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:

Original Link

Obesity: Supporting satisfaction instead of surgery

Obesity Surgery.jpg

Hot news from down under - a couple of surgeons who perform bariatric (stomach-stapling) operations would like to perform more of them on us, and would like tax money to fund their work. The media is running their advertisement as if it were a public health statement.

I've battled weight problems for my adult life, and I know there is no magic bullet for maintaining a healthy weight. Neither is there a magic scalpel. Cutting open your body to reduce your stomach capacity and all that could mean for your future is not a tenable general treatment.

Battling obesity en masse

New Zealand is, like most developed countries, guilty of more reporting than acting on the growing obesity problem. While this is always a sensitive subject, a recent longterm study showed that while there are obese healthy people, they are much less likely to remain healthy over the years.

So is it true that "Surgery still remains the most capable strategy for inducing robust and long-term weight loss"? May I see the source please? The (US) National Weight Control Registry research does not mention surgery at all in their summary of how most of their participants lost long-term weight.

But I am even more interested that New Zealand's tax money supports industries that support obesity. Fatty cholesterol-rich foods like beef, pork, chicken, eggs, and dairy. "Added-value" processed foods, which take natural raw foods and package them for the highest profit and shelf life instead of fiber and nutrients. Food technology trumps food quality.

Calorie density

Why does this matter? Jeff Novick, RD, MS explains in this article and this video presentation, but in short, calorie density reigns supreme in how much people eat.

Steak doesn't fill you up like oatmeal. Potato chips won't fill you up like potatoes.

Where the money goes

So if we're going to tweak our economic contribution to solve the obesity epidemic, let's not psych everyone into thinking we have to catch up with the Aussies in dangerous life-altering surgery rates.

Let's at least stop being part of the problem, and remove tax funding from those industries harming our national health. Restrict their advertising which often reports positive health benefits or just plain fun...and often arrives in our schools to advertise to our children.

Help make healthy food cheaper, more available, and more acceptable instead.

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Our Immune System Uses Plants To Activate Gut Protection

NF-Sep30 Why Broccoli is Crucial to Helping Our Immune System.jpg

It might seem that our skin is the first line of defense between our insides and the outside world, but our greatest interface with our environment is actually through the lining of our intestines, which covers thousands of square feet. And all that separates our gut from the outer world is a single layer of cells, 50 millionth of a meter thick - less than the thickness of a sheet of paper.

Compare that to our skin. In the video, The Broccoli Receptor: Our First Line of Defense, you can see a layer of skin, dozens of protective cells thick, to keep the outside world outside of our bodies. Why don't we have multiple layers in our gut wall? Because we need to absorb stuff from food into our body. It's a good idea for our skin to be waterproof, so we don't start leaking, but the lining of our gut has to allow for the absorption of fluids and nutrients.

With such a thin, fragile layer between our sterile core and outer chaos, we better have quite a defense system in place. Indeed, that's where "intraepithelial lymphocytes" come in.

Intraepithelial lymphocytes serve two functions: they condition and repair that thin barrier, and they provide a front-line defense against intestinal pathogens. These critical cells are covered with Ah receptors. Ah receptors are like locks, and for decades researchers have been searching for a natural key to fit in these locks to activate those receptors and sustain our immunity. We recently discovered a key: broccoli.

Cruciferous vegetables--broccoli, kale, cauliflower, cabbage, Brussels sprouts--contain a phytonutrient that is transformed by our stomach acid into the key that fits into the Ah receptor, stimulating our intraepithelial lymphocytes. In other words, broccoli leads to the activation of our immune foot soldiers.

In an editorial about Ah receptors and diet, researcher Lora V. Hooper from the Howard Hughes Medical Institute noted, "From childhood we learn that vegetables are good for us, and most of us eat our veggies without giving much thought to the evidence behind this accepted wisdom or to the mechanisms underlying the purported health-boosting properties of a vegetable-rich diet." But now we know that "specific dietary compounds found at high levels in cruciferous vegetables such as broccoli, cauliflower, and cabbage are essential for sustaining intestinal immune function." Green vegetables are in fact required to maintain a large population of those protective intraepithelial lymphocytes.

Maybe that's why vegetable intake is associated with lower risk of inflammatory bowel diseases such as ulcerative colitis, whereas the more meaty Western diet is associated with higher risk of inflammatory bowel diseases. This may be because the activating receptors on our intestinal immune cells are basically sensors of plant-derived phytochemicals.

This raises a broader question: Why did our immune system evolve this requirement for broccoli and other plant foods? Well, when do we need to boost our intestinal defenses the most? When we eat! That's when we may be ingesting pathogens. Linking heightened intestinal immune activation to food intake could serve to bolster immunity precisely when it is needed. At the same time, this would allow energy to be conserved in times of food scarcity, since maintaining these defenses takes considerable amounts of energy. Why remain at red alert 24 hours a day when we eat only a couple of times a day? We evolved for millions of years eating mostly weeds--wild plants, dark green leafy vegetables (or as they were known back then, leaves). By using veggies as a signal to upkeep our immune system, our bodies may be bolstering our immune defenses when we most need them. Thus, the old recommendation to "eat your veggies" has a strong molecular basis. (Did we really evolve eating that many plant foods? See my video Paleolithic Lessons).

This discovery has been all exciting for the drug companies who are looking into Ah receptor active pharmaceuticals. "However," as one research team at Cambridge concluded, "rather than developing additional anti-inflammatory drugs, changing diets which are currently highly processed and low in vegetable content, may be a more cost effective way towards health and well-being."

As remarkable as this story is, it is just the tip of the cruciferous iceberg! See, for example:

How else can we protect our immune function? Exercise (Preserving Immune Function In Athletes With Nutritional Yeast) and sleep (Sleep & Immunity)!

Given the variety and flexibility of most mammalian diets, a specific dependence on cruciferous vegetables for optimal intestinal immune function would seem overly restrictive, no? I address that in my video, Counteracting the Effects of Dioxins

-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, and From Table to Able.

Images thank to Nomadic Lass / Flickr.

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