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Cocoa and Chocolate in Human Health and Disease

Doi: 10.1089/ars.2010.3697

David L. Katz,Kim Doughty, and Ather Ali

Abstract

Cocoa contains more phenolic antioxidants than most foods. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-κB. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks. Antioxid. Redox Signal. 15, 2779–2811.

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I. Introduction

A. History

Chocolate is best known as an indulgent confection, but historically it has also been consumed for its purported healing properties (60). Foods and beverages made from beans from the Theobroma cacao tree (cocoa, cacao) have been consumed by humans since at least as early as 460 AD (224). The medicinal uses of cacao or chocolate either as a primary remedy or as a vehicle to deliver other medicines originated in Mesoamerica, where it was consumed by indigenous peoples, and diffused to Europe in the mid-1500s. Between the 16th and 20th centuries, well over 100 uses for cacao or chocolate, as a medical treatment, have been documented (60). Among these, three applications are most common: (i) to induce weight gain in emaciated patients; (ii) to stimulate the nervous system; and (iii) to improve digestion and elimination (60).

The Kuna Indians of the San Blas islands of Panama consume an average of three 10-ounce cups of cocoa beverage daily, ingesting approximately 1880 mg of procyanidins (39162). The prevalence of hypertension among the Kuna islanders is very low (2.2%) and blood pressure (BP) does not increase with age (104). The population also experiences lower rates of diabetes mellitus, myocardial infarction, stroke, and cancer than mainland Panamanians (103). Among Kuna who have migrated to urban areas on mainland Panama, the prevalence of hypertension is higher (10.7%) and reaches 45% among those over age 60 (Fig. 1) (104). McCullough et al. have hypothesized that the high intake of a traditional cocoa beverage may be partly responsible for the low incidence of cardiovascular disease among the Kuna islanders (162). Compared to Kuna living in a suburb of Panama City, those still living on the remote islands consume twice as much fruit, four times as much fish, and 10 times as much cocoa (162).

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696435/

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