Wine, Chocolate, and Coffee: Forbidden Joys?

Thomas F. Lüscher


Eur Heart J. 2021;42(44):4520-4522. 

In This Article

Chocolate and Cacao

The late Norman Hollenberg heard that the Kuna Indians living on an island outside of Panama consumed lots of salt and paradoxically had low blood pressure and decided to spend a sabbatical there.[9] Indeed, the Kuna Indians ate cacao nuts with salt, yet their blood pressure remained around 110/70 mmHg throughout life. Biochemical analyses of their urine showed that they excrete lots of derivatives of nitric oxide due to the stimulation of nitric oxide synthase by the flavonol epicathechin, an ingredient of cacao beans. Of note, when Kuna Indians move from their island to Panama City this protection is lost.

Chocolate is made out of cacao beans with different amounts of milk and sugar. Cacao may loose the protective epicathecin, depending on how they are dried and roasted. As it turned out dark, bitter chocolate that is adstringent in the cheeks is CV protective. Indeed, dark, but not milk chocolate improves endothelial function in otherwise healthy smokers. This endothelial protection has been confirmed in coronary arteries using the cold pressor test to assess vasomotion.[10] Furthermore, dark chocolate has positive effects on blood pressure, insulin resistance and platelet function (Graphical Abstract). Finally, large registries suggest an inverse relation of chocolate consumption with major CV events, although the evidence is somewhat limited.[11] Chocolate may even improve brain function. The downside is that in particular milk chocolate contains fat and sugar and thus calories that may increase the body weight.