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Dark Chocolate Fights Fatigue in Multiple Sclerosis

Because dark chocolate is relatively inexpensive-and many people like its taste-it could be a pragmatic adjunct to treatment in MS.

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Dark chocolate may improve fatigue in relapsing remitting multiple sclerosis (RRMS), according to a study published online on March 4, 2019, in the Journal of Neurology, Neurosurgery, and Psychiatry.1

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Dark chocolate has high levels of antioxidants called flavonoids. Research suggests that these flavonoids may stimulate blood flow to the brain as well as improve mood, cognition, and mental fatigue.2 A few small studies have already suggested that dark chocolate may improve physical fatigue in chronic fatigue syndrome3 and multiple sclerosis (MS).4

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Because dark chocolate is relatively inexpensive and many people like its taste, it could be a pragmatic adjunct for treating fatigue in MS.

To find out, researchers conducted a randomized double-blind placebo-controlled study that included 40 adults with RRMS that had been stable for the past 3 months. Participants came from neurology clinics in the Thames Valley, UK. Researchers randomized 19 participants to a high-flavonoid cocoa drink and 21 to a low-flavonoid cocoa drink for 6 weeks. Fatigue was assessed at clinic visits at Oxford University on weeks 0, 3, and 6. Patients also self-rated their fatigue three times daily.

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Six-week results suggested that those in the high-flavonoid group experienced a small improvement in fatigue, compared with the low-flavonoid group (Neuro-QoL effect size, 0.04). Patients in the high-flavonoid group were 45% more likely to respond, compared with the low-flavonoid group (hazard ratio [HR], 1.45).

Consuming the high-flavonoid cocoa drink had a medium effect on improvement in 6-minute walk distance (effect size, 0.45). Those in the high-flavonoid group were 80% more likely to experience improvement in the distance they could walk in 6 minutes, compared with the low-flavonoid group (HR, 1.80).

Half of people in both groups (n = 20/40) said they would continue drinking cocoa long-term, especially if it helped improve fatigue. The trial is a small, feasibility study and larger, longer-term studies are needed to confirm results.

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“[C]onsidering the possible anti-inflammatory mechanism, flavonoids [in dark chocolate] may be used as an adjunctive approach alongside other therapeutic interventions and suggest the possible benefit of such combined approaches for fatigue management [in multiple sclerosis],”1 wrote first author Shelley Coe, PhD, of Oxford Brookes University (Oxford, UK), and colleagues.

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References

1. 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. J Neurol Neurosurg Psychiatry. 2019 Mar 4. pii: jnnp-2018-319496. doi: 10.1136/jnnp-2018-319496.

2. Nehlig A. The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. Br J Clin Pharmacol. 2013;75:716-727.

3. Sathyapalan T, Beckett S, Rigby AS, et al. High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome. Nutr J. 2010;9:55. doi: 10.1186/1475-2891-9-55.

4. Coe S, Axelsson E, Murphy V, et al. Flavonoid rich dark cocoa may improve fatigue in people with multiple sclerosis, yet has no effect on glycaemic response: an exploratory trial. Clin Nutr ESPEN. 2017;21:20-25. doi: 10.1016/j.clnesp.2017.07.002. Epub 2017 Jul 25.

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