Drinking high-flavonoid cocoa could help to ease the symptoms of fatigue among people with multiple sclerosis, a small trial has suggested.
If the results of a feasibility trial are confirmed in larger studies, it could be a simple dietary solution for what is a difficult symptom to treat, says lead author Dr Shelly Coe, of Oxford Brookes University, UK.
The trial was carried out after other studies suggested that dark chocolate, containing between 70% and 85% cent cocoa solids, is associated with an improvement in subjectively assessed fatigue in people with chronic fatigue syndrome (ME).
The research team randomly assigned 19 adults recently diagnosed with the relapsing remitting form of MS and fatigue to drink a cup of either high-flavonoid cocoa powder mixed with heated rice milk, while a further 21 were given a low-flavonoid version every day for six weeks.
The participants were instructed to wait 30 minutes before taking any prescribed medication or eating or drinking anything else, but otherwise to stick to their usual diet.
Fatigue and fatigability were formally assessed before the start, at the mid-point, and at the end of the trial, while participants also subjectively rated their fatigue on a scale of 1 to 10, at 10.00, 15.00, and 20.00 hours each day, and monitored their activity with a pedometer.
After six weeks, a small improvement in fatigue was recorded among 11 of those drinking high-flavonoid cocoa compared with eight who had the low-flavonoid version.
The research team also noted a moderate effect on fatigability, with those drinking high-flavonoid cocoa able to cover more distance during the six-minute walk test.
Participants who drank the high-flavonoid version also showed a 45% improvement in subjectively assessed fatigue and an 80% improvement in walking speed.
Writing in the Journal of Neurology Neurosurgery & Psychiatry, they write: “The use of dietary approaches to reduce fatigue and associated factors in people with MS may be an easy, safe, and cost-effective way to have an impact on quality of life and independence, allowing people to feel more in control of their condition.
“A full evaluation, including wider geography, longer follow up and cost effectiveness is now indicated.”
Dr Coe said: “I’m excited we found what we did. MS is unpredictable and different for everyone, so we now need to know exactly how effective flavonoid-rich hot chocolate is and whether it can benefit all people with MS before it’s recommended.
“This work is still in its early stages, but with more data we very much hope to find a dietary approach that could help people with MS manage their symptoms, cheaply and safely, in the future."
Coe S, Cossington J, Collett J et al. A randomised double-blind placebo-controlled feasibility trial of flavonoid rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis. Journal of Neurology Neurosurgery & Psychiatr 5 March 2019; doi 10.1136/jnnp-2018-419496
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