Healing Foods Pyramid™

PyramidDark Chocolate
Dark Chocolate
is included in the Healing Foods Pyramid™ as part of a balanced, whole foods, plant-based diet. This Food Pyramid emphasizes foods that nourish the body, sustain energy over time, contain healing qualities and essential nutrients, and support a sustainable environment.

What are the recommended servings per week?

Why choose dark chocolate?

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. Cocoa liquor can be pressed to yield cocoa butter and cocoa cake which is ground up into cocoa powder. Cocoa liquor can also be combined with cocoa butter, sugar, vanilla, (and milk, in milk chocolate) to make chocolate.

What is dark chocolate?

Dark chocolate is also known as "bittersweet" or "semisweet" chocolate. It contains a high percentage (> 60%) of cocoa solids, and little or no added sugar. Dark chocolate has a rich, intense flavor, and is found in chocolate bars, candies and baking chocolate.

What qualities should you look for in dark chocolate?

Special Considerations: Milk vs. Dark Chocolate:

Chocolate: Comparisons of Antioxidant Activity and Cocoa Content

Listed from highest level of antioxidant activity to lowest level

Percentage of Cocoa (%)

Cocoa Powder

~ 88-96

Dark Chocolate/ Baking Chocolate

~ 45-80

Milk Chocolate

~ 5-7

White Chocolate

~ 0

What are the health concerns of chocolate?


There are measurable amounts of caffeine in dark chocolate; individuals who are sensitive to caffeine should be aware of this when considering adding dark chocolate to their diet

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. Individuals who suffer from migraines may consider experimenting to determine if dark chocolate is a trigger for them.

Ideas for Healthy Dark Chocolate Consumption


Caffeine: How does it Affect Blood Pressure?
Mayo Clinic
Accessed June 15, 2009

Candies, semisweet chocolate
USDA Agricultural Research Service — Nutrient Data Laboratory
Accessed June 15, 2009

British Nutrition Foundation
Accessed June 15, 2009

Chocolate’s Dark Secret
WebMD Website
Accessed June 15, 2009

Dark Heart Healthy Chocolate
WebMD Website
Accessed June 15, 2009

How much caffeine is in your daily habit?
Mayo Clinic
Accessed June 15, 2009

Inventory of the health and nutrition attributes of cocoa and chocolate:
December 2005
International Cocoa Organization
Accessed July 1, 2009

Tips for avoiding migraine headache triggers
WebMD Website
Accessed July 1, 2009

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.

Hamed MS, et al. Dark chocolate effect on platelet activity, C-reactive protein and lipid profile: a pilot study. Southern Medical Journal. 2008; 101 (12): 1203-1208.

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.

Lippi G, et al. Dark chocolate: consumption for pleasure or therapy? Journal of Thrombolysis. 2008 doi: 10.1007/s11239-008-0273-3.

Miller KB, et al. Antioxidant activity and polyphenol and procyanidin contents of selected commercially available cocoa-containing and chocolate products in the United States. Journal of Agriculture and Food Chemistry. 2006; 54: 4026-4068.

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

Nurk E, et al. Intake of flavonoid-rich wine, tea and chocolate by elderly men and women is associated with better cognitive test performance. The Journal of Nutrition. 2009; 139: 120-127.

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.

Shiina Y, et al. Acute effect of oral flavonoid-rich dark chocolate intake on coronary circulation, as compared with non-flavonoid white chocolate, by transthoracic Doppler echocardiography in healthy adults. 2007 Doi: 10.1016/j.ijcard.2007.07.131.

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.

The Healing Foods Pyramid™ was created by the Nutrition Education Team at the University of Michigan Integrative Medicine, Department of Family Medicine in 2005 and updated in 2009.