Alliance of Cocoa Producing Countries
66th General Assembly
Bavaro – Dominican Republic
– 5th September 2003
1. - Chocolate and Health
1(a) Food Choice
The world contains a huge range of edible items which
we could eat. In practice we select from a very
narrow range; our food choices are limited by a complex
interplay of different factors. These can be summarized
as follows :
- Attitudes and beliefs
- Physical, economic and political limitations
- Habits and customs
- Physiological needs
- Emotional, psychological needs
- Personal tastes and values.
Our attitudes and beliefs determine how acceptable
we find certain foods; added to this are various physical,
economic and political limitations which govern whether
or not we can afford particular foods, where we live
in relation to the food shops and markets and what those
Food choices are also influenced by our habits and
customs. These start early on in life, with the
family. Here we establish what we eat at different
mealtimes; thus breakfast is one type of meal, and a
family celebration is altogether something different.
We also select foods according to our perceived physiological
needs. These can be influenced by our views on
what is good for us. But while nutritional awareness
has increased greatly in recent years it still only
influences seven percent of our total food choice.
Promotional supports should therefore take this complex
interplay into consideration and be geared to demographically
1(b) Nutritional Contribution
Can Chocolate/Confectionary products fit into a healthy
diet? That is diet that provides the appropriate
proportions of energy from carbohydrates, fat and protein
and meets our requirements for vitamins and minerals?
The answer is yes.
For example, a 50g milk chocolate bar provides 10
percent of the UK Estimated Average Requirement of energy,
9 percent of protein, nearly 22 percent of calcium,
more than 10 percent of iron and 25 percent of riboflavin,
(for moderately active males 19 – 49 years). Clearly,
they are not just “empty calories” as they are often
Confectionary products also compare favourable with
other foods which are regarded as healthier.
Vitamin A, ug
Vitamin B12, ug
Vitamin C, mg
The above table shows that there is more riboflavin
and calcium in a filled chocolate bar than in wholegrain
bread and more iron and magnesium than in an apple.
On the other hand, a filled chocolate bar has
less calcium than milk and less vitamin C than the apple.
This illustrates the problem of classifying one
food as better than another for certain nutrients one
food is a better source and for other nutrients a different
food is a better source.
Chocolates and Confectionary are also consumed as
snacks and this has positive aspects especially for
children. They tend to have small appetites and
a high energy output for their body size. They
find it extremely difficult to get sufficient energy
from just three meals a day, whereas snacks provide
them with the energy and nutrients they need, when they
It is generally accepted that athletes improve performance
if they have a good reserve of body glycogen (obtained
from carbohydrates) prior to endurance events. It
has equally been shown that carbohydrates can improve
mental performance. Chocolate and Confectionary
are good sources of carbohydrates.
A SUMMARY OF CHOCOLATE NUTRITION
Fat g (%DV)
Almond Bar (1.4oz)
Covered Peanuts (15 pieces)
Milk Balls (17 pieces)
SemiSweet Chocolate Chips
The scientific evidence connecting chocolate consumption
with important health benefits continues to grow. The
naturally occurring flavanols in cocoa beans are excellent
antioxidants, essentially “mopping up” free radicals
that can damage arterial walls and trigger heart disease.
These flavanols such as catechin and epicatechin,
can make up as much as 10 percent of the dry weight
in a cocoa bean. However, processing raw cocoa
beans can result in a degradation of the valuable phenolic
components that act as antioxidants. Manufacturers
are currently modifying and controlling their processes
to preserve these components.
2. Some mis-facts that would need to be countered
Despite research to the contrary, chocolate consumption
is sometimes associated with deleterious effects on
health. Such erroneous beliefs typically are based
more on popular folklore than on facts. The following
is a review undertaken by the Secretariat of the scientific
literature regarding chocolate and health to help place
in perspective the nutritional and medical aspects of
this popular food. By communicating current factual
information about chocolate, health professionals can
help consumers understand how chocolate can be part
of a healthy eating plan based on balance, variety and
Basic research on the causes of acne vulgaris links
its occurrence to rising testosterone levels during
puberty. This results in enlargement of the sebaceous
glands, which can eventually lead to the development
of comedones (blackheads). The American Academy
of Dermatology has stated acne is not a dietary disease
and following the strictest diet will not by itself
clear the skin.
Yet the idea that diet, and specifically chocolate,
is implicated in the etiology of acne remained widespread
within the medical profession until recently. Among
the first to question the link between chocolate and
acne were researchers from the University of Missouri
in the 1960s. Grant and Anderson failed in their
attempt to induce an acne flare-up in eight individuals
with mild to moderate acne by feeding them a large amount
of chocolate. The authors discredited the assertion
that chocolate causes acne.
A larger study of 65 subjects reported excessive
intake of chocolate and fat did not alter the composition
or output of sebum from sebaceous glands or affect the
course of acne. Upon review of studies purporting
to show that high carbohydrate or high fat diets aggravate
acne, the authors concluded such claims are unproved
and that the sebaceous gland has a high degree of autonomy.
In two articles, Shalita has stated there is no
evidence that food, including chocolate, has a direct
role in the pathogenesis of acne.
In an extensive review of research on chocolate and
acne conducted in 1978, Fries concluded that the general
trend of published reports suggested that chocolate
ingestion was unrelated to the cause of acne. As
cited in the Journal of the American Medical Association:
“Diet plays no role in acne treatment in most patents…even
large amounts of chocolate have not clinically exacerbated
acne. The paucity of recent research on chocolate
and acne reflects the widespread acceptance of earlier
studies acquitting chocolate of any contributing role
A food allergy is a reaction by the body’s immune
system to a substance or ingredient in food – usually
a protein. According to the National Institutes
of health, approximately five million Americans (5-8
percent of children and 1-2 percent of adults) have
a true food allergy. Eight major food allergens
account for 90 percent of all allergic reactions: milk,
eggs, peanuts, tree nuts (such as walnuts or almonds),
soy, wheat, fish, and shellfish. Children are
most commonly affected by reactions to milk and eggs.
Chocolate is an uncommon food allergen.
Some people, health professionals included, incorrectly
confuse the terms “food sensitivity” and “food allergy.”
A food intolerance or sensitivity is a reproducible
adverse reaction, not psychologically based, which includes
enzyme deficiencies, pharmacological effects, non-immunologic
histamine-releasing effects and direct irritation. A
food allergy or hypersensitivity is a form of food intolerance
that includes an abnormal immunologic reaction mediated
by antibody and/or T lymphocytes.
The only completely objective test for confirming
a food allergy is the double-blind placebo-controlled
food challenge (DBPCFC). The most prevalent food
allergens confirmed by DBPCFC are eggs, milk, soy, fish,
peanuts, tree nuts and wheat.
Patients perceptions and physicians diagnoses of
food intolerance are not always accurate; fewer than
half of patients with histories of adverse reactions
to food can be confirmed by means of objective testing.
In the case of chocolate, Fries was rarely able
to confirm a parent’s suspicions of a child’s allergies.
According to Fries, few scientific publications relate
chocolate to allergy. Fries reported positive
skin test response to the cocoa bean in about two-thirds
of allergy patients. However, test results were
not related to clinical symptoms. Maslansky and
Wein questioned 500 allergy patients regarding their
tolerance of chocolate. Although 81 said they
suffered from chocolate allergy, only 10 had the requisite
reproducible symptoms for inclusion in the double-blind
study. Eight of these patients were challenged
and only three had a reaction. Of these three,
only one had both symptoms and a positive skin test.
In another study, 20 patients with a history of “allergic”
reactions to chocolate were fed either placebo or cocoa
in a double-blind manner. The cocoa ingested approximated
the amount in an average size chocolate bar. Participants
also were fed a chocolate bar at another point in the
study. The authors concluded that only one participant
probably was allergic to chocolate. Likewise,
other studies rarely confirmed suspected reactions to
chocolate by oral challenge.
Dermal antigen tests to determine allergic response
to foods can sometimes be misleading. Problems
with dermal antigen testing include a large number of
clinically insignificant positive tests, cross-reactivity
among foods from common genetic families, and use of
an improper antigen (i.e., cocoa bean instead of processed
cocoa). The cocoa bean goes through several procedures
(e.g., fermentation, roasting, grinding, conching) before
it can be consumed as chocolate. Thus, a higher
incidence of positive cutaneous tests may result than
the incidence of clinical reactions to other ingredients
or the products of its digestion.
Chocolate candies may contain other ingredients that
can elicit allergic reactions, including such common
foods as milk, soy lecithin, gluten, peanuts and tree
nuts. This highlights the importance of label
reading by people who may be sensitive to these ingredients.
The diagnosis of chocolate reactions should be based
on reliable studies, including food elimination and
food challenge tests.
Cocoa powder and chocolate are rich sources of high
quality polyphenol antioxidants, potentially beneficial
compounds similar to those found in fruits, vegetables
and red wine that may have the potential to reduce the
risk of developing heart disease and certain cancers.
Cocoa polyphenols were previously thought to only
play a role in flavor and aroma development in chocolate,
but more recently have been studied for their antioxidant
potentials and possible health benefits to humans.
Science has long held that damage done in the body
by free oxygen radicals is linked to heart disease,
certain cancers and physical degeneration maladies associated
with the aging process. Antioxidants in the blood
stream can help eliminate free radicals, potentially
reducing the risk of developing some serious diseases.
TOP ANTIOXIDANT FOODS
per 100 grams
Absorbance capacity) is a measure of
the ability of foods to subdue harmful oxygen
free radicals that can damage our bodies.
RED BELL PEPPER
Source: Data from U.S. Department of Agriculture
and the Journal of the American Chemical Society.
Among products derived from cocoa beans, cocoa powder
contains the highest amount of polyphenols, followed
by dark chocolate and milk chocolate. Depending
upon the measurement methodology used, a 40 g (1.5 ounce)
milk chocolate bar contains between 205-300 mg of polyphenols,
which compares favourably to a five-ounce glass of red
wine which contains 210 mg of polyphenols and has been
associated with reducing the risk of developing heart
disease. In a Dutch study, chocolate was found
to be a rich source of the polyphenol flavonoid catechin,
containing four times the amount found in tea.
By all forms of measurement reviewed, cocoa and dark
and milk chocolate have high polyphenol antioxidant
values compared to fruits and vegetables. A 1999
analysis of chocolate’s polyphenol antioxidant levels
utilizing the ORAC (Oxygen Radical Absorbance Capacity)
measurement methodology found dark chocolate to contain
13,120 ORAC units per 100 grams, or more than twice
the ORAC activity level of prunes (5,770 ORAC units
per 100 grams) which contains one of the highest levels
of fruits and vegetables tested.
Research focusing on the potential health benefits
of polyphenols in cocoa and chocolate has proven that
they are absorbed in the bloodstream. In a clinical
trial, eight subjects refrained from consuming foods
rich in polyphenols from the day before the rest until
the study was completed. Each subject consumed
chocolate with bread and water on two separate occasions:
first consuming 40 g of chocolate, and one week later,
consuming 80 g of chocolate. The total polyphenol
intake from chocolate was 892 mg, and 1783 mg respectively.
Blood samples were drawn before chocolate consumption
and at intervals of one, two, three and four hours after
consumption. Blood analysis found levels of the
polyphenol epicatechin rose after consumption of each
chocolate sample, reflecting rapid absorption. Other
studies have focused on the beneficial effects of the
absorbed polyphenols. One study found that feeding
a diet of 1 percent cocoa polyphenols to rabbits retarded
low density lipoprotein (LDL) cholesterol oxidation
in their blood, potentially preventing a first step
in the formation of atherosclerotic plaque. Feeding
35 g of cocoa powder to 12 male subjects demonstrated
a significant increase in LDL cholesterol’s resistance
to oxidation within two hours of cocoa consumption.
Ongoing human research continues to explore the health
benefits of chocolate’s polyphenol content. Preliminary
results of a Pennsylvania State University study that
fed controlled diets to 23 male and female subjects
supports the potential protective effects of polyphenol
antioxidants in chocolate and cocoa. Subject consumed
cocoa powder (22g) and dark chocolate (16g) in their
daily diets. Blood analysis revealed that the
subjects consuming the cocoa and chocolate had improved
cholesterol ratios, with a higher ratio of high density
lipoproteins (HDL) to LDL. A higher ratio of HDL
to LDL is associated with a lower risk for heart disease.
The cocoa and chocolate also appeared to have
a beneficial effect on the oxidation of LDL cholesterol.
An extensive literature search did not reveal any
studies in which attention-deficit hyperactivity disorder
(ADHD) was observed as a direct response to chocolate.
Past studies have observed the effects of various
foods, including chocolate, but none have focused solely
on chocolate. However, the relationship between
ADHD and ingestion of sugar, a major ingredient in sweetened
chocolate, has been explored in depth. The Food
and Drug Administration (FDA) concluded there is no
substantive evidence that the consumption of sugar is
responsible for behavior change in children or adults.
Another review of 11 double blind studies conducted
between 1984 and 1991 of sugar and ADHD in both “sugar
responders” and “non-sugar responders” showed similar
findings. Nine of the studies reported no significant
effect of sucrose on behavior. One study found
decreased activity following sucrose challenge and one,
the results of which were never replicated, noted inappropriate
behavior after sucrose consumption. The Surgeon
General’s Report on Nutrition and Health noted limited
data to support the idea that sugar causes uncontrolled
behavior in children.
A 1994 study has contributed additional evidence
that sugar does not affect a child’s behavior. In
the double-blind trial, 25 preschoolers and 23 children
aged six to 10 years with a subjective history of sugar-induced
behavior changes were fed each of three diets over a
nine-week period. One diet contained sugar at
twice the amount normally consumed by children, the
second contained aspartame, and the third contained
saccharin. All three diets were free of preservatives,
food coloring, chocolate and caffeine. Tests on
activity level, concentration and memory showed no effect
from any of the sweeteners. The American Dietetic
Association has taken the position that the use of nutritive
and nonnutritive sweeteners is appropriate when consumed
in moderation and within the context of a diet consistent
with the U.S. Dietary Guidelines for Americans.
Although considerable research has been conducted
on the effects of caffeine on behavior in children,
the role of caffeine in chocolate is largely a non-issue.
According to the Institute of Food Technologists,
chocolate contributes only 1.5 percent of children’s
total caffeine intake. Levels of caffeine range
from 3 to 10 mg in a typical 1.4 ounce bar of milk chocolate,
and from 2 to 7 mg in an 8-ounce glass of chocolate
milk. An ounce of bittersweet chocolate contains
5 to 35 mg of caffeine and an ounce of unsweetened baking
chocolate has 35 mg of caffeine – all considerably less
than the approximately 75 mg of caffeine found in an
eight-ounce cup of instant coffee or 135 mg in the same
amount of brewed coffee. People differ greatly
in their sensitivity to caffeine, and stimulant effects
in adults may result from consumption of 150 to 200
Food cravings and the effect of diet on mood have
been topics of many studies over the past three decades.
While research has determined food cravings do
exist, there is little scientific support for a link
between the consumption of certain foods and behavior
or mood changes.
It has been hypothesized that carbohydrate consumption
in general may improve mood by increasing tryptophan
transport to the brain, resulting in increased serotonin
levels. Studies in this area however, have produced
inconsistent results. It has been suggested that
chocolate may elevate mood, due to certain bioactive
compounds it contains, such as tyramine and phenylethylamine.
Science, however, has not proven this theory.
Other foods contain higher levels of the same
bioactive substances and are not associated with affecting
mood. Phenylethylamine, for example, is a neurotransmitter-type
substance similar to other substances that improve mood
when administered to certain depressed patients. The
amount of phenylethylamine in chocolate, however, is
quite small. Salami sausage contains about nine
times the amount of phenylethylamine found in chocolate
and cheddar cheese contains more than 10 times the level
in chocolate, but neither food is generally associated
with mood changes.
Food cravings also have been associated with chocolate.
Research on food cravings indicate that chocolate
is the most craved food among women while men crave
spicy foods, such as pizza. There may be several
causes for food cravings, including restrictive diets
that eliminate or significantly reduce consumption of
certain foods. This, in turn, may result in cravings
for those foods. It also has been suggested that
food cravings may be the result of the body’s need for
certain nutrients, such as the magnesium in chocolate
or the calcium in cheese. Scientific studies,
however, have not confirmed this hypothesis.
Research conducted by Michener and Rozin studied
subjects who reported experiencing chocolate cravings
at least once a week. Their methodology focused
on determining which of the two main components of chocolate
– cocoa solids (powder) or cocoa butter – actually satisfied
cravings. Cocoa powder contains all of the bioactive
ingredients found in chocolate, whereas “white chocolate”
is made from cocoa butter, milk and flavorings but contains
none of the bioactive ingredients.
When the subjects experienced chocolate cravings,
they were given one of the following: milk chocolate,
white chocolate, cocoa powder in a capsule, white chocolate
along with a capsule of cocoa powder, a placebo capsule
or nothing at all.
If chocolate cravings were related to chocolate’s
bioactive ingredients, then the cocoa powder capsule
and the milk chocolate sample should have satisfied
the cravings. However, this was not the case.
Only the milk chocolate, and to a lesser extent,
the white chocolate (which contains no bioactive ingredients)
satisfied the cravings. The cocoa powder capsules
had a similar effect to consuming nothing. The
study concluded that the sensory experience of eating
chocolate, not the bioactive components, were the important
factor in satisfying the craving for chocolate.
The menstrual cycle also appears to influence dietary
intake and food cravings. There is some scientific
evidence that women crave sweet foods in the pre-menstrual
and menstrual cycle while fiber intake decreases. There
is, however, also an increase in overall appetite in
the pre-menstrual period. Claims that women with
PMS or depression consume carbohydrate and chocolate
to self-medicate have little scientific support. Again,
it appears that increased consumption of these foods
is linked to their flavor and other sensory properties
rather than the bioactive compounds they contain.
- Dental Caries
Tooth decay begins when bacteria, particularly Streptococcus
mutans, accumulate on the teeth in the absence of adequate
oral hygiene, forming plaque. Bacteria metabolize
fermentable carbohydrates, leading to acid formation
and a decrease in plaque pH. Frequent or sustained
drops in pH can result in progressive demineralization
of the enamel, ultimately leading to caries. The
etiology of caries is a combination of elements: susceptible
teeth, dental plaque, food and the length of time food
remains in contact with the teeth.
Prevention of dental caries, therefore, requires
several measures. It is well known that fluoride
is a primary factor in the control of dental caries
and can significantly reduce caries. Other intervention
methods include control of fermentable carbohydrate
intake, proper oral hygiene and the application of plastic
sealants. There may even be a hereditary disposition
to caries resistance.
While sugars have been implicated in the development
of dental caries, it has long been known that any food
containing fermentable carbohydrates – including cooked
starches such as bread, cereal, crackers, etc. – can
promote caries formation. The cariogenicity of
food is related to the amount of total fermentable carbohydrates.
It is often assumed that starchy foods such as
potato chips and bread are not a factor in caries development
because oral bacteria cannot break down starches into
acids. In fact, sugars such as sucrose and fructose
tend to be less cariogenic than starch because they
dissolve in water and saliva, and are removed from the
mouth more rapidly. Processed high-starch snacks,
whether gelatinized, baked or fried, produce as much
acid in plaque as sucrose alone, but at a much slower
rate. Thus, the cariogenicity of food is not necessarily
related to its sugar content. Foods that are 50
percent sugar do not necessarily cause more tooth decay
than foods that are 10 percent sugar.
It is difficult to categorize foods by degree of
cariogenicity. Certain non-carbohydrate characteristics
of a food (e.g. fat, protein, minerals, buffering capacity,
water content, texture) can modify cariogenicity, as
can be sequence of food consumption. The frequency
of exposure to carbohydrate-containing foods plays an
important role. Eating more than five-to-six times
per day and continuous nibbling or sipping of foods
and beverages promotes tooth decay.
The retention time of food on the teeth also impacts
cariogenicity. Recommendations to avoid sticky
foods may be misleading. A food such as a caramel
or jelly bean is initially sticky, but then quickly
clears the mouth. In a study of the perceived
stickiness verses actual retention of 21 commercially
available foods, Kashket et al. found that cookies,
crackers and potato chips were more retentive than chocolate
bars, caramels, jelly beans and raisins.
Cocoa is not intrinsically cariogenic because it
does not contain significant fermentable carbohydrate.
For that reason, unsweetened chocolate is not
considered a contributing factor in the development
of caries in animals or humans, or in measures of plaque
formation, acidity, or enamel demineralization. Chocolate’s
lack of cariogenicity may hold true even when chocolate
is sweetened. Researchers for the classic 1950s
Vipeholm study in Sweden reported no statistically significant
difference in the incidence of dental caries among a
control group that consumed no sweets and another group
that consumed chocolate.
The results of several studies counter the common
misconception that sweetened chocolate is highly cariogenic.
Morrissey et al. tested the cariogenicity of several
common snack foods on rats, and found solid milk chocolate
among the lowest in cariogenicity of all the foods evaluated.
A study that specifically examined food retention
found that chocolate bars cleared the mouth rapidly
because they contain fat, despite the fact that subjects
rated chocolate bars as fairly sticky.
Moreover, certain naturally occurring substances
such as tannins in cocoa may play a role in the inhibition
of dental plaque formation. Yankell et al. found
that mixtures of sucrose and chocolate, cocoa, or confectionery
coating at ratios commonly used in candy were less cariogenic
in human subjects than a 10 percent sucrose solution,
as measured by plaque pH and plaque ionized calcium.
This may be due to the tannins or other undefined
components in chocolate.
The American Diabetes Association has recommended
changes in the approach to medical nutrition therapy
for people with diabetes mellitus. The new recommendations
permit a wider variety of carbohydrate sources than
previously allowed. In a move from strict dietary
control, the first new treatment goal calls for maintenance
of near-normal blood glucose levels by balancing food
intake with physical activity plus insulin or oral hypoglycemic
Prior to 1994, people with diabetes were instructed
to avoid simple sugars in order to better maintain blood
glucose levels. It was thought that simple sugars
were more rapidly digested and absorbed than complex
carbohydrates and therefore would contribute to high
blood sugar. However, many complex carbohydrates
also elicit a rapid blood glucose response.
The new recommendations permit limited amounts of
sucrose and other nutritive sweeteners, as long as they
are factored into the total carbohydrate consumed in
a day. These liberalized guidelines allow people
with diabetes to enjoy a wider variety of foods, including
desserts, chocolate and sweets that contain sugar, to
the extent that individual dietary goals continue to
be met and that blood sugar control is maintained.
A second goal emphasizes the importance of maintaining
optimal serum lipid levels through diet, activity and
weight management. Specific diet recommendations
should be individualized. A person with normal
serum cholesterol and triglyceride levels should consume
less than 30 percent of calories from fat, another person
with elevated low-density lipoproteins may require a
more stringent fat restriction. Elevated serum
triglycerides may necessitate more liberal use of monounsaturated
fats and a moderate restriction of carbohydrates to
People with diabetes can eat small amounts of chocolate
as part of their total food plan and still adhere to
the new nutrition guidelines. A study of 14 adolescents
with diabetes found that an occasional snack of milk
chocolate as part of a regularly planned snack did not
have a negative effect on postprandial blood sugar.
Individuals with high serum triglycerides may need
to limit their chocolate intake. In a study of
six men with non-insulin-dependent diabetes, researchers
found that test meals of 75 g (2.6 ounces) of milk chocolate
that was sweetened with sucrose, fructose or a disaccharide
alcohol elevated serum triglyceride levels. This
study suggests that chocolate should be consumed in
moderation, especially by those individuals with high
serum triglyceride levels. Chocolate sweetened
with non-nutritive sweeteners was not tested.
In diabetes management as in general health promotion,
maintenance of a healthy weight is a primary goal. Moderate
amounts of chocolate and other foods at the tip of the
Food Guide Pyramid can and should be included to the
extent that they add flavour and enjoyment without pushing
the diet beyond desirable calorie, fat, and cholesterol
Some individuals report reactions to chocolate that
are not classified as allergies. These reactions,
including migraine headaches, may be exacerbated by
genetics, lifestyle, medications and hormones.
Migraines, in particular, have long been associated
with chocolate consumption, particularly among women.
One study of 490 persons with migraines found
that 19 percent reported they thought chocolate caused
their headaches. Other research demonstrates a
lack of relationship between chocolate and headache.
Moffet, Swash and Scott studied a group of 25
migraine sufferers, giving them a chocolate sample and
a placebo (carob) two weeks apart. The subjects
completed questionnaires regarding their reactions within
48 hours of sample consumption. There was no difference
in headache occurrence after either sample. In
a second study, the researchers repeated the same procedure
with 15 of the 25 subjects and again found no difference
in reported headaches after either sample.
In a recent study, Pittsburgh State University researchers
demonstrated a lack of relationship between chocolate
and headache in a large sample of women with migraine
or tension-type headaches. After following a vasoactive-amine
elimination diet, 63 subjects ingested two 60 g chocolate
samples and to 60 g carob samples in random order on
four different occasions. Results indicated that
chocolate was no more likely to trigger a headache than
carob, even in subjects who strongly believed chocolate
was a trigger food. The subjects also were unsuccessful
at guessing which samples were chocolate during the
trials. The researchers conducted a separate evaluation
on 17 percent of the study’s subjects who identified
themselves as sensitive to chocolate as a headache trigger.
Ingestion of chocolate samples did not result
The reason that chocolate is frequently cited as
a food trigger by migraine sufferers despite evidence
to the contrary may lie in other aspects of chocolate.
Women are three times more likely than men to
suffer from migraines and women also crave chocolate
more frequently than men, but this does not prove a
cause-effect relationship. Sweet craving itself
has been reported as a prodromal symptom of migraine,
suggesting that chocolate craving and consumption may
be a symptom rather than a cause of migraine. Other
factors, including fluctuating estrogen levels associated
with the onset of menses have been clearly associated
with the onset of migraines.
Obesity is a condition which occurs when a person’s
body is unable to balance energy intake with energy
expenditure. The National Health and Nutrition
Examination Survey (NHANES III) states that 22 percent
of the U.S. adult population is obese and 55 percent
of American adults are obese or overweight. Health
risks related to obesity include coronary heart disease,
hypertension, diabetes, certain cancers. Gall stones
and others. Medical conditions related to obesity
are the second leading cause of death in the United
States, following diseases related to the habit of smoking.
According to the American Dietetic Association, successful
weight management requires lifestyle modification that
includes increased consumption of fruits, vegetables
and grains; a nonrestrictive approach to eating based
on hunger and satiety; and a gradual increase in physical
activity to at least 30 minutes a day.
The dietary debate continues on the role of diet
composition and weight gain, particularly fat and carbohydrate.
Most nutritionists agree that excess calories,
regardless of the source, are the cause of weight gain.
Others point to excess calories from fat or carbohydrate
for causing weight gain. While few studies actually
have analyzed different kinds of carbohydrates in relation
to weight gain, research studies do point to a relationship
between fat intake and obesity. Regardless of
the measure of diet composition, physical activity is
a critical factor in the energy balance equation for
both weight loss regimens and weight maintenance.
Proponents of certain fad diets suggest that the
growing prevalence of obesity in the United States is
due to high carbohydrate diets – particularly diets
rich in foods with a high glycemic index, such as white
bread, white rice and even certain vegetables. Consumption
of these foods leads to a rapid blood sugar response
and elevated blood insulin levels, especially among
the estimated 25 percent of the U.S. population believed
to be insulin resistant. This, according to the
theory, is believed to lead to excess carbohydrates
being stored as body fat. Research studies, however,
to not support this theory.
In fact, research on carbohydrate consumption and
obesity indicates that diets high in carbohydrates,
including sugar, do not result in weight gain when they
are consumed in amounts that do not exceed energy expenditure.
Studies even have found that groups of people
consuming the most sugar have the lowest levels of obesity,
which some nutritionists believe may be the result of
a decrease in fat intake as sugar intake increases.
In another recent study, 60 overweight women consumed
a low fat, reduced-calorie diet that was either high
or low in sucrose. After the six-week long diet,
the high and low sucrose groups demonstrated equally
significant reduction of body weight and percentage
of body fat.
While a “sweet tooth” appears to have little or no
connection to obesity, preference for foods containing
fat may have a role in weight gain. Studies suggest
that obese individuals prefer the same concentrations
of sugar in their diets as normal weight individual,
but they prefer higher concentrations of fat. A
fat, whether saturated, mono or polyunsaturated, provides
9 kcal/g, or more than twice the calories in carbohydrate
(4 kcal/g). A diet made up of predominately far-rich
foods increases the possibility of excess calorie consumption.
Studies of fat preferences among obese adults
reveal a close relationship between preferences for
fat and body fat.
There is no scientific evidence that chocolate consumption
is associated with obesity. On average, chocolate
has been found to contribute only 0.7 – 1.4 percent
of total daily energy intake. The pleasurable
sensory properties of chocolate make it a desirable
food which may generate feelings of guilt and associations
with weight gain in some people. However, no single
food causes obesity or weight gain. The overall
diet, coupled with a lack of appropriate energy expenditure,
is the underlying cause of weight gain.
- Serum Cholesterol
The National Cholesterol Education Program has increased
public awareness of the need to reduce saturated fat
intake. However, the relative effects of specific
saturated fatty acids on blood lipids is not fully understood
by most consumers.
Cocoa butter is the fat that occurs naturally in
cocoa beans. The U.S. government standards of
identity for chocolate specify that cocoa butter is
the only fat that is allowed in all types of chocolate
except milk chocolate, which contains approximately
80 percent fat from cocoa butter and 20 percent from
milk fat. Cocoa butter like all fats, is composed
of several fatty acids.
The percentage composition of major fatty acids in
cocoa butter is as follows:
- STEARIC ACID 35%
- OLEIC ACID 35%
- PALMITIC ACID 25%
- LINOLEIC ACID
Stearic and palmitic acids are saturated fatty
oleic acid is a monounsaturatedfatty acid,
acid is a polyunsaturatedfatty acid.
Early studies showed that cocoa butter did not raise
cholesterol as might be predicted by its saturated fatty
acid content because of the neutral effects of stearic
acid on blood cholesterol levels. Unlike palmitic
acid or other saturated fatty acids, studies have shown
that stearic acid does not raise blood cholesterol.
As discussed in a review of nearly 40 years of
scientific research, cocoa butter has been shown to
have a neutral effect on blood cholesterol levels, possibly
because of its high stearic acid content. Two
classic metabolic ward studies in 1965 reported that
diets high in cocoa butter had a neutral cholesterolemic
effect. For this reason, cocoa butter has long
been used as a neutral control in studies designed to
measure increases in serum cholesterol caused by other
fats high in saturated fatty acids.
Researchers have hypothesized that cocoa butter’s
anomalous effect on serum cholesterol may be due to
more than one factor. One theory suggests cocoa
butter is not as well absorbed by the body as other
saturated fatty acids. Another is that absorbed
stearic acid is rapidly converted by the body to oleic
acid, a monounsaturated fatty acid.
Kris-Etherton and colleagues at The Pennsylvania
State University have studied not only cocoa butter,
but also milk chocolate. In their study, subjects
consumed 10 ounces of milk chocolate per day in pudding
and brownies, supplying 80 percent of the approximately
37 percent of their dietary calories contributed by
fat. The total diet was controlled in all other
ways. Despite the fact that the chocolate enriched
diet was high in saturated fatty acids (approximately
20 percent of total calories), subjects experienced
a neutral cholesterolemic response compared to their
usual diet that did not include chocolate and which
contained about 14 percent of total calories from saturated
fatty acids. When participants consumed diets
rich in dairy butterfat on an equal fat and saturated
fat calorie basis, their mean cholesterol levels were
higher than when they consumed the milk chocolate enriched
diet. The study further demonstrated that stearic
acid did not produce hypercholesteriolemic effects compared
to other long-chain saturated fatty acids such as myristic
and lauric acid.
In another study, the same researchers had subjects
consume a National Cholesterol Education Program/American
Heart Association Step-One Diet, with the daily substitution
of a 1.6-ounce milk chocolate bar (a typical candy bar
weighs 1.4 ounces) in place of a high carbohydrate snack.
Consuming the chocolate bar did not adversely
affect their low-density lipoproteins, or LDL cholesterol
levels. Including the chocolate bar resulted in
an increase in the total fat content of the diet from
30 to 34 percent of total calories but did not alter
the mean LDL-cholesterol levels. At the same time,
the study demonstrated an increase in high-density lipoproteins,
or HDL-cholesterol levels. The study suggests,
strategies to reduce dietary fat should emphasize reduction
of the atherogenic saturated fatty acids rather than
Placing fewer restrictions on certain foods, thereby
providing greater flexibility in diet planning, enhances
palatability and promotes adherence to diets for the
health-conscious individual. This approach allows
moderate intake of foods containing fat, with greater
emphasis on those higher in stearic acid or unsaturated
fats. However, caloric consumption in excess of
expenditure contributes to obesity and can have a blood
cholesterol raising effect. Therefore, chocolate
can be included in small amounts, to the extent that
the overall diet falls within total calorie and saturated
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