There has been a lot of attention in the media regarding the health benefits of chocolate. Consequently, many people are wondering if chocolate really is good for them. This is not an easy question to answer because the benefits are relative to the type of chocolate, the processing method used, and chocolate's complex structural components (387 separate chemical compounds and 800 different flavors and scents have been identified1).

Chocolate is made from the bean of the cacao tree (Theobroma cacao) and is one of the few foods that is still completely harvested and separated by hand.2 The bitter cocoa bean is composed of 31% fat, 14% carbohydrates, and 9% protein.2 The beans are fermented, roasted, dehulled, and ground to a paste known as cocoa mass or chocolate liquor.2 How this chocolate liquor is then processed into an edible product has a tremendous impact on its health benefits. It is theorized that the cocoa mass is the part that contains the healthy components.

Dark chocolate contains approximately 30% sugar and 70% cocoa mass, with a small amount of pure vanilla extract and lecithin (less than 1% total); milk chocolate, in contrast, is comprised of about 40% sugar, 10% cocoa mass, 23% cocoa butter, 26% milk solids, and emulsifiers and flavorings.2 White chocolate has no cocoa mass and is composed of the cocoa butter alone, along with sugar, milk, flavorings, and emulsifiers.2 This means that the healthiest type of chocolate is dark chocolate, because it contains a higher cocoa mass content.

Flavonoids

Scientists believe that chocolate's health benefits are derived from the flavonoids found in the cocoa mass. The main ones are flavan-3-ols, oligomeric proanthocyanidins, and epicatechin.3 These flavonoids appear to have an antioxidant capacity, an antiplatelet function, and the ability to activate endothelial nitric oxide synthase.4 Dark chocolate has been found to lower BP, have a positive effect on endothelial function, raise HDL cholesterol, lower LDL cholesterol, and reduce overall cardiovascular mortality by 20% from the highest tertile of flavonoid intake to the lowest.5

Even though cocoa mass contains more flavonoids than any other food, it is hard to imagine that chocolate could have a significant impact on cardiovascular health because of its high fat content. However, one third of the fat found in chocolate is stearic acid. Although classified as a saturated fat, stearic acid has no effect on cholesterol levels. Another one third of the fat in chocolate is oleic acid, a monounsaturated fat also found in olive oil and proven to have a positive effect on lipid levels.6

Minerals and other properties

Cocoa mass also contains potassium, phosphorus, copper, iron, zinc, and magnesium.6,7 These minerals add to the cardiovascular health benefits of chocolate. Its ability to release the neurotransmitter dopamine and the endorphin phenyethylamine could help explain why eating chocolate alleviates premenstrual syndrome symptoms and depression.8 Chocolate may also contain valeric acid, which is why, despite containing the stimulants caffeine and theobromine, it acts as a stress reducer.8 These neurochemical changes also play a part in chocolate's cardioprotective properties.

Bottom line

There appears to be some evidence to justify eating a moderate amount (approximately 2 oz8) of dark chocolate daily. However, a person must then compensate for the additional calories by increasing the amount of daily exercise or reducing caloric intake of other fats, sweets, or carbohydrates to prevent obesity and the metabolic and cardiovascular risks related to it.

Furthermore, the majority of studies touting the benefits of chocolate are small or derived from reevaluation of secondary data. Additional large-scale observational and/or interventional studies are needed before clinicians can unreservedly recommend “a chocolate a day” to their patients. For information that can be photocopied and handed to patients, please see below. JAAPA

The author is the owner of Physician Assistant Medical Services (P.A.M.S.) in Williamsburg, WVa, a past president of the AAPA, and president of the Society for the Preservation of PA History. She has indicated no relationships to disclose relating to the content of this article.

REFERENCES

1. Richardson T. What is it about chocolate? In: Sweets: A History of Candy. New York, NY: MJF Books/Fine Communications; 2002:213-244.

2. Ashton J, Ashton S. It's all in a box of chocolates. In: A Chocolate a Day: Keeps the Doctor Away. New York, NY: Thomas Dunne Books/St. Martin's Press; 2003:9-24.

3. Steinberg FM, Bearden MM, Deen CL. Cocoa and chocolate flavonoids: implications for cardiovascular health. J Am Diet Assoc. 2003;103(2):215-223.

4. Engler MB, Engler MM, Chen CY, et al. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr. 2004;23(3):197-204.

5. Ding EL, Hutfless SM, Ding X, Girotra S. Chocolate and prevention of cardiovascular disease: a systematic review. Nutr Metab (Lond). 2006:3:2.

6. The American Dietetic Association. Chocolate: facts and fiction. Nutrition fact sheet. Chicago, Ill: American Dietetic Association Foundation; 2000.

7. Ashton J, Ashton S. Why chocolate is a health food. In: A Chocolate a Day: Keeps the Doctor Away. New York, NY: Thomas Dunne Books/St. Martin's Press; 2003:39-52.

8. Ashton J, Ashton S. The best food for mood. In: A Chocolate a Day: Keeps the Doctor Away. New York, NY: Thomas Dunne Books/St. Martin's Press; 2003:26-38.

 

Patient Information

The news is full of storieshat chocolate is good for your health. And everyone loves to eat chocolate. However, common sense tells us there is more to these stories than what the headlines are saying.

Chocolate is made from the cocoa bean. The beans are made into cocoa mass before being turned into food. Scientists have found something called flavonoids in the cocoa mass. These substances help to prevent heart disease. They lower blood pressure. They also lower the bad cholesterol levels and raise the good cholesterol levels in your blood. And they improve the way your blood vessels work. Flavonoids make foods and drinks have a dark color. They were first discovered in red wine. They are found in black and green teas and some dark fruits, like blueberries and red apples, too.

A 11/2-ounce piece of dark chocolate or a cup of chocolate milk made with 2 tablespoons of cocoa contains the same amount of flavonoids as 5 ounces of red wine. This is about the same amount as in two cups of strong green or black tea, four apples, or eight glasses of grape juice. Milk chocolate has less flavonoids than dark chocolate. There are almost no flavonoids in white chocolate.

How chocolate can be good

Some types of chocolate are better for you than other types. The difference depends on how much cocoa mass, sugar, and fat are used to make the chocolate. Chocolate foods with more cocoa mass are healthier. At least 70% of dark chocolate is cocoa mass. But only 10% of milk chocolate is cocoa mass, and there is no cocoa mass in white chocolate. So dark chocolate is the best type of chocolate to eat.

Because cocoa comes from a plant, it contains vitamins and minerals also found in vegetables. Some of the minerals are potassium, phosphorus, copper, iron, zinc, and magnesium. These minerals are important for heart health. They are important for general health, too. Chocolate also causes the brain to produce substances that lower stress and help with depression and PMS (premenstrual syndrome). No wonder eating a piece of chocolate candy makes us feel good.

Don't forget the calories

Eating a small piece of dark chocolate can be good for you. But this does not mean that eating a lot of chocolate is even better. Actually, eating more than 2 ounces of dark chocolate a day can be bad. Remember, 2 ounces of dark chocolate have about 200 calories. Just adding the chocolate to your diet can cause weight gain. You have to cut back on other foods with fats and carbohydrates, including other sweets, to prevent this from happening.

Also, the type of chocolate food you eat is important. Some types have extra fat and sugar added to them. For example, a dark chocolate candy with a creamy center has only a small amount of dark chocolate as the coating. The creamy center contains mostly fats and sugar. Eating one of those candies is not as healthy as eating a piece of solid dark chocolate that is the same size. A chocolate drink made with skim milk is better for you than one made with cream or whole milk. Also, many chocolate drink mixes have sugar added to the cocoa. This adds extra calories. Whipped cream on top adds extra fat.

Bottom line

Talk to your physician assistant about how you can eat dark chocolate and still be eating a healthy diet. You do not want to start eating dark chocolate if you have a health problem without talking to your physician assistant first. He or she can help you if you have questions on good eating habits, nutrition, or exercise.

Will a chocolate a day keep the physician assistant away? The answer: probably as much as an apple would.