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