Chocolate has a long and illustrious
reputation. Made from cocoa, which is derived from the beans of the cacao tree
(whose scientific name translates to “food of the gods”), it was used by some
of the earliest Mesoamerican cultures as food, medicine, ritual offering, and
perhaps even currency. It’s no less valuable in modern time as; the global
chocolate market grew by nearly 20 percent from 2016 to 2021, with an
approximate revenue of $980 billion in 2021, according to the market research
firm Statista.
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Taste surely plays a role in chocolate’s popularity,
but you may have also heard that this delectable treat is good for your health.
How does this perception stack up against the science?
“Cocoa is clearly good for you,” said Dr Dariush
Mozaffarian, a cardiologist and professor of nutrition at the Tufts Friedman
School of Nutrition Science and Policy. “Whether chocolate is good for you or
not depends on how much cocoa is actually in it, and what else is in it.”
Cocoa beans are packed with fiber and “loads of
phytonutrients,” Mozaffarian said, referring to the natural chemicals found in
plants. Cocoa is thought to contain about 380 different chemicals, among them a
large class of compounds called flavanols that have attracted significant
research interest for their potential health benefits. But it’s less clear how
many flavanols and other phytonutrients you need to improve health, or whether
your chocolate bar of choice contains enough of them to do so. And experts have
differing opinions on this point.
Milk chocolate typically contains about 20 percent
cocoa, Mozaffarian said, though the cocoa content can vary. (The American Food
and Drug Administration requires milk chocolate to contain at least 10 percent
cocoa, but some milk chocolate bars contain as much as 50 percent or more.)
Dark chocolate usually contains more cocoa than milk chocolate, but it can also
vary greatly, so check labels carefully, he said. For possible health benefits,
he recommended choosing dark chocolate that is at least 70 percent cocoa.
Many small, short-term human trials, have found that
dark chocolate or standardized cocoa supplements or drinks can modestly lower
blood pressure and improve blood cholesterol and the health of blood vessels in
adults. And some longer term observational studies have found that those who
eat more cocoa might have a lower risk of certain cardiovascular diseases,
Mozaffarian said.
In a systematic review published in February in the
journal JAMA Network Open, Mozaffarian and his colleagues examined how certain
foods and nutrients were associated with heart health conditions. They found
“probable or convincing evidence” that eating chocolate was linked with a
reduced risk of cardiovascular disease, estimating that an average daily intake
of just 10 grams, or about one-third of an ounce of chocolate, was associated
with a 6 percent reduction in the overall risk of cardiovascular disease.
But these types of estimates are based on
observational studies, which have important limitations, said Dr JoAnn Manson,
chief of preventive medicine at Brigham and Women’s Hospital in Boston. These
studies can only identify correlations between eating chocolate and health;
they cannot prove that chocolate causes benefits — people who eat more
chocolate may be different in other ways that affect their health, Manson said.
Observational study findings have also been
inconsistent. Some have found no benefit, and others have found that those who
eat chocolate habitually or more frequently are more likely to gain weight, she
pointed out. Such studies also do not often account for the different types of
chocolate, which can vary in their cocoa content. And the sugar, fat, and
calorie count might negate any health benefits from the cocoa.
To address some of these shortcomings, Manson and
her colleagues conducted a large, randomized trial of more than 21,000 older
adults in the US. Half of the participants were given a cocoa extract
supplement containing 500 milligrams of cocoa flavanols, and the other half
were given a placebo. Results of the study, called the COSMOS trial, were
published in June in The American Journal of Clinical Nutrition.
After following the participants for 3.6 years, the
researchers found that while — when compared with the placebo group — the cocoa
supplement group was not statistically less likely to have cardiovascular
events including heart attacks and strokes, they did have a 27 percent
reduction in cardiovascular deaths. Manson called these results “promising
signals for heart protection,” though she emphasized that another trial is
needed to confirm the findings before translating them into recommendations for
cocoa flavanol intake.
Importantly, the COSMOS trial did not give
participants chocolate, but rather concentrated capsules of cocoa extract
produced by chocolate-maker Mars, which also partially funded the study. To get
the same amount of bioactive cocoa flavanols from chocolate, a person would
have to eat close to 4,000 calories of milk chocolate or 600 calories of dark
chocolate per day, Manson said, noting that a large proportion of flavanols can
be destroyed during chocolate processing.
Chocolate is “a wonderful treat, but to perceive it
as a health food, I think it has its limitations,” Manson said.
Much of the research, including her own, on the
potential health benefits of chocolate and cocoa has been funded by chocolate
companies such as Mars, Manson said. “These trials are expensive,” and
government funding for nutrition studies in general is limited, she added.
Research suggests that the results from food industry-sponsored studies,
including those on chocolate, are more likely to be favorable to the companies
funding them, though Manson said that Mars was not involved with the design or
analysis of the COSMOS trial.
For his part, Mozaffarian is persuaded by the
existing research that dark chocolate containing 70 percent or more cocoa is
likely beneficial for heart health, even if it contains less flavanols than
tested in the COSMOS trial. “Eating a small amount of dark chocolate every day
is probably really good for us, and it will make you happy, because it tastes
good,” he said.
Mozaffarian said he does not receive any funding
from the chocolate industry, but he did admit one conflict of interest when it
comes to this particular food. “My conflict is that I do love dark chocolate,”
he said.
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