This Facts About reviews dark chocolate and gives examples of foods to choose from as well as foods to avoid. We provide a guide for selecting an appropriate portion size, and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per week?

• Up to 7 ounces per week, average 1 ounce per day

What is chocolate?

Chocolate is made using beans harvested from the cocoa tree, Theobroma cacao. The beans are removed from their pod, fermented, dried, roasted and then ground to produce a cocoa mass or cocoa liquor. This is then pressed to yield cocoa butter and cocoa cake which is ground up into cocoa powder.

What is dark chocolate?

Dark chocolate is also known as "bittersweet" or "semisweet" chocolate. It contains a high percentage (=70%) of cocoa solids, and little or no added sugar. Dark chocolate has a rich, intense flavor, and is found in candies and some of the chocolate morsels (chips) used in baking.

What qualities should you look for in dark chocolate?

• 70% cocoa or more
• Made from cocoa butter instead of fats such as palm and coconut oils. Although cocoa butter does contain significant amounts of saturated fat, it has been shown to have a neutral (or even a beneficial) effect on cholesterol unlike the saturated fat in both palm and coconut oils.
• Made without the use of 'hydrogenated' or 'partially hydrogenated' oils which are known to negatively impact cholesterol.
• Darker is better: plant chemicals like flavonoids contribute to pigment. So, more flavonoids means darker chocolate and potentially greater health benefits.

Why choose dark chocolate?

• Contains flavonoids called procyanidins & epicatechins; flavonoids are part of a group of antioxidants known as polyphenols and are found in a variety of foods including tea, red wine, and various fruits and vegetables
• Decreases LDL (bad) cholesterol oxidation
• Reduces the risk of blood clots
• Increases blood flow in arteries
• May lower high blood pressure
• Cocoa may have a beneficial effect on cholesterol levels because it consists mainly of stearic acid and oleic acid. Stearic acid is a saturated fat but unlike most saturated fatty acids, it does not raise blood cholesterol levels. Oleic acid, a monounsaturated fat, does not raise cholesterol and may even reduce it.
• May improve mood and pleasure by boosting serotonin and endorphin levels in the brain
• Contains a number of minerals, including calcium, magnesium, and potassium

Special Considerations:  Milk vs. Dark Chocolate:

• Because milk binds to antioxidants in chocolate making them unavailable, milk chocolate is not an antioxidant source and is higher in fat
• To get the benefits of antioxidants, avoid drinking milk with dark chocolate

 What are the health concerns of chocolate?

Caffeine

• Contained in chocolate
• An addictive stimulant that may negatively impact health by contributing to headaches, anxiety, insomnia, heart palpitations, high blood pressure, digestive and urinary tract disorders
• Has a diuretic effect, causing the body to lose water
• Increases stomach acid. Avoiding it may be beneficial to people with digestive concerns.
• Even modest amounts of caffeine may increase symptoms of hypoglycemia. Therefore, people with blood sugar concerns may consider avoiding caffeine
• Avoidance of caffeine reduces symptoms of fibrocystic breasts in some women

Kidney Stones

Chocolate contains oxalates which can lead to an increase in urinary oxalate excretion. Increased urinary oxalate increases the risk of kidney stone formation. As a result, those individuals prone to developing kidney stones should reduce their intake of oxalate from food - including chocolate - as a way to reduce urinary oxalate.

Migraine Headaches

Dark chocolate which contains a natural chemical, tyramine, is thought to trigger migraines although the data is inconclusive. Not all individuals who suffer from migraines are sensitive to tyramine. Other foods containing tryamine include fermented and aged cheeses, certain red wines, and citrus and overripe fruits. Rather than eliminating all tyramine foods at once, experiment to see if certain foods are more problematic than others.

Nutrition Tips

1. High-quality chocolate contains a high percentage of cocoa solids. It is brown or dark brown in color, and is glossy. Avoid purchasing chocolate that has a grayish tone, white spots on the surface, or small holes.
2. While a little dark chocolate is food, a lot is not better. Chocolate is loaded with calories so consume sparingly.
3. Freeze small servings of chocolate to decrease temptation and help with portion control.
4. Treat yourself to high quality dark chocolate that has >70% cocoa. It is so rich and delicious that a small portion is usually satisfying.
5. To avoid overindulging in chocolate, eat it when after you have enjoyed a nice lunch or dinner.
6. Have a piece of fruit prior to the chocolate to help satisfy your sweet craving.
   

This Facts About document is published by Monica Myklebust, MD, and Jenna Wunder, MPH, RD, at University of Michigan Integrative Medicine Clinical Services. Our mission is to care for people using an Integrative Medicine model that reaffirms the importance of relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.

Resources

Caffeine Content of Common Beverages
Mayo Clinic
www.mayoclinic.com
Accessed May 17, 2006

Caffeine:  How does it Affect Blood Pressure?
Mayo Clinic
www.mayoclinic.com
Accessed May 17, 2006

Candies, semisweet chocolate
USDA Agricultural Research Service – Nutrient Data Laboratory         
www.nal.usda.gov/fnic/foodcomp
Accessed May 17, 2006

Chocolate
British Nutrition Foundation
www.nutrition.org.uk
Accessed May 17, 2006

A Dark Chocolate a Day Keeps the Doctor Away
WebMD Website
http://my.webmd.com
Accessed May 17, 2006

Dark Chocolate is Healthy Chocolate
WebMD Website
http://my.webmd.com
Accessed May 17, 2006

The nutritional value of cocoa and chocolate and countering areas of concern such as obesity, cholesterol and tooth decay
International Cocoa Organization
www.icco.org/questions/nutrition.htm
Accessed May 17, 2006

Tyramine
Wikipedia
www.en.wikipedia.org
Accessed May 17, 2006

Original Research and Review Articles

Boekema PJ, et al.  Coffee and gastrointestinal function:  facts and fiction.  Scandinavian Journal of Gastroenterology.  1999;34suppl(230):35-39.

Engler MB, et al.  Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults.  Journal of the AmericanCollege of Nutrition.  2004;23(3):197-204.

Holmes RP, et al.  The impact of dietary oxalate on kidney stone formation.  Urology Research.  2004;32:311-316.

Horner NK et al.  Potential mechanisms of diet therapy for fibrocystic breast conditions show inadequate evidence of effectiveness.  Jounal of the American Dietetic Association.  2000;100(11):1368-1380.

Nestel PJ.  How good is chocolate?  American Journal of Clinical Nutrition.  2001;74:563-564.

Richardson T, et al.  Influence of caffeine on frequency of hypoglycemia detected by continuous interstitial glucose monitoring system in patients with long-standing type 1 diabetes.  Diabetes Care.  2005;28(6):1316-1320.

Serafini M, et al.  Plasma antioxidants from chocolate.  Nature.  2003;424:1013.

Taubert D, et al.  Chocolate and blood pressure in elderly individuals with isolated systolic hypertension.  Journal of the American Medical Association.  2003;290(8):1029-1030.

Wan Y, et al.  Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans.  American Journal of Clinical Nutrition.  2001;74:596-602.