Flavanol-rich cocoa: a cardioprotective nutraceutical. In the first, 20 patients with essential hypertension received 100g of dark chocolate (88mg flavanols) and 90g of white chocolate (no flavanols) daily for 15 days, in random sequence with a 7-day washout period between treatments (85). The rise in cGMP inhibits calcium flux and decreases cytosolic calcium concentration, resulting in smooth muscle relaxation and platelet aggregation inhibition (173, 174). Chocolate intake and incidence of heart failure: a population-based, prospective study of middle-aged and elderly women. Haskell CF. Kennedy DO. I. Apoptosis may be triggered intrinsically, through the mitochondrial pathway (118) or extrinsically by death ligands and receptors (99). Cocoa and wine polyphenols modulate platelet activation and function. Phytonutrients: Health Benefits and Foods to Eat - Verywell Fit Miller KB. Increased blood flow velocity in the middle cerebral artery has been demonstrated, providing insights to possible protective effects against dementia and stroke (238). Weisburger JH. Scharff L. Turk D. Gourley LM. Phytonutrient: A chemical compound found in plants that has positive impacts on human health and nutrition. However, just as the active ingredient making a food such as spinach or broccoli highly nutritious may be nothing less than spinach or broccoli, the same may be true of chocolate. Payne MJ. The phytochemicals in cocoa fall into a number of types. Macdonald IA. C hocolate is best known as an indulgent confection, but historically it has also been consumed for its purported healing properties ( 60 ). In 2003, Serafini and colleagues found that consumption of dark chocolate with 200ml of milk attenuated the increase in plasma antioxidant capacity observed after consumption of dark chocolate alone (227). Plants are the main natural source of numerous phytochemicals, although only a certain amount have been isolated and identified. Meeran SM. However, this association may be at least partially explained by cultural factors, as suggested by the work of Zellner et al. McKinley AJ. However, there is some evidence that flavanols and flavanol-rich foods, including cocoa, can inhibit angiotensin-converting enzyme (ACE) activity in vitro (2, 3). Beckett S. Atkin SL. Stahl L. Miller KB. Apgar J. Sweigart DS. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. . This publication was supported by Cooperative Agreement #U48 DP000053 from the Centers for Disease Control and Prevention. Bull C. Robinson J. Deanfield JE. Plasma antioxidants from chocolate. However, no change was observed in fasting glucose or insulin. Intake of soy, an important source of the isoflavone genistein, has been associated with up to 49% reduced risk of endometrial and ovarian cancers in women (182). Bethesda, MD 20894, Web Policies In one of these studies, the group assessed the effects of a single dose of high-flavanol cocoa beverage (917mg total flavanols) compared to a low-flavanol cocoa (37mg flavanols) in 10 healthy men. Saari JT. Cravings or increases in chocolate consumption also appear to be associated with negative mood (208). Coronary flow velocity reserve (CFVR) measured by echocardiography, BP, serum lipids, and markers of oxidative stress were assessed at baseline and at the end of the study. A 2010 meta-analysis of eight trials summarized the short-term impact of cocoa consumption on blood lipids (119). 9) (164, 169). also questioned the rigor of cocoa feeding trials, noting their small sample sizes and acknowledging the need for randomized, placebo-controlled, and cross-over studies. Sarkkinen ES. Stuart DA. Zadak Z. Hyspler R. Ticha A. Hronek M. Fikrova P. Rathouska J. Hrnciarikova D. Stetina R. Antioxidants and vitamins in clinical conditions. Allicin blocks or eliminates certain toxins from bacteria and viruses. Pearson DA. Kaplan-Meier curves for cumulative event-free survival associated with endothelial function measured as flow-mediated dilatation (FMD) (lowest tertile<2%, highest tertile>6.3%). No significant changes could be observed in the control group (circles). Both of the flavanol-rich preparations significantly increased cognitive performance and reduced mental fatigue relative to the control beverage. Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal. Yeung AC, et al. Phytochemicals act as chemoprevention they hinder cancer development by preventing DNA damage. For example, ingestion of cocoa containing 36mg of flavanols did not significantly change FMD, whereas cocoa containing 330mg increased FMD at 1, 2, and 3h after ingestion and cocoa containing 918mg increased FMD at 1, 2, 3, 4, and 6h after ingestion. Andres-Lacueva C. Effect of milk on the urinary excretion of microbial phenolic acids after cocoa powder consumption in humans. Kroger J. Schienkiewitz A. Weikert C. Boeing H. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study. Chocolate Chemistry, Chocolate Chemical Composition - WorldOfChemicals Chancellor MB. Schmitz HH. Stuart DA. Sapper TN. Another study found that a dark chocolate bar containing 500mg polyphenols lowered BP as effectively as a bar containing 1000mg (6). Kim HS. Cocoa and cardiovascular health. Crandon SK. Morris PJ. Neilson AP. Grassi D. Necozione S. Lippi C. Croce G. Valeri L. Pasqualetti P. Desideri G. Blumberg JB. Francis ST. Head K. Morris PG. Knab S. Delagrange D. Lieberman EH. Ranking of Consumption (Chocolate Confectionery) [Jan 5;2010 ]. Victor VM. Yet, no studies have investigated whether eliminating chocolate from the diet can improve symptoms. This study was followed by a string of other studies, which found no effect of milk on the bioavailability of cocoa flavanols (129, 210, 211). Schroeter H. Kelm M. Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. (84, 85). Ghosh D. Scheepens A. Vascular action of polyphenols. Patterns of chocolate consumption. Ross R. Atherosclerosisan inflammatory disease. Of note, in the trial reporting the lowest level of flavanols, subjects, nevertheless, experienced significant improvement in BP (256). They permit, however, comparison of structurally related compounds. Rozin P. Levine E. Stoess C. Chocolate craving and liking. Bringing plant-based food, such as fruits, vegetables, and whole grains, rich in phytochemicals, with beneficial nutrients, opens the door for healthy living. Schmitz HH. With the exception of products that have undergone Dutching, most cocoa and chocolate products will contain amounts of polyphenols that are reflective of the proportion of nonfat cocoa solids present (170). (66). Fewer subjects in the Farouque et al. Joshi SS. The health benefits are partly attributed to the compounds which possess antioxidants. However, these compounds also influence gene expression, and may help preserve eNOS. Endothelial NO is produced by endothelial nitric oxide synthase (eNOS), which converts L-arginine to L-citrulline in the presence of necessary cofactors (143). investigated the effects of acute (up to 6h after ingestion) and chronic (daily ingestion for 7 days) high-flavanol cocoa consumption on FMD in healthy male smokers (93). Tome D. Scalbert A. The boxes also contained craving rating scales, which the subjects were asked to complete before, immediately after, and 90min after consuming the given treatment. The test products were 46g of high-flavonoid (21mg procyanidins, 46mg epicatechin) or low-flavonoid (trace flavanols) dark chocolate, consumed once daily for 2 weeks. Ramiro-Puig et al. Kozukue N. Stability of green tea catechins in commercial tea leaves during storage for 6 months. Williamson G. Bioavailability and health effects of cocoa polyphenols. In studies, catechin has inhibited alpha-glucosidase activity (114) and inhibited absorption of glucose from the intestine (121, 273). The translation of this general theme in the literature into specific public health guidance would seem the next great challenge for the research community. There is reason to believe that the flavanols in cocoa may ameliorate insulin resistance by reducing oxidative stress, improving endothelial function, and/or altering glucose metabolism. Other intervention studies have had similar findings (6, 66, 84) but a few have found no effect of cocoa on BP (45, 65, 178, 180). Measures of insulin sensitivity were also calculated. Further, although cocoa may not appreciably change the quantity of lipids in the blood, it may change their quality, that is, their ability to cause blood vessel damage. Transport of proanthocyanidin dimer, trimer, and polymer across monolayers of human intestinal epithelial Caco-2 cells. Ljung R. Ahnve S. Ahlbom A. Hallqvist J. Although research to date has not specifically addressed whether cocoa may actually reduce adiposity, there is reason to believe that cocoa consumption may induce favorable metabolic changes through its effects on NO availability or lipid metabolism. Blumberg J. Mietus-Snyder ML. Lee KW. In another study, dark chocolate consumption significantly improved DNA resistance to oxidative stress in the short-term. In the double-blind, crossover trial, participants received 100ml of high-flavanol cocoa drink (176mg) and a low-flavanol cocoa (<10mg) on 2 consecutive days, in random sequence. Goldbohm RA. Hollenberg NK. Campos-Gimenez E. Jimenez Alvarez D. Nagy K. Donovan JL. Deficiency of NO favors the development of atherosclerosis and is associated with increased cardiovascular risk in conditions such as type 2 diabetes, metabolic syndrome, hypertension, and atherosclerosis (31, 80). Martinez G. McCullough M. Meinking T. Passan D. Preston M. Rivera A. Taplin D. Vicaria-Clement M. Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Glover V. Steiner TJ. Adapted from Fathi et al. conducted a comprehensive assessment of the metabolic impact of dark chocolate consumption in 30 subjects who consumed 40g of dark chocolate daily for 2 weeks (154). Gershwin ME. Kendall CW. Johnson C. Polak JF. In the first, participants received single doses of 74g dark chocolate and 74g white chocolate, in random sequence and with a 7-day washout period between treatments (66). Le Cornu KA. Willett WC. Flavanol intake and sample size per treatment arm or phase were similar in both studies, as were age, gender, and BMI. Urpi-Sarda M. Llorach R. Khan N. Monagas M. Rotches-Ribalta M. Lamuela-Raventos R. Estruch R. Tinahones FJ. Lavoie JL. Buyken AE. As the phytochemicals are natural source of Phytochemicals: Benefits, Concerns and Challenges 221 these health promoting compounds and can be a greater opportunity for developing In the former study, subjects received oral glucose tolerance tests (OGTT) after consuming either dark chocolate or white chocolate for 15 days. A nonsignificant decrease in FMD from baseline was observed in the low-flavonoid group (p=0.17), whereas a near-significant increase was observed in the high-flavonoid group (p=0.05). Willner and colleagues investigated the relationship between depressed mood and chocolate craving in an experimental study (278). One possible explanation for the results of Kris-Etherton et al. Mehrinfar R. Frishman WH. Wober C. Holzhammer J. Zeitlhofer J. Wessely P. Wober-Bingol C. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. Unless otherwise specified, treatment refers to daily dose. Lipids, n-6 fatty acids in particular, are susceptible to peroxidation by reactive oxygen species (ROS) produced as a result of normal metabolic processes or pathological events. High-cocoa polyphenol-rich chocolate improves HDL cholesterol in type 2 diabetes patients. Howe PR. Boyle A. Grossman W. Glantz SA. Currently, evidence does not support a link between chocolate or any other specific food and acne, though few well-designed studies have been undertaken (47). Inclusion in an NLM database does not imply endorsement of, or agreement with, (68). It is believed that flavonoids most likely represent the active ingredients responsible for immunomodulatory effects (127). Although molecular, metabolic, and overall medical effects of chocolate may owe something more to the whole than to any given part, food science would, nonetheless, benefit from further study of specific parts, or compounds, both in isolation and in various combination. Because of their high flavonoid content, the cocoa solids present in chocolate are typically hypothesized to affect measures of cardiovascular health, whereas other components of chocolate products (e.g., cocoa butter) are thought to have little or no effect. van der Veer E. Schweitzer DH. Phytonutrients can also be referred to as phytochemicals. The recommendations, of course, must consider the potential for weight gain and increased cardiovascular risk by consuming chocolate products containing high amounts of sugar, possibly countering some of the documented benefits of cocoa. Individuals who reported consuming (any type of) chocolate two or more times per week were 32% less likely to have prevalent coronary artery calcification compared with those who never ate chocolate. Muniyappa R. Hall G. Kolodziej TL. Spadafranca A. Martinez Conesa C. Sirini S. Testolin G. Effect of dark chocolate on plasma epicatechin levels, DNA resistance to oxidative stress and total antioxidant activity in healthy subjects. In comparison, the cocoa beverage/solid chocolate combination used in the Farouque et al. Delva P. Magnesium and coronary heart disease. Barriga P. Escarcega S. Jimenez M. Salazar Lowe D. Grivetti LE. El Bedoui J. Chataigneau M. Schini-Kerth VB. Grassi and colleagues reported that ingestion of 100g of flavonoid-rich dark chocolate for 15 days was associated with not only reduced BP and improved endothelial function, but also improved insulin sensitivity in hypertensive patients (84). Arlorio M. Bottini C. Travaglia F. Locatelli M. Bordiga M. Coisson JD. Foods and beverages made from beans from the Theobroma cacao tree (cocoa, cacao) have been consumed by humans since at least as early as 460 AD ( 224 ). Phytochemicals: Dietary Sources, Innovative Extraction, and Health Wolk A. Mittleman MA. Wang-Polagruto and colleagues studied the effects of consuming a high flavanol (446mg total flavanols) cocoa beverage relative to a low flavanol (43mg) cocoa beverage daily for 6 weeks in hypercholesterolemic postmenopausal women (269). However, some studies suggest that consumption of chocolate low in flavonoids may also be beneficial. Kirkpatrick NJ. Bielinski D. Martin A. McEwen JJ. Heiss C. Jahn S. Taylor M. Real WM. Belscak-Cvitanovic A. Benkovic M. Komes D. Bauman I. Horzic D. Dujmic F. Matijasec M. Physical properties and bioactive constituents of powdered mixtures and drinks prepared with cocoa and various sweeteners. Gershwin ME. Villablanca AC. What is not known is how best to make use of chocolate for purposes of health promotion per se. Baba et al. Different effects of palmitic and stearic acid-enriched diets on serum lipids and lipoproteins and plasma cholesteryl ester transfer protein activity in healthy young women. Miller KB. Mihardja S. Keen CL. A cultural history of the medicinal and ritual use of chocolate. Seizer P. Gawaz M. Platelets: inflammatory firebugs of vascular walls. Fisher ND. In contrast, in insulin-resistant individuals, insulin-mediated vasodilation is impaired and glucose disposal is inhibited. The three treatments tested were cocoa beverages containing 46mg (control), 520mg, and 994mg of total flavanols. Heiman ML. Obarzanek E. Swain JF. Decreased levels of plasma-oxidized LDL have been observed in subjects after long-term daily consumption of cocoa powder (14, 15) and dark chocolate (267). There is growing evidence that polyphenols may play a role in regulating apoptosis (203). Pueyo M. Darblade B. Rami J. Endothelium-derived nitric oxide and vascular physiology and pathology. Rocha M. Sola E. Banuls C. Garcia-Malpartida K. Hernandez-Mijares A. Oxidative stress, endothelial dysfunction and atherosclerosis. Schroeter H. Yeghiazarians Y. Desch S. Kobler D. Schmidt J. Sonnabend M. Adams V. Sareban M. Eitel I. Bluher M. Schuler G. Thiele H. Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. (PDF) PHYTOCHEMICALS: BENEFITS, CONCERNS AND CHALLENGES - ResearchGate Fisher ND. Further, improvements are often small when they are observed (165, 256). Chocolate Chocolate or cocoa is a food made from roasted and ground cacao seed kernels that is available as a liquid, solid, or paste, either on its own or as a flavoring agent in other foods. The interactions of flavonoids within neuronal signalling pathways. Harvey I. found a similar doseresponse effect in plasma epicatechin associated with doseresponse increases in plasma antioxidant capacity and decreases in plasma lipid oxidation products (268). Among the unknowns is which of the many polyphenolic compounds in chocolate exert specific effects, and this area invites further investigation. Katz DL. Massolt ET. Both flavanol-containing cocoas improved FMD compared to placebo (2.4 and 1.5% for sugar-free and sugared cocoa, respectively, compared with 0.8%; p<0.01). Schmitz HH. Weisburger JH. Reprinted with permission from Faridi et al. Theobromine. Further, acute improvement in FMD after a single dose of cocoa was found to be dose-dependent (17). Njike VY. Schmitz HH. 1. Kundu JK. Phytochemicals are found in fruits, vegetables, grains, seeds, nuts, and legumes; and they are what give plants their color. There were no significant differences in any of the cognitive test measures between the intervention and placebo groups. Chevaux K. Jackson L. Preston M. Martinez G. Schmitz HH. However, other biomarkers of inflammation, including IL-6 and high sensitivity-CRP, were unaffected (172). Schmitz HH. Green tea and tea polyphenols in cancer prevention. Kim SC. Consistent with the findings of Heiss et al. Deprez S. Mila I. Huneau JF. Miettinen TA. Heptinstall S. May J. An early ecological study investigated coronary mortality in relation to consumption of coffee, tea, cocoa, alcohol, and tobacco in 20 countries, but found no significant associations (28). Comparison of flavan-3-ol content with nonfat cocoa solids, total polyphenols, and percent cacao. Dietary phenolic compounds: inhibition of Na+-dependent D-glucose uptake in rat intestinal brush border membrane vesicles. Lee KW. They contend that a psychoactive component of cocoa is not likely to be the cause of chocolate cravings because milk chocolate, which contains a lower proportion of cocoa solids than dark chocolate or cocoa powder, is typically preferred. (202) demonstrated that a diet consisting of 10% cocoa can enhance antioxidant defenses in the thymus and influences differentiation of thymocytes. These results are preliminary; clinical trials are necessary to confirm cocoa's neuroprotective effects in humans. di Giuseppe R. Di Castelnuovo A. Centritto F. Zito F. De Curtis A. Costanzo S. Vohnout B. Sieri S. Krogh V. Donati MB. are surprising (135). Pearson TA. Phytochemical consumption is associated with a decrease in risk of several types of chronic diseases due to in part to their antioxidant and free radical scavenging effects.1 Recent research has also highlighted their potential role in improved endothelial function and increased vascular blood flow.2 Davison K. Coates AM. Al-Delaimy WK. The L-arginine-nitric oxide pathway. The Colorful Defenders: Plant Based Whole-foods and Phytochemicals Unabated inflammation will further increase the concentration of macrophages and lymphocytes that promote the formation of fibrous tissue in the lesion through the release of hydrolytic enzymes, cytokines, chemokines, and growth factors. Suwaidi JA. Phenylethylamine - it is a 'love drug' and it gives pleasurable effects by releasing b-endorphin. The highest quartile reported a mean chocolate intake of 7.5g/day. Schmitz HH. The study population included 470 Dutch men free of cardiovascular disease and diabetes from the Zutphen Elderly Study cohort. Given this reasonable assumption, the results of a study by Kris-Etherton et al. Luscher TF. The adverse effect of chocolate on lower esophageal sphincter pressure. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. Son JE. Chocolate cravings in American and Spanish individuals: biological and cultural influences. Corti et al. Antimutagenesis and anticarcinogenesis, from the past to the future. In this randomized, double-blind, placebo-controlled study, the active treatment was a chocolate bar and cocoa beverage, containing a total of 444mg of flavanols. VEGF, vascular endothelial growth factor.
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