title: High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome.
abstract: BACKGROUND
  Chocolate is rich in flavonoids that have been shown to be of benefit in disparate conditions including cardiovascular disease and cancer. The effect of polyphenol rich chocolate in subjects with chronic fatigue syndrome (CFS) has not been studied previously.
  
  
  METHODS
  We conducted a double blinded, randomised, clinical pilot crossover study comparing high cocoa liquor/polyphenol rich chocolate (HCL/PR) in comparison to simulated iso-calorific chocolate (cocoa liquor free/low polyphenols(CLF/LP)) on fatigue and residual function in subjects with chronic fatigue syndrome. Subjects with CFS having severe fatigue of at least 10 out of 11 on the Chalder Fatigue Scale were enrolled. Subjects had either 8 weeks of intervention in the form of HCL/PR or CLF/LP, with a 2 week wash out period followed by 8 weeks of intervention with the other chocolate.
  
  
  RESULTS
  Ten subjects were enrolled in the study. The Chalder Fatigue Scale score improved significantly after 8 weeks of the HCL/PR chocolate arm [median (range) Exact Sig. (2-tailed)] [33 (25 - 38) vs. 21.5 (6 - 35) 0.01], but that deteriorated significantly when subjects were given simulated iso-calorific chocolate (CLF/CP) [ 28.5 (17 - 20) vs. 34.5 (13-26) 0.03]. The residual function, as assessed by the London Handicap scale, also improved significantly after the HCL/PR arm [0.49 (0.33 - 0.62) vs. 0.64 (0.44 - 0.83) 0.01] and deteriorated after iso-calorific chocolate [00.44 (0.43 - 0.68) vs. 0.36 (0.33 - 0.62)0.03]. Likewise the Hospital Anxiety and Depression score also improved after the HCL/PR arm, but deteriorated after CLF/CP. Mean weight remained unchanged throughout the trial.
  
  
  CONCLUSIONS
  This study suggests that HCL/PR chocolate may improve symptoms in subjects with chronic fatigue syndrome.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Hull York Medical School, Michael White Diabetes Centre, Hull Royal Infirmary, 220-236 Anlaby Road, Hull, HU3 2RW UK. thozhukat.sathyapalan@hyms.ac.uk
authors.forename: Thozhukat
authors.initials: T
authors.lastname: Sathyapalan
authors.forename: Stephen
authors.initials: S
authors.lastname: Beckett
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Duane D
authors.initials: DD
authors.lastname: Mellor
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Atkin
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001007:Anxiety / Q000178:diet therapy; D015992:Body Mass Index; D002099:Cacao / Q000737:chemistry; D018592:Cross-Over Studies; D003863:Depression / Q000178:diet therapy; D004311:Double-Blind Method; D005221:Fatigue / Q000178:diet therapy; D015673:Fatigue Syndrome, Chronic / Q000178:diet therapy* / Q000523:psychology*; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage* / Q000032:analysis; D005526:Food, Formulated / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010636:Phenols / Q000008:administration & dosage* / Q000032:analysis; D010865:Pilot Projects; D059808:Polyphenols; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
chemical_list: D005419:Flavonoids; D010636:Phenols; D059808:Polyphenols