A daily cup of cocoa may help those with multiple sclerosis (MS) manage fatigue, according to a small trial study published online in the Journal of Neurology Neurosurgery & Psychiatry.
The reasons behind MS-related fatigue — estimated to affect nine in 10 MS patients — are complex, and likely to include neural, inflammatory, metabolic and psychological factors. At this time, there are no medications that offer long-term relief for this often debilitating symptom.
Previous research suggests that dark chocolate, containing between 70 and 85 percent cocoa solids, is associated with an improvement in fatigue in people with chronic fatigue syndrome. This prompted the researchers to investigate cocoa’s potential in addressing the fatigue commonly associated with MS.
Cocoa, like dark chocolate, is rich in flavonoids — substances found abundantly in fruit and vegetables and associated with anti-inflammatory properties. Cocoa flavanoids have also been linked to better mood, cognitive function and heart health.
For the new study, the researchers randomly assigned 40 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 (19 people) or a low flavonoid version (21 people) every day for six weeks. 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 — the speed with which mental and physical fatigue set in — were assessed by researchers at the beginning, at the mid-point and at the end of the trial. Participants also rated their fatigue on a scale of 1 to 10, three times a day, and monitored their activity with a pedometer.
After six weeks there was a small improvement in fatigue in 11 of those drinking high flavonoid cocoa compared with eight of those drinking the low flavonoid version.
There was also a moderate effect on fatigability, with the high-flavonoid participants able to cover more distance during a 6-minute walking test. In addition, those drinking the high flavonoid version showed a 45 percent improvement in subjectively assessed fatigue and an 80 percent improvement in walking speed.
And although not objectively measured, pain symptoms also improved more in the high flavonoid group.
“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,” write the researchers.
Given the anti-inflammatory properties of flavonoids, they could be used alongside other approaches, such as exercise, drug treatment, and physiotherapy, to treat fatigue, they suggest.
“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,” they conclude.
In a linked editorial, Dr. Paolo Ragonese from the University of Palermo in Italy, pointed out that the treatment and management of MS related fatigue “still represents a challenge…because its mechanisms are multifactorial.”
Diets rich in flavonoids are linked to longer life and a lower risk of cardiovascular disease as well as positive changes to the volume and diversity of gut bacteria (the microbiome), he said.
“Although [this] study is an exploratory trial, it adds further interesting suggestions to the possible positive effects of flavonoid intake on the management of fatigue in patients with MS,” Ragonese said.