Best Evidence Review

Getting to Chocolate's Great Heart of Darkness

Charles P. Vega, MD


November 22, 2011

In This Article


Previous research corroborates the findings of the current meta-analysis. Another meta-analysis comparing the highest and lowest tertiles of chocolate consumption found a relative risk of 0.81 (95% CI, 0.71-0.92) for death from coronary heart disease.[1]

Moreover, chocolate is not the only food that contains flavonoids. Soy products and tea are also rich in flavonoids. A review of randomized trials found that consumption of soy protein can significantly reduce diastolic blood pressure and LDL cholesterol values.[9] Although consuming black tea raised blood pressure temporarily, regularly drinking green tea reduced LDL cholesterol levels. It is worth noting that chocolate had more profound effects in lowering blood pressure than did soy protein and tea in this study.

Cocoa is prepared in myriad ways, and physicians should also consider that most clinical trials focus on the use of cocoa and dark chocolate with the highest concentrations of flavonoids. But this form of chocolate is less popular among consumers, who prefer lighter chocolate. Patients considering the potential health benefits of chocolate need to understand this point, as underlined in a study comparing dark chocolate rich in flavonoids with white chocolate, which is practically devoid of flavonoids.[10] Researchers found that dark chocolate significantly improved coronary blood flow as measured by Doppler echocardiography. In contrast, white chocolate had no effect on coronary flow.

The degree to which any cardiovascular benefit of chocolate is diluted by the sugar and fat added to the final product remains a substantial unknown. However, the effect of sweets in the current obesity epidemic may well be overstated. A recent study of national data from the United States found that although adults who ate more chocolate and sugar-containing candy consumed more total calories, saturated fats, and added sugars, they had lower body mass index values, mean waist circumference, and serum C-reactive protein values than did nonconsumers.[11] Candy and chocolate were also associated with some improvements in blood pressure and metabolic parameters.


Man does not live on bread alone. Nor does he live solely on steamed vegetables. Patients will always snack and have their dietary guilty pleasures. But now physicians can help these individuals make healthier choices among the items they crave but may be afraid to eat or drink. A glass of wine with dinner? That could benefit your cardiovascular health.[12] That extra cup of coffee in the morning?[13] It might help to prevent diabetes. And now we can consider adding flavonoid-rich dark chocolate and cocoa -- in moderation -- to that list of treats.

Can the deep-fried Quadruple BaConquest sandwich available at your local fast food restaurant be far behind on that list? Well, yes, it probably is.


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