A Healthy Way to Show Your Love?

Chocolate contains potentially health-promoting phytochemicals, but that doesn’t mean it 
promotes health.

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The origins of chocolate can be traced back to ancient history when cocoa was known as the “Food of the Gods,” and was given as a drink to priests and warriors. It wasn’t until 1861, however, that Richard Cadbury packaged his chocolate varieties in heart-shaped boxes for Valentine’s Day as a way to increase chocolate sales. Today, this symbol of love is often promoted as a “healthy” food. Is there enough evidence to recommend that chocolate should be consumed regularly for its health-promoting effects, or should it remain a sweet treat to be enjoyed in moderation?

The Flavanol Factor. Chocolate’s “health halo” comes from the presence of plant compounds (phytochemicals) called flavanols in the cocoa bean. In test tubes and animal studies, flavanols have been shown to have antioxidant and anti-inflammatory properties. Whether or not flavanols have these same effects in the human body—and whether a typical serving of chocolate contains enough flavanols to confer these benefits—is unknown. (It’s important to keep in mind that the cocoa bean undergoes many processing steps that reduce its flavanol content when it is made into cocoa powder or candy.)

Although findings have been inconsistent, some observational studies in humans have reported an association between flavanol consumption and lower risk of poor health outcomes, including chronic heart disease, stroke, and type 2 diabetes. These studies do not, however, prove cause and effect.

Flavanols are also found in other foods, such as tea, red and purple fruits and vegetables, and citrus fruits.

The Evidence. “When you hear about studies that have reported an association between chocolate consumption and health benefits, beware,” says Alice H. Lichtenstein, DSc, Gershoff professor at the Friedman School of Nutrition Science and Policy and editor-in-chief of this newsletter. “Studies have also reported associations between chocolate consumption and a country’s per capita number of Nobel laureates. I don’t think anyone would suggest habitually including chocolate in a child’s diet will increase their chances of winning a Nobel prize! There are many other variables that likely influenced the relationship. The association between chocolate and health benefits is observational. Observational data are important to generate hypotheses, but ultimately, they must be tested to establish cause and effect.”

TAKE CHARGE!

➧ Enjoy. Choose the kind of chocolate you like best—for enjoyment, not for any health benefit claims.

➧ Don’t refrigerate. Refrigerating chocolate causes it to “bloom,” or display a whitish coating from sugar rising to the surface. This does not mean it is spoiled. It’s unattractive, but safe to eat or cook with.

➧ Choose other flavanol-rich foods. 
Tea, red and purple fruits and vegetables, and citrus fruits also contain flavanols.

➧ Get creative. This Valentine’s Day, consider non-candy gifts for you loved ones, such as exotic fruits, specialty teas or coffees, a lovely plant, or bunch of flowers.

The type of research needed to get more definitive data is complex to conduct and depends on many factors. “While the biochemical mechanisms of flavanols are well-established,” says Jeffrey Blumberg, PhD, research professor at the Friedman School, “the potential for chocolate to contribute to health benefits is dependent on one’s background diet, including the type and amount of flavanols in the chocolate consumed and intake of other flavanol-rich foods like apples, berries, and tea.”

Keeping these limitations and uncertainties in mind, here are some of the reviews that looked at chocolate and health:

A 2017 systematic review assessed the association between chocolate consumption and risk of coronary heart disease (CHD), stroke, and type 2 diabetes. One serving of chocolate was defined as 1.1 ounces, or about 2 bite size pieces. Results demonstrated that, compared with the lowest intake (zero to one servings of chocolate per week), higher intake of chocolate was associated with lower risk of all three diseases. When researchers analyzed how much chocolate was associated with the lower risk, they observed little benefit beyond three servings of chocolate per week for CHD and stroke. For people with type 2 diabetes, two servings per week was associated with the lowest risk.

A 2016 systematic review of clinical trials that ranged from two weeks to one year reported that cocoa flavanol intake, either as supplements or cocoa products, resulted in a small to moderate improvement of biomarkers of cardiovascular disease and type 2 diabetes, such as insulin sensitivity and cholesterol levels. The range of flavanol consumption in the studies was 166 to 2,110 milligrams per day. (Note: one ounce of dark chocolate containing 70 to 85 percent cocoa solids has approximately 31 milligrams of flavanols and 170 calories. Hence, the amount of flavanols tested was equivalent to approximately 910 to 11,500 calories worth of dark chocolate.)

A more recent systematic review of clinical trials published in 2021 evaluated the effect of chocolate and cocoa product consumption on a variety of cardiometabolic risk factors, such as blood pressure, blood cholesterol levels, anthropometrics (weight, BMI, waist circumference, and body fat percentage), fasting blood sugar, and cognitive function. Unlike the 2016 review, there was no significant beneficial effect on any of the risk factors measured, except triglyceride levels.

Sweet Somethings. It’s important to remember that we often consume cocoa along with added sugars and refined grains (as in cookies, cakes, ice cream, and chocolate drinks). As with any food, when consumed in high quantities these treats will add calories to your diet, unless they are substitutes for other foods.

Existing evidence does not support a recommendation to add chocolate to your diet for its health benefits. If you enjoy consuming chocolate, Lichtenstein advises you choose the type you enjoy the most—not too much, and not too often. If you want to choose based on the highest flavanol content per bite, the best choices are those with the highest percentage of cocoa solids (see “Chocolate 101” box).

Whether it’s Valentine’s Day or not, moderation should be the operative word. 

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