Chocolate: A Health Food?

Headline grabbing stories in 2002 about chocolate's new-found health benefits stemmed from a study in the American Journal of Clinical Nutrition.1 The study was small, comprising only 23 subjects, and it was funded by the American Cocoa Research Institute. The abstract (summary) of the article, which is what most people read, stated that cocoa and chocolate, when added to a healthy diet, provided antioxidant benefits and increased the good HDL (high density lipoprotein) cholesterol. One antioxidant benefit was to impede the harmful, atherosclerosis-accelerating oxidation of LDL (low density lipoprotein cholesterol, the bad cholesterol). These were the findings that the media trumpeted.

But a closer look at the article wasn't quite as encouraging. The authors acknowledged that the beneficial effects from chocolate were small at best. "It is important to note that the clinical significance of these small differences in indexes of oxidation status remain to be clarified." Meaning that the small differences might have no significance at all. And regarding the so-called benefits of increasing HDL, these weren't significant, as the researchers noted: "the cocoa-chocolate diet had neutral effects on lipids and lipoproteins."

"I'd certainly like to believe that chocolate is good for me.
And why not? Even Andrew Weil says so."

In fact, as if anticipating that this study might be over-hyped, the journal headed the issue with an editorial to put the findings in perspective. In "How good is chocolate?" nutrition expert Paul Nestel noted that plants supply many thousands of healthful substances to the human diet. It is well known that soy, grapes, tea, onions, apples, citrus and many others are rich sources of antioxidants, so it's not surprising that cocoa contains an antioxidant, too. How important is the antioxidant in chocolate? Nestel questioned the importance of chocolate's modest effects on LDL oxidation. He further asked, "Given that there are thousands of flavonoids in the foods that we eat ... should each new finding be greeted as an encouragement to eat that particular source because it contains a special flavonoid?" 2

"Unfortunately for chocolate lovers, chocolate's high content of stearic acid puts it in the same category of risk of coronary disease as meat and butter -- i.e., pathogenic!"
-- American Journal of Clinical Nutrition

Also not mentioned was that chocolate contains a high amount of stearic acid, a saturated fat, and saturated fats are directly linked to elevated LDL cholesterol levels and to increased risks of coronary artery disease and coronary death. Chocolate supporters claim that stearic acid isn't like other saturated fats. Yet, in the Nurses' Health Study Involving more than 80,000 women over 14 years, the saturated fat in chocolate was shown to increase the risk of coronary heart disease by as much or even more than other, proven-harmful saturated fats.3

Stearic acid also appears to reduce the protective HDL and may increase tendencies toward fibrin and plaque deposition in the development of atherosclerosis. Based on these and other findings, a 1999 editorial in the American Journal of Clinical Nutrition concluded: "Unfortunately for chocolate lovers, chocolate's high content of stearic acid puts it in the same category of risk of coronary disease as meat and butter -- i.e., pathogenic!"4

Let's put chocolate's "benefits" into perspective. First, you can get similar antioxidants from almost any other plant-based foods. Vegetables, fruits, and whole grains are much better sources of antioxidants, and also contain many other healthful nutrients. And unlike chocolate, they won't increase your waistline with extra calories from sugar and fat.

Just three ounces of Toll House semi-sweet chocolate contain 420 calories, 210 (50%) from fat and 168 (40%) from sugar. And the saturated fat and simple sugar in chocolate are the kinds you want to avoid the most. Indeed, even if cocoa contains some healthful flavonoids, only 10% of the calories of Toll House semi-sweet chocolate come from cocoa. The rest is junk.

Food industry-funded studies notwithstanding, the bottom line on chocolate is this: Chocolate is a terrific food, but it isn't a health food. Use chocolate -- dark chocolate, not milk chocolate -- in moderation. Dr. Stephen Sinatra, who is a cardiologist, a colleague, and also a chocolate lover, suggests one ounce of dark chocolate a few times a week. I can live with that.

One ounce of dark chocolate three times a week.
Stephen Sinatra, M.D., cardiologist.

In fact, you can indulge yourself a lot more by using products and recipes that combine cocoa with healthier fats and sweeteners rather than manufactured chocolates. The food industry should work on this. Providing "healthy chocolate" made of cocoa and healthy ingredients would tap a big market of health-conscious chocolate lovers like me. Maybe then I could write a truly enthusiastic article about chocolate.

References
1. Wan, Y, Vinson, JA, Etherton, TD, et al. Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. American Journal of Clinical Nutrition, Nov. 2001;74:596-602.
2. Nestel, PJ. How good is chocolate? American Journal of Clinical Nutrition, Nov. 2001;74:563-4.
3. Hu, FB, Stamp, MJ, Manson, JE, et al. Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. American Journal of Clinical Nutrition, Dec. 1999;70:1001-1008.
4. Connor, WE. Harbingers of coronary heart disease: dietary saturated fatty acids and cholesterol. Is chocolate benign because of its stearic acid content? American Journal of Clinical Nutrition, Dec. 1999;70:951-952.

Copyright 2003, Jay S. Cohen, M.D. All rights reserved.
Readers have my permission to copy and disseminate all or part of these articles if it is clearly identified as the work of: Jay S. Cohen, M.D., The Free Underground MedicationSense E-Newsletter, July-August 2003, www.MedicationSense.com.