Everyone loves the taste of chocolate, but most people are unaware of its potential health benefits. Cocoa contains antioxidant polyphenols, whose consumption can improve heart and blood vessel health, protect the brain, and improve skin health. Read this post to learn more about the health benefits of cocoa.
What Is Cocoa?
For hundreds of years, cocoa has been used in body rituals and medicine throughout the world. Cocoa originated in the Americas and spread to Europe over time. Cocoa is used to reduce weight gain, reduce fatigue, stimulate the nervous system, and improve digestive function, among others [1].
Interestingly, Panama is well-known for its cocoa consumption, and its population has good health and low incidence of heart disease.
Cocoa comes from beans produced by the Theobroma cacao tree and contains many active components [2, 3, 4]:
- Polyphenols – antioxidant compounds that protect against bacteria and UV rays. The most abundant polyphenols in cocoa are flavonoids, catechins, and epicatechins.
- Theobromine – a plant-derived compound with potential benefits to heart, respiratory, and mouth health.
- Minerals – the most abundant ones are magnesium, copper, and iron, all of which are important in overall health and body function.
Cocoa Butter
Cocoa butter is the fat extracted from cocoa beans. Some of its components include the amino acids arginine and leucine, fatty acids, such as oleic, stearic, and palmitic acids, theobromine, and caffeine, among others [5].
Cocoa butter doesn’t contain the polyphenols and, therefore, doesn’t have the same potential health benefits as cocoa.
Mechanisms of Action
Flavanols (a class of flavonoids) present in cocoa increase the production of nitric oxide (NO) by blood vessels, which leads to their widening and increased blood flow.
Cocoa exerts its antioxidant properties due to flavanols, which decrease the production of free radicals and prevent oxidative damage [6].
Epicatechin and catechin cross the blood-brain barrier and localize in certain areas of the brain, potentially providing protection to this organ and improving cognitive function [7].
Flavanols also slow the digestion and absorption of carbohydrates, which helps balance glucose levels in the body [8].
Snapshot
Proponents
- May lower blood pressure and cholesterol, thus reducing the risk of heart disease
- Antioxidant activity
- May improve cognitive function and reduce cognitive decline
- May improve skin health
- May improve mood
- Pleasant flavor
Skeptics
- Insufficient evidence for some benefits
- May cause acne, migraines, food intolerance, and allergic reactions
- Commercial chocolate products are often unhealthy
Health Benefits
Likely Effective
1) Preventing Heart Disease
The flavonoids present in cocoa prevent the blockage of the blood vessels by improving their function, decreasing blood clotting, and lowering blood pressure [9, 10, 11].
A meta-analysis of 24 trials and over 1,100 people found that cocoa consumption reduced the improved blood pressure, insulin resistance, blood fat profile, and blood vessel function, all of which are risk factors for heart disease [12].
Another meta-analysis of 7 studies and almost 115,000 people associated dark chocolate consumption with an overall 37% reduction in heart disease rates. Importantly, a recent meta-analysis of 23 studies and over 405,000 people pointed out that the consumption must be moderate: over 100 g/week may be less effective and add the negative effects of high sugar intake [13, 14].
Similarly, 3 meta-analyses of 25 studies and over 610,000 people found a reduced incidence of coronary heart disease, heart failure, and heart attack (myocardial infarction) among those consuming moderate amounts of dark chocolate [15, 16, 17].
In contrast, 2 studies on over 72,000 people and a meta-analysis of 5 studies and over 180,000 people failed to associate chocolate consumption with irregular heart rate (atrial fibrillation) [18].
A study on over 2,000 people with high blood pressure and metabolic syndrome found cocoa supplementation a cost-effective measure to reduce cardiovascular events [19].
All in all, the evidence suggests that cocoa may help prevent heart conditions such as coronary heart disease, heart failure, or heart attacks by reducing blood pressure, blood clotting, blood fat levels, and insulin resistance. While not approved by the FDA for this purpose, you may discuss it with your doctor if it may help you as a complementary approach. Importantly, never take it in place of what your doctor recommends and prescribes and keep in mind that commercial chocolate may have negative effects due to its high content in sugar and fats.
2) Lowering Blood Pressure
Consumption of cocoa has been proven to lower blood pressure by widening the blood vessels and protecting against harmful effects of oxidative damage (such as reducing blood vessel function and promoting artery clogging) [20].
A study of 15 healthy people showed that the higher the concentration of flavanols, the greater the effect of cocoa on reducing blood pressure. Those who consumed dark chocolate, which has a high concentration of flavonols, saw a much more significant impact than those who consumed white chocolate (without flavonols) [21].
A diet rich in flavonoids (from dark chocolate, red apple, and green tea) as an add-on to blood pressure-lowering medication further improved blood pressure (and other heart disease risk parameters such as blood fat profile, obesity, and inflammation) in a clinical trial on 79 hypertensive people [22].
Chocolate and other cocoa products were found to lower blood pressure in 2 meta-analyses of 25 clinical trials [23, 24].
A meta-analysis of 35 trials showed that those who consumed high amounts of flavanols saw a greater reduction in blood pressure than those who consumed little to no flavanols [25].
Again, the evidence suggests that cocoa may help lower blood pressure. If you have hypertension, you may discuss with your doctor if including cocoa in your diet may help you. Remember that cocoa should only be used as an add-on to your treatment regime and never in place of approved blood pressure-lowering medication.
Possibly Effective
1) Antioxidant
The polyphenols in cocoa are antioxidants that prevent free radicals from damaging cells. Due to its abundance in these compounds, cocoa has a higher potential antioxidant capacity than red wine, green and black tea [26, 10].
In a clinical trial on 48 healthy people, consuming flavanol-rich cocoa improved antioxidant status (by increasing glutathione levels and reducing oxidative damage markers such as oxidized LDL and F2-isoprostane), especially at high doses. In another trial on 100 men, cocoa protected blood fats from oxidation [27, 28].
Dark chocolate, in combination with astaxanthin, reduced oxidative stress markers (oxidized LDL and MDA) in another trial on 32 aged people [29].
In a clinical trial on 38 people with non-alcoholic fatty liver disease, dark chocolate prevented the production of free radicals by blocking an enzyme that produces them (NOX2) [30].
In 2 small trials on 36 athletes, cocoa flavanols increased antioxidant capacity before and during exercise [31, 32].
To sum up, the evidence suggests that cocoa’s polyphenols may be antioxidant in humans. You may discuss with your doctor how to use cocoa to improve your antioxidant status.
2) Lowering Cholesterol
A study on 48 people at risk for heart disease and another study on 25 people with normal or slightly high cholesterol showed that consuming cocoa powder on a regular basis decreased LDL (bad) cholesterol and increased HDL (good) cholesterol [33, 34].
In line with this, a meta-analysis of 10 clinical trials and 320 people found that dark chocolate reduced LDL cholesterol but had no major effects on HDL cholesterol and triglycerides [35].
However, a meta-analysis of 8 trials and over 200 people found that the reduction was independent of the dose and cocoa was ineffective in healthy people [36].
In rats, cocoa butter lowered “bad” VLDL cholesterol [37].
Although a bit limited, the evidence suggests that cocoa may help lower “bad” cholesterol in people with high blood fat levels. You may use it as an add-on to your treatment regime if your doctor determines that it may be helpful in your case. Importantly, never use it in place of what your doctor recommends or prescribes.
3) Cognitive Function
Flavonoids, mainly catechin and epicatechin, may play a role in brain health enhancing its function, creating new brain cells, and even reversing brain damage in conditions such as Alzheimer’s and Parkinson’s diseases [38, 39].
These compounds cross the blood-brain barrier and localize in areas of the brain responsible for memory and learning, which is where most neurodegeneration occurs [38].
In 3 clinical trials on over 100 healthy adults, acute consumption of cocoa improved working memory, spatial memory, and visual search efficiency. However, dark chocolate only improved mood but had no effect on cognition in another trial on 72 middle-aged people [40, 41, 42, 43].
Cocoa also preserved cognitive decline in elderly adults by preserving white matter integrity and protecting a brain region whose decline is associated with memory impairment in (dentate gyrus) [44, 45, 46].
Three small studies on 30 volunteers showed that cocoa flavanols increase blood flow in the brain in both young and elderly people [47, 48, 49].
Again, limited evidence suggests that cocoa’s flavonoids may improve some cognitive functions and help prevent cognitive decline in elderly people. Further clinical research should determine how to use it for this purpose.
Insufficient Evidence
The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of cocoa for any of the below-listed uses. Remember to speak with a doctor before taking cocoa for any health conditions. You should never use it as a replacement for approved medical therapies.
1) Skin Health
Through its antioxidant properties, cocoa’s flavanols are the components most relevant to skin health.
A cocoa beverage with 320 g flavanols improved skin elasticity and reduced wrinkles in a trial on 64 women aged by repeated sun exposure [50].
Similarly, flavanol-rich cocoa improved blood circulation and partly reversed skin damage caused by smoking in a small trial on 11 smokers [51].
High-flavanol cocoa reduced the skin sensitivity to UV-induced redness in 2 clinical trials on 54 healthy people. However, it was ineffective in another trial on 33 people [50, 52, 53].
In another study on 10 healthy women, cocoa flavanols increased blood circulation and oxygen concentration in the skin [54].
In human skin explants, cocoa butter moderately increased skin thickness and collagen density. The butter was more effective in combination with cocoa polyphenols [55].
Although the results are promising, the evidence is insufficient to support the use of cocoa to promote skin health. Larger, more robust clinical trials are needed.
2) Mood
In 2 clinical trials on 120 healthy people, dark chocolate or cocoa consumption enhanced positive mood. Chocolate was more effective when combined with a mindfulness intervention in another trial on over 250 people [56, 43, 57].
In another trial on 48 people, chocolate improved an experimentally-induced negative mood [56].
This mood enhancement seems to be unrelated to theobromine, which unlike caffeine had no effects on mood or vigilance in a small trial on 24 people [58].
Although the evidence is limited, research suggests that dark chocolate may help improve mood.
Again, the results are promising but the evidence comes from a few clinical trials (one of which had negative results). Further clinical research is needed to confirm their findings.
3) Constipation
Cocoa husk is rich in dietary fiber, which may help keep the colon healthy. In a clinical trial on 48 constipated children, cocoa husk reduced constipation by speeding up bowel movements and softening stools. Cocoa bran improved stool bulk similarly to wheat bulk in another trial on 25 healthy adults [59, 60].
In another trial on 44 healthy people, consuming two servings of cocoa a day resulted in faster, more frequent bowel movements and softer stools [61].
Once again, the results are promising but only 3 small clinical trials attest to the effectiveness of cocoa at reducing constipation. More clinical trials on larger populations are needed to confirm their preliminary findings.
4) Blood Sugar Levels
Cocoa polyphenols, especially from dark chocolate, improved glucose breakdown, reduced blood pressure, and improved insulin resistance in a small trial on 15 healthy people [21].
Cocoa flavanols also reduced insulin resistance, blood pressure, and oxidative damage in another study on 90 elderly people with mild cognitive impairment [62].
In another trial on 19 people at risk of diabetes (impaired glucose tolerance), dark chocolate and cocoa improved insulin sensitivity, pancreatic function, and lowered blood pressure. However neither cocoa nor green tea was effective at improving sugar metabolism in another trial on 20 obese people at risk of insulin resistance [63, 64].
In a clinical trial on 93 postmenopausal, diabetic women, dietary flavanols as an add-on to conventional therapy reduced insulin resistance and biomarkers of heart disease risk. However, 2 small trials on 30 people with type 2 diabetes found that supplementation with cocoa had no effect on blood sugar levels and insulin resistance. In people with this condition, it seems to mainly improve blood vessel function and lower cholesterol [65, 66, 67].
A few, small clinical trials with mixed results cannot be considered conclusive evidence that cocoa helps with blood sugar control. Some weak evidence suggests that it may help in healthy but not in diabetic people. Nevertheless, more clinical trials are needed to shed some light on this potential benefit.
5) Fatigue
In a clinical trial on 30 healthy people taking mentally demanding tests, cocoa flavanols reduced mental fatigue [40].
In a small trial on 10 people, eating polyphenol-rich chocolate improved the symptoms of chronic fatigue syndrome [68].
In another small trial on 12 people with multiple sclerosis, flavonoid-rich dark chocolate slightly reduced self-reported fatigue [69].
Three small trials cannot be considered sufficient evidence that cocoa reduces fatigue. More clinical trials on larger populations are needed to validate their results.
6) Teeth Health
In a clinical trial on 32 children, using cocoa bean husk extract as a mouth rinse decreased plaque buildup by almost 50% and the levels of a microbe that causes cavities and gum disease (Streptococcus mutans) by almost 21% [70].
In a study on 24 extracted human teeth, applying a concentrated (200 mg/L) theobromine coat protected the enamel [71].
Only two small clinical trials have tested the role of cocoa in teeth health. Further clinical research is warranted to clarify this potential health benefit.
7) Airway Function
Cocoa butter is traditionally used to treat cough, both rubbed on the chest and back or drunk in combination with warm milk and honey.
In a small study on 10 healthy volunteers and guinea pigs, cocoa’s theobromine reduced the nerve activation that causes coughing [72].
In another small trial on 9 asthmatic children, both theobromine and theophylline widened the airways [73].
Again, two small clinical trials are clearly insufficient to claim that cocoa helps with airway function. More clinical research is needed to confirm these preliminary findings.
8) Copper Deficiency
Long-term tube-fed patients may suffer from deficiencies in micronutrients such as copper. Since cocoa powder is relatively rich in copper, it was effectively used to restore its deficiency in 27 people subjected to prolonged tube feeding [74, 75, 76].
Although the results are promising, this anecdotal evidence cannot be considered conclusive to support the use of cocoa in copper-deficient patients until more clinical research is conducted.
Animal and Cell Research (Lack of Evidence)
No clinical evidence supports the use of cocoa for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies should not be interpreted as supportive of any health benefit.
Preventing Neurodegenerative Diseases
Increased reactive oxidative species (ROS) play a role in the onset of brain disorders. Due to the antioxidant properties of polyphenols, consumption of cocoa may protect against neurodegenerative diseases such as Alzheimer’s and dementia as seen in cell-based studies [77].
In a study in rats, cocoa’s catechins and epicatechins reduced brain cell damage and death [78].
Obesity
In a study in rats, those fed cocoa had less fat production in the belly [79].
In mice, cocoa consumption reduced weight gain and fat uptake in the gut. Cocoa also reduced inflammation associated with obesity and improved insulin resistance [80].
Wounds
Cocoa has long been used as a remedy for skin conditions such as burns and cuts. While there is not a lot of clinical evidence for the topical use of cocoa products, they promoted skin regeneration and had antimicrobial activity in animal and cell-based studies [81, 82].
Magnesium Deficiency
Cocoa is rich in magnesium. A study in rats found that cocoa consumption increased magnesium levels and improved the symptoms of its deficiency [83].
Kidney Function
A cocoa butter supplement reduced kidney damage (measured as creatinine levels) in rats [37].
Adverse Effects
This list does not cover all possible side effects.
Although cocoa is generally safe when consumed in moderation, high amounts can cause the following adverse effects:
- Acne [84]
- Migraines [85]
- Allergies, skin inflammation, and lesions caused by trace metals such as nickel [86]
People with food sensitivities can have negative reactions to cocoa. To clearly establish chocolate as the food causing you food intolerance, you can try to follow an elementary diet for 2 weeks and then add one food at a time back in. Because elementary diets can lead to deficiencies, follow your doctor’s instructions carefully.
Importantly, although cocoa has many potential health benefits, commercial chocolate and its products often contain high amounts of compounds far from being healthy such as sugar, fat, and additives.
Sources of Cocoa
Cocoa is mostly consumed as chocolate, including milk and dark chocolate (white chocolate doesn’t actually have cocoa). The higher the percentage of cocoa in the chocolate, the more likely it is to produce any health benefits [87].
In addition to chocolate, cocoa is sold as cocoa beans, nibs, liquor, powder, and husk [88, 89].
Cocoa can also be supplemented in capsules. There are also topical products with cocoa and cocoa butter.
Other Sources of Cocoa’s Polyphenols
Other than cocoa, there are a variety of foods that contain some of its polyphenols, including black and green tea, grapes, apples, pears, berries, wine, and nuts [90, 91].
Compared to other sources, dark chocolate has the highest amount of flavonoids (10-15 grams/kg) [91].
Other healthy polyphenols (with posts):
