Chocolate, a food with many questions about health benefits

Is Chocolate Good for You: What’s Really the Best Advice?

Do you feel like you’re developing whiplash keeping track of claims about the perennial question, “Is chocolate good for you?” Media stories careen back and forth between raving over chocolate as a “powerhouse” of antioxidants and studies linking sweets with a wide array of health problems.

Is chocolate a help or a hindrance to health? Important answers lie in study details that you don’t get from looking only at the headlines. And any source that suggests we have clear-cut answers is leading you astray.

 

What You'll Find Here

Can You Boost Antioxidants by Eating Chocolate? Is chocolate anti-inflammatory?

Dark chocolate, Milk chocolate, Cocoa products Let’s clarify some misconceptions.

Is Dark Chocolate Good for Your Heart? What does research show about effects on blood vessel health, blood pressure, and cholesterol levels?

Can Chocolate Be Good for You? Perhaps, But Watch for Hype. Three key tips.

 

Can You Boost Antioxidants by Eating Chocolate?  Dark Chocolate, highest in flavanol compounds

Chocolate contains natural compounds called flavonoids that show powerful antioxidant effects in laboratory studies. Foods contain thousands of different flavonoids. Flavan-3-ols (sometimes simply called flavanols) are the type that stand out in cocoa powder and chocolate (and in both green and black tea).

[Health pro details: Sometimes you may see catechins, epicatechins, and procyanidins mentioned. These are the major types of flavan-3-ols in cocoa and chocolate.]

In isolated cells, studies show that these compounds can act as antioxidants, converting potentially damaging free radicals to more stable molecules. Perhaps even more important, they can trigger cells’ own intricate systems of antioxidant enzymes and pathways. And in rats, a daily dose of an extract of cocoa powder providing these flavan-3-ols can reduce markers of oxidative stress.

In any study, however, the amount of a compound present can be critical to effects seen. To be able to detect a potential effect, these cell and animal studies of flavan-3-ols often provide amounts or use cell concentrations equivalent in humans to amounts higher than would be reached by eating moderate amounts of chocolate as part of a healthy diet.

What About Human Trials of Cocoa Flavonoids?

The first large-scale human randomized, double-blinded, placebo-controlled trial called COSMOS tested a cocoa extract with high levels of flavan-3-ols to reduce the risk of CVD and cancer. Men aged 60 years and older and women aged 65 years and older were provided with capsules to take twice a day for an average of 3.6 years in this trial published in 2022. (Note: flavan-3-ols were the primary compounds in an extract of cocoa, but not the only ones.)

  • Among all people who completed the study, the trend for a 10% reduced risk of a composite of a broad range of cardiovascular events was not statistically significant, which means it could have occurred by chance. (This composite was the declared primary outcome of the study. It included deaths from CVD as well as heart attack, stroke, coronary revascularization, unstable angina requiring hospitalization, carotid artery surgery, and peripheral artery surgery.)
  • Overall, people in the study followed the protocol for taking the cocoa extract capsules quite well. Still, another analysis included only those who stuck with procedures most closely (eg. they didn’t miss more than 8 days per month taking the capsules). Among these most consistent users, the 15% reduced risk of total cardiovascular events was statistically significant.
  • However, in both groups, although there were trends for lower risk of specific kinds of cardiovascular events like heart attack, stroke, or cardiovascular interventions in those receiving the cocoa extract capsules, response varied enough that it was not statistically significant.

Study authors note that because of the multiple statistical analyses performed, results beyond the primary outcome should be interpreted cautiously. These results provide grounds for further research, not established effects.

Cocoa extract was not related to risk of cancer (total or site-specific) in the COSMOS study. In laboratory studies, flavonoid compounds have shown effects in that might help prevent or slow cancer development. However, lack of cancer-protective effects in this trial are not surprising:

  • In previous trials, a variety of antioxidant supplements have been ineffective in reducing cancer risk.
  • Most types of cancer develop over many years. To detect an effect on cancer risk, studies need to follow people for many years.
  • Current evidence on reducing cancer risk shows greatest support for overall dietary pattern, rather than supplements that boost individual nutrients or compounds, according to the American Institute for Cancer Research (AICR).

Take-Away Message: Before these studies on flavonoid compounds prompt you to expect health benefits by eating more chocolate, recognize this research as showing potential, not proof.

  • We need studies showing the effects of flavan-3-ols in amounts you get from typical portions of chocolate or cocoa.
  • We also need research to identify what differences in particular chocolate products, in your overall diet and among individuals might affect chocolate’s overall antioxidant effects.

 

Is Chocolate Anti-Inflammatory?

By supporting antioxidant defenses, laboratory studies show a reason that flavanol-rich chocolate and cocoa could help avoid or reduce chronic inflammation. Emerging evidence from human and rodent studies suggests that the flavanols and other polyphenol compounds in chocolate may be prebiotics. By nurturing growth of health-promoting gut bacteria, this could also lead to anti-inflammatory effects.

Some observational population studies have shown lower levels of CRP (a protein in the blood used as a measure of inflammation) among people who eat chocolate a few times a week.

However, evidence is sparse. Studies often ask about chocolate consumption as a whole. That may limit ability to see differences in markers of inflammation, which would likely differ based on the type of chocolate consumed.

Interventions providing high levels of flavan-3-ols in chocolate bars or beverages reduced CRP, a marker of inflammation, modestly (by an average of 0.83 mg/dl) in an analysis of human randomized controlled trials. However, these results are hard to interpret since other biomarkers of inflammation did not change in these interventions.

 

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Overall, it’s not a single food, but an overall dietary pattern that is the best strategy for an anti-inflammatory diet.

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Dark Chocolate vs Milk Chocolate  dark chocolate, milk chocolate, white chocolate

Laboratory studies often use isolated flavan-3-ol compounds or extracts of cocoa so that they can control a specific and consistent amount of these antioxidant-powering compounds.

Dark chocolate contains far more flavan-3-ols than milk chocolate. These compounds are what give dark chocolate its characteristic bitter flavor.

If you’re a milk chocolate lover, you’re less likely to get the potential benefits of the flavonoid compounds discussed here. But the questions people have about whether chocolate could have a downside relate to both dark and milk chocolate. (Good news: You’ll like the answer, even if you’re a lover of milk chocolate.)

Cocoa powder is another source of these flavan-3-ol compounds. There are differences among types of cocoa, however. And we’ll get to that, too.

Is Dark Chocolate Good for Your Heart?

Higher consumption of the broad class of phytochemicals called polyphenols, and of the specific flavan-3-ol type that chocolate provides, has been associated with a trend for lower risk of cardiovascular disease and type 2 diabetes in studies that follow a large group of people over time. But – and this is important – results vary widely, with decreases in risk from 1% to 30%. One study found a lower risk of CVD in men, but not women. And often this association is not statistically significant, meaning that it could have been observed by chance.

And studies that link better health with higher intake of polyphenols can signal a diet that includes plenty of a wide range of other plant foods, like vegetables, fruits, whole grains, nuts, and pulses (such as dry beans). Any differences in health could relate to the broad variety of phytochemicals, nutrients, and dietary fiber those foods provide.

A review combining evidence from systematic reviews and meta-analyses that included careful review of the quality of evidence found weak evidence linking chocolate consumption with lower risk of diabetes and death from cardiovascular disease (including heart attacks and strokes), but no evidence that was convincing or highly suggestive. Much of this uncertainty seems related to how the studies were conducted. For example, most studies didn’t analyze dark and milk chocolate separately.

And evidence from randomized controlled intervention trials is also too weak to count on for proof of better heart health with chocolate. Again, this doesn’t mean that chocolate wasn’t beneficial in these studies. But problems such as the choice of the “control” group’s treatment and small study size make it hard to see any effect.

Therefore, authors of large reviews of current research generally find no disadvantage (no increase in heart disease) linked to chocolate consumption. Risk of heart disease may be reduced with chocolate or cocoa a few times per week, but among all studies and wide groups of people, the association is modest.

So researchers caution that current research does not support using chocolate for the specific purpose of improving heart health or preventing cardiovascular disease. People may differ, based on their genetics, overall health, or eating habits and lifestyle in how much of a heart health benefit they get by including chocolate.

These studies include lots of “noise” — a wide range of sources and amounts of cocoa flavanols, and people who differ in many characteristics. So it’s expecting a lot to see one food linked to a difference in incidence of a disease like CVD that’s affected by many factors. By looking at studies on specific influences on cardiovascular health, it’s easier to see how chocolate might be good for your heart.

 

Chocolate for Healthy Blood Vessels?

The balance of how blood vessel walls contract and relax is vital to keeping blood pressure in a healthy range. The vascular endothelium is a single layer of cells that lines the inside of blood vessels. This endothelium secretes compounds that help regulate blood vessel constriction. And when blood flow is too restricted due to problems here (called endothelial dysfunction) or to stiffening of blood vessel walls, it sets the stage for atherosclerotic plaque that underlies cardiovascular disease.

So part of a heart-healthy diet means including foods for vascular health. The flavonoid compounds in chocolate seem to support blood vessel health by increasing antioxidant and anti-inflammatory defenses. And they also increase production of nitric oxide within the endothelium, which in turn triggers relaxation of blood vessels (allowing improved blood flow).

Evidence from population studies and controlled intervention studies shows short-term (1-2 hours) and longer-term (up to nearly 3 months) improvement in blood vessel function with dark chocolate or cocoa products. Improvement (measured by Flow-Mediated Dilation) is seen in healthy people and at people at greater risk of CVD, such as people with hypertension, diabetes, and overweight or obesity. This evidence is rated as strong. Cocoa and chocolate might also reduce artery stiffening, but studies have shown mixed results, and this evidence is currently rated as moderate.

An important question remains: how much is enough to promote healthy blood vessels? The answer probably varies for different individuals, since people differ in their blood vessels’ starting point and their exposure to factors that damage blood vessels.

A health claim authorized by the European Food Safety Authority (EFSA) in 2012 for cocoa flavanols to help maintain blood vessel elasticity and normal blood flow is based on consumption of 200 mg of cocoa flavanols per day. It’s stated that this could come from as little as 10 grams (about 1/3 ounce) of high-flavanol dark chocolate. A later amendment also includes capsules or tablets of cocoa extract with this dose of flavanols. [Note: See information below on flavanol content of cacao products; typical dark chocolate needs to be in substantially larger portions to provide this level of cocoa flavanols, according to major recognized polyphenol databases.]

Other research suggests that higher doses of flavan-3-ols may bring optimal benefits for blood vessels. Yet it’s also noted as possible that long-term use of lower amounts could be protective, especially in people currently without blood vessel damage.

 

Chocolate's flavanol compounds and heart-protective nutrients show potential to support healthy blood vessels and blood pressure. How much helps or hinders? More research is needed. Answers are surely individual. Click To Tweet

 

Can It Be True? Does Dark Chocolate Lower Blood Pressure?

Flavanol-rich chocolate and cocoa products modestly reduce blood pressure (by an average of 2/2 mm Hg) in short-term trials lasting 2 weeks to 4.5 months. Evidence in an analysis of 35 randomized controlled intervention trials was graded as “moderate” because there was substantial variation among studies (“heterogeneity”). In people with hypertension, the drop in blood pressure averaged 4 mm Hg. And there was a tendency for a greater blood pressure reduction in people with prehypertension than in people with normal blood pressure.

More research is needed to clarify whether this reduction in blood pressure continues (or perhaps is even enhanced) if chocolate flavonoid consumption continues.

These intervention trials used widely varying amounts of flavan-3-ol compounds — from amounts attainable with modest consumption of dark chocolate or cocoa powder to amounts that could only be reached with extra-concentrated products or large portions. And don’t expect blood pressure-lowering with milk chocolate, at least with amounts that reasonably fit in an overall healthy eating pattern.

Why would chocolate lower blood pressure?

  • Flavonoid compounds act as antioxidants and promote relaxation of blood vessels by increased nitric oxide production.
  • Dark chocolate also provides magnesium and potassium, which can be part of how foods help lower blood pressure. (Sorry, milk chocolate lovers – but amounts in a reasonable portion provide much smaller amounts.)

Watch out for headline hype on this, though. An ounce of dark chocolate provides an extra 40 to 65 mg of magnesium and 160 to 200 mg of potassium (depending on the concentration of cacao solids). That’s a step up, but it can’t make up for a diet low in dark green vegetables, whole grains, nuts, and pulses (like dry beans and soy foods).

On the other hand, effects of dark chocolate and cocoa on blood pressure could provide an example of how a whole food may promote health in ways that an isolated compound or extract can’t. Even though a food like dark chocolate or cocoa may not provide as high a dose of a specific nutrient or compound (like flavan-3-ols), it can provide multiple different nutrients and compounds that work together to promote health in concert with other health-protective foods.

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Is Chocolate Bad for Cholesterol? Is Chocolate Good for Cholesterol?

Much of the fat in chocolate is classified as saturated fat, so years ago there was concern that chocolate would raise blood cholesterol. However, about 30% of the fat in either dark or milk chocolate is a particular fatty acid (stearic acid) that does not raise LDL-cholesterol.

Analyses that pull together results of human randomized controlled trials demonstrate this. Chocolate consumption in these studies generally does not cause any change in LDL-cholesterol levels that is statistically significant. Overall, studies don’t show an effect, regardless of whether people in the study had medical conditions and regardless of trial length.

One caution: if you consume chocolate mainly as an ingredient in high-sugar foods concentrated in calories, it’s likely detracting rather than contributing to a heart-healthy diet.

 

Are you afraid to enjoy chocolate because you find that once you have some, your usually healthy eating habits transform into a rash of overeating or unhealthy choices?
It might be that rigid rules are backfiring.
>> Check here for more about research on a mindset of Flexible Restraint.

 

Can Chocolate Be Good for You? Perhaps, But Watch for Hype

1) Consider the Different Choices  Different kinds of chocolate

The flavonoid content of chocolate is highly variable. Dark chocolate, usually 50 to 85 percent cacao (which includes cocoa bean solids plus cocoa butter), is higher in flavonoids and has a more intense flavor. It’s less sweet, because as cocoa content goes up, sugar content drops. Milk chocolate can range from 7 to 50 percent cacao, so flavonoid content is lower. White chocolate contains no cocoa bean solids (and therefore is not a source of flavonoids).

The fat content of chocolate is not the problem that some people consider it to be. Seventy percent of chocolate’s fat is either monounsaturated or a particular type of saturated fat called stearic acid that does not raise blood cholesterol. Both dark and milk chocolate are heart healthy options, especially if they are replacing other sweets.

Cocoa provides chocolate flavor with flavonoids, too. Most widely available cocoa mixes contain cocoa treated with alkali to produce a richer taste. Unfortunately, this “Dutch cocoa” is substantially lower in flavanols. Gourmet cocoa mixes are available made with natural (untreated) cocoa. Natural cocoa (in the baking aisle at the grocery store) is a less expensive choice.

You can use plain natural cocoa to make a flavonoid-rich cup of cocoa with your own sweetener and milk. Or add it for flavor to smoothies and lots of other dishes. It adds a rich flavor in chili and other vegetable-rich dishes and in Mexican mole-type sauces for enchiladas or chicken.

 

2) Keep Potential Cacao Health Benefits in Context

Strongest evidence of heart health benefits from flavonoids found in cacao-based foods – chocolate and cocoa – involves about 200 mg of flavanols per day, with clearer benefits in studies providing about 500 to 600 mg/day.

Yet some long-term population studies show less cardiovascular disease among people who eat a few ounces of chocolate a week.

  • Perhaps the combination of other nutrients (like potassium and magnesium) in dark chocolate and longstanding consumption over time brings heart health benefits with lower levels of flavanol compounds.
  • Or perhaps people who consume small bits of chocolate are choosing it in place of other sweets or snack foods that are more highly refined and contain even higher levels of added sugars and unhealthy fats without providing protective phytochemicals and nutrients.

The crucial question: Are you including chocolate in a way that supports overall healthy habits? 

One ounce of dark chocolate:Chocolate with fruit and nuts
135-165 calories, 13 grams of sugar, 7 mg sodium; about 100 mg flavanols, 43 mg magnesium, 162 mg potassium

  • That means a portion providing 200 mg flavanols has 270-330 calories, 26 grams of sugar

One ounce of milk chocolate:
150 to 165 calories, 15 grams of sugar, 23 mg sodium; about 19 mg flavanols, 28 mg magnesium, 164 mg potassium

  • That’s 1/4 of a 4-oz bar or 4 small pieces

One ounce of white chocolate:
150 to 170 calories, 12 to 17 grams of sugar, 26 mg sodium; 0 flavanols, 3 mg magnesium, 80-110 mg potassium

One tablespoon (5 grams) of natural cocoa:
12 calories, 0 grams of sugar, 1 mg sodium; 114 mg flavanols, 27 mg magnesium, 114 mg potassium
*This flavanol content is for natural cocoa. Dutch- (alkali) processed cocoa, even if labeled dark cocoa, has much of the flavanol content removed.

 

Compare these choices to foods with chocolate as an ingredient —  Chocolate cake fits as a treat, but not with health benefits

  • Chocolate frosted donut: 260-300 calories, 13-18 grams of sugar, 220-290 mg sodium, 20 mg magnesium, 75-135 mg potassium
  • Three Oreo cookies: 160 calories, 14 grams added sugars, 135 mg sodium, 50 mg potassium
    • A third of the package of Oreo cookies (don’t think nobody does that!): 640 calories, 64 grams added sugars, 540 mg sodium, 200 mg potassium
  • 1 cup Ben & Jerry’s chocolate fudge brownie ice cream:  525 calories, 48 grams of added sugars, 140 mg sodium, 645 mg potassium
  • Starbucks Venti (20 oz) Caffè Mocha with whipped cream: 450 calories, 45 grams of total sugars, 190 mg sodium

Assume flavanol content is 0 to 10 mg in each of these foods. Chocolate syrup contains a small amount. Cocoa powder processed as an ingredient in commercial ice cream, baked goods and bakery mixes is processed with alkali, removing flavanols.

Nutrient content from USDA FoodData Central database supplemented with specifics directly from brands’ websites. Flavanol information from Phenol-Explorer database and Miller et al., J. Agric. Food Chem. reference.

 

3) Chocolate: Good for You If It’s Part of an Overall Healthy Eating Pattern and Brings You Joy  For people who love chocolate, moderate amounts can be healthy

Chocolate doesn’t replace vegetables and fruits. Flavonoid content of vegetables and fruits such as spinach, garlic, raisins, and oranges can be 8 to 16 times higher per serving than even dark chocolate. And we get those health-promoting phytochemicals in a serving of fruits and vegetables for 25 to 80 calories.

With overall smart food choices, most adults can maintain a healthy weight while consuming 120 to 350 calories a day from foods that aren’t rich in nutrients. Flavonoid-rich chocolate and cocoa could be great ways to “spend” those calories instead of foods that are negative influences on health, such as doughnuts, cookies, or regular soft drinks. Savor small portions of chocolate itself that provide flavonoid benefits, not chocolate cakes and pastries that are loaded with extra calories, sugar, and unhealthful fats.

Whether you eat a square or two of chocolate with morning tea or coffee, in small pieces mixed with nuts and dried fruit for an afternoon snack, or as a satisfying ending to lunch or dinner (alone, or with some fruit, as is common in some European countries), savor it. Remove the guilt. If you rapidly gulp it down in the car outside the grocery or convenience store, you’re probably missing the joy component that chocolate can add to a healthy diet.

 

Bottom Line on Chocolate and Health

Modest chocolate consumption — a few times a week or even a small amount daily — may not be a barrier to healthy eating and could even be healthful. Effects on health will likely depend on the type of chocolate or cocoa product you choose. And they probably vary among different individuals, too. More research is needed to clarify benefits of large-dose isolated flavanol compounds. Meanwhile, since health benefits of eating chocolate and cocoa can’t make up for unhealthy eating, if you choose to include chocolate, savor the taste and don’t assume that “more is better” applies here.

 

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References

Ahmed S, Ahmed N, Rungatscher A, et al. Cocoa Flavonoids Reduce Inflammation and Oxidative Stress in a Myocardial Ischemia-Reperfusion Experimental Model. Antioxidants (Basel). 2020 Feb 18;9(2):167. doi: 10.3390/antiox9020167.

Bernatoniene J, Kopustinskiene DM. The Role of Catechins in Cellular Responses to Oxidative Stress. Molecules. 2018 Apr 20;23(4):965. doi: 10.3390/molecules23040965.

Kuhnle GGC. Nutrition epidemiology of flavan-3-ols: The known unknowns. Molecular Aspects of Medicine. 2018;61:2-11.

Li W, Guo Y, Zhang C, et al. Dietary Phytochemicals and Cancer Chemoprevention: A Perspective on Oxidative Stress, Inflammation, and Epigenetics. Chem Res Toxicol. 2016;29(12):2071-2095.

Lin X, Zhang I, Li A, Manson JE, Sesso HD, Wang L, Liu S. Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Nutr. 2016 Nov;146(11):2325-2333. doi: 10.3945/jn.116.237644.

Martin MÁ, Ramos S. Impact of cocoa flavanols on human health. Food Chem Toxicol. 2021 May;151:112121. doi: 10.1016/j.fct.2021.112121

Mendonça RD, Carvalho NC, Martin-Moreno JM, et al. Total polyphenol intake, polyphenol subtypes and incidence of cardiovascular disease: The SUN cohort study. Nutr Metab Cardiovasc Dis. 2019 Jan;29(1):69-78. doi: 10.1016/j.numecd.2018.09.012.

Miller KB, Hurst WJ, Flannigan N, et al. Survey of commercially available chocolate- and cocoa-containing products in the United States. 2. Comparison of flavan-3-ol content with nonfat cocoa solids, total polyphenols, and percent cacao. J Agric Food Chem. 2009 Oct 14;57(19):9169-80. doi: 10.1021/jf901821x.

Panel EN. Scientific opinion on the substantiation of a health claim related to cocoa flavanols and maintenance of normal endothelium-dependent vasodilation pursuant to Article 13 (5) of Regulation (EC) No 1924/2006. EFSA J (2012) 10:2809. doi:10.2903/j.efsa.2012.2809

Ried K, et al. Does chocolate reduce blood pressure? A meta-analysis. BMC Med. 2010. 28;8:39

Sesso HD, Manson JE, Aragaki AK, et al. Effect of cocoa flavanol supplementation for prevention of cardiovascular disease events: The COSMOS randomized clinical trial. Am J Clin Nutr. 2022 Mar 16:nqac055. doi: 10.1093/ajcn/nqac055. Epub ahead of print. PMID: 35294962.

Veronese N, Demurtas J, Celotto S, et al. Is chocolate consumption associated with health outcomes? An umbrella review of systematic reviews and meta-analyses. Clin Nutr. 2019 Jun;38(3):1101-1108. doi: 10.1016/j.clnu.2018.05.019.

Yang CS, Chen JX, Wang H, Lim J. Lessons Learned from Cancer Prevention Studies with Nutrients and Non-Nutritive Dietary Constituents. Mol Nutr Food Res. 2016;60(6):1239-1250.

2 Comments

  1. Twinkle on November 30, 2022 at 11:46 am

    This article is very informative about dark chocolate. Thanks for giving us this information. Please keep it up!

    • Karen Collins on January 1, 2023 at 5:24 pm

      Thanks for the feedback! I’m glad you found the article helpful.

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Meet the author/educator

Karen Collins
MS, RDN, CDN, FAND

I Take Nutrition Science From Daunting to Doable.™

As a registered dietitian nutritionist, one of the most frequent complaints I hear from people — including health professionals — is that they are overwhelmed by the volume of sometimes-conflicting nutrition information.

I believe that when you turn nutrition from daunting to doable, you can transform people's lives.

Accurately translating nutrition science takes training, time and practice. Dietitians have the essential training and knowledge, but there’s only so much time in a day. I delight in helping them conquer “nutrition overwhelm” so they can feel capable and confident as they help others thrive.

I'm a speaker, writer, and nutrition consultant ... and I welcome you to share or comment on posts as part of this community!

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