I was approached by a patient of mine this week who wanted to know if she could start eating all the chocolate she wanted because she had heard about a recent study showing that chocolate consumption was beneficial to health. My resounding answer for her was, "No." Please allow me to explain why my answer was such a resounding no.
The main concern I had about her question was that she wanted a blanket approval for consumption of any and all forms of chocolate -- and she wanted to know whether she "could eat all the chocolate [she] wants." The component of her question that worried me was the idea that this study gave her the impression that she could consume large quantities of chocolate in any form she wanted; and she believed that it would help her health -- irrespective of its impact on her weight and the fact that it may make her less hungry for a healthy, balanced diet.
The recent meta-analysis and systematic review of prior studies was based on six cohort studies and one cross-sectional study -- none of which were randomized trials. There were 114,009 participants in these seven studies. Large variation was observed across these seven studies including chocolate consumption, methods and outcomes evaluation. The study participants were mostly Caucasian, although one study included Hispanics and African Americans and another study included Asian patients.
They reportedly found that chocolate consumption led to 37 percent cardiovascular disease reduction and 29 percent reduction in stroke, when comparing high chocolate consumers to low chocolate consumers (with high chocolate consumers being the ones with the health benefits).
Based on the information presented from this meta-analysis and systemic review, of course I understand why my patient was asking her question. Based on the surface data of this report, it seems that the more chocolate we eat, the greater the cardiovascular health benefit, right? It appears at first glance that this might be true. However, in my opinion, more studies need to be done and the jury is still out on what the clinical indication of how much chocolate is good for us and how much is too much.
The reason I say this is because this systematic review looked at various previous studies that were more observational in nature, rather than the gold standard of clinical randomized trials. Furthermore, there was significant variation amongst the studies, such that the actual quantities and types of chocolates were not consistent from study to study. There was no differentiation made between dark, white or milk chocolate. Chocolate in any form was included in the studies such as chocolate drinks, chocolate bars and chocolate snacks (including biscuits, confectionary, desserts and nutritional supplements).
Weight and other health aspects of the participants were not thoroughly addressed. There was also a lack of stringency in the evaluation on whether there was weight gain in the participants and whether there was any effect of weight gain on overall health. Finally, because the study participants were mostly Caucasian, this further puts into question whether you can even generalize the findings to all people; because the studies were mostly done only for certain segments of the population and there is a lack of variation of ethnicity in the patient populations.
Having said all that, please do not misconstrue my message about chocolate. I do, in fact, believe that dark chocolate is beneficial to health; especially when consumed in moderation and in combination with a mostly plant-based, anti-inflammatory diet. My concern is that this report will lead people to eat high levels of processed sweets that have any and all levels of processed-chocolate versions incorporated into the snack. And that they will use the findings of this systematic review to justify this high level of consumption of processed desserts -- which is not appropriate at all.
In my clinical practice, for those patients who have a sweet tooth, I usually recommend dark chocolate with greater than 70 percent cacao (also known as cocoa). This is because the antioxidant levels and health benefits are much greater with higher percentages of cacao. The polyphenol content of chocolate -- especially in high percentage dark chocolates -- is beneficial for endothelial and platelet function, which explains why cardiovascular disease benefits occur with an anti-inflammatory diet. So, if someone has a craving for sweets, it is much more beneficial to satiate the sweet tooth with pure dark chocolate than by eating processed cookies and sweets.
In my opinion, dark chocolate is great for health if consumed in moderation because it will help satiate sweet cravings while still providing health benefits -- which this study does confirm that concept. However, a word of caution for those of you readers out there who have a sweet tooth, please do not take this as a blanket approval that all processed chocolates at high quantities would be alright to eat all the time. You should still eat mostly a plant-based anti-inflammatory diet. When you have a craving for sweets, dark chocolate is a great choice -- in moderation; so long as you are not consuming so much of it that your waist line and weight are increasing in proportion to the quantity of your chocolate intake.