The n e w e ng l a n d j o u r na l of m e dic i n e

o c c a siona l no t e s

Chocolate Consumption, Cognitive Function,
and Nobel Laureates
Franz H. Messerli, M.D.

Dietary flavonoids, abundant in plant-based foods, cause the population of a country is substantially
have been shown to improve cognitive function. higher than its number of Nobel laureates, the
Specifically, a reduction in the risk of dementia, numbers had to be multiplied by 10 million.
enhanced performance on some cognitive tests, Thus, the numbers must be read as the number
and improved cognitive function in elderly patients of Nobel laureates for every 10 million persons
with mild impairment have been associated with in a given country.
a regular intake of flavonoids.1,2 A subclass of All Nobel Prizes that were awarded through
flavonoids called flavanols, which are widely October 10, 2011, were included. Data on per
present in cocoa, green tea, red wine, and some capita yearly chocolate consumption in 22
fruits, seems to be effective in slowing down or countries was obtained from Chocosuisse
even reversing the reductions in cognitive per- (,
formance that occur with aging. Dietary flavanols Theo­broma-cacao (
have also been shown to improve endothelial wissen/wirtschaft/international/konsum), and
function and to lower blood pressure by causing Caobisco (
vasodilation in the peripheral vasculature and in Data were available from 2011 for 1 country
the brain.3,4 Improved cognitive performance (Switzerland), from 2010 for 15 countries, from
with the administration of a cocoa polyphenolic 2004 for 5 countries, and from 2002 for 1 coun-
extract has even been reported in aged Wistar– try (China).
Unilever rats.5
Since chocolate consumption could hypotheti- Re sult s
cally improve cognitive function not only in indi-
viduals but also in whole populations, I won- There was a close, significant linear correlation
dered whether there would be a correlation (r = 0.791, P<0.0001) between chocolate con-
between a country’s level of chocolate consump- sumption per capita and the number of Nobel
tion and its population’s cognitive function. To laureates per 10 million persons in a total of 23
my knowledge, no data on overall national cog- countries (Fig. 1). When recalculated with the
nitive function are publicly available. Conceiv- exclusion of Sweden, the correlation coefficient
ably, however, the total number of Nobel laure- increased to 0.862. Switzerland was the top per-
ates per capita could serve as a surrogate end former in terms of both the number of Nobel
point reflecting the proportion with superior laureates and chocolate consumption. The slope
cognitive function and thereby give us some of the regression line allows us to estimate that
measure of the overall cognitive function of a it would take about 0.4 kg of chocolate per capita
given country. per year to increase the number of Nobel laure-
ates in a given country by 1. For the United States,
Me thods that would amount to 125 million kg per year.
The minimally effective chocolate dose seems to
A list of countries ranked in terms of Nobel hover around 2 kg per year, and the dose–response
laureates per capita was downloaded from curve reveals no apparent ceiling on the number
Wikipedia ( of Nobel laureates at the highest chocolate-dose
countries_by_Nobel_laureates_per_capita). Be- level of 11 kg per year.

n engl j med 1
The New England Journal of Medicine
Downloaded from by MARCO VITORIA on October 10, 2012. For personal use only. No other uses without permission.
Copyright © 2012 Massachusetts Medical Society. All rights reserved.

although perhaps that Sweden should have produced a total of celebratory events associated with this unique 2 n engl j med nejm. Considering that in this instance the observed The principal finding of this study is a surpris. late consumption has been documented to im. ceivable that persons with superior cognitive these findings are hypothesis-generating only function (i. It is con- the sprouting of Nobel laureates.4 kg per year. However. A second hypothesis. one cannot quite escape the intake per capita and the number of Nobel laure. amounts greatly enhance their cognition.e. Of course. of the health benefits of the flavanols in dark domized trial. reverse causation — prove cognitive function. number exceeds the expected number by a fac- ingly powerful correlation between chocolate tor of more than 2. Stockholm has some inherent patriotic bias tion between X and Y does not prove causation when assessing the candidates for these awards but indicates that either X influences Y. For personal use only. Discussion about 14 Nobel laureates. that enhanced cognitive performance that in a dose-dependent way. Prize would in itself increase chocolate intake sumption of 6.. or.0001 Denmark 25 Nobel Laureates per 10 Million Population Austria Norway 20 United Kingdom 15 United Ireland Germany The Netherlands States 10 France Belgium Canada Finland 5 Poland Australia Portugal Greece Italy Spain 0 Japan China Brazil 0 5 10 15 Chocolate Consumption (kg/yr/capita) Figure 1. chocolate intake could stimulate countrywide chocolate con- provides the abundant fertile ground needed for sumption — must also be considered. That receiving the Nobel be Sweden. the cognoscenti) are more aware and will have to be tested in a prospective. Y influ. or X and Y are influenced by a common sensitive to chocolate.791 P<0. since choco. . The n e w e ng l a n d j o u r na l of m e dic i n e 35 Switzerland Sweden 30 r=0. perhaps. it seems most likely that is. Obviously. ran. yet we observe 32. and even minuscule underlying mechanism. Correlation between Countries’ Annual Per Capita Chocolate Consumption and the Number of Nobel Laureates per 10 Million Population. No other uses without permission. chocolate and are therefore prone to increasing The only possible outlier in Figure 1 seems to their consumption. that the Swedes are particularly ences X. a correla. All rights The New England Journal of Medicine Downloaded from nejm. 2012. Copyright © 2012 Massachusetts Medical Society. we would predict countrywide seems unlikely. Given its per capita chocolate con. notion that either the Nobel Committee in ates in various by MARCO VITORIA on October 10.

Neuropsychiatr Dis Treat 2008. Mess- aoudi M. and Aging (CoCoA) ing asked to travel to Stockholm is uncertain. From St. humans. This research is evolving. occasional notes honor may trigger a widespread but most likely Nobel Prize. Chocolate consumption enhances cognitive func. n engl j med  nejm.100:94-101. and climatic factors may play some role. over many years. For personal use only. Hidalgo S. relation observed. for the observed association with improved cog- sumption and the number of Nobel laureates nitive function. at NEJM. Copyright © 2012 Massachusetts Medical Society. Rozan P. Hollenberg NK. tion of chocolate is the underlying mechanism tor that could possibly drive both chocolate con. 2012. Circulation 2009. and chocolate by elderly men and women is associated with better cognitive test performance. Cocoa and of Nobel laureates and chocolate consumption cardiovascular health. tea. Flammer AJ. cocoa flavanol consumption in elderly subjects with mild cogni- tive impairment: the Cocoa. 5. New York. The present data are based on country averages. Br J Nutr 2008. Bisson JF. it is diffi. and it closely correlates with the transient increase. Nejdi A. The cumulative dose of chocolate that tive function. Kwik-Uribe C. and insulin resistance through is needed to sufficiently increase the odds of be. Intake of flavonoid-rich and the specific chocolate intake of individual wine. 2012. Nobel laureates of the past and present remains 2. Luke’s–Roosevelt Hospital and Columbia University. Messerli reports regular daily chocolate consumption. Effects of long-term administration of a cocoa poly- Conclusions phenolic extract (Acticoa powder) on cognitive performances in aged rats. 4. . full text of this article at NEJM. Lüscher TF.119:1433-41. Fisher ND.1056/NEJMon1211064 Drevon CA. It J Nutr 2009. Grassi D. Differences in socioeconomic Dr. since both the number 3. blood pressure. remains to be determined whether the consump- cult to identify a plausible common denomina. Sorond FA. Refsum H.60:794-801. DOI: 10. number of Nobel laureates in each country. Desideri G. et al. Corti R.4:433-40. Cognition. Hypertension 2012. Nurk E. Study. Hollenberg NK. All rights reserved. No other uses without permission. Lalonde R. Benefits in cogni- unknown. Lipsitz LA. which is a sine qua non for winning the Copyright © 2012 Massachusetts Medical Society.139:120-7. et al. as to a third hypothesis. but Disclosure forms provided by the author are available with the they fall short of fully explaining the close cor. Cerebral are time-dependent variables and change from blood flow response to flavanol-rich cocoa in healthy elderly year to by MARCO VITORIA on October 10. S t udy Limitations This article was published on October 10. status from country to country and geographic mostly but not exclusively in the form of Lindt’s dark 3 The New England Journal of Medicine Downloaded from nejm. 1.