Interview with Dr. Sanford Newmark: Treating Autism with Integrative Medicine

Audio Interview

Hear a Patient Power interview with Dr. Sanford Newmark , a pediatrician who specializes in treating autism, attention deficit hyperactivity disorder (ADHD) and other developmental or chronic childhood conditions.

Andrew Schorr:

Learn from a leading expert about harnessing the power of integrative medicine to treat patients with autism, and hear from a mom of a child with autism on how this approach has made a lot of difference. It's all next on Patient Power.

Hello and welcome to Patient Power sponsored by UCSF Medical Center. I'm Andrew Schorr.

Well, autism is on the increase, and it's said now, that in the U.S., one out of every 88 children may be diagnosed with autism or on the autism spectrum, and we'll learn more about that. And we're going to hear from an expert on how integrative medicine can make a difference, and how at UCSF Medical Center, at the Osher Center for Integrative Medicine at UCSF, they're very dedicated to that.

But first I'd like to introduce you to the mother of a child diagnosed with autism, and how the work with the center is making a big difference for her child. So, let's meet Kaitlin Fox, who is the mother of three year old Dasha. Dasha does have a diagnosis of autism. Kaitlin is from San Francisco.

Kaitlin, thank you for joining us. Help us understand, let's go back to over a year ago, 20 months or so. What was going on — or even before that — with Dasha which you didn't feel was normal?

Kaitlin Fox:

I took Dasha to the daycare at my college that I went to. It's the Early Childhood Education Center, and I started noticing that at 18 months the other kids were starting to do really social things, like pointing and starting to talk, do animal noises and stuff, and Dasha just wasn't doing any of those things. And being a psychology major, I've taken some childhood development classes, so I began to kind of piece together that this wasn't the picture that it was supposed to look like. At this point things weren't really falling in place.

Andrew Schorr:

And so you eventually went to the pediatrician with Dasha?

Kaitlin Fox:

I did. I went to the pediatrician and she asked me some basic questions. Does Dasha laugh? Does she like to bounce on your knee, and things like that? And she does. She's actually pretty social in that way. She likes to give kisses and hugs, and so I started thinking, okay, maybe this isn't a problem. And, so, she gave me the M CHAT, I think is what's it's called. It's kind of a questionnaire to fill out, to see if your child is at risk for having autism, and I felt relieved after I filled it out, because I didn't think it sounded like Dasha. So, it was only until later, that I kind of realized I was in a little bit of denial at that point, and there definitely were some warning signs.

Andrew Schorr:

When you finally got a diagnosis of autism, is that one of these ones where you just pick yourself off the floor, or what was your reaction?

Kaitlin Fox:

So, the moment that I realized that she had autism was at the daycare orientation for the next semester of school. All the kids had gone away for summer. We were doing the orientation, and all the kids had developed all these new skills, and Dasha had just not developed anything. And, it was at that moment that I was like, this is autism, and I just started crying right then and there. I knew what it was. I had learned about it. It wasn't until a month later that I had a doctor actually say, yes, your daughter has autism.

I think I had time to kind of slowly process it before someone officially told me, but I think the first thing you want to do is, you want to learn everything you can about it, try and see, well, what type of future is possible for my child, then.

Andrew Schorr:

And you investigated, among other things, diet, and made some changes, and also you sought out specialized care, and that brought you to the center at UCSF. All that work, diet and working with someone in the know, that made a difference for your daughter.

Kaitlin Fox:

Yes. That made a huge difference.

Andrew Schorr:

Tell us about that. What sort of changes?

Kaitlin Fox:

So, one of the first things that happened was my mom came to me right after — this was even before she had a diagnosis from anyone, and my mom was saying, you know, I'm reading this stuff online and people are saying gluten and casein can be problems for children that have autism or suspected to be on the spectrum, and she was like, why not just give it a chance. Just take it out for a little while, see what happens. And, yeah, this is — I was in grief, and I was like, sure, why not. What can it hurt to test it out? My daughter had no words except for the ability to say hi occasionally, and she was 21 months at this point. When we did it, when we took those things out of her diet, a week later she just dropped 13 words.

Andrew Schorr:

Wow.

Kaitlin Fox:

Right away. So, at that point I was like, okay, maybe there's something to a different approach here.

Andrew Schorr:

You became curious, and then devoted to what we'll describe as an integrative approach, that included dietary review and changes, so that brought you to UCSF. How has it worked out, as far as the care for your daughter?

Kaitlin Fox:

Well, UCSF is just kind of night and day compared to what I was working with before. I tried several doctors whose methods seemed a little too extreme for me. I didn't want to try anything that could possibly be dangerous. I wasn't really getting taken seriously by the pediatrician that we had at the time, who was not in the UCSF medical group, and I started asking around, and people were saying, okay, UCSF is the place. Go to Dr. Newmark. He accepts insurance and all these things. So, I gave it a shot, and it's been just honestly amazing. It's been night and day.

The care that we get at UCSF, sometimes I just call my mom just to tell her, after the appointments, that I'm so blessed that I have access to this for my daughter, because the doctors listen. They care about the parent's perspective. They're willing to think outside of the box. They're capable of explaining the risks and benefits. I feel like they're very invested in their patients, and especially Dr. Newmark.

An Increase in Autism

Andrew Schorr:

Let's meet Dasha's doctor, Dr. Sanford Newmark, and learn more about autism and learn more about integrative medicine for autism. So now joining us is Dasha's doctor, pediatrician Dr. Sanford Newmark. He is head of the Pediatric Integrative Neurodevelopmental Clinic at the Osher Center for Integrative Medicine at UCSF in San Francisco.

Dr. Sanford Newmark, first of all, I know you must be delighted that the work that you're doing at the center has made a difference for Dasha.

Dr. Sanford Newmark:

Oh, I certainly am. That's what we're here for.

Andrew Schorr:

Well, let's talk about, first of all, the increase in autism. Do we know what's going on?

Dr. Sanford Newmark:

Well, I wish we knew better. The increase has been very dramatic from, maybe, four or five in 10,000 to, as you say, more than one in a 100. There is a great deal of controversy about how much of this increase is due to more awareness of autism, and how much is due to widening the diagnosis, and how much is due to just a lot more real autism. I believe that it's all of those, but I believe there's really a lot more children with autism around.

And so the question is why, and we really don't know. It must have something to do with the environment, because the genetics — autism is something that children are genetically predisposed to have, and it's something about the environment must have changed. And whether that has to do with food or toxins in the environment or other factors we don't even know of, is just really not clear yet.

Andrew Schorr:

Of course, for the parents of the child who has been diagnosed, they move on and they say, okay, what can we do about it, to have my child to be the best they can be, have as full life as they can. So, they sort of pick themselves off the floor, and they say, okay, let's get to work. So, help us understand this term, "integrative medicine." What does integrative medicine mean?

Integrative Medicine

Dr. Sanford Newmark:

Integrative medicine, in its simplest form, is the ability to combine both our powerful conventional medicine with, sometimes, equally powerful alternative approaches. So, as a physician I can — who as an integrative physician, I'm trained as an M.D., I know the conventional approach to various pediatric problems, but I can also make use of whatever works, whether that's diet and nutrition or behavioral things or certain herbs or even traditional Chinese medicine, I'm aware of and can use when appropriate those interventions.

And, one more thing. Integrative medicine, also, is a way of looking at patients, especially children, where you look at the whole child, not just a patient with a diagnosis that you're trying to fix. You really look at the whole child in the context of family, community, school, and use what is most natural and — has the least possibility of harm, at least to start with.

Andrew Schorr:

Now, if someone goes on the Internet, and many parents do when they are dealing with what, for them, may seem like a health crisis right off the bat, they're told this about their child, and they see things all over the map. How do you define integrative medicine as relying on what's proven?

Dr. Sanford Newmark:

Integrative medicine, we try and work with what's proven, when we can, but in the area of autism, there's not very much that's proven about treatment. So, then, we have to work with what is safe, and what may help, and what we have some evidence about. We can't only rely in the area of autism on treatments that have the kind of medical proof that we would love to have, perfect, absolute, double blind controlled studies. We're working on those, but meanwhile there are children with autism who need help. So, if we can find safe interventions that may really help, I will use them, even if they're not, quote, totally proven.

A good example of that might be something like fish oil for autism. There's some preliminary evidence that it's effective, I've had a lot of parents say that it's effective, but we really don't know for sure that it works, but it's also highly unlikely to cause any harm. So, it's something I would use.

Diet and Autism

Andrew Schorr:

Hmm. All right. Let's talk about diet. So, in Dasha's case, that seems to have made a great difference. So, how do you get at that, to see what changes in diet could be right for that child?

Dr. Sanford Newmark:

Right. So, Dasha was a really, a very typical example of kids with autism, in that she had a course where she was doing pretty well, developing well, and then developed a whole set of ear infections, which were treated with multiple antibiotics between 13 and 17 months old, and during that time she regressed. She lost her words. She withdrew socially into that, sort of, world of autism, and she also developed diarrhea, a chronic kind of diarrhea. So, the GI aspects of autism, gastrointestinal aspects of autism, are often very important, and if we can fix the GI system, often you see significant improvements in the autistic symptoms.

And, this mom actually got on the internet, found something called the gluten free, casein free diet, which is the most common diet we use for autism, and started it herself, even before she got to me. This is not an uncommon thing in the autism world that parents begin to do things themselves. And, she saw immediately a change. She saw immediately that her child became more responsive, started adding some words, and her diarrhea got a little better, all within several days.

And if she had asked her pediatrician most likely — I don't know her pediatrician specifically — most pediatricians would have told her that that diet was a waste of time and that she shouldn't bother, that the only treatment for autism are the various therapies, speech therapy, occupational therapy, physical therapy, behavioral therapy, all of which can help, but have only a limited amount of effectiveness.

Andrew Schorr:

Hmm. Now, Kaitlin, she sees you as a pretty conservative physician, and UCSF is a university based place. You're very thoughtful about these approaches.

Dr. Sanford Newmark:

Well, I hope I am. There's a wide variety, especially in the autism world, of practitioners who treat autism, and many of them are great physicians, and have really, really helped their patients, and yet, there are some who really go off the deep end, from my point of view, and use an enormous number of treatments, and — some of which could be harmful, and so, it can be hard for patients to have some kind of a balanced approach.

I remember one mom told me that she came home from her first visit to a practitioner, for autism, and was given 42 pills a day for her child to take.

What to Expect at UCSF

Andrew Schorr:

Hmm. Yeah, I think somebody really looks to you, to help them sort through things, because certainly, whether it's going to a practitioner like you described, or looking at 20 websites, your head can be spinning, and you really don't know how to do it. So, when people come to your clinic, there's a team approach, I imagine. So, what can they expect? When somebody comes, first, you're trying to assess the child, so, take us through a little bit of how you do that, to get to a point, like, what's been helping Dasha in her particular case.

Dr. Sanford Newmark:

Well, so, my initial clinic visit is divided into two one hour visits, separated by a couple of weeks, usually. So, I have two hours to really sit and talk to the mom or dad, and if the patient's old enough, and can, to them, about what's going on. What was the history that led to this? You know, what was the birth like? What were the early days like? What medical issues are there besides the autism? What have they done already, what are they thinking about?

And, of course, I examine the child and see if there's anything that necessitates some other specialist besides me. I mean, there are children I send to neurology but some that I don't. And, after gathering initial information, I usually order some laboratory work, some of which is sort of standard conventional laboratory work and some of it's which may not be standard conventional, that we send to specialty labs.

And, when all that's done, we come up with a treatment plan, and that can include, if they're not already doing it, that team you talked about. I mean, occupational therapist, speech therapist, sometimes behavioral therapist. I mean, they're really important in this whole scheme. I don't throw that part of it out. We need to make sure that's going on. And also, need to take a look at, once these kids are three they're eligible for special school, make sure they're there and in the right situation.

After putting all that information together we make a treatment plan and start and try and do things in a relatively orderly fashion, so, we're not trying every intervention at once, and not knowing what's working.

Andrew Schorr:

That was my next question. So, the parent and the child and you, you're on a journey together, and things may be shifted along the way.

Dr. Sanford Newmark:

Oh, absolutely. I mean, Dasha is a good example. I've seen her more or less every two, three months now, for over a year, about 15 months, and things move, they change. Things come up that you hadn't thought about before. They react one way to one treatment, they react another way to another treatment. It's definitely an ongoing process.

I want to say, the amount of energy and dedication this takes on the part of the parents is just amazing. Dasha's mother is a really good example. She's a single parent, and aside from working and taking care of Dasha, she has to give her a very specialized diet and deal with all her therapies, get all these nutritional supplements that we recommend. It's an enormous amount of work, but mothers, by and large, are so dedicated — and fathers, are so dedicated that they do it.

The Difference an Integrative Approach Makes

Andrew Schorr:

Love is an incredible fuel for sure, and it's, I'm sure, amazing the dedication. So, Doctor, I know it's very different, but how much of a difference have you found your integrative approach, that's done at some other key centers too, but you're very devoted to it at UCSF, can make? I know every kid's different, but when things, when you're hitting on all cylinders, give us an example of some difference a parent might see in their child.

Dr. Sanford Newmark:

Oh, my goodness. I mean, sometimes you have very, very dramatic results from this kind of treatment, and sometimes of course you don't. I don't want to act as if everybody responds very well, but when you have the dramatic results you can see kids, for instance, who have no words and who begin treatment and within six to nine months are speaking in sentences. You can see kids who hardly ever made any eye contact, and suddenly they're there, they're making eye contact. They're interacting with people.

I remember one child, very interesting, who we started treating and dad was over in Iraq fighting. He would e mail the mom regularly, and she told him about starting this treatment with me, and he was kind of, oh, yeah, well, whatever. He was pretty skeptical. And then he came home, and he was just shocked. Like three months later he said, oh, my gosh, it's like I have a little boy again. And, when you see that, it's really wonderful. And I have kids, and this isn't most of them, but some kids no longer fit the criteria for autism.

Andrew Schorr:

Hmm, wow. Doctor, now, obviously there may be people listening to us who have, at least initially, sought care somewhere else and whether they were bewildered by many things that were offered to them and told they need to do or told there was very little they could do, do you welcome them at your center, if only for a second opinion, if they wanted to do that?

Dr. Sanford Newmark:

Yes. I'm very happy to see people for a second opinion, and I do that. Sometimes people come to me from other cities or states, where they couldn't find anybody, or sometimes people come to me who it's the opposite. They've done an enormous amount of, we call it biomedical therapy, this integrative approach to autism, and they don't know what's going on anymore, and they want somebody to take a look and say, hey, what makes sense of what we're doing, what doesn't make sense? Where shall we go from here?

Andrew Schorr:

So, you're sort of our barometer on how things are going in autism, generally. I know we see this huge growth in the prevalence of it and seeing it happening, but for parents listening, can you give them some hope? You're working on it. Maybe there aren't some shining breakthrough answers yet, but how do you feel about things in this field to help them feel that things can be better?

Dr. Sanford Newmark:

I think we're making progress. As you say, we don't have that sort of magic bullet breakthrough, but right here at UCSF there's tremendous amount of research going on in this area. Over at Langley Porter Institute, they're doing really good research on some of the things that I use, like methyl B12 and fish oil, Omega 3 fatty acids, and they're looking at the genetics. I think, we'll get there, but it will be a while. Right now, we have to just keep on trying to diagnose every child as soon as we can, and begin treatment as soon as we can.

That's the other thing I would say. The earlier we get to these children, the more effective our treatment can be, and that's something I think that's really improving. I think pediatricians who used to, maybe, just kind of, reassure parents, oh, it will go away, you know, we'll just wait, you know, now they're really, really attuned to the possibility of autism, and, for the most part, referring earlier, so we can start all this treatment when they're young.

Andrew Schorr:

Hmm. Dr. Sanford Newmark, I want to thank you for all you do at the Osher Center there, and your devotion to integrative medicine for patients like Dasha, where we've seen a big difference. Thank you for all you do and for being with us.

Dr. Sanford Newmark:

Well, thank you for having me. It was a pleasure.

Kaitlin’s Advice for the Best Care for Your Autistic Child

Andrew Schorr:

Now joining us again is Dasha's mom, Kaitlin Fox. Kaitlin, so you've lived it. You've lived this care for your daughter at UCSF, an integrative holistic approach. What would you say to parents, who may be listening, who are curious about all of this? What would you say to them, so that they can get the best for their child?

Kaitlin Fox:

I would say that you should be willing to think outside the box when it comes to this. Do your research. Don't try something that could be dangerous for your child. I think there are a lot of people pedaling miracle recovery things that could end up being more dangerous than your child having autism. I think that you need to be determined to get the best for your child and keep searching, keep trying new things until you find what works.

And have a good doctor, like Dr. Sanford Newmark, to balance these sorts of things off, and think, okay, well, what could be bothering her in her diet? Let's run this test. Is her gut traumatized? Do we need to work on getting probiotics in there and controlling yeast? And, you know, thinking, okay, well, maybe this artificial flavoring is affecting their behavior, or maybe there's a vitamin deficiency, before we jump to things like, well, let's just give an antidepressant because they're aggressive. There are other paths that you might be surprised at how much of a result you could get from trying that alternative path.

Andrew Schorr:

One last question for you is, with the quality care that you agree you're getting, what is your hope for Dasha for the future, for her life?

Kaitlin Fox:

My hope is that she reaches her full potential and that she finds happiness there, whatever that might be. If she's trying her best, and we've given her the tools to be successful, and to make progress, wherever she ends up, that she's made the most progress possible and she is in a place where she is content, then that is where I will be happy, too.

Andrew Schorr:

Well, as we heard Dr. Sanford Newmark say earlier, tremendous credit goes to very loving, devoted parents such as you, Kaitlin, so thank you for all you do. You know, Dasha doesn't have a loud voice at this point, but I know if she could, she would be very, very thankful and know she was blessed, too. Thank you so much for being with us.

Kaitlin Fox:

Thank you.

Andrew Schorr:

All right. Andrew Schorr on Patient Power, helping you understand more about integrative medicine and how it's applied to autism at just a handful of centers, with UCSF, in San Francisco, being one of them, and how it can benefit a child like Dasha.

Thank you for joining us. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.

This interview was recorded in February, 2013.

 

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

Related Information

UCSF Clinics & Centers

Autism NeuroGenetic Clinic
1825 Fourth St., Fifth Floor (Neuro) and Sixth Floor (Genetics)
San Francisco, CA 94158
New Patient Appointments: (415) 514-5863
Nursing Assistance: (415) 353-2859
Fax: (415) 353-2400

Condition Information