Chocolate & Stroke Risk

Chocolate & Stroke Risk
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Dark chocolate is pitted against milk chocolate in a test of artery function.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The problem with publishing research on chocolate is that the press jumps on it, oversimplifying and sensationalizing the message. Then, the money starts rolling in from candy companies, muddying the message. But, lost in all that is an important idea—that the flavanol phytonutrients in cocoa do appear to be beneficial.

The sugar in chocolate isn’t good for us; the fat and excess calories in chocolate aren’t good for us; but, “natural cocoa powder can be [considered] a health food.” So, adding cocoa to a smoothie, or oatmeal, or whatever, would be health-promoting. But, ideally, choose unprocessed, un-Dutched cocoa, since the flavanols are what give cocoa its bitterness. So, they try to process cocoa with alkali to destroy them, on purpose. Thus, when it comes to cocoa, “bitter [appears to be] better.”

In my video on chocolate and artery function, I showed how dark chocolate could improve the function of coronary arteries in the heart within two hours of consumption, using fancy angiography. But, there are some blood vessels you can visualize with your eyes—the blood vessels in your eyes. Two hours after eating dark chocolate: significant improvement in the ability of the little veins in your eyes to dilate.

What about the blood vessels in your legs? Peripheral artery disease—atherosclerosis in the arteries feeding your limbs, leading to claudication, a crampy pain in your calf muscles when you try to exercise, due to impaired blood flow. So, maximal walking distance and maximal walking time were studied in 20 peripheral artery disease patients, two hours after eating dark chocolate, with a respectable 85+% cocoa, or after eating wimpy milk chocolate. After the dark chocolate, they could walk about a dozen more yards, and about 17 more seconds, than before the dark chocolate.

But, after the milk chocolate they weren’t even able to walk as far as baseline, and not a single second more. So, there does seem to be something in cocoa that’s helping, but a few seconds here or there aren’t going to cut it.

How about reversing the atherosclerosis—which we didn’t even think possible, until 1977? Wait—what happened in ’77? Dean Ornish didn’t start publishing on heart disease reversal until 1979. Well, actually, the first demonstration of atherosclerosis reversal with a cholesterol-lowering diet and drugs wasn’t on the coronary arteries going to the heart, but rather the femoral arteries, going to the legs.

What about the arteries going to the brain? Well, there’s a noninvasive way to measure arterial function within the brain, using transcranial ultrasound. If you ask someone to hold their breath, the brain says uh-oh, and starts opening up the arteries to increase blood flow to compensate. But, if the arteries in our brain are stiffened and crippled by atherosclerosis, they’re unable to open as much and as fast as they should—and so, are said to have a smaller “breath holding index,” which can be a risk factor for stroke. So, researchers designed an experiment in which they compared the results of a target food to something neutral, like oatmeal. So, did they choose like a spoonful of cocoa powder, or something? No. A randomized crossover trial of oatmeal, versus a “deep-fried Mars bar.”

Wait, why a deep-fried Mars bar? Well, this was published in the Scottish Medical Journal, and, evidently, deep-fried Mars bars are “a snack…strongly [associated] with Scotland.” Wait, is this just an urban legend, or something?  No. “627 fish and chip shops in Scotland [were called] to ascertain the delicacy’s availability,” and more than one in five said yeah, we’re selling up to 200 a week. Just follow the signs. Comes out a little something like this. Batter-dipped and deep-dried Snickers bars and pizza were, evidently, less popular. The researchers conclude that it’s “not just an urban [legend]. Encouragingly, [they] did find some evidence of the penetrance of the Mediterranean diet…albeit in the form of deep-fried pizza.”

Could this be contributing to Scotland having among the highest stroke rate in Europe? Well, they put it to the test, and, interestingly, there was a significant drop in cerebrovascular reactivity in men, compared to women. Maybe men are from Mars, women are from Snickers?

Regardless, what about chocolate that’s not deep-fried? There’s been a few population studies that have followed people over time, and found that those who ate chocolate appeared to have lower stroke rates—since confirmed by another study.

But, maybe chocolate consumption just happens to be related to other behaviors that are heart- and brain-healthy?  Like hey, people that exercise a lot have to eat more food, period. So, maybe they eat more chocolate? They didn’t see any evidence of that, but you can’t account for everything. To prove cause and effect, you’d have to like randomize people into two groups, and make half eat chocolate, and the other half not, and follow them out for a decade or two—to which one researcher replied, fat chance; you try to get people into a study where they could be randomized to 16 years without chocolate.

Please consider volunteering to help out on the site.

Image credits: jackmac34 via pixabay, and pettifoggist & Linelle Photography via flickr. Images have been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The problem with publishing research on chocolate is that the press jumps on it, oversimplifying and sensationalizing the message. Then, the money starts rolling in from candy companies, muddying the message. But, lost in all that is an important idea—that the flavanol phytonutrients in cocoa do appear to be beneficial.

The sugar in chocolate isn’t good for us; the fat and excess calories in chocolate aren’t good for us; but, “natural cocoa powder can be [considered] a health food.” So, adding cocoa to a smoothie, or oatmeal, or whatever, would be health-promoting. But, ideally, choose unprocessed, un-Dutched cocoa, since the flavanols are what give cocoa its bitterness. So, they try to process cocoa with alkali to destroy them, on purpose. Thus, when it comes to cocoa, “bitter [appears to be] better.”

In my video on chocolate and artery function, I showed how dark chocolate could improve the function of coronary arteries in the heart within two hours of consumption, using fancy angiography. But, there are some blood vessels you can visualize with your eyes—the blood vessels in your eyes. Two hours after eating dark chocolate: significant improvement in the ability of the little veins in your eyes to dilate.

What about the blood vessels in your legs? Peripheral artery disease—atherosclerosis in the arteries feeding your limbs, leading to claudication, a crampy pain in your calf muscles when you try to exercise, due to impaired blood flow. So, maximal walking distance and maximal walking time were studied in 20 peripheral artery disease patients, two hours after eating dark chocolate, with a respectable 85+% cocoa, or after eating wimpy milk chocolate. After the dark chocolate, they could walk about a dozen more yards, and about 17 more seconds, than before the dark chocolate.

But, after the milk chocolate they weren’t even able to walk as far as baseline, and not a single second more. So, there does seem to be something in cocoa that’s helping, but a few seconds here or there aren’t going to cut it.

How about reversing the atherosclerosis—which we didn’t even think possible, until 1977? Wait—what happened in ’77? Dean Ornish didn’t start publishing on heart disease reversal until 1979. Well, actually, the first demonstration of atherosclerosis reversal with a cholesterol-lowering diet and drugs wasn’t on the coronary arteries going to the heart, but rather the femoral arteries, going to the legs.

What about the arteries going to the brain? Well, there’s a noninvasive way to measure arterial function within the brain, using transcranial ultrasound. If you ask someone to hold their breath, the brain says uh-oh, and starts opening up the arteries to increase blood flow to compensate. But, if the arteries in our brain are stiffened and crippled by atherosclerosis, they’re unable to open as much and as fast as they should—and so, are said to have a smaller “breath holding index,” which can be a risk factor for stroke. So, researchers designed an experiment in which they compared the results of a target food to something neutral, like oatmeal. So, did they choose like a spoonful of cocoa powder, or something? No. A randomized crossover trial of oatmeal, versus a “deep-fried Mars bar.”

Wait, why a deep-fried Mars bar? Well, this was published in the Scottish Medical Journal, and, evidently, deep-fried Mars bars are “a snack…strongly [associated] with Scotland.” Wait, is this just an urban legend, or something?  No. “627 fish and chip shops in Scotland [were called] to ascertain the delicacy’s availability,” and more than one in five said yeah, we’re selling up to 200 a week. Just follow the signs. Comes out a little something like this. Batter-dipped and deep-dried Snickers bars and pizza were, evidently, less popular. The researchers conclude that it’s “not just an urban [legend]. Encouragingly, [they] did find some evidence of the penetrance of the Mediterranean diet…albeit in the form of deep-fried pizza.”

Could this be contributing to Scotland having among the highest stroke rate in Europe? Well, they put it to the test, and, interestingly, there was a significant drop in cerebrovascular reactivity in men, compared to women. Maybe men are from Mars, women are from Snickers?

Regardless, what about chocolate that’s not deep-fried? There’s been a few population studies that have followed people over time, and found that those who ate chocolate appeared to have lower stroke rates—since confirmed by another study.

But, maybe chocolate consumption just happens to be related to other behaviors that are heart- and brain-healthy?  Like hey, people that exercise a lot have to eat more food, period. So, maybe they eat more chocolate? They didn’t see any evidence of that, but you can’t account for everything. To prove cause and effect, you’d have to like randomize people into two groups, and make half eat chocolate, and the other half not, and follow them out for a decade or two—to which one researcher replied, fat chance; you try to get people into a study where they could be randomized to 16 years without chocolate.

Please consider volunteering to help out on the site.

Image credits: jackmac34 via pixabay, and pettifoggist & Linelle Photography via flickr. Images have been modified.

Doctor's Note

More on chocolate in:

More on stroke prevention in:

And speaking of stroke, stay tuned for my next video: Does Diet Soda Increase Stroke Risk as Much as Regular Soda?

If you haven’t yet, you can subscribe to my videos for free by clicking here.

123 responses to “Chocolate & Stroke Risk

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  1. I put a heaping soup spoon full of cocoa in my morning coffee with a bit of blackstrap molasses (to take the edge off the bitterness) (some almond milk too). Tastes really good. Hopefully it does me some good. It makes the Hershey company happy.

    1. I hope that coffee isn’t too hot. Heating cacao destroys the delicate phytonutrients and flavanols responsible for its health benefits.

      Throw some on your berries.

      1. After fermentation, the cocoa beans are roasted while still in the shell at temperatures ranging from 100C to 180C. So, it may be that the damage is already done.

        However, since cocoa and cacao have a reputation for health benefits, I suspect a fair amount of nutrients remain.

        1. Not sure that those roasting temperatures are universally true. According to the company from which I buy my Peruvian raw cacao powder, “Our cacao is shade-grown on sustainable certified organic farms. In order to preserve the complex flavor profile and health benefits, the beans are carefully harvested, fermented, sun-dried, and pressed, never reaching a temperature above 114°F.”

          While I’ve cut way back on my chocolate candy consumption, I include a tablespoon of the raw cacao powder in my berry smoothies. No extra sugar or fat required.

    2. I just put it in my almond milk. It’s not as sweet as hot chocolate, but I don’t need it to be. It’s more like umami than sweet, but still really good.

      1. We put in lots of Truvia (from CostCo) which is mostly Erythritol with stevia. Any good arguments against this sweet strategy? We use Truvia in baking, drinks, and wherever we want a sugar-sweet taste. Dr. Greger gives it a green light as I recall.

        1. Research it and decide for your self.
          Truvia: It is manufactured from a blend of three ingredients, which are:
          Erythritol: a sugar alcohol.
          Rebaudioside A: a sweet compound isolated from the stevia plant, listed as Rebiana on the label (1).
          Natural Flavors: it is unclear exactly what this means.
          Truvia is often confused with stevia, a natural sweetener made from the stevia leaf.
          Stevia leaves contain two sweet compounds, stevioside and rebaudioside A.
          Of the two, stevioside (but not rebaudioside A) has been linked to health benefits like lower blood sugar levels and reduced blood pressure (2, 3). However, there is no stevioside in Truvia, only tiny amounts of purified rebaudioside A, which has not been linked to any health benefits.
          https://authoritynutrition.com/truvia-good-or-bad/
          https://en.wikipedia.org/wiki/Truvia
          Cargill manufactures Truvia’s erythritol by processing corn into a food grade starch which it then ferments with yeast to create glucose and then processes further to create erythritol.

        2. Gayle: Dr. Greger does give a green light to erythritol but gives some caution for the stevia. I don’t know how that would all pan out with a mix like Truvia. I just thought you might want to look up the NutritionFacts videos on stevia if you were not already aware of them.

  2. I roast my own coffee, so I thought it wouldn’t be that hard to roast my own cocoa beans. It turns out that turning cocoa beans into something edible is quite complicated.

    1. They sell raw cacao nibs, which I like to eat out of hand along with nuts. They are expensive but a little goes a long way. If I remember correctly they have the highest polyphenol concentration of the cacao products.

      1. Saturated fat content of nibs is ~55%, compared to ~12% for powder, if that is a concern to anyone. I am generally in favor of eating the whole food, but cocoa butter has little going for it, IMO.

    2. that is interesting you roast your own coffee beans. I wanted to ask a question because I bought Hawaiian Green Coffee beans but I don’t know how to roast it ? Any ideas any one knows how is the best to use that?

      1. You can roast beans in an air popcorn popper, though you will need to do it outdoors or have good kitchen ventilation. I have a FreshRoast home roasting machine, which is basically a glorified popcorn popper, and a range hood that vents to outdoors. You can also roast beans in a skillet, though it’s harder to get a consistent result. There are many videos on YouTube on how to get a good roast.

        Home roasted coffee is a revelation.

    1. While your checking that out also check which brands contain the least amount of rodent hair and feces .
      Make sure you check that it wasn’t harvested by child slave labour . BTW Hershey is on list that could be using child slaves in their harvests of cocoa.
      Finally Dr. Neil Barnard for the Physicians committee for responsible medicine says.
      ” Chocolate , just like sugar , elicits an opiate reaction within the brain that trips the dopamine receptors and gives us a pleasure response , I don’t mean to say that chocolate is a drug but rather the whole darn drugstore!

      1. Any such list available to avoid purchasing from exploitative companies? Cocoa beans are known for health benefits so even if there is a metabolic reaction that involves dopamine receptors, I don’t see a problem there. Lots of activities also do the same thing, and I’m not about to give up running or sex either. :)

          1. Wow! Those lists were eye-openers! For starters I had no idea there were so many chocolate companies. And, though disappointing, it isn’t much of a surprise that you cannot trust several sources you’d like to think are trustworthy. It sounds like this group operates out of Seattle, since several of the companies (restaurants) are there, others in nearby British Columbia.

              1. Maybe there are just more chocolate eaters up here in the land of dark, depressing winters. However, today is a sunny, cold exception, even if we only get a few hours of it.

      2. Dr Greger has mentioned either in an older video or his book that her actually prefers dutch processed cocoa – personal preference taste-wise, if I remember correctly.
        Some people go crazy for chocolate , but I see it as a vehicle for fat and sugar. It just isnt the same without ! I do like those raw chocolate nibs though

          1. mmmm sounds good to me ToBeAlive!

            @Jeff Lebowski, thanks ! I didnt know about the different process, and I think jj has the right idea in drinking more to make up for lost antioxidants !

          1. I have read and I think Dr. Greger mentions that dutched cocoa has half the antioxidants of regular cocoa. Can’t find the link easily but that just means using twice as much dutched as regular for the same effect.

      1. Hi Jeff – are you sure about this? My understanding of the word “natural” is that it has no meaningful designation and that food companies can slap it on anything and call it natural. Correct me, please, if I am wrong or if someone else knows. THx!

      1. I like Dr Greger sense of humor and that is part of that. It is good to have that child joyful factor alive within yourself.

    1. Lee: Its my understanding the popups will be here through the end of volume 33. Look next to the video for the volume number. We are at video 19 out of 27 for volume 33. A little more patience and we will all get through this! ;-)

  3. I saw on the Washington Post list that links to a website that names all of the Alt Right websites that create fake news and are a wing of the Russian Propaganda efforts. I was totally taken aback to see that nutritionfacts.org was on this list as a website for fake news. What is up with this? How is it that the Washington Post considers nutritionfacts.org a proponent of fake news? This is crazy.

    1. The Washington Post quoted other researchers that pulled in the sites with an algorithm of some sort. Shortly after the article was published they removed some sites and nutrition facts is one of the sites that was removed. Battle fought and won.

      1. This is a great website with lots of scientifically backed information to improve our health and nutrition. Thanks Dr Greger. I liked this video regarding dark chocolate. I like to have a piece of dark chocolate with a walnut and date with my after dinner tea.

    2. Because apparently they are the ones who produce fake news and propaganda? And yes it is crazy, and total nonsense. Main stream media after all.

  4. I am still confused about the cholesterol issue. Doctors are saying if total cholesterol is over 200, but the HDL is very high and the LDL is very low, than the person is fine. Research has indicated that cholesterol under 150 means virtually no risk of heart attacks. What if the LDL is high and the total is under 150?

    1. The short answer is we don’t know. Remember, these are all “possible” risk factors. Cholesterol, in many studies, seems to have a U shaped curve with regard to age. Problem is, you don’t where on that curve you are. There are some opinions that HDL may not be protective after all. Then there’s the consideration of LDL density. A good and thorough lipid analysis would break down LDL into at least 3 separate categories to asses risk. Bottom line: do everything you can within reason to remain healthy, follow the science, when and if it changes, adjust if needed, and don’t stress over it. BTW, “virtually no risk” with regard to disease, I’m sorry, is a misnomer.

  5. No offense to our Scottish viewers but many Scots eat a poor diet and they smoke cigarettes, not to mention drink too much alcohol. My exes parents came from Scotland, they drank and smoke until it was too late.

    The same can be said for many Americans too.

  6. Off topic, but did many of you listen to Dr G’s first podcast yesterday? He covered four topics quickly, to the point, and I thought well done. Bravo to the good doctor!

        1. Found it. Thank you Rebecca. The good thing about the podcast is one could listen to it while doing something, which is not possible with the videos.

        1. I saw the black squares. I do not have iTunes. I clicked on google-something and it just took me to a page of written items. No podcast.
          ?

  7. Just wanted to get some opinions on this. I eat almost 100% WFPB. The only processed foods I eat are ezekiel bread, splenda packets, and (very rarely, maybe once per 2 weeks) larabars, tofu, KIND nut bars which have added sugar, & diet pepsi (I want more than anything to totally eliminate this because it’s increased cancer risk in a bottle but it’s just so refreshing…)

    However, this past week I discovered a product, a highly processed junk food but with little to no calories, and I actually like it. It’s Walden Farms marshmallow dip and it has so little calories it is counted as zero. The ingredients used to make something that tastes like junk food zero-calorie are: water, vegetable fiber, xanthan gum, sucralose, foodcolor, cellulose gel, marshmallow flavor, salt, sodium acid sulfate, carrageenan, vanilla flavor, potassium sorbate, sodium benzonate, cream flavor (non-dairy)
    obviously this is not good for me, but if I ate a serving, say, once a week, would it be harmless enough? I used it to mix with canned pumpkin and cinnamon for a simple <100 cal treat. If I didn't have this, I'd need tofu and dates to add the right sweetness and texture to the pumpkin… and that'd probably add 200+ calories and a lot of time. I know the extra calories would be worth the nutrition but all I really wanted was some pumpkin, and I don't buy dates 'cause they're expensive and as a former ED sufferer the sugar content and calories freak me out… So I probably wouldn't eat pumpkin if I didn't have this stuff… So might Dr. Greger say "if it gets you to eat more vegetables/fruits go for it?"

  8. another fascinating report. It may also be possible to reverse atherosclerosis (and osteoporosis) with calcium (plants or dairy) plus vitamins D and K. Especially the latter, which ensures calcium is deposited in the bones – rather than in the arteries and organs. Most vegans/vegetarians obtain plenty of K from (say) parsley and Natto. Vit D from sun, milk or supplements. Latest research from my home town has drawn a strong link between vitamin D deficiency in pregnancy and autism, so it is worth ensuring vit D levels are ideal – especially reproductive females. This research is consistent with demographics demonstrating a higher level of autism is regions further away from the equator, plus a possible link to increased urbanisation.
    I have been consuming significant quantities of non-alkalised cocoa powder for years. I believe it to be beneficial in many respects – not just arterial. Too much sugar in chocolate bars, so they should be avoided. At least the milk and nuts can beneficial. Moreover, the milk component in chocolate protects against dental caries. Personally, I make hot chocolate with stevia to minimise the bitterness – and milk – to make it edible. The only concerns are: 1. the high levels of lead and cadmium in some cocoa powders. However, these can detoxed with a plant based diet – esp. the consumption of (say) garlic and vitamin C rich foods. 2. The possible binding of cocoa polyphenols with milk proteins. I believe this process is reversed in the gut – but cannot be certain. If wrong, I am consuming large amounts of cocoa for no good reason.

    1. It’s K2, not K1, that appears to have the effect of directing calcium out of soft tissue and into bones and teeth, but the science is still very preliminary. I’m also interested in K2 and I take a supplement, but I acknowledge that there’s a lot we still don’t understand about it. A balanced view: https://sciencebasedmedicine.org/k2-the-vitamin-not-the-mountain/

      There’s no K2 in parsley, and I bet most vegans outside of Japan don’t eat much natto, so they’re depending entirely on conversion of K1 in their own gut. That may be adequate, or it may not. I take the view that a lot of these gut conversions that we depend upon have been compromised by pesticides, herbicides, and other toxins that, while not directly toxic to humans (sometimes), have a negative effect on the gut biome.

    1. Yeah, groan.

      Also of all the bars-of-candy I ever ate. “Mars” bar was never one of them. Never ate a Mounds or Almond Joy either.

      OH but the Butterfingers, Snickers, 3-Musketeers, Reese’s Cups, Twixs, Zeros, Heaths, Hersheys, Crunches, Kit Kats, and Take-5’s: All sound better to me, I used to think nothing of eating one or two per day- BUT deep-fried really? Ridiculous taken to the Supreme level.

  9. It is my opinion that your programmer(s) have made it entirely too hard to contribute to your organization. Who wants to reveal two pages of particulars about themselves just to contribute to your organization? I would be happy to contribute, but find it too hard to do. I think you should do a thorough review of your contribute pages and make the act of contributing a lot more reasonable. I would also bet that your contributions have fallen like a rock since you put up the current version of the page!

  10. IMO, chocolate/cocoa is a mix bag of good and bad. It is a copper bomb and will destroy the copper to Zn balance. Vegans are already high in copper but low in Zn and taking extra bombs cannot be a good thing. It will alter your behavior without you being aware. I stay away from it despite the magical narratives.

    1. I think that you have been viewing the wackier websites on the net, which are full of unsubstantiated claims like this. Presumably in a desperate attempt to make the high saturated fat and high meat diets they promote look almost healthy by comparison. I have not found any such concerns expressed in the professional literature.

      The fact is that because of its high fibre and phytate content, a vegetarian diet usually results in lower mineral bioavailability. There have even been some studies showing that vegetarians are deficient in copper (and zinc).
      http://link.springer.com/article/10.1007%2FBF02789145

      However, other studies have shown that “Despite the apparent lower bioavailability of zinc, copper, manganese, and selenium in vegetarian diets because of the high contents of phytic acid and/or dietary fiber and the low content of flesh foods in the diet, the
      trace element status of most adult vegetarians appears to be adequate.”
      http://ajcn.nutrition.org/content/59/5/1223S.full.pdf+html

      This all seems to be a good reason to take cacao rather than a reason to avoid it.

      1. Well, I was not saying that vegans have copper toxicity. Instead, I was trying to say that drinking EverydaY chocolate/cacao will bomb you with excess copper. Thus, your first link did not say that those vegans in Slovakia were drinking cacao drinks daily obtained from the internet (like I read happening here). As far as the nutritional link of cacao you added, it says cacao has 163% (excess) while Zn 39% of the DV. Excess metals are no good for the brain long term (accumulate). Ultimately, it is a personal decision. But I would like to make people aware paying attention to the after feeling of drinking cacao specially if done daily. It is hard to find a problem when someone says it is not a problem.

        1. https://en.wikipedia.org/wiki/Copper_toxicity

          https://upload.wikimedia.org/wikipedia/commons/0/00/Kayser-Fleischer_ring.jpg

          “There is a lot of research going on regarding the function of the Cu/Zn
          ratio in many conditions, neurological, endocrinological and
          psychological.[12][13][14]
          The diagnostic difficulties arise from the fact that many of the
          substances that protect us from excess copper perform important
          functions in our neurological and endocrine systems. When they are used
          to bind copper in the plasma, to prevent it from being absorbed in the
          tissues, their own function may go unfulfilled. Such symptoms often
          include mood swings, irritability, depression, fatigue, excitation,
          difficulty focusing, feeling out of control, etc.”

          1. Thanks Panchito.

            I find all this speculative reasoning deeply unconvincing. Absorption of copper from food is low – apparently ranging from 12% to 60%. Vegetarians, for reasons already discussed, tend to be at the lower end of this range. Therefore the fact that a serving of a particular food contains X% of the daily RDA does not mean that that is the amount that will be absorbed. Zinc absorption is also low.

            However nuts, beans, whole grains etc are all relatively good sources of zinc. There is no evidence that people eating WFPB diets have particularly poor copper zinc ratios. The biggest risk for vegetarians appears to come from low body levels of both copper and zinc.
            3.amazonaws.com/academia.edu.documents/38527612/2011_LopezdeRomana_JTEMB_CuReview.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1482033956&Signature=l%2FIIDVFdQ7BWn4EqgUlqG1YbjjA%3D&response-content-disposition=inline%3B%20filename%3DRisks_and_benefits_of_copper_in_light_of.pdf
            http://ajcn.nutrition.org/content/78/3/633S.full
            http://www.theveganrd.com/2009/05/getting-enough-zinc-on-vegan-diets.html

            As for mood and cognition, all the evidence I have seen suggests that regular consumption of cacao improves both mood and cognition.
            http://nutritionreviews.oxfordjournals.org/content/71/10/665.long
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575938/

            As I wrote before, all these claims seem to be based on speculation and come from the wackier websites. They do not appear to be supported by the evidence nor are they reflective of the professional literature.

            1. Thanks. As my last comment, I would emphasize to keep an open mind for the unexpected and see how it makes you/others feel long term depending on dosage and many other factors. For example, the following article shows the multitude of factors associated with clearing just caffeine from the body. It shows how an accumulating effect depends on the individual.

              http://mentalhealthdaily.com/2015/10/21/how-long-does-caffeine-stay-in-your-system/

              Hope I did not sound too negative.

              1. Thanks Panchito.

                I think that it is correct to be wary of products like cacao/cocoa. It is not a whole food after all. We might say it it is broadly equivalent to flour made from whole grains.

                It is just that all the internet speculation about why cacao should be bad ignores the bioavailability issue, ignores the data we have about vegetarians’ blood mineral levels and ignores the studies showing the actual effect of cacao consumption on mood and cognition. The old quip about a beautiful theory being destroyed by ugly facts, springs to mind.

          2. I didn’t spend too much reading about this Zn:Cu ratio, but according to cronometer (and they tend to be provide accurate info), Zn:Cu should be between cca 6:1 – 14:1, with the ideal ratio Zn:Cu 10:1. Quickly reviewing my most recent ~10 days of my almost 100% vegan diet in cronometer app, my Zn:Cu ratio was between 4:1 – 6:1, so a bit outside the recommenced interval. Just as a side note..

  11. I often use Raw CACAO powder not COCOA powder

    Is RAW Cacao bad for you, or is there just no research to match that on cocoa?

    Can I assume that cocoa benenfits would be similar in raw cacao?? Thank you very much DR. Gregor

    1. Raw cacao is one of the richest sources of antioxidants on planet earth and has been called the richest source. Definitely not bad for you. All cacao is is unprocessed cocoa in its whole unadulterated form. So it’s even healthier than its heated and processed version, cocoa. Not sure why it’s never referred to here. Probably due to available studies.

  12. It’s a real shame that cocoa powder is so high in oxalates. People prone to kidney stones ( the common calcium oxalate type) are advised to avoid cocoa powder.

    1. I’ll betcha that whole-foods vegans don’t often get kidney stones. I think humans evolved to cope with oxalates since they’re ubiquitous in the plant world.

    1. Un-Dutched cocoa means cocoa that has NOT been produced using the Dutch process.

      Google “Dutch process chocolate” for more information.

      1. Thank you Tom, it helped. It took me more than 1 hour to find a explanation in German – very scary. But now I know a little bit more – the different is the alkalisation – dutched cacao means alkalized. Thankfully are more sorts of cacao in Germany not alkalized – if you grape to organic types. :-)

        1. Most products, even the organic ones, don’t state on the label whether they have been alkalized/dutch processed or not. You can easily tell by the color and taste however, non-alkalized cocoa is brighter in color and has a slight sourness.

          My favorite non-dutched (organic & fair trade) cocoa available in Germany is GEPA Amaribe. They also produce a dark chocolate from that cocoa (GEPA Grand Noir Edelbitter 85%).

          1. Hi Timar, I run immediately to the next shop yesterday to look for cacao. I noted that in Germany htey tell you if the cacao is duched or not, you have to look on the “Zutaten” if the tell you 100% cacao than you canb e sure it is undutched but mostly the is written, Zutaten: Kakaopulver*, Säureregulator: Kaliumcarbonat *aus biologischerLandwirtschaft. (this means dutched) :-) Fortunately I have taken always the other one, instinctly…

  13. One disquieting detail not discussed is the contamination of most cocoa by cadmium. See ConsumerLab.com for their analysis this contaminant in different cocoas sold. Mars sells a purified cocoa concentrate (CocoaVia) that presumably is free of cadmium.

    1. I have a teaspoon of cacao powder everyday and sometimes a tablespoon and once in a while I use a ton of cacao powder in desserts. After regularly (every day) making smoothies with cacao powder for a period of months and regularly having desserts containing cacao (about once a week give or take) I had gotten my heavy metal levels checked and had zero issues with any heavy metals including cadmium which I was also tested for. I was using Sunfood cacao powder as I find it has the strongest flavor and scent and it goes a really long way but I’ve also used World Berries cacao powder prior to that. Probably nothing to worry about when buying from an organic and reputable company but one could always contact the company and inquire.

  14. It seems cacao is one food that Dr. G does not recommend in its whole form. We eat cacao nibs sprinkled on our cooked grains pretty much every morning. Should we switch to cocoa (I would really miss the satisfying crunch from the nibs!)? Is the cacao fat going to harm us if we are eating strictly wfpb?

    1. where does he not recommend cacao? I couldn’t find any videos on that but I know that Dr. Greger isn’t against plant foods with fat, such as nuts and seeds which he recommends which have more fat that cacao. And cacao is one of the best sources of antioxidants. I have a teaspoon of cacao powder everyday and when I have a couple tablespoons in a dessert (love mixing it in almond butter or making hot chocolate with it) I feel amazing and not just because of how great it makes your brain feel but that’s always awesome.

    2. I never saw a video where he advises against cacao. All cacao is is the unprocessed and unheated version of cocoa, so all its nutrients and antioxidants are intact. It’s been called the richest source of antioxidants ever discovered and while I don’t know if that’s entirely accurate, it’s definitely one of the richest sources of antioxidants and highly nutritious. I’m guessing he refers to cocoa due to available studies–most studies are probably done using cocoa powder and not cacao. I feel amazing on cacao powder, I have a teaspoon everyday and feel incredible when I have a couple tablespoons or so in a dessert.

  15. It’s true! Been in Scotland for the last 10 years, and finally tried the deep-fried Mars bar last year. Thought it was gonna be disgusting. Well, it wasn’t. Nice warm melted (though super unhealthy) chocolate. Now I stick to my 85% dark organic ones. :)

  16. I would love to hear Dr Greger’s comments regarding ascorbic acid and Lysine to clear up plaque from arteries and improve cardiovascular health. Dr Linus Pauling found that 2 grams of lysine and 4 grams of ascorbic acid (human dosing) reduced plaque buildup in arteries by 25% in only 5 weeks.

    He tested it on guinea pigs which have the same shortage of ascorbic acid (vitamin C) as humans do. I do not understand (actually I kind of do) why stains are so popular when this treatment is safe and effective.

    I take both of these and also take 1400 mg of L-arginine for cardiovascular pliability. I also indulge in dark chocolate a few times a week but only for it’s health benefits .. of course. A company makes coconut bars with coated dark chocolate so I get medium chain triglycerides too.

    1. John,

      Sounds like the direct quote from Linus’s patent: http://www.newmediaexplorer.org/chris/5278189.pdf I’d encourage you to consider that he was specific in looking at Lp(a) and not the whole current litney of CV markers.

      I would however very much encourage you to read this piece by Rath etal that truly addresses a different approach to why vitamin c makes sense and perhaps how we should rethink the cholesterol controversy in toto…. http://file.scirp.org/pdf/WJCD_2016111610335652.pdf Please see the third question at the conclusion of the article.

      Interestingly, but not surprisingly, there is literature for just the opposite supposition, ie. too much C is potentially dangerous: http://www.sciencedirect.com/science/article/pii/S0009898103004650 or not very significnat on the cholesterol levels http://www.sciencedirect.com/science/article/pii/S0261561415001685

      Take it with a grain of salt (pun intended) as the levels used and other factors negate some of the conclusions. I would like to see a selective subpopulation trial ( high Lp(a)) with the Pauling approach and coupled with diet change I suspect we would have a “new” , albeit unpatentable treatment….. just thinking aloud.

      Dr. Alan Kadish moderator for Dr. Greger

      1. Thanks for the reply Dr. Kadish.

        I really just kind of feel into what I’m doing now. I started taking 2 grams of vit C for stiff joints, and sore shoulder .. I guess really close to a frozen shoulder. That was probably 5 years ago and I’ve been taking it since then. A few weeks ago I played street football with the family, at the age of 62. As for lysine, I take it for my skin youthful appearance ;-). My triglycerides are really good .. always have been. I was just really surprised by the Pauling studies, and then a video lecture where he stated that lysine keeps LDL from binding.

        Thanks for the links too .. that second one is really nice in the way it reviews the cardiovascular vitamin C connection. I love your site!

      2. I am very dubious about the second link you recommend. Rath was not listed as an author although the actual authors are indeed associated with the “Rath Research Institute”. Having looked at a number of Rath’s papers and claims some years ago. I confess that I came away with the view that he is either barking mad or a complete charlatan. Apparently I am not the only person to hold this view.
        https://www.quackwatch.org/11Ind/rath.html
        http://www.quackometer.net/blog/2008/09/matthias-rath-charlatan.html
        http://skepdic.com/rath.html
        https://en.wikipedia.org/wiki/Matthias_Rath
        http://www.badscience.net/2009/04/matthias-rath-steal-this-chapter/
        etc etc

        The paper also rests its case heavily upon the notorious Zoe Harcombe article printed in the pay-to-publish Open Heart Journal.
        https://www.theguardian.com/lifeandstyle/2015/feb/10/research-criticising-1980s-fat-guidelines-misguided-say-scientists
        http://www.sciencemag.org/news/2014/03/scientists-fix-errors-controversial-paper-about-saturated-fats
        http://carbsanity.blogspot.com/2015/03/zoe-harcombe-and-adele-hites-hyper.html

        Incidentally, this paper itself is found in a pay-to-publish journal. I don’t think that we should assume too much credibility for it since it is an attempt to justify the “unifiied theory” promoted by Rath.

        Be very, very wary of the claims in that article. Rath and quackery are pretty much synonyms.

  17. That deep fried mars bar was one of the grossest things I’ve ever seen… And just hearing “deep friend pizza” makes me want to throw up…

  18. In my little taste test, Ghiradelli cocoa seemed much smoother than Hershey’s. (Ghirardelli pkge states “non-alkalized”. ) I like it in smoothie with frozen cherries or strawberries and a pinch of erythritol. Also good as hot chocolate.

    As occasional treat, I like Ghirardelli semi-sweet chocolate chips–a handful or less served in a small bowl for Chinese dipping sauce. Fewer additives than chocolate bars, plus I seem to eat less this way.

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