Flavonoid-Rich Cocoa Could Reduce Multiple Sclerosis-Related Fatigue

Flavonoids are a group of natural polyphenolic compounds with variable structures. They are found in fruits, vegetables, grains, bark, roots, stems, flowers, tea and wine. High levels of flavonoids, which have anti-inflammatory properties, are found in natural cocoa. According to a new study, flavonoid-rich cocoa may help curb the fatigue that is typically associated with multiple sclerosis.

Flavonoid-rich cocoa could reduce fatigue in multiple sclerosis patients. Image credit: Steve Buissinne.

Flavonoid-rich cocoa could reduce fatigue in multiple sclerosis patients. Image credit: Steve Buissinne.

Fatigue is the most common symptom reported by individuals affected by multiple sclerosis, affecting the majority of patients.

It is often present even when neurological disability is low and in the early stages of the disease, but impacts significantly the quality of life in multiple sclerosis patients, diminishing independence in everyday activities. None of the currently available approaches offers long term relief.

Previous research suggests that dark chocolate, containing 70-85% cocoa solids, is associated with an improvement in subjectively assessed fatigue in people with chronic fatigue syndrome.

This prompted Oxford Brookes University’s Dr. Shelly Coe and colleagues to see if it might also be worth exploring its potential in helping to tackle multiple sclerosis-related fatigue.

The researchers randomly assigned 40 adults recently diagnosed with the relapsing remitting form of multiple sclerosis and fatigue to drink a cup of either high flavonoid cocoa powder mixed with heated rice milk (19) or a low flavonoid version (21) every day for six weeks.

Participants were instructed to wait 30 min 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 formally assessed before the start, at the mid-point, and at the end of the trial.

And participants also subjectively rated their fatigue on a scale of 1 to 10, at 10.00, 15.00, and 20.00 hours each 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.

And there was a moderate effect on fatigability, with those drinking high flavonoid cocoa able to cover more distance during the 6 min walk test.

Those drinking the high flavonoid version showed a 45% improvement in subjectively assessed fatigue and an 80% improvement in walking speed.

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,” Dr. Coe said.

“Given the anti-inflammatory properties of flavonoids, they could be used alongside other approaches, such as exercise, drug treatment, and physiotherapy, to treat fatigue.”

The study was published in the Journal of Neurology, Neurosurgery Psychiatry.

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Shelly Coe et al. A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis. Neurol Neurosurg Psychiatry, published online March 4, 2019; doi: 10.1136/jnnp-2018-319496

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