Break Out the Chocolate–FDA Recognizes Cardiovascular Benefits of Cocoa Flavanols

On Feb. 3 the U.S. Food and Drug Administration (FDA) announced their approval for a qualified health claim regarding the relationship between high-flavanol cocoa powder and reduced risk of cardiovascular disease.

The qualified health claim covers products that contain at least 200 milligrams (mg) of cocoa flavanols per serving and at least 4 percent of naturally conserved cocoa flavanols.

The approved health claim is based on a 2018 filing stating that 200 mg of cocoa flavanols can support heart health. The FDA approved the claim but noted that scientific evidence is still very limited.

The 200 mg level in the FDA approved claim is low compared to cocoa flavanol levels administered in successful clinical trials of brain, heart, and metabolic health which seem to range between 500 mg and 1000 mg.

This is consistent with the new flavanol consumption guidelines from the Academy of Nutrition and Dietetics, recommending 400 mg to 600 mg daily to achieve improved cardio-metabolic outcomes.

Harvard’s five-year, 21,400-person placebo-controlled COSMOS study published in March 2022 in The American Journal of Clinical Nutrition, found that consuming 500 mg of cocoa flavanols per day significantly reduced deaths from cardiovascular disease by 27 percent compared to placebo. The researchers also found a meaningful reduction in major cardiovascular events.

Ground Breaking Dietary Guidelines 

The new dietary guideline for daily consumption of flavanols was the first guideline ever recommended that was not based on deficiencies but rather an improvement in health outcomes.

157 randomized controlled studies and 15 cohort studies on flavanols were reviewed by the expert guideline panel to inform these new guidelines.

The panel found that daily consumption of flavanols can reduce the risk associated with cardiovascular disease and diabetes and may help improve blood pressure, cholesterol concentrations, and blood sugar.

The suggested daily flavanol intake for the general adult population is 400–600 mg/d.

The authors recommend people achieve target flavanol levels by increasing consumption of nutrient-dense, high-flavanol foods, including cocoa, tea, apples, and berries, and clarify that this is a “food-based guideline” not a recommendation for flavanol supplements.

Quality Matters

Cardiovascular diseases (CVD) are the leading cause of death globally. Studies show that diet quality plays a key role in cardiometabolic disease-free life expectancy and many other studies highlight the cardiovascular benefits of cocoa flavanols.

Flavanols are antioxidants known to produce a powerful anti-inflammatory response, and cocoa beans are a good natural source of these antioxidants.

Cacao has a long history of use dating back thousands of years to the ancient Mayan and Aztec civilizations where it was used for medicinal purposes and in rituals and ceremonies. Cocao is still used today in ceremonies where raw cacao is said to open the heart.

The flavanol content of cacao products is dependent upon the plant quality, origin, and agricultural and processing practices—so it’s important to purchase it from a reputable source. Processing and heating cocao can cause it to lose its beneficial properties.

It’s also often treated with alkaline to reduce bitterness, which can cause a 60 percent decrease in flavanol content. Because of this not all products containing cocoa will provide the same benefits.

Health Benefits

Here are just a few of the ways research has shown that cocoa can improve our health:

1. Keeps arteries young and reduces high blood pressure:

The quote “man is as old as his arteries” made over 300 years ago by English physician Thomas Sydenham still holds true today. Both high blood pressure and arterial stiffness increase a person’s risk of heart disease and strokes.

A study published in Frontiers in Nutrition in June 2022 confirms that cocoa flavanols can improve vascular function, and decrease blood pressure and arterial stiffness in adults within the first 3 hours after ingestion and also shows sustained benefits at 8 hours.

The study also found that cocoa flavanols only decreased blood pressure if it was elevated. If the blood pressure was low in a person on a certain day, the cocoa flavanols decreased blood pressure and arterial stiffness less.

This finding is significant as doctors often fear that some blood pressure tablets can decrease blood pressure too much on some days.

The flavanols in cocoa are also shown to increase nitric oxide levels in the blood, which can help keep arteries open, elastic, healthy, and reduce blood pressure.

2. Reduced risk of CVD, including coronary heart disease and stroke:

 Studies suggest a strong correlation between daily consumption of cocoa and better cardiovascular health that may reduce the risk of heart attack and stroke.

Cocoa has been found to stabilize blood sugar, improve cholesterol, reduce inflammation, and have a blood thinning effect, which reduces the risk of clotting and increases blood circulation to the heart. These outcomes have all been linked to a lower risk of heart attack, heart failure, and stroke.

3. Boosts stem cells

Cocoa flavanols have also been shown to increase circulating stem cells.

In a 2019 interview, Dr. William Lee recounts a clinical study where participants drank a high flavonol hot chocolate drink twice a day for a month.

Participants who drank the high-flavanol beverage had twice as many circulating stem cells compared to the placebo group. The high-flavanol group also showed a major improvement in blood flow and a 47 percent increase in artery flexibility.

4. Improves brain function and cognitive decline

Research shows that compounds in cocoa may enhance memory, improve blood flow to the brain, and improve mental performance.

Studies also indicate cocoa can have a positive effect on neurodegenerative diseases.

A recent systematic review of 19 cocoa flavanol trials on cognition, published in the Journal of Antioxidants, evaluated results from studies including over two hundred thousand participants.

The researchers found that improvements in executive cognitive function, processing speed, and working memory were generally observed in studies where participants consumed cocoa drinks containing 500–900 mg of cocoa flavanols.

 The study concluded that “cocoa flavanols may be a promising tool for managing cognitive decline.”

According to a study done by Dr. Walter Willett, of Harvard University, published in Neurology, people who consumed 600 mg of flavonoids per day had a 20 percent lower risk of cognitive decline than those who consumed only 150 mg per day.

 The study spanned over 20 years and included over 75,000 participants who entered at an average age of 51.

The study authors said, “our results are exciting because they show that making simple changes to your diet could help prevent cognitive decline.”

Choosing the Right Chocolate

Processing significantly reduces the number of flavonols, so positive health effects most likely will not be seen from the average chocolate bar.

According to researchers at Johns Hopkins University here are some criteria to look for to maximize the health benefits of cocoa:

• The higher the cocoa content, the more beneficial flavonols the chocolate contains. Most of the benefits seen in research are associated with chocolate that has at least 70 percent cacao content.
• Be sure to check the ingredients. Experts recommend minimally processed dark chocolate with no sugar additives as sugar is shown to be detrimental to our health.
• Researchers have not come up with a specific recommendation of how much dark chocolate should be consumed to achieve health benefits but studies mentioned in this article show that as little as 200 mg of cocoa flavanols per day can support healthy circulation. Brain function and cardio function happen around 500 mg daily before leveling off at about 1,000 mg per day.