Forum Activity for @Steve Parker, M.D.

Is chocolate a part of the traditional Mediterranean diet?

Posted in: History of Chocolate

Thanks for you comments, Clay.This is what I've read in the medical literature recently about the fats in dark chocolate:The fats are 1/3 oleic (healthy monounsaturated, as in olive oil), 1/3 stearic (saturated, but no effect on cholesterol levels, unlike some other saturated fats), and 1/3 palmitic (saturated, and could increase cholesterol levels and heart risk). So its sort of a wash in terms of adverse health effects.That's compatible with your remarks.And regarding dark chocolate's antioxidant flavonoids:Elevation of HDL cholesterol, with no effect on total and LDL cholesterol,Decreased LDL cholesterol oxidation , leading to fewer atherosclerotic complications .Researcher Ancel Keys, who I consider the father of modern cardiovascular epidemiology, was the key investigator (pun intended) for the Seven Countries Study, published in the journal Circulation in 1970, then as a book by Harvard University Press in 1980. This study is the one that found lower rates of cardiovascular disease and longer lifespans in association with the "Mediterranean diet." The version of the Mediterranean diet he studied was the one eaten around 1950-1960, or so. That's when the Seven Countries Study research was done.Many say that the Mediterranean diet of that period was unusually low in meat, a result of post-World War II economic deprivation.To my knowledge, no one was comparing diet and rates of chronic disease and death across various cultures 150 to 200 years ago. So we don't know with certainty if the traditional Mediterranean diet of 1809 was any healthier than any others in existence then or now.BTW, I'm working on a blog post about the recent Italian study showing significantly lower CRP levels in healthy people eating an average of 20 grams of dark chocolate every three days.-Steve

Is chocolate a part of the traditional Mediterranean diet?

Posted in: History of Chocolate

I am a huge advocate of the traditional Mediterranean diet (defined by me at my website) because of its ability to prolong life and prevent or mitigate certain chronic diseases such as cardiovascular disease (heart attacks and strokes), cancer (breast, prostate, uterus, and colon), type 2 diabetes, and dementia. Oldways Preservation Trust has also defined the traditional Mediterranean diet, as has Wikipedia .The traditional Mediterranean diet associated with the health benefits was the one eaten around the middle of the 20th century, heavily influenced by southern Italy and Greece.Most of the readily available literature on the traditional Mediterranean diet does not mention chocolate, but instead mentions fresh fruit and honey as deserts or to satisfy a sweet tooth.Could you save me some research time and tell me if chocolate was commonly eaten by the traditional Mediterraneans? Dark or milk?Thanks!
updated by @Steve Parker, M.D.: 04/17/15 06:13:20PM

Is like or dislike for dark chocolate genetically determined?

Posted in: Tasting Notes

Thanks for the comments and tip, Clay. Will try Bonnat.-Steve

Is like or dislike for dark chocolate genetically determined?

Posted in: Tasting Notes

Good points, Langdon.My wife and 12-year-old daughter had little, if any, exposure to dark chocolate in childhood. But neither did I.Neither of them will try the dark chocolates again in the near future!I'm thinking about how our tastes change over time, too. In childhood I couldn't stand tomatoes, broccoli, and Brussel sprouts. Now I enjoy them. Still, could be age-related alterations in gene expression. Complicated and interesting issue.-Steve

Is like or dislike for dark chocolate genetically determined?

Posted in: Tasting Notes

I have friends who can take a good-sized bite out of a raw jalapeno, chew it, and enjoy it. If I tried that, I would turn fire engine red, sweat profusely, and smoke would seep from my ears. I like jalapeno, but can tolerate only small amounts.I was reminded of differences in taste when my family was experimenting with different strengths of dark chocolate bars, starting with 65% cacao, then 70%, 72%, 86%, and finally 100%. I enjoyed all of it except for 100% (which is made for cooking).On the other hand, Mrs. Parker and my daughter had to spit all of it out, and my daughter wiped her tongue with a paper towel hoping it would rid her of the taste. "Repulsion" comes to mind.Dark chocolates tend to have chocolate listed as the first ingredient, as either chocolate, unsweetened chocolate, bittersweet chocolate, or semi-sweet chocolate. Generally, dark chocolates have 60 to 75% of total calories derived from fat. As the cacao and fat percentages rises, you often see less sugar contributing to total calories in a serving. And the bitterness factor rises, thanks to polyphenols. Bitter, acrid, pungent - its all the same to me. Sugar and fat counteract the bitterness.The heat of a jalapeno and the bitterness of dark chocolate are detected by different taste receptors on our tongues.The best-known bitterness receptor detects the chemical called PROP (6-n-propylthiouracil). One fourth of us cant taste it; half of us are moderate tasters; one fourth of us are supertasters. Supertasters can detect PROP in minute concentrations undetectable to others and find it repulsive.But PROP receptors are not the only bitterness detector. So far, about 25 have been identified from human genome sequences. For example, PTC (phenylthiocarbamide) is another bitter chemical taste controlled by genetics.ScienceDaily on Feb. 5, 2001, reported on a study in women that found no difference from PROP tasters and non-tasters in evaluation or enjoyment of white, bittersweet, or bitter chocolate. Researchers noted that fat and sugar counteract bitterness.Nevertheless, I suspect my wifes and daughters strong aversion to dark chocolate is genetic rather than a simple preference or I can take it or leave it attitude. Must be in one of those 24 other bitter-detection genes.What do you think?
updated by @Steve Parker, M.D.: 04/25/15 07:31:21AM

Health Benefits of Chocolate

Posted in: Tasting Notes

If Dark Chocolate Is Healthy, Whats The Right Dose?Antioxidant flavonoids and other phytonutrients in dark chocolate are thought possibly to improve health, primarily through reduction in cardiovascular diseases such as heart attacks and strokes.In terms of a medicinal agent, we have not been sure of the therapeutic dose. A recent study (2008) out of Italy provides a clue.Researchers at Catholic University, Campobasso, Italy, surveyed residents in southern Italy regarding chocolate intake and measured their C-reactive protein (CRP) levels. CRP is a marker of inflammation and a predictor of coronary artery disease such as heart attacks. Generally, higher levels of CRP are associated with higher risk of heart attacks. If you have a choice, go for lower levels of CRP.Participants in the study were selected by simple random sampling from city hall registries and were at least 35 years old. Researchers were looking for healthy people, so the following were excluded from the study: those who reported known cardiovascular disease, eating a special diet, or on drug therapy for high blood pressure, diabetes, or adverse blood lipids. Twenty percent of initial recruits refused to participate. Of the 10,994 initial recruits, 4,849 men and women made it into the final study.Of the 4,849 subjects, two subgroups were identified: 1) a control group of 1,317 (27%) who never ate any type of chocolate, and 2) a test group of 824 (17%) subjects who regularly ate dark chocolate only.Interviewers administered questionnaires to the subjects to document clinical and personal information such as dietary habits, socioeconomic status, physical activity, medical history, risk factors for cardiovascular disaese and tumors, family history of cardiovascular disease, drug use, etc.Regarding chocolate consumption, participants were asked about frequency - daily, weekly, or monthly - of a standard dose (20 grams) and about type of chocolate: milk, dark, nut chocolate, or any type. Someone eating more than one type of chocolate was classified as any type.Other measurements: blood pressure, weight, height, waist circumference, blood glucose, serum lipids (various cholesterols and triglycerides), and high-sensitivity C-reactive protein.FindingsAge-adjusted CRP levels were lower in dark chocolate users (1.13 mg/L) than in the nonconsumers of chocolate (1.30 mg/L).Dark chocolate eaters were divided into thirds: the lowest third of average consumption, the middle third, and the highest third. The lowest third ate under 19 grams per week. The middle third ate between 19 and 47 grams per week. The highest third ate over47 grams per week. The chocolate-related reduction in CRP was lost in people who were in the highest third (or tertile), i.e., eating more than 47 grams a week or 20 grams every three days. People in the lowest tertile of dark chocolate consumption had a CRP reduction the same as the middle third.Systolic blood pressure in dark chocolate consumers was 3 mmHg lower than the pressure in nonconsumers. No difference in diastolic pressures.DiscussionThe researchers cite two clinical trials that investigated the effect of cocoa on markers of inflammation but did not find any association. They wonder if those studies enrolled too few participants, or whether the relatively high doses of chocolate masked the effect. In the present study, the lowering of CRP was seen in consumption of up to 20 grams every three days, but seemed to disappear at higher doses.The authors write that:". . . regular intake of small amounts of dark chocolate . . . consumption should have no harmful effect on anthropometric variables such as BMI [body mass index] and waist:hip ratio and can be viewed as a promising behavioural approach to lower, in a quite pleaseant way, cardiovascular risk factors at a general population level." And . . ."According to data reported in apparently healthy American men and women, ranges of serum CRP measured in our nonchocolate consumer population would belong to a moderate risk estimate quintile, whereas the ranges found in dark chocolate consumers would beclassified as a mild risk estimate. For the decrease in serum CRP values from moderate to mild quintile, the relative risk of suffering a future cardiovascular event would apparently decrease by 26% in men and 33% in women."The authors are careful to point out that this study does not prove that low-dose dark chocolate lowers CRP levels. Its an association. Additional studies are necessary to explain the mechanisms linking dark chocolate consumption and regulation of serum CRP concentrations.My CommentsThe healthy dose of dark chocolate may be quite small: no more than 20 grams every three days, and perhaps quite a bit less. This is not much by U.S. standards. The serving size listed on many bars in the U.S. is 40 grams. Forty grams has about 100 calories. Twenty grams twice a week translates to 6 calories a day.The authors of this study dont address whether 40 grams a week would be just as healthy as 80 grams every two weeks.Eating more, on average, than 20 grams every three days may entirely wipe out the healthy effects. This effect is like wines: a little is probably good for you, too much is either neutral or harmful.Im sorry to be so wishy-washy on this issue, but thats the state of the science today. The study at hand may help us optimize dark chocolates effect on C-reactive protein. But dark chocolates other healthy effects may require other doses, higher or lower.The next step is to take 20,000 middle-aged people, give half of them various doses of scheduled dark chocolate, give the other half placebos, then record rates of diseases and death over the next 10 years. Who would pay for this multi-million dollar study? Either government or chocolate manufacturers.-Steve Parker, M.D.-----------------------------------------------------------------------Reference: Di Giuseppe, Romina, et al. Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population. Journal of Nutrition, , 138 (2008): 1,939-1,945.

Health Benefits of Chocolate

Posted in: Tasting Notes

Thanks very much for your critique, Clay.My reference to cacao cultivation in South America is from "Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy Italian population," by Romina di Guiseppe, et al, in the journal, Nutritional Epidemiology, vol. 138, page 1939, published in 2008. They mention specifically Northern South America. But the authors don't cite a primary source.Yes, my use of "fine chocolate" is vague. I'm trying to differentiate generic Easter bunny chocolate and "mockalate" from serious brand-name chocolate (e.g., by Lindt?)I'll try to link back to here from my healthy lifestyle blog post.-Steve

Health Benefits of Chocolate

Posted in: Tasting Notes

I'm close to posting the following on my healthy lifestyle blog (Advanced Mediterranean Diet Blog), and wondered if you guys had any comments.__________________________________________________________________________________________________Theobroma cacao, the cocoa tree, has been cultivated in Central and South America for over 3000 years. Cocoa is derived from the tree's seed, also known as the cocoa bean.Chocolate is a product of the processed cocoa bean. Dark chocolate has at least 65% cocoa content, and has much more of the potentially healthy chemicals from the cocoa bean, as compared with milk chocolate. White chocolate isn't really chocolate.It's been a little over 10 years since we first read in a medical journal about cocoa and chocolate as potential sources of antioxidants for health. What have we learned since then?Phytochemicals are chemicals produced by plants, and there are hundreds of thousands of them. Polyphenols are a subset of phytochemicals. Flavonoids, with strong antioxidant properties, are a subset of polyphenols. And a subset of flavonoids, called flavonols, have particularly potent biological effects in humans. Prominent flavonols in dark chocolate are flavan-3-ol, catechin, and epicatechin. Also metabolically active are proanthocyanidins, which are polymeric condensation products of flavan-3-ol.Are you bored yet? Have I convinced you of my authority on the subject? Say yes, or I'll keep going! [Please say yes: I'm boring myself!]Note that some chocolate manufacturers process the cocoa beans to remove some of the polyphenols, to reduce bitterness or pungency.Other rich sources of flavonols are wine, tea, and various fruits and berries.How could dark chocolate, especially its flavonoids, be healthful?* Flavonoids are antioxidants that protect from injury caused by free radicals* Enhanced nitric oxide production, leading to relaxation of arteries (vasodilation), leading to reduced blood pressure: up to 6 mmHg systolic and 3 mmHg diastolic* Elevation of HDL cholesterol, with no effect on total and LDL cholesterol* Inhibition of platelet aggregation and activation, leading to fewer blood clots that cause heart attacks and strokes* Decreased inflammation* Reduction of C-reactive protein, a marker of inflammation* Decreased neutrophil (white blood cell) activation. White blood cells play a role in inflammation* Decreased LDL cholesterol oxidation, leading to fewer atherosclerotic complications* Improved function of the cells that line blood vessels (endothelium)* Possible enhanced insulin sensitivity* May act as anti-carcinogens and neuro-protective agents* May act as an antidepressantBottom line? Dark chocolate, especially because of flavonoids, may well be protective against cardiovascular disease such as heart attacks and strokes.[Did you notice I'm waffling . . . may be protective.]What's in dark chocolate other than flavonoids?A 40 gram serving of fine dark chocolate has:* Calories: 200* Calories from fat: 150* Fiber: 4.5 grams (a good source of fiber on a "per calorie" basis)* Sugar: 11 grams* Saturated fats: 10 grams"But aren't saturated fats bad for me?"The fats in dark chocolate are 1/3 oleic (healthy monounsaturated, as in olive oil), 1/3 stearic (saturated, but no effect on cholesterol levels, unlike some other saturated fats), and 1/3 palmitic (saturated, and could increase cholesterol levels and heart risk). So it's sort of a wash.[I'm not getting into the diet-heart hypothesis now. Don't bait me.]What's the healthy "dose" of dark chocolate?No one is sure. It's certainly no more than 100 grams (3.5 ounces) a day, and the optimal dose may be as low as 20 grams every three days. If you eat too much, it will make you fat. 100 grams is 500 calories; that's probably way too much. Even if you start eating 20 grams - 100 calories - every three days, you will gain weight unless you give up some other food or exercise a little more."Parker, why are you waffling?"Because no one has ever done a study to see if adding dark chocolate actually reduces death rates or sickness from specific diseases in humans. I think it probably does, but who knows for sure? Nobody. What we need is a randomized, controlled trial of dark chocolate as a supplement in 10,000 middle-aged adults followed over the course of 10 years. I'd sign up for that in a heartbeat. Just don't give me the placebo.Steve Parker, M.D.--------------References:Erdman, J.W., et al. Effects of cocoa flavanols on risk factors for cardiovascular disease. Asian Pacific Journal of Clinical Nutrition, 17 supplement 1 (2008): 284-287.Farouque, H.M, et al. Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study. Clinical Science, 111 (2006): 71-80.Heptinstall, S., et al. Cocoa flavanols and platelet and leukocyte function: recent in vitro and ex vivo studies in healthy adults. Journal of Cardiovascular Pharmacology, 47 supplement 2 (2006): S197-205.Keen, C.L., et al. Cocoa antioxidants and cardiovascular health. American Journal of Clinical Nutrition, 81 supplement 1 (2005): 298S-303S.Mehrinfar, R. and Frishman, W.H. Flavanol-rich cocoa: a cardioprotective nutraceutical. Cardiology Reviews, 16 (2008): 109-115.Engler, M.B, and Engler, M.M. The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease. Nutrition Reviews, 64 (2006): 109-118.Lippi, G. et al. Dark chocolate: consumption for pleasure or therapy? Journal of Thrombosis and Thrombolysis, September 23, 2008 (Epub ahead of print).Hooper, L, et al. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 88 (2008): 38-50.Cooper, K.A., et al. Cocoa and health: a decade of research. British Journal of Nutrition, 99 (2007): 1-11. Epub August 1, 2007.Aron, P.M., and Kennedy, J.A. Flavon-3-ols: nature, occurrence and biological activity. Molecular Nutrition and Food Research, 52 (2008): 79-104.Buijsse, B, et al. Cocoa intake, blood pressure, and cardiovascular mortality [in men]: the Zutphen Elderly Study. Archives of Internal Medicine, 166 (2006): 411-417.Ding, E.L., et al. Chocolate and prevention of cardiovascular disease: a systematic review. Nutrition and Metabolism, 3 (2006): 2.