We have seen more gains with this protocol than any other. Although it's focussed on sleep, and the gut, what stood out to us were the cognitive gains. Our son's preschool teacher remarked on how he'd changed at the end of the first week and she had no idea we'd changed anything.
I ignored this protocol for some time since it looked too simplistic. That was a very silly mistake. Luckily a good friend of mine with an autoimmune condition kept on nudging me to look into it since he'd had great success with it (and he'd tried many other things).
Although on the face of it, it seems very simple there is certainly very important nuance in here and you need to follow it carefully to really benefit.
Having said that, I implemented it very sloppily at first and the rapid gains we saw convinced me to dig in further.
This is my explanation of the protocol. There is much, much more detail in Dr Gominak's e-book and site but frankly that is overwhelming and who has the time? This is an attempt at a summary that can be followed easily.
What is it? Very, very briefly:
Carefully dosed, very basic B complex in three phases of dosages, of roughly three months each (the final phase is dependent on how long you need it).
Simultaneously, optimising vitamin D levels (using testing that is very easy to access for most people and should be possible globally - see below).
Also B12 and a multivitamin (though we have not used the multivitamin) throughout and beyond the end of the time on the protocol.
We used:
B Complex
Now Foods B50 capsules (beware: They also sell tablets which are therefore harder to swallow or divide!)
https://www.iherb.com/pr/now-foods-b-50-100-veg-capsules/39670
Note: There is now a product which is a very high quality and non-methylated B complex which looks like it would work very well for this protocol; Thiaviate:
Vitamin D
https://www.iherb.com/pr/nature-s-answer-vitamin-d-3-drops-100-mcg-4-000-iu-0-5-fl-oz-15-ml/20745
Also we used Thorne's K2 (seems expensive but there is a huge amount in this bottle!)
B12
Pure Encapsulations Adeno/Hydroxy which has already proved to be a key brand/form even before the protocol (UK supplier - email or call them to order from the EU or rest of the world, since they need to manually remove the VAT at the time of writing)
See below "What about the B12?" for specific notes on the B12!
Note: Testing B12 is pointless if you are already supplementing since the supplement will raise blood levels and give a false "high" reading.
It's relatively cheap to do this and the most expensive part is simply buying the RightSleep Workbook which you'll need to be able to really understand the protocol but also to make the adjustments needed as you go through it.
But I'm getting a little ahead of myself!
Who is Dr Stasha Gominak?
Dr Stasha Gominak is a neurologist who trained at Baylor (very respected US university) and who has practiced since the 80s. The full story of how she worked out this protocol is long, took many years and some serendipity but she has now used it very successfully with thousands of people who have seen very good results with many different chronic conditions. In fact, most of her experience is unrelated to Autism but her comments on Autism in particular here, really made me stop and take note: https://youtu.be/n1Qm5x7Lxgc?t=3140
And her site, with links to labs to get inexpensive skin-prick Vitamin D testing is here:
https://drgominak.com/rightsleep-method/
There is a ton of info on her site and it really is worth reading it all, (I'd start with the FAQ) but I'll try to summarise it:
Dr Gominak believes that the B Vitamins and D work together to restore the normal population of microbes in the gut, which are essential for immune function and, critically, sleep. She says openly that is only her hypothesis but it does fit what she's observed and that it doesn't actually matter hugely what the exact mechanism is, as long as people are seeing huge results from it.
She has used the protocol on literally thousands of people and seen huge improvements.
What do you need to do?
Ideally you need to get the RightSleep Workbook and read it carefully! But... we just started into this and saw such huge gains that we bought the book later.
The workbook the price of a single bottle of high quality supplements and considering the gains it's just now worth considering the cost.
Frankly though... I find the work book a very hard read! So that's part of why I am summarising it here. But it does contain important details that I may have missed (and it certainly contains info on how to adjust the Vitamin D dosing based on blood results).
For those that know a lot about B vitamins
At first, please do not fret about methylated forms (B50 blends typically do not contain methylated forms) or folic acid (it is only long term use of folic acid in those who do not metabolise it that is an issue) etc etc etc.
There is a danger of overthinking this and allowing "the perfect to become the enemy of the good" when starting out.
If you want a really good, non-methyl B-complex though, use Thiavite (note, ThiaVITE): https://www.objectivenutrients.com/products/
Not doing the protocol because of concerns over the forms of B vitamins would have meant missing out on something extremely important to my son's health (and mine, in fact! Remember this is not mainly aimed at ASD and both my wife and I have seen huge, huge benefits in sleep and now we dream far, far more).
Detailed Breakdown of the Protocol
It's more simple than this great list of bullet points might suggest! I've just had to add details to answer questions!
According to the protocol: Start taking a multivitamin which has a low dose of all the B vitamins (Dr Gominak doesn't recommend brands) and continue for the duration of the protocol.
We did not do this - multivits introduce too many variables into an easily perturbed system like my son's biology. Dr Gominak thought this might be a mistake when I spoke to her about it but fully understood that it might also be wise.
The multivitamin is doing two things:
Providing B vitamins which can be adjusted as part of latter stages of the protocol (by taking fractions of the pill).
It should ideally contain 10 mg of B5.
Providing other vitamins and minerals that are likely to be needed as part of the healing triggered by the protocol.
Either test B12 levels (via blood) or simply take a B12 supplement anyway.
Note: Testing B12 is pointless if you are already supplementing since the supplement will raise blood levels and give a false "high" reading.
Dr Gominak suggests that you will eventually try stopping B12 a couple of years after completing the protocol and find that you are fine without it.
It seems like a good idea to test again, a year or two after stopping.
The workbook also mentions you might need this one vitamins for the rest of your life.
The type of B12 might be critical. Especially for an ASD child. See below.
Critically, get proper D testing to ensure that you are within the optimal range.
Test once before you start to get a baseline.
Test again after 1 month, and then again at 2 months.
That should be enough to optimise the D level.
Use these companies which do the correct testing using mass spectrometry:
EU: https://www.cerascreen.de/ (not cheap! Far cheaper to use the UK one ↑)
You need to have a D level of 60-80 ng/ml (150-200 nmol/L UK).
Exactly how to adjust the dose is covered in the workbook.
B Vitamins, First Stage:
First 3 months: Take a B50 (that's a B complex with 50mg of each of the B vitamins).
For a child, take half the cap (to make a "B25").
Obviously: Build up the dose slowly from a small amount!
Start counting the three months once you can take the full amount.
B Vitamins, Second Stage:
According to the protocol: After 3 months, stop the B50 but continue the multivitamin.
Dr Gominak says that if you do not, then your sleep will actually worsen badly. However, see the next points!
But Dr Gominak is not kidding about it sucking if you take too much for too long! I didn't reduce the amount I was taking fast enough and it was horrible. I would wake up literally feeling ill. As soon as I dropped the B vitamins way back down (to almost nothing) I felt just fine again.
This may effectively be the end of the protocol for many people (other than monitoring D levels occasionally perhaps). At least until "Stopping" below.
We did not stop at this point. Well, we tried. We dropped the B50 to about 1/10th of a cap (to mimic the dose of Bs from the multivitamin that we were not using) but that resulted in terrible sleep-onset insomnia and we had five nights where he was fine then four nights where he set a record for the latest he'd ever gone to sleep. This resolved as soon as we went up to 1/3rd of a cap (remember, since he's a child, he was on 1/2 a cap for the first three months).
I know that Dr Gominak stresses that you should drop the B50 but after seeing another ASD child also have horrible sleep issues (which didn't resolve by increasing the dose again) when dropping from 1/2 cap to only a 1/4 of a cap, for an ASD child personally, for an Autistic child, I'd consider skipping this step and moving directly to the last stage of ramping the dose in increments of 5 mg (2.5 mg in children).
B Vitamins, Third Stage:
After a further 3 months, at the 6 month mark (or, as mentioned above, perhaps at the 3 month mark!), and if you are still having pain or other physical symptoms, start to ramp up the B vitamins in increments of 5 mg (more details in the workbook).
Dr Gominak says that B5 is the key vitamin at this stage, but to continue to take all the others along with it regardless.
The workbook assumes you are still taking the multivitamin and that it contains 10 mg of B5.
We were not taking the multivitamin so instead we ramped from where we were.
Ramp up the Bs like this: Increase the dose by 5 mg (2.5 mg for a child) every three days (two days on the same dose, increase if possible on the third day).
Dr Gominak says you can switch to a liquid B complex and count the drops to finely adjust the dose like this.
You can also use fractions of the multivitamin until you then also start adding fractions of the B50 capsule.
I want to keep using capsules: Luckily a whole capsule of Now Foods B50 weighs about 500 mg on my scales. Which makes it really easy to work out! 500 mg contains 50 mg of each B vitamin. So when the scales say 550 mg that means there are 55 mg of each B vitamin.
Don't stress about whether it's 500 mg! Just make sure you can increment in 5 mg steps (2.5 mg in children) so that you can find the optimal dose.
Our son is non-verbal and even a verbal ASD child is unlikely to be aware enough of physical symptoms such as pain and stiffness in the morning (which is what the workbook says to judge by - remember Dr Gominak is a neurologist so that is her main patient population. So, to me, it seems reasonable to instead judge using sleep. Additionally, my wife and I didn't have pain symptoms but saw improvements in our sleep (as monitored via Oura rings) and in fact when I hit the 65mg point my sleep showed a very, very marked improvement. (Later note: I say I had no pain but, my stiff neck that I've had for 35 actually does seem to have resolved once I hit 110 mg!)
Watch for improvements or regressions in sleep.
If sleep is improving, go up.
If sleep is regressing, hold and if necessary go down a level.
Most people should stop at maximum of 85 mg (so that's 42.5 mg for a child). The book has more details about when going higher might be worth a try.
You are not aiming for perfect sleep, you're aiming for the point where the sleep is best: Too much causes bad sleep, and so does too little. So go up and down to find where it seems best.
Stopping:
After around 6-12 months then either pain or sleep will start to worsen again.
It's not clear when this 6-12 months starts! I assume it's after you stop the B50 if you don't do the third stage or after you find the optimum dose if you do the third stage.
That indicates it's time to lower the dose by around 5 mg per month, until you are no longer taking the Bs or multivitamin.
What about the B12?
Note: Testing B12 is pointless if you are already supplementing since the supplement will raise blood levels and give a false "high" reading.
The protocol calls for testing B12 and only supplementing if the test shows a low level. However many ASD kids show very high levels of B12 on tests despite having other signs of needing it. According to practitioners such as Dr Amy Yasko and Dr Ben Lynch that usually means that they need Lithium before they can absorb it. Lithium orotate (Swanson do a good one) is not the same as Lithium carbonate. Lithium carbonate is poorly absorbed and given in massive, massive doses (around 1000 mg or more) which can be toxic and so must be regulated very carefully. Whereas Lithium orotate is usually given at around 5 mg.
Also on the RightSleep site it does mention that if you do not want to test you can blindly supplement with B12 since it is very safe to do so.
We found that using a Pure Encapsulations Adeno/Hydroxy form (UK supplier - email or call them to order from the EU or rest of the world, since they need to manually remove the VAT at the time of writing) at a rate of only about 1/10th of a cap seemed to make a big difference in getting him to fall asleep (I don't have the reference but I found a study showing that B12 makes people fall asleep earlier). Since then I've heard from another parent who's son wasn't falling asleep until 6-8 AM and when she added the B12 (same form) he rapidly started falling asleep earlier and sleeping better.
Beware of using a methylated form of B12 (or B9; Methyl Folate) since for many people, adding extra methyl groups causes very bad emotional swings (anger, depression etc). If you can use it, that's great! But very many ASD kids cannot (at least, early on in their recovery).
Honestly, this protocol really is far more simple than all this text might make it appear! Please do give this a try and don't make the mistake that I nearly made of ignoring it!