Constipation is a neurological condition caused by a release of methane from intestinal bacteria or an injured nervous system that is not adequately repaired.nnImprovement of constipation occurs with improvement in the balance of intestinal bacteria or a reduction of inflammation. The Nemechek Protocol lowers inflammation naturally and can dramatically improve the protocol.
If you are seeing progress across multiple areas but still have 1-2 areas, such as speech or constipation, that are not responding or have stagnant recovery then the recommendation is to add Vagus Nerve Stimulation (VNS) to kickstart recovery in those less responsive areas.
There are no treatments for constipation that will counteract or lessen the impact of rifaximin. I suggest asking your pediatrician if your child’s constipation is not responding to treatment.
I generally recommend a non-fiber supplement such as magnesium (Milk of Mag) or MiraLax. Vitamin C only helps constipation when it causes a toxic reaction in the gut that results in diarrhea, thereby helping with constipation.
A common mechanism for worsening behaviors in a child with autism is a decline in brain blood pressure. Many children with autism have dysfunction of their autonomic nervous system, making it difficult for the nervous system to maintain proper blood pressure and oxygen delivery to the brain. The nervous system responds by releasing noradrenaline to boost pressure and normalize oxygen delivery. Noradrenaline is best known as the “fight or flight” hormone and can cause aggressive, anxious, irritable behavior in children.nnThere are a variety of triggers that can strain the nervous system and result in a temporary drop in blood pressure further. Pain (dental issues, abdominal cramping), infections (middle ear or sinus infections), and intestinal cramping or straining to pass stool (vasovagal reflex) are capable of dropping the blood pressure further and triggering negative behaviors.
The worsening of constipation does indicate that bacterial overgrowth has been resolved and that the true extent of the ANS dysfunction has been revealed. Continued adherence to the protocol will slowly begin to improve autonomic function and constipation should resolve over the next few months. Until then I recommend using any over the counter constipation remedies on an as-needed basis)
I have a video that discusses the recent options I am using in this scenario. You can find it in the video library entitled “Rifaximin Failure: July 2022 Update.
If a child does not tolerate even tiny doses of inulin or PHGG, there is no option but to discontinue it.
After twelve months of continuous therapy, I recommend reducing rifaximin therapy to the monthly cycles of ten-day courses. If recovery stops again because of relapsing bacteria, I restart continuous therapy for the patient for another 6 months and then try to reduce to monthly cycles again. With more time, my hope is the monthly cycles of rifaximin might also be discontinued, with rifaximin only needing to be used occasionally.
If there is little to no improvement with continuous rifaximin, the small intestine is overgrown with bacteria not sensitive to rifaximin. These organisms can be archaebacteria from the colon or bacteria from the oropharynx.nnAdding daily inulin (1/4 tsp per day) to the rifaximin can improve the response and trigger improvement.nnThe use of additional or different antibiotics would otherwise need to be guided by a gastroenterologist.