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Flavonoid-Rich Cocoa Improved Fatigue by 45% in Patients With RRMS


A recent study sought to determine the impact of flavonoids on fatigue in relapsing and remitting multiple sclerosis (RRMS).

A recent study sought to determine the impact of flavonoids on fatigue in relapsing and remitting multiple sclerosis (RRMS).

Nine out of 10 people with multiple sclerosis experience fatigue, which can be extremely difficult to treat and have adverse effects on health and quality of life. Dark chocolate containing 70% to 85% cocoa solids is well known for its high antioxidant and flavonoid content and has been shown in a previous small randomized controlled pilot study to suggest an increase in quality of sleep and reduction in fatigue.

Researchers in this trial enrolled 40 patients recently diagnosed with RRMS in a parallel, randomized, double-blind, placebo-controlled trial in order to analyze the feasibility and efficacy of a flavonoid intervention. Patients were randomized to a high (n = 19) or low (n = 21) flavonoid groups.

Participants were provided a cocoa beverage mixed with heated rice milk by the lead researcher at baseline and at week 3, and they were asked to consume the drink in their homes daily. The beverage was consumed after an overnight fast at the same time each morning. After the beverage was consumed, participants were instructed to wait 30 minutes before eating any other food or beverage and/or take their medication.

Throughout the 6-week intervention participants were asked to rate their level of fatigue on a numerical scale from 1 to 10 (10 being the worst). Patients rated their level of fatigue 3 times per day for 6 weeks. Fatigability was measured at baseline and week 6 using a 6-minute walk test.

The study authors found that adherence to the intervention was 100% (19/19) in the intervention group, and 90% (19/21) in the control group. The relative risk for those who responded and therefore had improved fatigue in the intervention group (11 of 19 responders) compared with the control group (8 of 20 responders) was 1.45. Additionally, there was a moderate effect for distance walked in 6 minutes (0.45, 95% CI 0.18 to 1.07) between the groups with the intervention demonstrating a larger increase in the meters walked in 6 minutes after the intervention.

In total, those drinking the high flavonoid version showed a 45% improvement in subjectively assessed fatigue and an 80% improvement in walking speed. “A full evaluation including wider geography, longer follow-up, and cost effectiveness is now indicated. This technology has the potential to be implemented in the UK and worldwide, alongside other rehabilitation measures including exercise, DMTs [disease modifying treatments] and physiotherapy,” wrote the authors.


Coe S, Cossington J, Collett J, et al. A randomized double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis [published online March 4, 2019]. BMJ. doi: 10.1136/jnnp-2018-319496.

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