Tag Archives: Hot Chocolate

Hot chocolate – the results are in…

Black and white photograph of a mug of hot chocolate

Cocoa helps MS patients feel full of beans again

(The Times, Tuesday 5th March 2019)

A mug of hot chocolate a day helps people with MS reduce fatigue, study finds

(Sky News, Tuesday 5 March 2019)

Earlier this year, you can imagine what an absolute joy it was to have many people telling me to ‘just have a cup of hot chocolate, because (they) read in the news that it would help my MS’.  Now look, I have a science degree. I also know that what you read in the news is not always accurate. I suspected that it wasn’t going to be quite as simple as drinking a mug of Bourneville or Green & Blacks a day  (other brands are available). In an attempt to find out for myself, from a purely pragmatic position, I thought I’d give it a go. And if it worked – great. Obviously, I wasn’t having bloods taken and monitored for this, nor was it going to be a particularly rigorous experimental procedure, but from the point of view of someone living with MS, it was worth a try. Here’s what happened –

[In case any of my former students or colleagues are reading this… I KNOW IT’S NOT LIKE A PROPER LAB REPORT OR SCIENTIFIC PAPER, STOP JUDGING ME]

Pros

  • The high flavonol concoction was very palatable. Important. Too many dietary supplements are absolutely vile. I’m looking at YOU, Fortisip and the like (other brands are available)
  • It was simple to make: a few spoonfuls of powder and hot water, and stir vigorously
  • I found the hot chocolate particularly useful when I was cold. This is, perhaps, a really obvious statement, but I can become chilled very quickly, even when it’s supposedly a warm day. My hands and feet, particularly my right foot, suffer badly (I don’t have Raynaud’s Syndrome, but I’ve always had temperature regulation issues. I’m not blaming that on the MS, but it is just one more thing which annoys me). The hot chocolate kept me nice and warm for a couple of hours.

Cons

  • It was hot chocolate – I don’t have a particularly sweet tooth, nor do I particularly like milky drinks. so it wouldn’t have been my first beverage of choice for every day. I drink a black coffee every day, sometimes two cups. If there was a mechanism by which the flavonol content could be suitably increased in coffee, or indeed any other drink, I would have found that more acceptable
  • Whilst it was easy to prepare, there were days that even that was too difficult for me. My fatigue was such that I struggled to get out of bed. On those days, I try to ensure that I’m hydrated as a minimum, because there are occasions where I’m too fatigued to even eat. I have a bottle of water by my bed, and use my limited energy to lift that to my lips. Yes, this sounds dramatised, but I can assure you that I wish I was exaggerating. Fortunately, I have come out of that particular period (if I hadn’t, I wouldn’t be able to even think about writing this blog!), but my point is that there were days that I could not have prepared this by myself, and I didn’t have anyone around to prepare it for me, thereby negating any cumulative effects the flavonols may have had
  • There was no way that I wanted hot chocolate on a hot day. Remember how hot Easter weekend was? Hot chocolate was the last thing I wanted. I didn’t even eat my Easter Egg until the following week. I can’t anticipate that I would want hot chocolate in the summer if we have a really hot and dry one like last year.  (NB: at the time of writing – mid June – we are currently in the middle of a weather warning for torrential rain and I have the heating on. Again.)

Results and Conclusions

Did it work? ie, did it alleviate my fatigue? Well… not that I could tell, unfortunately. Certainly not physically. As I said, I do have periods where I am so fatigued that all my body can do is exist. I also have periods where I am just tired, like everyone else. When I started my experiment, I didn’t realise that I was about to go into 3 weeks of such intense and unrelenting fatigue that I had to be checked for a relapse (it wasn’t). That period started and ended with my usual fluctuating and activity dependant levels of fatigue, and it was only within those shorter periods that I was able to make the drink.

When I was able to have the drink, I did notice that my ‘cog fog’ lifted slightly for a short while – for approximately an hour each time. However, this also happens after a cup of coffee. Cocoa has a certain amount of caffeine in it, and although this was controlled for in the original study, I wasn’t able to do so at home. So the cog fog might have been helped by the beverage, perhaps not.

I’m not sure what I was expecting  – did I imagine that the hot chocolate was going to act like some kind of energy drink? Did I consider the importance of a cumulative effect? The original study measured markers of fatigue/fatigability at 0, 3,  and 6 weeks. I didn’t have a chance to build up that cumulative effect, and at present, it would be difficult for me to say for certain that I would have a period of 6 consecutive weeks where I would have the energy to have the beverage every day.

Other thoughts –  is the absorption and bioavailability of  flavonols dependant on intestinal microflora? Is it genetic? (My honours dissertation was a study of soy isoflavones and LDL Cholesterol levels, and at that point in the literature (2011), it certainly seemed that both these factors played a role, and I’m aware that much more work has been done on this since then). In which case… was I starting from a disadvantage anyway given that I don’t have a complete GI system ?

I like to think that, as a former dietitian, I can make myself have the motivation to carry out a study like this. As an MS-er, I definitely have the motivation to try to drive away fatigue. But, I found it hard to maintain motivation when I considered it wasn’t working. Pragmatically, I would have found this difficult to sustain over a lifetime – if the effects are cumulative, I would need to have added the ‘hot choc’ break into my daily routine, which is fine when I’m at home, but more difficult if I’m not. Additionally, given that I couldn’t find a single product which provided sufficiently high levels of flavonols, a long term investment in this experiment would be quite expensive. Perhaps a product is out there somewhere, but given that product labelling is still minimal when it comes to exact amounts of phytonutrients, it was very difficult to identify.

Lastly, from what I now know about RRMS, everyone has a different experience. Fatigue is one of those symptoms which is caused by different factors in different people, and presents itself in many different ways. Have I overused the word ‘different’?  The paper by Coe et al (2019) gives an in depth and nuanced breakdown of the markers of fatigue used in the study, and is worth a read. The original study suggested that there is definitely potential to use flavonoid rich beverages to improve fatigue levels and fatigability in MS patients. Although it didn’t do much for me at this particular time, I’m glad I tried, and might be able to try again at some point. I’ll be keeping an eye open for further developments from this research group.

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…:-)