Edward, tell me, are the health benefits of cocoa real or just hype? This was a question from a hypertensive patient I have known for years. It is amazing the body of information available now on cocoa. There is one I believe that captures the health benefits of cocoa fairly well. It is titled “Cocoa and Cardiovascular Health” by Corti et al (2009).’ The paper is even carried by the highly esteemed American Heart Association (AHA).I found the background of this particular paper very interesting. For centuries, cocoa-rich chocolate has been known not only for its good taste ‘out also for its proposed health effects, The Incas considered it the drink of the gods, this association actually explains the scientific name of the cocoa tree, Theobroma cacao. Theo in Greek means god, broma means to drink. The Incas formed the largest empire in pre-Columbia America and controlled swathes of South America with their administrative, political arid military centre based in modem-day Peru. The paper notes that cocoa consumption dates back to 1600’ BC with an Aztec Emperor calling cocoa a divine drink which built up resistance and reduced fatigue.
The Aztecs had found out that a cup of cocoa drink permitted a man to walk for a whole day without food (Cortes H, 1519). The paper noted that in the 19th century, chocolate became a luxury item with its consumption regarded as a sin rather than a remedy. The recent discovery of biologically active phenolic compounds in cocoa has changed this perception and stimulated research on its effects on ageing, blood pressure regulation and atherosclerosis.
The first evidence of the cardiovascular benefits of cocoa was observed in Kuna Indians, a native population living on islands off the coast of Panama.

The Kuna belong to one of the few cultures that are protected against the age-dependent increase in blood pressure and the development of arterial hypertension. The Kunas consumed great amounts of cocoa daily.
Deaths from cardiovascular events were found to be far lower than in other Pan-American citizens. It noted that the factors involved were clearly environmental rather than genetic because the protection against cardiovascular diseases disappeared on their migration to urban Panama City, where the home-prepared cocoa is replaced by other food with lower flavanol content. The paper also referred to the Zutphen Elderly Study, involving 470 elderly men which showed cocoa intake improved cardiovascular health.
Cocoa contains flavanol, a polyphenol. Flavanols occur as monomers; epicatechin and catechin. These monomers can assemble as dimmers, oligomers, and polymers of catechins (Procyanidins).
Procyanidins (also known as condensed tannins), through the formation of complexes with salivary proteins, are the cause of the bitterness of cacao. It is important to note that after oral intake of cocoa, both the flavanol content and the total antioxidant capacity in plasma increase with the highest plasma peak concentrations of flavanols obtained 2-3 hours after ingestion, It is noteworthy that milk chocolate has the lowest flavanol , content compared with cocoa powder and dark chocolate.
A range of potential mechanisms through which flavanols and cocoa exert their benefits on cardiovascular health are activation of Nitric Oxide (NO) and antioxidant, anti-inflammatory, and antiplatelet effects, which in turn improve endothelial function, lipid levels, blood pressure, in- sulin resistance and clinical outcome.
The endothelium is a continuos, smooth, nonthrombogenic surface of all blood vessels that show a highly selective permeability in its healthy state. The endothelium synthesizes and releases a broad range of vasoactive substances.Functional impairment of the vascular endothelium in response to injury occurs long before the development of structural atherosclerotic changes. Nitric oxide (NO) synthesized by endothelial NO synthase (eNOS) induces relaxation of vascular smooth muscle cells, prevents leukocyte adhesion ‘and migration, smooth muscle cell proliferation and platelet adhesion and aggregation. Endothelial dysfunction reduces eNOS and/or NO bioavailabity and finally atherosclerotic disease.
Endothelial dysfunction is associated with cardiovascular disease, and predictive of coronary events. In patients with coronary artery disease, consuming foods rich in flavanols such as cocoa improves endothelial function through increased expression of NO.In patients with cardiovascular risk factors, a cocoa drink high in flavanol content (176 to 185mg) rapidly increases the circulating pool ofbioactive NO by more than a third and leading to vasodiation. Consuming a flavonoid-enriched cocoa beverage leads to regional changes in cerebral (brain) blood flow and an overall increased blood flow to gray matter (brain) for up to 3 hours (Loke et al 2008).
In elderly humans cerebral blood flow in the middle cerebral artery increases indicating protection against dementia and stroke (Francis et al 2006).
Cocoa flavanols and procyanidins exert strong anti-oxidant effects. Polyphenols from cocoa delayed the oxidation 01 low-density lipoprotein (LDL) bad cholesterol. Oxidative stress and reduced antioxidant defence play a crucial role in atherosclerosis.Consumption of 40g dark chocolate induced coronary vasodilation, improved coronary vascular function and decreased platelet adhesion (Flammer et al 2007).Cocoa reduces platelet aggregation within hours of its consumption. Cocoa decreases both platelet aggregation and adhesion (Hermann et al 2006).A small amount of dark chocolate daily (6g) reduced mean systolic blood pressure by 2.9±1.6 mm Hg and diastolic blood pressure by 1.9±l.O mm Hg with” no changes in body weight, plasma lipid levels, glucose, and 8-isoprostane (Taubert et al 2007). Cocoa has been found to reduce insulin resistance (Grassi et aI2005). Cocoa butter, a fat derived from cocoa plants and found predominantly in dark chocolate contains an average of 33% mono-unsaturated oleic acid and 33% staeric acid.
In hypertensive patients, daily consumption of 100g flavonoid rich chocolate over 2 weeks led to a significant 12% reduction of total and LDL cholesterol levels (Grassi et aI2005).In healthy subjects, daily consumption of75g polyphenol-rich dark chocolate over 3 weeks in- creased HDL cholesterol (good cholesterol) by up to 14% and inhibited lipid peroxidation (Mursu et aI2004).It should, however, be noted that the cardiovascular benefits of cocoa could be negated by high sugar and high fat (saturated) content in some of the products available.
Like everything, moderation i the key in realising its full benefits. The health benefits from the fore-going are skewed in favour of the products with high flavanol content, e.g. dark chocolate. If you are hypertensive never attempt to replace your antihypertensives with flavanol-enriched cocoa product. It should be seen as complimentary rather than substitution,
A thought came to me during Mother’s day celebration at church and all mothers in the church were given bars of chocolate. We have already done it for Valentine Day which we refer to as National Chocolate Day. Perhaps we should extend it to other such days on our national calendar.
Apart from the proven health benefits from regular use of flavanol-enriched cocoa, the potential economic gains are huge contributing to the socioeconomic development of the country.

Source: Ghanaian Times