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Is chocolate good for your heart? Finally the FDA has an answer – kind of

Cocoa contains compounds called flavanols, which have been shown to improve blood flow and lower blood pressure.
Kevin Delcroix
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Cocoa contains compounds called flavanols, which have been shown to improve blood flow and lower blood pressure.

There's plenty of mystique tied to chocolate. Over the centuries, cocoa has been touted as an aphrodisiac and a health elixir. The Mayans even used cocoa as a form of cash and buried their aristocrats with it. It appears they believed that "it helped people get into the afterlife and survive in the afterlife," says Nat Bletter, an ethnobotanist and chocolate-maker.

As myths have evolved over cocoa's several thousand year history as a food, so too has the scientific pursuit to understand how it may influence our health. Cocoa contains lots of bioactive compounds called flavanols, which have antioxidant and anti-inflammatory properties. In recent years, studies have shown the flavanols in cocoa can help improve blood flow and lower blood pressure.

Back in 2018, a company that manufactures chocolate and cocoa products, Barry Callebaut AG Switzerland, petitioned the U.S. Food and Drug Administration to allow the use of a health claim on labels, pointing to the link between the consumption of flavanol-rich cocoa and a reduced risk of cardiovascular disease. Now, after an exhaustive review of studies, the FDA has responded.

In early February, the agency gave a green light to use certain, limited health claims on products made with high-flavanol cocoa powder. But, the agency says there's not enough evidence to support claims on regular chocolate, the kind most of us consume. Perhaps that's because some of the more convincing research comes from studies of cocoa flavanol supplements, not candy.

Take, for instance, the Cosmos trial, which included more than 20,000 men and women, aged 60 and older. Participants in the study agreed to consume 500 milligrams of cocoa flavanols, in the form of capsules, each day for several years to test whether it may help reduce the risk of heart disease. It was a randomized, double-blind, placebo-controlled trial, so participants didn't know if they were being given cocoa flavanols or a placebo.

"We did see promising signals for prevention of cardiovascular disease events," explains Dr. JoAnn Manson of Brigham and Women's Hospital, and one of the authors of the study. Overall, there was not a statistically significant decrease in heart attacks or strokes among participants taking the cocoa supplements, but fewer of them died from heart disease. "We actually saw a 27% reduction in cardiovascular disease deaths," says Manson. The study was published in the American Journal of Clinical Nutrition last summer, and researchers hope to replicate the findings with continued research.

Scientists have honed in on a particular mechanism that helps explain how chocolate can influence our cardiovascular systems. The bio-active flavanols in cocoa can prompt the production of more nitric oxide, a gas which causes our blood vessels to open up — or dilate. "Vasodilation seems to be the mechanism for lowering of blood pressure and what appears to be signals for reduction in cardiovascular events," Manson says.

But – bad news for chocoholics – she says these findings should not be interpreted as an invitation to eat more chocolate given candy bars contain sugar, fat and calories. "We found in the Women's Health Initiative that eating chocolate several times a week, just regular chocolate candy, did lead to weight gain," Manson says. And excess weight is associated with increased risk of cardiovascular disease.

So, where does that leave us, the chocolate-loving public?

Despite dozens of published studies evaluating the links between chocolate and health, the FDA's assessment is that, as of now, the science is still inconclusive. It's pretty clear that the compounds in cocoa are good for us, but we may not get enough of them when we consume highly-processed, sweetened chocolate candy bars.

Perhaps this is why the newly approved health claims are limited and confusing. Here's one example: "Cocoa flavanols in high flavanol cocoa powder may reduce the risk of cardiovascular disease, although the FDA has concluded that there is very limited scientific evidence for this claim."

"How is a consumer going to interpret that?" asks nutrition scientistChristopher Gardner, a professor at Stanford University. He says a health claim like this is unlikely to be helpful.

One of the challenges, he says, is that it's nearly impossible to do the kind of study that could prove whether a given amount of chocolate reduces heart disease. For starters, scientists would need to recruit thousands of people, half of whom would have to agree to eat chocolate every day for many years. The other half would need to agree to never eat chocolate. "Who would sign up for that?" Gardner asks.

For now, when people ask him if chocolate is healthy, his response is, "compared to what?" If you're deciding between jelly beans and dark chocolate, then dark chocolate is better, he says, given the flavanols. "The jelly bean is basically just sugar," Gardner says. His take, as a chocolate lover himself, is that it's good to slow down and savor small amounts.

Some manufacturers have started marketing chocolate products that are higher in flavanols, even as high as 200 mg per serving. The FDA says that to be able to make a health claim, cocoa products should have at least 4% of naturally conserved cocoa flavanols. But these chocolates may well taste more bitter than most of us typically enjoy.

In Europe, chocolate maker Barry Callebaut, the company that petitioned the FDA, is already allowed to use a health claim on dark chocolate products stating that cocoa flavanols have a positive impact on blood flow. The company calls the FDA's action in the U.S. a "major milestone" in the development of cocoa as an ingredient that could be blended or added to a range of products. "This presents an opportunity to develop and enhance better-for-you products leveraging high-flavanol cocoa powder, especially in the (sports) beverage and protein mix categories," wrote Hugo Van Der Goes, Vice President Cocoa North America at Barry Callebaut, in a statement. Callebaut already sells a cocoa powder that the company says qualifies for the new health claim.

Some chocolate lovers may push back against the idea of sports drinks infused with cocoa. Nat Bletter, who operates Madre Chocolate in Hawaii, and makes a minimally-processed chocolate, high in antioxidants, says while some chocolate connoisseurs are interested in health benefits, others are all about the taste. "They sometimes want to feel like they're sinning a little bit when they're eating chocolate," he says. He likes to help his customers get the most out of every bite by using all their senses when they eat chocolate. "Don't just taste it," Bletter says. "You can smell it before you put it in your mouth." And you don't have to chew it right away. "Let it melt on your tongue and see if you can get all the different flavors," he says.

Just like wine, chocolate can have lots of unique and interesting flavors, so the aim is to relish it.

"People need to have some fun and enjoy it," Gardner says and not get too hung up on the evidence for, or against health claims.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Allison Aubrey is a correspondent for NPR News, where her stories can be heard on Morning Edition and All Things Considered. She's also a contributor to the PBS NewsHour and is one of the hosts of NPR's Life Kit.
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