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Saxby SM, Shemirani F, Crippes LJ, Ehlinger MA, Brooks L, Bisht B, Titcomb TJ, Rubenstein LM, Eyck PT, Hoth KF, Gill C, Kamholz J, Snetselaar LG, Wahls TL. Effects of a Remote Multimodal Intervention Involving Diet, Walking Program, and Breathing Exercise on Quality of Life Among Newly Diagnosed People with Multiple Sclerosis: A Quasi-Experimental Non-Inferiority Pilot Study. Degener Neurol Neuromuscul Dis 2024; 14:1-14. [PMID: 38222092 PMCID: PMC10787513 DOI: 10.2147/dnnd.s441738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Background Interventions involving diet, physical activity, and breathing exercises are shown to be beneficial in managing both fatigue and quality of life (QoL) related to MS; however, the impact of such interventions among people newly diagnosed with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) who decline disease-modifying therapies (DMTs) is unknown. Methods A 12-month prospective quasi-experimental non-inferiority trial recruited people newly diagnosed with CIS or RRMS who voluntarily declined DMTs (health behavior group; HB, n = 29) or followed standard of care (SOC, n = 15). Participants in the HB group were remotely coached on the study diet, moderate-intensity walking, and breathing exercises. All participants completed questionnaires validated to assess MS symptoms, including perceived mental and physical QoL (MSQOL54); fatigue (Fatigue Severity Scale, FSS; and Modified Fatigue Impact Scale, MFIS); mood (Hospital Anxiety and Depression Scale, HADS); and cognitive function (Perceived Deficits Questionnaire, PDQ). Results During the 12 months, the HB group experienced improvement in scores for mental QoL (MSQOL54 - Mental, 0.24, 95% CI 0.01, 0.47; p = 0.04), fatigue (Total MFIS, -7.26, 95% CI -13.3,-1.18; p = 0.02), and perceived cognitive function (Total PDQ, PDQ-Attention, PDQ-Promemory, and PDQ-Planning, p ≤ 0.03 for all). A between-group difference was observed only for PDQ-Planning (p = 0.048). Non-inferiority analysis revealed that the 12-month changes in means for the HB group were not worse than those for the SOC group with respect to fatigue (FSS, p = 0.02), mood (HDS-Anxiety, p = 0.02; HADS-Depression, p < 0.0001), physical QoL (MSQOL54 - Physical, p = 0.02), or cognitive dysfunction (Total PDQ, p = 0.01). Conclusion The multimodal lifestyle intervention for individuals newly diagnosed with CIS or RRMS, who voluntarily decline DMTs, did not yield patient-reported outcomes worse than those observed in the SOC group regarding perceived mental quality of life, mood, fatigue, and cognitive function. Trial Registration clinicaltrials.gov identifier: NCT04009005.
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Affiliation(s)
- Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Landon J Crippes
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary A Ehlinger
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Lisa Brooks
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Babita Bisht
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Karin F Hoth
- Department of Psychiatry and the Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Christine Gill
- Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - John Kamholz
- Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | | | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Crippes LJ, Saxby SM, Shemirani F, Bisht B, Gill C, Rubenstein LM, Ten Eyck P, Carr LJ, Darling WG, Hoth KF, Kamholz J, Snetselaar LG, Titcomb TJ, Wahls TL. Diet-induced changes in functional disability are mediated by fatigue in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES randomized parallel-arm trial. Mult Scler J Exp Transl Clin 2023; 9:20552173231209147. [PMID: 37916030 PMCID: PMC10617283 DOI: 10.1177/20552173231209147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
Background People with multiple sclerosis (MS) often report dietary modifications; however, evidence on functional outcomes remains sparse. Objective Evaluate the impact of the low-saturated fat (Swank) and modified Paleolithic elimination (Wahls) diets on functional disability among people with relapsing-remitting MS. Methods Baseline-referenced MS functional composite (MSFC) scores were calculated from nine-hole peg-test (NHPT), timed 25-foot walk, and oral symbol digit modalities test (SDMT-O) collected at four study visits: (a) run-in, (b) baseline, (c) 12 weeks, and (d) 24 weeks. Participants were observed at run-in and then randomized at baseline to either the Swank (n = 44) or Wahls (n = 43) diets. Results Among the Swank group, MSFC scores significantly increased from -0.13 ± 0.14 at baseline to 0.10 ± 0.11 at 12 weeks (p = 0.04) and 0.14 ± 0.11 at 24 weeks (p = 0.02). Among the Wahls group, no change in MSFC scores was observed at 12 weeks from 0.10 ± 0.11 at baseline but increased to 0.28 ± 0.13 at 24 weeks (p = 0.002). In both groups, NHPT and SDMT-O z-scores increased at 24 weeks. Changes in MSFC and NHPT were mediated by fatigue. Discussion Both diets reduced functional disability as mediated by fatigue. Trial Registration Clinicaltrials.gov Identifier: NCT02914964.
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Affiliation(s)
- Landon J Crippes
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Babita Bisht
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Christine Gill
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Lucas J Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Warren G Darling
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - John Kamholz
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | - Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa, Iowa City, IA, USA
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Bisht B, Dey P, Singh AK, Pant S, Mehata MS. Spectroscopic Investigation on the Interaction of Direct Yellow-27 with Protein (BSA). Methods Appl Fluoresc 2022; 10. [PMID: 35977534 DOI: 10.1088/2050-6120/ac8a8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Abstract
Direct yellow 27 (DY-27) interaction with bovine serum albumin (BSA) was investigated using multi-spectroscopic techniques to understand the toxicity mechanism. Fluorescence quenching of BSA by DY-27 was observed as a result of the formation of a BSA-DY27 complex with a binding constant of 1.19 × 105M-1and followed a static quenching mechanism with a quenching constant Ksvof 7.25 × 104M-1. The far UV circular dichroism spectra revealed the conformational changes in the secondary structure of BSA in the presence of DY-27. The calculated average lifetime of BSA is 6.04 ns and is nearly constant (5.99 ns) in the presence of dye and supports the proposed quenching mechanism. The change in free energy (ΔG) was calculated to be -28.96 kJ mol-1and confirmed the spontaneity of the binding process. Further, docking studies have been conducted to gain more insights into the interactions between DY-27 and serum albumin.
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Affiliation(s)
- Babita Bisht
- Department of Physics, Kumaun University, D.S.B. Campus, Kumaun University, Nainital, 263002, India, Nainital, 263001, INDIA
| | - Pinki Dey
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney 2033, Australia, Sydney, 2052, AUSTRALIA
| | - Avinash Kumar Singh
- Special Centre for Nanoscience, Jawaharlal Nehru University, Munirka, New Delhi, Delhi, 110067, INDIA
| | - Sanjay Pant
- Department of Physics, Kumaun University, D.S.B. Campus, Kumaun University, Nainital, 263002, India, Nainital, 263001, INDIA
| | - Mohan Singh Mehata
- Applied Physics, Delhi Technological University, Bawana Road, Delhi, 110042, Delhi, Delhi, 110042, INDIA
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Dean C, Parks S, Titcomb TJ, Arthofer A, Meirick P, Grogan N, Ehlinger MA, Bisht B, Fox SS, Daack-Hirsch S, Snetselaar LG, Wahls TL. Facilitators of and Barriers to Adherence to Dietary Interventions Perceived by Women With Multiple Sclerosis and Their Support Persons. Int J MS Care 2022; 24:235-241. [DOI: 10.7224/1537-2073.2021-051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
People with multiple sclerosis (MS) frequently report implementing dietary strategies as part of their personal wellness programs; however, little is known about the perceived themes of healthy behavior change in people with MS.
Methods:
Semistructured one-on-one interviews were conducted with 20 women with MS enrolled in 2 different restrictive dietary intervention studies and their 18 self-identified support persons consisting of partners and adult children. Interviews were transcribed, coded, categorized, and then grouped into summative themes. The frequency of issues being mentioned as facilitators of or barriers to diet adherence was evaluated to identify possible differences in perceived experiences between women with MS and their support persons during the studies.
Results:
Five qualitative themes were identified: (1) personal motivation, (2) diet components, (3) time, (4) support, and (5) resource access. Major facilitators of dietary adherence were positive support from support persons and study staff, access to resources, symptom improvement, and personal motivation. Major barriers included the novelty of the study diet, lack of cooking skills, no change in or worsening of symptoms, lack of diet knowledge, and food preferences and temptations. Symptom severity was more frequently reported as a barrier to study diet adherence among participants with secondary progressive MS.
Conclusions:
Methods to enhance personal motivation and ensure positive support from support persons and study staff may improve study diet adherence. Due to the unique challenges faced by people with MS, future studies should tailor interventions to their unique MS cohort to increase diet adherence.
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Affiliation(s)
- Cassidy Dean
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Samantha Parks
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Tyler J. Titcomb
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
- From the Department of Epidemiology, College of Public Health (TJT, LGS), University of Iowa, Iowa City, IA, USA
| | - Andrea Arthofer
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Paul Meirick
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Nicole Grogan
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Mary A. Ehlinger
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Babita Bisht
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Sara Shuger Fox
- From the Department of Exercise Science (SSF), Central College, Pella, IA, USA
| | | | - Linda G. Snetselaar
- From the Department of Epidemiology, College of Public Health (TJT, LGS), University of Iowa, Iowa City, IA, USA
| | - Terry L. Wahls
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
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Bisht B, Madhavan N. Quick Access to High-Purity Peptide Drugs Bradykinin, Leuprolide Analogue, 2(PZ-128), and Rapastinel with Minimal Reagents. J Org Chem 2021; 86:17667-17672. [PMID: 34823358 DOI: 10.1021/acs.joc.1c01906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Peptide drugs bradykinin, a leuprolide analogue, 2(PZ-128), and rapastinel are synthesized in 56-77% yield using heating-assisted liquid-phase peptide synthesis on a soluble polynorbornene support. These drugs of commercial utility and complex structures are obtained in 2-5.5 h with no epimerization and >95% purity using only 1.2 equivalents of amino acids and coupling reagents. The peptide yield and purity are comparable or superior to the reported methods.
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Affiliation(s)
- Babita Bisht
- Department of Chemistry, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra 400076, India
| | - Nandita Madhavan
- Department of Chemistry, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra 400076, India
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Bisht B, Bhardwaj P, Giri M, Pant S. Fluorescence Spectral Properties of Methyl Orange in Homogeneous Media. J Fluoresc 2021; 31:1787-1795. [PMID: 34499289 DOI: 10.1007/s10895-021-02820-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
The methyl orange [C14H14N3SO3Na], an azo dye exhibited strong emission and large Stokes shift in various solvents, and the largest shift (Δλ = 125.51nm or Δν = 9297cm-1) was obtained in the water. The UV-visible spectra of the dye showed the absorption in the range (33,333 - 20,000) cm-1. We found that solvent effects on the absorption wavelength are consistent. The bathochromic shift in water and the hypsochromic shift in methanol observed in the absorption (43 nm) as well as in the fluorescence (42 nm) spectra predict the strong solute-solvent interaction. The fluorescence quantum yield (ɸf) was decreased from 24% in DMSO to 5% in water. The fluorescent properties of this dye are strongly solvent dependent, the wavelength of minimum fluorescence emission (λem = 435.51nm) shifts to the red. The maximum and minimum calculated oscillator strength is 32% with (Ɛmax = 29011 M-1cm-1) and 11% (Ɛmax = 6682 M-1cm-1) in methanol and DMSO, respectively. Protonated solvents without exception give a shorter lifetime and lower quantum yield. The average excited-state lifetime of the dye was found maximum (τav = 5.36 ns) in DMSO. Also, fluorescence lifetime was combined to deduce the radiative and non-radiative decay rate.
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Affiliation(s)
- Babita Bisht
- Photophysics Laboratory, Department of Physics, Centre of Advanced Study, D.S.B. Campus, Kumaun University, Uttarakhand, 263 002, Nainital, India
| | - Priyank Bhardwaj
- Department of Physics, Jagdish Saran Hindu (PG) College, Amroha, Mahatma Jyotiba Phule, Rohilkhand University, Uttar Pradesh, 243 006, Bareilly, India
| | - Manoj Giri
- Department of Physics, Sri Venkateswara College, University of Delhi, Benito Juarez Road, 110 021, New Delhi (Delhi), India.
| | - Sanjay Pant
- Photophysics Laboratory, Department of Physics, Centre of Advanced Study, D.S.B. Campus, Kumaun University, Uttarakhand, 263 002, Nainital, India.
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7
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Bisht B, Imandi V, Pant S, Sen A. Solvent-Dependent Spectral Properties in Diverse Solvents, Light Harvesting and Antiviral Properties of Mono-Azo Dye (Direct Yellow-27): A Combined Experimental and Theoretical Study. J Comput Biophys Chem 2021. [DOI: 10.1142/s2737416521500368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this paper, we have discussed for the first time a detailed electronic absorption study of the mono-azo dye Direct Yellow 27 [C[Formula: see text]H[Formula: see text]N4Na2O9S3] (DY-27) with five different homogeneous media by applying experimental and theoretical techniques along with some new characteristics of DY-27 in the field of solar cells as well as antiviral activities. A clear absorption band in the UV-visible region was observed, although the absorption maxima lie in the visible region. The electronic absorption transitions observed in our study were fully spin and symmetry allowed transitions with [Formula: see text]–[Formula: see text] character. Time-dependent density functional theory (TD-DFT) analysis has been done for understanding the electronic and the charge transfer performance. Moreover, the impacts of polar protic and polar aprotic solvents in the structural variation of DY-27 have been reported here. Further, applications of the dye in the field of solar cell, as well as antiviral activity, were performed using molecular modeling approaches. The dye exhibited a D–[Formula: see text]–A–A structure with a high light-harvesting efficiency (LHE) and good injection efficiency acts as an effective dye sensitized solar cell (DSSC). Molecular docking studies of the dye DY-27 performed with M-protease of the different corona viruses, MERS, SARS-CoV-1 and SARS-CoV-2 indicated comparable binding energies with the controlled inhibitors and best interactions are observed for the SARS-CoV-1.
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Affiliation(s)
- Babita Bisht
- Photophysics Laboratory, Department of Physics, Centre of Advance Study, DSB Campus, Kumaun University, Nainital 263002, India
| | - Venkataramana Imandi
- Center for Computational Biology and Bioinformatics School of Computational & Integrative Sciences (SCIS), Jawaharlal Nehru University, New Delhi, India
| | - Sanjay Pant
- Photophysics Laboratory, Department of Physics, Centre of Advance Study, DSB Campus, Kumaun University, Nainital 263002, India
| | - Anik Sen
- Department of Chemistry, GITAM Institute of Science, GITAM (Deemed to be University), Gandhi Nagar, Rushikonda, Visakhapatnam, Andhra Pradesh 530045, India
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Wahls TL, Titcomb TJ, Bisht B, Eyck PT, Rubenstein LM, Carr LJ, Darling WG, Hoth KF, Kamholz J, Snetselaar LG. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin 2021; 7:20552173211035399. [PMID: 34377527 PMCID: PMC8326636 DOI: 10.1177/20552173211035399] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the effect of the modified Paleolithic elimination (Wahls) and low-saturated fat (Swank) diets in relapsing-remitting MS (RRMS). Methods Individuals (n = 87) with RRMS were randomized to the Swank or Wahls diets in a parallel group clinical trial consisting of four timepoints: 1) run-in, 2) baseline, 3) 12-weeks, and 4) 24-weeks. Results 77 participants completed 12 weeks and 72 completed 24 weeks. The 12-week change from baseline in fatigue was -0.94 ± 0.18 (FSS) and -9.87 ± 1.93 (MFIS; both p < 0.0001) for Swank, and -0.71 ± 0.24 (FSS; p = 0.004) and -14.41 ± 2.22 (MFIS; p ≤ 0.0001) for Wahls. Physical MSQoL scores improved by 6.04 ± 2.18 (p = 0.006) for Swank and by 14.5 ± 2.63 (p < 0.0001) for Wahls. Mental MSQoL scores improved by 11.3 ± at 2.79 (p < 0.0001) for Wahls while the Swank did not change (3.85 ± 2.63; p = 0.14). Neither group showed significant changes in 6-minute walking distance at 12 weeks. All outcomes were maintained or further improved at 24 weeks. Conclusions Both diets were associated with clinically meaningful within-group reductions in fatigue and improvements in QoL.Trial Registration: Clinicaltrials.gov Identifier: NCT02914964.
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Affiliation(s)
- Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Babita Bisht
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | | | - Lucas J Carr
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Warren G Darling
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - John Kamholz
- Department of Neurology, University of Iowa, Iowa City, IA, USA
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Wahls T, Titcomb T, Bisht B, Ramanathan M. Patient Empowerment and the Exclusion of Dietary Intervention Studies. Comment on "Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations". Interact J Med Res 2021; 10:e17063. [PMID: 33595444 PMCID: PMC7929754 DOI: 10.2196/17063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/27/2021] [Indexed: 01/30/2023] Open
Affiliation(s)
- Terry Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
| | - Tyler Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States.,Department of Epidemiology, University of Iowa, Iowa City, IA, United States
| | - Babita Bisht
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, United States.,Department of Neurology, State University of New York, Buffalo, NY, United States
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Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma β-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. J Am Coll Nutr 2020; 40:13-25. [PMID: 32213121 DOI: 10.1080/07315724.2020.1734988] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the feasibility of a modified MCT-based ketogenic diet and its impact on plasma β-hydroxybutyrate and MS outcomes compared to a modified Paleolithic diet and usual diet in people with Multiple Sclerosis (MS). METHODS Fifteen individuals with MS were randomized to 3 groups: 1) modified Paleolithic diet (Paleo; n = 6); 2) medium-chain triglyceride (MCT)-based ketogenic diet that included coconut as a fat source (Keto; n = 5); or 3) usual diet (Control; n = 4). Participants had blood drawn every 4 weeks to monitor nutritional ketosis. Participants completed 4-day weighed food records, measures of disability, fatigue, quality of life (QoL), cognitive function, and physical function at baseline and 12-weeks. RESULTS Macronutrient intake significantly shifted toward a ratio indicative of a ketogenic diet in the Keto group at 12 weeks. Similarly, plasma β-hydroxybutyrate indicated nutritional ketosis in the Keto group, whereas neither macronutrient intake nor plasma β-hydroxybutyrate indicated nutritional ketosis in the Paleo and Control groups. The Paleo group had significant within group reductions in fatigue scores and maintained cognitive function scores compared to the Control group. The Keto group had significant reductions in fasting glucose and insulin compared to baseline values; however, no clinical outcomes significantly changed. CONCLUSIONS Participants consuming the MCT-based ketogenic diet achieved nutritional ketosis; however, it was not associated with significant clinical improvement in this study whereas the modified Paleolithic diet was associated with significant clinical improvements. Larger randomized controlled trials are needed to determine the safety and efficacy of the modified Paleolithic and MCT-based ketogenic diets on MS.
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Affiliation(s)
- Jennifer E Lee
- Department of Psychology, Mount Mercy University, Cedar Rapids, Iowa, USA.,College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Tyler J Titcomb
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Babita Bisht
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | | | - Rebecca Louison
- Department of Psychology, Mount Mercy University, Cedar Rapids, Iowa, USA
| | - Terry L Wahls
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.,Department of Extended Care and Rehabilitation Service Line, Iowa City VA Health Care System, Iowa City, Iowa, USA
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Bisht B, Naganna N, Madhavan N. A rink-amide soluble support: high purity conotoxins and other peptides accessed with minimal reagents. Org Biomol Chem 2019; 17:7238-7246. [PMID: 31328741 DOI: 10.1039/c9ob01214a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The use of peptides as therapeutics has been growing due to their biocompatibility. Solid phase peptide synthesis typically used to access these peptides requires excess reagents and/or microwave irradiation to drive reactions to completion because the reaction medium is heterogeneous. Reported herein is a soluble polynorbornene support containing rink amide attached sites for synthesizing oligopeptides and conotoxins in high purity using only 1.2 to 2 equivalents of coupling reagents. The support can be isolated as a precipitate from the reaction medium by adding ether. The loading capacity of the support can be easily determined by spectroscopy and can also be tuned by varying the monomer ratio. This support is promising for accessing peptides as the methodology uses minimal reagents and by-products can be easily separated.
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Affiliation(s)
- Babita Bisht
- Department of Chemistry, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra 400076, India.
| | - Nimmashetti Naganna
- Department of Chemistry, Indian Institute of Technology Madras, Chennai, Tamil Nadu 600036, India
| | - Nandita Madhavan
- Department of Chemistry, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra 400076, India.
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Fellows Maxwell K, Wahls T, Browne RW, Rubenstein L, Bisht B, Chenard CA, Snetselaar L, Weinstock-Guttman B, Ramanathan M. Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study. PLoS One 2019; 14:e0218075. [PMID: 31211794 PMCID: PMC6581256 DOI: 10.1371/journal.pone.0218075] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate associations between lipid profiles and fatigue in a cohort of progressive multiple sclerosis (MS) patients on a diet-based multimodal intervention. Methods This pilot study included 18 progressive MS patients who participated in a prospective longitudinal study of fatigue following a diet-based multimodal intervention that included exercise, neuromuscular electrical stimulation and stress reduction. The diet recommended high intake of vegetables and fruits, encouraged consumption of animal and plant protein and excluded foods with gluten-containing grains, dairy and eggs. Fatigue was measured on the Fatigue Severity Scale (FSS) at baseline and every 3 months for 12 months. A lipid profile consisting of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) was obtained on fasting blood samples at baseline and 12 months. Results FSS scores decreased from a baseline of 5.51 (95% CI: 4.86, 6.16) to a mean of 3.03 (95% CI: 2.23, 3.82) at 12 months (p < 0.001). At 12 months, increases in HDL-C (mean change: +6.0 mg/dl; 95% CI: 0.3, 12.0; p = 0.049) and decreases in BMI (mean change: -2.6 kg/m2; 95% CI: -3.6, -2.5; p < 0.001), LDL-C (mean change: -10.4 mg/dl; 95% CI:-19.7, -1.2; p = 0.029), TG (mean change: -29.2 mg/dl; 95% CI: -44.3, -14.2; p = 0.001), TG to HDL-C ratio (mean change: -0.6; 95% CI: -1.0, -0.3; p = 0.002) and TC to HDL-C ratio (mean change:-0.6; 95% CI: -1.0, -0.3; p = 0.003) were observed compared to baseline. Improvements in FSS were associated with increases in HDL-C (β = -0.05; 95% CI: -0.1, -0.0004; p = 0.048) and changes in TC (p = 0.005) from baseline to 12 months. Conclusions Lipid profile variables are associated with improvements in fatigue in progressive MS patients on a diet-based multimodal intervention.
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Affiliation(s)
- Kelly Fellows Maxwell
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
| | - Terry Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
- Department of Neurology, University of Iowa, Iowa City, Iowa, United States of America
| | - Richard W. Browne
- Department of Biotechnical and Clinical Laboratory Sciences, State University of New York, Buffalo, New York, United States of America
| | - Linda Rubenstein
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Babita Bisht
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Catherine A. Chenard
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Bianca Weinstock-Guttman
- Department of Neurology, State University of New York, Buffalo, New York, United States of America
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, New York, United States of America
- Department of Neurology, State University of New York, Buffalo, New York, United States of America
- * E-mail:
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Bisht B, Darling WG, White EC, White KA, Shivapour ET, Zimmerman MB, Wahls TL. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis 2017; 7:79-93. [PMID: 30050380 PMCID: PMC6053103 DOI: 10.2147/dnnd.s128872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the effects of a multimodal intervention including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation and massage on walking performance and balance of subjects with progressive multiple sclerosis (MS). MATERIALS AND METHODS Twenty subjects with mean (standard deviation) age of 51.7 (6.4) years and Expanded Disability Status Scale score of 6.2 (1) participated in a 12-month study. Assessments were completed at baseline, 3, 6, 9, and 12 months. RESULTS The entire cohort did not show significant changes in any of the assessments over 12 months except higher speed of walking toward the 10 feet mark during timed up and go (TUG) test at 6 months compared with baseline (mean change 7.9 cm/s [95% confidence interval {CI}]: 0.3, 15.2; p=0.041). Sub-group analysis revealed that 50% subjects (n=10) showed decrease in TUG time from baseline to at least 3 of 4 time-points post-intervention and were considered as responders (TUG-Res), the remaining 10 subjects were considered as nonresponders (TUG-NRes). Over 12 months, TUG-Res showed decreased mean TUG time by 31% (95% CI: -52%, -2%), increased median Berg Balance Scale scores (42 to 47), 30% increase in mean timed 25-foot walk speed (>20% considered clinically significant) and increased speed of walk toward 10 feet mark during TUG by 11.6 cm/s (95% CI: -3.0, 25.9) associated with increases in step lengths and decrease in step duration. TUG-NRes showed deterioration in walking ability over 12 months. Comparison of TUG-Res and TUG-NRes showed no significant differences in adherence to intervention but better stride duration and longer step length at baseline for TUG-Res than for TUG-NRes (p<0.05). CONCLUSION A multimodal lifestyle intervention may improve walking performance and balance in subjects with progressive MS who have mild-to-moderate gait impairment, whereas subjects with severe gait impairments may not respond to this intervention. Future trials should assess effects of this intervention in subjects with MS during early stages of the disease.
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Affiliation(s)
- Babita Bisht
- Department of Internal Medicine, Carver College of Medicine,
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | - Warren G Darling
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | - Emily C White
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | - Kaitlin A White
- Department of Health and Human Physiology, UI College of Liberal Arts and Sciences
| | | | | | - Terry L Wahls
- Department of Internal Medicine, Carver College of Medicine,
- Department of Extended Care and Rehabilitation Service Line, Iowa City VA Health Care System, Iowa City, IA, USA,
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Lee JE, Bisht B, Hall MJ, Rubenstein LM, Louison R, Klein DT, Wahls TL. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr 2017; 36:150-168. [PMID: 28394724 DOI: 10.1080/07315724.2016.1255160] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to examine whether participation in a 12-month multimodal intervention would improve mood and cognitive function in adults with progressive multiple sclerosis (MS). METHODS In this one-arm, open-label feasibility trial, participants were prescribed a home-based multimodal intervention, including (1) a modified Paleolithic diet; (2) an exercise program (stretching and strengthening of the trunk and lower limb muscles); (3) neuromuscular electrical stimulation (EStim) of trunk and lower limb muscles; and (4) stress management (meditation and self-massage). Individuals completed measures of mood (Beck Anxiety and Depression Inventories) and cognitive (Cognitive Stability Index, Cognitive Screening Test, Delis-Kaplan Executive Function System) and executive function (Wechsler Adult Intelligence Scale) at baseline and 3, 6, 9, and 12 months after the start of the intervention. Dosage of the multimodal intervention was assessed at 3, 6, 9, and 12 months. RESULTS The more individuals participated in the intervention activities, the greater improvements they had from baseline to 12 months on self-report measures of anxiety (Beck Anxiety Inventory [BAI]; ps = 0.001 to 0.02), depression (Beck Depression Inventory [BDI]; ps = <0.0001 to 0.09), cognitive function (Cognitive Stability Index [CSI/T], Delis-Kaplan Executive Function System [DKEFS]; ps = 0.001 to 0.06), and executive function (Wechsler Adult Intelligence Scale [WAIS]; ps = <0.0001 to 0.09). Mood and cognitive improvements were more closely related to a higher intake of the modified Paleolithic diet than to exercise and stress management dosage. Anxiety and depression changes were evident after just a few months, whereas changes in cognitive function were generally not observed until later in the intervention period. Mood and cognitive function changes from baseline to 12 months were significantly associated with fatigue improvements (ps = <0.0001 to 0.03). CONCLUSIONS A modified Paleolithic diet, exercise, EStim, and stress management intervention like this one has the potential to improve the mood and cognitive symptoms that can lead to considerable suffering in people with MS, potentially improving quality of life and function for people with progressive MS.
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Affiliation(s)
- Jennifer E Lee
- a Department of Psychology , Mount Mercy University , Cedar Rapids , Iowa.,b College of Nursing, The University of Iowa , Iowa City , Iowa
| | - Babita Bisht
- c Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City , Iowa
| | - Michael J Hall
- d Department of Psychiatry , Iowa City VA Health Care System , Iowa City , Iowa.,e Department of Psychiatry , Carver College of Medicine, University of Iowa , Iowa City , Iowa
| | | | - Rebecca Louison
- a Department of Psychology , Mount Mercy University , Cedar Rapids , Iowa
| | - Danielle T Klein
- c Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City , Iowa
| | - Terry L Wahls
- c Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City , Iowa.,g Extended Care and Rehabilitation Service Line, Iowa City VA Health Care System , Iowa City , Iowa
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Bisht B, Darling WG, Shivapour ET, Lutgendorf SK, Snetselaar LG, Chenard CA, Wahls TL. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis 2015; 5:19-35. [PMID: 30728736 PMCID: PMC6361513 DOI: 10.2147/dnnd.s76523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fatigue is a disabling symptom of multiple sclerosis (MS) and reduces quality of life. The aim of this study was to investigate the effects of a multimodal intervention, including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, and stress management on perceived fatigue and quality of life of persons with progressive MS. Methods Twenty subjects with progressive MS and average Expanded Disability Status Scale (EDSS) score of 6.2 (range: 3.5–8.0) participated in the 12-month phase of the study. Assessments were completed at baseline and at 3 months, 6 months, 9 months, and 12 months. Safety analyses were based on monthly side effects questionnaires and blood analyses at 1 month, 3 months, 6 months, 9 months, and 12 months. Results Subjects showed good adherence (assessed from subjects’ daily logs) with this intervention and did not report any serious side effects. Fatigue Severity Scale (FSS) and Performance Scales-fatigue subscale scores decreased in 12 months (P<0.0005). Average FSS scores of eleven subjects showed clinically significant reduction (more than two points, high response) at 3 months, and this improvement was sustained until 12 months. Remaining subjects (n=9, low responders) either showed inconsistent or less than one point decrease in average FSS scores in the 12 months. Energy and general health scores of RAND 36-item Health Survey (Short Form-36) increased during the study (P<0.05). Decrease in FSS scores during the 12 months was associated with shorter disease duration (r=0.511, P=0.011), and lower baseline Patient Determined Disease Steps score (rs=0.563, P=0.005) and EDSS scores (rs=0.501, P=0.012). Compared to low responders, high responders had lower level of physical disability (P<0.05) and lower intake of gluten, dairy products, and eggs (P=0.036) at baseline. High responders undertook longer duration of massage and stretches per muscle (P<0.05) in 12 months. Conclusion A multimodal intervention may reduce fatigue and improve quality of life of subjects with progressive MS. Larger randomized controlled trials with blinded raters are needed to prove efficacy of this intervention on MS-related fatigue.
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Affiliation(s)
- Babita Bisht
- Department of Internal Medicine, Carver College of Medicine, University of Iowa
| | - Warren G Darling
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa
| | | | - Susan K Lutgendorf
- Department of Psychology, College of Liberal Arts and Sciences, University of Iowa.,Department of Urology, Carver College of Medicine, University of Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa
| | - Catherine A Chenard
- Department of Internal Medicine, Carver College of Medicine, University of Iowa
| | - Terry L Wahls
- Department of Internal Medicine, Carver College of Medicine, University of Iowa.,Department of Internal Medicine, VA Medical Center, Iowa City, IA, USA
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Bisht B, Darling WG, Grossmann RE, Shivapour ET, Lutgendorf SK, Snetselaar LG, Hall MJ, Zimmerman MB, Wahls TL. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med 2014; 20:347-55. [PMID: 24476345 DOI: 10.1089/acm.2013.0188] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Multiple sclerosis is an autoimmune disease influenced by environmental factors. OBJECTIVES The feasibility of a multimodal intervention and its effect on perceived fatigue in patients with secondary progressive multiple sclerosis were assessed. DESIGN/SETTING This was a single-arm, open-label intervention study in an outpatient setting. INTERVENTIONS A multimodal intervention including a modified paleolithic diet with supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation, and massage was used. OUTCOME MEASURES Adherence to each component of the intervention was calculated using daily logs. Side-effects were assessed from a monthly questionnaire and blood analyses. Fatigue was assessed using the Fatigue Severity Scale (FSS). Data were collected at baseline and months 1, 2, 3, 6, 9, and 12. RESULTS Ten (10) of 13 subjects who were enrolled in a 2-week run-in phase were eligible to continue in the 12-month main study. Of those 10 subjects, 8 completed the study and 6 subjects fully adhered to the study intervention for 12 months. Over a 12-month period, average adherence to diet exceeded 90% of days, and to exercise/muscle stimulation exceeded 75% of days. Nutritional supplements intake varied among and within subjects. Group daily average duration of meditation was 13.3 minutes and of massage was 7.2 minutes. No adverse side-effects were reported. Group average FSS scores decreased from 5.7 at baseline to 3.32 (p=0.0008) at 12 months. CONCLUSIONS In this small, uncontrolled pilot study, there was a significant improvement in fatigue in those who completed the study. Given the small sample size and completer rate, further evaluation of this multimodal therapy is warranted.
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Affiliation(s)
- Babita Bisht
- 1 Department of Health and Human Physiology, University of Iowa College of Liberal Arts and Sciences , University of Iowa, Iowa City, IA
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Abstract
AIMS/HYPOTHESIS On the basis of our previous studies, we investigated the possible role of focal adhesion kinase (FAK) in the development of insulin resistance in skeletal muscle, a major organ responsible for insulin-stimulated glucose uptake. MATERIALS AND METHODS Insulin-resistant C2C12 skeletal muscle cells were transfected with FAK wild-type or FAK mutant plasmids, knocked down using small interfering RNA (siRNA), and their effects on the levels and activities of insulin-signalling molecules and on glucose uptake were determined. RESULTS A significant decrease in tyrosine phosphorylation of FAK in insulin-resistant C2C12 cells was observed. A similar decrease was observed in skeletal muscle obtained from insulin-resistant Sprague-Dawley rats fed a high-fat diet. Increased levels of FAK in insulin-resistant C2C12 skeletal muscle cells increased insulin sensitivity and glucose uptake. These effects were reversed by an increase in the level of kinase activity mutant FAK or suppression of endogenous FAK by siRNA. FAK was also found to interact downstream with insulin receptor substrate-1, phosphatidylinositol 3-kinase and protein kinase C and glycogen synthase kinase 3beta, leading to translocation of glucose transporter 4 and resulting in the regulation of glucose uptake. CONCLUSIONS/INTERPRETATION The present study provides strong evidence that the modulation of FAK level regulates the insulin sensitivity of skeletal muscle cells. The results demonstrate a direct role of FAK in insulin-resistant skeletal muscle cells for the first time.
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Affiliation(s)
- B Bisht
- Signal Transduction Research Laboratory, Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, S.A.S. Nagar, Chandigarh 160062, India
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