Michael Hunter, MD on Medika Life

A Ridiculous Way to Improve Your Heart Health

“All you need is love. But a little chocolate now and then doesn’t hurt.” ― Charles M. Schulz

COULD COCOA — OR DARK CHOCOLATE — BE A HIGH BLOOD PRESSURE management tool? First, a disclosure: I love dark chocolate. Eom to my office or home, and you will find more than a half-dozen varieties of the stuff.

Before you leap to chocoholic status (for hypertension risk reduction), you probably want evidence that previously reported laboratory results translate well into the real world.

Enter a new study from the University of Surrey that illustrates the power of cocoa to reduce high blood pressure. I want to wander a bit through the known health benefits of this nectar of the gods before exploring the provocative new study from the United Kingdom.

The new study has this unwieldy title: “Assessing Variability in Vascular Response to Cocoa With Personal Devices: A Series of Double-Blind Randomized Crossover n-of-1 Trials,” but I hope to analyze it with more accessible language.

Dark chocolate is chock full of nutrients that may benefit your health. Created from cacao tree seeds, it is a potent source of antioxidants. Let’s explore three science-based health benefits of dark chocolate or cocoa.

Photo by Daniel Fazio on Unsplash

1. Chocolate can improve cholesterol.

Dark chocolate positively impacts cholesterol by lowering “bad” LDL and improving insulin sensitivity. Let’s look at the evidence, admittedly not high-level.

As reported in a small randomized study in 2014, dark chocolate consumption (supplemented with the flavanol lycopene) significantly reduced levels of total cholesterol, LDL (“bad”) cholesterol, and triglycerides.

The results seem logical. Some types of LDL cholesterol are more likely to oxidize (when contacting free radicals in our body). This oxidation renders the LDL particle reactive, damaging other tissues, including the heart’s artery lining.

Cocoa lowers oxidation-prone types of LDL. With its antioxidants, the food substance enters our bloodstream to protect lipoproteins. We need to be mindful that dark chocolate also contains health-harming sugar.

2. Chocolate might protect your skin from the sun.

You read that correctly: The bioactive substances in dark chocolate may reduce sun-induced skin damage.

One well-done 6-month study involved subjects who consumed a flavanol-rich cocoa beverage. The beverage consumers significantly improved facial wrinkles and skin elasticity compared with the control group.

Before we open a cocoa stand, we should note that not all studies have demonstrated such positive results. Still, when I recently traveled to Kauai (Hawaii), I got in daily dark chocolate, aiming for at least 70 percent cocoa solids with little added sugar.

Of course, I recognize that dark chocolate is no replacement for other forms of sun protection, including sunscreen.

3. Chocolate may boost your brain.

Did you know that dark chocolate may improve your brain functioning? Cocoa rich in flavanols improves brain blood flow, at least in young adults. Consume cocoa, and you may witness improvements in memory, attention, and verbal learning, according to a systematic review from Madrid (Spain).

What about older adults? Can cocoa flavonoids help us maintain cognitive function? The answer is maybe. Lower level evidence comes in the form of a retrospective study showing the substance helped older adults maintain cognitive function (and dropped the chances of progression to dementia). This research study is by no means definitive.

Here is what I previously wrote about the dark chocolate/brain connection:Dark Chocolate and CognitionDark chocolate is chock full of nutrients that can positively affect your health.medium..com.

In the short term, we may get a brain function bump through cocoas compatriots, theobromine, and caffeine. Perhaps these substances are the reason I get a jump-start in brain function.

In summary, cocoa and dark chocolate may improve brain function by increasing blood flow or through the stimulants in the food (such as caffeine and theobromine). Fortunately for me, compared with regular coffee, the caffeine content of dark chocolate is relatively low.

Photo by Elnaz Asadi on Unsplash

“The greatest tragedies were written by the Greeks and Shakespeare…neither knew chocolate.”
― Sandra Boynton

Chocolate Parmesan Tapioca with a Pan-Seared Scallop

Salad with Chèvre Chaud, Honey, and Mint Dressing
Roasted Butternut Squash and Cacao Soup
Oysters with a Mignonette Sauce

Armagnac-and-Chocolate-Infused Daube de Bœuf à la Gascogne
Sweet Potato Curry with Mussels
Chocolate Pasta with a Gorgonzola Cheese Sauce

Moules à la Plancha with Chorizo served over a bed of Arugula

Selection of the Château’s Cheeses

Mousse au Chocolat spiced with Pimento Chili Peppers and Chocolate Flakes, garnished with Mint.

I spun around on one heel, excited to get prepping. Unbeknownst to me, the rest of the kitchen staff had arrived, their jaws agape as they stared at the menu. As usual, Phillipa was the first to speak up. “That menu looks wicked incredible.”
“I don’t know about adding hot peppers to the mousse au chocolat,” said Jane, and the granny brigade nodded in agreement.
I was so sick of her know-it-all attitude. I knew a thing or two, and I was going to stand by my decision. “The combination has Aztec roots. To honor the fertility goddess, they drank xocolāt, a chocolate concoction spiced with chili pepper and vanilla. It’s delicious and unexpected.”
Jane rolled her eyes. “You’re the chef.”
“I am,” I said, wanting to challenge her. “And this is the menu.”
― Samantha Verant, The Secret French Recipes of Sophie Valroux

Chocolate and the heart — New findings

Back to our original question: Can cocoa — or chocolate act as a medicine for high blood pressure? A new study from the United Kingdom provides real-world evidence that the answer is yes.

The study authors observe that cocoa flavanols can lower blood pressure and arterial stiffness as much as some prescribed medicines. But here’s the rub: The great results have been obtained only in tightly controlled experimental settings.

Commenting in Medscape UK, lead study author Christian Heiss, professor of cardiovascular medicine at the University of Surrey, explains that:

“High blood pressure and arterial stiffness increase a person’s risk of heart disease and strokes, so it is crucial that we investigate innovative ways to treat such conditions.”

“Before we even consider introducing cocoa into clinical practices, we need to test if the results reported in laboratory settings safely translate into real-world settings, with people going about their everyday lives.”

Here’s what the scientists did: The team randomized 11 healthy volunteers (under age 45 years) who consumed either cocoa flavanol capsules or placebo capsules (containing brown sugar) on alternate days. They did one of two randomized sequences over eight consecutive days, with capsules taken each morning before breakfast.

Here are the results of this novel double-blind, randomized cross-over trial, published in Frontiers in Nutrition:

  • Both 12-hour systolic blood pressure and pulse wave velocity decreased, the former by an average of 1.4 mm Hg.
  • There appeared to be much inter-individual variation in responses and considerable between-day variation in individual responses.
  • Blood pressure and arterial stiffness dropped when they had been high at baseline. Those with a low blood pressure measurement in the morning had no benefit from cocoa flavanols.
  • The effectiveness peaked within three hours of cocoa flavanol ingestion (with a second, smaller peak about eight hours after consumption).

My take — Chocolate and the new study results

This study showed a small drop in blood pressure and arterial stiffness in everyday life, but only for those with elevations within the normal range. At first, I thought the 1.4 mm Hg drop in blood pressure seemed remarkably small until I noted this observation of the study authors:

“The magnitude of effects, in particular within the first 3 hours, is similar to what standard antihypertensive medications achieve in clinical trials, highlighting the clinical relevance and potential of flavanols for use in clinical practice.”

According to the researchers, the amounts of cocoa flavanols in the study are high but achievable through a regular diet.

Regrettably, the researchers did not obtain blood samples that would have allowed for an analysis of flavanol metabolites. Finally, whether a regular dark chocolate consumption habit results in long-term blood pressure decreases is unknown.

Me. Courtesy of the author.

I will close with the usual caveats: Chocolate is rich in calories, sugars, and fat. I consume it in small amounts to dodge extra calories. Of course, dark chocolate alone is not going to be enough.

Don’t forget to move, maintain a healthy weight, watch your salt intake, and check your blood pressure. Hopefully, you will not need medicines to keep your blood pressure healthy.

Do you eat dark chocolate? If yes, what is your favorite? Thank you for joining me today.


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Michael Hunter, MD
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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