If autism is defined as altered cognition and neurodevelopment that involves elevated propionic acid levels and increased inflammatory cytokines, then bacteria overgrowth is an absolute necessity for autism to occur; otherwise, where would the propionic acid come from? As of yet, there are no other significant sources of propionic acid other than from overgrowth of bacteria that have been identified.

Some people undergo a “SIBO breath test” looking for a SIBO diagnosis, but the breath test is prone to many sources of error.  Within my practice, I stopped using SIBO breath testing on my patients to determine overgrowth because unacceptably high false positive and false negative results made it clinically useless. nnThe “gold standard” test for determining bacterial overgrowth is a procedure that requires a long endoscope to be passed into the small intestine to sample bacteria within the jejunum portion of the small intestine. Then the sample needs to undergo quantitative culturing, DNA identification, and metabolic activation testing of the species in the sample. nnI do not recommend that any of my patients undergo the gold standard test because it is expensive, impractical, is not available outside of a research study, and is unnecessary to improve using The Nemechek Protocol®.

I make detailed notes about the clinical improvements of intestinal, psychiatric, musculoskeletal, and neurological improvements my patients experience within the first month after treatment with inulin or rifaximin. This collective set of symptoms is what I referred to as the SIBO fingerprint. I then use these changes in symptoms to check for bacterial overgrowth relapses because a relapse will often result in the return of many of the same symptoms that improved originally on inulin or rifaximin.

Generally speaking, there are few to no side effects from the ingredients used in the protocol but I’ll break it down into its components. Olive oil and fish are capable of occasionally causing nausea if too much is given at one time. Both of these oils can sometimes cause diarrhea and maybe a slight worsening of behavior as well. If this occurs, it is a sign that you most likely still have some degree of bacterial overgrowth and I’ll recommend to my patients to either switch from inulin to rifaximin or increase their use of rifaximin.nnInulin has been proven to be very safe in even neonates but in some children, inulin in doses greater than 1/4 or 1/2 a teaspoon might trigger an increase of hyperactivity, anxiousness and even trigger a little aggression. These issues will quickly resolve simply by lowering the dose.nnIn my experience working with children, rifaximin has little to no side effects since it does not enter the bloodstream. In adults, there have been reported cases of enterocolitis but I have never seen this occur in children.

Using a nasal steroid spray (fluticasone) regularly can reduce sinus and middle ear infections. Discuss starting this treatment with your pediatrician.