title: Chocolate--guilty pleasure or healthy supplement?
abstract: Dark chocolate and other cocoa products are popular in the population as a whole, but their overall health benefit remains controversial. Observations from the Kuna Indian population have shown an impressive cardiovascular health benefit from cocoa. For various reasons, this benefit has not been as robust as in other populations. Additionally, several mechanisms have been proposed that might confer cocoa's possible health benefit, but no consensus has been reached on cocoa's physiologic role in promoting cardiovascular health. Flavanols, as well as theobromine, may contribute to enhancements in endothelial function and subsequent improvements in various contributors to cardiovascular disease (CVD) including hypertension, platelet aggregation and adhesion, insulin resistance, and hypercholesterolemia. While the benefits of cocoa may be altered at the various stages of growth, development, and production, it appears that for many people "healthy" dark chocolate may, indeed, provide a pleasurable role in CVD risk reduction. The objectives of this review are to discuss the associations of cocoa with decreased blood pressure and improved CVD risk, to describe the possible mechanisms for these potential benefits, and to highlight considerations for the use of cocoa as a dietary supplement.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Latham
authors.forename: Zeb K
authors.initials: ZK
authors.lastname: Hensen
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Minor
mesh_terms: D001792:Blood Platelets / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D002099:Cacao / Q000737:chemistry; D002182:Candy; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000187:drug effects; D019587:Dietary Supplements; D004730:Endothelium, Vascular / Q000187:drug effects / Q000502:physiology; D005419:Flavonoids / Q000494:pharmacology*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008019:Life Style; D009569:Nitric Oxide / Q000378:metabolism; D018570:Risk Assessment; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D008078:Cholesterol, LDL; D005419:Flavonoids; D009569:Nitric Oxide
references.citation: Am J Clin Nutr. 2008 Dec;88(6):1685-96
references.pmid: 19064532
references.citation: Free Radic Biol Med. 2004 Nov 1;37(9):1351-9
references.pmid: 15454274
references.citation: J Nutr. 2007 Jun;137(6):1436-41
references.pmid: 17513403
references.citation: Am J Clin Nutr. 2007 Mar;85(3):895-909
references.pmid: 17344514
references.citation: Ann Intern Med. 2001 Dec 18;135(12):1019-28
references.pmid: 11747380
references.citation: Am J Clin Nutr. 2013 Jun;97(6):1201-9
references.pmid: 23595874
references.citation: Clin Dev Immunol. 2005 Mar;12(1):1-9
references.pmid: 15712593
references.citation: Arch Biochem Biophys. 2010 Sep 1;501(1):112-5
references.pmid: 20494650
references.citation: Hypertension. 2003 Dec;42(6):1206-52
references.pmid: 14656957
references.citation: Platelets. 2003 Aug;14(5):325-7
references.pmid: 12944249
references.citation: Am J Hypertens. 2010 Jan;23(1):97-103
references.pmid: 19910929
references.citation: J Nutr. 2007 Mar;137(3 Suppl 1):718S-737S
references.pmid: 17311968
references.citation: J Am Coll Nutr. 2004 Jun;23(3):197-204
references.pmid: 15190043
references.citation: J Clin Hypertens (Greenwich). 2012 Jul;14(7):467-71
references.pmid: 22747620
references.citation: J Nutr. 2008 Sep;138(9):1671-6
references.pmid: 18716168
references.citation: BMJ. 2012 May 30;344:e3657
references.pmid: 22653982
references.citation: Eur Heart J. 2012 Sep;33(17):2172-80
references.pmid: 22173910
references.citation: Hypertension. 2012 Sep;60(3):794-801
references.pmid: 22892813
references.citation: J Am Coll Cardiol. 2008 Jun 3;51(22):2141-9
references.pmid: 18510961
references.citation: Mol Nutr Food Res. 2013 Feb;57(2):191-202
references.pmid: 23136121
references.citation: J Agric Food Chem. 2006 Jan 11;54(1):229-34
references.pmid: 16390204
references.citation: Cochrane Database Syst Rev. 2012 Aug 15;(8):CD008893
references.pmid: 22895979
references.citation: JAMA. 2007 Jul 4;298(1):49-60
references.pmid: 17609490
references.citation: Hypertension. 2005 Aug;46(2):398-405
references.pmid: 16027246
references.citation: Hypertension. 2010 Jun;55(6):1289-95
references.pmid: 20404213
references.citation: JAMA. 2003 Aug 27;290(8):1029-30
references.pmid: 12941673
references.citation: J Am Coll Cardiol. 2005 Oct 4;46(7):1276-83
references.pmid: 16198843
references.citation: J Cardiovasc Pharmacol. 2011 Jan;57(1):44-50
references.pmid: 20966764
references.citation: Am J Clin Nutr. 2005 Jan;81(1 Suppl):292S-297S
references.pmid: 15640493
references.citation: Am J Clin Nutr. 2007 Mar;85(3):709-17
references.pmid: 17344491
references.citation: Eur Heart J. 2010 Jul;31(13):1616-23
references.pmid: 20354055
references.citation: Eur Heart J. 2010 Nov;31(21):2583-92
references.pmid: 20852295
references.citation: Heart. 2006 Jan;92(1):119-20
references.pmid: 16365364
references.citation: J Cardiovasc Pharmacol. 2006;47 Suppl 2:S99-102; discussion S119-21
references.pmid: 16794463
references.citation: Circulation. 2009 Mar 17;119(10):1433-41
references.pmid: 19289648
references.citation: J Cardiovasc Pharmacol. 2006;47 Suppl 2:S103-9; discussion 119-21
references.pmid: 16794446