My child has been having difficultly sleeping since starting the protocol. Is that normal?

Increased insomnia sometimes is part of the awakening and often resolves with 1-2 months.

When might my child first respond to treatment?

Depending on the severity of a child’s underlying developmental delay, children may start making eye contact, becoming more aware of their surroundings, allowing more physical contact, or otherwise communicating and speaking more within a few days to weeks of starting the protocol.

We just switched to rifaximin and on day two of administering it, my child’s behavior has gotten worse. Can you experience awakening so fast on rifaximin?

Yes, the awakening can occur within 1-2 days in some cases.

Is it possible to get an awakening just from the fish oil and olive oil?

I don’t think so. As I described in my book, the awakening refers to the drop in propionic acid that occurs after reversing bacterial overgrowth. This typically occurs within the first 1-2 weeks. There is no evidence that fish oil and olive oil can do that specifically. Improvements from inflammation reduction by fish oil and olive oil might be noted 4-8 weeks later, and I can see someone referring to this as an awakening. However, this would be just from improvements in brain function and not the elimination of the sedating effects of propionic acid.

We started the protocol and my child seems worse. What went wrong? What should I do?

When starting with inulin, sometimes the child will exhibit some positive and negative behaviors in a process referred to as “the awakening.” If the proper brands and doses of inulin fish oil and olive are used, the negative behaviors often start improving in 4-6 weeks.nnOn occasion, the inulin itself can cause an increase in hyperactivity, anxiety, and sometimes aggression. These negative reactions often occur when using more than 1/4 tsp of inulin per day. The higher the dose, the worse the negative behaviors. If this is the case with my patients, I recommend stopping the inulin and starting monthly rifaximin.

Since starting the protocol two months ago my child has developed some strange new behaviors but we have not seen any improvements. Does that mean it is not working?

The Awakening can be a very confusing time for many parents, but it is normal to see more confusing behaviors in early recovery than actual gains. That is because the ultimate goal of The Nemechek Protocol is to lower excessive inflammation. Only once inflammation is reduced and maintained can the brain shift into repair mode, and recovery starts. Reduction of bacterial overgrowth with Inulin or Rifaximin is just one way that we lower inflammation. The fish oil and olive oil each provide further reduction via different mechanisms. The oils, however, can take up to 6 weeks to fully start working, so in many cases, you need to wait 6-8 weeks to get to the point where gains start happening. Just hang in there, and things will begin to improve.

Since starting the protocol my child has become disruptive and has developed some strange behaviors. I am worried that my child is regressing. Should I stop?

Eliminating the sedative effect of propionic acid will give a child’s parent a sense of potentially how neurologically imbalanced their child is. Some behaviors may seem worse because the propionic acid suppressed their ability to act out these behaviors as a drug. nnSuch behaviors might be stimming, anxiety, aggression, hyperactivity, or sleeplessness. Parents are now seeing their child for the first time without the sedating effects of propionic acid. In other words, a child’s behavior may initially worsen, but that does not mean the protocol is not working. It means we have discovered a key to the potential recovery and the starting point we begin working from.

My child did not have an Awakening. Does that mean that the protocol is not working?

No, not at all. Not every child will experience noticeable awakening symptoms. Particularly older children and those who are not on the spectrum and are therefore not under the influence of excessive levels of propionic acid. As long as a child is showing signs of neurological recovery within the first 3 months, you can be assured that the protocol is working.

If we do not see an awakening because of a mild ASD diagnosis, do we continue at the same dosage or do we increase the dosage?

If your child has very mild autism or has been diagnosed with just developmental delay, a sensory issue, or motor delay, you will not see much if any sign of an awakening. I treat them in the same manner as a child diagnosed with moderate to severe autism.

How long can the awakening last?

The positive aspects of the awakening (improved eye contact and awareness) should last as long as excessive propionic acid is no longer being released into the bloodstream. The occasional negative effects of the awakening (insomnia, hyperactive, aggression) generally only last for a few days to a few weeks and then begin to resolve. If the negative effects of the awakening do not dissipate, and there is evidence of chronic pain or infection, especially from the teeth, then I assume the overgrowth of intestinal bacteria is not fully effective, and the balancing regimen needs to be increased.