Coffee May Help Ease Fatigue in MS Patients With Milder Disability

Drinking coffee each day appears to help people with multiple sclerosis (MS) and milder disability and fatigue, with this patient group reporting in a questionnaire that caffeine allowed them to better concentrate on tasks and broaden their attention spans, a study reports.

Its researchers suggest that “for selected patients” regular coffee consumption could be a way of easing MS-related fatigue.

The study “The Effect of Coffee and Caffeine Consumption on Patients with Multiple Sclerosis-Related Fatigue” was published in the journal Nutrients.

Fatigue is a common symptom of MS, affecting over 70% of people with the disease. This symptom is not that of feeling tired but, according to a 2008 study, is  defined as an extreme exhaustion that occurs suddenly or can be triggered by factors like activity, stress,  infections, or digestion.

A previous study reported that 14% of MS patients perceived fatigue as their worst symptom, and 55% considered it among the symptoms that most affect them.

Despite its negative effect on patients’ lives, there is no clear therapeutic recommendations to tackle fatigue in MS. Non-drug therapies and healthy lifestyle have become important alternatives in fatigue prevention. Simple approaches like drinking coffee might also have a positive effect.

Coffee is composed of more than 1,000 ingredients, including caffeine, its most studied one. Caffeine is well known for stimulating the central nervous system (CNS, brain and spinal cord) and promoting short-term improvement in attention. It is also described to have a positive impact on cognition and memory.

Due to its structure, caffeine can cross the blood-brain barrier — a highly selective membrane that shields the CNS from circulating blood — and can lower the effect of adenosine, a neurotransmitter that has a calming effect. (Neurotransmitters are substances produced in response to nerve signals that act as chemical messengers.)

Researchers at the University of Regensburg Hospital in Germany investigated how coffee consumption might help ease fatigue in people with MS.

They assessed the coffee consumption habits of MS patients, and beneficial and harmful effects of daily consumption on reported fatigue.

In total, 124 MS patients filled out a questionnaire on their coffee consumption. Their fatigue was assessed using the Fatigue Severity Score (FSS), which ranges from nine to 63, with higher scores indicating more severe fatigue, and the Epworth sleepiness scale (ESS). Questions also addressed problems with falling asleep and sleeping through the night, and whether patients felt fit and well rested in the morning.

Forty-six patients (median age, 49) were classified as having fatigue, while 78 others (median age, 45) were classified as ‘no fatigue.’ No significant differences in terms of age, sex, diagnosis (type of MS), or coffee consumption habits were found.

Unemployment rates were significantly higher in the fatigue group (56.5%) compared with the ‘no fatigue’ group (21.8%). Forty-three patients reported not to be working at the time of the analysis, including 29 not able to work due to MS.

The groups’ median score on the expanded disability status scale (EDSS) — a method of quantifying disability in MS, with higher scores marking greater disability — was 2.5, indicating mild disability.

Among the fatigue group, 39.1% of patients had an EDSS of 4.0 or higher (indicative of significant disability), as did 19.2% patients in the ‘no fatigue’ group. No significant differences in coffee habits between different EDSS intervals — an EDSS of 0, below 4, or 4 and above — were found.

Thirty-four patients reported having problems falling asleep, but no link was found to coffee consumption. Similarly, 66 patients (53.2%) reported waking up more than once at night, with no correlation with coffee drinking habits.

On average, these people drank 2.67 cups of coffee daily, with one cup defined as 150 ml (about 5 ounces). Most patients reported to drink up to four cups of coffee per day, while 14 were not coffee drinkers.

The majority (79.9%) consumed their coffee during the day, or before 6 p.m., and 8.1% drank coffee in the evening. Those drinking coffee later than 6 p.m. also were heavier coffee drinkers (6.6 cups per day, on average). The team found no association between late coffee drinking and sleeping problems.

Almost half of these people (58 patients or 46.8%) reported needing coffee to start the day as the reason for its consumption, while 32 (25.8%) said they did not feel any effects from drinking coffee.

No significant differences were found between the daily coffee intake and EDSS scores or FSS values. However, researchers observed that coffee drinkers with milder to mid-level disability, as measured by EDSS scores between 0 and 4, reported better concentration and attention spans, and a more structured daily routine.

“It can be hypothesized that these patients are able to benefit from the effects of coffee consumption due to their still preserved cognitive reserves,” researchers wrote.

Coffee consumption also carried no notable side effects. “In our cohort, no negative impact of coffee or caffeine consumption on sleep quality could be found and no serious side effects were observed,” the researchers wrote.

“MS patients with an EDSS score higher than 0, but lower than 4, noted the strongest effect of coffee consumption on their cognitive abilities, mainly regarding a higher mental capacity and a more structured daily routine,” they added.

“Since coffee showed no severe side effects and in the absence of an effective fatigue therapy, coffee consumption might be a therapeutic approach for selected patients with MS-related fatigue,” the team suggested.