June 22, 2018
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Have you had your chocolate today?

By Dr. Jonathan Wood, Eastern Maine Medical Center,

Why do the Kuna, indigenous peoples from islands off the Panamanian coast, have virtually no hypertension (high blood pressure) and no increase in blood pressure with age? And why do these findings disappear with migration to urban centers like Panama City?

This phenomenon has been described in similar isolated populations and usually, when investigated, is connected to a lower salt intake in the native environment. But the native Kuna have higher salt intake than their urban counterparts. So why the extraordinary differences in cardiovascular disease?

The answer: cocoa! The Kuna drink an estimated (likely underestimated) five cups of a native cocoa drink each day. It is their primary drink and it contains large amounts of flavanols, a naturally occurring antioxidant and blood vessel relaxer.

When this “Kuna phenomenon” was first described less than ten years ago, a flurry of studies of chocolate and cocoa followed. Could this be the new “red wine,” something yummy that actually was good for your heart health? Unfortunately, to get the same amount of flavanol contained in the five plus cups of Kuna cocoa drink, one would have to eat and estimated 4.5 lbs of dark chocolate or 15 lbs of milk chocolate! These amounts are obviously not practical nor advisable to suggest. So studies have been done looking at smaller amounts and trying to account for the other less healthy things (fat, sugar, etc) in commercial chocolate. But it has been difficult. And the amounts still have seemed too large to promote without more solid data.

But now, once again, chocolate is in the news – – and it’s good news! A German study recently published in the European Heart Journal looked at detailed diet (including chocolate), blood pressure, several known cardiovascular risk factors, and some other demographics in a group of nearly 20,000 men and woman, age 35-65. This group was then followed over eight years. 300 of them suffered heart attacks or strokes during that time. When controlled for all the other factors, it seems that the lower chocolate diet in these 300 people may be responsible: i.e. the more chocolate eaten, the lower risk of stroke or heart attack. Of note, the effect was more pronounced for strokes than heart attacks.

The particularly interesting aspect of this study was the amount of chocolate that seemed to be needed to confer “protection”. The difference between the “low” chocolate group (more strokes) and the “high” chocolate group (fewer strokes) was 6 grams/day. And how much is 6 grams? Not much…

  • 1 1/2 Hershey’s Kisses = 6 grams
  • 2 little “rectangles” from a standard Hershey bar = 6 grams (one bar should last six days!)
  • 11 Nestle semi-sweet morsels = 6 grams

And should you choose milk or dark? Clearly, dark chocolate has more flavanols than milk chocolate, so if you like it, dark chocolate is a better choice.

So should we all rush out and start a daily dose of chocolate? Probably not – – this study was a retrospective observational design and needs to be repeated in a prospective way. But is a little bit of chocolate okay or perhaps even healthy? Likely, yes. And it seems a very little bit (6 grams) may go a long way…if you can control yourself and not eat the whole bar!

Remember, our chocolate bars (unlike the Kunas’ drink) have much more in them than just cocoa…

A good rule of thumb: everything in moderation!

Dr. Jonathan Wood is a critical care pediatrician at Eastern Maine Medical Center in Bangor.

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