Did you know you can consume one food daily with cardioprotective, anti-inflammatory, anti-oxidant, weight control, and anti-aging characteristics, which also fight food-borne inflammation?
As an internal medicine physician, I recommend the daily consumption of extra virgin olive oil as a core component of a healthy, low-inflammation lifestyle.
Olive oil is not only anti-inflammatory, but it is also widely recognized as the major health-promoting factor of the Mediterranean diet.
The health-promoting effect is a major component of the brain healing power of my recently patented medical treatment for Methods of Reversing Autonomic Nervous System Damage, also known as The Nemechek Protocol®.
Olive oil contains various compounds (phenols, oleic acid, and Vitamin E) that lower inflammation and improve health by counteracting the toxic effects of compounds such as linoleic acid and palmitic acid. Linoleic acid is a common component of pre-prepared or processed food that most people eat daily.
Linoleic acid is an omega-6 fatty acid that is required by the human body to create inflammation and was consumed by primitive humans when they ingested plants as part of their diet.
Unfortunately, modern humans worldwide consume in excess of 20-30 times the necessary amount of linoleic acid.
Omega-6 competes with the omega-3 that our brains and nervous systems require to maintain good health. Oleic acid is an omega-9 fatty acid that, combined with phenols, blocks the harmful effects of omega-6 and repairs the damage already done by omega-6 in the body.
Linoleic Acid Triggers Inflammation
Worldwide, the excessive intake of linoleic acid in convenient, cheap, processed foods is considered the primary driving force behind the global epidemic of chronic inflammatory diseases. The genes within human DNA are believed to be responsible for diabetes mellitus type 2, most cancers, strokes, heart attacks, high blood pressure, chronic kidney disease, autoimmune disorders, Alzheimer’s dementia, and Parkinson’s disease.
The genes for these disorders remained harmlessly inactive within the human genome until they began being switched on in the last 100-150 years. The gene for predisposing an individual to develop the elevated blood sugar levels associated with diabetes mellitus type 2 are estimated to have laid mostly silent within the human genome for at least 25,000-35,000 years.
Now those genes are being turned on in large part from inflammation due to the ingestion of excessive linoleic acid and are triggering a worldwide epidemic of diabetes mellitus.
The same wave of food-borne inflammation that swept through the global population over the last century is also responsible for the general increases of all the other medical conditions previously mentioned (diabetes, cancers, strokes, heart attacks, high blood pressure, chronic kidney disease, autoimmune disorders, Alzheimer’s and Parkinson’s) which are estimated to be affecting three out of every five people at this time.
Fortunately, consuming a few tablespoons of high-quality extra virgin olive oil each day has the unique capacity to block the harmful inflammatory effects of linoleic acid.
The Protective Effect of Olive Oil
Extra virgin olive oil (EVOO) contains various chemicals that help directly block the toxic effects of linoleic acid but further improve our health and protect our bodies from other sources of inflammation.
EVOO comes from the fruit of an olive tree that is crushed to extract the oil at a temperature no higher than 86 degrees. EVOO is high in oleic acid, at about 75%.
EVOO is minimally processed compared to other common cooking oils such as canola, corn, soybean, and vegetable oils. These other oils lack the protective and reparative qualities of EVOO.
The primary protective effect of EVOO is the mono-unsaturated fatty acid (MUFA), known as oleic acid. Oleic acid is capable of not only blocking the toxic inflammatory effects of linoleic acid in a multitude of animal studies but can also help reverse inflammatory brain injury, diabetes, and obesity triggered by linoleic acid.
EVOO also contains a variety of other chemical compounds referred to as phenols. Phenols provide various health benefits but are also important in preserving the health benefits of olive oil while it is stored in the bottle.
The greater the concentration of phenols in EVOO, the longer the shelf life of the oil. Unfortunately, phenols are a gaseous molecule that can pass through plastic when olive oil is stored in a plastic container. When this happens, the olive will deteriorate rapidly, and the olive oil will spoil even before the “Best by Date” on the container.
Because of this, only purchase EVOO that is stored in a dark green glass bottle or a tin container to prevent the loss of phenols and protect the oil from sunlight.
Indirect sunlight exposure will reduce shelf life, while direct sunlight can make the oil lose its extra virgin qualities within days.
A common misrepresentation by industrial olive oil producers is that while their olive oil may be of the healthy extra virgin grade when it is bottled, the oil has deteriorated because it was stored in a plastic container and is no longer considered healthy by the time it is purchased by the consumer.
What is the Difference between Extra Virgin Olive Oil and Plain Olive Oil?
Extra virgin is the highest quality and most expensive olive oil classification with superior physiochemical and sensory properties. It should have no defects and a flavor of fresh olives. Virgin olive oil is classified into EVOO according to the degree of acidity, which is the ratio of free fatty acids to total oleic acid.
EVOO must be produced entirely by mechanical means without using any solvents and under temperatures that will not degrade the oil. Olive oils that require any additional chemical or temperature extraction method are not considered to be extra virgin.
A producer must use fresh olives in good condition and monitor every step of the process with great care. Even in perfect storage conditions, the oil will degrade over time, so it is important to enjoy it within 18 months after the harvest date.
Olive Oil Reduces the Risk of Death from Diabetes Mellitus, Strokes, and Heart Attacks
Extra virgin olive oil improves a wide variety of traditional markers for diabetes and cardiovascular disease and is known to greatly reduce the risk of strokes and heart attacks.
Worldwide cardiovascular diseases account for over 17 million deaths a year, and over 7 million of those deaths are from coronary artery disease. EVOO is considered to be a potentially cardioprotective food as it helps control the risk factors of coronary artery disease and aids in the reduction of cytokines and inflammatory markers.
Some of the well-known benefits that arise from the daily consumption of olive oil are:
- Decreases Blood Pressure
- Increases HDL Cholesterol Levels and Protective Function
- High Phenol Olive Oil Decreases LDL Cholesterol
- Decreases LDL Cholesterol Oxidation (oxidized cholesterol is dangerous)
- Decreases Excessive Blood Clotting
- Decreases Inflammation and Oxidation throughout the Body
- Decreases Insulin and Blood Glucose (sugar) Levels
EVOO and Weight Control
The autonomic nervous system is the brain’s master control mechanism and regulates your gut physiology, appetite, mood, and inflammation.
EVOO helps people feel full after a meal which helps people control their weight. This full feeling is associated with a derivative of oleic acid called OEA (Oleoiletanolamide).
Research suggests that ingesting dietary fat stimulates epithelial cells of the small intestine and releases the OEA. Upon release, it engages sensory fibers of the vagus nerve to diminish food intake.
The absorptive epithelium of the small intestine converts the oleic acid contained within the olive oil into OEA. OEA acts with receptors causing the feeling of satiety which affects meal size and reduces feeding frequency.
The autonomic vagus nerve also plays an important role in metabolism. The vagus nerve communicates information about the volume and type of nutrients between the gut and the brain. The vagus nerve can send signals upwards to the brain and inhibit or stimulate food intake.
The Benefit of a High Phenol Olive Oil
Phenol is a term for a special kind of molecule (also called phenolics), and olive oil contains a variety of phenols that are known to have their own powerful health-promoting properties. Phenolic compounds are created when the olive is crushed to obtain the oil.
Total phenol levels in extra virgin olive oil can range from 50 – 1,500 mg/kg, but those above 200 mg/kg are considered in the health-promoting range.
Olive oil phenols are known to lower blood pressure and increase the levels of healthy cholesterol (HDL) and are anti-inflammatory. Phenol compounds are also powerful anti-oxidants, inhibit cancer growth and limit the development of stroke and heart attack causing atherosclerosis.
Studies have shown the anti-inflammatory effects of olive oil at different stages in the development of atherosclerosis have a positive effect on the reduction of cell adhesion molecules, platelets, monocytes, and lymphocytes involved in the inflammatory process.
From a total of 17 different phenols found in olive oil, oleocanthal and squalene are two of the most important.
Oleocanthal creates a peppery sensation when you swallow pure olive oil. It is also a powerful, natural anti-inflammatory agent that operates in a fashion similar to ibuprofen (Advil, Motrin) but without the side effects of bleeding ulcers and kidney problems that accompany NSAIDs. I have had patients cancel their knee replacement surgeries after consistently consuming EVOO because of their reduction in joint pain.
Oleocanthal has also been linked to a reduced risk of Alzheimer’s disease because it can reduce the accumulation of amyloid proteins. EVOO is the only cooking oil that contains oleocanthal.
EVOO is one of the richest renewable sources of squalene. Squalene is a phenol structurally similar to beta-carotene that supports skin health and helps keep your skin looking healthy by protecting it from the harmful rays of the sun and also greatly lowers the incidence of skin cancer.
Interestingly, my wife and I live in the perpetually sunny climate of Arizona, and we do not wear sunscreen. We realized we stopped sunburning once we added EVOO supplementation to our already high omega-3 diet.
In addition to squalene, EVOO has anti-aging qualities because it contains natural anti-oxidants that play a role in protecting lipid membranes from oxidative damage. High levels of Vitamin E in EVOO also protect cells from free radicals to help reduce the effects of aging.
The phenol content of olive oil is related to a variety of factors such as growing conditions (weather, water, etc.), the variety of olive tree (referred to as cultivar), production methods (quality of olive, time of harvest, filtering), and storage conditions (heat, exposure to oxygen, type of container).
The phenol content is also one of the important factors in determining how fresh olive oil will remain in the bottle. The higher the phenols, the longer the oil can be stored in the glass bottle and the longer it will retain its beneficial properties as EVOO.
There is no evidence that consuming less olive oil daily because it may have more phenols will give you the same health benefits. I highly recommend against doing this.
There are many types of phenols from many different types of plants. Phenols from strawberries, wine, or any other food have different biological effects are are not the same as the unique phenols found in olive oil.
How to Buy High-Quality Olive Oil
There is a great deal of poor-quality olive oil in the marketplace. Some estimate that 75% of olive oil marked extra virgin no longer meets the criteria of extra virgin olive oil by the time the consumer purchases it.
The FDA does not regulate EVOO. And with no regulation but the USDA, some oils are being sold that have been adulterated with soy and other oils. Others are of such poor quality that although they meet the minimum standard at the time of bottling, by the time the consumer purchases the oil, it has deteriorated so much it no longer contains the health benefits for the consumer.
The key factors that a consumer can look for when choosing the best possible olive oil are:
- Freshness is Everything: Never consume olive oil 18 months before harvest. Some producers only provide expiration dates, not harvest dates, making it hard to determine actual freshness.
- EVOO degrades when exposed to oxygen and light, so once opened, finish the bottle within 3-6 months.
- “Best by Dates” are now being put on major brands, but if the oil is stored in a plastic container, those dates are invalid due to the loss of phenols through the plastic (see below).
- Phenol Content is Important: EVOO with phenol contents in 400-200 mg/kg is much healthier for you and will not deteriorate during storage as quickly as those with lower phenol contents. Remember, oil stored in plastic deteriorates more quickly (see below).
- Glass or Metal Containers only: The phenol molecules that give the olive oil its health-promoting properties and help maintain its self-life are gaseous molecules that will leak through a plastic bottle. Despite the quality of the oil that went into the plastic bottle, it will often no longer qualify as extra virgin nor be health-promoting by the time the consumer purchases it.
- Filtered Oil Lasts Longer: While unfiltered olive oil may have unique taste properties, the plant matter that is not filtered out causes the oil to go rancid more quickly. Unfiltered olive oil only lasts three months after the oil is pressed.
- Do Not Store Near Heat: Olive oil stored in excessive heat will cause the oil to degrade faster. I recommend buying the oil straight from the farmer to minimize the risk of third parties not correctly storing the oil. Store in a cool, dry place in your house. Do not place the olive oil bottle next to your stove. High-quality EVOO can withstand cooking temperatures up to 420 degrees but not prolonged heat exposure sitting next to your stove.
- Use COOC-Certified EVOO: The vast majority of olive oil certifications are more of a pledge by the manufacturer, and some have a taste (sensory) certification. As a scientist, I need more assurance than this. I recommend consuming olive oils that are certified by the California Olive Oil Counsel (COOC). COOC certification is the only approval worldwide that process that includes mandatory chemical analysis of the oil by third-party laboratories, and their standards are among the strictest worldwide.
- Buy Direct from The Growers: Many worldwide have access to olive oil from local farmers. I have found olive oil farmers to be a passionate group, and I believe your chances of getting the best possible olive oil is when you buy the oil directly from the farmers, whether they are in the U.S. or anywhere else in the world.
Everyone Needs Extra Virgin Olive Oil
We live in a time of increased inflammation which is reflected in how people collectively get sick faster and at younger ages. The major source of this inflammation comes from grain-based oils (corn oil, soy oil, sunflower oil, safflower oil, etc.) that we cook with or are added to the prepared foods we purchase. These inflammatory oils are in our food supply to stay, so we must do everything we can to protect ourselves from their food-born inflammation.
This health crisis is affecting everyone. Inflammation is understood to be a major trigger for most non-infectious diseases, and the World Health Organization (WHO) estimates that 3 of every 5 people worldwide will die from an inflammatory disease such as heart attacks, strokes, kidney failure, cancer, lupus, inflammatory bowel disease, diabetes, and Alzheimer’s dementia.
In addition, when we feed our livestock (chicken, turkey, and fish) corn or soybeans, for instance, we are feeding them corn oil and soy oil. What we feed the animals, we ultimately feed ourselves. These oils concentrate in the meat of these animals and become another source of inflammation for us.
To say it in simple words: the highly inflammatory nature of the food most of us consume every day has rapidly become one of the greatest health threats to the entire global population.
So, while it may seem unusual for a physician to tell people to drink olive oil, the daily consumption of just two tablespoons of high-quality extra virgin olive oil will greatly reverse this risk of inflammation.
To make sure you get the daily amount consumed, add at least two tablespoons of extra virgin olive oil to your foods before eating them or do as I do, drink two tablespoons of EVOO a day like you would any medication or natural supplement.
The health benefits I have described make the quality and amount of extra virgin olive oil you consume one of the most important health-related decisions you should make. And with cardioprotective, anti-inflammatory, anti-oxidant, weight control, and anti-aging qualities, which most importantly fight food-born inflammation, high phenol EVOO is your health’s new favorite food.
I have been testing and treating the autonomic nervous system for 13 years. I have developed a recently patented treatment program, the Methods of Reversing Autonomic Nervous System Damage, also known as The Nemechek Protocol ® for Autonomic Recovery. It is designed to reduce multiple sources of inflammation and encourage the restoration of the body’s natural brain repair mechanism.
I believe that the key to restoring our natural inflammation control mechanisms is to reduce inflammation throughout the brain and body using every scientific, nutritional, and bioelectric tool available.
I am an internal medicine physician (D.O.) from UCLA, and my Internal Medicine and Autonomic practice is in the Phoenix, Arizona, area. For additional information, go to AutonomicMed.com.
This post is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and does not create any patient-physician relationship.
Addendum (Aug. 24, 2019):
“I cannot comment specifically about ATSAS EVOO, but I can say that the medical benefits of EVOO for an adult occurred when approximately 30 ml of EVOO is consumed daily and that the EVOO needs to have 200-400 mg/kg of phenols.
It is important to remember that EVOO also contains oleic acid and other antioxidants, which greatly contribute to EVOO’s health benefits.
To say that one can use a smaller amount of EVOO because it has a higher concentration of phenols is not scientifically correct. In my work on brain recovery, I do not believe that the phenol content is the primary reason it has such a strong anti-inflammatory impact on the body and brain.
So my advice is to purchase EVOO harvested within the last 12 months, has a phenol count of around 400, and is stored in a glass, tin, or foiled-lined container to prevent phenol loss through the plastic. A phenol count close to 200-400 will guarantee that by the time of the next harvest, the olive oil will still have enough potency to protect you medically.
Purchasing fresh EVOO with a phenol count below 400 (instead of EVOO with phenol levels of 700, 1000, or more) will have a milder taste that is more acceptable to most people and much less expensive than ultra-high phenol EVOOs.
Note: Do not store EVOO in the refrigerator; cold and hot temperatures will lessen the medical benefits of the oil. Cooking with EVOO doesn’t make it toxic but can lessen the phenol content. Exposure of the EVOO to oxygen that gets into the bottle will also decrease its shelf life.”
Good day Dr. Nemechek! Thank you for your hardwork. My son is 6 yrs old and has been 1 year on the protocol at all approved brands, no supplements. I reintroduced organic milk for 5 consecutive days (he’s sensitive to milk before, it causes hyperactivity to him), his teacher says that his awareness is off for a few days now and it takes a few times for him to respond to his name being called. There’s also inappropriate laughter on a number of occasions. He’s not experiencing a relapse because he hasn’t been sick for a few months now. Does… Read more »
Sounds like inulin failure, I would recommend rifaximin to my patients at this point.
Hi Dr. Nemechek,
I wonder does 1 runny nappy a day mean my daughter has diarrhea and I was right stopping oils and need to continue introducing them slower or is it something else and I’m okay to just start them again as diarrhea would be classed as more than one a day, there was no recent changes in oil prior to this starting.
Stopping the oils is a good way to determine if the oil is the cause or it is from something else.
My 3 year old daughter is on the protocol since February, I increased the Inulin to 1/4 tsp after the awakening and saw your post this was wrong, she seems paranoid sitting in the corner of the bedroom with her back to the wall, scared at the playground when it was her favorite place, I’ve decreased to an 1/8 will it take long for this to reverse of will it ever? Should I stay at an 1/8 or decrease again as she had the awakening at the 1/16 I think but it’s not the recommended amount in the book. I… Read more »
Just stop everything, wait for her changes to resolve and try again at the lower doses.
We have gut colonized penicillum… using mycotoxin and oat test… will inulin and olive oil help? We have very little microbiome due to penicillium killing everything. Currently using itraconazole
First, the mycotoxin and oat tests are inaccurate from a clinical management point of view.
You need to thoroughly read my book to understand what to do.
https://autonomicrecovery.shop
Dear Dr. Nemecheck
My 3 yo daughter (ASD) and I have been on your protocol with excellent results so far. I want to start my 70 yo mother on it but I’m hesitant. She has been on seizure and blood pressure medications for decades, and now this has resulted in some muscle and skin degenerative disorder, and she is taking a corticosteroid and Azathioprine permanently. Would it be safe to start her on the Refaximin while she is taking those medications? Thank you very everything!
OF
Generally the rifaximin is safe since it does not get in the blood stream and therefore has little chance of affect the blood levels of these other medications.
I advise you to consult her managing physician first.
Hi Dr nemichek.
Thank you for your amazing work. I have read the book and implementing the same.
I HV a question on fish oil and it’s replacement Can other sources of omega 6 like walnuts and flax seeds etc be used.
The reason for switch is because family is vegetarian and resistant to fish oil usage.
Awaiting reply.
Best Regards,
Naila
There is no vegetarian replacement for the omega-3 fatty acids found in fish oil.
My son is 6 years old in protocol 9 Montes, All products According to the instructions, We do not see awakening, no probiotics, no omega 6, I’m desperate, What else can I do?
After 6 months, if there is no improvement I worry that the inulin is not successfully balancing the SIBO.
Hello Dr,
My 5yr old had open heart surgery to switch her arteries at birth. She was s behind her peers in school and has very loose joints so always falling and clumsy. Would the same amount of doses apply to her or would she need lower dose of oils? We have read the book but I’m asking from her heart perspective because after some months of being on Protocol I wanted to up her fish oil. Thank you
Same amount of oils should be safe in her. If you are concerned, run it by one of her physicians.
Hello Dr Nemechek, my son age 8 has ASD and ADHD. He has been on protocol for 1 year with good gains. Twice recently he has regressed, increase in aggression and huge increase in stimming , this may be as a result of seasonal allergies. He is on Intuniv (guanfacine) for his ADHD. Intuniv is also used as a treatment for high blood pressure . I have seen your comments about low blood pressure, could it be possible that as he is improving the Intuniv is causing the regression. ?Would simply increasing his salt be enough to counteract? Many thanks… Read more »
Yes, there comes a point in which the Intuniv might be making things worse instead of better.
Thank you for all your work in developing and disseminating this protocol. Do you know if it will help in cases of anoxic brain injury? (The patient is tube fed and in a nursing home, so I will need empirical data to get him on the protocol.)
Yes it can help but I have no published studies.
Hi Dr. Nemechek, thank you for this post. My 6 year old ASD has been on the protocol for 1.5 years. He has had several gains – the most imp was that his stools got more solidified and we were able to potty train him. However, as soon as I give him anything more than a sprinkling of EVOO, e.g. 1 tbsp on food, his BMs become mushy and he starts having accidents. Is there any alternative to EVOO? I feel like his SIBO is controlled but his brain is not healing because his body can’t handle EVOO.
No alternative to EVOO.
Simple use tiny amounts sprinkled within the food during the day
Thank you!
Hi: My daughter is being on the protocol for 3 months. She’s 6 now. She was born prematurely(placenta abruption), low muscle tone and when she was around 2 she had a c-diff overgrowth that lasted almost a year with antibiotics. Se has global development delays(speech, motor and some autism traits, like not looking in the eyes). What has improved so far in the protocol is that she’s not as tired as before, she has made some gains socializing with her classmates. The focus is still a big issue since it won’t let her concentrate. We are at 1/4tbs inulin and… Read more »
If you are seeing any significant improvements, you know the gut is balanced and you never need to increase the inulin dose nor repeat rifaximin.
Only thing is you might double the fish oil dose. If this doesn’t help, she’ll need a VNS
Hi,
I have many health issues. I’m 57 years old. I’m currently allergic to all of the oral antibiotics on the market. I broke out in hives.
Would I be able to take Rifamaxin or not? If not, then I will do the inulin. I believe that I have histamine issues so I’ll leave the fish oil alone for the meantime.
Thank you for your help,
Fish oil does not contain histamine.
Your problem is SIBO. Although it doesn’t work nearly as well as rifaximin, you might try some inulin.
Hello sir just wanted to knw my 3.9 yr old son is already on homeopathy medicines since 1 year.can i start the protocol along with homeopathy medicine or it can delay the recovery…pls rply thanks in advance
Please read the protocol
Dr. Nemecheck please advice! I have messaged on the blog before, but for some reason my question was not posted. I really need your advice on Rifaximin. My son is on protocol since December 2018 I have tried different doses of inulin and upped to 1,5 tsp with no gains or awakening. In the VIP group I was advised to try Rifaximin. We do not work with any doctor currently and I purchased Rifaximin in Russia which is sold without prescription. What would be the dose for 4,5 year old ? You book mentions it’s same dose for everyone, but… Read more »
The prescribing doctor needs to decide this
Hello Dr Nemecheck, we’re applying your protocol on our child with, what I think are, good results.
I have read and understood the basics of your protocol so I’m confident with your comment
“Probiotics = playing with fire” but the other day I’ve found this and other article abouth Lactobacillus plantarum PS128
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521002/
have you had the chance to read something obout?
should we introduce this new supplement.
Thank you very much, your work is being very helpful to many.
You prove my point.
Where are you going to get Lactobacillus plantarum? And with a 80% fraud rate in the supplement market why would you trust the supplement manufacturer?
In my practice, we routine have patients that had serious adverse reactions to probiotics. Why risk it when my protocol is proving so effective without the downside?
I’ve always said some day there will be useful probiotics but now is not the time.
hey dr Nemecheck! how can you explain diarrhea after eating kimchy or any homemade pickled vegetables after taking rifaximine .???? the only thing that stops it is taking a very strong probiotic . ( I know 🙁 its wrong . one time after a antibiotic shot i had diarrhea with cramps for 4 weeks no matter what i tried nothing worked until i had one capsule of probiotic(could not take it anymore 🙁 and immediate went away. I’m puzzled. I’m very familiar with your videos and your amazing book . 8 months on NP feeling amazing otherwise. also amazing results… Read more »
No idea but I can say you are extremely lucky to have any improvement after using probiotics.
Probiotics = playing with fire.
How can you determine if an EVOO is high in phenols?
Ask the grower.
Hi Docyor. I need some help. My son 12 years old adhd has started epilim 400 mg twice a day. Can I still put him on the protocol. I’m worried about the fact that it can trigger his seizures but i do believe in this protocol for his adhd symptoms.
The protocol lowers inflammation only and does not trigger seizures.
Dr. Nemechek,
For my 17 year old son with epilepsy , could I see the beginnings of healing by starting with Inulin? Or should I go straight to Rifaximin? Not sure how I would get a prescription. Also, how do you set up a VNS on a patient? Is it done via an operation and implanted internally? I know you are booked many months in advance and I would be coming from VA.
Thank you,
Susan Pearson
I recommend starting with rifaximin to my 17-year old patients.
Implantable VNS is generally the best approach for severe epilepsy. I recommend discussing this option with a neurologist.