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Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension

Do you wonder?

To the Editor: Chocolate may have beneficial cardiovascular effects, possibly due to cocoa polyphenols. Experiments in animals suggest that plant polyphenols decrease blood pressure; however, evidence from human clinical trials is lacking. We examined whether dark chocolate (polyphenol-rich chocolate [PRC]) may lower BP in individuals with mild isolated hypertension.

Methods

We conducted a randomized crossover trial in 13 otherwise healthy individuals (6 men and 7 women, aged 55-64 years, with body mass index of 21.9-26.2 [calculated as weight in kilograms divided by the square of height in meters]) with recently diagnosed and untreated stage 1 mild isolated systolic hypertension (mean [SD] systolic BP, 153.2 [3.9] mm Hg; mean [SD] diastolic BP, 83.8 [3.5] mm Hg). After a cocoa-free run-in phase of 7 days, participants were randomly assigned to receive 14 consecutive daily doses of either 100-g dark PRC bars containing 500 mg of polyphenols and 480 kcal of energy (Ritter Sport Halbbitter, Alfred Ritter, Waldenbuch, Germany), or 14 days of 90-g white chocolate (polyphenol-free chocolate [PFC]) bars that also contained 480 kcal and similar amounts of cocoa butter, macronutrients, fiber, electrolytes, and vitamins (Milka Weisse Schokolade, Kraft Foods, Bremen, Germany). After a cocoa-free washout phase of 7 days, participants were crossed over to the other condition. Participants were asked to substitute the chocolate bars for foods of similar energy and macronutrient composition. Overall diet during the study period was assessed by reports of daily food intake and by measurement of body weight, plasma concentrations of lipids and glucose, and urinary excretion of sodium, potassium, and nitrogen at the run-in phase and after each intervention period.

The BP was recorded daily, in a blinded fashion, with participants in a seated position, 12 hours post-dose, in the left upper arm with a validated oscillometer (Omron HEM 722C, Omron, Mannheim, Germany). A systolic BP of more than 170 mm Hg or a diastolic BP of more than 100 mm Hg at a single visit was necessary for referral for antihypertensive pharmacological treatment. At the end of the study participants were referred to their physician for further monitoring and management of BP. We received approval for our study from the ethics committee of the Medical Faculty of the University of Cologne; all participants gave written informed consent.

Results

Participants had significantly lower systolic and diastolic BPs within 10 days of beginning PRC, but this effect was not seen during the PFC period. At the end of the 14-day PRC intervention, mean (SD) systolic BP had declined by 5.1 (2.4) mm Hg (P<.001; paired 2-tailed t test) and mean (SD) diastolic BP by 1.8 (2.0) mm Hg (P = .002; paired 2-tailed t test) compared with PFC. After discontinuation of PRC consumption, BP returned to preintervention values within 2 days. Heart rate was not affected by either treatment. There were no sex differences in the effects of chocolate on BP. None of the participants reached the predefined threshold that would have required antihypertensive drug therapy. Daily energy intake and macronutrient composition remained stable throughout the study. Body mass index, 24-hour urinary excretion of sodium, potassium, and total nitrogen, as well as fasting plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and glucose were not significantly different between the run-in phase and the postintervention periods.

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Dark Healthy Chocolate and Flavoniods

Flavonoids are polyphenolic compounds that are ubiquitous in nature and are categorized, according to chemical structure, into flavonols, flavones, flavanones, isoflavones, catechins, anthocyanidins and chalcones. Over 4,000 flavonoids have been identified, many of which occur in fruits, vegetables and beverages (tea, coffee, beer, wine and fruit drinks). The flavonoids have aroused considerable interest recently because of their potential beneficial effects on human health-they have been reported to have antiviral, anti-allergic, anti-inflammatory, antitumor and antioxidant activities.

Antioxidants are compounds that protect cells against the damaging effects of reactive oxygen species, such as singlet oxygen, superoxide, peroxyl radicals, hydroxyl radicals and peroxynitrite. An imbalance between antioxidants and reactive oxygen species results in oxidative stress, leading to cellular damage. Oxidative stress has been linked to cancer, aging, atherosclerosis, ischemic injury, inflammation and neurodegenerative diseases (Parkinson's and Alzheimer's). Flavonoids may help provide protection against these diseases by contributing, along with antioxidant vitamins and enzymes, to the total antioxidant defense system of the human body. Epidemiological studies have shown that flavonoid intake is inversely related to mortality from coronary heart disease and to the incidence of heart attacks.

The recognized dietary antioxidants are vitamin C, vitamin E, selenium, and carotenoids. However, recent studies have demonstrated that flavonoids found in fruits and vegetables may also act as antioxidants. Like alpha-tocopherol (vitamin E), flavonoids contain chemical structural elements that may be responsible for their antioxidant activities. A recent study by Dr. van Acker and his colleagues in the Netherlands suggests that flavonoids can replace vitamin E as chain-breaking anti- oxidants in liver microsomal membranes. The contribution of flavonoids to the antioxidant defense system may be substantial considering that the total daily intake of flavonoids can range from 50 to 800 mg. This intake is high compared to the average daily intake of other dietary antioxidants like vitamin C (70 mg), vitamin E (7-10 mg) or carotenoids (2-3 mg). Flavonoid intake depends upon the consumption of fruits, vegetables, and certain beverages, such as red wine, tea, and beer. The high consumption of tea and wine may be most influential on total flavonoid intake in certain groups of people.

The oxidation of low-density lipoprotein (LDL) has been recognized to play an important role in atherosclerosis. Immune system cells called macrophages recognize and engulf oxidized LDL, a process that leads to the formation of atherosclerotic plaques in the arterial wall. LDL oxidation can be induced by macrophages and can also be catalyzed by metal ions like copper. Several studies have shown that certain flavonoids can protect LDL from being oxidized by these two mechanisms.

Comments By: Dr.'s Donald R. Buhler & Cristobal Miranda

Does Dark Healthy Chocolate Help Cardio and Blood Flow?

Researchers have some news for chocolate lovers: it may be good for you. Scientists reported preliminary evidence recently that cocoa and other chocolates may keep high blood pressure down, your blood flowing and your heart healthy.

The research, the latest which correlates eating flavonoid-rich foods with a reduced risk of cardiovascular disease(1), was presented in February at the American Association for the Advancement of Science's (AAAS) annual meeting in Boston.

One study found that a substance in cocoa helps the body process nitric oxide (NO), a compound critical for healthy blood flow and blood pressure. Another study showed that flavonols in cocoa prevent fat-like substances in the bloodstream from oxidizing and clogging the arteries, and make blood platelets less likely to stick together and cause clots. Flavonoids are plant compounds with potent antioxidant properties; so far, scientists have found more than 4,000 kinds. Cocoa beans contain large quantities of flavonoids, and so do red wine, tea, cranberries, peanuts, strawberries, apples and many other fruits and vegetables.(2) The flavonoids in chocolate are called flavonols.

Generally, science has found that dark chocolate is higher in flavonoids than milk chocolate.(3) The way that cocoa powder and chocolate syrups are manufactured removes most flavonoids.
Promotes Blood Flow

The other study compared how blood platelets responded to a flavonol-rich cocoa drink with 25 grams of semi-sweet chocolate pieces and a blood-thinning, 81-milligram aspirin dose. The research found similar reactions to the two from a group of 20- to 40-year-olds: both the drink and the aspirin prevented platelets from sticking together or clotting, which can impede blood flow.(5)

In other words, flavonol-rich cocoa and chocolate act similarly to low-dose aspirin in promoting healthy blood flow. Reducing the blood's ability to clot also reduces the risk of stroke and heart attacks.

Acai is the world's healthiest chocolate.

You need to discover the Acai dark chocolate breakthrough! There has never been a healthier dark chocolate snack ever invented that is combined with Acai berries and packed with ORAC benefits that slows aging and
prevents disease. In fact, there is no other item in the health food store or online that you can order that has this much ORAC in their products, unless you take several capsules, and that's no fun.... why not indulge in a very
decadent and healthy dark chocolate snack?