Introduction
Autism Spectrum Disorder (ASD) is a complex set of neurodevelopmental syndromes exhibiting a wide range of social, communication, and behavioral challenges. Traditionally, medical treatments for ASD have followed a "one-size-fits-all" approach. However, advancements in genomics and molecular biology have revealed individual molecular differences that can be targeted with precision medicine strategies. The Nemechek Protocol represents one such approach, aiming to address the underlying molecular imbalances contributing to ASD symptoms by focusing on gut health, reducing inflammation, and supporting neurological function. This article will explore the core principles of the Nemechek Protocol, its dietary components, and the scientific rationale behind its recommendations, drawing heavily on research related to gene variants like SHANK3 and the role of factors like zinc and melatonin.
Understanding the Molecular Basis of ASD and the Nemechek Protocol
ASD is rarely caused by a single gene; instead, it typically arises from a combination of multiple genetic factors interacting with each other and epigenetic influences from diet, lifestyle, and environment. The Nemechek Protocol acknowledges this complexity by focusing on interventions that can modulate gene expression and function without directly altering DNA. These interventions may include:
- Increasing the transcription of a protein product by affecting transcription factors or increasing reaction speed.
- Ensuring that co-factors that help push the reaction are plentiful.
- Adding factors that stabilize protein products or decrease protein degradation.
- Bypassing the affected gene product by identifying and promoting the synthesis of downstream reactions to gain the desired therapeutic effect.
This approach is exemplified by the protocol's focus on the SHANK3 gene, a high-risk genomic variant associated with ASD.
SHANK3 and the Importance of Molecularly Targeted Interventions
SHANK3 is a scaffolding protein vital for the structure and function of glutamatergic synapses. Variants in the SHANK3 gene, such as the c.1304 + 48 C>T transition, can decrease SHANK3 protein levels and disrupt glutamate signaling, leading to synaptic disorganization and ASD symptoms. The Nemechek Protocol addresses this by:
- Promoting SHANK3 Expression: Encouraging physical activity and light exposure to increase melatonin levels, which have been shown to positively modulate SHANK3 expression. The protocol recommends supplementation with melatonin, using blue-light-filtering glasses during evening hours, avoiding screen time at night to lower blue light exposure, and utilizing blue-light-filtering devices on electronics used in the evenings.
- Ensuring Adequate Cofactors: Maintaining high zinc levels, as zinc acts as a transcription factor and regulatory cofactor for SHANK3. In a low-zinc environment, SHANK3 has an inactive conformation and often forms oligomers that impair its function as a scaffolding protein. In a high-zinc environment, the SHANK3- zinc complex can function as a scaffolding protein that allows for the “maturation” of synaptic AMPA-type glutamate receptors and, therefore, the proper development of glutamatergic signaling pathways.
Core Components of the Nemechek Protocol Diet
The Nemechek Protocol diet focuses on reducing inflammation, restoring gut health, and supporting neurological function. Key aspects include:
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1. Minimizing Inflammatory Omega-6 Fatty Acids
A major source of inflammation is the intake of polyunsaturated fats from high omega-6 fatty acid cooking oils, cheap fillers in processed foods, eating livestock that was fed grains, or fish that is farm-raised. The protocol advocates for a significant reduction in omega-6 fatty acids, which are abundant in many processed foods and vegetable oils commonly used in American diets, particularly soy oil.
2. Increasing Omega-3 Fatty Acid Intake
A recent study has shown that long term omega-3 fatty acid supplementation coupled with omega-6 fatty acid restriction improves cognitive function, reduces neuroinflammation (i.e., TNF-α expression), and increases brain cell production (i.e., neuronal progenitor proliferation) in mice. Supplementation with omega-3 fatty acids, particularly DHA, is a cornerstone of the protocol to counteract the inflammatory effects of excess omega-6 and support brain health.
3. Promoting Gut Health with Inulin and Rifaximin
Reversal of small intestine bacterial overgrowth (SIBO) often results in major improvements in food intolerance. The protocol often involves addressing Small Intestinal Bacterial Overgrowth (SIBO) using rifaximin, an antibiotic that targets bacteria in the gut, followed by inulin, a prebiotic fiber that promotes the growth of beneficial gut bacteria.
4. Dietary Guidelines: Foods to Include and Avoid
The Nemechek Protocol emphasizes a diet rich in whole, unprocessed foods while avoiding specific ingredients known to contribute to inflammation or gut dysbiosis.
Foods to Include:
- Olive Oil and High Oleic Oils: Olive oil, particularly extra virgin olive oil (EVOO), is a primary source of healthy fats due to its high oleic acid content. High oleic sunflower oil (HOSO) is acceptable.
- Nuts: Almonds, pecans, pistachios, cashews, and walnuts are good sources of ALA. Generally nuts, raw or dry-roasted are fine.
- Other Fats: Palm kernel, coconut, and canola oils.
Foods to Avoid:
- "Bad Oils": Sunflower, soy, corn, safflower, cottonseed, grapeseed, peanut, margarine, shortening.
- Peanut Butter: Peanuts should be avoided.
5. Melatonin Supplementation and Circadian Rhythm Support
Melatonin supplementation is recommended, along with strategies to protect and promote endogenous circadian rhythms/melatonin synthesis with the blue-light-filtering interventions discussed above. Studies have indicated a comorbidity between abnormal melatonin levels and ASD, with lower levels at a higher frequency in the ASD groups than in control subjects. This also supports that melatonin may play a role in the development of the symptomatology of ASD.
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6. Zinc Supplementation
Maintaining high zinc levels is crucial both during and after development for individuals with SHANK3 variants and is likely the most significant of all interventions identified to date for this pathway. The literature provides clear evidence supporting zinc supplementation as a potential intervention for decreased function variants in this pathway.
Additional Considerations
- Food Intolerances: Some individuals may need to reduce a variety of foods from their diets (nightshades, carbohydrates, or gluten) in order to feel well.
- Probiotics and Inulin: When using inulin, probiotic medications should be stopped.
Potential Benefits and Clinical Observations
Parents have reported improvements in their children's eye contact, presence, mood, and energy levels after starting the Nemechek Protocol.
Read also: The Gut Protocol Diet