Friday, June 1, 2012

I'm Sorry To Be A Party Pooper, But...

Many people love chocolate for obvious reasons. When they hear it's good for them, that's just frosting on the cake (pun intended). Over the next day or so, you are going to see and hear a tsunami of headlines, yet again, about the heart benefits of eating dark chocolate. The headlines will blare how dark chocolate prevents cardiovascular events.

This breaking news will be the result of a modeling study that predicts that patients with metabolic syndrome who eat dark chocolate every day could have 85 fewer events per a population of 10,000 over 10 years. The study, conducted by Chris Reid, PhD, of Monash University in Melbourne, Australia and colleagues was supported by a grant from a pharmaceutical company.  (For more about metabolic syndrome, please read end of blog).

The researchers used a Markov model to assess health effects and associated costs of daily consumption of plain dark chocolate compared with no chocolate in a population with metabolic syndrome but without diabetes or cardiovascular disease.

That's my first problem with the study.

It wasn't a gold standard randomized double blind controlled study. It wasn't even a good observational study. It was a mathematical calculation, and at that it only showed a benefit of .85 (yes, point eighty five) fewer heart related events per 100 people, and of the heart events, they are predicting .15 fewer events leading to death. That means for every 1000 people who eat the chocolate, there would be 1.5 fewer deaths.

Okay, you say, I get to eat chocolate and maybe I'll be the one guy or gal out of a thousand that benefits from it. So here's my real problem with the study. As a modeling study, it also made assumptions about the type of chocolate that was consumed. The researchers wrote, ""Evidence to date suggests that the chocolate would need to be dark and of at least 60% to 70% cocoa, or formulated to be enriched with polyphenols." There is no reference to the sugar content of the chocolate.

True, dark chocolate in high concentrations (usually over 75% cacao) contains polyphenols, which are healthful antioxidants. However, the sweetness in the dark (or sometimes called bittersweet) chocolate always comes from added sugar of one sort or another. This sugar is usually not healthy and is also fattening.

I know from personal experience that when I added for the purported health benefit (and the taste) one small piece (1/8 of a bar) of dark chocolate a night with 75% cacao (the higher the cacao the more sugar needed to make it enjoyable), my weight started to slightly increase from that one solo change. I stopped the practice.

If you think that this was a study that should make you go out and buy some dark chocolate, here is what the researchers said about their own study.

Reid and colleagues noted that the study was "limited by its reliance on the Framingham algorithm, which may underestimate risk in a high-risk population, and by assumptions about the risk of death following a cardiovascular event." Furthermore, "the study was also limited by the assumption that the benefits of dark chocolate, which have only been observed in short-term trials, extend to 10 years."

By the way, there are many non-processed rich sources of polyphenols in fruits and vegetables such as blueberries, black berries, strawberries, red grapes, eggplant, etc., so you don't need to eat chocolate to get your daily dose.

In conclusion, dark chocolate is better than regular chocolate. The higher the percentage of cacao, the more healthy polyphenols it contains, but watch out for the increase in carbohydrates. Nibble on no more than 1/8 of a bar at any given time. Most importantly, if you want to eat it, do it for the taste, because the heart benefits are still inconclusive.

More on Metabolic syndrome

From PubMed

Insulin resistance syndrome; Syndrome X

Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke and type 2 diabetes .

Causes, incidence, and risk factors

Metabolic syndrome is becoming more and more common in the United States. Some estimate it as affecting 25% of the U.S. population. Researchers are not sure whether the syndrome is due to one single cause, but all of the risks for the syndrome are related to obesity.

The two most important risk factors for metabolic syndrome are:
  • Extra weight around the middle and upper parts of the body (central obesity). The body may be described as "apple-shaped."
  • Insulin resistance, in which the body cannot use insulin effectively. Insulin is needed to help control the amount of sugar in the body. As a result, blood sugar and fat levels rise.
Other risk factors include:
  • Aging
  • Genes that make you more likely to develop this condition
  • Hormone changes
  • Lack of exercise
People who have metabolic syndrome often have two other problems that can either cause the condition or make it worse:
  • Excess blood clotting
  • Low levels of inflammation throughout the body


  • Extra weight around your waist (central or abdominal obesity)

Signs and tests

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:
  • Blood pressure equal to or higher than 130/85 mmHg
  • Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
  • Large waist circumference (length around the waist):
    • Men - 40 inches or more
    • Women - 35 inches or more
  • Low HDL cholesterol:
    • Men - under 40 mg/dL
    • Women - under 50 mg/dL
  • Triglycerides equal to or higher than 150 mg/dL
Tests that may be done to diagnose metabolic syndrome include:
  • Blood pressure measurement
  • Fasting glucose test
  • HDL cholesterol level
  • LDL cholesterol level
  • Total cholesterol level
  • Triglyceride level


The goal of treatment is to reduce your risk of heart disease and diabetes. Your doctor will recommend lifestyle changes or medicines to help reduce your blood pressure, LDL cholesterol, and blood sugar.
Recommendations include:
  • Lose weight. The goal is to lose between 7% and 10% of your current weight. You will probably need to eat 500 - 1,000 fewer calories per day.
  • Get 30 minutes of moderate intensity exercise, such as walking, 5 - 7 days per week.
  • Lower your cholesterol using weight loss, exercise, and cholesterol lowering medicines, if needed.
  • Lower your blood pressure using weight loss, exercise, and medicine, if needed.
Some people may need to take daily low-dose aspirin.
People who smoke should quit.

Expectations (prognosis)

People with metabolic syndrome have an increased long-term risk for developing cardiovascular disease and type 2 diabetes.


  • Atherosclerosis
  • Diabetes
  • Heart attack
  • Kidney disease
  • Nonalcoholic fatty liver disease
  • Peripheral artery disease
  • Stroke

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