The Health Benefits of Chocolate

The chocolate and antioxidants story begins with oxygen. We all know that oxygen is essential for life. Every cell in the body requires oxygen to get energy from nutrients. Without it, our bodies would simply shut down.

Ironically, though, the very same oxygen molecules that keep us alive are easily turned into rogue particles that can leave a path of destruction throughout the body. The damage they cause sets the stage for a variety of diseases and, scientists suspect, prompts many of the changes we associate with aging.

How can something so vital become so harmful? When an oxygen molecule is in its normal, beneficial form, the electrons in its chemical structure are paired off. If that oxygen molecule loses one of its electrons, however, it becomes unstable -- and destructive. This unstable molecule is called a free radical.

A free radical wants nothing more than to replace its missing electron, and it will steal one from wherever it can. If it robs a nearby oxygen molecule, that molecule becomes an unstable free radical. That destabilized molecule may, in turn, grab an electron from another molecule, causing a free-radical chain reaction.

Alternately, an oxygen free radical may attack a nearby healthy cell, punching a hole in the cell's membrane to steal an electron and causing damage that may remain, even if the assaulted cell is able to replace its missing electron. The process in which oxygen free radicals assault stable molecules or healthy cells is called oxidation.

Free radicals can damage any tissue or organ, as well as any fat, protein, or carbohydrate molecule, in the body. The "victims" may include DNA, the genetic material that regulates cell growth; the fat molecules in every cell's protective membrane; the low-density lipoprotein (LDL) molecules that carry cholesterol in the bloodstream; and the proteins that help form the structure of the heart, blood vessels, muscles, skin, and other tissue.

Down the road, these kinds of insults may accumulate and lead to inflammation, abnormal or uncontrolled cell growth, hardening of the arteries, and other disease-inducing changes. Among the diseases thought to be associated with free-radical damage are coronary heart disease, cancer, emphysema and other lung ailments, Parkinson's disease, rheumatoid arthritis and certain other immune-system disorders, cataracts and macular degeneration, and Alzheimer's disease and certain other dementias.

How does an oxygen molecule lose an electron in the first place? Sometimes, the loss occurs during the body's normal use of oxygen for metabolic processes. In other words, some free radicals are simply natural byproducts of living. But far more often, exposure to environmental toxins such as air pollution, cigarette smoke, and the sun's ultraviolet (UV) rays results in the creation of free radicals.

Fortunately, our bodies have a natural defense mechanism against free-radical damage. The key element of that mechanism is a class of molecular compounds called antioxidants. Antioxidants neutralize free radicals, either by shielding healthy cells or by halting free-radical chain reactions. We have a number of antioxidant defenders at our disposal, each with its own protective functions.

Some come in the form of vitamins and minerals. Vitamin C, vitamin E, and beta-carotene (a form of vitamin A) are antioxidants, as are the minerals selenium, manganese, and zinc. In addition, special chemicals from plants, called phytochemicals, can act as antioxidants in our bodies. We arm ourselves with these natural protective chemicals by eating a diet rich in plant foods, including vegetables, fruits, whole grains, legumes, and nuts.

Unfortunately, this antioxidant defense mechanism is not foolproof. It typically has little difficulty keeping up with the free radicals created by normal bodily functions, but it can be overwhelmed when we expose ourselves to too many environmental toxins and/or don't replenish our antioxidant stores by regularly consuming enough minimally processed plant foods (processing, as well as overcooking, tends to strip plant foods of some of their natural antioxidants).

The resulting oxidative stress is thought to set the stage for the various diseases associated with free-radical damage. The good news is we can reduce our exposure to many environmental causes of free radicals. Plus, we can bolster our defenses against free-radical damage by boosting our dietary intake of antioxidants. That's where cocoa and chocolate can help.

Move on to the next section to learn about flavonoids, cacao's antioxidant fighters.

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Researchers have discovered that cacao is rich in antioxidant phytochemicals, especially a type called polyphenols. Polyphenols are found not only in chocolate products but in fruits and fruit juices, vegetables, tea, coffee, red wine, and some grains and legumes. And the available research seems to strongly point to some role for polyphenols in preventing a variety of diseases.

The largest and most important class of polyphenols are the flavonoids. More than 5,000 flavonoids have been identified so far, and they have begun to attract a lot of attention for their potential health benefits. Among the flavonoid-rich foods that have shown promise lately are strawberries and blueberries, garlic, red wine, and tea.

But these plant foods can't hold a candle to cacao-rich dark chocolate and cocoa products when it comes to flavonoid content and antioxidant power. Cocoa, for example, has almost twice the antioxidants found in red wine and close to three times the antioxidants in green tea, when compared in equal amounts.

One of the flavonoids in cacao (known as cocoa flavonoids, or cocoa polyphenols) gaining a particular reputation for healing is epicatechin. One Harvard Medical School scientist is so impressed by epicatechin's effects that he has said it should be considered essential for human health and, therefore, raised to the status of a vitamin. He's also stated that the health benefits of epicatechin are so striking that it may rival penicillin and anesthesia in terms of importance to public health.

The researcher developed his views on epicatechin after spending years studying the health benefits of heavy cocoa drinking on an isolated tribe of people called the Kuna, who live on islands off the coast of Panama. The Kuna drink up to 40 cups of natural (unsweetened) cocoa per person every week. The Harvard scientist, working with an international team of colleagues, found that the island Kuna have remarkably low rates (less than 10 percent) of four of the five most common killer diseases in the industrialized world: heart disease, stroke, cancer, and diabetes.

The research further indicates that the Kuna's high intake of epicatechin from their cocoa is a primary cause of the low disease rates. Indeed, when tribe members leave their isolated islands to settle on mainland Panama -- where they drink far less of the natural cocoa -- their disease rates rise.

In addition to demonstrating the healing potential of cocoa, the Kuna research highlights an important point about that potential. The Kuna not only drink large quantities of cocoa, the cocoa they drink has a very high flavonoid content -- far higher than the flavonoid content of many of the sweetened, high-calorie, high-fat cocoa and chocolate products found on grocery-store shelves. And that's essential to its apparent health benefits.

The Kuna grow their own cacao beans, gently roast and minimally process them, and use them to make an unadulterated cocoa that has a very high percentage of cocoa solids. And it's the cocoa solids that contain the flavonoids.

Flavonoids, however, also give natural chocolate a very bitter taste. So in an effort to please their sweet-toothed consumers, chocolate manufacturers have traditionally tried to tame that natural bitterness by removing flavonoids and/or masking their taste. Nearly every step of the typical processes that turn cacao beans into chocolate and cocoa -- including fermenting, roasting, and Dutching -- removes some of the flavonoids. Likewise, adding ingredients such as sugar and milk to chocolate or cocoa -- again, to mask or replace bitterness -- leaves less room for cocoa solids and therefore results in a lower-flavonoid product.

While the rest of us cannot control the way our cacao beans are grown and processed, as the Kuna do, we can increase our chances of getting and benefiting from cocoa flavonoids by opting for cocoa and chocolates with the most cocoa solids and the least sugar and milk added.

A variety of studies illustrate and support the specific disease-fighting effects of chocolate and cocoa. Learn about the role that chocolate plays in preventing heart disease in the next section.

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In the past several years, scientists have produced some compelling research exploring the connection between chocolate and heart disease prevention. Research has suggested that cocoa flavonoids can help lower blood pressure, improve blood-vessel function, make blood less likely to form dangerous clots, and prevent the creation of artery-clogging blood-cholesterol molecules. All of these effects help ensure smooth, adequate, and uninterrupted blood flow to the heart and brain, lowering the risk of heart attack and stroke.

Blood Pressure. In a study published in August 2003 in the Journal of the American Medical Association, eating dark chocolate helped individuals lower mild high blood pressure, while eating white chocolate did not. The study included 13 men and women, ages 55 to 64, who had untreated mild high blood pressure. Each participant ate 90 grams of either dark chocolate or white chocolate each day for two weeks.

Before the two-week experiment ended, those who ate the dark chocolate had significantly lower blood pressure, while the folks who ate white chocolate showed no such improvement. (Dark chocolate contains chocolate liquor, made of cocoa solids and cocoa butter. White chocolate does not contain chocolate liquor and therefore provides no flavonoid-containing cocoa solids.)

In a similar study in Italy, published in 2005 in the journal Hypertension, researchers studied ten men and ten women who had high blood pressure. They were randomly assigned to eat either 100 grams of flavonoid-rich dark chocolate or 90 grams of flavonoid-free white chocolate each day for 15 days without increasing their total calorie intake (they were instructed to lower their calorie intake from other foods to compensate).

Then, after a one-week break, they switched, with the subjects who previously ate dark chocolate daily now eating white chocolate, and vice versa, for another 15 days. The results: When the subjects ate dark chocolate, their systolic blood pressure (the upper number) dropped an average of 12 points and their diastolic pressure (the bottom number) dipped an average of 8. Eating white chocolate provided no such benefits.

And a 2007 review of ten different studies of chocolate's effects on blood pressure indicated that flavonoid-rich cocoa and chocolate can indeed have a place in a blood-pressure-lowering diet as long as the total calorie count of the diet stays the same. On average, chocolate products lowered systolic pressure by 4 to 5 points and diastolic by 2 to 3 -- enough to lower heart-disease risk by 10 percent and stroke risk by 20 percent. The scientists did note, however, that because the studies were short term, it's unclear if the same effects would occur with consumption of small amounts of chocolate over the long term.

Blood-Vessel Function. In studies that were published in the Journal of the American College of Cardiology in 2005 and in Proceedings of the National Academy of Sciences in 2006, researchers demonstrated that the flavonoids (specifically, epicatechin) in flavonoid-rich cocoa beverages trigger the production of a natural substance called nitric oxide. Nitric oxide, in turn, causes blood vessels to dilate (relax), allowing for smoother blood flow.

Flavonoid-rich cocoa may even benefit the compromised blood-vessel function of smokers, to the point of potentially reversing some of the vessel damage caused by smoking, according to a study published in the Journal of Cardiovascular Pharmacology in March 2007. In smokers, the activity of endothelial cells (cells lining artery walls) is reduced; this reduction in activity is an early signal of blood-vessel diseases such as hardening of the arteries (atherosclerosis).

In the two-part smoker study, 11 healthy male smokers first drank a series of specially made flavonoid-rich cocoa beverages (provided by Mars candy company) containing 28 milligrams to 918 milligrams of flavonols, a subgroup of flavonoids. Two hours after they drank the beverage with 179 milligrams of flavonols, their blood-vessel function showed a 50 percent improvement. As they drank the cocoas with greater amounts of flavonols, the benefits increased. After they drank the cocoa with 918 milligrams, their cigarette-induced blood-vessel damage appeared to have been reversed to the extent that their blood vessels functioned as well as those of someone with no risk factors for cardiovascular disease.

The first stage of the trial was followed by seven days of drinking three daily doses of the special cocoa (for a total of 918 milligrams of flavonols each day) to determine if the benefits continued. The subjects' blood flow improved each day, and after taking a 306 milligram dose on day seven, their cigarette-induced damage had nearly been reversed once again.

The study paper indicated that the level of improvement in blood-vessel function after seven days of consuming the flavonol-rich cocoa was similar to the improvements produced by long-term treatment with statin drugs. (The researchers also noted that these improvements caused by cocoa flavonoids did not appear to be the result of their antioxidant effects.) One week after the end of the study, however, the subjects' blood-vessel function had returned to prestudy levels, indicating that cocoa drinking would have to continue to sustain these benefits. The authors also noted that larger studies need to be done to confirm these very exciting findings.

In another study released in March 2007, scientists found that consuming eight ounces of special flavonoid-rich cocoa every day for six weeks significantly improved the blood-vessel health of people who were mildly obese. In the study, 45 mildly obese adults consumed either a flavonoid-rich, dark-chocolate cocoa mix sweetened with sugar; an artificially sweetened version of the same cocoa mix; or a placebo (control) mix made of sweetened whey powder. The artificially sweetened cocoa mix was associated with a 39 percent improvement in blood flow, and the sugared cocoa was linked with a 23 percent improvement. The placebo mix, however, lowered blood flow by 12 percent.

Blood Clotting. When the inner walls of arteries are narrowed by deposits of cholesterol and other debris, a blood clot can easily shut down the blood supply to the organ fed by the artery -- leading to a heart attack, stroke, or other serious tissue damage. For that reason, many heart patients are prescribed a daily 81 milligram aspirin tablet, which thins their blood and helps prevent clots.

In a 2002 study, scientists were astonished to find that drinking a flavonoid-rich cocoa drink could be just as effective as the aspirin at preventing clots. The research found similar reactions to both treatments in a group of 20- to 40-year-olds: Both the cocoa drink and the aspirin kept blood platelets from sticking together and forming clots. The researchers stopped short of suggesting that heart patients who have been prescribed a daily aspirin should drink cocoa instead. (And you should NOT stop taking any medication that has been prescribed for you without first consulting your doctor.) But for people at risk who can't take aspirin every day, it's possible that eating more flavonoid-rich foods could provide similar benefits.

Blood Cholesterol. Consuming saturated fat in food can increase total blood-cholesterol levels and, especially, levels of LDL cholesterol, the so-called "bad" form of blood cholesterol. Having too much LDL cholesterol is a risk factor for cardiovascular diseases, including heart attack and stroke, because LDL molecules tend to deposit excess cholesterol on the inner lining of artery walls, narrowing the arteries and setting the stage for a clot to cut off blood flow to the heart or brain.

Scientists have discovered, however, that not all LDL molecules are equally damaging. It appears that LDL molecules that have been oxidized are the true culprits in clogging arteries. And that's where cocoa flavonoids may help. First, research suggests cocoa flavonoids may lower LDL levels. For example, in the 2005 study of Italians with high blood pressure, cited previously, the subjects who consumed flavonoid-rich dark chocolate experienced a 10 percent decrease in their LDL levels, in addition to a drop in blood pressure. Second, two 2001 studies showed that cocoa flavonoids can actually protect LDL molecules from oxidation.

In another bit of good news, scientists have determined that even the fat in cacao isn't so bad. Although cocoa butter is technically a saturated fat, it does not appear to increase LDL levels in the blood the way other saturated fats do. Half the saturated fat in cocoa butter is stearic acid, which studies indicate has a neutral effect on blood cholesterol. Chocolate also contains some oleic acid -- the same type of monounsaturated fat found in olive oil, which can actually help lower LDL levels and boost levels of high-density lipoproteins (HDLs) -- the "good" form of cholesterol that helps remove excess cholesterol from the blood.

Chocolate also plays a role in preventing other diseases. Keep reading to find out more.

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New research has discovered that the health benefits of chocolate extends to other diseases.

Cancer

Study after study has demonstrated that a high intake of fruits and vegetables is associated with a reduced risk of several common cancers, such as those of the lung, colon, prostate, and breast. Scientists suspect that the reduction in risk comes, at least in part, from the antioxidants in those plant foods. Further, several laboratory, animal, and human studies point specifically to flavonoids as providing protection against cancer-promoting free-radical damage. And of the plant-based beverages known to be rich in flavonoids, Cornell University food scientists were amazed to find that cocoa contains the highest levels by far.

There is even some early evidence suggesting cocoa flavonoids may help fight skin cancer. In 2006, German researchers reported on their study of 24 women who added cocoa to their breakfast every day for about three months. Half the women consumed a flavonoid-heavy hot cocoa, and the others drank a cocoa that had few flavonoids. At the end of the trial, the researchers applied UV light -- like that given off by the sun and found to cause skin cancer -- to each subject's skin. The skin of the women who drank the high-flavonoid cocoa did not redden as much as the skin of the women who drank the flavonoid-poor cocoa, suggesting the flavonoids prompted some type of innate skin protection.

Diabetes

An emerging area of interest is the potential benefits of cocoa flavonoids for people with the most common form of diabetes, type 2. People with type 2 diabetes have become resistant to the effects of insulin, a hormone released by the body that escorts sugar into cells for use as fuel. As a result, damaging levels of sugar build up in the blood. Insulin sensitivity relies, in part, on nitric oxide.

And some early evidence suggests that cocoa flavonoids may help decrease insulin resistance and improve blood-sugar control by increasing the availability of nitric oxide. (The positive effects of cocoa flavonoids on blood vessels and circulation would also benefit people with diabetes, whose nerves and blood vessels become damaged by years of exposure to high blood-sugar levels.)

According to the study of Italian men and women in which dark chocolate produced a decrease in both blood pressure and LDL cholesterol, eating 100 grams of dark chocolate every day for 15 days appeared to improve insulin sensitivity and lower blood-sugar levels, as well. Consuming flavonol-free white chocolate did not.

It should be remembered, however, that the study subjects lowered their intake of calories from other foods to compensate for the added chocolate in their diet. That's an essential point to reiterate when discussing the potential benefit of chocolate or cocoa in people with diabetes. Excess weight greatly increases the risk of type 2 diabetes, and any blood-sugar benefit that might be attained by consuming cocoa or chocolate would be easily negated by the excess weight gain that would likely occur if the chocolate calories were simply added to the diet.

Memory and Cognition

Cocoa flavonoids may act in more than one way to benefit mental performance, particularly in people with certain types of dementia. For example, free-radical damage and inflammation in the brain have both been cited as potential contributors to the memory problems and cognitive decline that can occur with age and that are characteristic of dementias. We've already explored the amazingly powerful antioxidant effects of cocoa flavonoids. But these flavonoids also appear to suppress leukotrienes (substances that trigger inflammation in the body) and increase forms of anti-inflammatory nitric oxide.

In addition, the improvement in the health and function of blood vessels and the increased circulation that appear to result from consuming cocoa flavonoids may prove beneficial for those suffering dementia or other problems related to poor blood flow to the brain. In British research that was reported at the February 2007 annual meeting of the American Association for the Advancement of Science, drinking a flavonoid-rich cocoa beverage increased blood flow to key areas of the brain for two to three hours following ingestion. This increase in blood flow to the brain, scientists speculate, may be the result of greater amounts of nitric oxide in the circulation prompted by the cocoa flavonoids.

Some scientists are now considering the prospect of using cocoa flavonoids to help people with dementia and those who have had a stroke, as well as to enhance brain function in people suffering from fatigue, sleep deprivation, or poor circulation to the brain due to the aging of blood vessels.

Chocolate can be an important addition to your diet. Move on to the final section to learn about enjoying chocolate wisely.

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Enjoying chocolate wisely can mean adding numerous health benefits to your diet. With such promising evidence of chocolate's healing potential, why isn't it considered a health food?

Despite the persistence of the myth, it's not because chocolate causes acne. It doesn't. (Although because we tend to reach for comfort foods when we're under stress, and stress can aggravate acne, it's an easy myth to believe.)

And it's not because chocolate is especially dangerous to teeth. Like any other carbohydrate, chocolate can indeed serve as food for oral bacteria, which excrete the acids that eat away at tooth enamel. But because it has a smooth texture and literally melts in your mouth, chocolate is actually a little less likely to cause cavities than are, say, bread and other baked goods or candies such as licorice and caramel that tend to actually get stuck on or between teeth. As long as you practice good oral hygiene and brush, or at least rinse, after eating chocolate, it's not a major danger to your pearly whites.

No, the reason health experts aren't pushing chocolate as a health food is the high calorie counts of commonly consumed chocolate products. There's no two ways about it: Chocolate is a relatively calorie-dense food to begin with, and the super-sweet, creamy, milky, high-fat versions so many Americans favor simply compound the problem. Such concentrated sources of calories could hardly be considered required eating in a nation battling overweight and obesity.

What's more, because so many folks find it so taste-tempting, there's a real concern that they'll find it difficult to moderate their consumption. The potential result is even more unwanted pounds. And those unwanted pounds would easily outweigh the health benefits. Overweight and obesity increase the risk of heart disease, stroke, diabetes, and some forms of cancer.

So, must you send chocolate, despite its healing powers, back to the forbidden-fruit category? No. As a matter of fact, making favorite foods totally off-limits can provoke feelings of deprivation that can trigger binging and other unhealthy eating habits, which can lead to the very weight gain you are trying to avoid.

The better approach is to choose chocolate products that provide the most flavor and healing benefits for the fewest calories and then make room in your diet to accommodate them. It will take some effort -- you'll need to check and compare labels to find the best calorie bargains -- and self-discipline -- you can't eat as much as you want without risking your health -- but you'll be able to have your chocolate and keep your weight in check, too.

According to the government's Agricultural Research Service, when it comes to the common chocolate products that pack the most flavonoids and the greatest antioxidant punch, natural (rather than Dutched), unsweetened cocoa powders top the list. They also tend to be the lowest in calories and so can be the most weight-wise way to quench your chocolate desires.

The process of Dutching, or alkalinizing, cocoa powder removes some of the natural flavonoids, so if you can find it, choose an un-Dutched dark-chocolate cocoa powder (not a milk-chocolate cocoa mix), and prepare it with water. Sugar-sweetened powders retain fewer flavonoids -- the sugar leaves less room for flavonoid-containing cocoa solids -- and, of course, are higher in calories, so try an unsweetened powder (if you can't handle it unsweetened, you'll at least be able to add only as much sugar as is absolutely necessary) or, if you can find one, an artificially sweetened one.

When it comes to solid chocolates, opt for dark chocolates. Milk chocolates typically have no more than half the amount of cocoa solids that dark chocolates contain -- and therefore they have far fewer healing flavonoids and much less antioxidant power. With the added milk and sugar, milk chocolate bars simply have far less room for cocoa solids and are often considerably higher in empty calories (calories that provide no nutritional benefit other than energy).

A typical milk chocolate bar contains 30 percent cacao, 20 percent milk solids, 1 percent vanilla and emulsifier, and 49 percent sugar. Some research even suggests that milk may interfere with the absorption of the antioxidants in cacao. And don't even bother with white chocolate if you're looking for any health benefits. It contains only cocoa butter, not cocoa solids (so no healing flavonoids), and loads of sugar.

These days, it seems, there's been an explosion in varieties and brands of dark chocolates. So how do you choose? Again, you want the products that are highest in cocoa solids. A helpful clue to cocoa-solid content is the "% Cacao" that is being listed on more and more chocolates. It's not a guarantee of a hefty dose of cocoa solids, however. That's because the "% Cacao" refers not only to the cocoa solids but to the total percentage of ingredients that come from cacao beans, including cocoa powder and cocoa butter.

But only the solids (including those within the cocoa powder) contain flavonoids. So even though two chocolate bars list "70% Cacao," for example, one can have fewer cocoa solids -- and so fewer flavonoids -- and more cocoa butter than the other. (The flavonoid content of a chocolate product may also be affected by such variables as the types of cacao beans used to create it, the soil and weather conditions those beans were grown in, the recipe and processing used, and the storage and handling of the finished product.) Still, in the absence of a label listing only the percentage of cocoa solids, it can be a helpful guide.

You'll also find useful information in the ingredients list and the Nutrition Facts panel. When comparing chocolates that have the same "% Cacao," look not only at the calorie counts but at which ingredients, other than those from cacao, have been added. Opt for the lowest-calorie product with the fewest noncacao ingredients.

How much chocolate and/or cocoa is it okay to consume? Moderation is absolutely key. If natural cocoa, especially an unsweetened variety, satisfies your taste for chocolate, that's definitely the way to go. You can probably enjoy a few cups a day. Because of its calorie content, however, you shouldn't look to add solid chocolate regularly to your diet unless you really enjoy it. If you do, you'll need to make room for it in your diet and then enjoy only as much as you've made room for.

That means that if you'd like to enjoy a square or two (but not much more) of cacao-rich dark chocolate every day, you'll need to cut back -- by an equivalent number of calories or more -- on other sugary or fatty foods you eat that day. (If you're also trying to lose weight, you'll need to cut back even further on other sources of empty calories and, preferably, increase your physical activity level, too.)

Do not replace nutrient-rich foods, such as vegetables, fruit, and whole grains, with chocolate. That would truly be shooting yourself in the foot. Instead, cut back on foods such as sugary, high-fat baked goods; ice cream; fatty dressings and sauces; salty, greasy fast foods and snack foods; sweetened sodas; and other types of candy.

Once you've made room in your daily diet, make time to truly enjoy your chocolate. Take a few moments, sit down, and slowly savor the deep, rich flavor and melt-in-your-mouth texture of a high-quality dark-chocolate square. And remind yourself that there's no need to feel guilty about satisfying your chocolate desires in a responsible, healthy way.

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Written by Carol Turkington