Tag Archives: Fatigue

The Preliminary Scoping Phase

That sounds quite official, doesn’t it? Day 4 of my extremely unscientific hot chocolate ‘project’. I’m calling this the preliminary scoping phase…well, it’s not a controlled experiment, is it? I’m happy that I’ve actually prepared and drank the hot choc for 4 days in a row. That’s participant engagement right there! Some observations:

Given that I really don’t have a sweet tooth, this has been less effort for me than I anticipated. Mind you, the drink I’m making is quite bitter. My husband commented that it was ‘quite messy’. No, that’s me making a mess, not the drink.

The drink is very filling. Remember, I’m making it with instant (water-based) hot chocolate and approximately 20g of high flavanol cacao (perhaps I’ll weigh it tomorrow. It’s probably slightly more than 20g, given the heapedness of my heaped tablespoon). The calorific value is approximately 171kcal per serving (that’s 107 kcal for the hot choc, 64 kcal for the cacao). Not exactly a small snack, but I’m not bothered about that, because my appetite has been quite low recently.

I’ve not been taking it at the same time every day. My primary focus has been making and drinking the drink, and I’ve managed that. Yes, it has only been 4 days, but I’m that kind of person who looks for a medal for flossing her teeth once a month ( MY DENTIST SAID THIS WAS FINE BECAUSE IT’S BETTER THAN NOTHING. Stop judging me). Good job I don’t wear a lot of make up – I’d have to chip it off every so often and my pillowcases would need bleached. I digress. 4 days in a row is a start.

Talking of which, tomorrow is my last day for a while. I’m going into hospital this week to have my gallbladder removed, because I’m middle aged, unfit, and a bit chunky. I’m such a good catch! It’s nothing to do with the MS, although the MS treatment I’m on (Lemtrada) can exacerbate already dodgy gallbladders. Ach, I wasn’t doing anything else anyway. So, now that I’ve done the preliminary scoping phase, I can start again properly when I’m on my feet again.

The lead author of the original study sent me a copy of the original research paper (Thank you very much, Dr Coe). Turns out I would not have been eligible for the original study anyway – my neurologist thinks I may have had a relapse recently (oh, but I have felt absolutely grim!), and I’ve to have an MRI and an evoked potential test to establish if this is the case. The original study – quite rightly – ruled out patients who had had a relapse within the previous 3 months.

Do I think the hot chocolate has worked at all? Well. The original study looked at fatigue and fatiguability, and I really don’t think 4 days is enough to judge. I’ve certainly felt more mentally alert and my concentration has been better in the period after consumption, allowing for about half an hour digestive transit time, but I think I’m coming out of this period of relapse/exacerbation anyway, so it’s very difficult to assess. However, I will keep going – allowing for the break later this week and next – since one of my objectives was to assess for myself how practical a single nutrient intervention might be. Nutritional interventions are, by their very nature, complex, and don’t always show an immediate effect (perhaps caffeine is a good example of an fast-acting intervention effect) Obviously, I’m not having bloods taken for this, so I have no idea whether there’s even any kind of cumulative effect on biochemistry. My only measures are of self observed Quality of Life markers, and when I’m back on my feet, I will attempt a more structured and better recorded project.

Meantime, I think I’ve done enough to be able to establish that a single mug of hot chocolate is not a miracle cure…don’t get me started on the mass media’s ‘understanding’ of health and science. That’s for another blog post 🙂

That Twitter thread re. fatigue and hot chocolate

Note: I’ve copied and pasted this, unedited. And look, I’ve added some tags…

I have #RRMS ( Relapsing Remitting Multiple Sclerosis) One of my symptoms is fatigue. We’re not just talking about being a bit sleepy, this is full on ‘my vital signs are there but not much else/ has someone slipped me a mickey finn’ type overwhelming fatigue. It is truly horrible.It affects everything – mobility, cognition, appetite, eyesight, temperature control, muscular function etc. I need a cane if I’m outside. There are bits that I have forgotten, but that’s a ‘thing’ too. My memory is erratic! Some days are better than others. Today is ok.

I mean that I got up, had a shower, got dressed, and had a yoghurt & a coffee. That took approx 4 hours. I’m not on top form, but I don’t *think* I’ll have to have a nap. Wouldn’t rule it out though..Why am I telling you all this, Twitterpeeps? I wouldn’t normally go public like this and I don’t want to whinge, but you need context.

More context: I have a BA in Education Studies, trained as a dietitian, used to teach nutrition at @LJMUEHC , and currently don’t/can’t work.

..I clicked ‘post’ too soon. Sigh. Anyway. I AM DOING AN EXPERIMENT. N=1, ie me. Have you seen the media reports about ‘hot chocolate alleviates MS fatigue’? Those reports are based on this: https://jnnp.bmj.com/content/early/2019/01/31/jnnp-2018-319496?int_source=trendmd&int_medium=trendmd&int_campaign=trendmd

So I’m testing it out. DO you know how difficult it is to find the flavanol content of hot choc? I figured I’d have to design my own. The authors of the study used 18g of high flavanol choc powder to 200ml milk. I don’t really like milky drinks, and I don’t have a sweet tooth.

So, I bought some high flavanol cacao, and some standard water based hot choc to make the drink: see photo. Other brands are widely available. I didn’t measure the cacao, I just used a very heaped tablespoon. And stirred. And stirred.

Photograph of cacao, hot chocolate sachet, and tablespoon
I got that tablespoon from Braemar Castle, 26 years ago. They’re not having it back.

Initial observations: that’s a lot of stirring, but it did dissolve. Also, this has the potential to become v expensive. Looks ok, smells… v chocolatey!

Post drink – it tasted really nice and not too sweet. Do I feel less fatigued? I don’t know! I was having an ok day anyway. I do feel like having a little lie down, in the same way as you do after a big meal. We’ll see.

I’ll keep going for a few days – my fatigue levels fluctuate – it will be interesting to see if it makes any difference. I’m more interested in the practical side of this: will I be able to do this independently every day? My lovely husband is more of a carer than I would like.

How much would this cost in the long term? A box of 30 Wispa hot choc sachets was about £7, the cacao was about £8. I got them both from Amazon. I don’t think the cacao will last a week, never mind a month. As a personal experiment, I think it’s worth a try – if it helps, HOORAY, if not.. well: there are worse things to do. Watch this space…:-)