Eat More Chocolate?

Protecting your heart may be as simple as consuming more chocolate, a meta-analysis published in the British Medical Journal seems to conclude, and may be the answer to our worldwide epidemic of metabolic syndrome, diabetes and resulting cardiovascular disease.  But not so fast.  As Rick and I discuss in this week's podcast, there's a lot more digging to be done with this data before we debate the relative merits of Hershey's versus Cadbury versus Ritter.

First of all, meta-analyses are somewhat suspect just by themselves.  I always think of them as like V-8 juice, where many vegetables are blended together but then a conclusion about carrots alone or beets alone is attempted:  not easy to do.  Similarly, this study considered seven studies together, in total comprising some 115,000 subjects.  None of the studies was the gold standard of research: prospective, double blinded, placebo controlled, randomized.  Of course those would be difficult criteria to meet with regard to eating chocolate.  Even so, these were cohort and cross sectional studies, a much lower investigational bar. 

The authors themselves reveal that large variations in measurement of chocolate consumption, methods and outcomes exist between the studies.  Yet the data were analyzed in toto and revealed a 37% reduction in the risk of cardiometabolic disorders and a 29% decreased risk of stroke among those in the group who consumed the most chocolate!  Wow!  This compares favorably with statin medications!  Should we all switch to the gratifying activity of eating chocolate rather than taking a statin?  Not based on this study, Rick and I agree.

Among our many issues with this study include the fact that no characterization of which type of chocolate supposedly conferred this huge benefit was identified.  As many previous studies have established, the heart-healthy variety of chocolate appears to be dark, judiciously consumed and lower in fat and sugar when compared to its cousins, milk and white chocolate.  Research from Johns Hopkins has shown that chocolate consumption seems to result in an antiplatelet effect so that blood doesn't clot as readily, something we can reliably reproduce with aspirin and other medications.  As yet, the optimal dose response for chocolate doesn't seem to have been determined.

Lest we appear as wet blankets on the chocolate party, Rick and I concur that like red wine, olive oil and other foods with purported health benefits, for now the best course seems to be moderation, moderation, moderation.  If you're a chocolate lover, by all means eat some.  Should you force yourself to eat the dark variety if you really love milk chocolate, as I do?  Hmmmm.  Don't know, but I'm sticking with what I like.  I find many of the super dark chocolates just about unpalatable.    Finally, if you are already taking medications such as a statin, aspirin or another anti-clotting agent, don't sub in chocolate and give up on your drugs without discussing such a strategy with your primary care doc. 

Other topics this week include two CPR update studies from NEJM, a new anticoagulant medication for folks who have atrial fibrillation in the same journal, and a long term follow up on tamoxifen for women with breast cancer in the Lancet.  Until next week, y'all live well.

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Dean September 7, 2011 at 6:49 pm

It's not about chocolate, it's about dark chocolate. It's not about eating more chocolate. The "more" in this study was still a modest amount. As with almost all good things, too much is bad for you. The authors are correct, moderation is key.


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