Simply follow the inulin dosing instructions from my book. A dose of inulin that is too high can impact cerebral blood pressure and trigger issues such as excessive hyperactivity, anxiety, agitation, and extreme thirst or hunger. An inulin dose that is lower than I suggest might not be effective. Members of the Nemechek Navigator can purchase Nemechek Blue inulin here at a 10% discount.
If there has been no substantial increase in recovery over a 2-3 months despite taking inulin and there is no interference from probiotics, antibiotics, supplements, or a chronic illness, the child has experienced inulin failure.
I am not sure why inulin failure occurs. Still, I speculate that a different species of bacteria that is unresponsive to the prebiotic effects of inulin now inhabits the small intestine. nAs children age, the inulin becomes less and less effective at controlling bacterial overgrowth. I believe this is due to the natural maturation of the intestinal bacteria as children mature into adulthood. We are not just trying to suppress “gut bacteria” as a singular entity; we need to suppress and balance over a thousand distinct species within the large intestine, all of which have unique characteristics.nThe species of bacteria that tend to overgrow in the small intestine of a younger child (let us call them species A) may tend to be more sensitive to the prebiotic effects of inulin. As a result, inulin is more effective in younger children.
The primary reason inulin fails to control bacteria overgrowth is that the bacteria overgrowing is not sensitive to the acidification prebiotic effects of inulin.
Inulin and rifaximin are the only products I use to rebalance or re-arrange bacterial overgrowth. I do not use or recommend using any other fibers, prebiotics, antibiotics, or herbal remedies.
Inulin Failure (also referred to as the Plateau) is the least common response to The Nemechek Protocol®. If no significant improvement in autistic or developmental issues is observed after the first three to six months on the protocol, I consider the inulin to be ineffective and refer to this as “inulin failure.” At this point, I will suggest shifting from inulin to monthly rifaximin.
Unlike other common antibiotics, rifaximin does not lower intestinal bacterial biodiversity, and the development of long-term bacterial resistance to rifaximin is rare even with continuous, daily dosing over a year or more. Although bacterial resistance to rifaximin occurs very rarely, the resistance quickly disappears after discontinuing rifaximin for only a few weeks. The rifaximin can then be restarted with the same positive effect.nn
Extreme and intense hyperactivity, anxiety, and/or aggression are the key features of inulin intolerance. But bear in mind that many children will increase these behaviors early in recovery during the Awakening, and these are two very different situations. nnChildren with increased anxiety and aggression due to inulin intolerance often had little to none of these behaviors before starting inulin. Children with increased aggression and anxiety due to the Awakening often had significant pre-existing negative behaviors that have just escalated. nnIf there is any confusion over whether you are dealing with inulin intolerance, I recommend my patients stop the inulin and switch to rifaximin.
Occasionally some children will have a very intense reaction to inulin even at extremely low doses. The most common extreme side effects of inulin are increased hyperactivity, anxiety, and even aggression. An awakening reaction from the reduction in propionic acid may have an identical intensity and appearance as inulin intolerance but can often be determined by prior history.nnChildren with increased anxiety and aggression due to inulin intolerance often had little to none of these behaviors before starting inulin. Whereas children with increased aggression and anxiety due to the awakening often had significant pre-existing negative behaviors that have just escalated. nnIf there is still confusion over whether you are dealing with inulin intolerance or an awakening effect, I recommend my patients stop the inulin and switch to rifaximin.
Occasionally some children will have a very intense reaction to inulin even at extremely low doses. In some children, the increase in anxiety, aggression, and hyperactivity is so extreme that inulin needs to be discontinued. I refer to this situation as “inulin intolerance.” Some children will have these reactions even at doses a low as 1/32 tsp or 1/64 tsp of inulin per day. The best option is to discontinue inulin entirely and treat the patient with a ten-day course of rifaximin. Rebalancing the intestinal bacteria with rifaximin does not result in the same type of adverse response. When starting rifaximin after inulin intolerance, I often recommend starting the children on repeated ten-day cyclic rifaximin each month for a minimum of twelve months.