Transit Training / Travel Instruction

 

Monty coming home by himself, at night, from a trip to see his friend Vera, who proudly sent me the photo - not nervous at all.

 

Today’s post is a practical one, it is all about developing independent travel skills. This is all part of what is called “adaptive behavior,” which are the skills you need to function independently in life.

I still recall one mother’s reaction from years ago when a teenager with autism traveling by bus was mentioned:-

“I’d be petrified I’d never see him again”

Your success in mastering life skills matters much more than your IQ, or any academic results.

Depending on where you live, there may be free services available to teach both children and adults, with some kind of special need, how to safely use public transport. There may be group classes, but some even provide a 1:1 helper to ride with the learner to teach the travel route until they can manage unassisted. We followed this latter model with Monty, now aged 20.  It did not take so long, but we encountered many disruptions along the way that provided key learning opportunities – more of that later.

In North America it is the transit authority or school that may offer this training, whereas in the UK it seems to be the municipal authority.

 

 

Example from the UK – Essex County Council

 Transit training in Vancouver

 

There are video training courses and apps for smart phones.

It is apparent that a wide range of people, from low IQ to high IQ are using these services.  It is quite well known that some Aspies struggle with travel by plane, but others may not like sitting next to strangers on the bus.

As with all trainings, they range from the superficial, like how to buy the ticket, to the comprehensive where many of the possible disruptions are planned for.

This is very similar to learning how to buy food/groceries - there is more to it than just learning how to stand in line and pay for your shopping. 

In the jargon this is all part of “adaptive behavior.” I think it would be much clearer if it was called “adaptable behavior.” Many people with autism are not adaptable at all and when things change, or go wrong, they can fall apart.

 

When things go wrong  – it’s also called “life”

In my brief research I came across quite a lot from the US and just a small amount from the UK. Many of the anecdotes from the US are very upbeat, with parents happy that their child has achieved travel independence.  Some of the children / young adults do not appear very disabled, I should point out.

There remains the issue of what happens when things go wrong.

I always told Monty’s 1:1 school assistants not to worry if something went wrong – it’s when things go wrong that you actually learn something useful.  The same is true with independent travel, inevitably things are going to go wrong – more of that later.

Here is a comment I found on the UK’s National Autism Society’s website:-

 

                https://community.autism.org.uk/f/adults-on-the-autistic-spectrum/3426/travel-training

“My local authority is reviewing the cost of providing specialised transport for disabled adults and children. This is quite a widely reported issue nationally, as it affects vital transport links for people on the spectrum, especially those having to travel long distances to use support services and day centres.

One clever wheeze my local council has come up with is that they are going to train people with learning disabilities or autism how to travel independently by bus or train.

Yep, if you haven't heard this idea before, if my council are pushing this, sure enough lots of councils will be trying the same thing.

Seems they haven't factored in change. If the bus route changes. If the train leaves late or there's a confusing on train announcement. If the driver of the bus doesn't understand the difficulty. 

So for local authorities to come up with the clever saving, oh we'll teach disabled people how to go by bus or train. It is truly tragic how badly served we are.”

 

Clearly there are some people who will never be able to safely travel independently.  If you cannot master being out as a pedestrian unaccompanied, you are not ready for public transport training.

Given how broadly autism is now diagnosed with 1 in 25 (four percent) of seven to 14 year old Australians now having an autism diagnosis, it is only a very small proportion who cannot be helped.  Many will not need any help at all.

 

Getting used to things going wrong

Things rarely go exactly to plan and it is these unexpected events that can be hard for some people with autism, or intellectual disability, to deal with.

How do you build resilience to change? By being exposed to it, not being hidden from it.

Many things can go wrong when traveling independently, some are quite predictable, like forgetting to get off the bus at the correct stop, some are not.

 

Bad news can be good news

Since starting independent travel a couple of years ago, Monty has experienced his share of surprises/upsets.

Early on in his bus training he was getting used to traveling by himself on a small local bus and we had his former school assistant following in her car. He was supposed to go from near our house to the park. A lady riding in the bus, who had previously seen Monty practising with his assistant, thought he must have forgotten to get off and so she led him off the bus in what was the middle of his planned journey.  We had not expected that, but no harm done.

A bigger issue occurred recently when Monty took his regular two bus journey to his “work” – about an hour door to door. After getting off the first bus as usual and walking to another bus stop, the second bus had its route modified, due to a road closure, and Monty ended up at a big shopping mall.  He then headed off back towards his work on another bus, but again got stuck because of the road closure.  He could not fully explain what was going on by telephone, so I told him to go to a specific McDonalds, buy a cheeseburger and fries and wait for Dad.  This clearly was a stressful experience, but it is important to complete your activity, so after he finished eating I took him to his work by car.

Fortunately, with a tracking app on your smartphone, you cannot really lose your adult child. I use Google’s Family Link app.

You do need to always pack your phone, remember to charge it and not turn the ringer volume down to zero. Being able to answer your phone and use it to make calls have to be already mastered. Many children with autism hate the sound of a phone ringing and so just turn it off. If your house has poor cell phone coverage you need to teach calling via WhatsApp as well as by phone.

Monty has been taught "if you have a problem, call Dad" and call me he does. At every stage of his bus travels he calls to update me, so the tracking App is really just for emergencies. 

  

The broader concept of Adaptive Behavior, for those interested

Adaptive behavior is the technical term used for daily living skills.

 You might wonder why it is called adaptive behavior. The term "adaptive behavior" is used because it emphasizes the ability of individuals to adapt to their environment and meet the demands of everyday life. It goes beyond simply having basic skills like walking, talking, and eating; it encompasses the ability to learn, solve problems, interact with others, and manage one's personal life.

The word "adaptive" highlights the dynamic nature of these skills, as they are constantly being modified and refined to fit the changing circumstances of an individual's life. As we grow and develop, we learn new ways of coping with challenges, navigating relationships, and achieving our goals.

In addition, the term "behavior" emphasizes the active and intentional nature of these skills. It's not just about having the potential to perform certain actions; it's about actually using those skills in a functional and purposeful way.

Overall, the term "adaptive behavior" captures the essence of what it means to be able to function effectively in the world around us. It's about having the skills and abilities to adapt to new situations, solve problems, and build meaningful relationships, all of which are essential for a fulfilling and independent life.

Adaptive behavior is the collection of conceptual, social, and practical skills that all people learn in order to function in their daily lives. It encompasses a wide range of abilities, from basic self-care skills to more complex problem-solving and social interaction skills. Adaptive behavior is essential for individuals to live independently and to participate fully in their communities.

Conceptual skills are the ability to understand and apply information and concepts. They include:

• Literacy: The ability to read and write at a level that is appropriate for one's age and environment.
• Self-direction: The ability to set goals, make decisions, and manage one's own time and behavior.
• Concepts of number, money, and time: The ability to understand and use basic mathematical concepts, to handle money responsibly, and to manage one's time effectively.

Social skills are the ability to interact with others in a positive and productive way. They include:

• Interpersonal skills: The ability to communicate effectively, build relationships, and resolve conflict.
• Social responsibility: The ability to follow rules, be considerate of others, and contribute to the community.
• Self-esteem: A positive sense of self-worth and value.
• Gullibility or naïveté: The ability to recognize and avoid being taken advantage of.
• Social problem-solving: The ability to identify and solve social problems in a constructive way.
• Following rules: The ability to understand and follow rules and expectations.
• Obeying laws: The ability to understand and obey laws and regulations.
• Avoiding being victimized: The ability to protect oneself from harm or exploitation.

Practical skills are the ability to perform the tasks of everyday living. They include:

• Activities of daily living (personal care): The ability to take care of oneself, such as bathing, dressing, eating, and using the toilet.
• Occupational skills: The ability to perform the tasks of a job or other productive activity.
• Use of money: The ability to manage money responsibly, including budgeting, saving, and spending.
• Safety: The ability to stay safe from harm, including fire, traffic, and other hazards.
• Health care: The ability to manage one's health, including taking medication, seeing a doctor, and understanding one's health conditions.
• Travel/transportation: The ability to travel from place to place safely and independently.
• Schedules/routines: The ability to manage one's time and follow schedules and routines.
• Use of the telephone: The ability to use a telephone to communicate with others.

Adaptive behavior skills develop gradually over time, from infancy to adulthood. Children with disabilities may develop these skills more slowly or with more difficulty than children without disabilities. However, with appropriate intervention and support, children can learn to develop the adaptive behavior skills they need to succeed in life.

  

Conclusion - creating dependence vs creating independence

A recuring theme in dealing with a child who has special needs is to what extent you accommodate those needs, versus trying to overcome them.

If your child struggles at the dentist, do you simply resort to sedation for every visit? or at least try and learn how to be treated like a typical patient?

It is fashionable these days to exaggerate smaller problems to try and get some benefits, or maybe some ADHD meds. A case in point is in Australia with a ballooning budget for those with a disability. In order to access financial support via their NDIS (National Disability Insurance Scheme), some clinicians have been exaggerating the severity of autism, only level 2 and 3 gets you financial benefits.  The end result will be a completely unaffordable scheme and some children/adults held back by a diagnosis they do not warrant. Ultimately there will be insufficient money to support those that need it the most.

In Australia a record 11.5 per cent of boys aged between five and seven are now receiving funding from the NDIS.  Not surprisingly this has put immense pressure on the program’s $42 billion annual budget.

 

Save money on specialist transport by investing in transit training!

A problem the Aussies have is that once someone joins their NDIS disability scheme, they apparently are likely never to leave it. So most of those 5-7 years olds will still likely be on it in 10, 20 and 50 years’ time. The average recipient receives over $30,000 a year.

We recently learnt from the US that about a third of children diagnosed with autism before 36 months of age no longer have symptoms qualifying for an autism diagnosis by the age of 7 years.

 

Persistence of Autism Spectrum Disorder From Early Childhood Through School Age

Key Points

Question:  What is the frequency with which children diagnosed clinically with autism spectrum disorder (ASD) at 12 to 36 months of age continue to meet criteria for ASD based on functioning at 5 to 7 years of age, and what factors are associated with ASD persistence?

Findings:  Of the 213 children in this cohort study, 79 (37%) had nonpersistent ASD. Higher baseline adaptive functioning and female sex were associated with nonpersistent ASD.

Meaning:  These findings suggest that an ASD diagnosis in a child younger than 3 years may not persist, and child-specific factors may be associated with persistence.

 

A big shake up will have to occur down under, or they will go broke.

 

IQ vs Adaptive Behavior as predictors for success

The interesting thing is that plenty of people with low IQ travel by bus every day, with no need for transit training.  Some higher IQ autistic teens and adults seem to struggle and many of them are fully verbal.

Adaptive behavior is the predictor of future independence/semi-independence.

You may well need your IQ to do some kind of office job, but without some adaptive behavior you will not be able to get to and from it.

If you are lucky, adaptive behavior is taught at school, but for many it will have to learnt outside school.

What about those unable to move towards transit training because they cannot safely cross a road? Try and raise IQ pharmacologically where possible, so that basic concepts of danger and self-preservation can be mastered.  Remarkable success is possible if you persist.

 

“I’d be petrified I’d never see him again”

This undoubtedly is a concern many parents of an adult or child with special needs will have.

Plenty of people thought Monty couldn't, or shouldn't, travel independently. There are always a hundred good reasons not to. It's too hot, it's too cold, it might rain, what if he gets lost, what if someone mistreats him ... and the list goes on. 

At least the training option already exists in many countries to move towards travel independence. Perhaps there should be courses for nervous parents too!

Glycine-NAC for longevity, but for Autism? and Ketogenic “Autistic” Fish

Fish taking a ketone ester

Lonesome fish

  

Baylor College of Medicine in the US have a patent on the combination of glycine and the anti-oxidant NAC to promote healthy aging, which they licensed to Nestle. You can easily make it yourself - just buy both separately. 

GlyNAC supplementation reverses mitochondrial dysfunction, oxidative stress and aging hallmarks to boost strength and promote health in aging humans

One of the intriguing questions from this trial is why so many improvements occur toward promoting health. We believe that this is due to the combined effort of three separate components – glycine, cysteine (from NAC) and glutathione, and not just due to glutathione itself. Glycine and cysteine are both very important for cellular health on their own, and GlyNAC provides both. 

We believe that the improvements in this trial and in our previous studies are the result of the combined effects of glycine and NAC and glutathione, and we refer to this combination as the "Power of 3" said Sekhar.

You need cysteine and glycine to make the body's key antioxidant, glutathione (GSH).  Older people and people with autism are likely to lack GSH.

If you add the precursors via supplementation, you will hopefully increase the production of GSH.

  

GlyNAC (Glycine and N-Acetylcysteine) Supplementation in Mice Increases Length of Life by Correcting Glutathione Deficiency, Oxidative Stress, Mitochondrial Dysfunction, Abnormalities in Mitophagy and Nutrient Sensing, and Genomic Damage

Determinants of length of life are not well understood, and therefore increasing lifespan is a challenge. Cardinal theories of aging suggest that oxidative stress (OxS) and mitochondrial dysfunction contribute to the aging process, but it is unclear if they could also impact lifespan. Glutathione (GSH), the most abundant intracellular antioxidant, protects cells from OxS and is necessary for maintaining mitochondrial health, but GSH levels decline with aging. Based on published human studies where we found that supplementing glycine and N-acetylcysteine (GlyNAC) improved/corrected GSH deficiency, OxS and mitochondrial dysfunction, we hypothesized that GlyNAC supplementation could increase longevity. We tested our hypothesis by evaluating the effect of supplementing GlyNAC vs. placebo in C57BL/6J mice on (a) length of life; and (b) age-associated GSH deficiency, OxS, mitochondrial dysfunction, abnormal mitophagy and nutrient-sensing, and genomic-damage in the heart, liver and kidneys. Results showed that mice receiving GlyNAC supplementation (1) lived 24% longer than control mice; (2) improved/corrected impaired GSH synthesis, GSH deficiency, OxS, mitochondrial dysfunction, abnormal mitophagy and nutrient-sensing, and genomic-damage. These studies provide proof-of-concept that GlyNAC supplementation can increase lifespan and improve multiple age-associated defects. GlyNAC could be a novel and simple nutritional supplement to improve lifespan and healthspan, and warrants additional investigation.

 

Glycine and N‐acetylcysteine (GlyNAC) supplementation in older adults improves glutathione deficiency, oxidative stress, mitochondrial dysfunction, inflammation, insulin resistance, endothelial dysfunction, genotoxicity, muscle strength, and cognition: Results of a pilot clinical trial

GlyNAC supplementation for 24‐weeks in OA was well tolerated and lowered OxS, corrected intracellular GSH deficiency and mitochondrial dysfunction, decreased inflammation, insulin‐resistance and endothelial dysfunction, and genomic‐damage, and improved strength, gait‐speed, cognition, and body composition. Supplementing GlyNAC in aging humans could be a simple and viable method to promote health and warrants additional investigation.

 

 

 

Multifarious Beneficial Effect of Nonessential Amino Acid, Glycine: A Review

Glycine is most important and simple, nonessential amino acid in humans, animals, and many mammals. Generally, glycine is synthesized from choline, serine, hydroxyproline, and threonine through interorgan metabolism in which kidneys and liver are the primarily involved. Generally in common feeding conditions, glycine is not sufficiently synthesized in humans, animals, and birds. Glycine acts as precursor for several key metabolites of low molecular weight such as creatine, glutathione, haem, purines, and porphyrins. Glycine is very effective in improving the health and supports the growth and well-being of humans and animals. There are overwhelming reports supporting the role of supplementary glycine in prevention of many diseases and disorders including cancer. Dietary supplementation of proper dose of glycine is effectual in treating metabolic disorders in patients with cardiovascular diseases, several inflammatory diseases, obesity, cancers, and diabetes. Glycine also has the property to enhance the quality of sleep and neurological functions. In this review we will focus on the metabolism of glycine in humans and animals and the recent findings and advances about the beneficial effects and protection of glycine in different disease states. 

As glycine is a very successful immunomodulator that suppresses the inflammation, its action on arthritis is investigated in vivo through PG-PS model of arthritis. PG-PS is a very crucial structural component of Gram-positive bacterial cell walls and it causes rheumatoid like arthritis in rats. In rats injected with PG-PS which suffer from infiltration of inflammatory cells, synovial hyperplasia, edema, and ankle swelling, these effects of PG-PS model of arthritis can be reduced by glycine supplementation [66].

 

Glycine has a wide spectrum of defending characteristics against different injuries and diseases. Similar to many other nutritionally nonessential amino acids, glycine plays a very crucial role in controlling epigenetics. Glycine has much important physiological function in humans and animals. Glycine is precursor for a variety of important metabolites such as glutathione, porphyrins, purines, haem, and creatine. Glycine acts as neurotransmitter in central nervous system and it has many roles such as antioxidant, anti-inflammatory, cryoprotective, and immunomodulatory in peripheral and nervous tissues. Oral supplementation of glycine with proper dose is very successful in decreasing several metabolic disorders in individuals with cardiovascular disease, various inflammatory diseases, cancers, diabetes, and obesity. More research investigations are needed to explore the role of glycine in diseases where proinflammatory cytokines, reperfusion or ischemia, and free radicals are involved. Mechanisms of glycine protection are to be completely explained and necessary precautions should be taken for safe intake and dose. Glycine holds an enormous potential in enhancing health, growth, and well-being of both humans and animals.

  

Ketogenic Fish – rebuilding social affinity 

Regular readers will have noted that some people with autism, but normal IQ, are deeply troubled by their lack of social affinity and seek out ways to improve it.

Perhaps we can learn something on that subject from Masato Yoshizawa, an evolutionary developmental biologist and neurobiologist at the University of Hawaii. Yes, that’s right, an evolutionary developmental biologist – they exist! Back in 2018 he published a paper called “The evolution of a series of behavioral traits is associated with autism-risk genes in cavefish”.

“Many people first doubted that the fish have an autism-like state; I also doubted it at first,” said Yoshizawa. But as he soon found out, even patterns of gene regulation resembled autistic patients.

His recent paper uses his cavefish to look at how the ketogenic diet affects behaviour. 

In the experiment, cavefish where fed the same ketogenic milk provided to human patients, albeit with a few modifications for fish consumption, and their behavior was monitored. As a comparison, a type of A. mexicanus fish that lives in rivers and not caves were also tested.

The surface fish do not display the same autism like behaviors as their cave dwelling relatives. In the presence of other surface fish, individuals will begin to follow each other and swim together, something rarely seen in cavefish, Yoshizawa said. The surface fish also do not do the repetitive behavior of swimming in circles.

 

Using these fish as a comparison, Yoshizawa and his students watched and waited. Amazingly, after a month of the ketogenic diet, the cavefish began to act like the more social surface fish. They would follow each other in groups and ceased going round in circles. There were some other behaviors, such as attention to a specific task and sleeping, that were unaffected, but overall the results were promising and according to Yoshizawa, suggest dopamine could be key to how the diet affects behavior.

 

According to Yoshizawa, there are two plausible ideas as to how the ketones produced by a ketogenic diet are acting on behavior. The first involves the mitochondria, which use either carbs or fat to produce energy in our cells, and the other involves epigenetics, which simple refers to any non-genetic influence which turns genes on and off.

 

Ketones are known to create detectable increases in gene expression in cells. Pulling apart exactly how things like, diet, environment, genes and neurotransmitters are linked is incredibly difficult but could reveal which pathways are best to target for autism treatments or could identify a specific ketone which works more efficiently than others.

 

 

Cavefish provide clues to the keto diet's effect on autism-like behavior 

 

Metabolic shift toward ketosis in asocial cavefish increases social-like affinity

 

Background

Social affinity and collective behavior are nearly ubiquitous in the animal kingdom, but many lineages feature evolutionarily asocial species. These solitary species may have evolved to conserve energy in food-sparse environments. However, the mechanism by which metabolic shifts regulate social affinity is not well investigated.

Results

In this study, we used the Mexican tetra (Astyanax mexicanus), which features riverine sighted surface (surface fish) and cave-dwelling populations (cavefish), to address the impact of metabolic shifts on asociality and other cave-associated behaviors in cavefish, including repetitive turning, sleeplessness, swimming longer distances, and enhanced foraging behavior. After 1 month of ketosis-inducing ketogenic diet feeding, asocial cavefish exhibited significantly higher social affinity, whereas social affinity regressed in cavefish fed the standard diet. The ketogenic diet also reduced repetitive turning and swimming in cavefish. No major behavioral shifts were found regarding sleeplessness and foraging behavior, suggesting that other evolved behaviors are not largely regulated by ketosis. We further examined the effects of the ketogenic diet via supplementation with exogenous ketone bodies, revealing that ketone bodies are pivotal molecules positively associated with social affinity.

Conclusions

Our study indicated that fish that evolved to be asocial remain capable of exhibiting social affinity under ketosis, possibly linking the seasonal food availability and sociality.

 

Are these behavioral and growth changes induced by ketosis? The KD contains high amounts of fat, sufficient levels of proteins, and a minimum amount of carbohydrates. This question motivated us to test the molecular basis of the effects of KD feeding by supplementing major ketosis metabolites, ketone bodies, to the standard diet.

 

In humans, KD feeding induces ketosis, in which the liver releases beta-hydroxybutyrate (BHB) and acetoacetate via beta-oxidation of fat [63].

 

Instead of supplying a massive amount of fat using the KD, BHB might be responsible for the majority of effects observed after KD feeding. With this idea, the ketone ester (D-b-hydroxybutyrate-R 1,3-Butanediol Monoester; delta-G® [64]) was provided as a supplement to both surface fish and cavefish for 5 weeks. The ketone ester (KE) was expected to undergo complete hydrolysis by the gut esterases, resulting in two BHB molecules (and acetoacetate) [64]. It does not contain any salt ions, unlike the sodium or potassium salt forms of BHB, nor does it has the racemic L-form, where only the D-form is considered to be biologically active [65]. Since we were unsure whether gut esterases were available in juvenile-adolescent fish at 3 months old, we used 6–7-month-old fish that have a mature gut system but are in the young adult stage. The results indicated that the KE supplementation significantly reduced the serum GKI (Additional file 2: Fig. S8), while promoting nearby interactions in cavefish (Fig. 7A, B). Swimming distance was slightly reduced in cavefish (Fig. 7C). Turning bias was not reduced by KE supplementation in cavefish (Fig. 7D). There was no detectable difference between CD and KE supplemental diets in sleep duration or VAB (Additional file 2: Fig. S9A and B, respectively).

  

We also tested the supplemental feeding of the BHB salt form (sodium salt form of racemic BHB: 50% L-form and 50% D-form). We used 11–12-month-old fish in this study since the younger fish seemed to suffer from the high-salt-containing diet. The 4-week feeding result was essentially the same as the KE-supplemented diet feeding: the BHB salt supplemental diet significantly reduced GKI in the serum of surface and cavefish (Additional file 2: Fig. S10), while promoting nearby interactions in cavefish but reduced the duration of nearby interactions in surface fish (Additional file 2: Fig. S11A, B). No major change in response to the BHB feeding was detected in swimming distance (Additional file 2: Fig. S11C), turning bias (Additional file 2: Fig. S11D), sleep (Additional file 2: Fig. S12A), and VAB (Additional file 2: Fig. S12B) in cavefish, while the BHB salt reduced growth (standard length and weight) in surface fish (Additional file 2: Fig. S12C, D). In contrast, cavefish did not show any detectable negative effects on growth under the BHB salt supplemental feeding (Additional file 2: Fig. S12C, D).

 

In summary, BHB (KE and BHB salt) treatment encompassed the effect of the KD treatment—promoting social interactions. BHB, particularly KE, had a no-detectable negative effect on growth. These facts suggest that ketone bodies can be responsible factors for the positive effects on social behaviors of KD feeding. BHB treatment also indicated that older-age cavefish (6–7 months or 11–12 months old) were still capable of responding to ketone bodies, not only younger age groups (3–4 months old).

 

You can treat an old-fish new tricks!

Indeed, some of our adult readers are treating themselves with ketone esters.

Both ketone esters and ketone salts were trialed in the fish. In humans ketone esters are the clear winner because they provide a much longer lasting effect.

There is no reason why they have to be so expensive, the bulk chemical is not expensive.

  

Conclusion

For longevity and, more importantly, healthy life expectancy it has long been clear that high doses of anti-oxidants are beneficial.

The question is how best to get this effect.

The most potent way is via intravenous infusion of something like ALA (alpha lipoic acid). In some countries intravenous ALA is a mainstream therapy for people with diabetes, not surprisingly thanks to the ALA some of these people also overcome their other health conditions, like heart disease, and increase their healthy lifespan.

Most people will not have this option and probably do not want intravenous therapy anyway.

Oral supplementation with NAC is cheap, effective and available.

Is adding glycine going to have any incremental effect?  Quite possibly it will. If you are lacking glycine, this will hold back your production of GSH (glutathione). Glycine itself might well provide a health benefit.

Dr Sekhar, over at Baylor College in Houston, refers to the “power of three” (NAC, glycine and glutathione/GSH). The immediate, short-lived, beneficial effect is directly from the anti-oxidant effect of NAC itself.

If, like me, you have chosen to take NAC you are experiencing the “power of two” (NAC and Glutathione/GSH).  Glycine is really cheap and so why not take the extra step and add it? You may increase Glutathione/GSH and glycine has its own direct antioxidant and anti-inflammatory properties.

When it comes to young people with autism who take NAC, is the benefit from the immediate antioxidant effect of NAC, or is it from the increase in GSH?  Here I think we know the answer.  The behavioral effect of NAC is quite short-lived and it matches the short half-life of NAC.  Is there a secondary effect from NAC releasing cysteine that gradually increases GSH (glutathione)? Quite possibly, but in autism you really do need to give NAC 3-4 times a day, so the direct effect of NAC itself looks to be key.

Is Glycine NAC going to be better than NAC for young people with autism? Glycine has its own interesting properties and glycine is cheap. It even can help some of those with sleep problems (3g one hour before bed time).

There are plenty of anecdotal reports on the internet of Aspies finding glycine supplementation helpful - some find it makes them more social.

There is a potential problem for bumetanide-responders. In these people if GABA is operating "in reverse", due to high intracellular chloride, the same may be true of glycine. You would then expect a negative reaction

GABA and glycine in the developing brain

GABA and glycine are major inhibitory neurotransmitters in the CNS and act on receptors coupled to chloride channels. During early developmental periods, both GABA and glycine depolarize membrane potentials due to the relatively high intracellular Cl⁻ concentration. Therefore, they can act as excitatory neurotransmitters. GABA and glycine are involved in spontaneous neural network activities in the immature CNS such as giant depolarizing potentials (GDPs) in neonatal hippocampal neurons, which are generated by the synchronous activity of GABAergic interneurons and glutamatergic principal neurons. GDPs and GDP-like activities in the developing brains are thought to be important for the activity-dependent functiogenesis through Ca 2+ and/or other intracellular signaling pathways activated by depolarization or stimulation of metabotropic receptors. However, if GABA and glycine do not shift from excitatory to inhibitory neurotransmitters at the birth and in maturation, it may result in neural disorders including autism spectrum disorders.

 

And those ketone esters (KE)?

Well they are really expensive, when packaged up for humans, but they should be helpful to a sub-group within autism.

Will ketone esters (KE) make our reader Stefan feel more social? Quite possibly, but they are likely too expensive to take every day. Glycine is cheap and worth a try for social affinity, based on the anecdotes from other Aspies.

Some readers are already big fans of ketone esters.  They do not need any further proof from those cavefish in Hawaii.