Score another one for chocolate

Chocolate has been climbing the wellness-food ladder for two decades. Most of the early hype was thin. Most of the more recent data is real. A study published in the British Medical Journal looked at dark chocolate as an intervention for people with metabolic syndrome, and the findings are worth a clean summary.

What metabolic syndrome actually is

Metabolic syndrome is a cluster of cardiovascular and metabolic risk factors. The specific cutoffs vary slightly by clinical body, but the core picture is the same. Insulin resistance. Elevated triglycerides. Central obesity. High blood pressure. Low HDL cholesterol. Most clinicians would add to the official definition a state of low-grade systemic inflammation, because that is what the underlying biology is doing.

This cluster carries a meaningfully elevated risk of cardiovascular events and type 2 diabetes. It is common in Western countries, where its prevalence runs around 30 percent of adults.

What the chocolate data suggests

The Markov-model analysis published in BMJ in 2012 estimated that, if 10,000 adults with metabolic syndrome consumed dark chocolate daily for ten years, around 70 fatal cardiovascular events would be avoided over that period. That puts dark chocolate, used appropriately, in the same general order of magnitude as some prescription preventive therapies for this population.

The caveats matter.

The caveats

• It has to be dark chocolate. Cacao content matters. Aim for 70 percent or higher. Milk chocolate does not produce the effect.
• Sugar has to stay low. Most commercial dark chocolate adds enough sugar to undo the cardiovascular benefit. Look for products with 5 grams of added sugar or less per serving.
• The active compounds are flavanols, particularly epicatechin and procyanidins. These are reduced by some processing methods, particularly Dutch processing with alkali, which can strip the flavanol content significantly. Cocoa labeled as raw or minimally processed retains more.
• Doses are about polyphenol content, not chocolate mass. The relevant intake range in the protective studies is roughly 200 to 500 mg of cocoa flavanols per day, which translates to one to three small squares of high-cacao, low-sugar chocolate.

The calorie question

If you add 100 to 300 calories of dark chocolate to your day without adjusting other intake, you will gain weight over time. The cardiovascular benefit does not cancel the caloric load. Treat this as a swap, not an addition.

Where I stand personally

I do not eat dark chocolate every day for the cardiovascular benefit. I have other tools for that, fish oil, CoQ10, the lifestyle inputs I write about. I do enjoy a square or two a few times a week. The pleasure is real. The data is real. The two are not in conflict for most people.

Worth eating. Not worth pretending it is a treatment.

— Doc