The Right Chocolate Dose?

A number of studies have shown cardiovascular benefits of eating flavanol rich cocoa. Cocoa is the important substance of chocolate. Especially dark chocolate can contain high levels of flavanols.

The possible underlying mechanisms of these cardioprotective properties of chocolate can be several.

One of the possible mechanism mentioned before is the potential anti-inflammatory activities that are relevant to cardiovascular health. With inflammation, substances are formed which can produce adverse cardiovascular effects. In a recent publication the relation between anti-inflammatory effects of chocolate and protection against adverse cardiovascular effects was further elucidated.

A J-shaped relationship between dark chocolate consumption and serum CRP was observed; consumers of up to 1 serving (20 g) of dark chocolate every 3 d had serum CRP concentrations that were significantly lower than nonconsumers or higher consumers. Our findings suggest that regular consumption of small doses of dark chocolate may reduce inflammation.

So now we have three “dosages” of chocolate recommended:

• an average amount of 6.7 grams of chocolate per day, corresponding to a small square of chocolate twice or three times a week
• no more than 25 gram, or 2.5 squares of dark chocolate, a day
• up to 1 serving (20 g) of dark chocolate every 3 days

This can be explained by the fact that the protective mechanism can be any combination of the proposed mechanisms, all we have to do is wait for the mechanism with the highest dosage ;).

Chocolate had a higher flavonoid antioxidant quantity-quality index than did fruit, vegetables, red wine, and black tea. Cocoa contains higher levels of total phenolic phytochemicals and flavonoids per serving than black tea, green tea, and red wine, suggesting that cocoa might be more beneficial to health than tea and red wine because of its higher antioxidant capacity.

In recent research it is hypothesized that a common mechanism for both red wine and dark chocolate is responsible for their protective effect on the cardiovascular system.

Green tea reduces LDL cholesterol. The combination of green tea with dark chocolate can have a synergistic protective effect on the cardiovascular system.

Elevated serum level of CRP is an independent predictor of cardiovascular events in Japanese patients with coronary artery disease.

What is CRP?

Arterial damage is thought to result from inflammation due to chemical insults. CRP is a general marker for inflammation and infection, so it can be used as a very rough proxy for heart disease risk. Since many things can cause elevated CRP, this is not a very specific prognostic indicator. Nevertheless, a level above 2.4 mg/l has been associated with a doubled risk of a coronary event compared to levels below 1 mg/l

How was this study done?

The Moli-sani Project is an ongoing cohort study of men and women aged > 34 y randomly recruited from the general population. By July 2007, 10,994 subjects had been enrolled. Of 4849 subjects apparently free of any chronic disease, 1317 subjects who declared having eaten any chocolate during the past year (mean age 53; 51% men) and 824 subjects who ate chocolate regularly in the form of dark chocolate only (50; 55% men) were selected. High sensitivity-CRP was measured by an immunoturbidimetric method.

Why is this important?
This is important because two previous small, short-term clinical trials did not find any association between the cocoa consumption and markers of inflammation. Besides the small size of such studies that
might have generated false negative results, they used relatively high doses of chocolate that could have masked the effect. In this research the dose-response curve shows that the effect of dark chocolate on serum CRP was present up to the intake of 1 serving every 3 d and tended to disappear at higher doses.
Even in an apparently healthy population, regular consumption of dark chocolate might have clinically relevant benefits in the primary prevention of cardiovascular disease.

Limitations
This is just an observational although large study. Possible confounding factors were dealt with in multivariate analysis, nevertheless complete exclusion of confounding factors can not be ruled out and generalization is limited.

Romina di Giuseppe,, Augusto Di Castelnuovo,, Floriana Centritto,, Francesco Zito,, Amalia De Curtis,, Simona Costanzo,, Branislav Vohnout,, Sabina Sieri,, Vittorio Krogh,, Maria Benedetta Donati,, Giovanni de Gaetano,, and Licia Iacoviello (2008). Regular Consumption of Dark Chocolate
Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population Journal of Nutrition, 138, 1939-1945 DOI: 18806104