X-Message-Number: 27658
Date: Tue, 28 Feb 2006 19:31:18 -0800 (PST)
From: Doug Skrecky <>
Subject: cocoa is associated with a reduced mortality rate

[A number of possible mortality reducing techniques are being
investigated. However, contrary to expectations, reductions
in calorie intake have been consistently associated with
elevated mortality rates in aged humans. Although this brings
into question the applicability of animal CR studies to humans,
an alternative explanation exists for this dietary conumdrum.
A major confounding factor might be the avoidance of chocolate,
as well as similar beneficial high fat foods, in humans watching
their calorie intake.]

Cocoa Intake, Blood Pressure, and Cardiovascular Mortality
The Zutphen Elderly Study
Arch Intern Med. 2006;166:411-417.
Background: Small, short-term, intervention studies indicate that
cocoa-containing foods improve endothelial function and reduce
blood pressure. We studied whether habitual cocoa intake was
cross-sectionally related to blood pressure and prospectively
related with cardiovascular mortality.
Methods: Data used were of 470 elderly men participating in the
Zutphen Elderly Study and free of chronic diseases at baseline.
Blood pressure was measured at baseline and 5 years later, and
causes of death were ascertained during 15 years of follow-up.
Habitual food consumption was assessed by the cross-check dietary
history method in 1985, 1990, and 1995. Cocoa intake was estimated
from the consumption of cocoa-containing foods.
Results: One third of the men did not use cocoa at baseline. The
median cocoa intake among users was 2.11 g/d. After adjustment,
the mean systolic blood pressure in the highest tertile of cocoa
intake was 3.7 mm Hg lower (95% confidence interval [CI],
-7.1 to -0.3 mm Hg; P = .03 for trend) and the mean diastolic
blood pressure was 2.1 mm Hg lower (95% CI, -4.0 to -0.2 mm Hg;
P = .03 for trend) compared with the lowest tertile. During
follow-up, 314 men died, 152 of cardiovascular diseases. Compared
with the lowest tertile of cocoa intake, the adjusted relative
risk for men in the highest tertile was 0.50 (95% CI, 0.32-0.78;
P = .004 for trend) for cardiovascular mortality and 0.53
(95% CI, 0.39-0.72; P < .001) for all-cause mortality.
Conclusion: In a cohort of elderly men, cocoa intake is inversely
associated with blood pressure and 15-year cardiovascular and
all-cause mortality.

Hypertension. 2005 Aug;46(2):398-405. Epub 2005 Jul 18.
Cocoa reduces blood pressure and insulin resistance and improves
endothelium-dependent vasodilation in hypertensives.
    Consumption of flavanol-rich dark chocolate (DC) has been
shown to decrease blood pressure (BP) and insulin resistance in
healthy subjects, suggesting similar benefits in patients with
essential hypertension (EH). Therefore, we tested the effect of
DC on 24-hour ambulatory BP, flow-mediated dilation (FMD), and
oral glucose tolerance tests (OGTTs) in patients with EH. After a
7-day chocolate-free run-in phase, 20 never-treated, grade I
patients with EH (10 males; 43.7+/-7.8 years) were randomized to
receive either 100 g per day DC (containing 88 mg flavanols) or
90 g per day flavanol-free white chocolate (WC) in an isocaloric
manner for 15 days. After a second 7-day chocolate-free period,
patients were crossed over to the other treatment. Noninvasive
24-hour ambulatory BP, FMD, OGTT, serum cholesterol, and markers
of vascular inflammation were evaluated at the end of each
treatment. The homeostasis model assessment of insulin resistance
(HOMA-IR), quantitative insulin sensitivity check index (QUICKI),
and insulin sensitivity index (ISI) were calculated from OGTT
values. Ambulatory BP decreased after DC (24-hour systolic
BP -11.9+/-7.7 mm Hg, P<0.0001; 24-hour diastolic BP
-8.5+/-5.0 mm Hg, P<0.0001) but not WC. DC but not WC decreased
HOMA-IR (P<0.0001), but it improved QUICKI, ISI, and FMD. DC
also decreased serum LDL cholesterol (from 3.4+/-0.5 to 3.0+/-0.6
mmol/L; P<0.05). In summary, DC decreased BP and serum LDL
cholesterol, improved FMD, and ameliorated insulin sensitivity in
hypertensives. These results suggest that, while balancing total
calorie intake, flavanols from cocoa products may provide some
cardiovascular benefit if included as part of a healthy diet for
patients with EH.

Am J Clin Nutr. 2005 Mar;81(3):611-4.
Short-term administration of dark chocolate is followed by a
significant increase in insulin sensitivity and a decrease in blood
pressure in healthy persons.
    BACKGROUND: Numerous studies indicate that flavanols may exert
significant vascular protection because of their antioxidant
properties and increased nitric oxide bioavailability. In turn,
nitric oxide bioavailability deeply influences insulin-stimulated
glucose uptake and vascular tone. Thus, flavanols may also exert
positive metabolic and pressor effects. OBJECTIVE: The objective
was to compare the effects of either dark or white chocolate bars
on blood pressure and glucose and insulin responses to an
oral-glucose-tolerance test in healthy subjects. DESIGN: After a
7-d cocoa-free run-in phase, 15 healthy subjects were randomly
assigned to receive for 15 d either 100 g dark chocolate bars,
which contained approximately 500 mg polyphenols, or 90 g white
chocolate bars, which presumably contained no polyphenols.
Successively, subjects entered a further cocoa-free washout phase
of 7 d and then were crossed over to the other condition.
Oral-glucose-tolerance tests were performed at the end of each
period to calculate the homeostasis model assessment of insulin
resistance (HOMA-IR) and the quantitative insulin sensitivity
check index (QUICKI); blood pressure was measured daily. RESULTS:
HOMA-IR was significantly lower after dark than after white
chocolate ingestion (0.94 +/- 0.42 compared with 1.72 +/- 0.62;
P < 0.001), and QUICKI was significantly higher after dark than
after white chocolate ingestion (0.398 +/- 0.039 compared with
0356 +/- 0.023; P = 0.001). Although within normal values,
systolic blood pressure was lower after dark than after white
chocolate ingestion (107.5 +/- 8.6 compared with
113.9 +/- 8.4 mm Hg; P < 0.05). CONCLUSION: Dark, but not white,
chocolate decreases blood pressure and improves insulin
sensitivity in healthy persons.

Clin Dev Immunol. 2005 Mar;12(1):11-7.
Regular consumption of a flavanol-rich chocolate can improve
oxidant stress in young soccer players.
    The consumption of a diet rich in certain flavonoids,
including the flavanol sub-class, has been associated with a
reduced risk for vascular disease. We evaluated the effects of
the regular consumption (14 d) of a flavanol-containing milk
chocolate (FCMC) or cocoa butter chocolate (CBC) on variables
related to vascular disease risk, oxidative stress and physical
activity. Twenty-eight free-living, young (18-20 years old) male
soccer players consumed daily 105 g of FCMC (168 mg of flavanols)
or CBC (< 5 mg of flavanols), as part of their normal diet. The
consumption of FCMC was significantly associated with a decrease
in diastolic blood pressure (- 5 mm Hg), mean blood pressure
(- 5 mm Hg), plasma cholesterol (-11%), LDL-cholesterol (-15%),
malondialdehyde (- 12%), urate (- 11%) and lactate dehydrogenase
(LDH) activity (- 11%), and an increase in vitamin E/cholesterol
(+ 12%). No relevant changes in these variables were associated
with CBC consumption. No changes in the plasma levels of
(-)-epicatechin were observed following analysis of fasting
blood samples. In conclusion, FCMC consumption was associated
with changes in several variables often associated with
cardiovascular health and oxidant stress. The presence of
significant quantities of flavanols in FCMC is likely to have
been one of the contributing factors to these results.

J Am Coll Nutr. 2004 Jun;23(3):197-204.
Flavonoid-rich dark chocolate improves endothelial function and
increases plasma epicatechin concentrations in healthy adults.
    BACKGROUND: Dark chocolate derived from the plant (Theobroma
cacao) is a rich source of flavonoids. Cardioprotective effects
including antioxidant properties, inhibition of platelet activity,
and activation of endothelial nitric oxide synthase have been
ascribed to the cocoa flavonoids. OBJECTIVE: To investigate the
effects of flavonoid-rich dark chocolate on endothelial function,
measures of oxidative stress, blood lipids, and blood pressure in
healthy adult subjects. DESIGN: The study was a randomized,
double-blind, placebo-controlled design conducted over a 2 week
period in 21 healthy adult subjects. Subjects were randomly
assigned to daily intake of high-flavonoid (213 mg procyanidins,
46 mg epicatechin) or low-flavonoid dark chocolate bars
(46 g, 1.6 oz). RESULTS: High-flavonoid chocolate consumption
improved endothelium-dependent flow-mediated dilation (FMD) of
the brachial artery (mean change = 1.3 +/- 0.7%) as compared to
low-flavonoid chocolate consumption (mean change = -0.96 +/- 0.5%)
(p = 0.024). No significant differences were noted in the
resistance to LDL oxidation, total antioxidant capacity,
8-isoprostanes, blood pressure, lipid parameters, body weight or
body mass index (BMI) between the two groups. Plasma epicatechin
concentrations were markedly increased at 2 weeks in the
high-flavonoid group (204.4 +/- 18.5 nmol/L, p < or = 0.001) but
not in the low-flavonoid group (17.5 +/- 9 nmol/L, p = 0.99).
CONCLUSION: Flavonoid-rich dark chocolate improves endothelial
function and is associated with an increase in plasma epicatechin
concentrations in healthy adults. No changes in oxidative stress
measures, lipid profiles, blood pressure, body weight or BMI were

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