Cocoa

Aka: Cocoa, Chocolate, Cocoa Extract, Cacao Plant, Cacao Bean

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II. Definitions

  1. Cacao Plant
    1. Most commonly Theobroma cacao, a tree in family Sterculiaceae or Byttneriaceae
    2. Cacao Beans and other extracts are fermented and roasted to produce cocoa and Chocolate

III. Mechanism

  1. Cocoa Extracts contain flavonoids (or Flavanols)
    1. Epicatechin
    2. Catechin
    3. Procyanidins
    4. Xanthines (e.g. theobromine)
  2. Flavonoids may increase vasodilation and decrease Blood Pressure (limited evidence)
    1. Nitric oxide increased (activates endothelial nitric oxide synthase or eNOS)
    2. Inhibits Angiotensin Converting Enzyme
  3. Other potential other effects with weaker evidence
    1. Insulin Sensitivity increased
    2. Enhanced cognition
    3. Antiinflammatory effects
      1. May suppress endogenous pro-inflammatory factors
      2. May scavenge oxygen free radicals

IV. Efficacy

  1. Cardiovascular Death risk reduction (limited evidence)
    1. Cocoa containing >=4% naturally conserved cocoa flavinoids, at 500 mg daily for 3.5 years
    2. Does not appear to lower risk of Cerebrovascular Accident or Myocardial Infarction
    3. Buijsse (2006) Arch Intern Med 166(4):411-7 +PMID: 16505260 [PubMed]
    4. Sesso (2022) Am J Clin Nutr 115(6):1490-500 +PMID: 35294962 [PubMed]
  2. Blood Pressure lowering (limited evidence)
    1. May lower Blood Pressure by up to 4 mmHg systolic, and 2 mmHg diastolic
    2. Hooper (2012) Am J Clin Nutr 95(3):740-51 +PMID: 22301923 [PubMed]
    3. Ludovici (2017) Front Nutr 4:36+PMID: 28824916 [PubMed]

V. Adverse Effects

  1. Heavy Metal Contamination (esp. Lead, Arsenic, Cadmium)
    1. Varies by the soil in which cacao trees are grown
    2. Higher risk with increasing percent cocoa and the hardness of Chocolate
    3. Lo Dico (2018) Food Chem 245:1163-8 +PMID: 29287336 [PubMed]
    4. Abt (2018) Food Addit Contam Part B Surveill 11(2):92-102 +PMID: 29310543 [PubMed]
  2. Caffeine Exposure
    1. Cocoa typically contains 35 mg Caffeine per serving (similar to caffeinated drinks)
    2. Cocoa products are only required to list the Caffeine amount ADDED to the naturally present Caffeine
    3. Avoid with other stimulants, beta Agonists, or other high Caffeine sources

VI. Safety

  1. Avoid excessive cocoa in pregnancy and Lactation (moderate amounts appear safe)
    1. High doses may be associated with excessive Caffeine and Heavy Metal exposure

VII. References

  1. (2024) Presc Lett 31(2): 12
  2. Tan (2021) Nutrients 13(9):2909 +PMID: 34578786 [PubMed]

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Related Studies

Cost: Medications

chocolate (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CHOCOLATED LAXATIVE Generic OTC $0.10 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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