Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Regular dark chocolate consumption's reduction of oxidative stress and increase of free-fatty-acid mobilization in response to prolonged cycling. Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults. Acute dark chocolate and cocoa ingestion and endothelial function: a randomized controlled crossover trial. Beneficial effects of dark chocolate on exercise capacity in sedentary subjects: underlying mechanisms. A double blind, randomized, placebo controlled trial. Reduction in blood pressure and serum lipids by lycosome formulation of dark chocolate and lycopene in prehypertension Effects of dark chocolate and cocoa consumption on endothelial function and arterial stiffness in overweight adults. Methylxanthines are the psycho-pharmacologically active constituents of chocolate Dark Chocolate Improves Coronary Vasomotion and Reduces Platelet Reactivity Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. Cocoa flavanols reduce N‐terminal pro‐B‐type natriuretic peptide in patients with chronic heart failure The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects. Dark chocolate supplementation reduces the oxygen cost of moderate intensity cycling Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Dark chocolate and reduced snack consumption in mildly hypertensive adults: an intervention study Central Arterial Hemodynamic Effects of Dark Chocolate Ingestion in Young Healthy People: A Randomized and Controlled Trial Effect of Chocolate and Yerba Mate Phenolic Compounds on Inflammatory and Oxidative Biomarkers in HIV/AIDS Individuals The effect of acute pre-exercise dark chocolate consumption on plasma antioxidant status, oxidative stress and immunoendocrine responses to prolonged exercise Dark chocolate or tomato extract for prehypertension: a randomised controlled trial Dark chocolate and vascular function in patients with peripheral artery disease: a randomized, controlled cross-over trial. Bioavailability of (-)-epicatechin upon intake of chocolate and cocoa in human volunteers Protective Effects of Flavanol-Rich Dark Chocolate on Endothelial Function and Wave Reflection During Acute Hyperglycemia High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome Flavonoid-Rich Dark Chocolate Improves Endothelial Function and Increases Plasma Epicatechin Concentrations in Healthy Adults Appetite suppression through smelling of dark chocolate correlates with changes in ghrelin in young women Eating chocolate can significantly protect the skin from UV light. High-cocoa polyphenol-rich chocolate improves blood pressure in patients with diabetes and hypertension Effect of cocoa bran on low-density lipoprotein oxidation and fecal bulking. Flavonoid rich dark cocoa may improve fatigue in people with multiple sclerosis, yet has no effect on glycaemic response: An exploratory trial. Pharmacological versus sensory factors in the satiation of chocolate craving Consumption of cocoa flavanols results in an acute improvement in visual and cognitive functions Potential effects of chocolate on human pregnancy: a randomized controlled trial Cocoa consumption reduces NF-κB activation in peripheral blood mononuclear cells in humans. A reduced-calorie dietary pattern including a daily sweet snack promotes body weight reduction and body composition improvements in premenopausal women who are overweight and obese: a pilot study. Oxidised LDL levels decreases after the consumption of ready-to-eat meals supplemented with cocoa extract within a hypocaloric diet. Steady state visually evoked potential (SSVEP) topography changes associated with cocoa flavanol consumption The Effects of Acute Post Exercise Consumption of Two Cocoa-Based Beverages with Varying Flavanol Content on Indices of Muscle Recovery Following Downhill Treadmill Running Realistic intake of a flavanol-rich soluble cocoa product increases HDL-cholesterol without inducing anthropometric changes in healthy and moderately hypercholesterolemic subjects. Chocolate and Prevention of Cardiovascular Disease: A Systematic Review The role of fatty acid saturation on plasma lipids, lipoproteins, and apolipoproteins: I. Effects of whole food diets high in cocoa butter, olive oil, soybean oil, dairy butter, and milk chocolate on the plasma lipids of young men. Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study. Flavanol-rich chocolate acutely improves arterial function and working memory performance counteracting the effects of sleep deprivation in healthy individuals Cardiovascular effects of flavanol-rich chocolate in patients with heart failure. Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit platelet function.
BACKGROUND Flavonoids are polyphenolic compounds of plant origin with antioxidant effects . Flavonoids inhibit LDL oxidation and reduce thrombotic tendency in vitro . Little is known about how cocoa powder and dark chocolate , rich sources of polyphenols , affect these cardiovascular disease risk factors . OBJECTIVE We evaluated the effects of a diet high in cocoa powder and dark chocolate ( CP-DC diet ) on LDL oxidative susceptibility , serum total antioxidant capacity , and urinary prostagl and in concentrations . DESIGN We conducted a r and omized , 2-period , crossover study in 23 healthy subjects fed 2 diets : an average American diet ( AAD ) controlled for fiber , caffeine , and theobromine and an AAD supplemented with 22 g cocoa powder and 16 g dark chocolate ( CP-DC diet ) , providing approximately 466 mg procyanidins/d . RESULTS LDL oxidation lag time was approximately 8 % greater ( P = 0.01 ) after the CP-DC diet than after the AAD .  Serum total antioxidant capacity measured by oxygen radical absorbance capacity was approximately 4 % greater ( P = 0.04 ) after the CP-DC diet than after the AAD and was positively correlated with LDL oxidation lag time ( r = 0.32 , P = 0.03 ) . HDL cholesterol was 4 % greater after the CP-DC diet ( P = 0.02 ) than after the AAD ; however , LDL-HDL ratios were not significantly different . Twenty-four-hour urinary excretion of thromboxane B(2 ) and 6-keto-prostagl and in F(1)(alpha ) and the ratio of the 2 compounds were not significantly different between the 2 diets . CONCLUSION Cocoa powder and dark chocolate may favorably affect cardiovascular disease risk status by modestly reducing LDL oxidation susceptibility , increasing serum total antioxidant capacity and HDL-cholesterol concentrations , and not adversely affecting prostagl and ins This study investigated the effects of regular consumption of dark chocolate ( DC ) , rich in cocoa polyphenols , on plasma metabolites , hormones , and markers of oxidative stress after prolonged exhaustive exercise . Twenty active men cycled at 60 % maximal oxygen uptake ( VO2max ) for 1.5 hr , with the intensity increased to 90 % VO2max for a 30-s period every 10 min , followed by a ride to exhaustion at 90 % VO2max . In the 2 wk before exercise participants consumed 40 g of DC or an isocarbohydrate-fat control cocoa liquor-free chocolate ( CON ) twice daily and once 2 hr before exercise in a r and omized , counterbalanced , crossover design . Venous blood sample s were taken immediately before exercise , postexercise ( fixed duration ) , postexhaustion , and after 1 hr of recovery . F2-isoprostanes were significantly lower ( post hoc tests : p < .001 ) at exhaustion and after 1 hr of recovery with DC . Oxidized low-density lipoproteins were significantly lower with DC ( p < .001 ) both before and after exercise and at exhaustion . DC was also associated with ~21 % greater rises in free fatty acids during exercise ( main effect : p < .05 ) . Changes in circulating glucose , insulin , glucagon , cortisol , and interleukin (IL)-6 , IL-10 , and IL-1ra were unaffected by treatment . Time to exhaustion at 90 % VO2max was not significantly different between trials ( 398 ± 204 and 374 ± 194 s for DC and CON , respectively ) . These results suggest that regular DC intake is associated with reduced oxidative-stress markers and increased mobilization of free fatty acids after exercise but has no observed effect on exercise performance Consumption of flavanol-rich dark chocolate ( DC ) has been shown to decrease blood pressure ( BP ) and insulin resistance in healthy subjects , suggesting similar benefits in patients with essential hypertension ( EH ) . Therefore , we tested the effect of DC on 24-hour ambulatory BP , flow-mediated dilation ( FMD ) , and oral glucose tolerance tests ( OGTTs ) in patients with EH . After a 7-day chocolate-free run-in phase , 20 never-treated , grade I patients with EH ( 10 males ; 43.7±7.8 years ) were r and omized to receive either 100 g per day DC ( containing 88 mg flavanols ) or 90 g per day flavanol-free white chocolate ( WC ) in an isocaloric manner for 15 days . After a second 7-day chocolate-free period , patients were crossed over to the other  treatment . Noninvasive 24-hour ambulatory BP , FMD , OGTT , serum cholesterol , and markers of vascular inflammation were evaluated at the end of each treatment . The homeostasis model assessment of insulin resistance ( HOMA-IR ) , quantitative insulin sensitivity check index ( QUICKI ) , and insulin sensitivity index ( ISI ) were calculated from OGTT values . Ambulatory BP decreased  after DC ( 24-hour systolic BP −11.9±7.7 mm Hg , P<0.0001 ; 24-hour diastolic BP −8.5±5.0 mm Hg , P<0.0001 ) but not WC . DC but not WC decreased HOMA-IR ( P<0.0001 ) , but it improved QUICKI , ISI , and FMD . DC also decreased serum LDL cholesterol ( from 3.4±0.5 to 3.0±0.6 mmol/L ; P<0.05 ) . In  summary , DC  decreased BP and serum LDL cholesterol , improved FMD , and ameliorated insulin sensitivity in hypertensives . These results suggest that , while balancing total calorie intake , flavanols from cocoa products may provide some cardiovascular benefit if included as part of a healthy diet for patients with EH BACKGROUND In recent years , there has been increased interest in the potential health-related benefits of antioxidant- and phytochemical-rich dark chocolate and cocoa . OBJECTIVE The objective of the study was to examine the short-term ( 6 wk ) effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health in healthy older adults . DESIGN A double-blind , placebo-controlled , fixed-dose , parallel-group clinical trial was used . Participants ( n = 101 ) were r and omly assigned to receive a 37-g dark chocolate bar and 8 ounces ( 237 mL ) of an artificially sweetened cocoa beverage or similar placebo products each day for 6 wk . RESULTS No significant group ( dark chocolate and cocoa or placebo)-by-trial ( baseline , midpoint , and end-of-treatment assessment s ) interactions were found for the neuropsychological , hematological , or blood pressure variables examined . In contrast , the midpoint and end-of-treatment mean pulse rate assessment s in the dark chocolate and cocoa group were significantly higher than those at baseline and significantly higher than the midpoint and end-of-treatment rates in the control group . Results of a follow-up question naire item on the treatment products that participants believed they had consumed during the trial showed that more than half of the participants in both groups correctly identified the products that they had ingested during the experiment . CONCLUSIONS This investigation failed to support the predicted beneficial effects of short-term dark chocolate and cocoa consumption on any of the neuropsychological or cardiovascular health-related variables included in this research . Consumption of dark chocolate and cocoa was , however , associated with significantly higher pulse rates at 3- and 6-wk treatment assessment BACKGROUND Studies suggest cardioprotective benefits of dark chocolate containing cocoa . OBJECTIVE This study examines the acute effects of solid dark chocolate and liquid cocoa intake on endothelial function and blood pressure in overweight adults . DESIGN R and omized , placebo-controlled , single-blind crossover trial of 45 healthy adults [ mean age : 53 y ; mean body mass index ( in kg/m(2 ) ) : 30 ] . In phase 1 , subjects were r and omly assigned to consume a solid dark chocolate bar ( containing 22 g cocoa powder ) or a cocoa-free placebo bar ( containing 0 g cocoa powder ) . In phase 2 , subjects were r and omly assigned to consume sugar-free cocoa ( containing 22 g cocoa powder ) , sugared cocoa ( containing 22 g cocoa powder ) , or a placebo ( containing 0 g cocoa powder ) . RESULTS Solid dark chocolate and liquid cocoa ingestion improved endothelial function ( measured as flow-mediated dilatation ) compared with placebo ( dark chocolate : 4.3 + /- 3.4 % compared with -1.8 + /- 3.3 % ; P < 0.001 ; sugar-free and sugared cocoa : 5.7 + /- 2.6 % and 2.0 + /- 1.8 % compared with -1.5 + /- 2.8 % ; P < 0.001 ) . Blood pressure decreased after the ingestion of dark chocolate and sugar-free cocoa compared with placebo ( dark chocolate : systolic , -3.2 + /- 5.8 mm Hg compared with 2.7 + /- 6.6 mm Hg ; P < 0.001 ; and diastolic , -1.4 + /- 3.9 mm Hg compared with 2.7 + /- 6.4 mm Hg ; P = 0.01 ; sugar-free cocoa : systolic , -2.1 + /- 7.0 mm Hg compared with 3.2 + /- 5.6 mm Hg ; P < 0.001 ; and diastolic : -1.2 + /- 8.7 mm Hg compared with 2.8 + /- 5.6 mm Hg ; P = 0.014 ) . Endothelial function improved significantly more with sugar-free than with regular cocoa ( 5.7 + /- 2.6 % compared with 2.0 + /- 1.8 % ; P < 0.001 ) . CONCLUSIONS The acute ingestion of both solid dark chocolate and liquid cocoa  improved endothelial function and lowered blood pressure  in overweight adults . Sugar content may attenuate these effects , and sugar-free preparations may augment them In heart failure patients the consumption of (-)-epicatechin ( (-)-Epi)-rich cocoa can restore skeletal muscle ( SkM ) mitochondrial structure and decrease biomarkers of oxidative stress . However , nothing is known about its effects on exercise capacity and underlying mechanisms in normal , sedentary subjects . Twenty normal , sedentary subjects ( ∼50 years old ) were r and omized to placebo or dark chocolate ( DC ) groups and consumed 20 g of the products for 3 months . Subjects underwent before and after treatment , bicycle ergometry to assess VO2 max and work , SkM biopsy to assess changes in mitochondrial density , function and oxidative stress and blood sampling to assess metabolic endpoints . Seventeen subjects completed the trial . In the DC group ( n = 9 ) , VO2 max increased ( 17 % increase , p = 0.056 ) as well as maximum work ( watts ) achieved ( p = 0.026 ) with no changes with placebo ( n = 8) . The DC group evidence d increases in HDL levels ( p = 0.005 ) and decreased triglycerides ( p = 0.07 ) . With DC , SkM evidence d significant increases in protein levels for LKB1 , AMPK and PGC1α and in their active forms ( phosphorylated AMPK and LKB1 ) as well as in citrate synthase activity while no changes were observed in mitochondrial density . With DC , significant increases in SkM reduced glutathione levels and decreases in protein carbonylation were observed . Improvements in maximum work achieved and VO2 max may be due to DC activation of upstream control systems and enhancement of SkM mitochondria efficiency . Larger clinical studies are warranted to confirm these observations Twenty-nine healthy volunteers aged 47–69 years old were r and omly assigned to a 28-day oral intake of different dark chocolate ( DC ) formulations . The main group received daily 30 g of proprietary lycopene-containing ( L-tug ) lycosome formulation of DC with enhanced bioavailability of cocoa flavanols . Two control groups daily consumed either 30 g of regular DC alone or along with 7 mg of lycopene , which corresponds to the amount of lycopene ingested with L-tug formulation . It was found that L-tug was more efficient in reducing diastolic blood pressure ( mean value of −6.22 mmHg , 95 % CI : 5.00 , 8.00 ) when compared with the regular DC group ( −3.00 mmHg , P < 0.05 ) or the group which ingested the DC and lycopene as two separate formulations ( mean reduction of −4 mmHg , 95 % CI : 2.47 , 6.00 , P = 0.0262 ) . Only marginal superiority for L-tug formulation in the reduction in systolic blood pressure was seen . However , the L-tug formulation was the only formulation of DC which affected serum lipids . There was a reduction in total cholesterol ( from median 228.00 mg/dL [ 95 % CI : 206.2 , 242.5 ] to 187.00 mg/dL [ 95 % CI : 166.2 , 202.2 , P < 0.05 ] ) with corresponding decline of low-density lipoprotein ( LDL ) cholesterol ( from a median of 166.00 mg/dL [ 95 % CI : 130.8 , 177.0 ] to 151.00 mg/dL [ 95 % CI : 122.8 , 167.4 ; P < 0.05 ] ) at the end of the intervention period . Similar decline was seen in serum triglycerides ( P < 0.05 ) . Serum high-density lipoprotein ( HDL ) cholesterol , glucose levels , and C-reactive protein ( CRP ) values remained statistically unchanged in all study groups throughout the intervention period . A superior biological activity of the L-tug lycosome formulation of DC extending beyond its antihypertensive effect to lipid-lowering ability opens up new possibilities for the use of DC for health purpose s helping to reduce daily caloric intake without compromising on the health benefits of DC consumption The consumption of cocoa and dark chocolate is associated with a lower risk of CVD , and improvements in endothelial function may mediate this relationship . Less is known about the effects of cocoa/chocolate on the augmentation index ( AI ) , a measure of vascular stiffness and vascular tone in the peripheral arterioles . We enrolled thirty middle-aged , overweight adults in a r and omised , placebo-controlled , 4-week , cross-over study . During the active treatment ( cocoa ) period , the participants consumed 37 g/d of dark chocolate and a sugar-free cocoa beverage ( total cocoa = 22 g/d , total flavanols ( TF ) = 814 mg/d ) . Colour-matched controls included a low-flavanol chocolate bar and a cocoa-free beverage with no added sugar ( TF = 3 mg/d ) . Treatments were matched for total fat , saturated fat , carbohydrates and protein . The cocoa treatment significantly increased the basal diameter and peak diameter of the brachial artery by 6 % ( + 2 mm ) and basal blood flow volume by 22 % . Substantial decreases in the AI , a measure of arterial stiffness , were observed in only women . Flow-mediated dilation and the reactive hyperaemia index remained unchanged . The consumption of cocoa had no effect on fasting blood measures , while the control treatment increased fasting insulin concentration and insulin resistance ( P= 0·01 ) . Fasting blood pressure ( BP ) remained unchanged , although the acute consumption of cocoa  increased resting BP by 4 mmHg . In summary , the high-flavanol cocoa and dark chocolate treatment was associated with enhanced vasodilation in both conduit and resistance arteries and was accompanied by significant reductions in arterial stiffness in women Rationale Liking , cravings and addiction for chocolate ( “ chocoholism ” ) are often explained through the presence of pharmacologically active compounds . However , mere “ presence ” does not guarantee psycho-activity . Objectives Two double-blind , placebo-controlled studies measured the effects on cognitive performance and mood of the amounts of cocoa powder and methylxanthines found in a 50 g bar of dark chocolate . Methods In study 1 , participants ( n=20 ) completed a test battery once before and twice after treatment administration . Treatments included 11.6 g cocoa powder and a caffeine and theobromine combination ( 19 and 250 mg , respectively ) . Study 2 ( n=22 ) comprised three post-treatment test batteries and investigated the effects of “ milk ” and “ dark ” chocolate levels of these methylxanthines . The test battery consisted of a long duration simple reaction time task , a rapid visual information processing task , and a mood question naire . Results Identical improvements on the mood construct “ energetic arousal ” and cognitive function were found for cocoa powder and the caffeine+theobromine combination versus placebo . In chocolate , both “ milk chocolate ” and “ dark chocolate ” methylxanthine doses improved cognitive function compared with “ white chocolate ” . The effects of white chocolate did not differ significantly from those of water . Conclusions A normal portion of chocolate exhibits psychopharmacological activity . The identical profile of effects exerted by cocoa powder and its methylxanthine constituents shows this activity to be confined to the combination of caffeine and theobromine . Methylxanthines may contribute to the popularity of chocolate ; however , other attributes are probably much more important in determining chocolate ’s special appeal and in explaining related self-reports of chocolate cravings and “ chocoholism ” Background — Dark chocolate has potent antioxidant properties . Coronary atherosclerosis is promoted by impaired endothelial function and increased platelet activation . Traditional risk factors , high oxidative stress , and reduced antioxidant defenses play a crucial role in the pathogenesis of atherosclerosis , particularly in transplanted hearts . Thus , flavonoid-rich dark chocolate holds the potential to have a beneficial impact on graft atherosclerosis . Methods and Results — We assessed the effect of flavonoid-rich dark chocolate compared with cocoa-free control chocolate on coronary vascular and platelet function in 22 heart transplant recipients in a double-blind , r and omized study . Coronary vasomotion was assessed with quantitative coronary angiography and cold pressor testing before and 2 hours after ingestion of 40 g of dark ( 70 % cocoa ) chocolate or control chocolate , respectively . Two hours after ingestion of flavonoid-rich dark chocolate  , coronary artery diameter was increased significantly ( from 2.36±0.51 to 2.51±0.59 mm , P<0.01 ) , whereas it remained unchanged after control  chocolate . Endothelium-dependent coronary vasomotion improved significantly after dark chocolate ( 4.5±11.4 % versus −4.3±11.7 % in the placebo group , P=0.01 ) . Platelet adhesion decreased from 4.9±1.1 % to 3.8±0.8 % ( P=0.04 ) in the dark chocolate group but remained unchanged in the control group . Conclusions — Dark chocolate  induces coronary vasodilation , improves coronary vascular function , and decreases platelet adhesion 2 hours after consumption . These immediate beneficial effects were paralleled by a significant reduction of serum oxidative stress and were positively correlated with changes in serum epicatechin concentration CONTEXT Regular intake of cocoa-containing foods is linked to lower cardiovascular mortality in observational studies . Short-term interventions of at most 2 weeks indicate that high doses of cocoa can improve endothelial function and reduce blood pressure ( BP ) due to the action of the cocoa polyphenols , but the clinical effect of low habitual cocoa intake on BP and the underlying BP-lowering mechanisms are unclear . OBJECTIVE To determine effects of low doses of polyphenol-rich dark chocolate on BP . DESIGN , SETTING , AND PARTICIPANTS R and omized , controlled , investigator-blinded , parallel-group trial involving 44 adults aged 56 through 73 years ( 24 women , 20 men ) with untreated upper-range prehypertension or stage 1 hypertension without concomitant risk factors . The trial was conducted at a primary care clinic in Germany between January 2005 and December 2006 . INTERVENTION Participants were r and omly assigned to receive for 18 weeks either 6.3 g ( 30 kcal ) per day of dark chocolate containing 30 mg of polyphenols or matching polyphenol-free white chocolate . MAIN OUTCOME MEASURES Primary outcome measure was the change in BP after 18 weeks . Secondary outcome measures were changes in plasma markers of vasodilative nitric oxide ( S-nitrosoglutathione ) and oxidative stress ( 8-isoprostane ) , and bioavailability of cocoa polyphenols . RESULTS From baseline to 18 weeks , dark chocolate intake reduced mean ( SD ) systolic BP by -2.9 ( 1.6 ) mm Hg ( P < .001 ) and diastolic BP by -1.9 ( 1.0 ) mm Hg ( P < .001 ) without changes in body weight , plasma levels of lipids , glucose , and 8-isoprostane . Hypertension prevalence declined from 86 % to 68 % . The BP decrease was accompanied by a sustained increase of S-nitrosoglutathione by 0.23 ( 0.12 ) nmol/L ( P < .001 ) , and a dark chocolate dose result ed in the appearance of cocoa phenols in plasma . White chocolate intake caused no changes in BP or plasma biomarkers . CONCLUSIONS Data in this relatively small sample of otherwise healthy individuals with above-optimal BP indicate that inclusion of small amounts of polyphenol-rich dark chocolate as part of a usual diet efficiently reduced BP and improved formation of vasodilative nitric oxide . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00421499 Previous studies with plant sterols ( PS ) and cocoa flavanols ( CF ) provide support for their dietary use in maintaining cardiovascular health . This double-blind , placebo-controlled , cross-over study evaluated the efficacy of daily consumption of a cocoa flavanol-containing dark chocolate bar with added PS on serum lipids , blood pressure , and other circulating cardiovascular health markers in a population with elevated serum cholesterol . We recruited 49 adults ( 32 women , 17 men ) with serum total cholesterol concentrations of 5.20 - 7.28 mmol/L and blood pressure of < or = 159/99 mm Hg . Following a 2-wk lead-in utilizing the AHA style diet , participants were r and omized into 2 groups and instructed to consume 2 cocoa flavanol-containing dark chocolate bars per day with ( 1.1 g sterol esters per bar ) or without PS . Each 419-kJ bar was nutrient-matched and contained approximately 180 mg CF . Participants consumed 1 bar 2 times per day for 4 wk then switched to the other bar for an additional 4 wk . Serum lipids and other cardiovascular markers were measured at baseline and after 4 and 8 wk . Blood pressure was measured every 2 wk . Regular consumption of the PS-containing chocolate bar result ed in reductions of 2.0 and 5.3 % in serum total and LDL cholesterol ( P < 0.05 ) , respectively . Consumption of CF also reduced systolic blood pressure at 8 wk ( -5.8 mm Hg ; P < 0.05 ) . Results indicate that regular consumption of chocolate bars containing PS and CF as part of a low-fat diet may support cardiovascular health by lowering cholesterol and improving blood pressure Abstract Aims Poor prognosis in chronic heart failure ( HF ) is linked to endothelial dysfunction for which there is no specific treatment currently available . Previous studies have shown reproducible improvements in endothelial function with cocoa flavanols , but the clinical benefit of this effect in chronic HF has yet to be determined . Therefore , the aim of this study was to assess the potential therapeutic value of a high dose of cocoa flavanols in patients with chronic HF , by using reductions in N‐terminal pro‐B‐type natriuretic peptide ( NT‐proBNP ) as an index of improved cardiac function . Methods and results Thirty‐two patients with chronic HF , stable on guideline ‐directed medical therapy , were r and omized to consume 50 g/day of high‐flavanol dark chocolate ( HFDC ; 1064 mg of flavanols/day ) or low‐flavanol dark chocolate ( LFDC ; 88 mg of flavanols/day ) for 4 weeks and then crossed over to consume the alternative dark chocolate for a further 4 weeks . Twenty‐four patients completed the study . After 4 weeks  of HFDC , NT‐proBNP ( mean decrease % ± st and ard deviation ) was significantly reduced compared with baseline ( −44 ± 69 % ) , LFDC ( −33 ± 72 % ) , and follow‐up ( −41 ± 77 % ) values . HFDC  also reduced diastolic blood pressure compared with values after LFDC ( −6.7 ± 10.1 mmHg ) . Conclusions Reductions in blood pressure and NT‐proBNP after HFDC  indicate decreased vascular resistance result ing in reduced left ventricular afterload . These effects warrant further investigation in patients with chronic HF Numerous studies indicate that polyphenol-rich chocolate reduces fasting blood glucose , blood pressure ( BP ) and total cholesterol in healthy individuals and hypertensives with or without glucose intolerance . The aim of the present study was to investigate the effect of two doses of polyphenol-rich dark chocolate ( DC ) on fasting capillary whole blood glucose , total cholesterol and BP and to examine whether improvements in these parameters are associated with changes in adrenocorticoid excretion in overweight and obese individuals . The study used a r and omised , single-blind , cross-over design where fourteen overweight and obese subjects were r and omised to either take 20 g DC with 500 mg polyphenols then 20 g DC with 1000 mg polyphenols or vice-versa . Participants followed each diet for 2 weeks separated by a 1-week washout period . It was observed that the 500 mg polyphenol dose was equally effective in reducing fasting blood glucose levels , systolic BP ( SBP ) and diastolic BP ( DBP ) as the 1000 mg polyphenol dose suggesting that a saturation effect might occur with increasing dose of polyphenols . There was also a trend towards a reduction in urinary free cortisone levels with both groups although it did not reach statistical significance . No changes in anthropometrical measurements were seen . We suggest that more research is required to investigate the mechanism(s ) by which polyphenol-rich foods influence health Background Dark chocolate ( DC ) is abundant in flavanols which have been reported to increase the bioavailability and bioactivity of nitric oxide ( NO ) . Increasing NO bioavailability has often demonstrated reduced oxygen cost and performance enhancement during submaximal exercise . Methods Nine moderately-trained male participants volunteered to undertake baseline ( BL ) measurements that comprised a cycle V.O2max$$ \overset{.}{V}{O}_{2 max } $ $ test followed by cycling at 80 % of their established gas exchange threshold ( GET ) for 20-min and then immediately followed by a two-minute time-trial ( TT ) . Using a r and omised crossover design participants performed two further trials , two weeks apart , with either 40 g of DC or white chocolate ( WC ) being consumed daily . Oxygen consumption , RER , heart rate and blood lactate ( BLa ) were measured during each trial . Results  DC consumption increased GET and TT performance compared to both BL and WC ( P < 0.05 ) .  DC consumption increased V.O2max$$ \overset{.}{V}{O}_{2 max } $ $ by 6 % compared to BL ( P < 0.05 ) , but did not reach statistical significance compared to WC . There were no differences in the moderate-intensity cycling for V.O2$$ \overset{.}{V}{O}_2 $ $ , RER , BLa and heart rate between conditions , although , V.O2$$ \overset{.}{V}{O}_2 $ $ and RER exhibited consistently lower trends following DC consumption compared to BL and WC , these did not reach statistical significance . Conclusion Chronic supplementation with DC result ed in a higher GET and enhanced TT performance . Consequently , ingestion of DC reduced the oxygen cost of moderate intensity exercise and may be an effective ergogenic aid for short- duration moderate intensity exercise BACKGROUND Numerous studies indicate that flavanols may exert significant vascular protection because of their antioxidant properties and increased nitric oxide bioavailability . In turn , nitric oxide bioavailability deeply influences insulin-stimulated glucose uptake and vascular tone . Thus , flavanols may also exert positive metabolic and pressor effects . OBJECTIVE The objective was to compare the effects of either dark or white chocolate bars on blood pressure and glucose and insulin responses to an oral-glucose-tolerance test in healthy subjects . DESIGN After a 7-d cocoa-free run-in phase , 15 healthy subjects were r and omly assigned to receive for 15 d either 100 g dark chocolate bars , which contained approximately 500 mg polyphenols , or 90 g white chocolate bars , which presumably contained no polyphenols . Successively , subjects entered a further cocoa-free washout phase of 7 d and then were crossed over to the other condition . Oral-glucose-tolerance tests were performed at the end of each period to calculate the homeostasis model assessment of insulin resistance ( HOMA-IR ) and the quantitative insulin sensitivity check index ( QUICKI ) ; blood pressure was measured daily . RESULTS HOMA-IR was significantly lower after dark than after white chocolate ingestion ( 0.94 + /- 0.42 compared with 1.72 + /- 0.62 ; P < 0.001 ) , and QUICKI was significantly higher after dark than after white chocolate ingestion ( 0.398 + /- 0.039 compared with 0356 + /- 0.023 ; P = 0.001 ) . Although within normal values , systolic blood pressure was lower after dark than after white chocolate ingestion ( 107.5 + /- 8.6 compared with 113.9 + /- 8.4 mm Hg ; P < 0.05 ) . CONCLUSION Dark , but not white , chocolate decreases blood pressure and improves insulin sensitivity in healthy persons Background Several studies have shown that cocoa and cocoa-containing foods have the potential to lower blood pressure and improve endothelial function . Most of the studies reporting the beneficial effects of dark chocolate on blood pressure have been short ( ≤ 4 weeks ) . The aim of the present 8-wks ( weeks ) study was to assess the effects of regular consumption of dark chocolate during a reduced snack consumption intervention on blood pressure and other cardiovascular risk factors in mildly hypertensive individuals . Design This was a r and omized , controlled , cross-over trial involving 22 adults ( 8 women , 14 men ) , aged 33–64 y , BMI 27.7 ± 3.7 kg/m2 with mild hypertension . During the intervention period ( 8-wks ) the participants reduced the intake of habitual snacks and replaced them with dark chocolate ( 49 g/day ) . In the control period , they only reduced the snacks without any added chocolate .  Data ( blood lipid profile , glucose , insulin , 24 h blood pressure ) was collected in the beginning and end of both periods ( intervention and control ) , and some variables also in the run-in and run-out periods ( weight , body fat percentage , blood pressure , arterial stiffness index , diet and physical activity ) . Results Daily consumption of dark chocolate had no effects on 24 h blood pressure , resting blood pressure ( mean ± SD , pre 142 ± 11.5/89 ± 8.4 mmHg vs. post 142 ± 14.2/88 ± 9.4 mmHg in systolic and diastolic blood pressure , respectively ) or arterial stiffness ( mean ± SD , pre 7.68 ± 0.88 vs. post 7.76 ± 0.89).Weight was reduced by 1.0 ± 2.2 kg during the control ( reduced snack only ) period , but was unchanged while eating chocolate ( p < 0.027 between the treatments ) . Conclusion The data collected in this study indicates that inclusion of dark chocolate daily in the diet had no significant effects on blood pressure or other cardiovascular risk factors during a reduced snack period . Trial registration Clinical Trials.gov identifier Introduction . The aim of this study was to assess the vascular benefits of dark chocolate in healthy and young individuals . Methods . A r and omized and controlled trial was carried out involving 60 healthy volunteers , r and omized into two groups :  control group ( CG ; n = 30 ) and  intervention group ( IG ; n = 30 ) . The IG ingested a daily dosage of 10 g of dark chocolate ( > 75 % cocoa ) for a month . Blood pressure ( BP ) , flow-mediated dilation ( FMD ) , arterial stiffness index ( ASI ) , aortic pulse wave velocity ( PWV ) , and pulse wave analysis ( PWA ) were assessed at baseline and one week after the one-month intervention period . Results . Arterial function improved after intervention in the IG , with PWV decreasing from 6.13 ± 0.41 m/s to 5.83 ± 0.53 m/s ( P = 0.02 ) , with no significant differences observed in the CG . A significant decrease in ASI ( 0.16 ± 0.01 to 0.13 ± 0.01 ; P < 0.001 ) and AiX ( −15.88 ± 10.75 to −22.57 ± 11.16 ; P = 0.07 ) was also depicted for the IG . Endothelial function improved in the IG , with the FMD increasing 9.31 % after the 1-month intervention ( P < 0.001 ) , with no significant variation in the CG . Conclusion . The daily ingestion of 10 g dark chocolate ( > 75 % cocoa ) during a month significantly improves vascular function in young and healthy individuals Flavonoids in cocoa and yerba mate have a beneficial role on inflammation and oxidative disorders . Their effect on HIV individuals has not been studied yet , despite the high cardiovascular risk of this population . This study investigated the role of cocoa and yerba mate consumption on oxidative and inflammatory biomarkers in HIV+ individuals . A cross-over , placebo-controlled , double-blind , r and omized clinical trial was conducted in 92 individuals on antiretroviral therapy for at least six months and at viral suppression . Participants were r and omized to receive either 65 g of chocolate or chocolate-placebo or 3 g of yerba mate or mate-placebo for 15 days each , alternating by a washout period of 15 days . At baseline , and at the end of each intervention regimen , data regarding anthropometry , inflammatory , oxidative and immunological parameters were collected . High-sensitivity C-reactive protein , fibrinogen , lipid profile , white blood cell profile and thiobarbituric acid reactive substances were assessed . There was a difference between mean concentrations of HDL-c ( ANOVA ; p ≤ 0.05 ) among the different regimens : dark chocolate , chocolate-placebo , yerba mate and mate-placebo . When a paired Student t-test was used for comparisons between mean HDL-c at baseline and after each regimen , the mean concentration of HDL-c was higher after supplementation with dark chocolate ( p = 0.008 ) Purpose Acute antioxidant supplementation may modulate oxidative stress and some immune perturbations that typically occur following prolonged exercise . The aims of the present study were to examine the effects of acutely consuming dark chocolate ( high polyphenol content ) on plasma antioxidant capacity , markers of oxidative stress and immunoendocrine responses to prolonged exercise . Methods Fourteen healthy men cycled for 2.5 h at ~60 % maximal oxygen uptake 2 h after consuming 100 g dark chocolate ( DC ) , an isomacronutrient control bar ( CC ) or neither ( BL ) in a r and omised-counterbalanced design . Results DC enhanced pre-exercise antioxidant status ( P = 0.003 ) and reduced by trend ( P = 0.088 ) 1 h post-exercise plasma free [ F2-isoprostane ] compared with CC ( also , [ F2-isoprostane ] increased post-exercise in CC and BL but not DC trials ) . Plasma insulin concentration was significantly higher pre-exercise ( P = 0.012 ) and 1 h post-exercise ( P = 0.026 ) in the DC compared with the CC trial . There was a better maintenance of plasma glucose concentration on the DC trial ( 2-way ANOVA trial × time interaction P = 0.001 ) , which decreased post-exercise in all trials but was significantly higher 1 h post-exercise ( P = 0.039 ) in the DC trial . There were no between trial differences in the temporal responses ( trial × time interactions all P > 0.05 ) of hypothalamic – pituitary – adrenal axis stress hormones , plasma interleukin-6 , the magnitude of leukocytosis and neutrophilia and changes in neutrophil function . Conclusion Acute DC consumption may affect insulin , glucose , antioxidant status and oxidative stress responses , but has minimal effects on immunoendocrine responses , to prolonged exercise Background Flavanol-rich chocolate and lycopene-rich tomato extract have attracted interest as potential alternative treatment options for hypertension , a known risk factor for cardiovascular morbidity and mortality . Treatment of prehypertension ( SBP 120–139/DBP 80–89 mmHg ) may forestall progression to hypertension . However , there has been only limited research into non-pharmacological treatment options for prehypertension . We investigated the effect of dark chocolate or tomato extract on blood pressure , and their acceptability as an ongoing treatment option in a prehypertensive population . Methods Our trial consisted of two phases : a r and omised controlled three-group-parallel trial over 12 weeks ( phase 1 ) followed by a crossover of the two active treatment arms over an additional 12-week period ( phase 2 ) . Group 1 received a 50 g daily dose of dark chocolate with 70 % cocoa containing 750 mg polyphenols , group 2 were allocated one tomato extract capsule containing 15 mg lycopene per day , and group 3 received one placebo capsule daily over 8 weeks followed by a 4-week washout period . In phase 2 the active treatment groups were crossed over to receive the alternative treatment . Median blood pressure , weight , and abdominal circumference were measured 4-weekly , and other characteristics including physical activity , general health , energy , mood , and acceptability of treatment were assessed by question naire at 0 , 8 and 20 weeks . We analysed changes over time using a linear mixed model , and one time point differences using Kruskal-Wallis , Fisher's-Exact , or t-tests . Results Thirty-six prehypertensive healthy adult volunteers completed the 6-month trial . Blood pressure changes over time within groups and between groups were not significant and independent of treatment . Weight and other characteristics did not change significantly during the trial . However , a marked difference in acceptability between the two treatment forms ( chocolate or capsule ) was revealed ( p < 0.0001 ) . Half of the participants allocated to the chocolate treatment found it hard to eat 50 g of dark chocolate every day and 20 % considered it an unacceptable long-term treatment option , whereas all participants found it easy and acceptable to take a capsule each day for blood pressure . Conclusion Our study did not find a blood pressure lowering effect of dark chocolate or tomato extract in a prehypertensive population . Practicability of chocolate as a long-term treatment option may be limited . Trial registration http://www.anzctr.org.au Identifier : Flavonoid-rich dark chocolate has positive effects on vascular function in healthy subjects and in patients at risk of atherosclerosis . The impact of dark chocolate on endothelial and microvascular function in patients with symptomatic peripheral artery disease ( PAD ) has not been investigated so far . In an investigator blinded , r and omized , controlled , cross-over trial we assessed the effect of flavonoid-rich dark chocolate and cocoa-free control chocolate on flow-mediated dilatation ( FMD ) of the brachial artery and on microvascular function ( assessed by Laser Doppler fluxmetry ) in 21 patients with symptomatic ( Fontaine stage II ) PAD . Measurements were done in each patient on 2 single days , with an interval of 7 days , at baseline and at 2 hours after ingestion of 50 g dark chocolate or 50 g white chocolate , respectively . FMD remained unchanged after intake of dark chocolate ( baseline and 2 hours after ingestion , % : 5.1 [ IQR 4.4 to 7.3 ] and 5.5 [ IQR 3.9 to 10.4 ] ; p = 0.57 , and after intake of white chocolate ( baseline and 2 hours after ingestion , % : 6.4 [ IQR 4.5 to 11.4 ] and 4.4 [ IQR 2.6 to 8.7 ] ; p = 0.14 . Similarly , microcirculatory parameters were not significantly altered after intake of any chocolate compared with the respective baseline values . In conclusion , a single consumption of 50 g dark chocolate has no effect on endothelial and microvascular function in patients with symptomatic PAD We evaluated the levels of  (-)-epicatechin ( EC )  and its metabolites in plasma and urine after intake of chocolate or cocoa by male volunteers . EC metabolites were analyzed by HPLC and LC/MS after glucuronidase and /or sulfatase treatment . The maximum levels of total EC metabolites in plasma were reached 2 hours after either chocolate or cocoa intake . Sulfate , glucuronide , and sulfoglucuronide ( mixture of sulfate and glucuronide ) conjugates of nonmethylated EC were the main metabolites present in plasma rather than methylated forms . Urinary excretion of total EC metabolites within 24 hours after chocolate or cocoa intake was 29.8 ± 5.3 % and 25.3 ± 8.1 % of total EC intake . EC in chocolate and cocoa was partly absorbed and was found to be present as a component of various conjugates in plasma , and these were rapidly excreted in urine Nitric oxide plays a pivotal role in regulating vascular tone . Different studies show endothelial function is impaired during hyperglycemia . Dark chocolate increases flow-mediated dilation in healthy and hypertensive subjects with and without glucose intolerance ; however , the effect of pretreatment with dark chocolate on endothelial function and other vascular responses to hyperglycemia has not been examined . Therefore , we aim ed to investigate the effects of flavanol-rich dark chocolate administration on ( 1 ) flow-mediated dilation and wave reflections ; ( 2 ) blood pressure , endothelin-1 and oxidative stress , before and after oral glucose tolerance test ( OGTT ) . Twelve healthy volunteers ( 5 males , 28.2±2.7 years ) r and omly received either 100 g/d dark chocolate or flavanol-free white chocolate for 3 days . After 7 days washout period , volunteers were switched to the other treatment . Flow-mediated dilation , stiffness index , reflection index , peak-to – peak time , blood pressure , endothelin-1 and 8-iso-PGF2&agr ; were evaluated after each treatment phase and OGTT . Compared with white chocolate , dark chocolate ingestion improved flow-mediated dilation ( P=0.03 ) , wave reflections , endothelin-1 and 8-iso-PGF2&agr ; ( P<0.05 ) . After white chocolate ingestion , flow-mediated dilation was reduced after OGTT from 7.88±0.68 to 6.07±0.76 ( P=0.027 ) , 6.74±0.51 ( P=0.046 ) at 1 and 2 h after the glucose load , respectively . Similarly , after white chocolate but not after dark chocolate , wave reflections , blood pressure , and endothelin-1 and 8-iso-PGF2&agr ; increased after OGTT . OGTT causes acute , transient impairment of endothelial function and oxidative stress , which is attenuated by flavanol-rich dark chocolate . These results suggest cocoa flavanols may contribute to vascular health by reducing the postpr and ial impairment of arterial function associated with the pathogenesis of atherosclerosis Background Chocolate is rich in flavonoids that have been shown to be of benefit in disparate conditions including cardiovascular disease and cancer . The effect of polyphenol rich chocolate in subjects with chronic fatigue syndrome ( CFS ) has not been studied previously . Methods We conducted a double blinded , r and omised , clinical pilot crossover study comparing high cocoa liquor/polyphenol rich chocolate ( HCL/PR ) in comparison to simulated iso-calorific chocolate ( cocoa liquor free/low polyphenols(CLF/LP ) ) on fatigue and residual function in subjects with chronic fatigue syndrome . Subjects with CFS having severe fatigue of at least 10 out of 11 on the Chalder Fatigue Scale were enrolled . Subjects had either 8 weeks of intervention in the form of HCL/PR or CLF/LP , with a 2 week wash out period followed by 8 weeks of intervention with the other chocolate . Results Ten subjects were enrolled in the study . The Chalder Fatigue Scale score improved significantly after 8 weeks of the HCL/PR chocolate arm [ median ( range ) Exact Sig . ( 2-tailed ) ] [ 33 ( 25 - 38 ) vs. 21.5 ( 6 - 35 ) 0.01 ] , but that deteriorated significantly when subjects were given simulated iso-calorific chocolate ( CLF/CP ) [ 28.5 ( 17 - 20 ) vs. 34.5 ( 13 - 26 ) 0.03 ] . The residual function , as assessed by the London H and icap scale , also improved significantly after the HCL/PR arm [ 0.49 ( 0.33 - 0.62 ) vs. 0.64 ( 0.44 - 0.83 ) 0.01 ] and deteriorated after iso-calorific chocolate [ 00.44 ( 0.43 - 0.68 ) vs. 0.36 ( 0.33 - 0.62)0.03 ] . Likewise the Hospital Anxiety and Depression score also improved after the HCL/PR arm , but deteriorated after CLF/CP . Mean weight remained unchanged throughout the trial . Conclusion This study suggests that HCL/PR chocolate may improve symptoms in subjects with chronic fatigue syndrome Background : Dark chocolate derived from the plant ( Theobroma cacao ) is a rich source of flavonoids . Cardioprotective effects including antioxidant properties , inhibition of platelet activity , and activation of endothelial nitric oxide synthase have been ascribed to the cocoa flavonoids . Objective : To investigate the effects of flavonoid-rich dark chocolate on endothelial function , measures of oxidative stress , blood lipids , and blood pressure in healthy adult subjects . Design : The study was a r and omized , double-blind , placebo-controlled design conducted over a 2 week period in 21 healthy adult subjects . Subjects were r and omly assigned to daily intake of high-flavonoid ( 213 mg procyanidins , 46 mg epicatechin ) or low-flavonoid dark chocolate bars ( 46 g , 1.6 oz ) . Results : High-flavonoid chocolate consumption improved endothelium-dependent flow-mediated dilation ( FMD ) of the brachial artery ( mean change = 1.3 ± 0.7 % ) as compared to low-flavonoid chocolate consumption ( mean change = −0.96 ± 0.5 % ) ( p = 0.024 ) . No significant differences were noted in the resistance to LDL oxidation , total antioxidant capacity , 8-isoprostanes , blood pressure , lipid parameters , body weight or body mass index ( BMI ) between the two groups . Plasma epicatechin concentrations were markedly increased at 2 weeks in the high-flavonoid group ( 204.4 ± 18.5 nmol/L , p ≤ 0.001 ) but not in the low-flavonoid group ( 17.5 ± 9 nmol/L , p = 0.99 ) . Conclusion : Flavonoid-rich dark chocolate  improves endothelial function and is associated with an increase in plasma epicatechin concentrations in healthy adults . No changes in oxidative stress measures , lipid profiles , blood pressure , body weight or BMI were seen Cephalic effects on appetite are mediated by vagal tone and altered gastrointestinal hormones . The objective of this study is to explore the relationship between appetite and levels of gastrointestinal hormones after smelling chocolate and after melt- and -swallow 30 g chocolate ( 1.059 oz , 85 % cocoa , 12.5 g of sugar per 100 g product ) . Twelve female residents ( BMI between 18 and 25 kg/m(2 ) ) all participated in two 60-minute study sessions . In the first session , all 12 women  ate chocolate ; for the second session , they were r and omized either to smell chocolate ( n=6 ) or to serve as a control ( no eating or smelling ; n=6 ) . At the start of the sessions , levels of insulin , glucagon-like peptide-1 ( GLP-1 ) and cholecystokinin ( CCK ) , but not glucose , correlated with appetite scored on a visual analogue scale ( VAS ) . In contrast , ghrelin levels correlated inversely with scored appetite . Chocolate eating and smelling both induced a similar appetite suppression with a disappearance of correlations between VAS scores and insulin , GLP-1 and CCK levels . However , while the correlation between VAS score and ghrelin disappeared completely after chocolate eating , it reversed after chocolate smelling , that is , olfactory stimulation with dark chocolate ( 85 % ) result ed in a satiation response that correlated inversely with ghrelin levels BACKGROUND Cocoa beans fresh from the tree are exceptionally rich in flavanols . Unfortunately , during conventional chocolate making , this high antioxidant capacity is greatly reduced due to manufacturing processes . AIM To evaluate the photoprotective potential of chocolate consumption , comparing a conventional dark chocolate to a specially produced chocolate with preserved high flavanol ( HF ) levels . METHODS A double-blind in vivo study in 30 healthy subjects was conducted . Fifteen subjects each were r and omly assigned to either a HF or low flavanol ( LF ) chocolate group and consumed a 20 g portion of their allocated chocolate daily . The minimal erythema dose ( MED ) was assessed at baseline and after 12 weeks under st and ardized conditions . RESULTS In the HF chocolate group the mean MED more than doubled after 12 weeks of chocolate consumption , while in the LF chocolate group , the MED remained without significant change . CONCLUSIONS Our study demonstrated that regular consumption of a chocolate rich in flavanols confers significant photoprotection and can thus be effective at protecting human skin from harmful UV effects . Conventional chocolate has no such effect BACKGROUND The aim was to examine the effects of high-cocoa polyphenol-rich chocolate on lipid profiles , weight , blood pressure , glycemic control , and inflammation in individuals with Type 2 diabetes and hypertension . METHODS Sixty individuals [ 32 in dark chocolate group ( DCG ) and 28 in white chocolate group ( WCG ) ] with Type 2 diabetes on stable medication were enrolled in a r and omized , placebo-controlled double-blind study . Subjects were r and omized to consume 25 g DCG or WCG for 8 weeks . Changes in weight , blood pressure , glycemic control , lipid profile , and high sensitive C-reactive protein ( hsCRP ) were measured at the beginning and end of the intervention . This clinical trial was registered at the Iranian registry of clinical trials . RESULTS In DCC group , compared with baseline , serum levels of Apo A-1 ( P = 0.045 ) was increased and fasting blood sugar ( FBS ) ( P = 0.027 ) , hemoglobin A1c ( HbA1c ) ( P = 0.025 ) , Apo B ( P = 0.012 ) and Log of hsCRP ( P = 0.043 ) levels were decreased at the end of study . No changes were seen within the WCG in studied parameters . High polyphenol chocolate consumption compared to white chocolate result ed in significant decrease in of systolic ( −5.93 ± 6.25 vs. −1.07 ± 7.97 mmHg , P = 0.004 ) and diastolic blood pressure ( −6.4 ± 6.25 vs. 0.17 ± 7.9 mmHg , P = 0.002 ) , FBS ( −7.84 ± 19.15 vs. 4.00 ± 20.58 mg/dl , P = 0.019 ) over the course of 8 weeks of daily chocolate consumption neither weight nor body mass index and TG levels altered from baseline . CONCLUSION High polyphenol chocolate is effective in improving TG levels in hypertensive patients with diabetes and decreasing blood pressure and FBS without affecting weight , inflammatory markers , insulin resistance or glycemic control BACKGROUND Legumes have reported benefits in terms of reduced risk for coronary heart disease and of colonic health . A novel legume fiber , cocoa bran , also may have favorable health effects on serum lipid levels , low-density lipoprotein ( LDL ) cholesterol oxidation , and fecal bulk . METHODS Twenty-five healthy normolipidemic subjects ( 13 men and 12 women ) ( mean + /- SEM age , 37 + /- 2 years ; mean + /- SEM body mass index [ calculated as weight in kilograms divided by the square of height in meters ] , 24.6 + /- 0.7 ) ate cocoa-bran and chocolate-flavored low-fiber breakfast cereals for 2-week periods , with 2-week washout , in a double-blind crossover study . The cocoa-bran cereal provided 25.0 g/d of total dietary fiber ( TDF ) . The low-fiber cereal ( 5.6 g/d TDF ) was of similar appearance and energy value . Fasting blood sample s were obtained at the start and end of each period , and 4-day fecal collection s were made from days 11 through 14 . RESULTS High-density lipoprotein ( HDL ) cholesterol level was higher ( 7.6 % + /- 2.9 % ; P = .02 ) and the LDL/HDL cholesterol ratio was lower ( 6.7 % + /- 2.3 % ; P = .007 ) for cocoa-bran compared with low-fiber cereal at 2 weeks . No effect was seen on LDL cholesterol oxidation . Mean fecal output was significantly higher for cocoa-bran than for low-fiber cereal ( 56 + /- 14 g/d ; P<.001 ) and equal to the increase seen in the same subjects with wheat fiber in a previous study . CONCLUSIONS A chocolate-flavored cocoa-bran cereal increased fecal bulk similarly to wheat bran and was associated with a reduction in the LDL/HDL cholesterol ratio . In view of the low-fat , high-fiber nature of the material , these results suggest a possible role for this novel fiber source in the diets of normal , hyperlipidemic , and constipated subjects CONTEXT Current research suggests that dark cocoa may reduce fatigue ; however , the effect on fatigue in people with MS ( pwMS ) has never been established . The objective of this feasibility study was to explore the acute effect of high flavonoid cocoa on measures of fatigue and glycaemic response . METHODS This was a r and omised crossover participant blind exploratory study in 12 participants ( 2 male and 10 female ) with MS-related fatigue ( > 4 on the Fatigue Severity Scale ; FSS ) . After fasting overnight , participants consumed the high flavonoid cocoa drink ( 350 mg gallic acid equivalents {GAE}/g ) or a low flavonoid cocoa control ( 120 mg GAE/g ) , consuming the alternative drink on the next visit . Fatigue was self-reported on a 100 mm visual analogue scale at 30-min time intervals for 2 h post cocoa consumption and every 2 h for the rest of the day . Fatigability was monitored using a 6 min walk test ( 6MWT ) at the end of the visit ( 2 h ) , and activity monitors worn for 24 h commencing at 12 noon on the day of testing . The feasibility of performing the trial including outcome measures was documented . RESULTS A moderate effect was found in self-reported fatigue throughout the day in favour of the high flavonoid group ( Cohen 's d 0.32 , 95 % non- central t CI -0.57 to 1.20 ) . Fatigability measures did not change . Participants consumed and enjoyed the cocoa , all participants completed the study and outcome measures were accepted . CONCLUSION The results of this study support further trials to investigate the feasibility and efficacy of pure cocoa as a dietary supplement for fatigue in pwMS This is the first experimental study directed at differentiating between physiological or sensory accounts of the satiation of nondrug cravings , using  chocolate craving , the most common craving in North America . At the onset of craving ,  chocolate cravers consumed a chocolate bar , the caloric equivalent in " white chocolate " ( containing none of the pharmacological components of chocolate ) , the pharmacological equivalent in cocoa capsules , placebo , and no treatment conditions had virtually no effect . White chocolate produced partial abatement , unchanged by the addition of all the pharmacological factors in cocoa . This result indicates no role for pharmacological effects in the satisfaction of chocolate craving . It also suggests a role for aroma independent of sweetness , texture , and calories Cocoa flavanols ( CF ) influence physiological processes in ways that suggest their consumption may improve aspects of neural function , and previous studies have found positive influences of CF on cognitive performance . In this preliminary study we investigated whether visual , as well as cognitive , function is influenced by an acute dose of CF in young adults . We employed a r and omized , single-blinded , order counterbalanced , crossover design in which 30 healthy adults consumed both dark chocolate containing 720 mg CF and a matched quantity of white chocolate , with a one week interval between testing sessions . Visual contrast sensitivity was assessed by reading numbers that became progressively more similar in luminance to their background . Motion sensitivity was assessed firstly by measuring the threshold proportion of coherently moving signal dots that could be detected against a background of r and om motion , and secondly by determining the minimum time required to detect motion direction in a display containing a high proportion of coherent motion . Cognitive performance was assessed using a visual spatial working memory for location task and a choice reaction time task design ed to engage processes of sustained attention and inhibition . Relative to the control condition , CF improved visual contrast sensitivity and reduced the time required to detect motion direction , but had no statistically reliable effect on the minimum proportion of coherent motion that could be detected . In terms of cognitive performance , CF improved spatial memory and performance on some aspects of the choice reaction time task . As well as extending the range of cognitive tasks that are known to be influenced by CF consumption , this is the first report of acute effects of CF on the efficiency of visual function . These acute effects can be explained by increased cerebral blood flow caused by CF , although in the case of contrast sensitivity there may be an additional contribution from CF induced retinal blood flow changes Objective : This trial was undertaken to evaluate the effects of high-cocoa-content chocolate supplementation in pregnancy on several haematochemical and clinical parameters . The study had as reference population the pregnant women requesting an obstetric control at Outpatient Clinic of Obstetrics and Gynaecology of the S. Maria della Misericordia University Hospital , Perugia , Italy . C and i date s who participated in this study were all Caucasian women aged 18–40 years , who had a single gestation pregnancy between 11th + 0 and 13th + 0 week gestational age . Methods : We conducted a single-center r and omized controlled trial . The pregnant women selected were r and omized into Group A , which received daily doses of 30 g of chocolate ( 70 % cocoa ) , and Group B , which was free to increase their diet with other foods . Results : Ninety women were r and omized . Significant difference was found between the two groups for diastolic blood pressure ( p = 0.05 ) , systolic ( p < 0.0001 ) and levels of liver enzymes , with values lower in Group A than in Group B. Total cholesterol levels and weight gain in Group A did not increase more than in Group B. Conclusions : A modest daily intake of high-cocoa-content chocolate contributes to reduce blood pressure , glycemic and liver pattern during pregnancy without affecting the weight gain BACKGROUND AND AIMS Epidemiological studies have demonstrated an association between high-polyphenol intake and reduced incidence of atherosclerosis . The healthy effects of cocoa-polyphenols may be due to their antioxidant and anti-inflammatory actions , although the exact mechanisms are unknown and depend on the matrix in which cocoa-polyphenols are delivered . Nuclear factor κB ( NF-κB ) is a key molecule in the pathophysiology of atherosclerosis involved in the regulation of adhesion molecules(AM ) and cytokine expression and its activation is the first step in triggering the inflammatory process . The aim of this study was to evaluate the effect of acute cocoa consumption in different matrices related to the bioavailability of cocoa-polyphenols in NF-κB activation and the expression of AM . METHODS AND RESULTS Eighteen healthy volunteers r and omly received 3 interventions : 40 g of cocoa powder with milk ( CM ) , with water ( CW ) , and only milk ( M ) . NF-κB activation in leukocytes and AM ( sICAM , sVCAM , E-selectin ) were measured before and 6h after each intervention . Consumption of CW significantly decreased NF-κB activation compared to baseline and to CM ( P < 0.05 , both ) , did not change after CM intervention , and significantly increased after M intervention ( P = 0.014 ) . sICAM-1 concentrations significantly decreased after 6h of CW and CM interventions ( P ≤ 0.026 ; both ) and E-selectin only decreased after CW intervention ( P = 0.028 ) . No significant changes were observed in sVCAM-1 concentrations . CONCLUSIONS The anti-inflammatory effect of cocoa intake may depend on the bioavailability of bioactive compounds and may be mediated at least in part by the modulation of NF-κB activation and downstream molecules reinforcing the link between cocoa intake and health Reduced-calorie diets are difficult to follow because they often require elimination of certain foods , leading to poor compliance and limited success . However , a low-calorie , nutrient-dense diet has the potential to accommo date a daily snack without exceeding energy requirements , even during weight loss . This pilot study evaluated the effects of a reduced-calorie diet including either a daily dark chocolate snack or a non-chocolate snack on anthropometric and body composition measurements . In a r and omized clinical trial , 26 overweight and obese ( body mass index ≥25 to ≤43 ) premenopausal women were assigned to a reduced-calorie diet that included either a daily dark chocolate snack or non-chocolate snack ( n=13 per group ) for 18 weeks . At baseline and end of study , body weight and waist and hip circumferences were measured along with fat mass , lean mass , and body fat percentage by dual-energy x-ray absorptiometry . Energy and macronutrient intakes were estimated from 4-day food records . Within- and between-group changes from baseline were analyzed using paired t tests and independent t tests , respectively . Women in both snack groups reduced estimated daily energy intake ( P<0.001 ) . Women in both the dark chocolate snack and non-chocolate snack groups , respectively , experienced decreases ( P<0.001 ) in body weight ( -5.1 vs -5.1 kg ) , hip circumference ( -5.8 vs -5.4 cm ) , waist circumference ( -5.7 vs -3.5 cm ) , fat mass ( -3.9 vs -3.6 kg ) , and body fat percentage ( -3.4 % vs -3.1 % ) , with no change in lean mass . Improvements in anthropometric and body composition measurements among overweight and obese premenopausal women can be achieved with a reduced-calorie diet including either a daily dark chocolate snack or non-chocolate snack BACKGROUND AND AIMS Cocoa flavanols are recognised by their favourable antioxidant and vascular effects . This study investigates the influence on health of the daily consumption of ready-to-eat meals supplemented with cocoa extract within a hypocaloric diet , on middle-aged overweight/obese subjects . METHODS AND RESULTS Fifty healthy male and female middle-aged volunteers [ 57.26 ± 5.24 years and body mass index ( BMI ) 30.59 ± 2.33 kg/m(2 ) ] were recruited to participate in a 4 week r and omised , parallel and double-blind study . After following 3 days on a low-polyphenol diet , 25 volunteers received meals supplemented with 1.4 g of cocoa extract ( 645.3 mg of polyphenols ) and the other 25 participants received control meals , within a 15 % energy restriction diet . On the 4th week of intervention individuals in both dietary groups improved ( p < 0.05 ) anthropometric , body composition , blood pressure and blood biochemical measurements . Oxidised LDL cholesterol ( oxLDL ) , showed a higher reduction ( p = 0.030 ) in the cocoa group . Moreover , myeloperoxidase ( MPO ) levels decreased only in the cocoa supplemented group ( p = 0.007 ) . Intercellular Adhesion Molecule-1 ( sICAM-1 ) decreased significantly in both groups , while Vascular Cell Adhesion Molecule-1 ( sVCAM-1 ) did not present differences after the 4 weeks of intervention . Interestingly , cocoa intake showed a different effect by gender , presenting more beneficial effects in men . CONCLUSIONS The consumption of cocoa extract as part of ready-to-eat meals and within a hypocaloric diet improved oxidative status ( oxLDL ) in middle-aged subjects , being most remarkable in males . REGISTRATION NUMBER Registered at www . clinical trials.gov ( NCT01596309 ) In a r and omized , double-blind placebo controlled trial , 63 middle-aged volunteers aged between 40 and 65 years were administered a daily chocolate drink containing 250 mg or 500 mg cocoa flavanols versus a low cocoa flavanol ( placebo ) drink over a 30-day period . Participants were tested at baseline as well as at the end of the treatment period on a test of Spatial Working Memory . Steady State Probe Topography ( SST ) was used to assess neurocognitive changes associated with cocoa flavanol supplementation during the completion of the Spatial Working Memory task . SST is an electrophysiological technique which utilizes a 13 Hz diffuse visual flicker in order to generate a steady state visually evoked potential ( SSVEP ) . Changes in the amplitude and phase of the SSVEP response after 30 days were compared between treatment groups . Behavioral measures of accuracy and reaction time were not found to be significantly different between treatment groups , while average SSVEP amplitude and phase differences at a number of posterior parietal and centro-frontal sites were found to be significantly different between groups during memory encoding , the working memory hold period and retrieval . In the absence of significant behavioral effects , these differences in brain activation can be interpreted as evidence of increased neural efficiency in spatial working memory function associated with chronic cocoa flavanol consumption Dietary flavanols have been associated with reduced oxidative stress , however their efficacy in promoting recovery after exercise induced muscle damage is unclear . This study examined the effectiveness of acute consumption of cocoa-flavanols on indices of muscle recovery including : subsequent exercise performance , creatine kinase , muscle tenderness , force , and self-perceived muscle soreness .  Eight endurance-trained athletes ( VO2max 64.4 ± 7.6 mL/kg/min ) completed a downhill running protocol to induce muscle soreness , and 48-h later completed a 5-K ( kilometer ) time trial . Muscle recovery measurements were taken at PRE , 24 h-POST , 48 h-POST , and POST-5 K . Participants consumed 1.0 g of carbohydrate per kilogram of body weight of a r and omly assigned beverage ( CHOC : 0 mg flavanols vs. CocoaCHOC : 350 mg flavanols per serving ) immediately after the downhill run and again 2 h later . The same protocol was repeated three weeks later with the other beverage . An ANOVA revealed no significant difference ( p = 0.97 ) between trials for 5 K completion time  ( CHOC 1198.3 ± 160.6 s , CocoaCHOC 1195.5 ± 148.8 s ) . No significant difference was found for creatine kinase ( CK ) levels ( p = 0.31 ) , or muscle soreness ( p = 0.21 ) between groups over time . These findings suggest that the acute addition of cocoa flavanols to low-fat chocolate milk offer no additional recovery benefits To assess whether antioxidant , anti-inflammatory and other cardio-protective effects attributed to cocoa are achieved when regularly consuming moderate amounts of a flavanol-rich soluble cocoa product , a non-r and omized , controlled , crossover , free-living study was carried out in healthy ( n = 24 ; 25.9 ± 5.6 years ) and moderately hypercholesterolemic ( 200 - 240 mg dL(-1 ) ; n = 20 ; 30.0 ± 10.3 years ) volunteers . Participants consumed two servings per day ( 7.5 g per serving ) of a soluble cocoa product ( providing 45.3 mg flavanols per day ) in milk , which was compared with consuming only milk during a 4 week period . The effects on systolic and diastolic blood pressure and heart rate were determined , as well as on serum lipid and lipoprotein profiles , interleukins (IL)-1β , IL-6 , IL-8 , IL-10 , tumor necrosis factor-α ( TNF-α ) , monocyte chemoattractant protein-1 ( MCP-1 ) , vascular ( VCAM-1 ) and intercellular cell adhesion molecules ( ICAM-1 ) , serum malondialdehyde ( MDA ) , carbonyl groups ( CG ) , ferric reducing/antioxidant power ( FRAP ) , oxygen radical absorbance capacity ( ORAC ) , and free radical scavenging capacity ( ABTS ) . During the study , the volunteers ' diets and physical activity were also evaluated , as well as any changes in weight , skin folds , circumferences and related anthropometric parameters . Cocoa and certain polyphenol-rich fruits and vegetables and their derivatives were restricted . After consuming the cocoa product positive effects were observed such as an increase in serum HDL-C ( p < 0.001 ) and dietary fiber intake ( p = 0.050 ) , whereas IL-10 decreased ( p = 0.022 ) . Other cardiovascular-related biomarkers and anthropometric parameters were unaffected . We have therefore concluded that regular consumption of this cocoa product in a Spanish-Mediterranean diet may protect against cardiovascular disease in healthy and hypercholesterolemic subjects without producing any weight gain or other anthropometric changes Background Consumption of chocolate has been often hypothesized to reduce the risk of cardiovascular disease ( CVD ) due to chocolate 's high levels of stearic acid and antioxidant flavonoids . However , debate still lingers regarding the true long term beneficial cardiovascular effects of chocolate overall . Methods We review ed English- language MEDLINE publications from 1966 through January 2005 for experimental , observational , and clinical studies of relations between cocoa , cacao , chocolate , stearic acid , flavonoids ( including flavonols , flavanols , catechins , epicatechins , and procynadins ) and the risk of cardiovascular disease ( coronary heart disease ( CHD ) , stroke ) . A total of 136 publications were selected based on relevance , and quality of design and methods . An up date d meta- analysis of flavonoid intake and CHD mortality was also conducted . Results The body of short-term r and omized feeding trials suggests cocoa and chocolate may exert beneficial effects on cardiovascular risk via effects on lowering blood pressure , anti-inflammation , anti-platelet function , higher HDL , decreased LDL oxidation . Additionally , a large body of trials of stearic acid suggests it is indeed cholesterol-neutral . However , epidemiologic studies of serum and dietary stearic acid are inconclusive due to many method ologic limitations . Meanwhile , the large body of prospect i ve studies of flavonoids suggests the flavonoid content of chocolate may reduce risk of cardiovascular mortality . Our up date d meta- analysis indicates that intake of flavonoids may lower risk of CHD mortality , RR = 0.81 ( 95 % CI : 0.71–0.92 ) comparing highest and lowest tertiles . Conclusion Multiple lines of evidence from laboratory experiments and r and omized trials suggest stearic acid may be neutral , while flavonoids are likely protective against CHD mortality . The highest priority now is to conduct larger r and omized trials to definitively investigate the impact of chocolate consumption on long-term cardiovascular outcomes The present studies were conducted to evaluate the cholesterolemic effects of whole-food diets high in stearic acid . In study no. 1 , normocholesterolemic young men were fed diets high in stearic acid provided by cocoa butter ( CB ) ; oleic acid provided by olive oil ( OO ) ; linoleic acid provided by soybean oil ( SO ) ; and myristic acid ( and lauric acid ) provided by dairy butter ( B ) . In study no. 2 , different subjects with similar baseline characteristics were fed diets high in stearic acid provided by milk chocolate ( C ) , CB , CB+B ( 4:1 , MIX ) , and myristic ( and lauric ) acid provided by B. Both studies used a r and omized , crossover , double-blind experimental design , and experimental subjects ( n = 18 for study no. 1 and n = 15 for study no. 2 ) in each study consumed every diet for 26 days with a 1-month wash-out period between each experimental period . The diets provided 37 % of calories from fat , of which 81 % was provided by the test fat . Ten ounces ( 280 g ) C was provided daily by the C diet . In study no. 1 , the B diet was hypercholesterolemic , whereas the SO diet was hypocholesterolemic , compared with the other diets . The OO and SO diets were hypocholesterolemic compared with the CB diet . Low-density lipoprotein ( LDL ) cholesterol levels , in general , paralleled the changes in plasma total cholesterol levels . SO significantly decreased apolipoprotein ( apo ) B levels compared with the other diets . Plasma very-low density lipoprotein ( VLDL ) cholesterol , high-density lipoprotein ( HDL ) cholesterol , and apo A-I levels were unaffected by the experimental diets . ( ABSTRACT TRUNCATED AT 250 WORDS Evidence suggests that flavonoid-containing diets reduce cardiovascular risk , but the mechanisms responsible are unclear . In the present study , we sought to determine the effect of flavanol-rich cocoa on vascular function in individuals with CAD ( coronary artery disease ) . Forty subjects ( 61+/-8 years ; 30 male ) with CAD were recruited to a 6-week r and omized double-blind placebo-controlled study . Subjects consumed either a flavanol-rich chocolate bar and cocoa beverage daily ( total flavanols , 444 mg/day ) or matching isocaloric placebos daily ( total flavanols , 19.6 mg/day ) for 6 weeks . Brachial artery FMD ( flow-mediated dilation ) and SAC ( systemic arterial compliance ) were assessed at baseline , 90 min following the first beverage and after 3 and 6 weeks of daily consumption . Soluble cellular adhesion molecules and FBF ( forearm blood flow ) responses to ACh ( acetylcholine chloride ; 3 - 30 microg/min ) and SNP ( sodium nitroprusside ; 0.3 - 3 microg/min ) infusions , forearm ischaemia and isotonic forearm exercise were assessed at baseline and after 6 weeks . FMD , SAC and FBF responses did not differ between groups at baseline . No acute or chronic changes in FMD or SAC were seen in either group . No difference in soluble cellular adhesion molecules , FBF responses to ischaemia , exercise , SNP or ACh was seen in the group receiving flavanol-rich cocoa between baseline and 6 weeks . These data suggest that over a 6-week period , flavanol-rich cocoa does not modify vascular function in patients with established CAD Background : Sleep deprivation is a risk factor for cardiovascular disease . Cocoa flavonoids exert cardiovascular benefits and neuroprotection . Whether chocolate consumption may mitigate detrimental effects of sleep loss on cognitive performance and cardiovascular parameters has never been studied . Aim : We investigated the effects of flavanol-rich chocolate consumption on cognitive skills and cardiovascular parameters after sleep deprivation . Methods : Thirty-two healthy participants underwent two baseline sessions after one night of undisturbed sleep and two experimental sessions after one night of total sleep deprivation . Two hours before each testing session , participants were r and omly assigned to consume high or poor flavanol chocolate bars . During the tests were evaluated , the Psychomotor Vigilance Task and a working memory task , office SBP and DBP , flow-mediated dilation and pulse-wave velocity . Results : Sleep deprivation increased SBP/DBP . SBP/DBP and pulse pressure were lower after flavanol-rich treatment respect to flavanol-poor treatment ( SBP : 116.9 ± 1.6 vs. 120.8 ± 1.9 mmHg , respectively , P = 0.00005 ; DBP : 70.5 ± 1.2 vs. 72.3 ± 1.2 mmHg , respectively , P = 0.01 ; pulse pressure : 46.4 ± 1.3 vs. 48.4 ± 1.5 mmHg , P = 0.004 ) . Sleep deprivation impaired flow-mediated dilation ( 5.5 ± 0.5 vs. 6.5 ± 0.6 % , P = 0.02 ) , flavanol-rich , but not flavanol-poor chocolate counteracted this alteration ( flavanol-rich/flavanol-poor chocolate : 7.0 ± 0.6 vs. 5.0 ± 0.4 % , P = 0.000001 ) . Flavanol-rich chocolate mitigated the pulse-wave velocity increase ( P = 0.001 ) . Flavanol-rich chocolate preserved working memory accuracy in women after sleep deprivation . Flow-mediated dilation correlated with working memory performance accuracy in the sleep condition ( P = 0.04 ) . Conclusion : Flavanol-rich chocolate counteracted vascular impairment after sleep deprivation and restored working memory performance . Improvement in cognitive performance could be because of the effects of cocoa flavonoids on blood pressure and peripheral and central blood flow AIMS Flavanol-rich chocolate ( FRC ) is beneficial for vascular and platelet function by increasing nitric oxide bioavailability and decreasing oxidative stress . Congestive heart failure ( CHF ) is characterized by impaired endothelial and increased platelet reactivity . As statins are ineffective in CHF , alternative therapies are a clinical need . We therefore investigated whether FRC might improve cardiovascular function in patients with CHF . METHODS AND RESULTS Twenty patients with CHF were enrolled in a double-blind , r and omized placebo-controlled trial , comparing the effect of commercially available FRC with cocoa-liquor-free control chocolate ( CC ) on endothelial and platelet function in the short term ( 2 h after ingestion of a chocolate bar ) and long term ( 4 weeks , two chocolate bars/day ) . Endothelial function was assessed non-invasively by flow-mediated vasodilatation of the brachial artery . Flow-mediated vasodilatation significantly improved from 4.98 ± 1.95 to 5.98 ± 2.32 % ( P = 0.045 and 0.02 for between-group changes ) 2h after intake of FRC to 6.86 ± 1.76 % after 4 weeks of daily intake ( P = 0.03 and 0.004 for between groups ) . No effect on endothelial-independent vasodilatation was observed . Platelet adhesion significantly decreased from 3.9 ± 1.3 to 3.0 ± 1.3 % ( P = 0.03 and 0.05 for between groups ) 2 h after FRC , an effect that was not sustained at 2 and 4 weeks . Cocoa-liquor-free CC had no effect , either on endothelial function or on platelet function . Blood pressure and heart rate did not change in either group . CONCLUSION Flavanol-rich chocolate acutely improves vascular function in patients with CHF . A sustained effect was seen after daily consumption over a 4-week period , even after 12 h abstinence . These beneficial effects were paralleled by an inhibition of platelet function in the presence of FRC only BACKGROUND Flavonoids may be partly responsible for some health benefits , including antiinflammatory action and a decreased tendency for the blood to clot . An acute dose of flavanols and oligomeric procyanidins from cocoa powder inhibits platelet activation and function over 6 h in humans . OBJECTIVE This study sought to evaluate whether 28 d of supplementation with cocoa flavanols and related procyanidin oligomers would modulate human platelet reactivity and primary hemostasis and reduce oxidative markers in vivo . DESIGN Thirty-two healthy subjects were assigned to consume active ( 234 mg cocoa flavanols and procyanidins/d ) or placebo ( < or = 6 mg cocoa flavanols and procyanidins/d ) tablets in a blinded parallel- design ed study . Platelet function was determined by measuring platelet aggregation , ATP release , and expression of activation-dependent platelet antigens by using flow cytometry . Plasma was analyzed for oxidation markers and antioxidant status . RESULTS Plasma concentrations of epicatechin and catechin in the active group increased by 81 % and 28 % , respectively , during the intervention period . The active group had significantly lower P selectin expression and significantly lower ADP-induced aggregation and collagen-induced aggregation than did the placebo group . Plasma ascorbic acid concentrations were significantly higher in the active than in the placebo group ( P < 0.05 ) , whereas plasma oxidation markers and antioxidant status did not change in either group . CONCLUSIONS Cocoa flavanol and procyanidin supplementation for 28 d significantly increased plasma epicatechin and catechin concentrations and significantly decreased platelet function . These data support the results of acute studies that used higher doses of cocoa flavanols and procyanidins
Conclusion : Cocoa/DC supplementation does not reduce anthropometric measures significantly .
However subgroup analysis regarding dose ( ≥ 30 g/day ) and duration ( between 4 to 8 weeks ) revealed significant reduction of body weight and BMI
ABSTRACT Background : Cocoa and dark chocolate ( DC ) have been reported to be effective for health promotion ; however the exact effect of cocoa/DC on anthropometric measures have not been yet defined .