Chocolate:

Ancient Medicine to
Modern Marvel
A Guide to Chocolate and Health

Our Commitment to
Cocoa Farming Families
The U.S. cocoa and chocolate industry
is working actively to help cocoa farming families around the world. Industry
members have formed partnerships with
producing countries, non-governmental
organizations (NGOs), government agencies and development organizations to foster economic and social development as
well as environmental conservation in the
cocoa-growing regions of West Africa, Asia
and the Americas. Industry-supported programs are improving farm family incomes,
working to ensure responsible labor practices, expanding access to education, and
protecting the tropical ecosystem.
The Chocolate Manufacturers Association proudly supports the World Cocoa
Foundation, a unique partnership of industry, government, international agencies and NGOs. The Foundation plays a
leading role in helping cocoa farming families by developing and managing on-theground programs and acting as a forum
for broad discussion of the cocoa farming
sectors needs. For more information, go
to www.worldcocoafoundation.org.

Chocolate and a Balanced Diet

Chocolate and healthy diet may sound like words that do
not belong in the same sentence, however, chocolate can easily
be part of a healthy, balanced lifestyle. In fact, research shows
that there are several positive reasons for including chocolate
in a balanced diet. This booklet provides new information
that confirms what ancient civilizations discovered long ago
- chocolate provides not only a delightful sensory experience but
may also provide health benefits.

Cocoa Ancient Civilizations

Version of Gold
For centuries, civilizations have coveted the cocoa bean and saved it

for special occasions. Believed to be of divine origin, cocoa beans were

used by ancient civilizations in offerings to the gods and for royalty.

The first documented use of the bean was more than 2,000 years ago
by the Olmec, Mayan and Aztec cultures. Consumed as a bitter drink,
cocoa was believed to have magical and medicinal powers. So sought
after was the cocoa bean that it was traded as a form of currency
and used as an offering during sacred ceremonies. In fact, Mayan

text refers to cocoa beans as the gods food. Years later, the botanist
Linnaeus would officially name the cocoa tree Theobroma cacao, which
translates as the gods food.

Europeans were introduced to cocoa by the Spanish conquistadors in the

1500s. Spaniards began sweetening cocoa, while still primarily serving
it as a beverage reserved for the upper class. European royalty soon
developed a passion for the drink and demand for the luxury grew.

Chocolate, as we know it today, became popular in North America in

the 18th century. Thomas Jefferson, the third president of the United
States, is quoted saying, The superiority of chocolate, both for health
and nourishment, will soon give it the preference over tea and coffee
in America which it has in Spain. Similar to the

ancient Mesoamerican civilizations, Europeans and

Americans prescribed cocoa and chocolate for
certain ailments, such as digestive disorders,

There ar

positive re several
including easons for
chocolate
!

heart pains, inflammation, and mental fatigue.

( J Nutr 2000; 130 (8S): 2057S-71S) By the 1800s,

the Industrial Revolution allowed for the

mass production of what we know today as

chocolate and introduced the once limited
delicacy to a much wider audience.

(The Ultimate Encyclopaedia of Chocolate, 1997)

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What Makes Chocolate

So Amazing?

Mineral content (in milligrams) and percent of

Daily Value (%DV) for cocoa and chocolate products*

Chocolate has a number of unique characteristics that make it a treat

enjoyed by cultures around the world. As a flavor, chocolate is a favorite

of Americans, overwhelmingly favored in consumer surveys, when

compared to other flavors. But what makes chocolate itself so special and
so in demand? This can be attributed to its pleasurable sensory experience

as well as the culture and traditions associated with chocolate. With cocoa
butters unique melting properties and cocoas unique flavor and aroma,

Semisweet
(Dark)
Chocolate Bar

Semisweet
Chocolate
Chips

Baking
Chocolate,
Unsweetened

1 envelope
(28 g / 1 oz)

1 Tbsp
(5 g / 0.18 oz)

1 bar
(40 g / 1.4 oz)

1 bar
(40 g / 1.4 oz)

1 Tbsp
(15 g / 32 pcs)

1/2 square
(14 g/ 0.5 oz)

Calcium

Milk
Chocolate Bar

(0.4%)

chocolate is the preferred

Copper

Cocoa Powder,
Unsweetened

(5.0%)

celebrations and holidays.

Iron

many people find chocolate to be especially delightful. Chocolates smooth,

Cocoa
Mix Powder

melt-in-your-mouth sensation is like no other.

With a history rooted strongly in ritual,
confectionery enjoyed during
Chocolate has also long been

Magnesium

given as a gift to express

love and appreciation. This

Phosphorus

tradition can be traced back to

the Aztecs and their emperor

Montezuma, who used the cocoa

improve intimate encounters.

Today, science is uncovering what our ancestors appeared to know long

ago: cocoa and chocolate may have health-promoting effects. Not only are

cocoa and chocolate natural sources of several minerals such as magnesium,

phosphorus and potassium, but being plant-based foods, they contain

Zinc

Potassium

beverage as a nuptial aid and to

3.7

0.1

0.3

(1.8%)

23

(5.8%)

88

(8.8%)

199

(5.7%)

0.4

(2.7%)

(0.6%)

0.2

(9.4%)

0.7

(3.9%)

25

(6.2%)

37

(3.7%)

76

(2.2%)

0.3

(2.3%)

76

(7.6%)

0.2

(9.8%)

0.9

(5.2%)

25

(6.3%)

83

(8.3%)

149

(4.2%)

0.8

(5.4%)

13

(1.3%)

0.3

(14.0%)

1.2

(6.9%)

46

(11.5%)

53

(5.3%)

146

(4.2%)

0.6

(4.3%)

(0.5%)

0.1

(5.2%)

0.5

(2.6%)

17

(4.3%)

20

(2.0%)

55

(1.6%)

0.2

(1.6%)

14

(1.4%)

0.4

(22.5%)

2.4

(13.3%)

46

(11.5%)

56

(5.6%)

116

(3.3%)

1.4

(9.0%)

*Source: U.S. Department of Agriculture, Agricultural Research Service, USDA Nutrient Data Laboratory.
2005. USDA National Nutrient Database for Standard Reference, Release 18.

phytonutrients now being studied and associated with potential health

benefits. One class of phytonutrients gaining attention are flavanols. These

compounds found in cocoa and chocolate are similar to the compounds you

may have heard of in tea and wine. Many of the recently reported health
benefits of cocoa and chocolate are attributed to these compounds.

( J Am Diet Assoc 2003 Feb; 103 (2): 215-23)

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The Unique Qualities of Chocolate

Although chocolate can fit into a healthy diet, many still perceive
chocolate to be a guilty pleasure. There is an unfounded belief that
chocolate consumption has negative health effects. People can now
put their minds at ease. A significant and growing body of research
suggests that, when eaten in moderation as part of a balanced diet
and active lifestyle, chocolate does not have a negative impact on
health and, in fact, may have positive benefits.
One of the primary concerns people have about chocolate is the high

fat content and how it could impact cholesterol levels. The fat naturally
found in cocoa beans is cocoa butter. It is made up of both saturated

fats (which in general are considered to raise cholesterol levels) and

unsaturated fats (which are associated with lowering cholesterol levels).

However, despite its saturated fat content, chocolate does not raise

blood cholesterol levels. Studies that fed participants chocolate daily

for several weeks showed no change in blood cholesterol when total

calories in the diet were kept the same. The reason may be stearic acid,
one type of saturated fat found in the cocoa butter. Stearic acid is

technically classified as a saturated fat; however, it is converted to an

unsaturated fat in the body and therefore does not impact cholesterol
levels in the same way as other saturated fats.

(Am J Clin Nutr 1994; 60 (6): 1037S-42S; USDA National Nutrient Database for Standard
Reference, Release 18)
Another common concern is the carbohydrate and sugar content in

chocolate and its potential for raising blood sugar levels. Carbohydrate

content, however, is only part of the picture because foods containing

carbohydrates impact the body differently based on a number of

factors. The glycemic index, or GI, is a measure of how foods containing

carbohydrates impact blood sugar. The GI describes this difference

by ranking carbohydrate-containing foods according to their effect on

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blood sugar levels. Foods with a low GI have a smaller impact on blood
sugar levels; high GI foods raise blood sugar to a greater extent (and

then cause a drop in it). Chocolate is a low GI food, meaning that it is

absorbed more slowly into the blood stream and results in more stable
blood sugar levels than higher GI foods. It is thought that lower GI

foods may be more satisfying since they keep blood sugar more stable.
Some scientists and health professionals believe that eating a diet of

mostly low to moderate GI foods may offer protection against a number

of chronic diseases and may assist in weight control.

(Eur J Clin Nutr 2002 Nov; 56 (11): 1049-71, Am J Clin Nutr 2002; 76-1, 5-56)

Maintaining a Healthy Weight

Can Include Chocolate
Recent Dietary Guidelines emphasize the importance of balancing food
intake with physical activity to maintain a healthy weight. The revised

Food Guide Pyramid helps communicate the importance of adequacy and

variety among the basic food groups, while leaving room for foods that
provide enjoyment.

Chocolate can play a

role in a healthy, active

lifestyle. As both a favored

flavor and food, chocolate

provides enjoyment in the

diet. Including favorite

foods such as chocolate in

moderation can help avoid
feelings of deprivation

and make it easier to maintain a healthy

diet. Small amounts of chocolate can

be very satisfying and easily fit into a

nutritious diet that balances calories
in and calories out. Furthermore,

incorporation of chocolate or cocoa

within other foods, including baked

goods, beverages, cereals and healthy

snacks, adds appeal as well as
nutritional value.

Revised Food Pyramid!

amid.com )

(Download your pyramid at www.mypyr

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Chocolate: A Plant-Based Food

Plants naturally contain compounds called phytochemicals,
which serve to protect them from environmental stress. When
plant-derived foods are eaten, these same compounds may
convey protective effects for humans as well. Research suggests
that these compounds may help protect against diseases such as
heart disease and cancer.
Cocoa beans are not really beans,

but rather are seeds inside the pods

of the Theobroma cacao tree. They

are used to make cocoa and chocolate.

They are particularly rich in a group
of phytochemicals called flavanols,

which are also found in certain other

plant-based foods and beverages

such as red wine, green tea, nuts and

apples. Ongoing research for over 15

years has linked the consumption of

flavanol-rich foods with a reduced

incidence of certain diseases.

One population in particular, the Kuna Indians who live off the coast of

Panama, provides a good example of the potential benefits of cocoa. As part

of their traditional diet, the Kuna consume several cups daily of flavanol-

rich cocoa beverages. Interestingly, they do not experience the typical agerelated increase in blood pressure as populations of other Western societies
do. It is believed that the flavanols in the cocoa help to maintain their

healthy blood pressure. Additional studies also indicate that flavanols may
indeed protect against hypertension and cardiovascular disease.

(Lancet 1993; 342: 1007-1011, Data presented at XXII International conference on polyphenols,
25-28 Aug 2004; Helsinki, Finland, Hypertension 1997; 29: 171-6)
(Archives of Internal Medicine 2006; 166: 411-417)

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Chocolate and Blueberries:

What They Have in Common

Your Vascular System Loves

Chocolate Too!

You may have heard

Many of the potential benefits of flavanols may be due to their protective

packed blueberry and the

blood flow throughout your entire body. To function properly, all biological

about the antioxidant-

effects on the blood vessels. Healthy blood vessels support efficient

potential health benefits

systems including the cardiovascular system, kidneys, eyes, brain and

that are attributed to

muscles rely on a healthy supply of blood. Flavanols, found abundantly

the antioxidants in foods.

in certain plant-based foods and beverages, have been shown to affect

These antioxidants may

several mechanisms involved in maintaining blood vessel health.

protect against damage

One mode of action is flavanols

from free radicals. A

influence on platelets, substances in

study published by

the blood that can cause blockages in

the U.S. Department

the arteries when they clump

of Agriculture (USDA)

together. Flavanols reduce the

examined several cocoa and chocolate

products, finding a link between the amount of natural cocoa

and antioxidant activity. The USDA study opens up opportunities for

cocoa as an ingredient and finished product.

( J Agric Food Chem 2004; 52(12): 4026-37; J Ag Food Chem 2006; 54 (11): 4057-61)
(Am J Clin Nutr 2007; 85: 709-11)
Comparison of antioxidant capacity of foods

(Oxygen Radical Absorbance Capacity assay, micromoles TE per serving)1

tendency for platelets to stick

together. In studies where

participants consumed flavanol-rich

chocolate or a flavanol-rich cocoa

beverage, researchers saw reduced

platelet stickiness, similar to the
reduced clotting action from a
baby aspirin.

(Am J Clin Nutr 2000; 72: 30-5; Thromb

Res 2002; 106: 191-7)
Research has also shown that flavanols may decrease

inflammation by improving the ratio of anti-inflammatory compounds to

pro-inflammatory compounds. Additionally, flavanols may improve blood flow

by helping blood vessels widen or dilate. Together these actions may help
maintain or even improve vascular health.

(Am J Clin Nutr 2005 Jan; 81 (1 Suppl): 304S-12S; J Am Coll Cardio 2004; 23: 197-204; Am J
Hypertens 2005 Jun; 18 (6): 785-91)
Chocolate and cocoa products analyzed by Gu et al. (2005). (J Ag Food Chem 2004; 52: 4026-37)
(J Agric Food Chem 2004; 52(12): 4026-37)
(Serving sizes based on the FDAs Reference Amounts Customarily Consumed)

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Diabetes and Chocolate

Chocolate and the Immune System

People with diabetes tend to think that chocolate is not allowed. Fitting

The flavanols naturally found in cocoa and chocolate have been shown

some health benefits even for those living with diabetes. High blood

immune responses in the body. This may be helpful in controlling overly

cocoa and chocolate into a well-balanced eating plan however, may offer
sugar, impaired circulation and unhealthy blood vessels are all potential
complications in diabetes and pose prominent health concerns. Because
flavanols have the potential ability to improve blood flow and keep

vessels healthy, a diet rich in flavanols may benefit those with diabetes.

(Nutrition 2007; 23 (4): In Press)

An emerging area of study is chocolates impact on insulin sensitivity.

When sensitivity to insulin decreases, cells cannot pull sugar out of the

blood stream to be used as fuel. This creates increased levels of sugar in

the blood, thus defining pre-diabetes, or Type 2 diabetes. When flavanolrich chocolate was given to participants for 15 days, researchers saw

lower blood sugar levels than before the treatment period. This suggests
that flavanol-rich chocolate may help to increase insulin sensitivity, thus

helping to control blood sugar levels. More research is needed to confirm

and understand cocoa and chocolates potential effect on the prevention
and treatment of diabetes.

to affect the immune system by suppressing compounds that create

active immune

responses associated
with arthritis,
heart disease

and autoimmune
diseases. More

research is needed
to understand the
impact of cocoa

and chocolate on

immune function.

( J Med Food 2002; 5 (1): 17-22)

Other Research Findings of Interest

Studies are also being conducted on the potential anti-cancer effects

(Am J Clin Nutr 2005; 81: 611-4)

of flavanols. Breast cancer cells have been shown to stop multiplying

when combined with specific flavanols in a test tube. These studies

are promising but are only the very beginning of understanding cocoa
flavanols potential in anti-cancer effects.

(Mol Cancer Ther 2005 Apr; 4 (4): 537-46)

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Chocolate Myths: Fact or Fiction

pYes
4
pNo

Is chocolate high in caffeine?

Most people do not realize that milk chocolate contains relatively small
amounts of caffeineabout the same amount as a cup of decaffeinated
coffee. Chocolate does, however, also naturally contain theobromine,
a close relative to caffeine. Amounts range from 81 mg in a 1.4-ounce
milk chocolate bar to 193 mg in a 1.4-ounce semisweet (dark) chocolate
bar. Although in the same family as caffeine, theobromine has been
found to have different effects on the body. For one, it is believed
that theobromine does not have as potent of a stimulating effect on
the central nervous system as caffeine. Additionally, theobromine may
suppress cough. (FASEB J 2005 Feb; 19 (2): 231-3)

Do people actually have a

biological need for chocolate?

pYes
4
pNo

We certainly enjoy the unique melting sensation of chocolate on our

tongues and the variety of flavor experiences ranging from milk
chocolate to dark bitter chocolate. But the prevailing question still
lingersdo people actually have a biological need for chocolate? Several
research studies have attempted to either prove or disprove this
question. Nutrients and compounds in chocolate have come into question
as possibly having the ability to create a craving. One recent study
suggested that caffeine-like compounds or certain minerals found in
chocolate might cause people to
continue to want to eat chocolate.
If this were true, other foods
with the same compounds would
also be craved; however, this was
not the case. One study included
participants who claimed to crave
chocolate at least once a week. The
participants were given cocoa (which

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contains all of the compounds and nutrients believed to cause

the cravings), white chocolate (which does not contain the compounds
or nutrients believed to cause the cravings), cocoa butter and milk
chocolate. If chocolate indeed contained a special compound that causes
cravings, then the cocoa should have been craved. However, only the
white chocolate and milk chocolate satisfied participants cravings. This
very important study confirmed what most scientists believe, which is
that the craving some experience is due to the sensory enjoyment
experienced when eating chocolate.

(Physiol Behav 1994; 56 (3): 419-422)

Is chocolate allergenic?

pYes
4
pNo

A food allergy is a reaction by the bodys immune system to a substance in

food, usually a protein. To accurately diagnose a food allergy, a controlled
food challenge test should be administered. Of the approximately one to
two percent of American adults and five to eight percent of children who
have a true food allergy, ninety percent are allergic to either milk, eggs,
peanuts, tree nuts, soy, wheat, fish or shellfish.
Chocolate is an uncommon food allergen. However, it is important
to recognize that foods may contain other ingredients that can elicit
allergic reactions, including milk, soy, lecithin, gluten, peanuts and tree
nuts. To help identify these ingredients more easily, processed food
products are now required to indicate on the food label if they contain
one of the top eight allergens.

Does chocolate cause migraines?

pYes
4
pNo

Migraines and headaches have long been rumored to be triggered

by chocolate consumption; however, studies have not been able to
demonstrate this relationship. In several studies, there was no difference
in the occurrence of headaches in headache or migraine sufferers after
eating either chocolate or a non-chocolate-containing food. No relationship
was found even in those migraine sufferers who identified themselves as
sensitive to chocolate as a headache trigger. The reason that migraine
sufferers frequently cite chocolate as a trigger may simply be coincidental

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timing. Women are more likely than men to suffer from migraines and
women more often report strong desires for chocolate, especially before
and during menstruation. The fluctuating estrogen levels experienced with
the menstrual cycle are believed to be a trigger of migraines.

(Cephalalgia 1997; 17: 855-8)

Does chocolate cause acne?

pYes
4
pNo

Studies going as far back as the 1960s have

failed to show any relationship between
chocolate consumption and the development
of acne. An extensive research review in the
Journal of the American Medical Association on
chocolate and acne stated diet plays no role
in acne treatment in most patients even
large amounts of chocolate have not clinically
exacerbated acne.

( JAMA 1970 Mar 16; 211 (11): 1856)

Does chocolate affect behavior
and cause hyperactivity?

pYes
4
pNo

An extensive review of
research studies indicates
that there is no relationship
between consumption of
sugar-containing foods
and changes in behavior.
In addition, studies which
specifically tested chocolate
and candy failed to show any
relationship between ingestion of these foods and hyperactive behavior
in children with and without Attention-Deficit Hyperactivity Disorder.
It is believed that the environment in which sugary foods are often
eaten, such as a birthday party, is what affects behavior.

(Crit Rev Food Sci Nutr 1996 Jan; 36 (1-2): 31-47)

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Does chocolate
cause cavities?

pYes
4
pNo

Good dental health involves a

number of factors, including
oral hygiene, fluoride intake,
genetics and diet. Foods containing
fermentable carbohydrate
can promote cavity formation.
However, a foods effect also
depends on the amount of time
spent in the mouth allowing oral
bacteria to promote tooth decay.

The Chocolate Manufacturers

Association (CMA)

Although sweetened chocolate

does contain fermentable
carbohydrate, it clears the
mouth relatively quickly and has
not been found to contribute
to the development of cavities.
One study investigated the
development of plaque from
chocolates with various levels of cocoa and found that all chocolate
types had a lower effect on dental plaque than sucrose (table sugar).
In fact, research has shown that regular brushing (twice a day) with a
fluoride toothpaste has a greater impact on reducing the development of
dental cavities in children than restricting sugary foods. Additionally, no
association was found between consumption of chocolate confectionery
and the development of cavities. Interestingly, the flavanols in cocoa may
actually be good for dental health. Cocoa flavanols have been shown to
decrease plaque formation through anti-bacterial activity.

lly

ay actua
m
s
l
o
n
Flava
que!

a
l
p
e
s
a
e
r
dec

(Eur J Paediatr Dent 2003 Dec; 4 (4): 203-10; Caries Res 1999; 33 (2): 101-13;
Arch Oral Biol 1985; 30 (11-12): 821-6)

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The Chocolate Manufacturers Association

(CMA) has served as the premier trade
group for manufacturers and distributors
of cocoa and chocolate products in the
United States since 1923. The association
was founded to fund and administer research, promote chocolate to the general
public and serve as an advocate of the industry before Congress and government
agencies. CMA supports science-based
approaches to a healthy lifestyle that promote energy balance through diet and activity choices. Please visit our website at
www.chocolateusa.org to learn more about us.

The American Cocoa

Research Institute (ACRI)
The American Cocoa Research Institute
(ACRI) was founded in 1947. It is the research arm of the CMA and is devoted to
research in scientific areas related to cocoa
and chocolate.