Chocolate and Health: A Brief Review of the Evidence

  • Francesco VisioliEmail author
  • Elena Bernardini
  • Andrea Poli
  • Rodolfo Paoletti


Interest in the biological activities of cocoa polyphenols is steadily increasing. In fact, the high polyphenol content of cocoa, coupled with its widespread presence in many food items, render this food of particular interest from the nutritional and “pharmacological” viewpoints. Indeed, the number of publications concerning cocoa and chocolate is increasing steadily (Fig. 5.1). Of such publications, an increasing proportion concerns the effects of polyphenols and, in particular, flavonoids on human biology and health (Fig. 5.2). As outlined in detail in other chapters of this book, research is unraveling new and diversified healthful actions of “minor constituents” of cocoa. This is also reflected by the increasing number of patents covering industrial processes that aim at maintaining the highest possible amounts of polyphenols in cocoa. In fact, the current manufacturing process destroys roughly 95% of the polyphenols originally present in the cocoa bean [1].


Nitric Oxide Cocoa Bean Dark Chocolate Cocoa Powder Arterial Dilatation 
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  1. 1.
    Visioli F, Bernaert H, Corti R et al (2009) Chocolate, lifestyle, and health. Crit Rev Food Sci Nutr 49:299–312PubMedCrossRefGoogle Scholar
  2. 2.
    Vinson JA, Proch J, Zubik L (1999) Phenol antioxidant quantity and quality in foods: cocoa, dark chocolate, and milk chocolate. J Agric Food Chem 47:4821–4824PubMedCrossRefGoogle Scholar
  3. 3.
    Lee KW, Kim YJ, Lee HJ et al (2003) Cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine. J Agric Food Chem 51:7292–7295PubMedCrossRefGoogle Scholar
  4. 4.
    Schroeter H, Heiss C, Balzer J et al (2006) (−)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans. Proc Natl Acad Sci U S A 103:1024–1029PubMedCrossRefGoogle Scholar
  5. 5.
    Tomas-Barberan FA, Cienfuegos-Jovellanos E, Marin A et al (2007) A new process to develop a cocoa powder with higher flavonoid monomer content and enhanced bioavailability in healthy humans. J Agric Food Chem 55(10):3926–3935PubMedCrossRefGoogle Scholar
  6. 6.
    Smith AR, Visioli F, Hagen TM (2006) Plasma membrane-associated endothelial nitric oxide synthase and activity in aging rat aortic vascular endothelia markedly decline with age. Arch Biochem Biophys 454:100–105PubMedCrossRefGoogle Scholar
  7. 7.
    Smith AR, Visioli F, Frei B et al (2006) Age-related changes in endothelial nitric oxide synthase phosphorylation and nitric oxide dependent vasodilation: evidence for a novel mechanism involving sphingomyelinase and ceramide-activated phosphatase 2A. Aging Cell 5:391–400PubMedCrossRefGoogle Scholar
  8. 8.
    Cooke JP (2003) Flow, NO, and atherogenesis. Proc Natl Acad Sci USA 100:768–770PubMedCrossRefGoogle Scholar
  9. 9.
    Grassi D, Lippi C, Necozione S et al (2005) Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr 81:611–614PubMedGoogle Scholar
  10. 10.
    Grassi D, Necozione S, Lippi C et al (2005) Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 46:398–405PubMedCrossRefGoogle Scholar
  11. 11.
    Title LM, Cummings PM, Giddens K et al (2000) Oral glucose loading acutely attenuates endothelium-dependent vasodilation in healthy adults without diabetes: an effect prevented by vitamins C and E. J Am Coll Cardiol 36:2185–2191PubMedCrossRefGoogle Scholar
  12. 12.
    Tomaru M, Takano H, Osakabe N et al (2007) Dietary supplementation with cacao liquor proanthocyanidins prevents elevation of blood glucose levels in diabetic obese mice. Nutrition 23:351–355PubMedCrossRefGoogle Scholar
  13. 13.
    Engler MM, Engler MB, Malloy MJ et al (2003) Antioxidant vitamins C and E improve endothelial function in children with hyperlipidemia: Endothelial Assessment of Risk from Lipids in Youth (EARLY) Trial. Circulation 108:1059–1063PubMedCrossRefGoogle Scholar
  14. 14.
    Martino F, Pignatelli P, Martino E et al (2007) Early increase of oxidative stress and soluble CD40L in children with hypercholesterolemia. J Am Coll Cardiol 49(19):1974–1981PubMedCrossRefGoogle Scholar
  15. 15.
    Zalba G, Beaumont FJ, San Jose G et al (2000) Vascular NADH/NADPH oxidase is involved in enhanced superoxide production in spontaneously hypertensive rats. Hypertension 35:1055–1061PubMedCrossRefGoogle Scholar
  16. 16.
    Lodi F, Cogolludo A, Duarte J et al (2006) Increased NADPH oxidase activity mediates spontaneous aortic tone in genetically hypertensive rats. Eur J Pharmacol 544:97–103PubMedCrossRefGoogle Scholar
  17. 17.
    Higashi Y, Sasaki S, Nakagawa K et al (2002) Endothelial function and oxidative stress in renovascular hypertension. N Engl J Med 346:1954–1962PubMedCrossRefGoogle Scholar
  18. 18.
    Heiss C, Kleinbongard P, Dejam A et al (2005) Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol 46:1276–1283PubMedCrossRefGoogle Scholar
  19. 19.
    Vlachopoulos C, Aznaouridis K, Alexopoulos N et al (2005) Effect of dark chocolate on arterial function in healthy individuals. Am J Hypertens 18:785–791PubMedCrossRefGoogle Scholar
  20. 20.
    Pignatelli P, Di Santo S, Buchetti B et al (2006) Polyphenols enhance platelet nitric oxide by inhibiting protein kinase C-dependent NADPH oxidase activation: effect on platelet recruitment. FASEB J 20:1082–1089PubMedCrossRefGoogle Scholar
  21. 21.
    Pignatelli P, Ghiselli A, Buchetti B et al (2006) Polyphenols synergistically inhibit oxidative stress in subjects given red and white wine. Atherosclerosis 188:77–83PubMedCrossRefGoogle Scholar
  22. 22.
    Hermann F, Spieker LE, Ruschitzka F et al (2006) Dark chocolate improves endothelial and platelet function. Heart 92:119–120PubMedCrossRefGoogle Scholar
  23. 23.
    Vivekananthan DP, Penn MS, Sapp SK et al (2003) Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 361:2017–2023PubMedCrossRefGoogle Scholar
  24. 24.
    The Local Food-Nutraceuticals Consortium (2005) Understanding local Mediterranean diets: a multidisciplinary pharmacological and ethnobotanical approach. Pharmacol Res 52:353–366CrossRefGoogle Scholar
  25. 25.
    Halliwell B, Rafter J, Jenner A (2005) Health promotion by flavonoids, tocopherols, tocotrienols, and other phenols: direct or indirect effects? Antioxidant or not? Am J Clin Nutr 81:268S–276SPubMedGoogle Scholar
  26. 26.
    Lotito SB, Frei B (2006) Consumption of flavonoid-rich foods and increased plasma antioxidant capacity in humans: cause, consequence, or epiphenomenon? Free Radic Biol Med 41:1727–1746PubMedCrossRefGoogle Scholar
  27. 27.
    Vinson JA, Proch J, Bose P et al (2006) Chocolate is a powerful ex vivo and in vivo antioxidant, an antiatherosclerotic agent in an animal model, and a significant contributor to antioxidants in the European and American Diets. J Agric Food Chem 54:8071–8076PubMedCrossRefGoogle Scholar
  28. 28.
    Wan Y, Vinson JA, Etherton TD et al (2001) Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Am J Clin Nutr 74:596–602PubMedGoogle Scholar
  29. 29.
    Baba S, Osakabe N, Kato Y et al (2007) Continuous intake of polyphenolic compounds containing cocoa powder reduces LDL oxidative susceptibility and has beneficial effects on plasma HDL-cholesterol concentrations in humans. Am J Clin Nutr 85:709–717PubMedGoogle Scholar
  30. 30.
    Mursu J, Voutilainen S, Nurmi T et al (2004) Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med 37:1351–1359PubMedCrossRefGoogle Scholar
  31. 31.
    Serafini M, Bugianesi R, Maiani G et al (2003) Plasma antioxidants from chocolate. Nature 424:1013PubMedCrossRefGoogle Scholar
  32. 32.
    Lorenz M, Jochmann N, von Krosigk A et al (2007) Addition of milk prevents vascular protective effects of tea. Eur Heart J 28:219–223PubMedCrossRefGoogle Scholar
  33. 33.
    Schroeter H, Holt RR, Orozco TJ et al (2003) Nutrition: milk and absorption of dietary flavanols. Nature 426:787–788PubMedCrossRefGoogle Scholar
  34. 34.
    Rein D, Lotito S, Holt RR et al (2000) Epicatechin in human plasma: in vivo determination and effect of chocolate consumption on plasma oxidation status. J Nutr 130:2109S–2114SPubMedGoogle Scholar
  35. 35.
    Wang JF, Schramm DD, Holt RR et al (2000) A dose-response effect from chocolate consumption on plasma epicatechin and oxidative damage. J Nutr 130:2115S–2119SPubMedGoogle Scholar
  36. 36.
    Wiswedel I, Hirsch D, Kropf S et al (2004) Flavanol-rich cocoa drink lowers plasma F(2)-isoprostane concentrations in humans. Free Radic Biol Med 37:411–421PubMedCrossRefGoogle Scholar
  37. 37.
    Heptinstall S, May J, Fox S et al (2006) Cocoa flavanols and platelet and leukocyte function: recent in vitro and ex vivo studies in healthy adults. J Cardiovasc Pharmacol 47Suppl 2:S197–S205PubMedCrossRefGoogle Scholar
  38. 38.
    Selmi C, Mao TK, Keen CL et al (2006) The anti-inflammatory properties of cocoa flavanols. J Cardiovasc Pharmacol 47Suppl 2:S163–S171PubMedCrossRefGoogle Scholar
  39. 39.
    Heinrich U, Neukam K, Tronnier H et al (2006) Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women. J Nutr 136:1565–1569PubMedGoogle Scholar
  40. 40.
    Neukam K, Stahl W, Tronnier H et al (2007) Consumption of flavanol-rich cocoa acutely increases microcirculation in human skin. Eur J Nutr 46:53–56PubMedCrossRefGoogle Scholar
  41. 41.
    Bayard V, Chamorro F, Motta J et al (2007) Does flavanol intake influence mortality from nitric oxide-dependent processes? Ischemic heart disease, stroke, diabetes mellitus, and cancer in Panama. Int J Med Sci 4:53–58PubMedCrossRefGoogle Scholar
  42. 42.
    Francis ST, Head K, Morris PG et al (2006) The effect of flavanol-rich cocoa on the fMRI response to a cognitive task in healthy young people. J Cardiovasc Pharmacol 47Suppl 2:S215–S220PubMedCrossRefGoogle Scholar
  43. 43.
    Katz DL, Doughty K, Ali A (2011) Cocoa and chocolate in human health and disease. Antiox Redox Sign, doi:10.1089/ars.20103697 (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Francesco Visioli
    • 1
    Email author
  • Elena Bernardini
  • Andrea Poli
  • Rodolfo Paoletti
  1. 1.Laboratory of Functional FoodsIMDEA-FoodMadridSpain

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