My child is on monthly rounds of Rifaximin and about to start the next round but is showing signs of developing a common cold. Should I start the round of Rifaximin as planned or wait?

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I generally counsel my parents to hold the next scheduled round of rifaximin for a few days until the child’s symptoms have resolved. If you are in the middle of giving a round of rifaximin or are using it continuously I recommend my patients do not interrupt the rifaximin even if another physician prescribes an antibiotic course for a middle ear or sinus infection.

My child is progressing nicely on monthly Rifaximin. When should I stop or switch to “as needed”?

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If a child’s recovery improved with cyclic/monthly Rifaximin. I recommend a minimum of 12 monthly cycles before trying to shift to intermittent Rifaximin.

After a few months of Monthly Rifaximin I am still not seeing any changes. What should I do?

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Even with monthly rifaximin, some patients still will not show evidence of recovery, and this is because they are relapsing even before the next course of rifaximin has begun.   If a patient is not showing any improvement after three months of rifaximin, I start these patients on non-stop, twice daily, continuous rifaximin along with five minutes of daily vagus nerve stimulation. nThe children are relapsing rapidly because of slow intestinal motility, often from autonomic nervous system damage.  I believe that the addition of vagus nerve stimulation in the patient will help insure their intestinal motility can improve to the degree that continuous rifaximin can ultimately be discontinued.

My child is not recovering well in some areas with monthly Rifaximin. Can I start vagus nerve stimulation (VNS) before trying continuous (daily) Rifaximin?

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The decision to try continuous rifaximin or add vagus nerve stimulation are two separate and discrete issues. If monthly cycles of rifaximin are not adequately controlling bacterial overgrowth, there will be little to no neurological gains after three months, and the increase to continuous rifaximin is warranted.nnThe addition of vagus nerve stimulation is based on whether or not neurological recovery occurs across all areas (speech, motor, socialization, hyperactivity, emotional regulation, etc.). If there is substantial improvement in some areas, but little to no improvement in others, then the addition of vagus nerve stimulation is warranted.

Behavior seems worse on Rifaximin. What could be going on? Is this common for the first several monthly cycles?

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Behavior can worsen on rifaximin as part of the awakening process. It should improve over 1-2 months. If not, I will increase my patients from monthly cycles of rifaximin to continuous rifaximin.

Is it ok to use Movicol while on the Protocol?

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Yes, Movicol and MiraLax are both approved to be used with the protocol.

Will will the anesthesia used to obtain an MRI or CT scan disrupt gut bacteria and trigger a relapse?

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The level of sedation required for these procedures is much lighter than that required for surgery, and I think because of this the risk of recurrent SIBO is much less.

Can a person with MTHFR do The Nemechek Protocol?

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Yes, they can. Finding a gene for any particular medical condition does not mean the gene is necessarily active. A common example is that many people with brown eyes may be carrying a gene for blue eyes. They have the gene for blue eyes, but it has not been activated. I have seen a wide variety of children recovering with The Nemechek Protocol® despite tests demonstrating the presence of abnormal genes or genetic deletions.

Is mucous in the stool a sign of inflammation?

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Mucous is a sign of regional inflammation, and it is best to report this to your pediatrician rather than just treating with rifaximin.

Can The Nemechek Protocol benefit persons with MS (multiple sclerosis)?

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Yes. The Nemechek Protocol for Autonomic Recovery is designed to reduce elevated levels of pro-inflammatory cytokines, and the presence of abnormally primed M1- microglia. These 2 pathological processes prevent recovery from brain injury, interfere with neuronal/synaptic pruning, interfere with brain development in utero, and are a key feature of the neurodegenerative disorders (Alzheimer’s, Parkinson’s, ALS). It is capable of reversing a wide range of chronic neurological conditions (migraine and cluster headaches, chronic fatigue, generalized anxiety, depression/PTSD, ADD/ADHD) as well as intestinal disorders (heartburn, reflux, IBS, constipation, diarrhea, etc.), and it’s potent anti-inflammatory effect substantially reduces symptoms associated with autoimmune disorders (Crohn’s, psoriasis, MS, rheumatoid arthritis, Hashimoto’s, etc.)