The study “A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis” was published in the Journal of Neurology, Neurosurgery & Psychiatry.
Fatigue is experienced by 90% of people with MS and, despite many approaches for fatigue management, exercise shows signs of being the most effective. However, even exercise has its limitations, and beneficial strategies are needed.
Dark chocolate containing 70 to 85% cocoa solids has shown success in improving fatigue in people with chronic fatigue syndrome. A small trial showed that consumption of flavonoid rich dark cocoa for a short term increased sleep quality and reduced fatigue in people with MS.
Flavonoids are a type of antioxidant found in several plant-based foods, such as dark chocolate (which has more than 70 percent cocoa levels), and have been linked with improved heart and gut health, and increased longevity.
The impact of flavonoids on fatigue in RRMS patients, however, remains poorly characterized.
A team led by researchers at Oxford Brookes University, U.K., evaluated whether daily consumption of flavonoid-rich pure cocoa can reduce fatigue in RRMS patients. The study was funded by the Multiple Sclerosis Society (MS Society).
The team performed a randomized, placebo-controlled trial (ISRCTN69897291) that enrolled 40 people — 10 men and 30 women, mean age of 44 years — recently diagnosed with RRMS and fatigue. Participants were randomized to have a high (19 patients) or low (21 patients) flavonoid cocoa beverage daily for six weeks.
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Cocoa was consumed at the same time each morning following an overnight fast. Patients were advised to wait 30 minutes before consuming any other food or beverage or taking medications. The cocoa was provided as a powder, and consumed with heated rice milk.
Fatigue and fatiguability were measured at three time points: the beginning of the study, at week three, and at the end of the study (week six).
Patients rated their level of fatigue on a numerical rating scale (NRS), ranging from 1 to 10 (10 being the worst). Fatiguability was measured at the beginning and at the end of the study, using the 6-minute walk test (6MWT) — a test that measures the maximum distance an individual is able to walk over a total of six minutes on a hard, flat surface.
Results showed that fatigue was improved in 11 of 19 patients who drank flavonoid-rich cocoa (57.9%), compared to eight of the 20 patients in the low-flavonoid cocoa group (40%).
Also, patients given high-flavonoid cocoa walked a longer distance during the 6MWT — from 360.9 meters (393 yards) at baseline to 394.6 meters (430 yards) at six weeks, compared to 344 meters (376 yards) at baseline to 354.5 meters (387 yards) at six weeks in the low-flavonoid group.
Overall, the team concluded that “a flavonoid beverage demonstrates the potential to improve fatigue and fatiguability in RRMS.”
“Our study establishes that the use of dietary interventions is feasible and may offer possible long-term benefits to support fatigue management, by improving fatigue and walking endurance,” they added.
Larger trials, however, are needed to confirm these initial findings, they said.