Can cacao really help with MS fatigue?

Ophelia, who was diagnosed with MS in 2014, took part in a clinical trial to see if drinking cacao could help to improve fatigue.

I was diagnosed with MS in early 2014 after three back to back relapses at the age of 48. My main residual symptoms are neuropathic pain, cognitive problems, double vision and fatigue. 

I’ve learned to manage my fatigue by not getting up in the mornings until usually at least 11am where possible, as I am useless in the mornings (so I’m basically still a teenager). This meant going part time in the afternoons for work after diagnosis, before eventually retiring.

One day a large envelope arrived through my door from Oxford Brookes University with an invite to a trial regarding MS fatigue. Excitedly I read the acceptance criteria, and realised that I might meet them, so I completed the forms and sent them off. 

Being on a trial was something I had always wanted to do, as it sounded interesting and I wanted to help in some way towards improving knowledge of, treatment or cure for MS. The trial was to see whether flavonoids (found in high percentage cocoa chocolate) helped reduce fatigue.

I was accepted on the trial, and before I knew it was on my way to Oxford, unfortunately early one morning! Being morning I was exhausted, especially as I wasn’t allowed to eat before my blood test. I was slurring my speech, and was feeling wobbly on my walking test. Half asleep, I filled in more forms and was given a fitness tracker to wear for a set period of time to monitor my movement at home.  

Most importantly, I was given individual packs of hot chocolate and boxes of rice milk. The trial was a double blind trial, meaning that neither the participants nor the testers know who is taking the real stuff or the placebo. The instructions were to take the hot chocolate in the mornings at least  half an hour before any food or medication. I would then need to come back in six weeks to be tested again.

I was texted a few times a day and had to report back on how fatigued I felt. I absolutely loved the rich chocolate drink! I could have drunk it at least four times a day given the chance, but I stuck to the rules like a good girl. My partner said that he thought I was less fatigued, as he noticed that I hadn’t been sleeping so late every day, even though I stayed in bed, generally playing on my iPad, like you do.

The six weeks passed quickly, so back at Oxford again, the blood and walk tests were repeated. I was told that I walked faster this time. And I was told that I would find out which chocolate I had been given when the results came out.

I was asked which group I thought I was in, and I said the high flavonoid group, as when I stopped taking the chocolate drink, my fatigue dramatically increased. 

When the results came out, about 18 months later, I was informed that I had been in the high flavonoid group. 

The headline of the study is that a daily drink of flavonoid-rich hot chocolate could have a positive long-term effect on fatigue. I’m pleased to have been part of this exciting research, and really enjoyed the chocolate too! I’ve recently started taking it again on my morning porridge. Any dark cocoa over 75% should be high flavonoid if anyone is thinking of trying it for themselves - either chocolate bars or cocoa powder. 

It didn’t dramatically improve my fatigue, but as they say, every little helps.

Chocolate in all it's delicious forms comes from the cacao plant, Theobroma cacao.

Twenty years ago, the word cocoa in English would have meant everything from the plant, the raw or dried bean, the powder and many of the products made from it. So you will still find plenty of people talking about cocoa plants or cocoa beans. These days, there is more of a distinction. The plant itself and food ingredients made from raw or unprocessed parts of the plant are usually all called cacao. The word cocoa is now generally used for cooked or processed cacao, as found in chocolate bars, drinks, or the cocoa powder used in baking.

The Dutch processing method of making cocoa powder, which is considered to produce a better flavour and colour in the powder, involves soaking the dried beans in an alkaline solution before they are ground up. Research has shown that Dutch processing removes between 60-90% of the flavonoids that are considered to be the active ingredient in this fatigue study. However, a newer process, developed in 2008 by Spanish scientists found that by blanching the beans in hot water stopped the flavonoids being lost. Many products made this way are labelled as cacao.

Ultimately, whether a product has the word cocoa or cacao on it might come down to marketing as well as how it was produced.  Vegan and health food companies have begun to use the word cacao to distinguish their products from mainstream chocolate products, which might have a less healthy reputation. You may need to read the ingredients carefully to find out what you have got!

• Cocoa improves MS fatigue