6

The Un-Prescription Action Plan for Basic GI Support

The road to health is paved with good intestines!
Sherry A. Rogers, MD

Like a good story, a good Action Plan has a beginning, a middle, and an end. The Basic GI Support Protocol is the foundation, the beginning, of your Action Plan. This chapter shows you how to get started with enzymes, probiotics, and antimicrobials, how to progress, and most important of all, how to transition to a Maintenance Schedule. More support: I have created a calendar app called “The Un-Prescription for Autism” to help you schedule these protocols with ease. You will also find a fun online game called “Fact or Fart?” at www.LoveAutismHealth.com that will help with FAQs and troubleshooting.

If you do nothing more than the Basic GI Support Protocol you would probably relieve 80 percent of the day-to-day discomfort and misery that a child on the spectrum may experience. By misery, I mean constipation, diarrhea, sleep deprivation, rashes, itching, nausea, stomachaches, irritability, and aggression. It isn’t all your child will ever need, but it can be a huge step forward in improving his quality of life. Chapter 7 will add Basic Immune Support, and Chapter 9’s Online Action Plan will lead you on a year of ideas to build out your child’s team and health plan. My goal is for our beloved children to find that “sweet spot” of vibrant health on the autism spectrum.

The Basic GI Support Protocol

The New Patient Questionnaire (NPQ) that we explored in Chapter 1 has, no doubt, revealed areas of health to support and, at the same time, generated the building blocks of your child’s custom Un-Prescription Action Plan. Now we learn when and how to put it all together, and it starts with the Basic GI Support Protocol. Don’t skip any of the steps you are about to learn—through years of experience, I have developed these protocols in a sequence that maximizes results and minimizes undesirable side effects. Give each step a good effort, and do them in the order presented.

These protocols can be integrated with conventional or alternative methods. They can be used while on prescription medications or with natural supplements. These protocols do not treat or cure autism spectrum disorder. They are intended to support optimal health and function of children and adults with ASD so that your amazing child can have his or her best chance of success and happiness.

The Basic GI Support Protocol is the foundation of your child’s health plan. Start with this protocol and then branch out and expand the plan from there. Let me show you an example of a Basic GI Support Protocol in Figure 6-1 on page 151, and then you can spend the rest of the chapter learning how to customize it for your own child. You can vary the speed and dosing to minimize side effects.

Then you can go on to add some basic supplements such as zinc or essential fatty acids indicated by the NPQ, or you can add the Basic Immune Support Protocol from Chapter 7 to help support vibrant health for your son or daughter. The Chapter 9 Online Action Plan gives you a year’s worth of ideas with tips and suggested protocols.

Remember to keep detailed records in your Un-Prescription Organizer as you go, work with your doctor for oversight and lab tests, and transition to a Maintenance Schedule when the time is right.

Let’s get started and customize the plan for your own child.

Step One: Enzymes

First, let’s review the basics:

Choose a broad-spectrum digestive enzyme blend that contains DPP-IV.

Choose a delivery method: capsules, powder, or chewables (you can also open capsules).

If your child is on one of the less common time-release medications with a pure cellulose coating, consider a cellulase-free formulation.

Choose an appropriate dose, which is based on the size of the meal, not your child’s age or weight.

Check the ingredients for anything your child is allergic to, such as pineapple or egg white.

Look for and read any cautions or contraindications with the brand you choose.

Choose your Enzyme Schedule (options to choose from are explained later in this chapter).

Work with the school and daycare so your child can have enzymes with meals and snacks.

Take occasional “enzyme holidays” (discussed later in this chapter, plus an example is provided in Chapter 9).

Transition to a Maintenance Schedule at some point.

For the best chance of success and to avoid wasted time, go over the common mistakes that are made with the enzymes (see Chapter 10) before you start.

Shortcut to Starting Tonight

If you’re lucky enough to live in an area where you can purchase the enzymes today, you can get started with the evening meal. And if you aren’t able to buy them today, just serve a meal that is gluten-free and casein-free for dinner all week, and you will already be starting the journey to free your child’s system of opioid neuropeptides. Meanwhile, go online and order your enzymes today.

If your son or daughter cannot swallow capsules, you’ll have to mix the supplements with food or drinks. For very resistant eaters, parents may have to take charge and simply mix the enzyme or supplement with a teaspoon or so of juice, draw it up into a needleless plastic syringe (available at pharmacies), and squirt it toward the back and side of the child’s throat. Don’t aim directly at the back of the throat, as that would trigger a gag response, but rather to the back and over to one side.

Once you have progressed to using enzymes with every meal and snack, the time has come to address the meals that your son or daughter is getting at school. Most state school systems will allow you to sign a medication order and will then administer the enzymes with the meals and snacks served to your child during the school day. Private schools and daycares will usually make the same accommodation.

You may have to provide a letter from your doctor stating that your child must have the enzymes with every meal and snack, along with the dosage requirement. It is very important that the letter specifies the enzymes must be given with every meal, snack, and carton of milk, and that they be given at the beginning of the meal, not an hour before lunch in the nurse’s office.

If your school cannot give over-the-counter supplements, see www.Houston-enzymes.com for ideas on getting the enzymes to school mixed into food or drink. If it is impossible to have your child take the enzymes at school, you can pack a GFCF lunch and snack, or ask your doctor to order GFCF school meals and snacks, which can be eaten without the enzymes.

And since I know you’re going to ask . . . if your child’s diet is strictly GFCF, he does not have to take the enzymes with every single meal and snack. When it was first suggested to me that my GFCF child take the enzymes, I cynically thought that the doctor just wanted to make additional money and it really wasn’t necessary. Science has shown that children with ASD may not make enough digestive enzymes and the digestive support may be very welcome, even if GFCF.

Figure 6-1

Dosing Suggestions

Enzymes may be used in children as young as infants who are no longer breast-feeding and are eating solid food.

In general, follow the manufacturer’s dosing instructions.

Dosing is based on the size of the meal, not the age or weight of the child. I’ve had to use conservative judgment and clinical observations to come up with suggestions for younger patients. Our goal is to support digestion, especially of gluten and casein, and ease constipation. Children one to two years of age do not eat large volumes of food, so I usually suggest using just a trace amount of the enzymes with meals and cups of milk. If constipation persists after a few weeks, gradually increase the dose until it clears.

For children three to four years of age, I suggest starting with one-quarter to one-half the recommended dose on the bottle. If that clears up constipation by the last week of the plan, stick with that dose, otherwise increase to no more than the manufacturer’s suggested dose.

For children age 5 and up, follow the manufacturer’s suggested dose.

You’ll know you’re at the right dose when your child is no longer constipated. If stools are still large, hard, or in little balls, gradually increase the dose (up to the manufacturer’s limits) until they normalize.

I’ve had a number of children who suddenly began to eat a lot more food at meals after starting the enzymes, much to the surprise of their parents. I suspect they are unconsciously attempting to overwhelm the enzyme dose (eating more food than the enzyme dose can handle), in a desperate attempt to get more opioids. If your child begins to suddenly eat more at meals, increase the dose of enzymes accordingly.

The Basic “Go” Schedule for Enzymes

Here is the basic enzyme schedule that I suggest in my center. This pace is usually neither too fast nor too slow. You will likely see no changes in the first week, maybe some edginess in Week 2, but Week 3 is usually a doozy—loaded with irritability, possibly even anger and aggression as your child weans off of the alleged opioid neuropeptides.

Week 1: Give the enzymes with one meal a day.

Week 2: Give the enzymes with two meals a day.

Week 3: Give the enzymes with three meals a day.

Week 4 and thereafter: Give the enzymes with every meal and snack.

The “Slow” Schedule for Enzymes

This is a baby-steps plan. It’s an extended plan for children who experience a really difficult withdrawal. Use this protocol if your child is considered aggressive and violent and at risk for getting kicked out of daycare or school. For those parents who are hanging on by their fingernails and cannot tolerate their child getting one bit more aggressive as they go through the predicted spikes in behavior and irritability, here’s your plan!

It will take twice as long to do each step. Stay on each step for two weeks or even longer before progressing to the next step.

Weeks 1 and 2: Give the enzymes with one meal a day.

Weeks 3 and 4: Give the enzymes with two meals a day.

Weeks 5 and 6: Give the enzymes with three meals a day.

Week 7 and thereafter: Give the enzymes with every meal and snack.

The “Whoa” Schedule for Enzymes

I call this one “how not to give the enzymes.” Some parents are overeager to get results and start giving their child the digestive enzymes with every meal and snack from day one. This strategy may throw him into an abrupt opioid withdrawal and is a bit harsh in my opinion. Choose a kinder, gentler schedule.

The “Detective” Schedule for Enzymes

When a child is an extremely sensitive food detective and can sense even minute amounts of supplements added to his food or drink, some parents get “extreme” too. They start the enzymes using only five to ten specks instead of a full dose in the food. Sometimes the full dose cannot be put into one item, such as a drink, without being detected. We then suggest putting a small amount in the drink, a few grains on the fruit sauce, a few specks in the mashed potatoes, and so on. Over the course of several weeks or months, the amounts are very gradually increased until the child accepts it. Of course, it takes much longer to get there this way, but hang in there—you can be the tortoise and still win the race.

It does not matter how slowly you go, as long as you do not stop.
Confucius

Month 1: Give the enzymes with one meal a day.

Month 2: Give the enzymes with two meals a day.

Month 3: Give the enzymes with three meals a day.

Month 4 and thereafter: Give the enzymes with every meal and snack.

The “Already GFCF” Schedule for Enzymes

I’m not worried about an opiate-type withdrawal if a child is already gluten- and casein-free, and I introduce enzymes faster in this case.

Week 1: Give the enzymes with two meals a day.

Week 2 and thereafter: Give the enzymes with every meal and snack.

The “GFCF/Enzyme Combo” Schedule

Use this plan if you are super gung-ho and want to start the GFCF diet and implement the enzymes. It’s really simple: You are gradually introducing GFCF meals and giving them with enzymes. An easy-to-make mistake is to give enzymes with lunch and make dinner GFCF—but then you are taking away the opioid-forming foods too fast and will trigger a nasty withdrawal. Let me be clear: The GFCF meal is the one that gets the enzymes.

Week 1: Give one GFCF meal a day with enzymes.

Week 2: Give two GFCF meals a day with enzymes.

Week 3: Give three GFCF meals a day with enzymes.

Week 4 and thereafter: All meals and snacks are GFCF and are taken with enzymes.

The Maintenance Schedule for Enzymes

What do you do after gut health and balance are achieved?

Ideally, I would love for your child to be able to digest food and absorb nutrients without relying on digestive enzymes. However, I know you don’t want to risk a return to the wild behaviors your child may have experienced before using the enzymes. So how do you know when to reduce or eliminate their use?

This is where art meets science, as it is completely individualized for each child or adult. A few children may be able to minimize or eliminate the enzymes after a year or less, many may be successful eliminating them after several years, and some individuals will always need enzymes for digestive support.

Indicators Your Child May Still Need Digestive Enzymes

If there are behavior or mood changes after eating meals without the enzymes

If constipation returns after eating meals without enzymes.

If you can see undigested food in your child’s bowel movements with the naked eye

If comprehensive stool testing indicates low digestive enzymes or poor digestion and absorption

If your child has gall bladder problems (anyone without a gall bladder would benefit from ongoing use of digestive enzymes)

I don’t consider wheat and dairy to be good choices for those on the spectrum, but for parents who would like to include these foods in their child’s diet, here’s a way to evaluate if the child can tolerate them without enzymes.

Try a simple test with a food that contains casein, not gluten. (Casein exits the body quickly in two to three days, whereas the effects of gluten may hang around for weeks.) On a Friday afternoon, try sampling a mouthful or two of a dairy product (ideally from an organic, grass-fed source) such as milk, cheese, or ice cream and don’t give the enzymes with it. Then observe for the rest of the weekend. If you see a regression of mood, irritability, hyperactivity, sleep disruption, brain fog, or constipation, you have your answer—not ready yet!—and the ill effects should be gone in time for school on Monday. Wait a few more months and try again.

If nothing bad happened after trying this simple test, you may continue to gradually reintroduce dairy products without the enzymes. Most people find they can consume a daily serving or two of dairy without enzymes but cannot just feast on it all day long. Some are able to reintroduce it into their diet without problems.

Once dairy is successfully introduced, try a bite or two of organic wheat without enzymes. (I strongly suggest consuming only organic wheat because glyphosates, which are herbicides, are sprayed on virtually all nonorganic wheat right before harvest in this country.) Again, I suggest a Friday afternoon so that any disappointing reactions happen at home and not at school. Better yet, try it when school is out for the summer.

My son can now eat small amounts of gluten without any negative behavioral effects, but he seems to have an intolerance to it on the GI level, because it causes gas, diarrhea, and a deep fatigue. He has made the decision to simply avoid wheat and gluten altogether. It’s a sensible choice for many on the autism spectrum.

Who Gets a “Pass” on the Enzymes?

Some children won’t need enzymes at all. If you tried the enzymes and/or the GFCF diet strictly for 100 percent of meals, snacks, and glasses of milk for several months and saw absolutely no changes whatsoever, it’s a good bet your child doesn’t need to keep taking them. And if you let your child abruptly start eating gluten- and casein-containing foods without the enzymes and saw no negative behaviors or symptoms, it’s also a good bet he doesn’t need them. But if you did the diet or enzymes some of the time, or only for wheat but not milk (or vice versa) and other variations of that nature, you should still give them a good try. Many of you will be surprised.

Enzyme “Holidays”

Our children can become sensitive to anything that is consumed repetitively, and that includes the enzymes. It is a good idea to periodically forgo the enzymes completely for a few weeks or a month, and use the GFCF diet during that time instead.

Step Two: Probiotics

First, the basics:

Only begin the probiotic schedule after your child is taking the digestive enzymes with DPP-IV with every meal and snack and is mostly constipation-free. He will continue to take the enzymes daily as you begin this step.

Choose a multispecies or a single-species formulation.

Choose a formulation (i.e., infant, children, or adult). Use an infant formulation for birth to two years of age. The formulation I use is a powder (Ther-Biotic Infant Formula from Klaire Labs), but it still has a delivery system to get through the gastric acid and deliver a full load of viable beneficial bacteria to the small intestine. Check with the manufacturer, but most infant formulas can be used from the day of birth.

Choose capsules, powder, gummies, or chewables.

Choose a strength. I suggest a minimum of 25 billion colony-forming units (CFUs) for ages two and up.

Choose a Probiotic Schedule (described in the next sections).

Eventually transition to a Maintenance Schedule (optional).

Mix it up! Once your child is fully on the probiotic schedule, you can use different blends and formulations of probiotics.

Note: “Week 1” of the probiotic schedules is not the same as Week 1 of the enzyme schedules. The Probiotic Schedules are designed to be started after your child is able to take the digestive enzymes with every meal and snack.

The Infant Probiotic Schedule (Up to Two Years of Age)

Powdered infant formula probiotics are easier to digest than adult formulas; they can be dabbed around the nipple for breast-feeding or added to a bottle of breast milk or already-warmed formula for bottle feedings.

Healthy babies and toddlers up to twenty-four months of age can go with the manufacturer’s dosing guidelines. If your baby is struggling with colic, diarrhea, painful gas, eczema, or diaper rash, here’s a slower, gentler way that will minimize gas and crankiness to start:

Week 1: Give ½ of the recommended dose, every other day.

Week 2: Give ½ of the recommended dose, daily.

Week 3 and thereafter: Give the full daily dose recommended by the manufacturer.

Probiotic Support for Two Years of Age and Up

The Basic “Go” Probiotic Schedule

Week 1: Take ½ dose of probiotic with the evening meal every day.

Week 2 and thereafter: Take the regular dose with the evening meal daily.

The “Slow” Probiotic Schedule

Here’s a kinder, gentler, slower schedule to minimize the initial irritability side effect of starting a powerful probiotic.

Weeks 1 and 2: Give ¼ to ½ of the manufacturer’s suggested dose every other day.

Weeks 3 and 4: Give ½ of the suggested dose every day.

Week 5 and thereafter: Try moving up to the full suggested dose once daily with a meal.

The “Whoa” Probiotic Schedule

How not to give probiotics!

Avoid giving full-dose, high-potency probiotics to a constipated child

Avoid starting the probiotics at the same time you’re starting the GFCF diet and/or digestive enzymes with DPP-IV

Avoid giving a full dose if your child has painful gas

None of this will likely cause any physical harm to your child, and perhaps your child will just sail through the protocol with no problems. For some children, it’s just no big deal. But siblings and classmates may bear the brunt of the irritability, so I urge you to start slow until you see how your child will be affected.

Here’s why I introduce probiotics slowly: The way the gut feels pain is different from the way your arm or leg feels pain. You could probably slice through the intestine with a scalpel and not feel all that much pain. But if the intestine is s-t-r-e-t-c-h-e-d, it’s exquisitely painful. Starting a high-potency probiotic can produce tons of gas, which inflates and stretches the GI tract and causes tummy aches and sharp gas pains, which can lead to explosive meltdowns and tantrums. It’s not very nice to do this to a child. So I always start low and go slow with these powerful supplements.

The “Modified School Year” Probiotic Schedule

This schedule reduces embarrassing gas at school while your child’s GI system gets used to the probiotic.

Month 1: Take ¼ dose on Fridays and Saturdays with the evening meal.

Month 2: Take the full dose on Fridays and Saturdays with the evening meal.

Month 3 and thereafter: Gradually increase the number of days per week you are giving a probiotic until your child can tolerate a full dose seven days a week with the evening meal.

The “Detective” Probiotic Schedule

Use your judgment, but a very slow guideline would be:

Month 1: Gradually introduce a few specks of probiotic daily with the evening meal.

Month 2: Try giving ⅛ dose or capsule each evening with a meal.

Months 3, 4, and 5 and thereafter: Gradually work up to one full capsule. If the most you can get up to is half a capsule, that is better than nothing.

If you reach a certain volume (e.g., one-quarter of a capsule), after which your child can tell that you have put probiotic powder in his food or drink and refuses it, switch your strategy and try using a smaller amount with every meal so that you can get the full dose in by the end of the day.

The “Already on a Probiotic” Schedule

If my new patients are already on a daily probiotic, they are good to go and should just continue taking it daily, even when just starting the enzymes. If the probiotic they are already on is not a high-potency probiotic with a good delivery system, I have them switch to a better product and break it in over two weeks to minimize gas.

Week 1: Take one dose every other day with the evening meal.

Week 2 and thereafter: Take one dose daily with the evening meal.

Optional: The Maintenance Probiotic Schedule

So, how long should you keep giving a daily probiotic? If I had my way, everyone would take a daily probiotic for as long as they live. However, some families tell me that they don’t like taking supplements every day, and some tell me it’s a bit expensive for them.

So here is my advice: Once gut balance and control are achieved, I continue to give probiotics on a regular basis. For some children this may be a daily probiotic for the rest of their life, but others may do fine with every other day or even just on weekends.

How do you know when to cut back? When your child no longer has eczema or other rashes. When his breath is sweet and fresh, or she no longer struggles with tummy pain, diarrhea, and constipation. In other words, when your child is not sick all the time. You know your child better than anyone else, so just pay attention to your “parent radar” to find the perfect Maintenance Schedule for your child.

Early research seems to indicate ASD individuals may have a predisposition to dysbiosis, so probiotics are one piece of the health plan I would never give up.

Step Three: The Antimicrobial Rotation

This piece of the Action Plan is hands-down either the most abused or the most neglected area in supporting health on the autism spectrum. It’s also a little trickier than the enzymes and probiotics. The heart of this piece of the health plan is rotation among different antifungal and antimicrobial agents. It may seem confusing at first, until you realize that basically it’s just an antimicrobial (AM) in the mornings. The AM may be different every week, but your daily routine is just one AM in the mornings.

Figure 6-2 is a basic overview of how the rotation works.

Figure 6-2

Just like with the enzymes and probiotics, the Antimicrobial Rotation can be started slowly, on weekends as a Modified School Year Schedule, in minute amounts for detectives, and so on.

Please note: I do not suggest an antimicrobial rotation for children less than five years of age without a doctor’s supervision, and never for infants and toddlers.

Continue to take the enzymes with meals and snacks, and the probiotic with the evening meal.

Always work with your child’s doctor.

Use supplements formulated for children.

Take the antimicrobial on an empty stomach in the morning (suggested), although it may be given with food or drink.

Choose an Antimicrobial Rotation Schedule (see next sections).

If your child has a prescription antifungal, you are welcome to put it into the rotation list with your doctor’s approval.

Eventually, transition to a Maintenance Schedule. (The Maintenance Schedule is discussed later in this chapter, and an example is provided in Chapter 9.)

Dosing Suggestions

I suggest only minimal short-term use of S. boulardii for children ages 2 to 5, at a dosing range of 1.5 billion to 3 billion CFUs.

With caution, I suggest using only ¼ to ½ dose of AMs for children ages 6 to 14.

With caution, I follow the manufacturer’s suggested dosing for those ages 15 and older, unless they are severely underweight.

I am very conservative in the dosing suggestions for children because we are not treating an infection but, instead, supporting GI balance and health. I find that even using a fraction of the children’s dose can often improve balance in the GI tract. Never give your child adult doses. For children ages 3 and up, some parents have successfully used a tiny fraction of the dose of liquid herbal extracts (such as those suggested by Herb Pharm or KidsWellness). I recommend that you do this only under a doctor’s supervision.

If you have results from a recent comprehensive stool test that indicate a fungal or bacterial overgrowth, look at the Sensitivity and Resistance information. This is where the lab grew out the invader and tested it against various prescription and natural agents to see what killed it and what did not. Rotate among the choices that the overgrowth is sensitive to for a month or two, then return to a wide-ranging general rotation. Just because a stool test from two years ago indicated you should use Caprylic acid and fluconazole doesn’t mean you should only use those two agents and, worse yet, still be on them a year later. Treat appropriately, and then get back to a wide- ranging rotation. Otherwise, you are creating a haven for any microbe not sensitive to Caprylic acid and fluconazole.

I usually suggest beginning with S. boulardii for one month, followed by a weekly antimicrobial rotation, as shown in Figure 6-2.

The Basic “Go” Antimicrobial Schedule

To lay the groundwork for an AM rotation, I start my patients out with an initial four weeks of S. boulardii (Sac b) before beginning to rotate through various antimicrobial agents. It’s a one-time only thing, is an inexpensive way to get started, and has a lot of bang for the buck. After the first four weeks, Sac b will join the list of antimicrobials to rotate through a week at a time. Sac b will usually cause a lot of really smelly gas (children in my practice have nicknamed it “the stinky pill”) as well as irritability or even rashes; these side effects may last a few days or a few weeks.

After four weeks of Sac b, your child will then begin to use a different AM each week. It’s not feasible (or necessary) for parents to purchase ten or twelve different AMs, so I have them just get three or four different varieties and rotate through those bottles on a weekly basis until they begin to run out. The parents then purchase different AMs to replace those bottles and continue the rotation.

Each week when you start a new antimicrobial, your child may go through another round of die-off symptoms. Usually these are smaller than when you first started. Some supplements may have no noticeable effect, but that’s okay; they are still policing the “neighborhood” of the GI tract and doing their job. Once in a while, a new antimicrobial will set off some really spectacular gas and irritability. It’s probably working to curb some yeast or bacteria that nothing else had killed yet and was living in there rent-free. You may need to cut back on the dose or the frequency of that particular AM, but don’t discard it—it’s in there kicking something’s butt, which is a good thing.

First Four Weeks (Sac b)

Week 1: Suggested dose is 1.5 billion CFUs S. boulardii every other day for one week.

Weeks 2, 3, and 4: Take 3 billion CFUs daily in the mornings.

Now for the Rotation

Week 5 and thereafter: Discontinue the S. boulardii for now. Choose three or four other supplements (from the following suggested list) and use only one at a time. For example, use one antimicrobial daily in the mornings for one week. Then put that one away, and use the next one for a week. Continue to rotate through your choices on a weekly basis.

I don’t use a lot of antimicrobial blends. In fact, early on, I strongly prefer pure, single supplements because children with ASD often have sensitivities to medications, foods, and supplements. Let’s get some gut healing on board first, and then your child will probably be able to tolerate herbal blends better.

Suggested Antimicrobials

To start, I am suggesting only pure, single antimicrobial agents. You can branch out to using blends later on in the Maintenance Schedule:

Artemisia

Berberine

Black walnut

Caprylic acid

Clove

Cranberry

Garlic

Goldenseal

Grapefruit seed extract

Olive leaf extract

Oregano

Oregon grape

Pau d’arco

Quinic acid (cat’s claw)

Saccharomyces boulardii

Thymol (oil of thyme)

Undecylenic acid

Usnea

Uva ursi

Note: Only take one type of antimicrobial each week. Do not take them all at once.

The “Slow” Antimicrobial Rotation Schedule

Begin with half doses every other day or even every third day. Gradually increase to the suggested dose as your child can tolerate it.

The “Modified School Year” Antimicrobial Rotation Schedule

Use only on weekends during the school year (two days a week instead of seven days a week).

The “Detective” Antimicrobial Rotation Schedule

Use mere specks or partial drops every other day and mix with food or drink. Gradually increase to the suggested dose as your child can tolerate it.

The “Already on an Antimicrobial Rotation” Schedule

If your child is already on antifungals or antimicrobials, just expand into a wide-ranging weekly rotation.

The Maintenance Schedule

How long should I do this rotation for? When do I cut back?

When a stool test comes back negative for yeast or bacterial overgrowth, you can cut back.

No stool test? Try the rotation for a few months, then cut back to every other day for a month or two. If no GI symptoms return, try using antimicrobials only on weekends. For my patients who struggle with chronic dysbiosis, the most I ever suggest to cut back to is every other weekend. I always continue to rotate and use different antimicrobial agents. Once we get good “gut control,” I like to stay off the merry-go-round and avoid dysbiotic relapses.

Once on a Maintenance Schedule, try an antimicrobial blend, as opposed to a single pure agent.

What does this entire three-step Basic GI Support Protocol look like when it’s all put together, week by week? Chapter 9 and its digital companion, the Online Action Plan, give you a year’s worth of protocol suggestions, from the basics and beyond. The free basic version of my calendar app, The Un-Prescription for Autism, will help with scheduling these protocols in your calendar.

In Chapter 7 I’ll explore how the immune system may be different in autism spectrum disorder, and strategies for immune support. Turn the page for some great tips.