A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis

Research output: Contribution to journalArticlepeer-review


  • Shelly Coe
  • J Cossington
  • Johnny Collett
  • H Izadi
  • M Ovington
  • L Durkin
  • M Kirsten
  • M Clegg
  • DT Wade
  • J Palace
  • G DeLuca
  • K Chapman
  • J Harrison
  • E Buckingham
  • Helen Dawes

Colleges, School and Institutes


The impact of flavonoids on fatigue has not been investigated in Relapsing and Remitting Multiple Sclerosis (RRMS).

Objective: To determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS.

Methods: A randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley (ISRCTN: 69897291). During a six week intervention participants consumed a high or low flavonoid cocoa beverage daily. Fatigue and fatigability were measured at three visits (weeks 0, 3 and 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation.

Results: 40 pwMS (10 men, 30 women, age 44 ± 10 yrs) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data was <20% and adherence to intervention of allocated individuals was >75%. There was a small effect on fatigue (Neuro-QoL: effect size {ES} 0.04; confidence interval {CI} -0.40-0.48) and a moderate effect on fatigability (six-minute walk test: ES 0.45; CI -0.18 - 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved.

Conclusion: A flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS.  


Original languageEnglish
Number of pages7
JournalJournal of Neurology Neurosurgery and Psychiatry
Issue number5
Early online date4 Mar 2019
Publication statusE-pub ahead of print - 4 Mar 2019


  • multiple sclerosis, neuropharmacology, quality of life, randomised trials