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Indulging in Chocolate May Help Prevent Heart Disease

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Recent research from England suggests that middle-aged and older adults who indulge in up to 3.5 ounces of chocolate a day (equivalent to more than two standard Hershey bars) appear to have lower rates of heart disease compared to those who avoid chocolate.

This conclusion was drawn from a study that tracked the health of nearly 21,000 residents of Norfolk, England, for 11 years. Among the participants with the highest chocolate consumption, 12% developed or died of cardiovascular disease during the study, compared to 17.4% of those who refrained from eating chocolate. The findings were published online in the medical journal Heart.

Desire vs. Evidence

As tempting as it is to believe in the heart-healthy benefits of chocolate, we should not yet equate eating chocolate with consuming fruits, vegetables, and whole grains. All of the large studies, including the one from Norfolk, are observational in nature. This means that researchers gathered information about participants' eating habits, monitored their health, and established statistical connections. Such studies can offer valuable insights, but they cannot prove cause and effect. Randomized trials are necessary to determine that.

It is possible that those who enjoy eating chocolate engage in other heart-protective behaviors, such as eating a wide variety of nutritious foods. Interestingly, participants in the non-chocolate group exhibited higher average weight, more artery-damaging inflammation, increased rates of diabetes, lower physical activity levels, and diets with the least amount of fat compared to chocolate eaters.

Milk Chocolate: A Viable Option?

Previous studies on the chocolate-heart connection primarily found that only dark chocolate provided cardiovascular protection. However, in the Norfolk study, all types of chocolate, including milk chocolate, appeared to have the same beneficial effect.

Scientists remain uncertain about the specific components of chocolate that may bolster heart health. Flavonoids, a type of antioxidant produced by plants, could be the key. These compounds are present in tea, red wine, blueberries, apples, pears, cherries, and nuts.

Flavonoids are particularly abundant in cacao beans, which are seeds of the cacao tree. The process of fermenting, drying, and roasting cacao beans produces cocoa powder, a primary ingredient in chocolate.

Cocoa flavonoids have demonstrated the ability to lower blood pressure, enhance blood flow to the brain and heart, prevent blood clots, and combat cell damage. Additionally, these flavonoids have been shown to improve cognitive function.

No Chocolate Prescription—Yet

While healthcare providers may write prescriptions for exercise or increased consumption of vegetables and fruits, prescribing chocolate is not on the horizon. Nevertheless, they are unlikely to advise against moderate chocolate consumption. As the Norfolk study researchers concluded, "There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk."

No recommended daily amounts have been established for chocolate or cocoa flavonoids. The European Food Safety Authority suggests that a daily intake of 200 mg of cocoa flavonoids is a reasonable target for the general population.

The cocoa content in chocolate varies significantly, and the amount of flavonoids may not always be listed. To maximize potential health benefits, choose dark chocolate, which typically contains more cocoa and flavonoids than milk chocolate, and less sugar and saturated fat.

Aim for chocolate bars with a cocoa content of 70% or higher. Enjoying an ounce of dark chocolate occasionally—alongside other heart-healthy habits—may be a delightful way to support cardiovascular health.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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