Chocolate & Cocoa

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: Chocolate

Postby JeffN » Sat Jul 21, 2018 7:07 pm

Chocolate intake and heart disease and stroke in the Women's Health Initiative: a prospective analysis

Background
Three recent meta-analyses found significant prospective inverse associations between chocolate intake and cardiovascular disease risk. Evidence from these meta-analyses suggests that such inverse associations may only apply to elderly individuals or those with pre-existing major chronic disease.

Objective
We assessed the association between habitual chocolate intake and subsequent incident coronary heart disease (CHD) and stroke, and the potential effect of modification by age.

Design
We conducted multivariable Cox regression analyses using data from 83,310 postmenopausal women free of baseline pre-existing major chronic disease in the prospective Women's Health Initiative cohort. Chocolate intake was assessed using a food-frequency questionnaire. Physician-adjudicated events or deaths were ascertained up to 30 September 2013.

Results
After exclusions, there were 3246 CHD and 2624 stroke events or deaths, representing incidence rates of 3.9% and 3.2% during 1,098,091 and 1,101,022 person-years (13.4 y), respectively. We found no association between consumption of chocolate and risk of CHD (P for linear trend = 0.94) or stroke (P = 0.24). The results for CHD and stroke combined were similar (P = 0.30), but were significantly modified by age (P for interaction = 0.02). For women age <65 y at baseline, those who ate 1 oz (28.35 g) of chocolate <1/mo, 1 to <1.5/mo, 1.5 to <3.5/mo, 3.5/mo to <3/wk, and ≥3/wk had HRs (95% CIs) of 1.00 (referent), 1.17 (1.00, 1.36), 1.05 (0.90, 1.22), 1.09 (0.94, 1.25), and 1.27 (1.09, 1.49), respectively (P for linear trend = 0.005). No association was apparent for older women.

Conclusion
We observed no association between chocolate intake and risk of CHD, stroke, or both combined in participants free of pre-existing major chronic disease. The relation for both combined was modified by age, with a significant positive linear trend and an increased risk in the highest quintile of chocolate consumption among women age <65 y. This trial was registered at clinicaltrials.gov as NCT03453073.
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Re: Chocolate

Postby JeffN » Thu Aug 09, 2018 6:54 am

Once again, the benefit, if any, is minuscule and was not sustained

" flavanol‐rich chocolate and cocoa products lower both systolic and diastolic blood pressure in mainly healthy adults by an average of 1.8 mmHg in the short term."


Effect of cocoa on blood pressure
Cochrane Systematic Review - Intervention Version published: 25 April 2017 see what's new
https://www.cochranelibrary.com/cdsr/do ... t=pressure

Abstract

Background

High blood pressure is an important risk factor for cardiovascular disease, contributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular‐related deaths in Western populations. Epidemiological studies suggest that cocoa‐rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction. Here we update previous meta‐analyses on the effect of cocoa on blood pressure.

Objectives

To assess the effects on blood pressure of chocolate or cocoa products versus low‐flavanol products or placebo in adults with or without hypertension when consumed for two weeks or longer.

Search methods

This is an updated version of the review initially published in 2012. In this updated version, we searched the following electronic databases from inception to November 2016: Cochrane Hypertension Group Specialised Register, CENTRAL, MEDLINE and Embase. We also searched international trial registries, and the reference lists of review articles and included trials.

Selection criteria

Randomised controlled trials (RCTs) investigating the effects of chocolate or cocoa products on systolic and diastolic blood pressure in adults for a minimum of two weeks duration.

Data collection and analysis

Two review authors independently extracted data and assessed the risks of bias in each trial. We conducted random‐effects meta‐analyses on the included studies using Review Manager 5. We explored heterogeneity with subgroup analyses by baseline blood pressure, flavanol content of control group, blinding, age and duration. Sensitivity analyses explored the influence of unusual study design.

Main results

Thirty‐five trials (including 40 treatment comparisons) met the inclusion criteria. Of these, we added 17 trials (20 treatment comparisons) to the 18 trials (20 treatment comparisons) in the previous version of this updated review.

Trials provided participants with 30 to 1218 mg of flavanols (mean = 670 mg) in 1.4 to 105 grams of cocoa products per day in the active intervention group. The control group received either a flavanol‐free product (n = 26 treatment comparisons) or a low‐flavanol‐containing cocoa powd er (range 6.4 to 88 mg flavanols (mean = 55 mg, 13 treatment comparisons; 259 mg, 1 trial).

Meta‐analyses of the 40 treatment comparisons involving 1804 mainly healthy participants revealed a small but statistically significant blood pressure‐reducing effect of flavanol‐rich cocoa products compared with control in trials of two to 18 weeks duration (mean nine weeks):Mean difference systolic blood pressure (SBP) (95% confidence interval (CI): ‐1.76 (‐3.09 to ‐0.43) mmHg, P = 0.009, n = 40 treatment comparisons, 1804 participants;
Mean difference diastolic blood pressure (DBP) (95% CI): ‐1.76 (‐2.57 to ‐0.94) mmHg, P < 0.001, n = 39 treatment comparisons, 1772 participants.

Baseline blood pressure may play a role in the effect of cocoa on blood pressure. While systolic blood pressure was reduced significantly by 4 mmHg in hypertensive people (n = 9 treatment comparisons, 401 participants), and tended to be lowered in prehypertensive people (n= 8 treatment comparisons, 340 participants), there was no significant difference in normotensive people (n = 23 treatment comparisons, 1063 participants); however, the test for subgroup differences was of borderline significance (P = 0.08; I2 = 60%), requiring further research to confirm the findings.

Subgroup meta‐analysis by blinding suggested a trend towards greater blood pressure reduction in unblinded trials compared to double‐blinded trials, albeit statistically not significant. Further research is needed to confirm whether participant expectation may influence blood pressure results. Subgroup analysis by type of control (flavanol‐free versus low‐flavanol control) did not reveal a significant difference.

Whether the age of participants plays a role in the effect of cocoa on blood pressure, with younger participants responding with greater blood pressure reduction, needs to be further investigated.

Sensitivity analysis excluding trials with authors employed by trials sponsoring industry (33 trials, 1482 participants) revealed a small reduction in effect size, indicating some reporting bias.

Due to the remaining heterogeneity, which we could not explain in terms of blinding, flavanol content of the control groups, age of participants, or study duration, we downgraded the quality of the evidence from high to moderate.

Results of subgroup analyses should be interpreted with caution and need to be confirmed or refuted in trials using direct randomised comparisons.

Generally, cocoa products were highly tolerable, with adverse effects including gastrointestinal complaints and nausea being reported by 1% of participants in the active cocoa intervention group and 0.4% of participants in the control groups (moderate‐quality evidence).

Authors' conclusions

This review provides moderate‐quality evidence that flavanol‐rich chocolate and cocoa products cause a small (2 mmHg) blood pressure‐lowering effect in mainly healthy adults in the short term.

These findings are limited by the heterogeneity between trials, which could not be explained by prespecified subgroup analyses, including blinding, flavanol content of the control groups, age of participants, or study duration. However, baseline blood pressure may play a role in the effect of cocoa on blood pressure; subgroup analysis of trials with (pre)hypertensive participants revealed a greater blood pressure‐reducing effect of cocoa compared to normotensive participants with borderline significance.

Long‐term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products.
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Re: Chocolate

Postby JeffN » Tue Dec 24, 2019 9:25 am

Consumerlab just released their 2019 update on chocolate and cocoa.

There remains an issue with contamination of heavy metals (Cadmium and lead).

Out of 19 chocolate bars tested, 10 failed their testing and were not approved.

Out of 10 cocoa powders tested, 6 failed their testing and were not approved.

The top pic for chocolate bar was Montezuma's Dark Chocolate Absolute Black — 100% Cocoa.

The Chocolove Strong Dark Chocolate 70%, the Chocolove Extra Strong 77%, and the Endangered Species Chocolate Strong and Velvety Dark Chocolate, 88% were also approved.

The top pic for cocoa was Ghirardelli Chocolate Premium Baking Cocoa — 100% Cocoa
The Valrhona Pudre De Cacao Pure Cocoa Powder (which is Dutch Processed) and the Volupta Organic Cacao Powder were also approved in regard to cadmium

Remember, chocolate is still high in calorie density, fat and saturated fat. My prior comments in this thread still apply to any approved bar or powder.

In Health
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Re: Chocolate

Postby JeffN » Wed May 26, 2021 6:49 am

Maybe some good news regarding heavy metal contamination

While the U.S. government has not set a limit for cadmium in supplements or foods, the European Union has established a cadmium limit of 0.6 mcg per gram of cocoa powder.

In May, 2021, it was proposed by the Codex Committee on Contaminants in Food that the European limit for chocolate be reviewed for adoption by the Codex Alimentarius, the international food standards agency that includes the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO). This review is scheduled for November 2021 (FAO 2021).

http://www.fao.org/fao-who-codexaliment ... c/1399078/

”Contaminants committee proposes new maximum levels for cadmium in chocolate

The 14th session of the Codex Committee on Contaminants in Food (CCCF14) has recommended for adoption to the Codex Alimentarius Commission new maximum levels (MLs) for cadmium in chocolate. Codex MLs ensure food does not contain contaminants at levels which could threaten human health. The levels set for cadmium are 0.3mg/kg for the category of chocolate containing up to 30 percent cocoa total solids and 0.7mg/kg for the 30 to 50 percent category.”



Also, since cadmium, as well as lead, compete for absorption with other metals, you may be able to reduce their absorption by making sure that you're getting adequate calcium, iron, and zinc in your diet (Nawrot, Biometals 2010)
https://pubmed.ncbi.nlm.nih.gov/20517707/

“Cadmium exposure in the population: from health risks to strategies of prevention
2010 Oct;23(5):769-82. doi: 10.1007/s10534-010-9343-z. Epub 2010 Jun 3.
PMID: 20517707 DOI: 10.1007/s10534-010-9343-z

Abstract

We focus on the recent evidence that elucidates our understanding about the effects of cadmium (Cd) on human health and their prevention. Recently, there has been substantial progress in the exploration of the shape of the Cd concentration-response function on osteoporosis and mortality. Environmental exposure to Cd increases total mortality in a continuous fashion without evidence of a threshold, independently of kidney function and other classical factors associated with mortality including age, gender, smoking and social economic status. Pooled hazard rates of two recent environmental population based cohort studies revealed that for each doubling of urinary Cd concentration, the relative risk for mortality increases with 17% (95% CI 4.2-33.1%; P < 0.0001). Tubular kidney damage starts at urinary Cd concentrations ranging between 0.5 and 2 μg urinary Cd/g creatinine, and recent studies focusing on bone effects show increased risk of osteoporosis even at urinary Cd below 1 μg Cd/g creatinine. The non-smoking adult population has urinary Cd concentrations close to or higher than 0.5 μg Cd/g creatinine. To diminish the transfer of Cd from soil to plants for human consumption, the bioavailability of soil Cd for the plants should be reduced (external bioavailability) by maintaining agricultural and garden soils pH close to neutral (pH-H(2)O of 7.5; pH-KCL of 6.5). Reducing the systemic bioavailability of intestinal Cd can be best achieved by preserving a balanced iron status. The latter might especially be relevant in groups with a lower intake of iron, such as vegetarians, and women in reproductive phase of life. In exposed populations, house dust loaded with Cd is an additional relevant exposure route. In view of the insidious etiology of health effects associated with low dose exposure to Cd and the current European Cd intake which is close to the tolerable weekly intake, one should not underestimate the importance of the recent epidemiological evidence on Cd toxicity as to its medical and public health implications.”

From the study - “The rate of Cd absorption is increased if the nutritional status of calcium, iron or zinc is low.“
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