ChiroACCESS Article

Chocolate and Your Health

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ChiroACCESS Editorial Staff



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October 31, 2012

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Want to possibly improve your brain power, reduce the risk of cardiovascular disease, or find an economical sports drink? If you do, chocolate may be an alternative.

In an October 2012 article in the New England Journal of Medicine a loose relationship was established between the countries with the highest chocolate intake and the number of Nobel Prize winners. The study concludes that “Chocolate consumption enhances cognitive function, which is a sine qua non for winning the Nobel Prize…” Due to the limitations of the study design, the author warns that there has been no clear cause and effect established by the research.

More rigorous studies have confirmed the reduction of cardiovascular disease and a reduction of the risk of stroke. A Cochrane study also concluded that chocolate had a small but statistically significant impact on lowering blood pressure and yet another recent study supported the effectiveness of chocolate milk as an inexpensive drink to help recovery after exercise.

Despite the many positive effects of chocolate it must be consumed in moderation and recognized that not all forms of chocolate have the same health value.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

Chocolate consumption, cognitive function, and Nobel laureates.  [Link]

N Engl J Med. 2012 Oct 18;367(16):1562-4.

Messerli FH.
St. Luke's-Roosevelt Hospital and Columbia University, New York, USA.

No Abstract

Hypoglycemic effects of cocoa (Theobroma cacao L.) autolysates.  [Link]

Food Chem. 2012 Sep 15;134(2):905-11.

Sarmadi B, Aminuddin F, Hamid M, Saari N, Abdul-Hamid A, Ismail A.
Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.

Fat, alkaloid and polyphenol contents of two clones of cocoa (UIT1 and PBC 140) were removed and the remaining powder was autolyzed at pH 3.5 and 5.2. Based on the results, autolysates of UIT produced at pH 3.5 exhibited the highest ability to inhibit a-amylase activity. However, no a-glucosidase inhibition activity was observed under the conditions specified. Autolysates produced under pH 3.5 caused the highest amount of insulin secretion. In streptozotocin-diabetic rats, all cocoa autolysates significantly decreased blood glucose at 4h. To assure that the results from the assays were not due to the polyphenols of cocoa autolysates qualitative and quantitative tests were applied. According to their results cocoa autolysates were found to be free from polyphenols. Analysis of amino acid composition revealed that cocoa autolysates were abundant in hydrophobic amino acids. It can be suggested that besides other compounds of cocoa, its peptides and amino acids could contribute to its health benefits.

Chocolate milk: a post-exercise recovery beverage for endurance sports.  [Link]

Med Sport Sci. 2013;59:127-34.

Pritchett K, Pritchett R.
Department of Nutrition Exercise and Health Sciences, Central Washington University, Ellensburg, Wash., USA.

An optimal post-exercise nutrition regimen is fundamental for ensuring recovery. Therefore, research has aimed to examine post-exercise nutritional strategies for enhanced training stimuli. Chocolate milk has become an affordable recovery beverage for many athletes, taking the place of more expensive commercially available recovery beverages. Low-fat chocolate milk consists of a 4:1 carbohydrate:protein ratio (similar to many commercial recovery beverages) and provides fluids and sodium to aid in post-workout recovery. Consuming chocolate milk (1.0-1.5•g•kg(-1) h(-1)) immediately after exercise and again at 2 h post-exercise appears to be optimal for exercise recovery and may attenuate indices of muscle damage. Future research should examine the optimal amount, timing, and frequency of ingestion of chocolate milk on post-exercise recovery measures including performance, indices of muscle damage, and muscle glycogen resynthesis.

High-polyphenol chocolate reduces endothelial dysfunction and oxidative stress during acute transient hyperglycaemia in Type 2 diabetes: a pilot randomized controlled trial.  [Link]

Diabet Med. 2012 Oct 6.

Mellor DD, Madden LA, Smith KA, Kilpatrick ES, Atkin SL.
Department of Clinical Science, University of Chester, Chester, U.K.

AIMS: To investigate the effects of high-polyphenol chocolate upon endothelial function and oxidative stress in Type 2 diabetes mellitus during acute transient hyperglycaemia induced following a 75-g oral glucose challenge.

METHODS: Ten subjects with Type 2 diabetes underwent a double-blinded randomized controlled crossover study. A 75-g oral glucose load was used to induce hyperglycaemia, which was administered to participants 60 min after they had ingested either low (control) or high-polyphenol chocolate. Participants undertook testing at weekly intervals, following an initial cocoa-free period. Endothelial function was assessed by both functional [reactive hyperaemia peripheral artery tonometry (EndoPAT-2000) and serum markers (including intercellular adhesion molecule 1, P-selectin and P-selectin glycoprotein ligand 1]. Urinary 15-F2t-isoprostane adjusted for creatinine was used as an oxidative stress marker. Measurements were made at baseline and 2 h post-ingestion of the glucose load.

RESULTS: Prior consumption of high-polyphenol chocolate before a glucose load improved endothelial function (1.7 ± 0.1 vs. 2.3 ± 0.1%, P = 0.01), whereas prior consumption of control chocolate resulted in a significant increase in intercellular adhesion molecule 1 (321.1 ± 7.6 vs. 373.6 ± 10.5 ng/ml, P = 0.04) and 15-F2t-isoprostane (116.8 ± 5.7 vs. 207.1 ± 5.7 mg/mol, P = 0.02). Analysis of percentage changes from baseline comparing control and high-polyphenol chocolate showed a significant improvement for high-polyphenol chocolate in both measures of endothelial function (P < 0.05) and for urinary 15-F2t-isoprostane (P = 0.04).

CONCLUSION: High-polyphenol chocolate protected against acute hyperglycaemia-induced endothelial dysfunction and oxidative stress in individuals with Type 2 diabetes mellitus. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Chocolate consumption and risk of stroke: A prospective cohort of men and meta-analysis.  [Link]

Neurology. 2012 Sep 18;79(12):1223-9.

Larsson SC, Virtamo J, Wolk A.
Correspondence & reprint requests to Dr. Larsson:

OBJECTIVE: To investigate the association between chocolate consumption and risk of stroke in men and conduct a meta-analysis to summarize available evidence from prospective studies of chocolate consumption and stroke.

METHODS: We prospectively followed 37,103 men in the Cohort of Swedish Men. Chocolate consumption was assessed at baseline using a food-frequency questionnaire. Cases of first stroke were ascertained from the Swedish Hospital Discharge Registry. For the meta-analysis, pertinent studies were identified by searching the PubMed and EMBASE databases through January 13, 2012. Study-specific results were combined using a random-effects model.

RESULTS: During 10.2 years of follow-up, we ascertained 1,995 incident stroke cases, including 1,511 cerebral infarctions, 321 hemorrhagic strokes, and 163 unspecified strokes. High chocolate consumption was associated with a lower risk of stroke. The multivariable relative risk of stroke comparing the highest quartile of chocolate consumption (median 62.9 g/week) with the lowest quartile (median 0 g/week) was 0.83 (95 % CI 0.70-0.99). The association did not differ by stroke subtypes. In a meta-analysis of 5 studies, with a total of 4,260 stroke cases, the overall relative risk of stroke for the highest vs lowest category of chocolate consumption was 0.81 (95% CI 0.73-0.90), without heterogeneity among studies (p = 0.47).

CONCLUSION: These findings suggest that moderate chocolate consumption may lower the risk of stroke.

Good news: coffee and chocolate are good for your physical and mental health.  [Link]

Ment Health Today. 2012 Jul-Aug:22.

Stafford N.
Bipolar UK.

No Abstract

Effect of cocoa on blood pressure.  [Link]

Cochrane Database Syst Rev. Cochrane Database Syst Rev.

Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP.
National Institute of Integrative Medicine, Melbourne, Australia.

BACKGROUND: High blood pressure is an important risk factor for cardiovascular disease attributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular related deaths in Western populations. Epidemiological studies suggest that cocoa rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction. Previous meta-analyses have shown that cocoa-rich foods may reduce blood pressure. Recently additional trials had conflicting results.

OBJECTIVES: To determine the effect of flavanol-rich chocolate or cocoa products on blood pressure in people with or without hypertension.

SEARCH METHODS: We searched the following electronic databases from inception to November 2011: Cochrane Hypertension Group Specialised Register, CENTRAL, MEDLINE and EMBASE. In addition we searched international trial registries, and the reference lists of review articles and included trials.

SELECTION CRITERIA: Randomised controlled trials (RCT) investigating the effects of chocolate or cocoa products on systolic and diastolic blood pressure in adults for a minimum of two weeks duration.

DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed the risk of bias in each trial in consultation with a third author. Random effects meta-analyses on all studies fitting the inclusion criteria were conducted using Review Manager version 5.1 and Stata version 12. Heterogeneity was explored by subgroup analyses and univariate meta-regression analysis of several variables including dosage of flavanol content (total or monomers) in chocolate or cocoa products, blinding, baseline blood pressure, theobromine content, sugar content, body-mass-index (BMI), duration and age.

MAIN RESULTS: Twenty studies met the inclusion criteria. Meta-analyses of the 20 studies involving 856 mainly healthy participants revealed a statistically significant blood pressure reducing effect of flavanol-rich cocoa products compared with control in short-term trials of 2-18 weeks duration: Mean difference SBP (95%CI): -2.77 (-4.72, -0.82) mm Hg, p=0.005, n=20; mean difference DBP (95%CI): - 2.20 (-3.46, -0.93) mm Hg, p=0.006, n=19 available for DBP. Trials provided participants with 30-1080 mg of flavanols (mean=545.5 mg) in 3.6-105 g of cocoa products per day in the active intervention group. In half of the trials (n=10) the active group consumed 500-750 mg of flavanols per day. The control group received either a flavanol-free product (n=12) or a low-flavanol containing cocoa powder (6.4 and 41 mg flavanols, n=8). Subgroup meta-analysis of trials with a flavanol-free control group revealed a significant blood pressure reducing effect, in contrast to trials using a low-flavanol product in the control group. This analysis may have been confounded by trial duration and the level of blinding of participants. Trial duration was short (mean 4.4 weeks, range 2-8 weeks, n=19, and one trial of 18 weeks). A significant blood pressure reducing effect was evident in trials of 2 weeks duration (n=9), but not in trials of >2 weeks duration (n=11). It is important to note that seven out of the nine trials (78%) of 2 weeks duration also had a flavanol-free control group. Therefore, subgroup analysis by duration might be confounded by flavanol dosage used in the control groups, and the level of blinding of participants. Adverse effects including gastrointestinal complaints and distaste of the trial product were reported by 5% of patients in the active cocoa intervention group and 1% of patients in the control groups.

AUTHORS' CONCLUSIONS: Flavanol-rich chocolate and cocoa products may have a small but statistically significant effect in lowering blood pressure by 2-3 mm Hg in the short term. Our findings are limited by the heterogeneity between trials, which was explored by univariate meta-regression and subgroup analyses. Subgroup meta-analysis of trials using a flavanol-free control group revealed a significant blood pressure reducing effect of cocoa, whereas analysis of trials using a low-flavanol control product did not. While it appears that shorter trials of 2 weeks duration were more effective, analysis may be confounded by type of control and unblinding of participants, as the majority of 2-week trials also used a flavanol-free control and unblinding of participants. Results of these and other subgroup analyses based on, for example, age of participants, should be interpreted with caution and need to be confirmed or refuted in trials using direct randomized comparison. Long-term trials investigating the effect of cocoa products are needed to determine whether or not blood pressure is reduced on a chronic basis by daily ingestion of cocoa. Furthermore, long-term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products.

Protective effects of flavanol-rich dark chocolate on endothelial function and wave reflection during acute hyperglycemia.  [Link]

Hypertension. 2012 Sep;60(3):827-32.

Grassi D, Desideri G, Necozione S, Ruggieri F, Blumberg JB, Stornello M, Ferri C.
University of L'Aquila, Department of Internal Medicine and Public Health, Viale S Salvatore, Delta 6 Medicina, 67100 Coppito, L'Aquila, Italy.

Nitric oxide plays a pivotal role in regulating vascular tone. Different studies show endothelial function is impaired during hyperglycemia. Dark chocolate increases flow-mediated dilation in healthy and hypertensive subjects with and without glucose intolerance; however, the effect of pretreatment with dark chocolate on endothelial function and other vascular responses to hyperglycemia has not been examined. Therefore, we aimed to investigate the effects of flavanol-rich dark chocolate administration on (1) flow-mediated dilation and wave reflections; (2) blood pressure, endothelin-1 and oxidative stress, before and after oral glucose tolerance test (OGTT). Twelve healthy volunteers (5 males, 28.2±2.7 years) randomly received either 100 g/d dark chocolate or flavanol-free white chocolate for 3 days. After 7 days washout period, volunteers were switched to the other treatment. Flow-mediated dilation, stiffness index, reflection index, peak-to-peak time, blood pressure, endothelin-1 and 8-iso-PGF(2a) were evaluated after each treatment phase and OGTT. Compared with white chocolate, dark chocolate ingestion improved flow-mediated dilation (P=0.03), wave reflections, endothelin-1 and 8-iso-PGF(2a) (P<0.05). After white chocolate ingestion, flow-mediated dilation was reduced after OGTT from 7.88±0.68 to 6.07±0.76 (P=0.027), 6.74±0.51 (P=0.046) at 1 and 2 h after the glucose load, respectively. Similarly, after white chocolate but not after dark chocolate, wave reflections, blood pressure, and endothelin-1 and 8-iso-PGF(2a) increased after OGTT. OGTT causes acute, transient impairment of endothelial function and oxidative stress, which is attenuated by flavanol-rich dark chocolate. These results suggest cocoa flavanols may contribute to vascular health by reducing the postprandial impairment of arterial function associated with the pathogenesis of atherosclerosis.
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1 Comment on:

Chocolate and Your Health

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Re:Chocolate and Your Health

by Frejya   (2/4/2013 7:04:53 AM)
Chocolate is an all time favorite with most people, especially women and kids. I am sure they all will be happy to know how beneficial this is for them. Chocolate does help reduce the risk of cardiovascular problems also it is recommended to people with low blood pressure problems. Including a bit of dark chocolate in your diet is a good option. Have the one with less sugar for all the diet conscious people.