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EXPERT REACTION: Chocolate could reduce fatigue in people with MS

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A nice cup of hot chocolate could be a safe, easy way to reduce fatigue symptoms associated with inflammation in people with multiple sclerosis (MS), according to international researchers. Cocoa, found in chocolate, is rich in flavonoids, which have anti-inflammatory properties. The team asked 40 people with MS to drink high- or low-flavonoid cocoa every day for six weeks. They found those who drank high-flavonoid cocoa rated their fatigue as lower, and were also able to cover more distance in 6-minute walking tests. If these results can be confirmed in larger studies, dark chocolate and cocoa could be an easy (and delicious) way to reduce fatigue symptoms, the researchers add.

Journal/conference: Journal of Neurology Neurosurgery & Psychiatry.

Link to research (DOI): 10.1136/jnnp-2018-319496

Organisation/s: University of South Australia, Oxford Brookes University

Funder: Funding for the trial was granted from the Multiple Sclerosis Society; Grant reference 32. HD is funded by Elizabeth Casson Trust and Higher Education Thames Valley and the Biomedical Research Centres. JC is funded by Heath Education Thames Valley. Disclosure funding for highly specialised services to run a national congenital myasthenia service and a neuromyelitis service. Support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Abide, Chugai Pharma, Alexion, MedDay, Argenx and Bayer Schering, Medimmune and unrestricted grants from Merck Serono, Novartis, Biogen Idec, Chugai, Alexion and Bayer Schering. MS society and Guthie Jackson Foundation research grants.

Media Release

From: The BMJ

JOURNAL OF NEUROLOGY NEUROSURGERY & PSYCHIATRY

Peer reviewed? Yes
Evidence type: Randomised controlled feasibility trial
Subjects: People

Cocoa may help curb fatigue typically associated with multiple sclerosis (MS)

May offer easy, safe approach to persistent symptom, if confirmed in larger studies, suggest researchers

Cocoa may help curb the fatigue that is typically associated with multiple sclerosis (MS), suggest the results of a small feasibility trial, published online in the Journal of Neurology Neurosurgery & Psychiatry.

Cocoa, like dark chocolate, is rich in flavonoids––substances found abundantly in fruit and vegetables and associated with anti-inflammatory properties.

If the findings are confirmed in larger studies, it may offer a simple dietary approach to a persistent and hard to treat symptom, which affects nine out of 10 people with MS, suggest the researchers.

The causes of mental and physical fatigue experienced by people with MS are complex, and likely to include neural, inflammatory, metabolic, and psychological factors. None of the currently available approaches offers long term relief, say the researchers.

Previous research suggests that dark chocolate, containing between 70 and 85 per cent cocoa solids, is associated with an improvement in subjectively assessed fatigue in people with chronic fatigue syndrome (ME).

This prompted the researchers to see if it might also be worth exploring its potential in helping to tackle the fatigue associated with MS.

They randomly assigned 40 adults recently diagnosed with the relapsing remitting form of MS 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 minutes 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 minute walk test.

Those drinking the high flavonoid version showed a 45 per cent improvement in subjectively assessed fatigue and an 80 per cent 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,” write the researchers.

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

“The use of dietary approaches to reduce fatigue and associated factors in people with MS may be an easy, safe, and cost-effective way to have an impact on quality of life and independence, allowing people to feel more in control of their condition.

“A full evaluation, including wider geography, longer follow up and cost effectiveness is now indicated,” they conclude.

In a linked editorial, Dr Paolo Ragonese, University of Palermo, points out that the treatment and management of MS related fatigue “still represents a challenge…because its mechanisms are multifactorial.”

And diets rich in flavonoids are linked to longer life and a lower risk of cardiovascular disease as well as positive changes to the volume and diversity of gut bacteria (the microbiome), he points out.

“Although [this] study is an exploratory trial, it adds further interesting suggestions to the possible positive effects of flavonoid intake on the management of fatigue in patients with MS,” he concludes.

Notes for editors
Research: A randomised double-blind placebo-controlled feasibility trial of flavonoid rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis doi 10.1136/jnnp-2018-419496
Editorial: Food of the gods for the treatment of multiple sclerosis related fatigue? Doi 10.1136/jnnp-2018-31926
Journal: Journal of Neurology Neurosurgery & Psychiatry

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Manny Noakes is a Nutrition Consultant

Flavonoids are antioxidant compounds in foods that are most concentrated in fruits, vegetables, wines, teas and cocoa. In particular dark chocolate containing 70% or more cocoa solids is well known for its anti-inflammatory effects due to a high antioxidant and flavonoid content. It has been shown has been shown to improve fatigue, immune function and sleep quality  in those with chronic fatigue syndrome.
 
This study tested the effect of a high ( 200 mg cocoa flavonoids) or low (19mg flavonoid) cocoa drink on fatigue, a debilitating symptom in multiple sclerosis - an autoimmune disease that affects the brain and spinal cord with damage to nerve cells. The researchers conducted a small but very well conducted study in 40 MS sufferers over 6 weeks. The results showed that those on the high flavonoid drink were able to walk further on a timed 6 minute walk compared to the low flavanoid drink.

Although larger studies are needed, this promising result shows that a diet containing high levels of cocoa flavanoids may help to reduce the fatigue symptoms of MS.

Last updated: 05 Mar 2019 10:21am
Declared conflicts of interest:
None declared.

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