Investigation of the effects of cocoa powder on fatigue severity in patients with relapsing-remitting multiple sclerosis: A Randomized controlled trial

Introduction Multiple Sclerosis (MS) is an immune-mediated central nervous system disorder, often accompanied by fatigue, which can be an initial symptom. Cocoa, rich in antioxidants like flavonoids, has previously reduced fatigue in chronic fatigue syndrome patients. This study aimed to assess cocoa's impact on fatigue in patients with relapsing-remitting MS (RRMS). Methods This study was a double-blind, parallel placebo-controlled trial in patients with RRMS. A total number of 60 patients entered the study and were divided into intervention and control groups. The intervention group consumed 25 grams of cocoa daily, split into two 12.5-gram sachets, while the placebo group received 2.5 grams daily. Modified fatigue impact scale (MFIS) and Fatigue severity scale (FSS) questionnaires were filled at baseline, week 4, and week 8. Results No significant changes were observed in FSS (P = .90) and MFIS (P = .37) during the interventions. No significant differences were observed in the questionnaire score changes between the two groups, except for the FSS decrease in the second four weeks(P < .05). FSS and MFIS were significantly correlated during different assessment times (P < .05). Both MFIS and FSS scores were correlated with Beck’s depression inventory score. Conclusions We indicated that FSS changed significantly after cocoa consumption in patients with RRMS. The FSS score of the cocoa group continued to decrease during the subsequent four weeks, unlike the placebo group. It appears that cocoa primarily affects physical fatigue rather than psychosocial or cognitive fatigue. While these results align with some prior studies, further research on larger populations is necessary to confirm these findings.