COCOA

OTHER NAME(S):

3,7-dihydro-3,7-dimethyl-1h-purine-2 6-dione, Beurre de Cacao, Cacao, Chocolat, Chocolat Noir, Chocolate, Cocoa Bean, Cocoa Butter, Cocoa Oleum, Cocoa Seed, Cocoa Semen, Cocoa Testae, Dark Chocolate, Dutch Chocolate, Fève de Cacao, Graine de Cacao, Theobroma, Theobroma cacao, Theobroma sativum, Theobromine, Théobromine.<br/><br/>

Overview

Overview Information

Cocoa is the plant from which chocolate is made. Bitter chocolate is produced by pressing roasted cocoa kernels (seeds) between hot rollers. Cocoa powder is produced by squeezing the fat (cocoa butter) from bitter chocolate and powdering the remaining material. Sweet chocolate is produced by adding sugar and vanilla to bitter chocolate. White chocolate contains sugar, cocoa butter, and milk solids.

Long regarded as a food treat, cocoa is now used by some people as medicine. Cocoa is commonly used by mouth for heart disease and high blood pressure. There is some scientific research that supports these uses. Some people apply cocoa butter to the skin to prevent wrinkles and stretch marks or take cocoa orally to treat many other conditions, including liver, bladder, and kidney disease and memory loss. But there is limited scientific research to support these other uses.

How does it work?

Cocoa contains a variety of chemicals, including antioxidants called flavonoids. It is not clear how these might work in the body, but they appear to cause relaxation of veins. This could lead to lower blood pressure. These compounds might also reduce the activity of chemicals in the body that promote inflammation or blockage of blood vessels.
Uses

Uses & Effectiveness?

Possibly Effective for

  • Heart disease. Some research shows that eating cocoa lowers the chance of heart disease and death, possibly by lowering blood pressure and improving the function of blood vessels.
  • High blood pressure. Most research shows that eating dark chocolate or cocoa products for 2-18 weeks can lower the top number in a blood pressure reading (systolic blood pressure) by 2.8-4.7 mmHg and the lower number (diastolic blood pressure) by 1.9-2.8 mmHg in people with normal blood pressure or high blood pressure.

Possibly Ineffective for

  • High cholesterol. Cocoa products do not seem to improve cholesterol levels in people with high cholesterol.

Insufficient Evidence for

  • Aging skin. Some research suggests that taking cocoa extract alone or in combination with other ingredients might improve skin wrinkles, elasticity, and roughness.
  • Chronic fatigue syndrome. Early research suggests that consuming a large amount of cocoa daily can reduce fatigue, anxiety, and depression and increase the overall ability to function in people with chronic fatigue syndrome.
  • Cirrhosis. Research suggests that consuming a liquid meal plus dark chocolate can improve liver health in people with cirrhosis.
  • Mental function. Evidence on the effects of cocoa for improving mental function is mixed. Some research shows that cocoa might improve some aspects of mental function. Other research show no benefit.
  • Constipation. Early research suggests that taking cocoa daily might soften stools in children with constipation..
  • Diabetes. Early research suggests that cocoa might reduce insulin resistance and improve sensitivity. However, cocoa does not appear to affect blood sugar levels.
  • Insect repellant. Early research suggests that applying cocoa oil to the skin reduces black fly insect bites.
  • High blood pressure in which only the first number (systolic pressure) is too high (isolated systolic hypertension). Early research suggests that eating 100 grams of dark chocolate that is rich in cocoa flavonoids daily might slightly reduce systolic and diastolic blood pressure in elderly people with isolated systolic hypertension.
  • Parkinson’s disease. Early research suggests that eating 200 mg of dark chocolate does not improve movement in people with Parkinson’s disease.
  • Weight loss. Early research suggests that following a reduced-calorie diet, eating two squares of dark chocolate, and drinking a sugar-free cocoa beverage daily for 18 weeks does not increase weight loss.
  • Intestinal disease.
  • Diarrhea.
  • Asthma.
  • Bronchitis.
  • Lung congestion.
  • Liver.
  • Bladder and kidney ailments.
  • Preventing wrinkles.
  • Preventing stretch marks during pregnancy.
  • Other conditions.
More evidence is needed to rate the effectiveness of cocoa for these uses.

Side Effects

Side Effects & Safety

Eating cocoa is LIKELY SAFE for most people. Cocoa contains caffeine and related chemicals. Eating large amounts might cause caffeine-related side effects such as nervousness, increased urination, sleeplessness, and a fast heartbeat.

Cocoa can cause allergic skin reactions, constipation, and might trigger migraine headaches. It can also cause digestive complaints including nausea, intestinal discomfort, stomach rumbling, and gas.

Applying cocoa butter to the skin is also LIKELY SAFE for most people. It can, however, cause a rash.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Cocoa is POSSIBLY SAFE in pregnancy and during breast-feeding when used in moderate amounts or in amounts commonly found in foods. But be sure to monitor your intake.

Cocoa in larger amounts is POSSIBLY UNSAFE because of the caffeine it contains. Caffeine found in cocoa crosses the placenta producing fetal blood concentrations similar to the mother’s levels. Although controversial, some evidence suggests that high doses of caffeine during pregnancy might be associated with premature delivery, low birth weight, and miscarriage. Some experts advise keeping caffeine consumption below 200 mg per day during pregnancy. Keep in mind that chocolate products provide 2-35 mg caffeine per serving and a cup of hot chocolate provides approximately 10 mg.

Caffeine is also a concern during breast-feeding. Breast milk concentrations of caffeine are thought to be approximately half the level of caffeine in the mother’s blood. If the mother eats too much chocolate (16 oz per day), the nursing infant may become irritable and have too frequent bowel movements because of the caffeine.

Anxiety: There is a concern that the caffeine in large amounts of cocoa might make anxiety disorders worse.

Bleeding disorders: Cocoa can slow blood clotting. Consuming a lot of cocoa might increase the risk of bleeding and bruising in people with bleeding disorders.

Heart conditions: Cocoa contains caffeine. The caffeine in cocoa might cause irregular heartbeat in some people and should be used cautiously in people with heart conditions.

Diabetes: Cocoa seems to be able to raise blood sugar levels and might interfere with blood sugar control in people with diabetes.

Diarrhea. Cocoa contains caffeine. The caffeine in cocoa, especially when taken in large amounts, can worsen diarrhea.

Gastroesophageal Reflux Disease (GERD): Cocoa seems to hinder the effectiveness of the valve in the food tube (esophagus) that keeps the contents of the stomach from coming back into the food tube or the airway. This could make the symptoms of GERD worse.

Glaucoma: Cocoa contains caffeine. The caffeine in cocoa increases pressure in the eye and should be used cautiously in people with glaucoma.

High blood pressure: Cocoa contains caffeine. The caffeine in cocoa might increase blood pressure in people with high blood pressure. However, for people who already consume a lot of caffeine, it might not cause a big increase.

Irritable bowel syndrome (IBS): Cocoa contains caffeine. The caffeine in cocoa, especially when taken in large amounts, can worsen diarrhea and might worsen symptoms of IBS.

Migraine headaches: Cocoa might trigger migraines in sensitive people.

Osteoporosis: Cocoa contains caffeine. The caffeine in cocoa might increase how much calcium is released in the urine. Cocoa should be used cautiously in people with osteoporosis.

Surgery: Cocoa might interfere with blood sugar control during and after surgical procedures. Stop eating cocoa at least 2 weeks before a scheduled surgery.

Rapid, irregular heartbeat (tachyarrhythmia): Cocoa from dark chocolate can increase heart rate. Cocoa products might also make irregular heartbeat worse.

Interactions

Interactions?

Moderate Interaction

Be cautious with this combination

!
  • Adenosine (Adenocard) interacts with COCOA

    Cocoa contains caffeine. The caffeine in cocoa might block the affects of adenosine (Adenocard). Adenosine (Adenocard) is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop taking cocoa or other caffeine-containing products at least 24 hours before a cardiac stress test.

  • Clozapine (Clozaril) interacts with COCOA

    The body breaks down clozapine (Clozaril) to get rid of it. The caffeine in cocoa seems to decrease how quickly the body breaks down clozapine (Clozaril). Taking cocoa along with clozapine (Clozaril) can increase the effects and side effects of clozapine (Clozaril).

  • Dipyridamole (Persantine) interacts with COCOA

    Cocoa contains caffeine. The caffeine in cocoa might block the affects of dipyridamole (Persantine). Dipyridamole (Persantine) is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop drinking cocoa or other caffeine-containing products at least 24 hours before a cardiac stress test.

  • Ergotamine (Ergomar) interacts with COCOA

    Cocoa contains caffeine. Caffeine can increase how much ergotamine (Ergomar) the body absorbs. Taking cocoa along with ergotamine (Ergomar) might increase the effects and side effects of ergotamine.

  • Estrogens interacts with COCOA

    The body breaks down the caffeine in cocoa to get rid of it. Estrogens can decrease how quickly the body breaks down caffeine. Taking caffeine along with estrogens might cause jitteriness, headache, fast heartbeat, and other side effects. If you take estrogens limit your caffeine intake.<br/><br/> Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.

  • Lithium interacts with COCOA

    You body naturally gets rid of lithium. The caffeine in cocoa can increase how quickly your body gets rid of lithium. If you take products that contain caffeine and you take lithium, stop taking caffeine products slowly. Stopping caffeine too quickly can increase the side effects of lithium.

  • Medications for asthma (Beta-adrenergic agonists) interacts with COCOA

    Cocoa contains caffeine. Caffeine can stimulate the heart. Some medications for asthma can also stimulate the heart. Taking caffeine with some medications for asthma might cause too much stimulation and cause heart problems.<br/><br/> Some medications for asthma include albuterol (Proventil, Ventolin, Volmax), metaproterenol (Alupent), terbutaline (Bricanyl, Brethine), and isoproterenol (Isuprel).

  • Medications for depression (MAOIs) interacts with COCOA

    Cocoa contains caffeine. Caffeine can stimulate the body. Some medications used for depression can also stimulate the body. Consuming cocoa with these medications used for depression might cause too much stimulation. This could cause serious side effects including fast heartbeat, high blood pressure, nervousness, and others.<br/><br/> Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.

  • Medications for diabetes (Antidiabetes drugs) interacts with COCOA

    Cocoa might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, cocoa might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.<br/><br/> Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

  • Phenylpropanolamine interacts with COCOA

    The caffeine in cocoa can stimulate the body. Phenylpropanolamine can also stimulate the body. Taking cocoa along with phenylpropanolamine might cause too much stimulation and increase heartbeat, blood pressure, and cause nervousness.

  • Theophylline interacts with COCOA

    Cocoa contains caffeine. Caffeine works in similar ways in the body as theophylline. Caffeine can also decrease how quickly the body gets rid of theophylline. Taking cocoa along with theophylline might increase the effects and side effects of theophylline.

Minor Interaction

Be watchful with this combination

!
  • Antibiotics (Quinolone antibiotics) interacts with COCOA

    The body breaks down caffeine to get rid of it. Some antibiotics might decrease how quickly the body breaks down caffeine. Taking these antibiotics along with cocoa can increase the risk of side effects including jitteriness, headache, increased heart rate, and other side effects.<br/><br/> Some antibiotics that decrease how quickly the body breaks down caffeine include ciprofloxacin (Cipro), enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar).

  • Birth control pills (Contraceptive drugs) interacts with COCOA

    The body breaks down the caffeine in cocoa to get rid of it. Birth control pills can decrease how quickly the body breaks down caffeine. Taking cocoa along with birth control pills can cause jitteriness, headache, fast heartbeat, and other side effects.<br/><br/> Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.

  • Cimetidine (Tagamet) interacts with COCOA

    Cocoa contains caffeine. The body breaks down caffeine to get rid of it. Cimetidine (Tagamet) can decrease how quickly your body breaks down caffeine. Taking cimetidine (Tagamet) along with cocoa might increase the chance of caffeine side effects including jitteriness, headache, fast heartbeat, and others.

  • Disulfiram (Antabuse) interacts with COCOA

    The body breaks down caffeine to get rid of it. Disulfiram (Antabuse) can decrease how quickly the body gets rid of caffeine. Taking cocoa (which contains caffeine) along with disulfiram (Antabuse) might increase the effects and side effects of caffeine including jitteriness, hyperactivity, irritability, and others.

  • Fluconazole (Diflucan) interacts with COCOA

    Cocoa contains caffeine. The body breaks down caffeine to get rid of it. Fluconazole (Diflucan) might decrease how quickly the body gets rid of caffeine. Fluconazole (Diflucan) might cause caffeine to stay in the body too long. Taking cocoa along with fluconazole (Diflucan) might increase the risk of caffeine side effects such as nervousness, anxiety, and insomnia.

  • Mexiletine (Mexitil) interacts with COCOA

    Cocoa contains caffeine. The body breaks down caffeine to get rid of it. Mexiletine (Mexitil) can decrease how quickly the body breaks down caffeine. Taking Mexiletine (Mexitil) along with cocoa might increase the caffeine effects and side effects of cocoa.

  • Verapamil (Calan, Covera, Isoptin, Verelan) interacts with COCOA

    The body breaks down the caffeine in cocoa to get rid of it. Verapamil (Calan, Covera, Isoptin, Verelan) can decrease how quickly the body gets rid of caffeine. Taking caffeine along with verapamil (Calan, Covera, Isoptin, Verelan) can increase the risk of caffeine side effects including jitteriness, headache, and an increased heartbeat.

Dosing

Dosing

The following doses have been studied in scientific research:

BY MOUTH:

  • For heart disease: Cocoa 19-54 grams daily, dark chocolate 46-100 grams daily, or cocoa products containing 16.6-1080 mg of cocoa polyphenols daily.
  • For high blood pressure: Chocolate or cocoa providing 25-1,080 mg of cocoa polyphenols daily.

View References

REFERENCES:

  • Selmi, C., Cocchi, C. A., Lanfredini, M., Keen, C. L., and Gershwin, M. E. Chocolate at heart: the anti-inflammatory impact of cocoa flavanols. Mol.Nutr Food Res 2008;52(11):1340-1348. View abstract.
  • Shiina, Y., Funabashi, N., Lee, K., Murayama, T., Nakamura, K., Wakatsuki, Y., Daimon, M., and Komuro, I. Acute effect of oral flavonoid-rich dark chocolate intake on coronary circulation, as compared with non-flavonoid white chocolate, by transthoracic Doppler echocardiography in healthy adults. Int J Cardiol. 1-24-2009;131(3):424-429. View abstract.
  • Shrime, M. G., Bauer, S. R., McDonald, A. C., Chowdhury, N. H., Coltart, C. E., and Ding, E. L. Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies. J Nutr 2011;141(11):1982-1988. View abstract.
  • Sies, H., Schewe, T., Heiss, C., and Kelm, M. Cocoa polyphenols and inflammatory mediators. Am J Clin Nutr 2005;81(1 Suppl):304S-312S. View abstract.
  • Smit, H. J., Gaffan, E. A., and Rogers, P. J. Methylxanthines are the psycho-pharmacologically active constituents of chocolate. Psychopharmacology (Berl) 2004;176(3-4):412-419. View abstract.
  • Sola, R., Valls, R. M., Godas, G., Perez-Busquets, G., Ribalta, J., Girona, J., Heras, M., Cabre, A., Castro, A., Domenech, G., Torres, F., Masana, L., Angles, N., Reguant, J., Ramirez, B., and Barriach, J. M. Cocoa, hazelnuts, sterols and soluble fiber cream reduces lipids and inflammation biomarkers in hypertensive patients: a randomized controlled trial. PLoS.One. 2012;7(2):e31103. View abstract.
  • Sorond, F. A., Hurwitz, S., Salat, D. H., Greve, D. N., and Fisher, N. D. Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people. Neurology 9-3-2013;81(10):904-909. View abstract.
  • Sorond, F. A., Lipsitz, L. A., Hollenberg, N. K., and Fisher, N. D. Cerebral blood flow response to flavanol-rich cocoa in healthy elderly humans. Neuropsychiatr.Dis.Treat. 2008;4(2):433-440. View abstract.
  • Spadafranca, A., Martinez, Conesa C., Sirini, S., and Testolin, G. Effect of dark chocolate on plasma epicatechin levels, DNA resistance to oxidative stress and total antioxidant activity in healthy subjects. Br.J Nutr 2010;103(7):1008-1014. View abstract.
  • Spencer, J. P., Schroeter, H., Rechner, A. R., and Rice-Evans, C. Bioavailability of flavan-3-ols and procyanidins: gastrointestinal tract influences and their relevance to bioactive forms in vivo. Antioxid.Redox.Signal. 2001;3(6):1023-1039. View abstract.
  • Srikanth, R. K., Shashikiran, N. D., and Subba Reddy, V. V. Chocolate mouth rinse: Effect on plaque accumulation and mutans streptococci counts when used by children. J Indian Soc Pedod.Prev Dent. 2008;26(2):67-70. View abstract.
  • Steffen, Y., Schewe, T., and Sies, H. Myeloperoxidase-mediated LDL oxidation and endothelial cell toxicity of oxidized LDL: attenuation by (-)-epicatechin. Free Radic.Res 2006;40(10):1076-1085. View abstract.
  • Steinberg, F. M., Bearden, M. M., and Keen, C. L. Cocoa and chocolate flavonoids: implications for cardiovascular health. J Am.Diet.Assoc. 2003;103(2):215-223. View abstract.
  • Storey, D. M., Koutsou, G. A., Lee, A., Zumbe, A., Olivier, P., Le Bot, Y., and Flourie, B. Tolerance and breath hydrogen excretion following ingestion of maltitol incorporated at two levels into milk chocolate consumed by healthy young adults with and without fasting. J Nutr. 1998;128(3):587-592. View abstract.
  • Stote, K. S., Clevidence, B. A., Novotny, J. A., Henderson, T., Radecki, S. V., and Baer, D. J. Effect of cocoa and green tea on biomarkers of glucose regulation, oxidative stress, inflammation and hemostasis in obese adults at risk for insulin resistance. Eur.J Clin Nutr 2012;66(10):1153-1159. View abstract.
  • Sudano, I., Spieker, L. E., Hermann, F., Flammer, A., Corti, R., Noll, G., and Luscher, T. F. Protection of endothelial function: targets for nutritional and pharmacological interventions. J Cardiovasc.Pharmacol. 2006;47 Suppl 2:S136-S150. View abstract.
  • Sudarma, V., Sukmaniah, S., and Siregar, P. Effect of dark chocolate on nitric oxide serum levels and blood pressure in prehypertension subjects. Acta Med.Indones. 2011;43(4):224-228. View abstract.
  • Thomas, K., Morris, P., and Stevenson, E. Improved endurance capacity following chocolate milk consumption compared with 2 commercially available sport drinks. Appl.Physiol Nutr Metab 2009;34(1):78-82. View abstract.
  • Todd, S., Corsnitz, D., Ray, S., and Nassar, J. Outpatient laparoscopic Nissen fundoplication. AORN J 2002;75(5):956, 959-4. View abstract.
  • Tokede, O. A., Gaziano, J. M., and Djousse, L. Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis. Eur.J Clin Nutr 2011;65(8):879-886. View abstract.
  • Tomas-Barberan, F. A., Cienfuegos-Jovellanos, E., Marin, A., Muguerza, B., Gil-Izquierdo, A., Cerda, B., Zafrilla, P., Morillas, J., Mulero, J., Ibarra, A., Pasamar, M. A., Ramon, D., and Espin, J. C. A new process to develop a cocoa powder with higher flavonoid monomer content and enhanced bioavailability in healthy humans. J Agric.Food Chem. 5-16-2007;55(10):3926-3935. View abstract.
  • Umemura, T., Ueda, K., Nishioka, K., Hidaka, T., Takemoto, H., Nakamura, S., Jitsuiki, D., Soga, J., Goto, C., Chayama, K., Yoshizumi, M., and Higashi, Y. Effects of acute administration of caffeine on vascular function. Am J Cardiol. 12-1-2006;98(11):1538-1541. View abstract.
  • Urpi-Sarda, M., Monagas, M., Khan, N., Llorach, R., Lamuela-Raventos, R. M., Jauregui, O., Estruch, R., Izquierdo-Pulido, M., and Andres-Lacueva, C. Targeted metabolic profiling of phenolics in urine and plasma after regular consumption of cocoa by liquid chromatography-tandem mass spectrometry. J Chromatogr.A 10-23-2009;1216(43):7258-7267. View abstract.
  • van Dam, R. M., Naidoo, N., and Landberg, R. Dietary flavonoids and the development of type 2 diabetes and cardiovascular diseases: review of recent findings. Curr Opin.Lipidol. 2013;24(1):25-33. View abstract.
  • van den Bogaard, B., Draijer, R., van Montfrans, G. A., and van den Born, B. J. Differential effect of cocoa drinks with low and high theobromine dose on peripheral and central blood pressure: A double blind placebo controlled randomised cross-over trial (abstract). J Hypertens 2010;28:e15.
  • van den Bogaard, B., Draijer, R., Westerhof, B. E., van den Meiracker, A. H., van Montfrans, G. A., and van den Born, B. J. Effects on Peripheral and Central Blood Pressure of Cocoa With Natural or High-Dose Theobromine. A Randomized, Double-Blind Crossover Trial. Hypertension 9-7-2010; View abstract.
  • Venkatesh Babu, N. S., Vivek, D. K., and Ambika, G. Comparative evaluation of chlorhexidine mouthrinse versus cacao bean husk extract mouthrinse as antimicrobial agents in children. Eur.Arch.Paediatr.Dent. 2011;12(5):245-249. View abstract.
  • Vik, T., Bakketeig, L. S., Trygg, K. U., Lund-Larsen, K., and Jacobsen, G. High caffeine consumption in the third trimester of pregnancy: gender-specific effects on fetal growth. Paediatr.Perinat.Epidemiol. 2003;17(4):324-331. View abstract.
  • Vitaglione, P., Barone, Lumaga R., Ferracane, R., Sellitto, S., Morello, J. R., Reguant, Miranda J., Shimoni, E., and Fogliano, V. Human bioavailability of flavanols and phenolic acids from cocoa-nut creams enriched with free or microencapsulated cocoa polyphenols. Br.J Nutr 5-28-2013;109(10):1832-1843. View abstract.
  • Wan, Y., Vinson, J. A., Etherton, T. D., Proch, J., Lazarus, S. A., and Kris-Etherton, P. M. Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Am.J Clin.Nutr. 2001;74(5):596-602. View abstract.
  • Wang-Polagruto, J. F., Villablanca, A. C., Polagruto, J. A., Lee, L., Holt, R. R., Schrader, H. R., Ensunsa, J. L., Steinberg, F. M., Schmitz, H. H., and Keen, C. L. Chronic consumption of flavanol-rich cocoa improves endothelial function and decreases vascular cell adhesion molecule in hypercholesterolemic postmenopausal women. J Cardiovasc.Pharmacol. 2006;47 Suppl 2:S177-S186. View abstract.
  • Westphal, S. and Luley, C. Flavanol-rich cocoa ameliorates lipemia-induced endothelial dysfunction. Heart Vessels 2011;26(5):511-515. View abstract.
  • Williams, S., Tamburic, S., and Lally, C. Eating chocolate can significantly protect the skin from UV light. J Cosmet.Dermatol. 2009;8(3):169-173. View abstract.
  • Wolz, M., Schleiffer, C., Klingelhofer, L., Schneider, C., Proft, F., Schwanebeck, U., Reichmann, H., Riederer, P., and Storch, A. Comparison of chocolate to cacao-free white chocolate in Parkinson's disease: a single-dose, investigator-blinded, placebo-controlled, crossover trial. J Neurol. 2012;259(11):2447-2451. View abstract.
  • Yochum, L., Kushi, L. H., Meyer, K., and Folsom, A. R. Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women. Am.J Epidemiol. 5-15-1999;149(10):943-949. View abstract.
  • Zomer, E., Owen, A., Magliano, D. J., Liew, D., and Reid, C. M. The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model. BMJ 2012;344:e3657. View abstract.
  • Zumbe, A. and Brinkworth, R. A. Comparative studies of gastrointestinal tolerance and acceptability of milk chocolate containing either sucrose, isomalt or sorbitol in healthy consumers and type II diabetics. Z.Ernahrungswiss. 1992;31(1):40-48. View abstract.
  • Abernethy DR, Todd EL. Impairment of caffeine clearance by chronic use of low-dose oestrogen-containing oral contraceptives. Eur J Clin Pharmacol 1985;28:425-8. View abstract.
  • American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-89. View abstract.
  • Aqel RA, Zoghbi GJ, Trimm JR, et al. Effect of caffeine administered intravenously on intracoronary-administered adenosine-induced coronary hemodynamics in patients with coronary artery disease. Am J Cardiol 2004;93:343-6. View abstract.
  • Arts IC, Hollman PC, Kromhout D. Chocolate as a source of tea flavonoids (Letter). Lancet 1999;354:488. View abstract.
  • Avisar R, Avisar E, Weinberger D. Effect of coffee consumption on intraocular pressure. Ann Pharmacother 2002;36:992-5.. View abstract.
  • Bara AI, Barley EA. Caffeine for asthma. Cochrane Database Syst Rev 2001;4:CD001112.. View abstract.
  • Baron AM, Donnerstein RL, Samson RA, et al. Hemodynamic and electrophysiologic effects of acute chocolate ingestion in young adults. Am J Cardiol 1999;84:370-3. View abstract.
  • Basu A, Betts NM, Leyva MJ, Fu D, Aston CE, Lyons TJ. Acute cocoa supplementation increases postprandial HDL cholesterol and insulin in obese adults with type 2 diabetes after consumption of a high-fat breakfast. J Nutr 2015;145(10):2325-32. View abstract.
  • Beach CA, Mays DC, Guiler RC, et al. Inhibition of elimination of caffeine by disulfiram in normal subjects and recovering alcoholics. Clin Pharmacol Ther 1986;39:265-70. View abstract.
  • Bell DG, Jacobs I, Ellerington K. Effect of caffeine and ephedrine ingestion on anaerobic exercise performance. Med Sci Sports Exerc 2001;33:1399-403. View abstract.
  • Benowitz NL, Osterloh J, Goldschlager N, et al. Massive catecholamine release from caffeine poisoning. JAMA 1982;248:1097-8. View abstract.
  • Bracken MB, Triche EW, Belanger K, et al. Association of maternal caffeine consumption with decrements in fetal growth. Am J Epidemiol 2003;157:456-66.. View abstract.
  • Briggs GB, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998.
  • Brown NJ, Ryder D, Branch RA. A pharmacodynamic interaction between caffeine and phenylpropanolamine. Clin Pharmacol Ther 1991;50:363-71. View abstract.
  • Bruinsma K, Taren DL. Chocolate: Food or Drug? J Am Diet Assoc 1999;99:1249-58. View abstract.
  • Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med 2006;166:411-7. View abstract.
  • Burnham TH, ed. Drug Facts and Comparisons, Updated Monthly. Facts and Comparisons, St. Louis, MO.
  • Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced cardiac arrhythmia: an unrecognised danger of healthfood products. Med J Aust 2001;174:520-1. View abstract.
  • Carbo M, Segura J, De la Torre R, et al. Effect of quinolones on caffeine disposition. Clin Pharmacol Ther 1989;45:234-40. View abstract.
  • Cardiovascular Benefits Claimed For Cocoa Flavonoids. www.medscape.com/reuters/prof/2000/02/02.21/dd02210b.html (Accessed 21 February 2000).
  • Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet 2000;39:127-53. View abstract.
  • Chiu KM. Efficacy of calcium supplements on bone mass in postmenopausal women. J Gerontol A Biol Sci Med Sci 1999;54:M275-80. View abstract.
  • Cone EH, Lange R, Darwin WD. In vivo adulteration: excess fluid ingestion causes false-negative marijuana and cocaine urine test results. J Anal Toxicol 1998;22:460-73. View abstract.
  • Connor WE. Harbingers of coronary heart disease: dietary saturated fatty acids and cholesterol. Is chocolate benign because of its stearic acid content? Am J Clin Nutr 1999;70:951-2.
  • Desideri G, Kwik-Uribe C, Grassi D, et al. Benefits in cognitive function, blood pressure, and insulin resistance through cocoa flavanol consumption in elderly subjects with mild cognitive impairment: the Cocoa, Cognition, and Aging (CoCoA) study. Hypertension 2012;60:794-801. View abstract.
  • Dietrich R, Paglieroni TG, Wun T, et al. Cocoa inhibits platelet activation and function. Am J Clin Nutr 2000;72:30-5.
  • Durrant KL. Known and hidden sources of caffeine in drug, food, and natural products. J Am Pharm Assoc 2002;42:625-37. View abstract.
  • Eby GA. Zinc ion availability--the determinant of efficacy in zinc lozenge treatment of common colds. J Antimicrob Chemother 1997;40:483-93. View abstract.
  • Ellinger S, Reusch A, Stehle P, Helfrich HP. Epicatechin ingested via cocoa products reduces blood pressure in humans: a nonlinear regression model with a Bayesian approach. Am J Clin Nutr 2012;95(6):1365-77. View abstract.
  • Eskenazi B. Caffeine—filtering the facts. N Engl J Med 1999;341:1688-9. View abstract.
  • Fernandes O, Sabharwal M, Smiley T, et al. Moderate to heavy caffeine consumption during pregnancy and relationship to spontaneous abortion and abnormal fetal growth: a meta-analysis. Reprod Toxicol 1998;12:435-44. View abstract.
  • Flammer AJ, Hermann F, Sudano I, et al. Dark chocolate improves coronary vasomotion and reduces platelet reactivity. Circulation 2007;116:2376-82. View abstract.
  • Forrest WH Jr, Bellville JW, Brown BW Jr. The interaction of caffeine with pentobarbital as a nighttime hypnotic. Anesthesiology 1972;36:37-41. View abstract.
  • Friedman G. Diet and the irritable bowel syndrome. Gastroenterol Clin North Am 1991;20:313-24. View abstract.
  • Fuhr U. Drug Interactions with Grapefruit Juice. Drug Saf 1998;18:251-72. View abstract.
  • Goldberg LD, Crysler C. A single center, pilot, double-blinded, randomized, comparative, prospective clinical study to evaluate improvements in the structure and function of facial skin with tazarotene 0.1% cream alone and in combination with GliSODin(®) Skin Nutrients Advanced Anti-Aging Formula. Clin Cosmet Investig Dermatol 2014;7:139-44. View abstract.
  • Gonzalez-Seijo JC, Ramos YM, Lastra I. Manic episode and ginseng: Report of a possible case. J Clin Psychopharmacol 1995;15:447-8. View abstract.
  • Grassi D, Lippi C, Necozione S, et al. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr 2005;81:611-14. View abstract.
  • Grassi D, Necozione S, Lippi C, et al. Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 2005;46:398-405. View abstract.
  • Hagg S, Spigset O, Mjorndal T, Dahlqvist R. Effect of caffeine on clozapine pharmacokinetics in healthy volunteers. Br J Clin Pharmacol 2000;49:59-63. View abstract.
  • Haller CA, Benowitz NL, Jacob P 3rd. Hemodynamic effects of ephedra-free weight-loss supplements in humans. Am J Med 2005;118:998-1003.. View abstract.
  • Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343:1833-8. View abstract.
  • Harder S, Fuhr U, Staib AH, Wolff T. Ciprofloxacin-caffeine: a drug interaction established using in vivo and in vitro investigations. Am J Med 1989;87:89S-91S. View abstract.
  • Healy DP, Polk RE, Kanawati L, et al. Interaction between oral ciprofloxacin and caffeine in normal volunteers. Antimicrob Agents Chemother 1989;33:474-8. View abstract.
  • Heiss C, Dejam A, Kleinbongard P, et al. Vascular effects of cocoa rich in flavan-3-ols. JAMA 2003;290:1030-1. View abstract.
  • Hentschel C, Dressler S, Hahn EG. Fumaria officinalis (fumitory)-clinical applications. Fortschr Med 1995;113:291-2. View abstract.
  • Hertog MG, Feskens EJ, Hollman PC, et al. Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen Elderly Study. Lancet 1993;342:1007-1011. View abstract.
  • Hollenberg NK, Fisher ND. Is it the dark in dark chocolate? Circulation 2007;116:2360-2. View abstract.
  • Hooper L, Kay C, Abdelhamid A, et al. Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials. Am J Clin Nutr 2012;95:740-51. View abstract.
  • Hu FB, Stampfer MJ, Manson JE, et al. Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J Clin Nutr 1999;70:1001-8. View abstract.
  • Hurrell RF, Reddy M, Cook JD. Inhibition of non-haem iron absorption in man by polyphenolic-containing beverages. Br J Nutr 1999;81:289-95. View abstract.
  • Institute of Medicine. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington, DC: National Academy Press, 2001. Available at: http://books.nap.edu/books/0309082587/html/index.html.
  • Jefferson JW. Lithium tremor and caffeine intake: two cases of drinking less and shaking more. J Clin Psychiatry 1988;49:72-3. View abstract.
  • Joeres R, Klinker H, Heusler H, et al. Influence of mexiletine on caffeine elimination. Pharmacol Ther 1987;33:163-9. View abstract.
  • Klebanoff MA, Levine RJ, DerSimonian R, et al. Maternal serum paraxanthine, a caffeine metabolite, and the risk of spontaneous abortion. N Engl J Med 1999;341:1639-44. View abstract.
  • Kockler DR, McCarthy MW, Lawson CL. Seizure activity and unresponsiveness after hydroxycut ingestion. Pharmacotherapy 2001;21:647-51.. View abstract.
  • Kris-Etherton PM, Derr J, Mitchell DC, et al. The role of fatty acid saturation on plasma lipids, lipoproteins, & apolipoproteins: I. Effects of whole food diets high in cocoa butter, olive oil, soybean oil, dairy butter, & milk chocolate on the plasma lipids of young men. Metabolism 1993;42:121-9. View abstract.
  • Kynast-Gales SA, Massey LK. Effect of caffeine on circadian excretion of urinary calcium and magnesium. J Am Coll Nutr. 1994;13:467-72. View abstract.
  • Lake CR, Rosenberg DB, Gallant S, et al. Phenylpropanolamine increases plasma caffeine levels. Clin Pharmacol Ther 1990;47:675-85. View abstract.
  • Lamport DJ, Pal D, Moutsiana C, et al. The effect of flavanol-rich cocoa on cerebral perfusion in healthy older adults during conscious resting state: a placebo controlled, crossover, acute trial. Psychopharmacology (Berl) 2015;232(17):3227-34. View absract.
  • Lane JD, Barkauskas CE, Surwit RS, Feinglos MN. Caffeine impairs glucose metabolism in type 2 diabetes. Diabetes Care 2004;27:2047-8. View abstract.
  • Massey LK, Whiting SJ. Caffeine, urinary calcium, calcium metabolism and bone. J Nutr 1993;123:1611-4. View abstract.
  • Massey LK. Is caffeine a risk factor for bone loss in the elderly? Am J Clin Nutr 2001;74:569-70. View abstract.
  • Mastroiacovo D, Kwik-Uribe C, Grassi D, et al. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study-a randomized controlled trial. Am J Clin Nutr 2015;101(3):538-48. View abstract.
  • Mester R, Toren P, Mizrachi I, et al. Caffeine withdrawal increases lithium blood levels. Biol Psychiatry 1995;37:348-50. View abstract.
  • Mustad VA, Kris-Etherton PM, Derr J, et al. Comparison of the effects of diets rich in stearic acid versus myristic acid and lauric acid on platelet fatty acids and excretion of thromboxane A2 and PGI2 metabolites in healthy young men. Metabolism 1993;42:463-9. View abstract.
  • Neufingerl N, Zebregs YE, Schuring EA, Trautwein EA. Effect of cocoa and theobromine consumption on serum HDL-cholesterol concentrations: a randomized controlled trial. Am J Clin Nutr 2013;97(6):1201-9. View absract.
  • Nix D, Zelenitsky S, Symonds W, et al. The effect of fluconazole on the pharmacokinetics of caffeine in young and elderly subjects. Clin Pharmacol Ther 1992;51:183.
  • Nurminen ML, Niittynen L, Korpela R, Vapaatalo H. Coffee, caffeine and blood pressure: a critical review. Eur J Clin Nutr 1999;53:831-9. View abstract.
  • O'Callaghan A, van Sinderen D. Bifidobacteria and Their Role as Members of the Human Gut Microbiota. Front Microbiol. 2016 Jun 15;7:925. View abstract.
  • Olivares M, Castillejo G, Varea V, Sanz Y. Double-blind, randomised, placebo-controlled intervention trial to evaluate the effects of Bifidobacterium longum CECT 7347 in children with newly diagnosed coeliac disease. Br J Nutr. 2014 Jul 14;112(1):30-40. View abstract.
  • Ottaviani JI, Balz M, Kimball J, et al. Safety and efficacy of cocoa fl avanol intake in healthy adults: a randomized, controlled, double-masked trial. Am J Clin Nutr 2015;102(6):1425-35. View abstract.
  • Pase MP, Scholey AB, Pipingas A, et al. Cocoa polyphenols enhance positive mood states but not cognitive performance: a randomized, placebo-controlled trial. J Psychopharmacol 2013;27(5):451-8. View abstract.
  • Peirce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York, NY: William Morrow and Co., 1999.
  • Petrie HJ, Chown SE, Belfie LM, et al. Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss. Am J Clin Nutr 2004;80:22-8. View abstract.
  • Pollock BG, Wylie M, Stack JA, et al. Inhibition of caffeine metabolism by estrogen replacement therapy in postmenopausal women. J Clin Pharmacol 1999;39:936-40. View abstract.
  • R, Rodriguez-Mateos A, Heuel J, et al.; Flaviola Consortium, European Union 7th Framework Program. Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study. Br J Nutr 2015;114(8):1246-55. View abstract.
  • Raaska K, Raitasuo V, Laitila J, Neuvonen PJ. Effect of caffeine-containing versus decaffeinated coffee on serum clozapine concentrations in hospitalised patients. Basic Clin Pharmacol Toxicol 2004;94:13-8. View abstract.
  • Rapuri PB, Gallagher JC, Kinyamu HK, Ryschon KL. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr 2001;74:694-700. View abstract.
  • Sanderink GJ, Bournique B, Stevens J, et al. Involvement of human CYP1A isoenzymes in the metabolism and drug interactions of riluzole in vitro. Pharmacol Exp Ther 1997;282:1465-72. View abstract.
  • Schneider DL, Barrett-Connor EL, Morton DJ. Thyroid hormone use and bone mineral density in elderly men. Arch Intern Med 1995;155:2005-7. View abstract.
  • Sinclair CJ, Geiger JD. Caffeine use in sports. A pharmacological review. J Sports Med Phys Fitness 2000;40:71-9. View abstract.
  • Sklar S, et al. Drug therapy screening system. Indianapolis, IN: First Data Bank 99.1-99. 2 eds.
  • Smith A. Effects of caffeine on human behavior. Food Chem Toxicol 2002;40:1243-55. View abstract.
  • Stanek EJ, Melko GP, Charland SL. Xanthine interference with dipyridamole-thallium-201 myocardial imaging. Pharmacother 1995;29:425-7. View abstract.
  • Taubert D, Berkels R, Roesen R, Klaus W. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA 2003;290:1029-30.. View abstract.
  • Taubert D, Roesen R, Lehmann C, et al. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA 2007;298:49-60. View abstract.
  • Taubert D, Roesen R, Schomig E. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 2007;167:626-34. View abstract.
  • The National Toxicology Program (NTP). Caffeine. Center for the Evaluation of Risks to Human Reproduction (CERHR). Available at: http://cerhr.niehs.nih.gov/common/caffeine.html.
  • Underwood DA. Which medications should be held before a pharmacologic or exercise stress test? Cleve Clin J Med 2002;69:449-50. View abstract.
  • Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3. View abstract.
  • Verna R. The history and science of chocolate. Malays J Pathol 2013;35(2):111-21. View abstract.
  • Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al. Effect of dark chocolate on arterial function in healthy individuals. Am J Hypertens 2005;18:785-91.. View abstract.
  • Wahllander A, Paumgartner G. Effect of ketoconazole and terbinafine on the pharmacokinetics of caffeine in healthy volunteers. Eur J Clin Pharmacol 1989;37:279-83. View abstract.
  • Wallach J. Interpretation of Diagnostic Tests. A synopsis of Laboratory Medicine. Fifth ed; Boston, MA: Little Brown, 1992.
  • Watson JM, Jenkins EJ, Hamilton P, et al. Influence of caffeine on the frequency and perception of hypoglycemia in free-living patients with type 1 diabetes. Diabetes Care 2000;23:455-9. View abstract.
  • Watson JM, Sherwin RS, Deary IJ, et al. Dissociation of augmented physiological, hormonal and cognitive responses to hypoglycaemia with sustained caffeine use. Clin Sci (Lond) 2003;104:447-54. View abstract.
  • Yoon HS, Kim JR, Park GY, et al. Cocoa flavanol supplementation influences skin conditions of photo-aged women: a 24-week double-blind, randomized, controlled trial. J Nutr 2016;146(1):46-50. View abstract.
  • Zheng XM, Williams RC. Serum caffeine levels after 24-hour abstention: clinical implications on dipyridamole (201)Tl myocardial perfusion imaging. J Nucl Med Technol 2002;30:123-7. View abstract.
  • Zubair, M. H., Zubair, M. H., Zubair, M. N., Zubair, M. M., Aftab, T., and Asad, F. Augmentation of anti-platelet effects of aspirin. J Pak Med.Assoc. 2011;61(3):304-307. View abstract.
  • Ahmad, N. and Mukhtar, H. Cutaneous photochemoprotection by green tea: a brief review. Skin Pharmacol Appl.Skin Physiol 2001;14(2):69-76. View abstract.
  • Al-Faris, N. A. Short-term consumption of a dark chocolate containing flavanols is followed by a significant decrease in normotensive population. Pakistan J Nutr 2008;7(6):773-781.
  • Al-Safi, S. A., Ayoub, N. M., Al-Doghim, I., and Aboul-Enein, F. H. Dark chocolate and blood pressure: a novel study from Jordan. Curr Drug Deliv. 2011;8(6):595-599. View abstract.
  • Allen, R. R., Carson, L., Kwik-Uribe, C., Evans, E. M., and Erdman, J. W., Jr. Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. J Nutr 2008;138(4):725-731. View abstract.
  • Almoosawi, S., Fyfe, L., Ho, C., and Al-Dujaili, E. The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects. Br.J Nutr 2010;103(6):842-850. View abstract.
  • Alspach, G. The truth is often bittersweet...: chocolate does a heart good. Crit Care Nurse 2007;27(1):11-15. View abstract.
  • Baba, S., Natsume, M., Yasuda, A., Nakamura, Y., Tamura, T., Osakabe, N., Kanegae, M., and Kondo, K. Plasma LDL and HDL cholesterol and oxidized LDL concentrations are altered in normo- and hypercholesterolemic humans after intake of different levels of cocoa powder. J Nutr 2007;137(6):1436-1441. View abstract.
  • Baba, S., Osakabe, N., Kato, Y., Natsume, M., Yasuda, A., Kido, T., Fukuda, K., Muto, Y., and Kondo, K. 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 2007;85(3):709-717. View abstract.
  • Baba, S., Osakabe, N., Yasuda, A., Natsume, M., Takizawa, T., Nakamura, T., and Terao, J. Bioavailability of (-)-epicatechin upon intake of chocolate and cocoa in human volunteers. Free Radic Res 2000;33(5):635-641. View abstract.
  • Balzer, J., Rassaf, T., Heiss, C., Kleinbongard, P., Lauer, T., Merx, M., Heussen, N., Gross, H. B., Keen, C. L., Schroeter, H., and Kelm, M. Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. J Am Coll.Cardiol. 6-3-2008;51(22):2141-2149. View abstract.
  • Beck, A. M., Damkjaer, K., and Beyer, N. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function. Nutrition 2008;24(11-12):1073-1080. View abstract.
  • Beck, A. M., Damkjaer, K., and Sorbye, L. W. Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents. Arch.Gerontol.Geriatr. 2010;50(3):351-355. View abstract.
  • Belz, G. G. and Mohr-Kahaly, S. [Cacoa and dark chocolate in cardiovascular prevention?]. Dtsch.Med.Wochenschr. 2011;136(51-52):2657-2663. View abstract.
  • Berry, N. M., Davison, K., Coates, A. M., Buckley, J. D., and Howe, P. R. Impact of cocoa flavanol consumption on blood pressure responsiveness to exercise. Br.J Nutr 2010;103(10):1480-1484. View abstract.
  • Buitrago-Lopez, A., Sanderson, J., Johnson, L., Warnakula, S., Wood, A., Di, Angelantonio E., and Franco, O. H. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011;343:d4488. View abstract.
  • Camfield, D. A., Scholey, A., Pipingas, A., Silberstein, R., Kras, M., Nolidin, K., Wesnes, K., Pase, M., and Stough, C. Steady state visually evoked potential (SSVEP) topography changes associated with cocoa flavanol consumption. Physiol Behav. 2-28-2012;105(4):948-957. View abstract.
  • Castell, D. O., Murray, J. A., Tutuian, R., Orlando, R. C., and Arnold, R. Review article: the pathophysiology of gastro-oesophageal reflux disease - oesophageal manifestations. Aliment.Pharmacol.Ther. 2004;20 Suppl 9:14-25. View abstract.
  • Castillejo, G., Bullo, M., Anguera, A., Escribano, J., and Salas-Salvado, J. A controlled, randomized, double-blind trial to evaluate the effect of a supplement of cocoa husk that is rich in dietary fiber on colonic transit in constipated pediatric patients. Pediatrics 2006;118(3):e641-e648. View abstract.
  • Chan, K. A clinical trial gone awry: the Chocolate Happiness Undergoing More Pleasantness (CHUMP) study. CMAJ. 12-4-2007;177(12):1539-1541. View abstract.
  • Cohen, D. L. and Townsend, R. R. Cocoa ingestion and hypertension-another cup please? J Clin Hypertens.(Greenwich.) 2007;9(8):647-648. View abstract.
  • Corder, R. Red wine, chocolate and vascular health: developing the evidence base. Heart 2008;94(7):821-823. View abstract.
  • Cordova, A. C., Sumpio, B. J., and Sumpio, B. E. Perfecting the plate: adding cardioprotective compounds to the diet. J Am Coll.Surg. 2012;214(1):97-114. View abstract.
  • Corti, R., Flammer, A. J., Hollenberg, N. K., and Luscher, T. F. Cocoa and cardiovascular health. Circulation 3-17-2009;119(10):1433-1441. View abstract.
  • Corti, R., Perdrix, J., Flammer, A. J., and Noll, G. [Dark or white chocolate? Cocoa and cardiovascular health]. Rev.Med Suisse 3-10-2010;6(239):499-4. View abstract.
  • Crews, W. D., Jr., Harrison, D. W., and Wright, J. W. A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults. Am J Clin Nutr 2008;87(4):872-880. View abstract.
  • d'El-Rei, J., Cunha, A. R., Burla, A., Burla, M., Oigman, W., Neves, M. F., Virdis, A., and Medeiros, F. Characterisation of hypertensive patients with improved endothelial function after dark chocolate consumption. Int J Hypertens. 2013;2013:985087. View abstract.
  • Davison, K., Berry, N. M., Misan, G., Coates, A. M., Buckley, J. D., and Howe, P. R. Dose-related effects of flavanol-rich cocoa on blood pressure. J Hum Hypertens. 2010;24(9):568-576. View abstract.
  • Davison, K., Coates, A. M., Buckley, J. D., and Howe, P. R. Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes.(Lond) 2008;32(8):1289-1296. View abstract.
  • De, Gottardi A., Berzigotti, A., Seijo, S., D'Amico, M., Thormann, W., Abraldes, J. G., Garcia-Pagan, J. C., and Bosch, J. Postprandial effects of dark chocolate on portal hypertension in patients with cirrhosis: results of a phase 2, double-blind, randomized controlled trial. Am J Clin Nutr 2012;96(3):584-590. View abstract.
  • Denke, M. A. Effects of cocoa butter on serum lipids in humans: historical highlights. Am J Clin Nutr 1994;60(6 Suppl):1014S-1016S. View abstract.
  • Desch, S., Kobler, D., Schmidt, J., Sonnabend, M., Adams, V., Sareban, M., Eitel, I., Bluher, M., Schuler, G., and Thiele, H. Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. Am J Hypertens. 2010;23(6):694-700. View abstract.
  • Desch, S., Schmidt, J., Kobler, D., Sonnabend, M., Eitel, I., Sareban, M., Rahimi, K., Schuler, G., and Thiele, H. Effect of cocoa products on blood pressure: systematic review and meta-analysis. Am J Hypertens. 2010;23(1):97-103. View abstract.
  • Di Renzo, G. C., Brillo, E., Romanelli, M., Porcaro, G., Capanna, F., Kanninen, T. T., Gerli, S., and Clerici, G. Potential effects of chocolate on human pregnancy: a randomized controlled trial. J Matern.Fetal Neonatal Med. 2012;25(10):1860-1867. View abstract.
  • Di, Castelnuovo A., di, Giuseppe R., Iacoviello, L., and de, Gaetano G. Consumption of cocoa, tea and coffee and risk of cardiovascular disease. Eur.J Intern.Med. 2012;23(1):15-25. View abstract.
  • Egan, B. M., Laken, M. A., Donovan, J. L., and Woolson, R. F. Does dark chocolate have a role in the prevention and management of hypertension?: commentary on the evidence. Hypertension 2010;55(6):1289-1295. View abstract.
  • Engler, M. B. and Engler, M. M. The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease. Nutr Rev. 2006;64(3):109-118. View abstract.
  • Engler, M. B., Engler, M. M., Chen, C. Y., Malloy, M. J., Browne, A., Chiu, E. Y., Kwak, H. K., Milbury, P., Paul, S. M., Blumberg, J., and Mietus-Snyder, M. L. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am.Coll.Nutr. 2004;23(3):197-204. View abstract.
  • Erdman, J. W., Jr., Carson, L., Kwik-Uribe, C., Evans, E. M., and Allen, R. R. Effects of cocoa flavanols on risk factors for cardiovascular disease. Asia Pac.J Clin Nutr 2008;17 Suppl 1:284-287. View abstract.
  • Eteng, M. U., Eyong, E. U., Akpanyung, E. O., Agiang, M. A., and Aremu, C. Y. Recent advances in caffeine and theobromine toxicities: a review. Plant Foods Hum.Nutr. 1997;51(3):231-243. View abstract.
  • Evans, R. W., Fergusson, D. M., Allardyce, R. A., and Taylor, B. Maternal diet and infantile colic in breast-fed infants. Lancet 6-20-1981;1(8234):1340-1342. View abstract.
  • Farouque, H. M., Leung, M., Hope, S. A., Baldi, M., Schechter, C., Cameron, J. D., and Meredith, I. T. Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study. Clin Sci (Lond) 2006;111(1):71-80. View abstract.
  • Feldens, C. A., Vitolo, M. R., and Drachler, Mde L. A randomized trial of the effectiveness of home visits in preventing early childhood caries. Community Dent Oral Epidemiol 2007;35(3):215-223. View abstract.
  • Fernandez-Murga, L., Tarin, J. J., Garcia-Perez, M. A., and Cano, A. The impact of chocolate on cardiovascular health. Maturitas 2011;69(4):312-321. View abstract.
  • Field, D. T., Williams, C. M., and Butler, L. T. Consumption of cocoa flavanols results in an acute improvement in visual and cognitive functions. Physiol Behav. 6-1-2011;103(3-4):255-260. View abstract.
  • Field, T., Peck, M., Scd, Hernandez-Reif, M., Krugman, S., Burman, I., and Ozment-Schenck, L. Postburn itching, pain, and psychological symptoms are reduced with massage therapy. J Burn Care Rehabil. 2000;21(3):189-193. View abstract.
  • Fisher, N. D., Hughes, M., Gerhard-Herman, M., and Hollenberg, N. K. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens. 2003;21(12):2281-2286. View abstract.
  • Flammer, A. J., Sudano, I., Wolfrum, M., Thomas, R., Enseleit, F., Periat, D., Kaiser, P., Hirt, A., Hermann, M., Serafini, M., Leveques, A., Luscher, T. F., Ruschitzka, F., Noll, G., and Corti, R. Cardiovascular effects of flavanol-rich chocolate in patients with heart failure. Eur.Heart J 2012;33(17):2172-2180. View abstract.
  • Flammer, A. J., Sudano, I., Wolfrum, M., Thomas, R., Enseleit, F., Periat, D., Luscher, T. F., Ruschitzka, F. T., Noll, G., and Corti, R. Acute and chronic effects of flavonoid-rich-chocolate on endothelial function in patients with chronic heart failure (abstract). J Hypertens 2010;28(e2)
  • Fogleman, C. D. Effect of cocoa on blood pressure. Am Fam.Physician 4-1-2013;87(7):484. View abstract.
  • Fraga, C. G., Actis-Goretta, L., Ottaviani, J. I., Carrasquedo, F., Lotito, S. B., Lazarus, S., Schmitz, H. H., and Keen, C. L. Regular consumption of a flavanol-rich chocolate can improve oxidant stress in young soccer players. Clin.Dev.Immunol 2005;12(1):11-17. View abstract.
  • Francis, S. T., Head, K., Morris, P. G., and Macdonald, I. A. The effect of flavanol-rich cocoa on the fMRI response to a cognitive task in healthy young people. J Cardiovasc.Pharmacol. 2006;47 Suppl 2:S215-S220. View abstract.
  • Galleano, M., Oteiza, P. I., and Fraga, C. G. Cocoa, chocolate, and cardiovascular disease. J Cardiovasc.Pharmacol. 2009;54(6):483-490. View abstract.
  • Ghosh, D. and Scheepens, A. Vascular action of polyphenols. Mol.Nutr Food Res 2009;53(3):322-331. View abstract.
  • Gomez-Juaristi, M., Gonzalez-Torres, L., Bravo, L., Vaquero, M. P., Bastida, S., and Sanchez-Muniz, F. J. [Beneficial effects of chocolate on cardiovascular health]. Nutr Hosp. 2011;26(2):289-292. View abstract.
  • Grassi, D., Desideri, G., and Ferri, C. Blood pressure and cardiovascular risk: what about cocoa and chocolate? Arch.Biochem.Biophys. 9-1-2010;501(1):112-115. View abstract.
  • Grassi, D., Desideri, G., Necozione, S., Lippi, C., Casale, R., Properzi, G., Blumberg, J. B., and Ferri, C. Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate. J Nutr 2008;138(9):1671-1676. View abstract.
  • Grassi, D., Desideri, G., Necozione, S., Ruggieri, F., Blumberg, J. B., Stornello, M., and Ferri, C. Protective effects of flavanol-rich dark chocolate on endothelial function and wave reflection during acute hyperglycemia. Hypertension 2012;60(3):827-832. View abstract.
  • Haber, S. L. and Gallus, K. Effects of dark chocolate on blood pressure in patients with hypertension. Am J Health Syst.Pharm. 8-1-2012;69(15):1287-3. View abstract.
  • Hayes, K. C. Saturated fats and blood lipids: new slant on an old story. Can.J Cardiol. 1995;11 Suppl G:39G-46G. View abstract.
  • Heinrich, U., Neukam, K., Tronnier, H., Sies, H., and Stahl, W. Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women. J Nutr 2006;136(6):1565-1569. View abstract.
  • Heiss, C., Finis, D., Kleinbongard, P., Hoffmann, A., Rassaf, T., Kelm, M., and Sies, H. Sustained increase in flow-mediated dilation after daily intake of high-flavanol cocoa drink over 1 week. J Cardiovasc.Pharmacol. 2007;49(2):74-80. View abstract.
  • Heiss, C., Jahn, S., Taylor, M., Real, W. M., Angeli, F. S., Wong, M. L., Amabile, N., Prasad, M., Rassaf, T., Ottaviani, J. I., Mihardja, S., Keen, C. L., Springer, M. L., Boyle, A., Grossman, W., Glantz, S. A., Schroeter, H., and Yeghiazarians, Y. Improvement of endothelial function with dietary flavanols is associated with mobilization of circulating angiogenic cells in patients with coronary artery disease. J Am Coll.Cardiol. 7-13-2010;56(3):218-224. View abstract.
  • Heiss, C., Kleinbongard, P., Dejam, A., Perre, S., Schroeter, H., Sies, H., and Kelm, M. Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll.Cardiol. 10-4-2005;46(7):1276-1283. View abstract.
  • Heptinstall, S., May, J., Fox, S., Kwik-Uribe, C., and Zhao, L. Cocoa flavanols and platelet and leukocyte function: recent in vitro and ex vivo studies in healthy adults. J Cardiovasc.Pharmacol. 2006;47 Suppl 2:S197-S205. View abstract.
  • Hermann, F., Spieker, L. E., Ruschitzka, F., Sudano, I., Hermann, M., Binggeli, C., Luscher, T. F., Riesen, W., Noll, G., and Corti, R. Dark chocolate improves endothelial and platelet function. Heart 2006;92(1):119-120. View abstract.
  • Hertog MG, Kromhout D, Aravanis C, and et al. Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. Arch Intern Med 2-27-1995;155(4):381-386. View abstract.
  • Hinds, T. S., West, W. L., Knight, E. M., and Harland, B. F. The effect of caffeine on pregnancy outcome variables. Nutr Rev. 1996;54(7):203-207. View abstract.
  • Hooper, L., Kroon, P. A., Rimm, E. B., Cohn, J. S., Harvey, I., Le Cornu, K. A., Ryder, J. J., Hall, W. L., and Cassidy, A. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2008;88(1):38-50. View abstract.
  • Innes, A. J., Kennedy, G., McLaren, M., Bancroft, A. J., and Belch, J. J. Dark chocolate inhibits platelet aggregation in healthy volunteers. Platelets. 2003;14(5):325-327. View abstract.
  • Jia, L., Liu, X., Bai, Y. Y., Li, S. H., Sun, K., He, C., and Hui, R. Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2010;92(1):218-225. View abstract.
  • Kaltenbach, T., Crockett, S., and Gerson, L. B. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch.Intern.Med 5-8-2006;166(9):965-971. View abstract.
  • Kannayiram, A., Rezaie, A., and Hadi, S. Chocolate-induced prolonged angiooedema in an elderly patient. Age Ageing 2008;37(4):479-480. View abstract.
  • Karp, J. R., Johnston, J. D., Tecklenburg, S., Mickleborough, T. D., Fly, A. D., and Stager, J. M. Chocolate milk as a post-exercise recovery aid. Int J Sport Nutr Exerc.Metab 2006;16(1):78-91. View abstract.
  • Kay, C. D., Kris-Etherton, P. M., and West, S. G. Effects of antioxidant-rich foods on vascular reactivity: review of the clinical evidence. Curr.Atheroscler.Rep. 2006;8(6):510-522. View abstract.
  • Keen, C. L. Chocolate: food as medicine/medicine as food. J Am.Coll.Nutr. 2001;20(5 Suppl):436S-439S. View abstract.
  • Keen, C. L., Holt, R. R., Oteiza, P. I., Fraga, C. G., and Schmitz, H. H. Cocoa antioxidants and cardiovascular health. Am J Clin Nutr 2005;81(1 Suppl):298S-303S. View abstract.
  • Khan, N., Monagas, M., Andres-Lacueva, C., Casas, R., Urpi-Sarda, M., Lamuela-Raventos, R. M., and Estruch, R. Regular consumption of cocoa powder with milk increases HDL cholesterol and reduces oxidized LDL levels in subjects at high-risk of cardiovascular disease. Nutr Metab Cardiovasc.Dis. 2012;22(12):1046-1053. View abstract.
  • Khawaja, O., Gaziano, J. M., and Djousse, L. Chocolate and coronary heart disease: a systematic review. Curr Atheroscler.Rep. 2011;13(6):447-452. View abstract.
  • Kim, W., Park, C. S., Yu, T. K., Park, H. H., Cho, E. K., Kang, W. Y., Hwang, S. H., Lee, E. S., and Kim, W. The preventive effects of dark chocolate on impaired endothelial function in medical personnel working sequential night shifts. Nutr Metab Cardiovasc.Dis. 2012;22(2):e3-e4. View abstract.
  • Knekt, P., Jarvinen, R., Reunanen, A., and Maatela, J. Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 2-24-1996;312(7029):478-481. View abstract.
  • Kondo, K., Hirano, R., Matsumoto, A., Igarashi, O., and Itakura, H. Inhibition of LDL oxidation by cocoa. Lancet 11-30-1996;348(9040):1514. View abstract.
  • Kris-Etherton, P. M. and Keen, C. L. Evidence that the antioxidant flavonoids in tea and cocoa are beneficial for cardiovascular health. Curr.Opin.Lipidol. 2002;13(1):41-49. View abstract.
  • Kris-Etherton, P. M., Derr, J. A., Mustad, V. A., Seligson, F. H., and Pearson, T. A. Effects of a milk chocolate bar per day substituted for a high-carbohydrate snack in young men on an NCEP/AHA Step 1 Diet. Am.J Clin.Nutr. 1994;60(6 Suppl):1037S-1042S. View abstract.
  • Kurlandsky, S. B. and Stote, K. S. Cardioprotective effects of chocolate and almond consumption in healthy women. Nutr Res 2006;26:509-516.
  • Landberg, R., Naidoo, N., and van Dam, R. M. Diet and endothelial function: from individual components to dietary patterns. Curr Opin.Lipidol. 2012;23(2):147-155. View abstract.
  • Larsson, S. C., Virtamo, J., and Wolk, A. Chocolate consumption and risk of stroke: a prospective cohort of men and meta-analysis. Neurology 9-18-2012;79(12):1223-1229. View abstract.
  • Lee, A. and Storey, D. M. Comparative gastrointestinal tolerance of sucrose, lactitol, or D-tagatose in chocolate. Regul.Toxicol.Pharmacol. 1999;29(2 Pt 2):S78-S82. View abstract.
  • Lee, K. W., Kundu, J. K., Kim, S. O., Chun, K. S., Lee, H. J., and Surh, Y. J. Cocoa polyphenols inhibit phorbol ester-induced superoxide anion formation in cultured HL-60 cells and expression of cyclooxygenase-2 and activation of NF-kappaB and MAPKs in mouse skin in vivo. J Nutr 2006;136(5):1150-1155. View abstract.
  • Lippi, G., Franchini, M., Montagnana, M., Favaloro, E. J., Guidi, G. C., and Targher, G. Dark chocolate: consumption for pleasure or therapy? J Thromb.Thrombolysis. 2009;28(4):482-488. View abstract.
  • Listl, S. Family composition and children's dental health behavior: evidence from Germany. J Public Health Dent. 2011;71(2):91-101. View abstract.
  • Llorach, R., Urpi-Sarda, M., Jauregui, O., Monagas, M., and Andres-Lacueva, C. An LC-MS-based metabolomics approach for exploring urinary metabolome modifications after cocoa consumption. J Proteome.Res 2009;8(11):5060-5068. View abstract.
  • Loffredo, L., Carnevale, R., Perri, L., Catasca, E., Augelletti, T., Cangemi, R., Albanese, F., Piccheri, C., Nocella, C., Pignatelli, P., and Violi, F. NOX2-mediated arterial dysfunction in smokers: acute effect of dark chocolate. Heart 2011;97(21):1776-1781. View abstract.
  • Macht, M. and Mueller, J. Immediate effects of chocolate on experimentally induced mood states. Appetite 2007;49(3):667-674. View abstract.
  • Martin, F. P., Antille, N., Rezzi, S., and Kochhar, S. Everyday eating experiences of chocolate and non-chocolate snacks impact postprandial anxiety, energy and emotional states. Nutrients. 2012;4(6):554-567. View abstract.
  • Martin, F. P., Rezzi, S., Pere-Trepat, E., Kamlage, B., Collino, S., Leibold, E., Kastler, J., Rein, D., Fay, L. B., and Kochhar, S. Metabolic effects of dark chocolate consumption on energy, gut microbiota, and stress-related metabolism in free-living subjects. J Proteome.Res 2009;8(12):5568-5579. View abstract.
  • Matsumoto, M., Tsuji, M., Okuda, J., Sasaki, H., Nakano, K., Osawa, K., Shimura, S., and Ooshima, T. Inhibitory effects of cacao bean husk extract on plaque formation in vitro and in vivo. Eur.J Oral Sci 2004;112(3):249-252. View abstract.
  • McBrier, N. M., Vairo, G. L., Bagshaw, D., Lekan, J. M., Bordi, P. L., and Kris-Etherton, P. M. Cocoa-based protein and carbohydrate drink decreases perceived soreness after exhaustive aerobic exercise: a pragmatic preliminary analysis. J Strength.Cond.Res 2010;24(8):2203-2210. View abstract.
  • Mehrinfar, R. and Frishman, W. H. Flavanol-rich cocoa: a cardioprotective nutraceutical. Cardiol.Rev. 2008;16(3):109-115. View abstract.
  • Mellor, D. D., Madden, L. A., Smith, K. A., Kilpatrick, E. S., and Atkin, S. L. High-polyphenol chocolate reduces endothelial dysfunction and oxidative stress during acute transient hyperglycaemia in Type 2 diabetes: a pilot randomized controlled trial. Diabet.Med. 2013;30(4):478-483. View abstract.
  • Mellor, D. D., Sathyapalan, T., Kilpatrick, E. S., Beckett, S., and Atkin, S. L. High-cocoa polyphenol-rich chocolate improves HDL cholesterol in Type 2 diabetes patients. Diabet.Med. 2010;27(11):1318-1321. View abstract.
  • Middeke, M. [Hypertensiology 2007]. Dtsch.Med Wochenschr. 6-22-2007;132(25-26):1368-1370. View abstract.
  • Milliron, T., Kelsberg, G., and St, Anna L. Clinical inquiries. Does chocolate have cardiovascular benefits? J Fam.Pract 2010;59(6):351-352. View abstract.
  • Mitchell, D. C., McMahon, K. E., Shively, C. A., Apgar, J. L., and Kris-Etherton, P. M. Digestibility of cocoa butter and corn oil in human subjects: a preliminary study. Am J Clin Nutr 1989;50(5):983-986. View abstract.
  • Moco, S., Martin, F. P., and Rezzi, S. Metabolomics view on gut microbiome modulation by polyphenol-rich foods. J Proteome.Res 10-5-2012;11(10):4781-4790. View abstract.
  • Monagas, M., Khan, N., Andres-Lacueva, C., Casas, R., Urpi-Sarda, M., Llorach, R., Lamuela-Raventos, R. M., and Estruch, R. Effect of cocoa powder on the modulation of inflammatory biomarkers in patients at high risk of cardiovascular disease. Am J Clin Nutr 2009;90(5):1144-1150. View abstract.
  • Monahan, K. D. Effect of cocoa/chocolate ingestion on brachial artery flow-mediated dilation and its relevance to cardiovascular health and disease in humans. Arch.Biochem.Biophys. 11-15-2012;527(2):90-94. View abstract.
  • Mullen, W., Borges, G., Donovan, J. L., Edwards, C. A., Serafini, M., Lean, M. E., and Crozier, A. Milk decreases urinary excretion but not plasma pharmacokinetics of cocoa flavan-3-ol metabolites in humans. Am J Clin Nutr 2009;89(6):1784-1791. View abstract.
  • Muniyappa, R., Hall, G., Kolodziej, T. L., Karne, R. J., Crandon, S. K., and Quon, M. J. Cocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertension. Am J Clin Nutr 2008;88(6):1685-1696. View abstract.
  • Murphy, K. J., Chronopoulos, A. K., Singh, I., Francis, M. A., Moriarty, H., Pike, M. J., Turner, A. H., Mann, N. J., and Sinclair, A. J. Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit platelet function. Am J Clin Nutr 2003;77(6):1466-1473. View abstract.
  • Mursu, J., Voutilainen, S., Nurmi, T., Rissanen, T. H., Virtanen, J. K., Kaikkonen, J., Nyyssonen, K., and Salonen, J. T. Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med 11-1-2004;37(9):1351-1359. View abstract.
  • Nahas, R. Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review. Can.Fam.Physician 2008;54(11):1529-1533. View abstract.
  • Nehlig, A. The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. Br.J Clin Pharmacol. 2013;75(3):716-727. View abstract.
  • Netea, S. A., Janssen, S. A., Jaeger, M., Jansen, T., Jacobs, L., Miller-Tomaszewska, G., Plantinga, T. S., Netea, M. G., and Joosten, L. A. Chocolate consumption modulates cytokine production in healthy individuals. Cytokine 2013;62(1):40-43. View abstract.
  • Neukam, K., Stahl, W., Tronnier, H., Sies, H., and Heinrich, U. Consumption of flavanol-rich cocoa acutely increases microcirculation in human skin. Eur.J Nutr 2007;46(1):53-56. View abstract.
  • Njike, V. Y., Faridi, Z., Shuval, K., Dutta, S., Kay, C. D., West, S. G., Kris-Etherton, P. M., and Katz, D. L. Effects of sugar-sweetened and sugar-free cocoa on endothelial function in overweight adults. Int J Cardiol. 12-23-2009; View abstract.
  • Ottaviani, J. I., Momma, T. Y., Heiss, C., Kwik-Uribe, C., Schroeter, H., and Keen, C. L. The stereochemical configuration of flavanols influences the level and metabolism of flavanols in humans and their biological activity in vivo. Free Radic.Biol Med. 1-15-2011;50(2):237-244. View abstract.
  • Parasramka, S. and Dufresne, A. Supraventricular tachycardia induced by chocolate: is chocolate too sweet for the heart? Am J Emerg.Med. 2012;30(7):1325-1327. View abstract.
  • Patane, S., Marte, F., La Rosa, F. C., and Rocca, R. L. Atrial fibrillation associated with chocolate intake abuse and chronic salbutamol inhalation abuse. Int J Cardiol. 1-24-2009; View abstract.
  • Pearson, D. A., Paglieroni, T. G., Rein, D., Wun, T., Schramm, D. D., Wang, J. F., Holt, R. R., Gosselin, R., Schmitz, H. H., and Keen, C. L. The effects of flavanol-rich cocoa and aspirin on ex vivo platelet function. Thromb.Res 5-15-2002;106(4-5):191-197. View abstract.
  • Persson, I. A., Persson, K., Hagg, S., and Andersson, R. G. Effects of cocoa extract and dark chocolate on angiotensin-converting enzyme and nitric oxide in human endothelial cells and healthy volunteers--a nutrigenomics perspective. J Cardiovasc.Pharmacol. 2011;57(1):44-50. View abstract.
  • Piehowski, K. E., Preston, A. G., Miller, D. L., and Nickols-Richardson, S. M. A reduced-calorie dietary pattern including a daily sweet snack promotes body weight reduction and body composition improvements in premenopausal women who are overweight and obese: a pilot study. J Am Diet.Assoc. 2011;111(8):1198-1203. View abstract.
  • Pitroipa, X., Sankara, D., Konan, L., Sylla, M., Doannio, J. M., and Traore, S. [Evaluation of cocoa oil for individual protection against Simulium damnosum s.i.]. Med Trop.(Mars.) 2002;62(5):511-516. View abstract.
  • Polagruto, J. A., Wang-Polagruto, J. F., Braun, M. M., Lee, L., Kwik-Uribe, C., and Keen, C. L. Cocoa flavanol-enriched snack bars containing phytosterols effectively lower total and low-density lipoprotein cholesterol levels. J Am Diet.Assoc. 2006;106(11):1804-1813. View abstract.
  • Potenza, M. V. and Mechanick, J. I. The metabolic syndrome: definition, global impact, and pathophysiology. Nutr Clin Pract 2009;24(5):560-577. View abstract.
  • Pritchett, K. and Pritchett, R. Chocolate milk: a post-exercise recovery beverage for endurance sports. Med.Sport Sci. 2012;59:127-134. View abstract.
  • Pritchett, K., Bishop, P., Pritchett, R., Green, M., and Katica, C. Acute effects of chocolate milk and a commercial recovery beverage on postexercise recovery indices and endurance cycling performance. Appl.Physiol Nutr Metab 2009;34(6):1017-1022. View abstract.
  • Pucciarelli, D. L. and Grivetti, L. E. The medicinal use of chocolate in early North America. Mol.Nutr Food Res 2008;52(10):1215-1227. View abstract.
  • Radin, D., Hayssen, G., and Walsh, J. Effects of intentionally enhanced chocolate on mood. Explore.(NY) 2007;3(5):485-492. View abstract.
  • Ramiro-Puig, E. and Castell, M. Cocoa: antioxidant and immunomodulator. Br.J Nutr 2009;101(7):931-940. View abstract.
  • Recio-Rodriguez, J. I., Gomez-Marcos, M. A., Patino-Alonso, M. C., Agudo-Conde, C., Rodriguez-Sanchez, E., and Garcia-Ortiz, L. Cocoa intake and arterial stiffness in subjects with cardiovascular risk factors. Nutr J 2012;11:8. View abstract.
  • Ried, K., Frank, O. R., and Stocks, N. P. Dark chocolate or tomato extract for prehypertension: a randomised controlled trial. BMC.Complement Altern.Med. 2009;9:22. View abstract.
  • Ried, K., Sullivan, T. R., Fakler, P., Frank, O. R., and Stocks, N. P. Effect of cocoa on blood pressure. Cochrane.Database.Syst.Rev. 2012;8:CD008893. View abstract.
  • Ried, K., Sullivan, T., Fakler, P., Frank, O. R., and Stocks, N. P. Does chocolate reduce blood pressure? A meta-analysis. BMC.Med 2010;8:39. View abstract.
  • Rossner, S. Chocolate--divine food, fattening junk or nutritious supplementation? Eur.J Clin.Nutr. 1997;51(6):341-345. View abstract.
  • Rudkowska, I. and Jones, P. J. Functional foods for the prevention and treatment of cardiovascular diseases: cholesterol and beyond. Expert.Rev.Cardiovasc.Ther. 2007;5(3):477-490. View abstract.
  • Santos, I. S., Victora, C. G., Huttly, S., and Carvalhal, J. B. Caffeine intake and low birth weight: a population-based case-control study. Am.J.Epidemiol. 4-1-1998;147(7):620-627. View abstract.
  • Sarria, B., Mateos, R., Sierra-Cinos, J. L., Goya, L., Garcia-Diz, L., and Bravo, L. Hypotensive, hypoglycaemic and antioxidant effects of consuming a cocoa product in moderately hypercholesterolemic humans. Food Funct. 2012;3(8):867-874. View abstract.
  • Sathyapalan, T., Beckett, S., Rigby, A. S., Mellor, D. D., and Atkin, S. L. High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome. Nutr J 2010;9:55. View abstract.
  • Scholey, A. B., French, S. J., Morris, P. J., Kennedy, D. O., Milne, A. L., and Haskell, C. F. Consumption of cocoa flavanols results in acute improvements in mood and cognitive performance during sustained mental effort. J Psychopharmacol. 11-26-2009; View abstract.
  • Schramm, D. D., Wang, J. F., Holt, R. R., Ensunsa, J. L., Gonsalves, J. L., Lazarus, S. A., Schmitz, H. H., German, J. B., and Keen, C. L. Chocolate procyanidins decrease the leukotriene-prostacyclin ratio in humans and human aortic endothelial cells. Am.J Clin.Nutr. 2001;73(1):36-40. View abstract.
  • Schroeter, H., Heiss, C., Balzer, J., Kleinbongard, P., Keen, C. L., Hollenberg, N. K., Sies, H., Kwik-Uribe, C., Schmitz, H. H., and Kelm, M. (-)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans. Proc Natl.Acad.Sci U.S.A 1-24-2006;103(4):1024-1029. View abstract.

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