Brooks Wingo, PhD Brooks Wingo, PhD, associate professor of occupational therapy, has several goals that underlie all her research efforts. One is identifying behavioral interventions that improve the health and lives of people with complex medical conditions and that can move rapidly from successful scientific investigation into widespread clinical care.  

That’s her hope for her current multisite randomized controlled trial, which will test the effects of a low glycemic load diet and calorie restriction in people with multiple sclerosis (MS). She and her colleagues hope to start enrollment in January 2023 for the trial, which will recruit participants at UAB and Washington University in St. Louis (WUSTL). 

“Unlike medications, which take years to move from research to patient care, clinics could implement these interventions almost immediately,” she says.

She and her collaborators at WUSTL and in UAB’s Department of Nutrition, School of Public Health, and Heersink School of Medicine also want to understand how these dietary interventions produce benefits. In this study, they’re using MRI to see if the interventions reduce neuroinflammation, which may contribute to common MS symptoms such as fatigue, poor sleep, and pain.

“Understanding how these mechanisms work and relate to each other and to MS symptoms and outcomes has potential to open up many new roads for research,” Dr. Wingo says.  

From social work to occupational therapy

Dr. Wingo has broken novel research ground as part of the Department of Occupational Therapy faculty, but she is not an occupational therapist. She earned her undergraduate and master’s degrees in social work, the field in which she began her professional career. 

As a social worker, she focused on mental health, and spent about 5 years working in inpatient and outpatient psychiatric units, doing everything from behavior modification to discharge and family planning. 

“Around this time, a new generation of antipsychotic medications became available, and they helped people who had not been helped by anything else,” Dr. Wingo says.

Although these atypical antipsychotics improved previously intractable symptoms of mental illnesses such as schizoaffective disorder and bipolar disorder, they caused rapid, intense weight gain and type 2 diabetes.

“We had patients who gained 30 pounds in the first month. We quickly moved from focusing on their mental health to treating their physical health, as well,” she says.

One of Dr. Wingo’s passions was—and still is—exercise, and her unit supervisor asked to help find ways to encourage these patients to increase their physical activity and improve their diet.

“We quickly realized that it was really difficult to help this patient population adopt healthy lifestyle habits, and that spurred me to get my PhD in health education and promotion, with a focus on obesity and healthy eating behaviors,” she says. “My goal was to find solutions that work for populations with many barriers to healthy behaviors.”

As Dr. Wingo progressed through her postdoctoral training in nutrition, she worked in a UAB weight loss clinic and considered which population she wanted to focus on in her professional research. It was then that James Rimmer, PhD, who is currently director of the UAB National Center on Health, Physical Activity and Disability, knocked at her door.

“He asked if I had considered working with people with disabilities. I hadn’t, but knew we had a few individuals with disabilities in the clinic, and that we didn’t know how to help them,” she says.

She began working with people with spinal cord injuries (SCI) and, later, MS. She dug into the literature to see what research had been done on obesity and nutritional interventions in these populations, and found almost nothing.

Dr. Wingo is on the American College of Rehabilitation Medicine Board of Governors, and was chair of its Career Development Networking Group in 2018. She is shown here (third from left) with other group leaders. “It was a twofold opportunity,” she says. “First, it was an area in which I could potentially make a big impact. Second, for an early career investigator at the time, the field was wide open.”  

The work also brought her into close contact with occupational therapists. “The OTs kind of adopted me. They do a lot of work with people with spinal cord injuries and MS, and we were using similar interventions,” she says.

Dr. Wingo felt her research and the work of occupational therapists complemented each other well, and after completing her postdoctoral training in 2013 she joined the Department of Occupational Therapy. She and the department have benefited from the collaboration ever since.

Adapting interventions for people with complex conditions 

The dietary interventions Dr. Wingo and her colleagues are studying are effective in the general population, which usually means middle-aged, relatively healthy white men.

“What we want to find out with our research is whether they work as well in people with MS, and if we can modify them so they’re easier for people with complex medical conditions to put into practice,” she says.   

People with MS and SCI often have multiple barriers to healthy eating. “They’re the same kind of barriers we all face, but on steroids,” Dr. Wingo says.

She notes that many of these individuals live on disability, and fresh fruits and vegetables may be out of their financial reach. The conditions, as well as the medications used to treat them, also can make it hard for these individuals to stick with behavioral changes that could potentially improve their symptoms and quality of life.

Dr. Wingo and her colleagues will soon submit a grant application for a study of time-restricted eating (TRE) that they have modified for people with MS. With this diet pattern, people restrict their eating to a certain number of hours per day and fast during the remaining hours.

Previous research shows that TRE seems to work best when people begin their window for eating early in the day. Yet, for many people with MS, who often feel fatigued and take medications that make them sleepy, getting up for an early breakfast isn’t feasible.

In her downtime, Dr. Wingo enjoys reading crime novels and traveling with her family. Here she and her husband, Greg, and her 14-year-old son, Shepard, prepare to snorkel in the Galapagos Islands. “We’re adapting TRE for this population by asking people to eat within an hour of waking, even if that’s at noon,” she says. “This study will help us understand how this strategy compares with eating windows that start earlier in the day.”

Dr. Wingo has also begun examining racial disparities in MS. She’s working with undergraduate students in the UAB School of Health Professions Honors Program to gather information from African Americans with MS on their diet and exercise patterns, socioeconomic and employment status, and other factors that may affect their symptoms and disease outcomes.

“We know that rates of obesity, cardiometabolic diseases, and diabetes are disproportionally higher among African Americans than whites in the general population, and that these factors are linked to worse health outcomes,” she says. “We’ve begun to paint a picture of these relationships so that, in the future, we can tailor interventions that improve health outcomes for people who don’t have good access to neurology care or primary care.”