slavin
Nicole Slavin

Dr Nemechek, my 5 year old has been on the protocol since September 18. His daily seizures have not improved at all. He has made some language gains but then lost them months ago. He is a NEC survivor and is missing the valve between his long and short intestines. Can the protocol work for him with this part of his anatomy missing? The seizures seem to suggest his gut is not healing.

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

With a history of NEC and a missing ileocecal valve, your child might need more than just inulin to control overgrowth.

Assistance with this would require an in office consultation

Julia
Julia

Hello, Doctor. What do you think about herpes viruses, cytomegalavirus, Ebstein-Barr virus? can they also be autism triggers? How does the protocol work in this case? Or we should contact a virologist for antiviral therapy.

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

CMV and EBV viruses are common viruses and are not triggers and do not need to be treated (even if the tiers are high).

Natalya
Natalya

My daughter is 11 years old. She is non-verbal. On a protocol of 5 months. During the protocol began to get fat. Now she has an extra 7 kg. Maybe we need rifaximin? Our pediatrician suspects that overweight is caused by inulin.
Our doses: inulin – 1 teaspoon, dha500 – 2 capsules, olive oil – 1 tablespoon.

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

The inulin does not cause people to gain weight.

Latifa
Latifa

Hi Dr.Nemechek ,
Could biocidin ( natural antibiotic ) replace rifaximin ?

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

No

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

Overgrowth of gut bacteria causes a substantial amount of systemic inflammatory stress such that I cannot attain autonomic recovery without substantial reversal of SIBO. Inulin is inexpensive, readily available, does not contain digestive enzymes or probiotics (both of which often prevent recovery) but most importantly it works. A child with only cumulative brain injury (your standard kid with ADD but no developmental issues) still needs control of SIBO in order to adequately recover. SIBO must be present because it tis the most common mechanism that triggers priming of the M1-microglia. Fish oil and EVOO will help reduce inflammatory stress not… Read more »

Alberta
Alberta

My 4 year old son has been on the protocol since August 2018. I recently posted here of the many gains we have chalked. Am from Ghana and finally I got the COOC Certified EVOO.So I completely stopped the one we were using. So we currently use only the approved brand. Unfortunately he started shouting so much, many tantrums and crying. I haven’t changed doses. The only thing thing is the addition of the approved brand of olive oil. He has stopped using some words he used to. The positive thing is he sleeps through the night Please can the… Read more »

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

Look for a source of relapse other than the olive oil.

Bill
Bill

Hi Dr. Nemechek, I have a question about tVNS. My son is 3.5 years old, diagnosed with ASD and SPD, non-verbal and has been on your protocol for 6 months now. Read the book first, watched your YouTube videos, everything I could find to educate myself. He is on no supplements, no probiotics, all approved brands. He’s had some small gains (better eye contact and chronic constipation has largely resolved) but a tremendous amount of negative behaviors have developed (head banging being the most disturbing, but lots of emotional dysregulation and meltdowns) and no real improvement in speech development. My… Read more »

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

If there is no general improvement to the base protocol then I worry about inulin failure and will treat with Rifaximin.

Tracie
Tracie

Hi Doctor Nemechek. Thanks for your amazing work. You have recommended many times to reduce the level of inulin during difficult ‘awakenings’ or ongoing aggression/anxiety. You’ve also mentioned in a post below that these difficult behaviours are not due to the fish oils buy might be that the SIBO has returned. How do you balance the low inulin levels that are reduced to lower aggression with preventing SIBO? What are the signs to look out for that SIBO has returned and then should inulin be increased back up even with difficult behaviours?

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

It’s difficult. This is a balancing act for sure.

Deanna
Deanna

Dr Nemechek, I feel off balance 24/7. I have blurry vision, brain fog, tinnitus, chronic fatigue and heavy metals. I’ve been diagnosed with mold, Lyme, CFS, MCS and heavy metals. Would this protocol help me? If so, what’s the best way to get started to heal especially the constant off balance feelings? I appreciate any feedback you may have. I’ve riled out menieres, crystals, vestibular issues etc. Thank you!

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

It very well could. The dosages for adults with autism were originally developed for adults without autism, and are the same dosages I use today.

John
John

Dr Nemechek, My 3/m son has been on the protocol for 7 months months now. Over the last 3 weeks we’ve been experiencing what I believe to be inflammatory relapse due to a recent illness. He’s very sensory disregulated, stimming is back to baseline, he’s back to having meltdowns, and is really having a hard time focusing. The thing that is throwing me for a loop is that he is back to having diarrhea 3 times per days. This is the first time we are seeing this with inflammatory relapse. We haven’t made any dietary changes, and no new supplements.… Read more »

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

I’ve seen this a couple times. Try stopping the oils for a 3-4 days to give the gut a little rest.

Usually the diarrhea stops and you’ll be able to add them back in a week or so.

Geetu Ahuja
Geetu Ahuja

Hi Dr Nemcheck,
I have a 10 yr old .. some docs say it is Aspergers, Some say ADHD. completely verbal but lot of repeatitions as well. he also has nocturnal seizures once a month. some people in his father’s family have history of Autism and epilepsy Will the protocol help? Pl note he is also on AEDs. Have been giving him Nordic Naturals fish oil. seen a bit of improvement in language

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

Yes, the protocol will help him in spite of the precise diagnosis.

jamuna
jamuna

Dear Doctor

our boy on your protocol almost year. we add spices and culinary items(like pepper, ajwon, basil, garlic, ginger, cumins, black cumin, rosemarry, centella asiatica, Bacopa monnieri and so on…) regullar basis. could we add those along your protocol or not?

thanking you

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

As part of normal cooking, yes. In higher dosages as a homeopathic or herbal treatment, no.

Nadyia
Nadyia

We just went up to 1/8 teaspoon of inulin and seems like he is more tired and wants to rest his head down on his desk or even lay down when doing activities. He is also on guanfacine prescribed by a neurodevelopmental pediatrician. We are seeing more of this issue now than with the guanfacine alone. How were you able to link cerebral hypoperfusion with inulin intake (I tried looking at literature and was not able to find much) and how do you measure for this. Since guanfacine reduces blood pressure need we be concerned with the combo?

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

Yes but guanfacine and inulin can lower cerebral blood pressure but I don’t think I’ve ever seen inulin do it at his low dosage.

Nadyia
Nadyia

Thanks, what test can be done to evaluate low cerebral blood pressure. Can it be measured by regular blood pressure?

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

No. Standard arm BP measurements do not always reflect low cerebral BP.

Thee are no readily available methods to measure brain blood pressure outside of the research environment.

Clinical symptoms are a very strong indicator of low brain BP

Parent
Parent

Hi Dr Nemechek,
The highest quality certified CBD oil in the UK is Provacan. It is also Kosher certified.
Do you think it will interfere with the protocol?

Thank you.

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

I do not need CBD to help my patients recover.

Renee
Renee

I age regressed to my late 20s and am currently in my late 30s. Is this some kind of age regression/dissociative identity disorder or an awakening!?!?!?!? So… I’ve been doing the Nemechek protocol for 3 years (basically fish oil). I’m in my late 30s and my mental health has declined after my pregnancies and through a stint with PTSD 6 years back. Basically, I had this weird change. I acted just like I did from my 20’s years ago. I was quite healthy, quite confident, etc. I immediately thought that I was recovering some lost part of my brain.. and… Read more »

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

Don’t overthink this. Maybe you are just finally feeling healthy again.

Noelle
Noelle

The Paediatrician has just prescribed 70daysof 1.5mg melatonin for my child’s sleeping issues. She is on your protocol for more than 5 months. She has sleeping problems prior your protocol. I am wondering if the above medication would interfere with your protocol.thanks

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

Generally it doesn’t but always be suspect that any supplement, herbal or homeopathic remedy has the potential to prevent your child from recovering.

SunnySideUp
SunnySideUp

Could you recommend a brand of algae DHA/EPA please? Fish oil gives us nasty histamine reactions, even in tiny amounts. Algae oils seem fine. Fish don’t produce the DHA/EPA themselves, they get it up the food chain from algae. Technically, these should work the same

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

Sorry but I do not have a recommendation for algae omega-3.

Lee
Lee

Hi Dr Nemechek. I have a question regarding t-VNS. If the vagus nerve runs down the ‘bowl’ of the ear right next to the ear canal, why do you not clip the electrode to that part of the ear and recommend the tragus or concha instead? Is it potentially harmful to stimulate the vagus nerve directly?

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

I am not certain what you mean by the “bowl”. That is generally what the concha is referred to as.

Amanda
Amanda

My 4.5 YO son has been on the protocol since January 1. Has been tolerating the program well (all the recommended brands and dosages) and has had some decent gains. In the last month he has begun having emotional episodes — crying and sad for no particular reason. Because we also give him eggs and salmon with omega 3s we thought he might be getting too much Omega 3s. For a week we stopped the Omegas, the Olive Oil (cause we weren’t sure), the salmon and the eggs. We stayed on the inulin. It took a few days but the… Read more »

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

I’ve never seen the oils (or other foods) cause this unless there is still some bacterial overgrowth remaining.

Kelsey
Kelsey

I just finished your book and want to begin the protocol. My Daughter is almost 2. She is undiagnosed with ASD but displays many delays and symptoms. Can you suggest which fish oil would be best for her (gummies or liquid) … I know this is all in your book but I just don’t want to mess with her anymore than she’s already going through. she weighs 31 pounds if that helps dose. Do you have a specific inulin you prefer? Through my research they are available from different roots/sources (agave or chicory etc). I wasn’t sure if one was… Read more »

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

It’s written in the book. There is no need for me to repeat it here.

Kimberlee
Kimberlee

Hi Dr. Nemechek, My adopted daughter was born a premie at 2.75 pounds and her brain MRI does indicate she had tiny brain bleeds from that. She was malnourished until we got her at the age of 2. She has been labeled with severe apraxia. She has been diagnosed with adhd as well….cannot stop moving. She is currently taking Ritalin to help her focus more. She has huge speech delays and cognitive delays. Do you feel like your program can help kids in this situation? If so, I’ll be happy to stop her other supplements but can she remain on… Read more »

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

Yes, there is hope she still has the ability to repair her underlying injuries and developmental issues. With a history of brain bleeds I would also generally recommend vagus nerve stimulation if at all possible.

Kim Jones
Kim Jones

While discussing the protocol with our neurologist today, she brought up a medication called Nacetylcysteine that also addresses proprionic acid. I’m curious about the comparison of outcomes between the medication and the protocol.

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

I’m uncertain how NAC is suppose to stop gut bacteria from producing propionic acid.

Fan
Fan

Hi Dr. Nemechek, my question is could I increase inulin to my child by adding micro-doses every 3-4 days? In Nov 2018 I have started your protocol on my child with 1/8 tsp inulin and after 3 weeks I have increased to 1/4tsp, as I have seen no gains. Unfortunately this has caused an extreme increase in hyperactivity and aggression. In Jan 2019 we decided to decrease the inulin to 1/8 and slowly (where are no gains still) increases it by 0.04mg every 3-4 days, so that he gets used to it. This way it is working – not so… Read more »

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

Its rare for me not to see some mild awakening at an 1/8th or 1/4 of a tsp of inulin. Most often the parents are looking for something too drmatic to qualify as the “awakening”. Maybe it was a poor choice of words but many kids exhibit more of a “coming out of a slumber” than an “awakening”. A real increase in awareness and responsiveness They might just be more observant looking at people or out the window of the car. You may not need to say their name very often to get their attention. This is where the Cookie… Read more »

Tatty
Tatty

My son is 6 years old and currently on 8th week of NP. First week was amazing “ Awakening “ it seemed like, second week began behaviors, stims, regression, meltdowns. However on 4-5 week he started complaining of pain tip of fingers wanting ice, gradually has gotten so bad pain entire hands, feet, and cheeks. He will not hold our hands or be held much he complains of feeling pain ice seems to soothe. Please what could this be? Will it go away? Dose 1. NN 3 gummies 2.Oil 1 tsp 3. Started at 1/2tsp down on 3rd week admin… Read more »

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

Very unusual. Stop all supplements and consult your pediatrician.

If the pediatrician cannot find anything, and the symptoms have resolved, add back the supplements one at a time with a few weeks between each.

Also be certain your supplements are the correct brand and have not spoiled in storage, etc.

Pragyan
Pragyan

Hi Dr.Nemecheck, my son 5 years of age has been prescribed a homeopathy medicine for 3 days due to cold,( no long term medication) is it allowed on the protocol ?

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

The short term use of medications is allowed.

baskaran yogarajah
baskaran yogarajah

dear dr nemechek my 6 year old nephew on your protocol without Supplementation since december 2017 . he have some improvements (no constipation, understand words, and sp on) but still non verbal . we gave him 2.8 gramm now Inulin , 1000 mg nordic natural pro Omega 3, and 7.5 ml California EVOO per day. we had one skype session with you . thank so much for your golden protocol . last four month he have some trouble in ear , Always he rubbed his ears, we have visited ear specialist and they didn’t understand any reason , and now… Read more »

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

If a basic examination is unrevealing, I don’t think anyone can fully explain this behavior. I can’t imagine borderline low levels of Vitamin D or iron (or any other supplement for that matter) causing this.

I find these behaviors completely resolve on their own over time.

P C
P C

Hello Doctor, we gave a round of Rifaximin to our 10 year old. This was a month ago in February. Did not see any symptom of awakening or any gain or loss in skills/behavior. Just a plateau. We give him 3 Capsules Now DHA and olive oil in cooking and 1 teaspoon over food. Can you guide us if we need to change something to overcome this plateau? Thanks

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

Sounds like you need to wait for things to improve.

Ivan
Ivan

Hi. What are your thoughts on the theory that some people with high levels of acetylcholine might have a negative response to fish oils, especially in high quantities? Could this explain some of the increased levels of anxiety and behaviour problems reported by certain parents?

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

I don’t believe it.

Carla
Carla

Hi Dr Nemechek. Please help… my 7 year old son has been on the protocol for 4 months, and despite exercising extreme patience, his behaviour has deteriorated to the point where he is angry and anxious all the time. He has become very obsessive about small things and can’t calm himself down. I have reduced inulin right down to 1/16 of a teaspoon. My question is this: I find it hard to believe that such a tiny amount of inulin can be responsible for this extreme change in behaviour – is there anything else that might explain it eg. changes… Read more »

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

Stop the inulin and see if it resolves. If so, he will probably need rifaximin.

Lusine
Lusine

Hello, Dr. Nemechek. I started the protocol with my son on February 9, 2019. My son is 10 years old, ASD, non-verbal. I have a question about inulin and rifaximin (olive oil and omega-3 I give recommended brands in recommended doses of the protocol). I started with 1/4 of inulin and every 2 weeks I raised the dose of inulin by 1/8 of a tea spoon. Since March 10, I already give 1/2 tsp. So far, I do not see awakening and visible changes in behavior. I have two questions: 1) Please tell me if I can raise the dose… Read more »

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

I think this is best answered by the pharmacist/chemist who prescribed this particular brand of Rifaximin (there are many and they differ).

Marco Vespa
Marco Vespa

Hi Doc, How does the macrophage transport of Aluminum into the brain related to vaccination play a role? If its a Proprionic acid issue, if you lower the levels , but still have vaccine induced insult, how would this play out with your protocol? Would that still not prime microglia? Thanks!

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

Apparently not too much since the children seem to have significant recovery that is microglial dependent.

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