Chronic fatigue syndrome (CFS) is a debilitating condition with high morbidity and associated reduced quality of life. There are data suggesting neuro-endocrine axis involvement in CFS including disturbance in hypothalamic-pituitary-adrenal axis, growth hormone axis, opioidergic system and interactions with 5-Hydroxy Tryptamine (5-HT) system. Studies with selective 5-HT-releasing agents, using prolactin or cortisol responses to stimulation, found evidence of enhanced serotonergic responses in patients with CFS. Cocoa is known to increase neurotransmitters like phenyl ethylamine, serotonin, and anandamide in the brain.
To study the effect of high cocoa polyphenol rich chocolate in patients with Chronic Fatigue Syndrome.
Double blinded, randomised, placebo controlled fashion using high cocoa polyphenol rich chocolate in comparison to simulated iso-calorific chocolate dyed brown as placebo.
Ten patients were enrolled in the study of which 5 patients completed both arms. The Chandler Fatigue Scale score improved significantly after 8 weeks of the high cocoa polyphenol rich chocolate phase (32.6 vs. 22.0 p value 0.012) and, interestingly, fell significantly when patients were given simulated iso-calorific chocolate (25.3 vs. 28.6 p value 0.026). The residual function, as assessed by the London Handicap scale, also improved significantly after the active phase (0.485 vs. 0.628 p value 0.018). The mean weight before and after the placebo arm were also unchanged (73.43 kg vs. 73.85 kg, respectively p value 0.345). Anecdotally, two patients were able to return back to work after having had their symptoms for a 2 year period and continued on high cocoa polyphenol rich chocolate.
High cocoa polyphenols rich chocolate 15 g three times daily improved fatigue and function in patients with chronic fatigue syndrome over a period of 8 weeks compared to simulated iso-calorific chocolate. Whether hormonal modulation by this high cocoa polyphenols rich chocolate also occurred needs clarification.