How cocoa supplements support heart health.

You hear it almost every day, be it government health agencies or private organizations, the unanimous directive is for Americans to eat more fruits and vegetables.

Despite constant media publicity, the majority of Americans do not ingest enough fruits and vegetables each day. Yet, scientists are increasingly telling Americans they must consume more to avoid a myriad of age-related problems.

However, one plant is not considered enough by the experts: cocoa. An abundance of new research shows that the unique antioxidants in cocoa provide broad-spectrum benefits to the arterial system.

Beneficial for Blood Pressure
Like all plants, cocoa contains antioxidants widely known as polyphenols. In particular, cocoa is rich in epicatechin, a polyphenol belonging to a class of antioxidants called flavonoids. These powerful compounds can support your heart by reducing risk factors, including high blood pressure.

Researchers from the University of Bonn in Germany showed that a daily intake of 25 mg of epicatechin could lower systolic blood pressure by 4.1 points and diastolic pressure by 2.0 points (1). By the way, we know that these changes probably seem trivial, but any reduction in blood pressure is a good thing.

Mull this one over in your brain: A retrospective, population-based analysis of 26 million people revealed a 200–400% higher mortality rate in hypertensive people between the ages of 20 and 49 when compared with a healthy population (2).

Can you see my point? Even seemingly trivial reductions in blood pressure can have a major impact on health and longevity.

Additionally, the researchers claim that a reduction of systolic pressure by just two points can reduce the risk of death after a stroke by 10% and reduce the risk of death from ischemic heart disease by 7%. In the end, small drops in blood pressure actually produce big drops in risk.

So, here are the details of the cocoa study (1):
• The German researchers analyzed the effects of cocoa, specifically epicatechin, on blood pressure by looking at several randomized clinical studies. It was kind of like a “mega” review.
• They found that the potential blood pressure-lowering effects of cocoa antioxidants were linked to the dose consumed. The more you eat, the greater the drop in pressure.
• They discovered that at least 25 mg of epicatechin is needed to produce a reduction in blood pressure.
• The scientists involved with the study believe that cocoa polyphenols increase the production of nitric oxide, which dilates blood vessels and drops pressure.

The researchers concluded, “Even if the blood pressure-reducing effect by epicatechin is restricted to pre-hypertensive and hypertensive subjects, we have to be aware that these are the primary groups who may benefit from this measure for prevention of and therapy for high blood pressure.”

Supporting Lipid Levels
A consistent finding amongst human clinical trials is that the ingestion of cocoa antioxidants modestly lowers dangerous LDL, and in some cases, significantly boosts beneficial HDL. One challenge in protecting against atherosclerosis in aging people is that their HDL levels often decline.

People with high levels of HDL have low vascular disease rates. Several years ago, a major American drug company spent about $1 billion for a synthetic compound that boosted HDL. The very unfortunate side effect of this drug was increased risk of mortality and human studies were halted. Ingestion of plant antioxidants, on the other hand, results in decreased risks of a wide range of degenerative diseases.

In a human study conducted this year, those receiving cocoa antioxidants showed an astounding 24% increase in HDL levels after 12 weeks compared to only 5% in the placebo group. The cocoa antioxidant group also showed a reduced measurement of markers of oxidative stress in the body by 24%, while a measurement of LDL oxidation was lowered by 9%. The placebo group did not show improvement (3).

A second human study showed that after only three weeks of consuming dark chocolate, test subjects showed an 11.4% increase in HDL levels. In the group receiving dark chocolate enriched with cocoa antioxidants, a 13.7% increase in artery-protecting HDL was observed. The white chocolate group did not show these beneficial increases in HDL, but all three groups  showed a decrease of LDL oxidation by 11.9% (4).

A decrease in LDL oxidation rates is a consistent finding in those who ingest cocoa antioxidants. It is the oxidation of LDL that enables this lipid to play such a significant role in the atherosclerosis process.

Very few compounds increase beneficial HDL. Up until now, the most effective way of boosting this artery-protecting lipid has been to use relatively high doses of niacin. The unpleasant “niacin flush” precludes most people from taking this vitamin in high enough doses.

The favorable effect on HDL shown in recent studies indicates that it might be possible to tolerably increase endothelial-protecting HDL by ingesting dark chocolate and/or standardized cocoa antioxidants supplements.

How Many Cocoa Polyphenols Do We Need?
Remember, studies documenting the remarkable benefits of chocolate-cocoa antioxidants were relatively short term, and often used standardized products with higher amounts of antioxidants rather than commercial, sugar-laden chocolate bars.

The encouraging news is that there are now cocoa products standardized to higher amounts of antioxidants that are free of sugar and excess fat. Low-cost cocoa antioxidant-standardized supplements are also available. The optimal dose of chocolate-cocoa polyphenols may be 100–130 mg a day.

Healthy Dark Chocolate Candy Bars
The amount of antioxidant-containing cocoa used to make dark chocolate bars varies widely, making it difficult to obtain a consistent polyphenol dose from commercial candy products. The major problem with typical chocolate candy bars, however, is that they contain hundreds of fat and sugar calories.

Intentionally adding chocolate candy to a diet already too high in calories could create as many health problems as what the cocoa polyphenols helps to prevent. So, which dark chocolate bar should be chosen? The ideal is dark chocolate that has at least 70% cocoa solids, because the higher the percentage of cocoa solids, the more antioxidants, specifically epicatechin, it provides.

Dark chocolate, also called plain chocolate or black chocolate, is produced by adding fat and sugar to cocoa liquor (liquefied pure chocolate). The United States has no official definition for dark chocolate, but European rules specify a minimum of 35% cocoa solids.

So, don’t just eat ones that say, “Made with dark chocolate.” Make sure it has the correct amount of cocoa solids. WF

Michael A. Smith, M.D., is senior health science specialist and media personality for Life Extension® in Fort Lauderdale, FL. He is the host of Healthy Talk radio on WWNN-AM reaching the greater Miami area audience, a recurring guest on The Suzanne Show with Suzanne Somers and is currently writing a book on the dietary supplement pyramid that is scheduled for publication in June 2013.

1. S. Ellinger, et al., “Epicatechin Ingested via Cocoa Products Reduces Blood Pressure in Humans: A Nonlinear Regression Model with a Bayesian Approach,” Am. J. Clin. Nutr. 95, 1365–1377 (2012).
2. C. Robitaille, et al., “Diagnosed Hypertension in Canada: Incidence, Prevalence and Associated Mortality,” CMAJ,184 (1), E49–E56 (2012), released online November 21, 2011.
3. S. Baba, et al., “Continuous Intake of Polyphenolic Compounds Containing Cocoa Powder Reduces LDL Oxidative Susceptibility and has Beneficial Effects on Plasma HDL-Cholesterol Concentrations in Humans,” Am. J. Clin. Nutr. 85 (3), 709–717 (2007).
4. J. Mursu, et al., “Dark Chocolate Consumption Increases HDL Cholesterol Concentration and Chocolate Fatty Acids May Inhibit Lipid Peroxidation in Healthy Humans,” Free Radic. Biol. Med. 37 (9), 1351–1359 (2004).

Published in WholeFoods Magazine, April 2013