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Chocolate Is Finally Put to the Test

Botanically speaking, seeds are small embryonic plants—the whole plant stuffed into a tiny seed and surrounded by an outer layer packed with vitamins, minerals, and phytochemicals to protect the seedling plant’s DNA from free radicals. No wonder they’re so healthy. By seeds, using the formal definition, we’re talking all whole grains; grains are seeds—you plant them and they grow. Nuts are just dry fruits with one or two seeds. Legumes (beans, peas, and lentils) are seeds, too, as are cocoa and coffee beans. So, finding health-promoting effects in something like cocoa or coffee should not be all that surprising. There is substantial evidence that increased consumption of all these little plants is associated with lower risk of cardiovascular disease.

Of course, much of chocolate research is just on how to get consumers to eat more. While it didn’t seem to matter what kind of music people were listening to when it came to the flavor intensity, pleasantness, or texture of a bell pepper, people liked chocolate more when listening to jazz than classical, rock, or hip hop. Why is this important? So food industries can “integrate specific musical stimuli” in order to maximize their profits. For example, purveyors may play jazz in the background to increase consumers’ acceptance of their chocolates. Along these lines, another study demonstrated that people rated the oyster eaten “more pleasant in the presence of the ‘sound of the sea’ than in the presence of ‘farmyard noises.’”

You’d think chocolate would just sell itself, given that it’s considered the most commonly craved food in the world. The same degree of interest doesn’t seem to exist as to whether or not Brussels sprouts might provide similar cardiovascular protection. So, it’s understandable to hope chocolate provides health benefits. Meanwhile, despite their known benefits, Brussels sprouts don’t get the love they deserve.

One of the potential downsides of chocolate is weight gain, which is the subject of my Does Chocolate Cause Weight Gain? video. Though cocoa hardly has any calories, chocolate is one of the most calorie-dense foods. For example: A hundred calories of chocolate is less than a quarter of a bar, compared to a hundred calories of strawberries, which is more than two cups..

A few years ago, a study funded by the National Confectioners Association—an organization that, among other things, runs the website—reported that Americans who eat chocolate weigh, on average, four pounds less than those who don’t. But maybe chocolate-eaters exercise more or eat more fruits and vegetables. The researchers didn’t control for any of that.

The findings of a more recent study published in the Archives of Internal Medicine were less easy to dismiss and there were no apparent ties to Big Chocolate. The researchers reported that out of a thousand men and women they studied in San Diego, those who frequently consumed chocolate had a lower BMI—actually weighed less—than those who ate chocolate less often. And, this was even after adjusting for physical activity and diet quality. But, it was a cross-sectional study, meaning a snapshot in time; so, you can’t prove cause and effect. Maybe not eating chocolate leads to being fatter, or maybe being fatter leads to not eating chocolate. Maybe people who are overweight are trying to cut down on sweets. What we need is a study in which people are followed over time.

There was no such prospective study, until now. More than 10,000 people were followed for six years, and a chocolate habit was associated with long-term weight gain in a dose-response manner. This means the greatest weight gain over time was seen in those with the highest frequency of chocolate intake. It appears the reason the cross-sectional studies found the opposite is that subjects diagnosed with obesity-related illnesses tended to reduce their intake of things like chocolate in an attempt to improve their prognosis. This explains why heavier people may, on average, eat less chocolate.

To bolster this finding came the strongest type of evidence—an interventional trial—in which you split people up into two groups and change half their diets. Indeed, adding four squares of chocolate to peoples’ daily diets does appear to add a few pounds.

So, what do we tell our patients? In 2013, researchers wrote in the American Family Physician journal that “because many cocoa products are high in sugar and saturated fat, family physicians should refrain from recommending cocoa….” That’s a little patronizing, though. You can get the benefits of chocolate without any sugar or fat by adding cocoa powder to a smoothie, for example. Too often, doctors think patients can’t handle the truth. Case in point: If your patients inquire, one medical journal editorial suggests, ask them what type of chocolate they prefer. If they respond with milk chocolate, then it is best to answer that it is not good for them. If the answer is dark chocolate, then you can lay out the evidence.

Even better than dark chocolate would be cocoa powder, which contains the phytonutrients without the saturated fat. I’ve happily (and deliciously) created other videos on cocoa and chocolate; so, check out Update on Chocolate, Healthiest Chocolate Fix, A Treatment for Chronic Fatigue Syndrome, and Dark Chocolate and Artery Function. 

Whether with Big Candy, Big Chocolate, or some other player, you always have to be careful about conflict of interest. For more information, watch my Food Industry Funded Research Bias video.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

68 responses to “Chocolate Is Finally Put to the Test

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  1. I used to include cocoa powder in my smoothies but stopped doing that based on a video I saw from Doctor Gregor (at least if I remember correctly I think it was on…I don’t see it cited above) mentioning the high cadmium content in many cocoa products so as a result (similar to the concerns raised with arsenic in rice) I’ve been restricting my consumption of cocoa powder.

      1. If you look at the nutrition label on that site carefully you can see that their math doesn’t add up. Total calories per serving are shown as 196, and carbs alone are shown as 50g (=200 calories), and protein as 17g (highly doubtful in itself) which is another 68 calories. I wouldn’t place much faith in that website.

        The cacao I bought a while ago shows fat calories at 5 of 20 per serving. If you eat an otherwise low-fat diet, this amount of fat is pretty small.

      2. Susan, the raw cocoa powder I buy has .5 gm. of fat, 3 gm. of carbs, and 2 gm. of fiber. Has 10 calories per tablespoon. You need to look at the actual package, and also consider serving size. One tablespoon adds a lot of flavor to a drink.

      3. Per your link, unsweetened cocoa has 12 calories, 6 calories from fat per tablespoon. I don’t see this as a big concern unless you’re consuming huge quantities.

    1. recently tested various cocoa products for cadmium. They actually found more cadmium in powder products than in dark chocolates. In fact, cadmium levels were unacceptable in most of the powder products they tested. Apparently there were some safe powders, but access to isn’t free. Personally, I no longer consume any of it.

      1. Panchito – would you mind supplying some bonafide research links re: parsley, cilantro as chelating agents. I have heard this as urban myth for decades and haven’t seen any reliable research that it is accurate. I’d love to see some scientific research on that topic that one can ‘take to the bank’. thx!!

  2. Please confirm the difference between cacao and cocoa. My understanding is that raw cacao powder is made by cold-pressing unroasted cocoa beans which allegedly keeps the living enzymes in the cocoa and removes the fat. Cocoa powder is raw cacao that’s been roasted at high temperatures. Does the roasting change the molecular structure of the cocoa bean, reducing the enzyme content and therefore lowering the overall nutritional value?

      1. I guess the issue for me is why Dr. Greger did not consider cacao in this blog, and my question is – which one is “healthiest?”

        1. I agree with you GeminiRat, i have always considered Raw Cacao to be one of best antioxidants available. I will not be influenced to change my mind by anyone here. I only buy cacao with lowest cadmium acceptable and available.

      2. Cmac? Really? Google it? sifting through and making sense of Google’s confusion is why I love this site and perhaps why people ask these kinds of questions on this site.

  3. It’s surprising for me to learn through this video that cocoa (or cacao) and coffee bean are considered seeds and not legumes.

    Whether you buy chocolate or cocoa, you need to make sure that it contains more than 70% real cocoa. Most commercial chocolate contains like 1-5% of real cocoa and it’s full of sugar.

    I can buy Trader Joe’s chocolate bit which contains 69% cocoa and 6g of sugar, for just a few bucks. Locally I can buy real 100% cocoa but I need to drive a little bit to buy and I am lazy to do so. But after this video then I will do it soon.

  4. Cocoa powder comes in two forms, Dutched or natural. Dutching process eliminates most of the phytonutrients. Dutching darkens the cocoa and makes it more mellow, acidity drops from 5 to 7 or more. I presume the natural cocoa powder is what is intended.

  5. Just order 100% non-GMO cocoa powder through to get a very high quality tested product. Also know there is a chocolate toothpaste on the market that is 100% natural. I got it at my dentist office at Pride Dental in Arlington, TX. They are for the most part an all natural dentistry establishment. It’s for kids, but I was curious years ago and bought me a tube of it. It does not come out brown. It comes out white, and it’s called Theodent. I noticed Crest now has one as well…However, Theodent is more than likely the higher quality of the two.

  6. Roasted cocoa powder is high in acrylamide (Burek et al. 1980; Johnson et al. 1986; Friedman et al. 1995) Raw cacao beans do not contain acrylamide so perhaps it might be better to switch to raw cacao powder.

  7. I am disappointed that there was no mention of the distinction between dutched and non-dutched cocoa powder. The effect on its nutritional value is apparently disputed, but according to some, dutching substantially diminishes the health benefits. I would like to know Dr. Greger’s opinion on the matter.

  8. I am wondering whether cacao or cocoa powders, due their caffeine content, can inhibit the uptake of nutrients from food which they are added to. I have heard that caffeine is particularly detrimental to the absorption of calcium and vitamin D. If so, is there still a problem if cocoa is consumed as a beverage separately from food?

      1. Jerry, to add to what you are saying, if one is concerned about caffeine interfering with a vitamin or nutrient of any kind, just put space between ingestion. Our bodies flush things like caffeine in a timely manner. Vitamins and minerals can go to their assigned places in the body (fat storage, bone storage etc.) and the caffeine can then come back at a later time and not affect those to, at least that is what I intuitively surmise.

        Another way to approach focused research problems is by combating them with other research, presumably more broad based.

        An example I’m thinking of is eating dried plums (prunes) to combat osteoblasts (stealing calcium from bones) and therefore requiring fewer osteoclasts (bone remodeling). This should mean the body requires less calcium which could lead to even better health as (I think) calcium can be one of those things that are detrimental when we get too much of it.

    1. Hi Joss- That concern originated form a study about ten years ago of bone density in women eating chocolate that found that chocolate intake was associated with lower bone density. A theory developed from this was that perhaps the oxalate content of the chocolate was preventing calcium absorption. I cannot find published data that cocoa or cacao inhibit calcium or vitamin D absorption. If you find specific information on this, let us know.

      As for caffeine, while it does influence calcium absorption, the amount in cacao hasn’t been found to lead to sufficient calcium disruption to cause osteoporosis. And caffeine in amounts of 300mg/day (16 oz of coffee) is not considered a risk factor for osteoporosis. Cacao has 12mg of caffeine per 2 tablespoons.

      Best, Dr Anderson, volunteer

  9. Unless there’s something new, I did research Hershey’s natural unsweetened cocoa powder, and found it to be fine. I add a tablespoon to my morning smoothie and it does give a noticeable boost in exercise performance. Consumer Lab did a report a few years ago, but its behind a pay wall. I saw it, the brand I mentioned was fine. One tablespoon, even daily, should be fine.

  10. I’ve been buying Raw Organic Cocoa Powder (from South America) for a few years now. When I mix up a large mug of cold brewed material I add cocoa, goat whey, creatine, ceylon cinnamon, ginger, clove powder, magnesium powder (redundant… I know) niacin, amla powder, Glycine, Glutamic Acid, GuSuiBu, Inulin powder, vanilla extract, Pure Maple Syrup, and top it off with almond milk.

    I only brew this about twice a week but one cup lasts a couple of days since the niacin (flush) holds me down to about a 1/4 of the mug at a time. At other times I have taken to eating a number of Hershey’s special dark mildly sweet chocolate chips as a fill in… presumably to have more cocoa anti-oxidants available.

    I haven’t watched Dr Greger’s chocolate videos yet, but I bet they reference the Nitrous Oxide benefit from eating chocolate… you know, to open up your arteries and veins.

    And while I also drink beet juice for this same purpose, I think it takes the beet juice about an hour to kick in whereas chocolate works much faster. For this reason, I eat some chocolate chips first thing in the morning when I get up and last thing before going to bed… plus at intervals throughout the day.

    I’ve actually lost visceral fat while doing this, but as I’ve mentioned in previous posts, I also loosely follow a ketogenic diet protocol, and that may have something to do with it.

    Just to be clear, I am not suggesting anyone follow my ways, but I offer them to you as something to research for yourself.

    1. YIKES!

      Just watched the Update on Chocolate video and saw where the Special Dark Heshey’s not only has alkali in it but cocoa butter as well. I’ll drop that from my eating habit and concentrate on getting my chocolate from the raw organic cocoa powder.

      Learned something important today so today has been a good day.

      1. I drink something that most people on this board don’t like. When I am in a hurry in the morning and don’t have time to cook a real vegetables soup then I drink chocolate bone broth and it’s delicious and healthy.

          1. You called something that billions of people including your grandma eat, disgusting?

            There is an hypocrisy when you kill lab rat to experiment blueberry effect on cancer cell, or torture the bees to pollinate your kale, or steal the honey from bees, or kill the insects to protect your kale and it’s all OK because simply you don’t see the feelings of the rats, bees and insects.



            1. “billions” eat chocolate bone broth?! lol

              I see you’ve been on the peta and onegreenplanet websites. Good for you. Hopefully you’ll see the injustice and make a positive change soon Jerry. Good luck.

              1. Scott B – I am so with you.
                Jerry complains about how bees and rats are treated yet is complicit in the torture of cows, horses, pigs, fowl for his precious bone broth. What a disconnect. What hypocrisy.

            2. I grew up with my Grandparents. While they certainly ate soup from bones they did not ever put chocolate in it. Chocolate, in my Grandparents home, was bought and consumed only on special occasions, perhaps a couple/few times a year.

              And while you’re waxing on about how the bees and rats are treated – why don’t you watch some videos on the feelings of your precious cows pigs and chickens as they live and die in CAFO farms. What hypocrisy Jerry!

    2. Lol what is goat whey doing there tho? Protein extract from breastmilk meant for baby goats? Dont you think its better to stick to plants bro?

      1. Lol what is goat whey doing there tho? Protein extract from breastmilk meant for baby goats? Dont you think its better to stick to plants bro?
        Heh, I’m “politically” agnostic, therefore I am free to choose from all sources of nutrition.

        That being said, I could almost argue that goat whey is far enough removed from origin-milk that it is not only “safe” to consume but is rather a health promoting product. Maybe there are some but I’ve seen no studies singling out goat whey, or even goat milk itself, as being harmful to our health.

        That’s one thing I have against NF.o… it’s either plant based or die!

  11. We love using organic baking cocoa for our banana chocolate ice cream. As Dr. Greger notes, this delicious powder has almost no calories, just 20 for 1 tbsp. Here is our latest Happy Vegan Couple cooking video showing how to make this delicious ice cream in just a few minutes. Forget running to the store for that more sugary non-dairy ice cream. Try this; you will likely love it!

  12. One bad thing about cocoa and chocolate is that it is prone to child exploitation. Coffee too. In order to avoid this, you need to buy products that have the Fair Trade logo, which are a little bit more expensive, but you will pay fair price to the farmers so that they don’t exploit child labor.

    1. Gosh Jerry – so good to see you have such breadth and depth of ethics when it comes to child labor and exploitation. And yet, when it comes to the torture of animals in CAFO farms that are killed by the billions every year you are completely fine with it. You cite a PETA article about bees caught in industrialized bee-keeping but buy and consume your precious bone broth made from the torture and death of factory farmed animals that harbor the same breadth of feelings as any rat that you complain about. And even if you consume farm-raised grass fed animals, they still end up with their heads chopped off for your consumption.
      What disconnected planet are you from? wow.

  13. Hello folks, by reading all your comments and concerns about the ingredients of cacao or cocoa I’m wondering that nobody take in consider to use “carob” (the powdered fruit of the carob tree). For me (after a while) it taste similar to cacao but without the negative ingredients like Theobromin, copper and so forth… why not taking in consider?

    1. Heilpraktiker, Like you I sometimes look for a plant solution to something that concerns me, i.e. using liquid Lo Han sweetener (monk fruit) instead of sugar to make some of my more bitter drinks palatable.

      But I’m curious if the carob has any of the same beneficial aspects of cocoa powder other than a semblance of taste?

      My health has steadily improved once I conquered my taste sense.

    2. Hi, Heilpraktiker_Ju. You can find Dr. Greger’s take on carob here. While carob might be a good substitute for the taste of cacao, it is not necessarily a good substitute for the phytonutrients of cacao. Theobromine and copper, natural constituents of cacao rather than added ingredients, are touted in some websites as negative, but are not necessarily so. Most research on toxicity of theobromine is from animal studies, which even the researchers state should not be applied to humans. In fact, theobromine may have some health benefits. Copper is also a natural constituent of cacao, and a trace mineral needed by the body. The key is to make sure that zinc intake is sufficient, as copper and zinc may compete for absorption. I hope that helps!

      1. Nope. Just bringing to peoples attention that there is cadmium in chocolate, cocoa, and cacao and some products have more than acceptable levels. Cadmium is a known toxin that can cause cancer and has other adverse health effects. Some of these products have lead too. Your site seemed quite concerned about rice and arsenic. Seems like you would be concerned about cadmium in chocolate too.

  14. and then there are those of us who seriously dislike chocolate, AND coffee.
    But, then again, I also have an abnormally adverse reaction to caffeine, at least caffeine from coffee.

    So, do you know if it could be a genetic thing like with cilantro? that some of us are just predisposed to react to the flavor of coffee or chocolate like it’s liquid detergent?

    Chocolate is the most beloved thing in the world, I’d say, the saturated fat and salt and sugar found in chocolate around the world are the most beloved thing. Even the darkest of dark chocolate is loaded with fat, sugar and salt.
    If you gave all these people just cocoa powder without any additives, i’d bet not one of them would like it.

    So, modified chocolate is the most beloved thing in the world, except for people like me, I’ll take my smoothie with fruit only, instead.

  15. I do understand that saturated fat is not assessed as very healthy. Thats one of the reason coconut oil should be prevented. What´s now the difference with Chocolate, especially dark chocolate?

  16. Chocolate has added fat and sugar–THAT’s the problem. So yes, that dark chocolate has the healthy antioxidants , but it also has those unhealthy ingredients of saturated fat and sugar. The good news as Dr. Greger mentions is that “you can get the benefits of chocolate without any sugar or fat by adding cocoa powder.”
    That’s the difference. So often when we talk about the benefits of chocolate we’re really talking about the benefits of cocoa. Hope that helps, unless I’m misunderstanding your question (?)

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