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RealTalk MS
Episode 419: A Whole-Person Health Approach to MS Care with Dr. Lynne Shinto
00:33:11
Some people living with MS adhere to a treatment plan based exclusively on what we might consider traditional medicine. Others opt for alternative treatments. And, still, others take a whole-person health approach, blending integrative medicine with...
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- [00:01]
A
I'm john strum and this is real talk, mississippi.
- [00:18]
It's September 9th and we have a lot to talk about. There are some people in the Ms. Community who adhere to a treatment plan driven exclusively by what we'd consider to be traditional Western medicine. And there are others in the Ms. Community who focus on the therapies and embrace a more holistic approach to healing. But for still others, taking a whole person approach blending integrative medicine with traditional treatments can transform living with ms, supporting a person's mind and body for better health and improved well being. This week, Dr. Lynn Shinto joins me to discuss a whole person health approach to treating Ms. Dr. Shinto is a professor of neurology and an Ms. Specialist in integrative Medicine at the center for Women's Health at Oregon Health and Science University in Portland, Oregon. But before we get to my conversation with Dr. Shinto, there are a few other things that you should know about.
- [01:26]
If you've listened to even a few episodes of this podcast, you already know that advocacy is a popular topic here. I've seen the impact that Ms. Activists can have on our state and national legislative issues, and I've not only seen, but I've experienced that feeling of empowerment that comes from advocating on behalf of something that's important to you. So I tend to talk about advocacy issues a lot. Lately, we've had to talk about a lot of negative news impacting people affected by Ms. And every other chronic health condition. This week, I'm happy to report on some encouraging news. Republicans in the House of Representatives have, at least for now, rejected President Trump's nearly $20 billion proposed NIH 2026 budget cut, writing in a summary of the fiscal 2026 spending bill that these funds are, quote, maintaining America's edge in basic biomedical research for cures to cancer, Alzheimer's disease and rare diseases. I'll remind you that every single FDA approved disease modifying therapy for Ms. Has benefited from research funded by the National Institutes of Health. And while this is good news for now, it still isn't great news. The House budget plan cuts health and human services spending by 6%, including a 19% reduction in the CDC's budget and and the elimination of the Agency for Health Care Research and Quality. So it's perhaps not all good news. But in an era where we've seen more than a thousand NIH workers fired and hundreds of millions of dollars in congressionally approved research funding simply erased, good news becomes relative. As Congress wrestles with 2026 appropriations, I'll continue to highlight the good, the bad, and the ugly when it comes to how those funding bills are actually going to impact people living with Ms. In the real world. I'll also invite each of you to become an Ms. Activist. If you're ever going to engage in advocacy, this is certainly the year to do it. Science and medical research are under attack in this country. We're losing some of our best and brightest minds in research as we're seeing important medical research projects just completely disappear. Please visit nationalmssociety.org advocacy and add your voice to the voices of thousands of Ms. Activists. You'll find that link in today's show. Notes.
- [04:16]
A research team at King's College London has announced the discovery of a new Ms. Subtype that characterized by significant cognitive deficits but minimal physical disability. Now, it's estimated that somewhere between 40 and 70% of the people with Ms. Experience cognitive dysfunction, most often affecting their memory, their attention span, and their ability to process information. Yet cognitive impairment is typically not considered as an outcome in clinical trials, and it's not always assessed during a clinic visit. In fact, when you think about an individual's EDSS score, cognitive disability is not well represented at all. Just a quick reminder, EDSS is an acronym for the Expanded Disability Status Scale. It's a clinical tool used by neurologists to measure and categorize the level of neurological impairment in someone with multiple sclerosis. It provides a standardized score from 0 to 10, with 0 indicating no disability, higher numbers representing increased disability and 10 representing death. And a long time criticism of EDSS is that it's heavily skewed toward physical disability and specifically walking related disability. So cognitive dysfunction never seems to get the necessary attention in the clinic. Part of that challenge is that a neuropsych assessment is usually conducted in person. It requires a trained professional, it's usually quite lengthy, or when they are shorter, they're less comprehensive. The alternative is, of course, online assessment tools. They're easily accessible from home, they're cost effective, and they're efficient. The question is, are they accurate? So the research team collaborated with the UK Ms. Register in creating an online cognitive assessment battery that was tailored to measure and monitor the aspects of cognition that are most impaired among people with Ms. The study involved just over 3,000 participants with Ms. And it used a three stage approach. In the first stage, the team evaluated the feasibility of using an already established online platform called Cognitron for deploying cognitive tasks remotely and under unsupervised conditions for people with Ms. Stage two of the study involved validating the results from Cognitron and Stage three involved comparing those results with the results from a standard in person neuropsychological psychological assessment, and the team found the results from Cognitron to be accurate when they compared them to the results from the in person neuropsych assessment. After the three stages of the study, the researchers conducted further analysis to identify and characterize distinct symptom based types of ms, and that's when they uncovered the prevalent subtype within the participants who experienced the substantial cognitive deficits but did not experience the visible physical disabilities that Ms. Is more commonly associated with. This was the largest study of cognition in ms, and from it researchers came away with a whole new subtype of Ms. That invisibly affects a significant number of people. And perhaps more importantly, they prove the accuracy and reliability of Cognitron as an online psychological assessment platform that can be rolled out and used to better identify the cognitive disabilities that may be impacting someone with Ms. If you'd like to review the details of this study, you'll find a link in today's show. Notes.
- [08:28]
Last week Dr. Kristin Crisco, a Canadian nurse, neurologist, researcher and clinician, was named the winner of the Rachel Horn Prize for Women's Research in Multiple Sclerosis. This year the Rachel Horn Prize was awarded to an outstanding early or mid career female scientist for their exceptional contributions to women's health research related to multiple sclerosis. Dr. Crisco is a neurologist at the Barlow Ms. Center at St. Michael's Hospital and and an assistant professor at the University of Toronto. Her work includes how to optimize treatment strategies and understanding the safety of Ms. Therapies before and during pregnancy and postpartum while breastfeeding. Her research has also focused on the increased risk and prevalence of peripartum mental illness in mothers with Ms. Dr. Crisco will receive her award in just a couple of weeks at the largest Ms. Research conference in the world, the 41st Congress of the European Committee for Research in Multiple Sclerosis, better known as ektroms, which takes place this year in Barcelona, Spain. Real Talk, Ms. will be at Ectrems and I'm looking forward to bringing you conversations with both Dr. Crisco and Rachel Horn.
- [09:53]
The National Ms. Society is offering its virtual New to Ms. Navigating your Journey program this Thursday, September 11th from 2 to 3:15pm Eastern Time. This program is especially designed for people who have been newly diagnosed with Ms. You'll learn about multiple sclerosis and its symptoms. You'll hear about best practices for managing your ms, you'll have a chance to engage with other virtual attendees, share your experiences, and have your questions answered by a healthcare care professional or someone who's been living with Ms. For a while. The Ms. Society offers this very popular program virtually in person and in Spanish. The virtual program is available on the second Thursday of every month and although the content doesn't change from month to month, it's a great opportunity to review what you heard the first time you participated. To get the most from this program, try to join with a care partner, family member, or friend. Make a list of your questions before the program starts. Make sure your tech is connected and working, and don't forget to take notes. There's a lot of information that gets shared in a fairly short amount of time. If you're interested in learning more about the new to Ms. Navigating your Journey program, or you're ready to register, you'll find that link in today's show. Notes when you learn about managing your ms, the first thing you often hear about is the importance of disease modifying therapies. And that's the right place to start because those DMTs have been shown to slow disease progression, which means you can experience a higher quality of life longer. But in addition to traditional treatments, there are complementary treatments that can also be important in treating your mind and body. My guest, Dr. Lynn Shinto, will join us in a moment to discuss how a whole person approach to Ms. Care can transform your Ms. Journey.
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Integrative medicine brings conventional and complementary treatments together in a coordinated way, and this approach to health and wellness represents a growing trend across the United States, especially among people who live with a chronic illness like Ms. Dr. Lynn Shinto is joining me today to explain what integrative medicine is all about and how using complementary treatments as part of your Ms. Care can work. Dr. Shinto is a professor of Neurology and an Ms. Specialist in Integrative Medicine at the center for Women's Health at Oregon Health and Science University. Welcome back to the podcast, Dr. Shinto.
- [12:44]
B
Hi John, I'm really happy to be here.
- [12:46]
A
I always like to start these conversations by getting our definitions out of the way. And given the topic we're going to be discussing, I think those definitions are particularly important. So I'm going to ask you the same question I asked the first time you were a guest on the podcast. Can you clarify what the terms complementary, alternative and integrative meaning?
- [13:10]
B
Complementary means you're doing maybe a traditional therapy like acupuncture or some dietary supplements with conventional medicine It's a complement too. Alternative is you're not doing the conventional medicine. Say you have back pain and you don't want to take a pain medicine and you decide to do just only acupuncture. That would be alternative to the conventional pain regimen. Or in Ms. It would be if you decided to not do a disease modifier and only do diet and exercise. That would be alternative. Complementary would be do the disease modifier and you do the diet and exercise.
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A
You know, I'm glad you kind of clarified that because honestly I've heard people use these terms interchangeably and they don't really mean the same thing at all.
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B
No they don't. Alternative is very different than complementary.
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A
How is complementary medicine different from what we consider to be conventional western medicine?
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B
Complementary medicine adds other types of therapies. We call them non conventional, which is kind of like a catch all phrase for anything that isn't the conventional protocol for a disease. Ms. Would be a good example. So in Ms. We have so many conventional therapies. Let's just talk about disease modifiers. Right, so there's FDA approved disease modifying therapies for Ms. That would be the conventional therapy.
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But say you wanted to.
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Add on an anti inflammatory diet and do some mindfulness based stress reduction. Well, those therapies haven't. Well actually some of the diets have been looked at in ms, although I wouldn't say that they would be thought of as mainstream or.
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Conventional still. But if you added other therapies on, then those would be the complementary therapies and they complement the conventional therapy. So they're not running against what the conventional therapy is doing. The diet, the exercise is still working to help Ms.
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So that's the difference. And that's complementary I think offers a lot more choices too. So you can kind of expand your.
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Armamentarium. It's like, oh, you have other choices that will work with the conventional therapy. So it's nice, it's nice to have choices.
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A
Can you explain how a whole person approach to care can be beneficial for someone living with a chronic illness like ms?
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B
So I think of a whole person approach as a connected approach. You know, it's more like we are whole being. Our head is attached to our bodies, our emotions are attached to our physical self. We are all connected. We are also connected to each other and to the planet.
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We are not just our disease or that pain or that left arm that has numbness. Everything's in there together. And so I think of whole person is really focusing on health restoration, on promoting resilience.
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And really looking at the whole being rather than the disease state.
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A
When I check in on social media, I see that when some people with Ms. Hear the term complementary treatment, their first go to is often the idea of using cannabis to treat Ms. Related pain and spasticity. So first, can you explain the difference between cannabis and cannabinoids? And then I hope you'll explain the risks and benefits of cannabinoid use for people with Ms.
- [17:44]
B
So cannabis is the whole plant, and the whole plant has cannabinoids. There are a lot of constituents which are the cannabinoids. The cannabis plant has hundreds and hundreds of different cannabinoids. I think the two that we all know are most familiar with are THC and CBD.
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Cannabinoids. So THC and CBD.
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Are, you know, there have been, there has been research and they are good for Ms. Spasticity and pain.
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So they do have benefit.
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Side effects exist though, and I would say that the side effects that.
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Are the most bothersome and sometimes worrisome are THC can really affect thinking ability. A lot of people who have used THC or even cannabis supplant that has THC in it can have brain fog. It definitely affects thinking ability. It can affect movement. You know, like people can feel off balance, it can cause vertigo.
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And actually in really high doses.
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It can be anxiety producing. So these are the side effects that you know are not beneficial. For cbd, it has less, less serious side effects and the main one would be grogginess. I mean, CBD is used a lot for sleep and so but it can cause some grogginess, you know.
- [19:40]
A
In other episodes of this podcast, we've discussed the benefits and the importance of getting a good night's sleep. We've also talked about why that can be a challenge for some people who are living with Ms. Are there natural ways that integrative medicine can help improve a person's sleep?
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B
My favorite natural ways to help improve sleep are mindfulness exercises.
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Mindfulness exercises. There are a lot of free phone apps right now.
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That are really nice, like Headspace, UCLA Mindful is another one. And doing these short exercises or sometimes it's listening to a guided meditation, maybe an hour before bed is really relaxing and can really help with sleep.
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Exercise, you know, not right before bed, but exercise in general has been shown to decrease anxiety and promote good sleep at night. For dietary supplements, I often recommend magnesium glycinate. It has very low side effects and it also is indicated for people with anxiety. It's also a muscle Relaxant. So there are a lot of people with Ms. Who have asbestos. And the magnesium actually.
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Relaxes the muscles and decreases pain that way.
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And the dose is about 200 to 400 milligrams at bedtime, about 30 minutes before bed. So there is, is good scientific evidence for magnesium glycinate for sleep.
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A
A moment ago I heard you mention mindfulness. So I'm hoping you can explain a little bit about what that actually is and how it can benefit someone living with Ms.
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B
So mindfulness. Jon Kabat Zinn, who kind of brought mindfulness to the US he was a Buddhist meditator and realized not very many Americans can do an hour, you know, Buddhist meditation sitting. So he sort of.
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Formed this, he kind of devised the Buddhist meditation into, into this mindfulness practice. And the main thing is like kind of be here, be now. It's like, don't worry about the future, don't think about the past, but really just be present in the, in the moment now. And for me, a really good example of a mindfulness practice is a body scan. This is actually back to sleep. This is really good to do at night to help with sleep. But if you're lying in bed, close your eyes, you can start with your toes. And you just think about how your toes are doing and you might have a pain in your toe and that's okay. Just notice the pain, know it's there, you don't have to fix it. And then move on to your ankle and notice what's going on in your ankle and you just move through your body that way. Just noticing what, how your body's doing. Some parts you might notice are perfectly fine and relaxed. That's great. You just keep going on. The point of that is that your body has all sorts of sensations and that's fine. You don't have to fix it, you don't have to do anything. All you have to do is be here and notice. And in doing that, it kind of is a release, it's relaxing.
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But that's an example of mindfulness and a mindfulness practice.
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A
Since you mentioned Jon Kabat Zinn, I'll just let our listeners know that his research at Massachusetts General Hospital showed gave evidence that mindfulness meditation was effective in helping cancer patients manage their pain. As you mentioned, it kind of put mindfulness on the map because it was stunningly successful in doing all that. Ms. Can impact a person's emotional well being just as much as it can their physical health. Antidepressants can effectively treat depression, but not everyone can tolerate the side effects. Are there integrative therapies that can be used in place of traditional antidepressants?
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B
That's a good question. It's a complex answer for me. I feel that there's a lot of information I would need to know before I would move to an alternative therapy for antidepressants.
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Some people really need to be on antidepressants. Sometimes they're not on for very long and the side effects.
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Can be very bothersome, but maybe transient. I feel the best strategy in that situation is to have the integrative provider work with the conventional provider on either a tapering plan, how to taper down and what to taper up on, or whether it's even safe to do a tapering plan. So my answer is going to be there's still. There's a lot of questions in that question. And I think a really, really safe and healthy and actually whole person strategy is to work with two experts on figuring out what the best treatment is for.
- [25:27]
A
Mood. What are some common myths or misconceptions that you find people have about integrative medicine?
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B
One of the most common myths to me is that integrative medicine is alternative medicine. So integrative medicine. We started out with this conversation, John, that it's really both. It's like conventional medicine with traditional or other therapies combined so that people have all these choices and they're doing both, and alternative medicine is not doing the conventional and doing something else. So that to me, and they're very different, they're different therapies. And so that to me is. I hear a lot. And so I always have to correct that, that misinterpretation.
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And the other one that I hear a lot is that dietary supplements.
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Are not like drugs, like conventional drugs, and that they're safer. And that's not necessarily true. Dietary supplements are still biologics. They still do things in your body. They still have interactions with.
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Other dietary supplements and also with conventional drugs. And so we need to look at them in a way that we understand that they're biologics and many of them are safe, but some of them.
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Will have effects. I mean, a good example that everybody knows about now, but this came through research like over 20 years ago, is you can't do St. John's Wort for depression if you're on a birth control pill. The St. John's Wort works through your liver. It's metabolized through your liver, as does birth control, and it will decrease the effect of the birth control. So before we knew this, women were doing this and it was, you know, pregnancies happen that were, you know, that were not expected. So that's just an example of where things might have an effect on each other.
- [27:55]
A
So what's an appointment with an integrative medicine specialist? Like, how do you work with people who are living with Ms. To develop a treatment plan that fits their needs and achieves their goals?
- [28:07]
B
The appointment with an integrative medicine provider is probably going to be long. It's like not too long, but minimum, I would say 60, like an hour, usually in 60 to 90 minutes. And a lot's covered in that time. I think one of the first questions, though is what are the person's goals?
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You know, what, what do you want to achieve? And sometimes the goals are, you know, I mean, if someone, if, you know, someone has ms, they come in and sometimes you expect, oh, the goal is to.
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You know, delay disease progression. But sometimes that's not the goal. Sometimes the goal is something completely different.
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Sometimes a goal is something like, you know, I used to really do a lot of paintings and I can't do them anymore because of the spasticity in my right hand. And so it. I always like to know what someone's goals are. So that's the first thing. And then for me, lifestyle is really the cornerstone of a lot of things, a lot of.
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Well being, wellness, resilience. So I really take a deep dive into what are you eating? No judgment there. No judgment. Just like the mindfulness, no judgment on what people are eating. And I tell people.
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Don'T worry about what you're eating. We just need to record this and know what it is. So what people are eating, what they're doing for physical activity or not. Some people really can't do physical activity for various reasons.
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What their emotional health is, what their sleep is.
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What their coping skills are, all these things. I like to know where that person's at and where I see a place where there can be improvement. We work on strategies to make improvement, whether it's diet, whether it's sleep, whether it's in emotional health. And that's how we sort of build a treatment plan that's unique to the person.
- [30:41]
A
Well, how can someone learn more about whole person health and find a doctor who includes integrative medicine in their practice?
- [30:50]
B
Yeah, so the national center for Complementary and Integrative Health has a website, I think it's www.nccih.gov. and then there's the Academic Consortium for Integrative Medicine and Health. And their link is imconsortium.org There are all the medical schools who have integrative medicine centers and they're a good resource.
- [31:23]
A
Well, Dr. Lynn Shinto, I want to thank you for all you do to improve the lives of people who are living with Ms. And thanks so much for talking with me today.
- [31:32]
B
Thank you, John.
- [31:34]
A
That's going to wrap up this episode of RealTalk Ms. Real Talk Ms. Is powered by the National Ms. Society. And you can share this episode of the podcast by letting your friends or family members know that all they have to do is point their web browser to@realtalkms.com 419. You'll find that link in today's show Notes so you can easily copy and paste it right into an email or a text. A recent blog post on the Ms. Canada website caught my attention. It was written by a woman who was diagnosed with Ms. Three years ago. And in that blog post she breaks down all the lifestyle changes that are designed to improve your quality of life and and make your Ms. Journey a bit easier. It turns out to be quite a list. Next week you'll meet the woman who wrote that blog post, Julie Polisena. And I hope you'll join me for my conversation with Julie. I'm John Strun. Thanks for listening. Stay safe and make healthy choices.
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B
Sam.