Is Chocolate a Functional Approach to Reverse Cardiometabolic Disease?
Chocolate is most of the time cut off the diet of people dealing with overweight. Indeed, high caloric foods are often a contributing factor in increased adiposity, which influences cardiometabolic disease development. However, chocolate is now being considered an antioxidant and anti-inflammatory agent. Therefore, chocolate could and should be regarded as a functional food to reverse cardiometabolic disease.
Chocolate and its impact on health and disease.
Chocolate is a product made from cacao, and its widely used around the world as a delicious snack. Indeed, it could be considered an indulgent dessert and a potent antioxidant agent due to its flavanols richness. The use of chocolate, specifically dark chocolate, has been associated with good health benefits. Conversely, chocolate supplementation has played an essential role in lowering blood pressure by improving endothelial dysfunction. It has also been postulated that chocolate can modulate fatty acid synthesis, enhance thermogenesis, and serve as an inhibitor of insulin receptor kinase activity.
Hypertension and Chocolate
The high content of flavonoids and proanthocyanidins found in cocoa and chocolate is the key player in numerous research publications. It is postulated that flavonoids in chocolate increase endothelial nitric oxide (NO) production, favoring vasodilation along with lower blood pressure. However, it has also been proposed that there are more favorable results in systolic blood pressure (SBP) when compared to diastolic blood pressure (DBP).
It appears that chocolate consumption is more effective when it is eaten for prolonged periods of time. Indeed, a meta-analysis that included 1804 participants treated with 40 different treatments, ranging from 1.4 to 105 grams of chocolate, was performed to observe its effects on blood pressure. Consequently, this study concluded that the chocolate impact was more powerful on those patients with higher blood pressure measures at baseline. Besides, those patients with a 6-18-week treatment showed a significant improvement in SBP and DBP compared to those who only have a 2-4-week treatment.
The most surprising effects were those seen on a randomized control trial, including 60 patients previously diagnosed with diabetes. Furthermore, this study showed that a 25gr chocolate ingestion for 8 weeks reduced -6.40mmHg SDP and -5.93mmHg.
Furthermore, it is believed that chocolate’s flavonoids can up-regulate NO synthase, reflecting in increased NO availability. Besides this, the anti-inflammatory and antioxidant properties would play a vital role in downregulating pathways involved in arterial stiffness.
Cholesterol and Chocolate
Another critical factor to be considered in the development of cardiometabolic disease is lipid serum levels. However, far from the recommendation that chocolate needs to be reduced or avoided as part of a preventive low-fat diet, chocolate has been linked to improved lipid serum levels. The underlying preventive function of chocolate is associated with a reduction of LDL oxidative effects and atherogenesis.
Chocolate was put to the test on a meta-analysis that included 320 patients treated with different amounts of chocolate. This study evaluated the difference in post-intervention values of serum total cholesterol, HDL, LDL, and triglycerides. Furthermore, this intervention resulted in a -6.23 mg/dl (-11.60, – 0.85 mg/dl), -0.76 mg/dl (-3.03, 1.51 mg/dl), -5.90 mg/dl (-10.47, -1.32 mg/dl), and -5.06 mg/dl (-13.45, 3.32 mg/dl), respectively. Besides this intervention, a clinical trial used 50gr chocolate and six portions of fruits and vegetables and compared this to a low polyphenol diet, no chocolate, and two portions of fruits and vegetables. Consequently, this study analyzed cholesterol and LDL levels after the intervention and found significant improvements in both markers.
Adding to these beneficial effects, a randomized controlled trial concluded that a 30gr dark chocolate consumption on a 4- week period could significantly increase HDL-C levels.
Chocolate chemical composition.
The application of chocolate and its results on numerous cardiometabolic factors have been studied in-depth. However, the leading players are the bioactive chocolate compounds that make these beneficial effects possible. In fact, it has been reported that the stearic acid found in chocolate is key for providing these effects.
Stearic acid is considered to be a non-atherogenic type of dietary saturated fat. The stearic acid content of cocoa butter ranges from 33%. It has been confirmed in numerous meta-analyses that stearic acid does not increases or lowers HDL, LDL, or total cholesterol levels, but it can beneficially lower triglycerides.
Some theories mention that stearic acid’s potential mechanism relies on lower absorption, related to its position on the triglyceride molecule. Besides this, stearic acid has a high percent desaturation providing the ability to transform to monosaturated oleic acid, a lipid-associated with protective effects against CHD and considered a hypocholesterolemic agent.
Additional studies are needed to determine how stearic acid provides protective effects against or neutral effects of CVD.
Flavonoids and chocolate
A 100gr bar of chocolate provides 170 mg of flavonoid antioxidants, procyanidins, and flavanols. Cocoa has a higher content of flavonoids, epicatechin, catechin, and procyanidins compared to green tea and red wine. Besides, chocolate is the primary dietary source of procyanidins consumed in Western countries.
The primary protective function that chocolate flavonoids exert on CVD relies on their chemical structure. Indeed, flavonoids possess scavenger abilities due to their chemical structure, providing them with antioxidant effects. Furthermore, this ability protects by reducing LDL oxidation, reflecting a reduction of atherosclerosis.
Another functional approach related to chocolate flavonoids is their potential to intercalate with the membranes of lipoprotein particles. It has also been hypothesized that there is an association between increased flavonoid-rich food consumption and a reduction of oxidative damage on lymphocytes.
Platelet aggregation is a contributing factor in atherosclerosis and endothelial dysfunction. However, chocolate has proven to be as effective as aspirin in regards to this matter. In fact, the active compounds catechin and epicatechin can reduce platelet aggregation, elevate NO concentration and improve endothelial dysfunction.
Besides this, the ingestion of chocolate can improve levels of prostacyclins while reducing leukotriene levels. Furthermore, the working mechanism is based on procyanidin’s ability to inhibit lipoxygenase pathways, therefore downregulating leukotrienes’ synthesis.
Chocolate can be a fun way of including flavonoids and phenols in our patient’s diet. Chocolate’s potent ability to scavenge ROS provides it with preventive properties that would reflect in the health benefits. In addition, dark chocolate is easy to find elsewhere. However, the recommendation is that dark chocolate should be more than 85% cacao to be useful as an antioxidant. Also, all of the aforementioned studies conclude that the prolonged dietary ingestion of chocolate is the leading factor that provides protection. On the downside, we have to mention that chocolate ingestion is associated with gastroesophageal reflux, bloating, and sadly, allergies, so be mindful of your symptoms when integrating it into your diet. – Ana Paola Rodríguez Arciniega, MS
Garcia, Jose P., et al. “The Cardiovascular effects of chocolate.” Reviews in cardiovascular medicine 19.4 (2018): 123-127.
Jumar, Agnes, and Roland E. Schmieder. “Cocoa flavanol cardiovascular effects beyond blood pressure reduction.” The Journal of Clinical Hypertension 18.4 (2016): 352-358.
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Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
Licensed in Texas & New Mexico