If inulin fiber loses its effectiveness over time, or the side effects (hyperactivity, anxiety, aggression) are intolerable, I recommend the use of rifaximin (brand name of Xifaxan® in the U.S.) 550 mg two times daily for 10 days to reduce the excessive colonic bacteria from the small intestine in my patients.
Propionic acid control and brain recovery are long-term processes, and each aspect of the protocol (intestinal balance, olive oil, and fish oil) have different timelines. Since we still can not completely prevent bacterial overgrowth, there will be an ongoing need to maintain the intestinal balance using either inulin or rifaximin. The deficiency of omega-3 fatty acids and excess omega-6 fatty acids are due to the unhealthy food supply. Until there are widespread improvements, regular supplementation with omega-3 fatty acids from fish oil (at present) and olive oil are most likely a long-term health requirement.
Yes, inulin can be used indefinitely if it seems to be able to control bacterial overgrowth
The long-term use of daily inulin in children is very safe, inexpensive, and controls SIBO as long as it remains effective. Eventually, as the child ages, the inulin will likely fail, and bacterial overgrowth will return. At this point, the child will need to be transitioned to intermittent courses of rifaximin to control any symptoms that occur from bacterial overgrowth.
I recommend giving my patients 1/8 to 1/2 teaspoon of inulin powder, once daily. Beyond the dose of 1/2 teaspoons a day, it is rare to see any added improvement in symptoms and the higher dose has the potential to increase hyperactivity, hunger, thirst, anxiety, or aggression and may cause discomfort from excessive gas, cramping, or bloating. Members of the Nemechek Navigator can purchase Nemechek Blue inulin here at a 10% discount.
I recommend everyone starts at 1/8th tsp of inulin. Purchase discounted Nemechek-Approved Inulin here.
When switching from inulin to rifaximin, I recommend my patients start with monthly 10-day courses of rifaximin and assess the effectiveness over the next few months. If there is no evidence of neurological recovery after 3-4 months, the child is relapsing before the monthly cycle is even complete, and recommend that they move on to continuous.
There is a large amount of fraud within the nutritional supplement industry. We recommend brands known to be genuine and have a proven record of effectiveness.
I have found a wide variety of other supplements, herbals, etc., can prevent recovery and sometimes even cause children to lose recent gains dramatically. The brain is a very delicate environment, and the addition of many healthy-sounding nutrients might throw off the natural homeostasis required for the brain to recover. Other than the essential fish oil, olive oil, and inulin or rifaximin, I prescribe no other nutrients to my patients other than food.
Occasional use of Manuka honey should not cause any problems.