Dark chocolate: Half a bar per week to keep at bay the risk of heart attack

Maybe gourmands are not jumping for joy. Probably they would have preferred bigger
amounts to support their passion, although the news is still good for them: 6.7 grams of
chocolate per day represents the ideal amount for a protective effect against
inflammation and subsequent cardiovascular disease. This effect was demonstrated for
the first time in a population study by the Research Laboratories of the Catholic
University in Campobasso, Italy, in collaboration with the National Cancer Institute of
Milan.
The findings come from one of the largest epidemiological studies ever conducted in
Europe, the Moli-sani Project, which has enrolled 20,000 inhabitants of the Molise
region (east of Rome) so far. By studying the participants recruited, researchers
focused on the complex mechanism of inflammation. A chronic inflammatory state is
known to represent a risk factor for the development of cardiovascular disease, from
myocardial infarction to stroke, just to mention the major diseases. Keeping the
inflammation process under control has become a major issue for prevention programs,
and C-reactive protein turns out to be one of the most promising markers, detectable
by a simple blood test.
The Italian team set out to relate the levels of this protein in the blood of examined
people with their usual chocolate intake. Out of 11,000 subjects, researchers identified
4,849 persons in good health and free of risk factors (normal cholesterol, blood
pressure, and other parameters). Among them, 1,317 did not customarily eat any
chocolate, whereas 824 consumed chocolate regularly, but only dark chocolate.
"We started from the hypothesis," said Romina di Giuseppe, 33, lead author of the
study, "that high amounts of antioxidants contained in the cocoa seeds, in particular
flavonoids and other kinds of polyphenols, might have beneficial effects on the
inflammatory state. Our results have been absolutely encouraging: People having
moderate amounts of dark chocolate regularly have significantly lower levels of Creactive protein in their blood. In other words, their inflammatory state is considerably
reduced." The 17% average reduction observed may appear quite small, but it is
enough to decrease the risk of cardiovascular disease by one-third in women and onefourth in men. It is undoubtedly a remarkable outcome."
Chocolate amounts are critical. "We are talking of a moderate consumption. The best
effect is obtained by consuming an average amount of 6.7 grams of chocolate per day,
corresponding to a small square of chocolate twice or three times a week. Beyond
these amounts the beneficial effect tends to disappear."
From a practical point of view, as the common chocolate bar is 100 grams, the study
states that less than half a bar of dark chocolate consumed during the week may
become a healthy habit. What about the milk chocolate? "Previous studies," the young
investigator continues, "have demonstrated that milk interferes with the absorption of
polyphenols. That is why our study considered just the dark chocolate."
Researchers wanted to sweep all the doubts away. They took into account that
chocolate lovers might consume other healthy food too, such as wine, fruits and
vegetables. Or they might exercise more than other people do. So the observed
positive effect might be ascribed to other factors but not to cocoa itself. "In order to
avoid this," researcher said, "we 'adjusted' for all possible 'confounding' parameters.
But the beneficial effect of chocolate still remained and we do believe it is real."

"This study," said Licia Iacoviello, Head of the Laboratory of Genetic and Environmental
Epidemiology at the Catholic University of Campobasso and responsible for the Molisani Project, "is the first scientific outcome published from the Moli-sani Project. We
consider this outcome as the beginning of a large series of data which will give us an
innovative view on how making prevention in everyday life, both against cardiovascular
disease and tumors."
"Maybe," Giovanni de Gaetano, director of the Research Laboratories of the Catholic
University of Campobasso, adds, "time has come to reconsider the Mediterranean diet
pyramid and take the dark chocolate off the basket of sweets considered to be bad for
our health."
The Moli-sani Project, carried out by the Research Laboratories of the Center for High
Technology Research and Education in Biomedical Sciences "John Paul II" at the Catholic
University in Campobasso, started in March 2005. It is funded by the Pfizer Foundation
and aims to recruit 25,000 citizens living in the Molise region, in order to investigate
environmental and genetic factors responsible for cardiovascular disease and tumors.
Until now researchers have recruited more than 20,000 people and the final number is
going to be reached by the end of 2008. The Moli-sani study is changing the face of a
whole Italian region turning it into a large scientific laboratory. From clinical tests to
electrocardiograms, from blood pressure to spirometry, from dietary habits to physical
exercise: it is a huge amount of information collected from each participant.
New study re-emphasizes natural cocoa powder has high antioxidant content
Over the past 10 years, dark chocolate and cocoa have become recognized through
numerous studies for flavanol antioxidant benefits. In a study published in September
2008 in the Journal of Agricultural and Food Chemistry, scientists from The Hershey
Company (Hershey, Pennsylvania, USA) and Brunswick Laboratories (Norton,
Massachusetts, USA) report on the levels of antioxidants in selected cocoa powders and
the effect of processing on the antioxidant levels. The study, which analyzed Hershey's
Natural Cocoa Powder and 19 other cocoa powders, reported that natural cocoa
powders have the highest levels of antioxidants. Natural cocoa powders contained an
average of 34.6 mg of flavanols per gram of cocoa powder, or about 3.5% of total
flavanols by weight. This places cocoa powder among the foods highest in these types
of antioxidants.
The study went on to look at a variety of Dutched (alkaline-processed) cocoa powders,
which are commonly used by the food industry. New findings showed that the Dutched
cocoa powders, especially the light- and medium-Dutched cocoa powders, retained
significant amounts of cocoa flavanol antioxidants. In fact, despite the losses created
by light to medium Dutch processing, these cocoa powders still were in the top 10% of
flavanol-containing foods when results were compared with thos for foods listed in the
US Deparment of Agriculture Procyanidin Database.
"This is an important finding for people who like all things chocolate," said Ken Miller,
the lead author of the paper. "Because cocoa powder is one of the richest sources of
flavanol antioxidants to start with, even lightly- or medium-Dutched processed cocoa
powders still retain significant levels of the beneficial antioxidants."
Dutching, or alkali treatment, of cocoa is a 180-year-old process used to lower the
bitterness and darken the color of cocoa powder. Dutched cocoas are commonly used
in beverages such as chocolate milk and hot cocoa mixes, in cakes and cookies, and in
a limited number of confections. In the United States, the presence of Dutched cocoa or

Dutched chocolate is indicated by looking for the terms "dutched" or "processed with
alkali" on the ingredients label.
In this study, the degree of cocoa alkalization caused a progressive, but not complete
loss, of flavanol antioxidants, with about 40% retained in lightly dutched cocoas, 25%
retained in medium dutched cocoas, and 10% retained in heavily dutched cocoas.
Preservation of Cocoa Antioxidant Activity, Total Polyphenols, Flavan-3-ols,
and Procyanidin Content in Foods Prepared with Cocoa Powder
L. Stahl 1 , K.B. Miller 1 , J. Apgar 1 , D.S. Sweigart 1 , D.A. Stuart 1 , N. McHale 1 , B. Ou
1 , M. Kondo 1 , and W.J. Hurst 1
ABSTRACT
Little is known about the effects of common cooking processes on cocoa flavanols.
Antioxidant activity, total polyphenols (TP), flavanol monomers, and procyanidin
oligomers were determined in chocolate frosting, a hot cocoa drink, chocolate cookies,
and chocolate cake made with natural cocoa powder. Recoveries of antioxidant activity,
TP, flavanol monomers, and procyanidins ranged from 86% to over 100% in the
chocolate frosting, hot cocoa drink, and chocolate cookies. Losses were greatest in the
chocolate cake with recoveries ranging from 5% for epicatechin to 54% for antioxidant
activity. The causes of losses in baked chocolate cakes were investigated by
exchanging baking soda with baking powder or combinations of the 2 leavening agents.
Use of baking soda as a leavening agent was associated with increased pH and
darkening color of cakes. Losses of antioxidant activity, TP, flavanol monomers, and
procyanidins were associated with an increased extractable pH of the baked cakes.
Chocolate cakes made with baking powder for leavening resulted in an average
extractable pH of 6.2 with essentially complete retention of antioxidant activity and
flavanol content, but with reduced cake heights and lighter cake color. Commercially
available chocolate cake mixes had final pHs above 8.3 and contained no detectable
monomeric flavanols after baking. These results suggest that baking soda causes an
increase in pH and subsequent destruction of flavanol compounds and antioxidant
activity. Use of an appropriate leavening agent to moderate the final cake pH to
approximately 7.25 or less results in both good leavening and preservation of cocoa
flavanols and procyanidins.
Recipe for success
Dr Hurst and his co-workers quantified the antioxidant activity, and the levels of total
polyphenol, flavanol monomers, and their oligomers (procyanidins) in typical cocoacontaining recipes and in several commercial cake mixes. They used Hersheys Natural
Cocoa in all products.
While excellent recoveries of antioxidant activity, polyphenol, flavanol monomers, and
procyanidins were observed in chocolate frosting, hot cocoa drink, and chocolate
cookies, ranging ranged from 86 to over 100 per cent, the chocolate cake displayed
poor recoveries, ranging from 5 to 54 per cent for antioxidant activity.
When baking soda was used as the leavening agent, the researchers noted that the pH
of the mix increased, and the colour darkened. The commercially available chocolate
cake mixes (which contained baking soda) were found to have high pHs, above pH 8.3,
and had virtually no monomeric flavanols after baking, said the researchers.
When baking soda was replaced with baking powder, the researchers noted a reduction
in the pH of the product to 6.2, and an essentially complete retention of antioxidant
activity and flavanol content.

These results suggest that the effect of increased pH due to baking soda can be
largely reversed by choosing the appropriate leavening acid in the form of a baking
powder or by adding acidic ingredients to the recipe, wrote the researchers.
The final pH of the baked cake needs to be pH 7.5 or less for preservation of
antioxidant activity and flavanol content, they added.
References :
Di Giuseppe, R., A. Di Castelnuovo, F. Centritto, F. Zito, A. De Curtis, S. Costanzo, B.
Vohnout, S. Sieri, V. Krogh, M.B. Donati, G. de Gaetano, and L. Iacoviello, Regular
Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of CReactive Protein in a Healthy Italian Population, J. Nutr. 138:1939-1945 (2008).
Miller, K.B., W.J. Hurst, M.J. Payne, D.A. Stuart, J. Apgar, D. S. Sweigart, and B. Ou,
Impact of Alkalization on the Antioxidant and Flavanol Content of Commercial Cocoa
Powders, J. Agric. Food Chem. 56:85278533 (2008).