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Could cocoa help MS fatigue?

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Summary

Cocoa is a drink traditionally associated with bedtime, so the idea that it could reduce fatigue in MS might seem unlikely.  But cocoa made from dark chocolate contains high levels of flavonoids which have the potential to reduce fatigue through a number of different biological processes.  Researchers designed a study to compare fatigue levels after drinking a low flavonoid or a high flavonoid cocoa drink on separate study days.

The study was small (12 participants) and involved just one drink of each type of cocoa. The results did indicate that a single drink of high flavonoid cocoa reduced self-reported fatigue, lead to increased physical activity during waking hours and less activity during sleeping hours, suggesting improved sleep quality.   

Building on these preliminary results, the researchers have recently completed a study with 40 participants taking either low or high flavonoid cocoa drink every morning for six weeks.  The data from this larger study is now being analysed and written up – we’ll share the results when they are published.

Background

Cocoa is a drink traditionally associated with bedtime, so the idea that it could reduce fatigue in MS might seem unlikely.  However, cocoa contains flavonoids, naturally occurring chemicals found in plant-based foods, including dark chocolate with cocoa levels of over 70%.  In theory, flavonoids could improve fatigue in a number of different ways.  This has never been investigated, so researchers at Oxford Brookes University carried out a small study to test whether drinking cocoa rich in flavonoids might improve fatigue.

How this study was carried out

12 participants with MS fatigue were recruited and asked to attend two study visits.  To ensure as much consistency as possible between study days, participants were asked to eat the same diet on the day before each visit, avoid vigorous exercise and to limit their alcohol and caffeine intake on the day prior to testing. 

On study days, participants were given either a low flavonoid or a high flavonoid cocoa drink, with at least three days between visits; participants were not aware of which kind of cocoa they were drinking.  The two drinks were matched as closely as possible for carbohydrate and energy content.  Some of the participants were following a diet which excludes dairy, so the drinks were made with rice milk.

After drinking the cocoa, participants recorded their fatigue level at 30 minute intervals using a visual analogue scale - a 10 cm line labelled “not at all fatigued” at one end and “extremely fatigued” at the other.  Distance walked in 6 minutes was measured 2 hours after the drink and physical activity recorded for 24 hours with a wrist-worn activity sensor.  Glycaemic response - changes in blood sugar levels – was also monitored for 2 hours after the drink.

What was found

All participants drank and enjoyed the cocoa and were happy with what they were asked to do on each study day.  No side effects were reported and neither of the drinks caused an excessive increase in blood sugar levels.  In the high flavonoid group, self-reported fatigue levels were moderately improved and 24 hour physical activity was increased.  There was more activity during the sleeping hours (10pm-9am) after the low flavonoid cocoa.  There was no measureable change in distance walked in 6 minutes.

What does it mean?

The researchers’ primary aim was to test the feasibility of carrying out this type of study rather than generate evidence on the effectiveness of high flavonoid cocoa in reducing fatigue.  The study was small (12 participants) and involved just one drink of each type of cocoa.  Having said that, the results do suggest that a single drink of high flavonoid cocoa reduced self-reported fatigue, lead to increased physical activity during waking hours and less activity during sleeping hours, suggesting improved sleep quality.  

The researchers concluded that the drink was safe and acceptable and that the encouraging, preliminary results merited further investigation.  They have recently completed a study with 40 participants taking either low or high flavonoid cocoa drink every morning for six weeks.  The data from this larger study are now being analysed and written up – we’ll share the results when they are published.

Coe S, et al.
Flavonoid rich dark cocoa may improve fatigue in people with multiple sclerosis, yet has no effect on glycaemic response: An exploratory trial.
Clinical Nutrition ESPEN 2017; 21: 20-25.
Abstract 

More about how diet and nutrition can help with fatigue

A healthy, well balanced diet with plenty of fruit and vegetables plus complex carbohydrates, some protein-rich foods such as meat, fish and lentils and not too much fat, salt or sugar is required to provide optimum energy levels. A poor diet or eating habits can leave the body lacking in the fuel needed to get through the day. Although food and drinks high in sugar give an initial boost, blood sugar levels quickly drop again leaving your energy levels low. High sugar foods and drinks are often low in nutrients, and the extra calories can cause unwanted weight gain.

The rate at which sugars are released from foods is called the glycaemic index (GI). Meals and snacks, which are rich in complex carbohydrates such as milk, fresh fruit, yoghurt and multigrain bread have a low glycaemic index, giving a slower, more sustained energy release. Taking a low GI food at the same time as a high GI food can slow down the rate of release, for instance a glass of milk with a sweet biscuit.

It is also very important to drink sufficient fluids, especially water. Being even mildly dehydrated can cause tiredness and sluggishness. Some people with MS restrict the amount of fluid they drink as they are concerned about bladder problems. However, too little fluid can increase the risk of urine infections, headaches and constipation, and thus worsen existing MS symptoms.

Trying to maintain a healthy weight is also helpful as being overweight or underweight can increase fatigue.

When you are struggling with MS fatigue, preparing and eating meals can be a problem too.  Our book, Living with fatigue, suggests ways to tackle this.

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