According to a new study, cocoa may help curb the fatigue that is typically associated with multiple sclerosis (MS).

The study was 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.

The findings, if confirmed in larger studies, may offer a simple dietary approach to a persistent and hard to treat symptom, which affects nine out of 10 people with MS. According to the study, the causes of mental and physical fatigue experienced by people with MS are complex, and likely to include neural, inflammatory, metabolic, and psychological factors.

 The researcher say, none of the currently available approaches offers long term relief. 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. Study experts 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.

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. Furthermore, 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," the researchers said.