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"Of course, we need to test whether the cocoa flavanols are
responsible," Buijsse says "A recently published study indeed indicates
that they are. This needs to be confirmed."
His study tracked cocoa, not flavanols. That may be a weakness in the study,
says Norman Hollenberg, MD, PhD, who recently published a .
Hollenberg's study, published in Proceedings of the National Academy of
Sciences, was funded by the candy company Mars Inc., which is developing
flavanol-rich cocoa products.
Cocoa is usually processed to remove bitterness. "Unfortunately, the
bitterness is the flavanoids," Hollenberg tells WebMD. Flavanols are a type
"I am aware that during the production process of chocolate (especially
alkalization and roasting of the cocoa beans), a part of the flavanols is
broken down," Buijsse says. "This may be true to some extent, but
commercially available cocoa foods still contain flavanols," he says.
"Although the flavanol content of commercially available cocoa foods is
lower than that used in certain intervention studies, our results suggest that
these foods may still exert an effect on cardiovascular health," Buijsse
Even so, there's good reason not to go overboard with cocoa and
"Chocolate contains loads of calories because of the sugar and fat in
it," Buijsse writes. "If people eat a lot of chocolate, they inevitably
gain weight. And having a high body weight is a major risk factor for high
blood pressure and CVD."
The Dutch study shows "evidence of protection, but we don't know how
much chocolate produces how much protection, and whether a large amount of
chocolate would produce even more protection. We just don't know,"
Like Buijsse, Hollenberg mentions a need for interventional studies.
Such studies cost "easily tens of millions and commonly hundreds of
millions of dollars, and they take years to do, and you can only do a limited
number of them," Hollenberg says. "So we use evidence from
observational studies of this sort to build our courage. And so we are still
building our courage."