Published on 11th March 2019


A daily cup of flavonoid-rich cocoa could help reduce fatigue in people with multiple sclerosis (MS), according to the findings of a small trial published in the Journal of Neurology, Neurosurgery & Psychiatry.1

Ninety per cent of people with MS – which affects more than 100,000 people in the UK – will experience fatigue as a symptom of their condition, which can severely affect quality of life.

In this trial, funded by the MS Society, 40 adults (10 men, 30 women) recently diagnosed with the relapsing remitting form of MS and fatigue consumed a cup of either high-flavonoid cocoa powder mixed with heated rice milk (19 participants) or a low-flavonoid version (21 participants) every day for six weeks.

Flavonoids – found in fruit, vegetables and dark chocolate – are associated with anti-inflammatory and antioxidant properties.

Researchers assessed fatigue and fatigability (i.e. the speed with which mental and physical fatigue set in) before the start, at three weeks, and at the end of the trial. Participants were also asked to rate their fatigue on a scale of one to 10 at certain times of the day and to monitor their activity using a pedometer.

After six weeks there was a small improvement in fatigue in 11 participants given the high-flavonoid cocoa, compared with eight of those drinking the low-flavonoid version. There was also a moderate effect on fatigability, with those who had drunk the high-flavonoid cocoa being able to cover more distance during a six-minute walk test.

Participants who had been given the high-flavonoid version showed a 45 per cent improvement in subjectively assessed fatigue and an 80 per cent improvement in walking speed. And although pain was not objectively measured, pain symptoms reportedly improved more in the high-flavonoid group.2

The researchers concluded: “The use of dietary approaches to reduce fatigue and associated factors in pwMS [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.” 

Dr Shelly Coe, lead author and a senior lecturer in nutrition at Oxford Brookes University, said: “I’m so excited we found what we did. MS is unpredictable and different for everyone, so we now need to know exactly how effective flavonoid-rich hot chocolate is and whether it can benefit all people with MS before it’s prescribed.

“This work is still in its early stages, but in the future and with more data we very much hope to find a treatment that could help people with MS manage their symptoms, cheaply and safely.”

To find out more about the diet-MS link, read our interview with Dr Terry Wahls, who reversed her MS symptoms with diet and lifestyle, in the next issue of Optimum Nutrition magazine (out in April). Sign up to the FREE digital version of the magazine here. (Also available in printed format).


  • Coe S et al (2019). A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis. J Neurol, Neurosurgery & Psychiatry. DOI: 10.1136/jnnp-2018-319496


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