Chocolate is Finally Put to the Test

Oct 10 Chocolate copy.jpeg

Botanically speaking, seeds are small embryonic plants--the whole plant stuffed into a tiny seed and surrounded by an outer layer packed with vitamins, minerals, and phytochemicals to protect the seedling plant's DNA from free radicals. No wonder they're so healthy. By seeds, using the formal definition, we're talking all whole grains; grains are seeds--you plant them and they grow. Nuts are just dry fruits with one or two seeds. Legumes (beans, peas, and lentils) are seeds, too, as are cocoa and coffee beans. So, finding health-promoting effects in something like cocoa or coffee should not be all that surprising. There is substantial evidence that increased consumption of all these little plants is associated with lower risk of cardiovascular disease.

Of course, much of chocolate research is just on how to get consumers to eat more. While it didn't seem to matter what kind of music people were listening to when it came to the flavor intensity, pleasantness, or texture of a bell pepper, people liked chocolate more when listening to jazz than classical, rock, or hip hop. Why is this important? So food industries can "integrate specific musical stimuli" in order to maximize their profits. For example, purveyors may play jazz in the background to increase consumers' acceptance of their chocolates. Along these lines, another study demonstrated that people rated the oyster eaten "more pleasant in the presence of the 'sound of the sea' than in the presence of 'farmyard noises.'"

You'd think chocolate would just sell itself, given that it's considered the most commonly craved food in the world. The same degree of interest doesn't seem to exist as to whether or not Brussels sprouts might provide similar cardiovascular protection. So, it's understandable to hope chocolate provides health benefits. Meanwhile, despite their known benefits, Brussels sprouts don't get the love they deserve.

One of the potential downsides of chocolate is weight gain, which is the subject of my Does Chocolate Cause Weight Gain? video. Though cocoa hardly has any calories, chocolate is one of the most calorie-dense foods. For example: A hundred calories of chocolate is less than a quarter of a bar, compared to a hundred calories of strawberries, which is more than two cups..

A few years ago, a study funded by the National Confectioners Association--an organization that, among other things, runs the website voteforcandy.com--reported that Americans who eat chocolate weigh, on average, four pounds less than those who don't. But maybe chocolate-eaters exercise more or eat more fruits and vegetables. The researchers didn't control for any of that.

The findings of a more recent study published in the Archives of Internal Medicine were less easy to dismiss and there were no apparent ties to Big Chocolate. The researchers reported that out of a thousand men and women they studied in San Diego, those who frequently consumed chocolate had a lower BMI--actually weighed less--than those who ate chocolate less often. And this was even after adjusting for physical activity and diet quality. But, it was a cross-sectional study, meaning a snapshot in time, so you can't prove cause and effect. Maybe not eating chocolate leads to being fatter, or maybe being fatter leads to not eating chocolate. Maybe people who are overweight are trying to cut down on sweets. What we need is a study in which people are followed over time.

There was no such prospective study, until now. More than 10,000 people were followed for six years, and a chocolate habit was associated with long-term weight gain in a dose-response manner. This means the greatest weight gain over time was seen in those with the highest frequency of chocolate intake. It appears the reason the cross-sectional studies found the opposite is that subjects diagnosed with obesity-related illnesses tended to reduce their intake of things like chocolate in an attempt to improve their prognosis. This explains why heavier people may, on average, eat less chocolate.

To bolster this finding came the strongest type of evidence--an interventional trial--in which you split people up into two groups and change half their diets. Indeed, adding four squares of chocolate to peoples' daily diets does appear to add a few pounds.

So, what do we tell our patients? In 2013, researchers wrote in the American Family Physician journal that "because many cocoa products are high in sugar and saturated fat, family physicians should refrain from recommending cocoa...." That's a little patronizing, though. You can get the benefits of chocolate without any sugar or fat by adding cocoa powder to a smoothie, for example. Too often, doctors think patients can't handle the truth. Case in point: If your patients inquire, one medical journal editorial suggest, ask them what type of chocolate they prefer. If they respond with milk chocolate, then it is best to answer that it is not good for them. If the answer is dark chocolate, then you can lay out the evidence.


Even better than dark chocolate would be cocoa powder, which contains the phytonutrients without the saturated fat. I've happily (and deliciously) created other videos on cocoa and chocolate, so check out Update on Chocolate, Healthiest Chocolate Fix, A Treatment for Chronic Fatigue Syndrome, and Dark Chocolate and Artery Function.

Whether with Big Candy, Big Chocolate, or some other player, you always have to be careful about conflict of interest. For more information, watch my Food Industry Funded Research Bias video.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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Chocolate is Finally Put to the Test

Oct 10 Chocolate copy.jpeg

Botanically speaking, seeds are small embryonic plants--the whole plant stuffed into a tiny seed and surrounded by an outer layer packed with vitamins, minerals, and phytochemicals to protect the seedling plant's DNA from free radicals. No wonder they're so healthy. By seeds, using the formal definition, we're talking all whole grains; grains are seeds--you plant them and they grow. Nuts are just dry fruits with one or two seeds. Legumes (beans, peas, and lentils) are seeds, too, as are cocoa and coffee beans. So, finding health-promoting effects in something like cocoa or coffee should not be all that surprising. There is substantial evidence that increased consumption of all these little plants is associated with lower risk of cardiovascular disease.

Of course, much of chocolate research is just on how to get consumers to eat more. While it didn't seem to matter what kind of music people were listening to when it came to the flavor intensity, pleasantness, or texture of a bell pepper, people liked chocolate more when listening to jazz than classical, rock, or hip hop. Why is this important? So food industries can "integrate specific musical stimuli" in order to maximize their profits. For example, purveyors may play jazz in the background to increase consumers' acceptance of their chocolates. Along these lines, another study demonstrated that people rated the oyster eaten "more pleasant in the presence of the 'sound of the sea' than in the presence of 'farmyard noises.'"

You'd think chocolate would just sell itself, given that it's considered the most commonly craved food in the world. The same degree of interest doesn't seem to exist as to whether or not Brussels sprouts might provide similar cardiovascular protection. So, it's understandable to hope chocolate provides health benefits. Meanwhile, despite their known benefits, Brussels sprouts don't get the love they deserve.

One of the potential downsides of chocolate is weight gain, which is the subject of my Does Chocolate Cause Weight Gain? video. Though cocoa hardly has any calories, chocolate is one of the most calorie-dense foods. For example: A hundred calories of chocolate is less than a quarter of a bar, compared to a hundred calories of strawberries, which is more than two cups..

A few years ago, a study funded by the National Confectioners Association--an organization that, among other things, runs the website voteforcandy.com--reported that Americans who eat chocolate weigh, on average, four pounds less than those who don't. But maybe chocolate-eaters exercise more or eat more fruits and vegetables. The researchers didn't control for any of that.

The findings of a more recent study published in the Archives of Internal Medicine were less easy to dismiss and there were no apparent ties to Big Chocolate. The researchers reported that out of a thousand men and women they studied in San Diego, those who frequently consumed chocolate had a lower BMI--actually weighed less--than those who ate chocolate less often. And this was even after adjusting for physical activity and diet quality. But, it was a cross-sectional study, meaning a snapshot in time, so you can't prove cause and effect. Maybe not eating chocolate leads to being fatter, or maybe being fatter leads to not eating chocolate. Maybe people who are overweight are trying to cut down on sweets. What we need is a study in which people are followed over time.

There was no such prospective study, until now. More than 10,000 people were followed for six years, and a chocolate habit was associated with long-term weight gain in a dose-response manner. This means the greatest weight gain over time was seen in those with the highest frequency of chocolate intake. It appears the reason the cross-sectional studies found the opposite is that subjects diagnosed with obesity-related illnesses tended to reduce their intake of things like chocolate in an attempt to improve their prognosis. This explains why heavier people may, on average, eat less chocolate.

To bolster this finding came the strongest type of evidence--an interventional trial--in which you split people up into two groups and change half their diets. Indeed, adding four squares of chocolate to peoples' daily diets does appear to add a few pounds.

So, what do we tell our patients? In 2013, researchers wrote in the American Family Physician journal that "because many cocoa products are high in sugar and saturated fat, family physicians should refrain from recommending cocoa...." That's a little patronizing, though. You can get the benefits of chocolate without any sugar or fat by adding cocoa powder to a smoothie, for example. Too often, doctors think patients can't handle the truth. Case in point: If your patients inquire, one medical journal editorial suggest, ask them what type of chocolate they prefer. If they respond with milk chocolate, then it is best to answer that it is not good for them. If the answer is dark chocolate, then you can lay out the evidence.


Even better than dark chocolate would be cocoa powder, which contains the phytonutrients without the saturated fat. I've happily (and deliciously) created other videos on cocoa and chocolate, so check out Update on Chocolate, Healthiest Chocolate Fix, A Treatment for Chronic Fatigue Syndrome, and Dark Chocolate and Artery Function.

Whether with Big Candy, Big Chocolate, or some other player, you always have to be careful about conflict of interest. For more information, watch my Food Industry Funded Research Bias video.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

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40 Whole Food Vegan Delicious Desserts

Dessert can be decadent without damaging your health goals. Opting for whole grain flours, whole food sweeteners, and oil-free options enables infinite versatility for wholesome, healthy deliciousness! *Notes: Opt for 100% pure maple syrup, date paste, or date syrup when applicable instead of agave, coconut nectar, or honey and (mineral-rich) blackstrap molasses if the strong taste works in a …

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Coca-Cola Stopped Sponsoring the Academy of Nutrition and Dietetics

NF-Nov10 Academy of Nutrition and Dietetics Conflicts of Interest.jpg

The American Dietetic Association (ADA) is the world's largest association of nutrition professionals. They claim to be devoted to "improving the nation's health." They promote a series of Nutrition Fact Sheets. Who writes them? Industry sources pay $20,000 per fact sheet to the ADA and explicitly take part in writing the documents. The ADA then promotes them through its journal and on its website.

Some of these fact sheets are "What's a Mom to Do: Healthy Eating Tips for Families" sponsored by Wendy's; "Lamb: The Essence of Nutrient Rich Flavor," sponsored by the Tri-Lamb Group; "Cocoa and Chocolate: Sweet News" sponsored by the Hershey Center for Health and Nutrition; "Eggs: A Good Choice for Moms-to-Be" sponsored by the American Egg Board's Egg Nutrition Center; "Adult Beverage Consumption: Making Responsible Drinking Choices" in connection with the Distilled Spirits Council; and "The Benefits of Chewing Gum" sponsored by the Wrigley Science Institute. For visuals, see Academy of Nutrition and Dietetics Conflicts of Interest.

Did you know there was a Wrigley Science Institute?

In 2008, the ADA announced that the Coca-Cola Company had become an "ADA Partner" through its corporate relations sponsorship program. The ADA "provides partners a national platform via ADA events and programs with prominent access to key influencers, thought leaders and decision makers in the nutrition marketplace." The ADA's press release also pointed out that "the Coca-Cola Company will share their research findings with ADA members in forums such as professional meetings and scientific publications." For example, did you know there are "No Harmful Effects of Different Coca-Cola Beverages on Rat Testicles?" Was that even a concern? Thou doth protest too much methinks...

When the American Academy of Pediatrics was called out on their proud new corporate relationship with Coke to support patient education on healthy eating, an executive vice-president of the Academy tried to quell protest by explaining that this alliance was not without precedent. The American Academy of Pediatrics has had relationships with Pepsi and McDonald's for some time. This is reminiscent of similar types of relationships in the past, like doctors promoting cigarette smoking.

The fact that the Academy of Pediatrics was also collaborating with Pepsi and McDonald's didn't seem to placate the critics. So the executive continued, noting that the American Dietetic Association has made a policy statement that "There are no good or bad foods." Indeed, that's the ADA's official position, "classification of specific foods as good or bad is overly simplistic."

One commentator asks, "Is this what [family doctors] have been reduced to...? To justify an unholy financial alliance we hide behind what others say and do and deny that there are actually unhealthy, 'bad' foods. I wonder how much money the ADA receives from the Coca-Cola Company and other food and beverage companies to have come up with this counter-intuitive 'no good or bad foods' philosophy?"

In 2012, the American Dietetic Association changed their name to the Academy of Nutrition and Dietetics. Did their policies change at all? A landmark report from one of my favorite industry watchdogs, Michele Simon, found that they continue to take millions of dollars in corporate sponsorship money every year from meat, processed junk, dairy, soda, and candy bar companies, and in return offer official educational seminars to teach dietitians what to say to their clients. So when you hear the title "registered dietitian," this is the group they're forced to be registered through. Thankfully there are also Dietitians for Professional Integrity.

After giving millions of dollars to the Academy of Nutrition and Dietetics, Coca Cola has apparently withdrawn sponsorship. It's not enought o disclose conflicts of interest; we should strive to eliminate them in medical and nutrition research.

For more on the corrosive effect of money and politics in nutrition, see:

There are lots of evidence-based dietitians, such as Brenda Davis, Jeff Novick, and Julieanna Hever--not to mention our very own Joseph Gonzales!

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Piotr Drabik / Flickr

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How Dark Chocolate Affects Our Arteries

NF-Nov5 Dark Chocolate and Artery Function.jpg

Chocolate: delicious beauty or harmful beast? Or both?

Although chocolate products can contain high levels of fat and sugar, the cocoa powder itself may have beneficial effects in a number of chronic disease conditions including heart disease.

Flow-mediated dilation, measured in the main artery of the arm, is considered one of the best measures of arterial function, a predictor of cardiovascular mortality. Researchers found that a little cocoa can give one a significant boost in arterial function within hours of consumption. It doesn't take much--just about a teaspoon of natural cocoa powder (or about a tablespoon or more of Dutched cocoa). For a graph of this, check out my video, Dark Chocolate and Artery Function.

Now, it might make us a little suspicious that the author of this study works in Hershey, Pennsylvania, at the Hershey Medical center, and has accepted money from our largest chocolate manufacturer's Center for Health and Nutrition, conveniently located near the intersection of Chocolate and Cocoa Avenue (seriously!).

However, putting together all of the best available evidence, dozens of randomized controlled trials, arterial function was significantly improved within hours, and after weeks and months of chronic cocoa consumption. It's always difficult to tease fact from fiction when such powerful financial interests are involved though. Many of the other studies were funded by industry as well, and as in all areas of research, evidence suggests that industry funding is associated with pro-industry conclusions. But even after removing studies funded by industry, reviewers found the same protective effect.

The reason researchers often measure arterial function in the arm rather than where we really need it--in the coronary arteries of the heart--is that it would require an angiogram, which is a much more invasive procedure. But what if we were able to find people already scheduled for an angiogram anyway? A double-blind, randomized trial of people already scheduled for an angiogram found that dark chocolate actually opens up coronary arteries. When researchers did what's called a "cold pressor test," where they plunge subjects' hands into buckets of ice water, they found that after dark chocolate consumption arteries actually dilated when they're normally supposed to constrict.

Because chocolate also contains fat and sugar, we have to be careful. Furthermore, most chocolate products are manufactured with milk, an ingredient known to influence the antioxidant capacity in our blood. Even if milk chocolate had the same flavonoid phytonutrient content as dark chocolate, the antioxidant effect of cocoa is potentially weakened in the blood when milk is consumed.

So not only are there triple the antioxidants in dark compared to milk chocolate, but the milk actively works against the effects in the human body. Eat dark chocolate, and we get a nice spike in the antioxidant power of our bloodstreams within an hour. Eat milk chocolate, and we get nothing. If we eat that same dark chocolate with a cup of milk, the benefit is suppressed. The addition of milk, either in your stomach or in the chocolate, inhibits the within-body antioxidant activity of chocolate and the absorption into the bloodstream of one of the target phytonutrients.

Sugar isn't good for us either. Sugar impairs arterial function. One bottle of soda's worth of sugar can cripple arterial function. That's why sugar-free cocoa improves arterial function better than the same amount of cocoa with sugar added. So, eliminating sugar appears to amplify the beneficial effects of cocoa.

The bottom line is that although the positive effects of chocolate and cocoa products seem apparent, precautions exist when we're talking about the calories, fat, and sugar in chocolate. Cocoa powder, then, offers the best of both worlds. Although not as tasty, cocoa-based products with little or no sugar or fat are certainly preferred. And we can make them tasty as I note in my Healthy Chocolate Milkshake recipe, and my healthy chocolate ice cream video.

More on the corrupting effect of money in nutrition research in Academy of Nutrition and Dietetics Conflicts of Interest.

I've covered chocolate before, coming to basically the same conclusion:

What effects do other foods have on arterial function? See:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Kyknoord / Flickr

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