Flashback Friday: Dark Chocolate and Artery Function

Flashback Friday: Dark Chocolate and Artery Function
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What do studies not funded by the chocolate industry show about the effect of cocoa on arterial health?

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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.

Chocolate: beauty, or the beast, or both? Although cocoa itself is frequently found in foods like “chocolate which can contain high levels of fat and sugar,” the cocoa powder itself “may have beneficial effects in a number of chronic disease conditions, including [heart] disease.”

Flow-mediated dilation, measured in the main artery of the arm, which is about the same caliber as our coronary arteries, is considered one of the best measures of arterial function—a predictor of cardiovascular mortality. A little bit of cocoa doesn’t do anything. But a little more, or a lot more, gives one a significant boost in arterial function within hours of consumption. How much does it take? Not much—just a teaspoon of natural cocoa powder, which would be like a tablespoon or more of Dutch cocoa.

Now, makes you a little suspicious that the author works in Hershey, Pennsylvania, at the Hershey Medical Center, and, indeed, has accepted money from our largest chocolate manufacturer’s Center for Health and Nutrition, conveniently located near the intersection of Chocolate and Cocoa Avenues.

Putting together all of the best available science, though—dozens of randomized controlled trials—arterial function was significantly improved within hours, and after weeks and months of chronic cocoa consumption. It’s always difficult to tease out fact from fiction when such powerful financial interests are involved. “Many [of these] studies were funded by industry” as well, “and [as] in all areas of research evidence suggests that industry funding is associated with pro-industry conclusions.” But, even after removing “those studies funded by industry,” they found the same protective effect.

The reason they measure arterial function in the arm, rather than where you really need it—the coronary arteries of the heart—is that that would require an angiogram, which is a little more invasive. But if you were able to find people already scheduled for an angiogram anyway… Here we go.

Double-blind randomized trial finds that dark chocolate actually opens up coronary arteries themselves. And, when they did what’s called a cold-pressor test, where they plunge your hand into a bucket of ice water—which normally causes your arteries to constrict—but, after dark chocolate, they dilated. Dark chocolate may also improve blood flow to the heart of our kidneys.

“Because chocolate also contains fat and sugar,” though, we have to be careful. “Furthermore, most chocolate products are manufactured with milk, a compound known to influence antioxidant…capacity in [our blood].” Even if milk chocolate had the same flavonoid phytonutrient content as dark chocolate, “the antioxidant effect of cocoa is potentially [weakened] in the [blood]” when milk is consumed.

So, not only are there triple the antioxidants in dark, compared to milk, chocolate, but the milk actively works against the effects in the human body. So, eat dark chocolate, and get a nice spike in the antioxidant power of our bloodstream within an hour. Milk chocolate—nothing. And, if you eat that same dark chocolate with a cup of milk, the benefit is suppressed. The “[a]ddition of milk”—either in our stomach, or in the chocolate itself—”inhibits the [within-body] antioxidant activity of chocolate and the absorption into the bloodstream of [one of the target phytonutrients].”

Sugar isn’t good for us, either. Sugar impairs arterial function. One bottle of soda’s worth of sugar can temporarily cripple arterial function. That’s why sugar-free cocoa improves arterial function better than the same amount of cocoa with sugar added. So, “[e]liminating sugar…appears to amplify the beneficial effects of cocoa.”

Bottom line: “Although the positive effects of chocolate and cocoa products seem apparent, precautions exist” when we’re talking about the calories, fat, and sugar in chocolate. Cocoa powder, then, offers the best of both worlds. “Although [not as tasty], cocoa-based products with little or no sugar or…fat are certainly preferred.” And, you can make them tasty, as I note in my healthy chocolate milkshake recipe, and my healthy chocolate ice cream video.

Please consider volunteering to help out on the site.

Images thanks to Bob.Fornal via flickr and Bronayur via Wikimedia

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.

Chocolate: beauty, or the beast, or both? Although cocoa itself is frequently found in foods like “chocolate which can contain high levels of fat and sugar,” the cocoa powder itself “may have beneficial effects in a number of chronic disease conditions, including [heart] disease.”

Flow-mediated dilation, measured in the main artery of the arm, which is about the same caliber as our coronary arteries, is considered one of the best measures of arterial function—a predictor of cardiovascular mortality. A little bit of cocoa doesn’t do anything. But a little more, or a lot more, gives one a significant boost in arterial function within hours of consumption. How much does it take? Not much—just a teaspoon of natural cocoa powder, which would be like a tablespoon or more of Dutch cocoa.

Now, makes you a little suspicious that the author works in Hershey, Pennsylvania, at the Hershey Medical Center, and, indeed, has accepted money from our largest chocolate manufacturer’s Center for Health and Nutrition, conveniently located near the intersection of Chocolate and Cocoa Avenues.

Putting together all of the best available science, though—dozens of randomized controlled trials—arterial function was significantly improved within hours, and after weeks and months of chronic cocoa consumption. It’s always difficult to tease out fact from fiction when such powerful financial interests are involved. “Many [of these] studies were funded by industry” as well, “and [as] in all areas of research evidence suggests that industry funding is associated with pro-industry conclusions.” But, even after removing “those studies funded by industry,” they found the same protective effect.

The reason they measure arterial function in the arm, rather than where you really need it—the coronary arteries of the heart—is that that would require an angiogram, which is a little more invasive. But if you were able to find people already scheduled for an angiogram anyway… Here we go.

Double-blind randomized trial finds that dark chocolate actually opens up coronary arteries themselves. And, when they did what’s called a cold-pressor test, where they plunge your hand into a bucket of ice water—which normally causes your arteries to constrict—but, after dark chocolate, they dilated. Dark chocolate may also improve blood flow to the heart of our kidneys.

“Because chocolate also contains fat and sugar,” though, we have to be careful. “Furthermore, most chocolate products are manufactured with milk, a compound known to influence antioxidant…capacity in [our blood].” Even if milk chocolate had the same flavonoid phytonutrient content as dark chocolate, “the antioxidant effect of cocoa is potentially [weakened] in the [blood]” when milk is consumed.

So, not only are there triple the antioxidants in dark, compared to milk, chocolate, but the milk actively works against the effects in the human body. So, eat dark chocolate, and get a nice spike in the antioxidant power of our bloodstream within an hour. Milk chocolate—nothing. And, if you eat that same dark chocolate with a cup of milk, the benefit is suppressed. The “[a]ddition of milk”—either in our stomach, or in the chocolate itself—”inhibits the [within-body] antioxidant activity of chocolate and the absorption into the bloodstream of [one of the target phytonutrients].”

Sugar isn’t good for us, either. Sugar impairs arterial function. One bottle of soda’s worth of sugar can temporarily cripple arterial function. That’s why sugar-free cocoa improves arterial function better than the same amount of cocoa with sugar added. So, “[e]liminating sugar…appears to amplify the beneficial effects of cocoa.”

Bottom line: “Although the positive effects of chocolate and cocoa products seem apparent, precautions exist” when we’re talking about the calories, fat, and sugar in chocolate. Cocoa powder, then, offers the best of both worlds. “Although [not as tasty], cocoa-based products with little or no sugar or…fat are certainly preferred.” And, you can make them tasty, as I note in my healthy chocolate milkshake recipe, and my healthy chocolate ice cream video.

Please consider volunteering to help out on the site.

Images thanks to Bob.Fornal via flickr and Bronayur via Wikimedia

122 responses to “Flashback Friday: Dark Chocolate and Artery Function

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  1. Thanks for sharing this information again. Recently I have read about the heavy metals like cadmium found in cocoa. How much of a concern is this?

    1. Hi Amy Whitworth, thanks for your question. Cadmium is naturally found in soil—due to for example volcanic activity, for­est fires, and weathering of rocks—and is taken up by many plants, including cocoa plants. Other reason for Cadmium being present in the soil could be due to phosphate fertilizer. So one has to take an informed decision how much and what kind of product they purchase or use. I hope this information is helpful to you.

      1. It’s right in the transcript…
        “Not much—just a teaspoon of natural cocoa powder, which would be like a tablespoon or more of Dutch cocoa.”

      2. Hi Holly,

        I am a volunteer for Dr. Greger. Thank you so much for your question.

        Dr. Greger suggests that the science points to cocoa powder being beneficial over dark chocolate. However, the video indicates that a teaspoon of unprocessed cocoa powder or a tablespoon of dutch-processed cocoa powder may yield the arterial benefits seen in the video. Dr. Greger has not given any type of suggestion for frequency of cocoa powder consumption, and does not include cocoa powder in the daily dozen. A focus of the diet on whole, plant foods such as fruits, vegetables, legumes, whole grains, nuts, and seeds should be the key, with “specialty” foods such as cocoa powder consumed in moderation (which has not really been defined, unfortunately).

        I know this is not a specific answer to your question, but I don’t believe there is an answer to the optimal level of cocoa powder (or really most any other specific food) to include in the diet.

  2. Keep in mind when selecting products on the store shelves that “sugar free” isn’t the same thing as “unsweetened.” The former usually are weasel-words that mean the product contains one or more sugar substitutes instead of sugar. Caveat emptor.

    Hey, hey, hey! Let’s be careful out there! https://www.youtube.com/watch?v=_pIkkzDagsY

    =]

  3. When he mentioned recipes to make chocolate healthy, he left out his NoBake Fudgy Brownie recipe in the How Not to Die Cookbook. They are awesome!

    1. Congratulations Nancy! I’ve slowly converted to the Daily Dozen, too, but have trouble eating the recommended quantities. But at least I believe I’m getting all the right ingredients.

      1. I agree. At 67, there is no way I can eat that much! (And I burn about 500 calories a day in exercise.) I concentrate on “beans, greens, berries, tea, and nuts” with broccoli and peppers every other day.

        1. Hi George, thanks for your comment. You might realize that we all do fasting in one way or another in particular while we sleep! For example if one eats their last meal for the day at 6.30 and stop eating until the next morning and have breakfast after 6.30 that would mean 12 hours of fasting.

          1. For example if one eats their last meal for the day at 6.30 and stop eating until the next morning and have breakfast after 6.30 that would mean 12 hours of fasting.
            ——————————————————————————————–
            i.e. the morning meal being called “break-fast”.

            1. Lonie:
              What research has shown is that to get the full benefit of autophagy one has to limit eating to an eight-hour window, which is not easy to do for most of us.

              1. Hi George,

                I kinda agree with Spring 03 that there are many different ways we fast, and would go further that how we fast is something that should be tailored to the individual. I’ve tried some of the Intermittent Fasts and while they may have benefited me internally, they weren’t a best practice for me lifestyle-wise.

                My best approach seemed to be the multi-day fast and then refeed. Plus, I accept the various study conclusions that this method of fasting is a good way to re-cycle white blood cells that are no longer useful. I’m assuming that is the same as the autophagy you were referring to.

                But perhaps more importantly, the multi-day fast also converts a body over to utilizing stored body fat as fuel after using up the available glucose which our bodies produce in the gut from the food we eat. I’ve been ketogenic for a period of time in the past and felt very good during that time. I went through a couple of procedures (blood plasma transfusion and a 2 cc cord blood stem cell infusion) and decided to forego keto while my body utilized the two treatments.

                I’m back to doing a multi-day fast (a 5-day one that ended January 1st) on occasion. Whether or not I continue doing that rests on my upcoming 6 month lab results. I’ve been living with high a1c for as long as I’ve been tested (when the Affordable Health Care Act required I have a Dr.) and by keeping inflammation under control have suffered no ill affects from it according to my lab results. Still, I’m on guard so I’ll compare my next set of lab results with those back when I was doing the keto and let that be my guide.

                One last comment about autophagy… assuming senescent cells are the target, maybe it is better to wake them up rather than destroy them?… to be determined.

                https://www.exeter.ac.uk/news/research/title_620529_en.html

                1. George, thanks for triggering my response to your post. After responding, I tried to think of anything different after the recent 5-day fast and I remember how weak I was during the last day or two of it and for a few days after re-feeding.

                  Then I remembered that glycogen, a stored version of glucose, is found in muscle tissue.

                  It would seem plausible that I utilized my glucose stores quickly and was drawing from my muscle tissue to release more. I don’t have a lot of body fat so maybe… just maybe… in order to feed my body it was required to “eat” more muscle.

                  Don’t know if this is what happened or not, but I think I will hold my next fast (4th of July?) down to 3 1/2 to 4 days. (As is often the case, these little revelations make even the coldest, dreary gloomy days a little brighter ‘-)

    1. Maryam & Ant, they’re working on a series of videos on IF. We’re all waiting patiently, & I’m sure Dr. G & staff will do a thorough job on the subject. Hopefully they’ll be out soon!

    2. “What else similarly slows our metabolism? Caloric restriction, such as eating every other day. This may be one reason why caloric restriction is associated with a longer lifespan in many animals. Maybe like a candle, burning with a smaller flame allows us to last longer. It’s hard to walk around starving all the time, but it’s easy to replicate that same metabolic benefit by eating a big salad every day.” https://nutritionfacts.org/2019/02/07/the-best-foods-to-slow-your-metabolism/?fbclid=IwAR2Z6Oc98qFm2kIjxXQgg2VoV32DudFQlo-OcYrHvF3-2lWsPbrDGmx3RTc

      I’d rather eat a salad than fast. Because I agree with “It’s hard to walk around starving all the time” — or even part of the time.

      The blog ends: “This may be why eating leafy green vegetables is among the six most powerful things we can do to live longer, along with not smoking, not drinking heavily, walking at least an hour a day, getting seven hours of sleep a day, and achieving an ideal weight. Doing even just one of these six may cut our risk of premature death by around 20 to 25 percent.”

    1. Hi Lisa C – Thanks for your question! In Dr. Greger’s video here (https://youtu.be/vMF1mzT0ARM) he uses a Dutch processed cocoa brand named Equal Exchange Organic Fair Trade Cocoa Powder. That would be one option to try out, otherwise it’s always best to opt for brands that are unsweetened and natural (the less processed, the better). I hope this helps!

      Janelle, RD
      Health Support Volunteer & Registered Dietitian

      1. Not to caused panic, but you are recommending “Equal Exchange” brand

        https://www.asyousow.org/environmental-health/toxic-enforcement/toxic-chocolate

        See: “Equal Exchange” included in the quote bellow from the above link

        ” we filed legal notices with over 20 companies, including Trader Joe’s, Hershey’s, Mondelēz, Lindt, Whole Foods, Kroger, Godiva, See’s Candies, Mars, Theo Chocolate, Equal Exchange, Ghirardelli, and Chocolove, for failing to warn consumers that their chocolate products contain cadmium or lead, or both.”

        1. Panchito,

          Soooo on the mark. Great find and we should indicate to everyone reading this that indeed the findings of toxic metals in chocolate is a real issue and remains unresolved . Please go to the website: https://www.asyousow.org/environmental-health/toxic-enforcement/toxic-chocolate and note that even in the 2018 testing the amounts of metals found are completely unacceptable.

          Probably the most disturbing aspect, after the toxic inclusions is their current state of affairs:

          In 2018, our legal efforts culminated in a first-of-its-kind settlement with the world’s largest chocolate companies. In partnership with As You Sow, 31 chocolate companies, including Cargill, Hershey, Mars, and Nestle, have committed to funding an independent expert committee to investigate the sources of lead and cadmium in chocolate, find feasible measures to lower levels of these metals, and evaluate and recommend the lead and cadmium concentration levels in chocolate that trigger Proposition 65 warnings….. Why should it take a warning label to force change ?

          Cocoa is faced with the same issues …. see: http://labs.naturalnews.com/heavy-metals-chart-superfoods-cacao.html for a brand breakdown.

          This certainly suggests purchasing the least contaminated products and becoming as active in changing the situation as possible.

          Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

  4. Yeah, you talk vagley about all oils. So, what oil is safest and healthiest. I’m not going to stop using my Avacado oll or Sesame Oil, but like to hear a video on all oils and alternative butters. I’m currently using a vegan cashew butter. Not sure if it’s a good alternative.

    Please send feedback if all possible. Thank you for all your hard work and all that you do.

    Kind regards!

  5. awesome video and info (always, thank YOU)
    1. is 3 tablespoons of organic raw cacao too much … or heart healthy? (it’s my caffeine in the morning)
    2. can you provide a link to your ice-cream recipe that you refer to please

    1. Not sure if it’s the same recipe as Dr. G but I make chocolate “nice-cream” by whizzing solidly frozen bananas and cocoa powder in a food processor. Process until smooth adding only a tiny bit of liquid if necessary. It’s kept me sane when I NEED dessert ;)

    2. Angie:
      One issue with cacao is that it’s a high-oxalate food. So, if you’re prone to kidney stones, a lot of cacao may not be a good idea.

  6. Great timing, I just made some fudge brownies using cocoa and nothing but healthy ingredients…black beans, sweet potato, oats, flax meal, a little strong black coffee (and cocoa powder), sweetened with a slurry of very ripe plantains, prunes, dates, cinnamon, and a touch of molasses, topped with walnuts and a few dark chocolate chips. Awesome and totally guilt free! No specific measurements sorry, the bulk of it is black beans and half again of sweet potato, the rest to taste then add just enough ground oats and flax to make a loose cookie dough consistency, or a very thick batter. (I also added some baking powder, but I don’t think it did much and next time I’ll omit it). After repeatedly “testing” several spoonfuls of the mix, I baked it for 45 minutes at 375 F. You can eat it warm with a spoon and some cashew cream afterwards if you can’t wait, but you have to let it cool to set completely before trying to cut it into squares, as it isn’t cakey but fudgy. In fact, best to refrigerate first. (I almost made the daily dozen, but ran out of kale and blueberries!)

    1. Vegetater, that sounds delicious! I’m going to try that next weekend! This weekend I’m making halva with some cacao powder. My sister-in-law made it for my brother’s 60th birthday party last year, and it was amazing! They’re visiting this weekend.

    2. Wow, those brownies sound delicious! I eat a lot of those ingredients quite frequently (black beans, sweet potato, oats, flax meal, a little strong black coffee (and cocoa powder), prunes, dates, cinnamon, and a touch of molasses, topped with walnuts) but not in the form of brownies.

    3. Vegetater, you should sell those as a meal!

      In re: your blueberry comment… I’ve found a great ice cream replacement. In a bowl pour in some blueberries (my preference is wild blueberries)… then pour some unsweetened almond milk from the refrigerator over the frozen blueberries.

      Let set for a minute or two while the frozen blueberries turns the almond milk into a cold slush. No need to sweeten as the blueberries seem sweeter when eaten this way. Even in the winter this is good (but chills your insides so wrap up.)

      It will be my go to cool-down dish this summer.

      1. Laughing at selling them as a meal!

        Yes, some of us have done chocolate as a meal – shakes, Slim fast, Atkins meal bars, etc.

        Not in a while but I used to like the simplicity of it.

        So it isn’t a bad idea for someone doing a special meal brownie.

    1. Watch the mental effects after a week or so (accumuation). It could be very difficult to point to think of the beans as a mental problem when they are supposed to be good for you.

    1. Hi I’m a RN health support volunteer. That is a great question. Dark chocolate would have sugar and other things added to it so it would not be a whole food. I would place is as a “yellow light” food on Dr. Greger’s traffic light system. So it should be consumed in limited quantities. Cocoa powder which does not have anything added to it would be a “green light” whole food.
      https://nutritionfacts.org/video/dining-by-traffic-light-green-is-for-go-red-is-for-stop/

      NurseKelly

  7. I will go real basic here. So I consume a teaspoon of cacao nibs and after an hour my artery function has spiked up and an hour or two later is back to normal. So now what? Am I striving to stay in spike land and keep consuming cacao nibs? How do i know if my artery function is already hunky dory. Is this just something I do before watching Wayne’s World II?

    1. after an hour my artery function has spiked up and an hour or two later is back to normal. So now what? Am I striving to stay in spike land and keep consuming cacao nibs?
      ———————————————————————————————————
      Keeping my arteries open as long as possible is an objective of mine also.

      My approach is to, in addition to dark 100% cacao, drink a swig or two of beet root juice throughout the day and especially before retiring at night. I also take a krill oil softgel at night as I’ve read omega 3’s at night helps reduce the prime time (during the night) heart attack risk.

      1. Lonie that’s interesting, do you have a reference for “omega 3’s at night helps reduce the prime time (during the night) heart attack risk”?

        Why is this heart attack time? I’d heard first thing in morning is common (from some Dr talk, I forget who?) Influenced by work stress, especially on a Monday (?). So drink water before bed and sleep in on a Monday? Ok now Im joining the lazy commenters, sharing stuff I’ve heard without bothering to look it up 1st. A cup of cacoa (with plant milk & omega 3 pill?) before bedtime? “Please excuse the super dose of cadmium”. A beetroot cacao smoothie before bed, or drink half and keep the rest by the bedside to finish just before (how many minutes) rising?

        1. Lonie that’s interesting, do you have a reference for “omega 3’s at night helps reduce the prime time (during the night) heart attack risk”?
          ————————————————————————-
          Hey Fan,

          I’m hoping I saved a link to that info… will spend time tonight looking and if I find it will post it.

          Interesting that your source said Mondays due to work stress. Sounds plausible for someone still in the workforce. Maybe our two sources are studying different cohorts.

          In re: the cup of cocoa before bedtime made with plant milk and an omega three pill? Every now and then I personally do something similar but with my cacao pouder I add a lot of other powders… too many to mention without going to my pantry and listing them. ‘-) But I’m not overly concerned about the cadmium or other metals that may be in the powders due to a link in a previous comments section suggesting adults do not absorb much of them… plus, I regularly add cilantro leaf/chlorella drops to my teas throughout the day and evening as a Heavy Metal Detoxifier.

          As for the beet root liquid intake, it is my understanding it takes about an hour before it completes its journey from the stomach back up to mix with the saliva in the mouth (just repeatin’… not ‘splainin’ how ‘-) to create the Nitric Oxide that purportedly keeps the arteries open for at least 5 hours, so that should last a total of about 6 hours after consumption. If one gets up during the night for a bathroom break as I do due to heavy tea consumption during the evening, I suppose another swig of beet juice could be a good insurance move, but my thinking is that you don’t lose the protective effect immediately and barring severe artery disease, may not be necessary.

          IIRC, the omega 3 pill protects against sites on the blood vessels that may cause platelet aggregation, leading to a blood clot.

          Oh, and for me personally I also take a White Willow Bark vegi-cap before bed due to the fact it holds down platelets in the system. Platelets of course rush to an injury to affect repairs, but my own personal experience when I have a scratch on the arm from pruning branches for instance, suggests that there is no excessive blood flow and the scratch is effectively sealed (from platelets?) quickly.

          This is to me very telling as White Willow Bark contains acetylsalicylic acid which is where aspirin is from. But it is my opinion, derived from others, that aspirin is a dangerous drug while the natural White Willow Bark is a natural and safe consumable.

          In my case I also take things like a magnesium vegi-cap, Alma and chamomile vegi-cap plus a Naringin supplement to prevent Alzheimer’s Disease. No need to just guard against just one health insult and leave yourself open to others. ‘-)

          1. Thanks Lonie, I was considering someone who works too hard under pressure.

            I immediately thought White Willow Bark, that’s natural aspirin, wonder how it works with occasional headaches. I usually try to avoid all headache tablets although aspirin seems to be the safest one, take after food

            I put magnesium on skin to absorb now and then. Any other supplements I take only occasionally, except B12 I take regularly

            1. Fan, I found the link to the research about heart attack danger… seems it is for patients who already had heart disease (which makes sense since they are probably most at risk of a heart attack.) On my own I substituted krill oil supplements for the referenced fish oil in the article below:

              “The study, published in the journal Circulation Research, looks at a group of recently discovered molecules, known as specialised pro-resolving mediators (SPMs), which are produced from omega-3 fatty acids, the same fatty acids found in fish oils. SPMs are involved in controlling both white blood cell and platelet behaviour during inflammation, allowing the body to heal itself. … In healthy people, they found that the SPM level increased during the early morning hours and helped keep in check the behaviour of both white blood cells and platelets in the blood vessels.

              In patients with cardiovascular disease, however, the production of these SPMs was significantly impaired, and associated with a marked increase in blood cell activation and the formation of clusters of white blood cells and platelets which can contribute to clot formation and blood vessel inflammation.”

              https://www.eurekalert.org/pub_releases/2018-03/qmuo-nii030818.php
              _____________________________________________________________________________
              I immediately thought White Willow Bark, that’s natural aspirin, wonder how it works with occasional headaches. I usually try to avoid all headache tablets although aspirin seems to be the safest one, take after food
              —————————————————————————————————-
              Now that you mention it, I no longer have headaches for decades and while it may not have been immediate, I think I quit having them once I stopped any and all NSAIDs for when I would have a headache.

          2. The dark green Arugula is probably just as good as beetroot juice in keeping nitric oxide levels high and blood vessels supple. Why not chew on some of that every few hours? Spinach is not far behind in those properties either. Arugula and spinach are also easier to find, cheaper, and more convenient to store and carry. I also prefer the taste of arugula and spinach to that of beet juice.

    2. Gregory Overcashier, cacao nibs are not the same as cocoa powder. They are very high fat though you say you consume a very small amount . (1 tsp) . For 1 ounce of nibs, there is
      130 calories, 110 of which comes from fat – most of that being saturated. (this is no doubt why I like them so much!)

      https://nutritiondata.self.com/facts/custom/933596/2

      I , myself, am concerned with artery /heart functioning, and do not consume nibs at all :(
      The cacao powders have had the fat removed

      I have heard wfpb people say in the past that even high percentage dark chocolate bars cause their cholesterol to rise. Just something to consider…

    3. Hi Gregory Overcashier,

      I am a volunteer for Dr. Greger. Thank you so much for your question.

      This is a very interesting question, without, perhaps, a definite answer. However, the goal is to eat a healthy diet and engage in other healthful lifestyle activities, like exercise, which will keep your artery functioning at a consistently higher level. You do not need to compulsively and consistently eat antioxidant-rich foods every hour or 2. However, if you know you will be sitting for a prolonged period of time, it may be beneficial to eat high-antioxidant foods like cocoa, green tea, berries, or greens.

      I hope this helps answer your question.

  8. Somewhat off topic – a question about STEVIA. The jury was in – in 2010 – that 1.8 mg/lb body weight or less was harmless. Some new products of sweeteners include Stevia in a mix, without disclosing the amount of Stevia in a 1 mg packet. I was in touch with a particular company, but they refused to reveal their “proprietary secret”. Can I assume that the same caution about Stevia is still in place and that one should desist buying these ill-defined mixes?

    1. You did view the NFO video on Stevia, right? https://nutritionfacts.org/video/is-stevia-good-for-you/ I tried to search for updated research (beyond 2010) but there was no clear updated recommendations regarding safety of dose or clarification regarding hazards with Stevia in a mix, as you’ve indicated.There was confirmation that Stevia products may not be totally safe, especially if not made with only Stevia (https://www.ncbi.nlm.nih.gov/pubmed/30287064/ Nine Stevia extracts and one drink were not compliant with the European Regulation.)
      I found one updated 2018 statement about Stevia beyond the 2010 date (https://examine.com/supplements/stevia/ Summary of Stevia Primary Information, Benefits, Effects, and Important Facts, but there were only a few studies in 2012 that were added for review, and not all were human studies, nor did this statement give specific guidance on dose. So your assumption that the same caution about Stevia is apt and your decision to reisist buying ill-defined mixes is wise.

  9. Funny Friday. I present to you: The shipwreck

    The SAD (standard American diet is a shipwreck. The shipwrecked people are left floating and looking for a floating branch. This “branch” is the ideology that will rescue them. But this sea also has sharks lurking around. The sharks offer ideological “branches” to brace onto. Believe or not, the best thing ever that can happen to you is to learn you are in an ideological shipwreck. Because only then you will be in real control.

    1. Is it possible to stick to related medical and food questions and sharing on-topic researched answers only, not soapbox grandstanding. Too much noise (people mistaking the platform for a personal chatroom) make a barrier to good health for other readers who come here to learn. Many of the comments are educational and important for improving health, but it’s always easier to give up without wasting time wading through miscellaneous chatter that sometimes clogs up the forum. I think the moderation should delete random offtopic chatter as the NOISE of numerous random offtopic remarks can actually stop people from improving their health. I’ve sent people to this website for specific healthcare information, but they’ve just given up as they found there was too much noise. Sad.

        1. Can someone please answer the question about the amount of cocoa or dark chocolate Dr. G. Is referring to in the video that helps artery function.

          1. Holly, I’ve read lots of research on Dark Chocolate… even health/cooking blogs and have seen a lot of concern from those last ones over gaining weight. I put little stock in those ’cause as with anything added to a diet requires something else to be reduced in amount or even eliminated.

            The one thing I remember someone saying was to eat dark chocolate at least 5 times a day. As I recall, they did not offer anything that backed that up, but since I want to keep my arteries open and add epigallocatechins to my diet to complement my green tea intake, I was doing at least that much already so they were preachin’ to the choir so-to-speak.

            To sum up, I have no idea what is optimal dark chocolate intake.

        2. Actually, off topic chatter, stories stemming from personal experience are welcomed so long as people are engaging in a polite and respectful manner. Sources are to be provided where medical/nutritional information claims are made. I understood that the forum was for everyone to enjoy. Maybe NF has changed their format?

        3. “Fan,” one person’s so-called noise could be another’s “Hmmm, what an interesting tidbit! I’ll check into that further…maybe that’s the answer I’m looking for!”

          Who are we to judge what might be helpful to somebody else. Also, who are we to judge what is considered strictly within the realms of “on topic.” For one, it could be a very narrow corridor indeed. If y’get my drift.

      1. My post is about the topic of diets. What you are saying is that only conversations can flow towards the direction of a more specific topic. Thus, the minerals of chocolate are more specific than chocolate. But you could go the other direction too, and talk about where chocolate fits on a diet and also where diet fits on its parent topic. What is wrong with thinking outwards?

      2. Is it possible to stick to related medical and food questions and sharing on-topic researched answers only, not soapbox grandstanding. Too much noise (people mistaking the platform for a personal chatroom) make a barrier to good health for other readers who come here to learn. Many of the comments are educational and important for improving health, but it’s always easier to give up without wasting time wading through miscellaneous chatter that sometimes clogs up the forum.
        ————————————————————————————————————————-
        Fan, I’m both pro and con your statement.

        That is, some of my best teachers were able to weave a little humor and a lot of off-topic into their lectures and there were more people paying attention in their classes than sleeping. That’s the pro.

        The con is when people get their panties in a know and post a long-winded rebuttal with no on-topic facts. But as long as they post a one or two sentence “back-atcha” I can read those quickly, chuckle, then move on. Offers a break in the often dull data. ‘-)

        1. “The con is when people get their panties in a know”
          ______________________________________________

          Should have been “panties in a knot” ‘-)

        2. I think that opinions don’t have to be necessarily encyclopedic or have an specific educational purpose. Classification systems have unspoken biases and thus flawed in some way. The chocolate topic may have to do with the upcoming next week date. I’ll confess that sometimes I open my mouth with thinking ahead or about the unexpected effects. But I am not perfect and I don’t know what is that.

      3. Fan, people complaining about others in this forum are merely adding to the so-called ‘NOISE’. Especially when the so-called offenders aren’t breaking any of the rules of comment etiquette.

        1. The site is well constructed in the sense that it gives the resources the video is based upon… if anyone wants to source the crowd (comments section) then they just have to wade through what is characterized as noise to get the occasional nugget of gold (information they seek.)

      4. And, Fan, remember skimming? I think most of us learned how to do it in 4th grade. You should try it sometime instead of giving up so easily. And it’s much more friendly than trying to censor everyone else in this forum.

      5. WFPB Fan,

        What I have found is that useful comments only happen in socially engaged communities and that bonding only happens with some degree of personal sharing.

        If you look at Dr Greger’s other sites, most of the comments are not engaging or useful. It is a community which likes each other who does the type of interaction which is happening.

        If you look at ALL of the WFPB doctors sites comments, useful comments only happen when the useful people are interacting with passionate people.

        If you join into a topic late, it can be daunting to wade through, but I just did and everybody was doing nutrition facts topics.

        Nobody was talking politics or sports or travel or art or whatever.

        These people are the most passionate group that I have found and I am saying it as someone who searches for passionate and helpful people who are interested in the science.

        I have gone on pre-med sites and these people here love WFPB and talk WFPB every day and when I went back to videos from 5 years ago, it still was the exact same mix of passion for science and passion for health and social comments.

        That is so hard to find anywhere.

        1. I know you would probably like most of us to get out of the way so you could see what Tom says, but it is fairly easy to scroll and look for the people you like.

          I have been stuck over at YouTube desperately missing all of the passionate people on this site.

          And I find I miss the recipes and the personalities and jokes and kindness and passion most of all.

          The moderators provide the most useful comments, but it is the people who I scroll looking for.

          1. The bigger thing is that Doctor Greger and the moderators comments are easy to find and they are the ones who will be useful.

            Other than that, for research and learning purposes, comments aren’t the right place to learn. If you Google any topic, there will be tons of articles by professionals and there are tons of YouTube Videos by Dr Greger and other doctors.

            If you bring up any comment, people will engage you, but there is no guarantee of that. If you bring up the topics on YouTube, people might call you names and make fun of you and that just is the culture.

            I just think comments are more like flea markets. Telling the people selling their stuff, if only you had better quality junk isn’t how flea markets work. Comments aren’t for advice or education because it is the part outside of the official site’s control unless they want yo micromanage whether people can bring up recipes or off topic health things or whether to scold them for making jokes.

            1. The fact that he doesn’t interfere with the anti-WFPB bullies on YouTube, I don’t think he wants to put his time and money and resources and volunteers time that way.

              1. If it was a classroom lecture, I would agree with you.

                I used flea market on purpose because stores tend to have lots of rules and order. There are professional flea markets and people can sell almost anything but they pay to be there and that tends to also have a degree of order, so do estate sales if a bank is putting it on, but if you drive through the neighborhoods passionately looking for garage sales and yard sales, anything at all goes. YouTube is more like that by nature. This is more like a flea market and only because professionals show up and moderators will answer your questions, so if you have questions, you reach past all of us and reach out to the moderators and you won’t havd to wade through anything at all. Only if you want to.

                1. If it was a discussion board arranged by topics, then it would make sense, but nobody comments on old videos.

                  Most people would never have their topics ever come up and might never have anybody respond to them if they went back to videos posted 4 or 5 years ago to stay within topics.

                  Plus, Dr Greger has invited people to request topics on these daily comments.

                  It is how he gets feedback of what people want to talk about.

                  1. If he limited it to comments of topic, we each would have a unique experience, rather than collective.

                    We would be interacting with people who commented 5 years ago, while someone else interacts with people maybd who left the site 2 years ago, and many people would never be responded to. Dr McDougalls site was like that. You could post a question and nobody responded, then you get a response 2 months later.

                    YouTube already is already often like that.

                    Five years from now, someone will have cancer and want to talk about Apricot kernels but it won’t be covered again.

                    And Dr Greger has moderators, but he probably isn’t looking at the nuggets from the rest of us because we aren’t professionals.

                    1. I think we are the gut microbiome and the fact that you are finding butyrate down in the comments is a miracle, not a guarantee. I don’t think you can separate butyrate from gut microbiome bacteria and waste products. If Dr Greger keeps feeding us, we can produce butyrate, but it is a messy process.

                      In Christianity, there was someone who wrote that you don’t have poop-less cows. That concept was about if you want the milk, you need to put up with the cow poop, which is a ridiculously not-vegan friendly analogy, but if we all separate to our individual topics, we stop the collective interaction and less butyrate gets produced.

                      Plus, this is a community where people come in with no good gut bacteria at all and they need a fecal transplant and nobody wants to hear about it, but this is not Dr Greger interacting with doctors or students or even people committed to WFPB, it is Dr Greger letting the public come in and some of them will not know science or nutrition or anything, which is where I was a year and a half ago.

                    2. And, yes, my milk doesn’t come from cows, but the other way they would say it is:

                      Church would be perfect except for the people.

                      I searched for a church without hypocrites, but every time I showed up, I found one.

  10. Yes WFPB fan, I completely agree with you. I have given up many times which is a shame because some comments are helpful, as is clarification by the volunteers. As folk do like to be friendly, then perhaps they could form a forum or facebook group or exchange emails to chat.

  11. Can unsweetened chocolate be regarded as a whole food? A cocoa bean contains cocoa butter, right?
    The ingredients for the unsweetened chocolate are: Cacao mass; cacao butter; 100% cacao. (Not sure I understand this – don’t know how much mass or butter it contains if it is 100% cacao!) (The brand is Cuisine Camino). Thanks!

    1. Hi Beth Barron – Thanks for your question! Unsweetened chocolate would technically not be considered a whole food because it has still be processed to some extent. You are correct that a cocoa bean contains cocoa butter. That is why the best way to reap the health benefits of cacao beans is to choose unsweetened cocoa powder, which does not contain fat or sugar.

      The unsweetened chocolate product you’re referring to is a type of dark chocolate that is 100% cacao-based, but it does also contain some fat coming from the cocoa butter. Dark chocolate can still serve as a nutritious treat, especially compared to milk chocolate. I’d encourage you to also try incorporating some of the cocoa powder (natural or the Dutch varieties) that the Cuisine Camino brand also offers. I hope this helps!

      Janelle, RD
      Registered Dietitian & NutritionFacts.org Health Support Volunteer

      1. Janelle – thank you so much for your reply. I was thinking in terms of the “nothing good removed, nothing bad added” definition of Whole Foods. In that sense, seeing as the bean contains cocoa, cocoa mass and cocoa fat, perhaps unsweetened chocolate, containing the same ingredients, could be considered a whole food? An avocado is a whole food, despite containing fat. (I realise that for optimal health benefits it is better to eat the “processed” cocoa powder rather than the “whole foods” bean (or unsweetened chocolate?) in this case.
        Thanks again to all of you.

    2. Can unsweetened chocolate be regarded as a whole food? A cocoa bean contains cocoa butter, right?
      The ingredients for the unsweetened chocolate are: Cacao mass; cacao butter; 100% cacao.
      ———————————————————————————————–
      Beth, your question implies a possible unwillingness to eat something GRAS (generally recognized as safe) and healthful if it means going outside the WFPB definition.

      I get that adhering to WFPB is important to many, but I don’t think it hurts to color outside the lines once in a while. ‘-)

  12. No. Chocolate is not a “whole food” but I am not the person that coined the term. I will also say that I see nothing wrong with not being whole food.

  13. That light brown concoction in the pic up at the top looks suspiciously like milk chocolate, not dark chocolate. Milk chocolate is a no-no.

  14. While the arterial function benefits are undeniable, is it really a good idea to look at one isolated function when working with nutrition science? Shouldn’t the collective effects be evaluated across all affected areas of physiology, including mental effects? While something may appear to benefit in one area, the combined effects on other areas might be detrimental overall.

  15. Jonathan Bleeker, this video is just a small presentation of the evidence for the effects of chocolate on arterial function. Dr Greger has many many videos on the topic of chocolate, and you can view the collection here https://nutritionfacts.org/topics/chocolate/
    These videos are often not meant to cover a complete assessment of a particular food… usually they present one idea, though there are introductory videos about wfpb eating for example, that are basically a broad overview.

    1. Holly, off topic comments are accepted in this forum. I suggest you read the community guidelines under the etiquette tab. There are no draconian rules here.

      Hope you enjoyed the information in the video.

      1. hi Nancy, yes agreed, in all the (many) years I have been reading NutritionFacts, the forums have encouraged respectful discussion and off-topic questions. Lately there has been postings by persistant peeps complaining that we straying from the topics featured in the daily video, and also wanting a concise summary of “recommendations” from Dr Greger regarding their presentations.

        I believe they miss the point. It is my understanding that Dr Greger has already given his recommendations within the framework of the Daily Dozen, and his page on supplemental b12, vit D etc. So, it’s up to us to slap those pages up on the fridge as a guide to our daily culinary adventures. The videos for me are not designed to be recommending anything specific usually, but more about showing “what plants can do” ie learning about the science behind the Daily Dozen. Cocoa is good, but so is coffee. Blueberries are good, but black raspberries and others are better and if people get that myopic about it they will miss the forest for the trees.

        Anyway Nancy, I really enjoyed hearing about your successes with the Daily Dozen. I probably fall short on daily beans consumtion more than anything, though lentils and chickpeas I find easiest to include lately. I’m going to cut down a bit on fruit and up the veg next. Thanks for your inspiration!

          1. I don’t mind that people want to communicate that they would find us more useful if we stay on topic.

            I just sense that next year, thousands of people could suddenly show up and you can’t micromanage the comments.

            Dr Greger has created a special atmosphere and people are so passionate and interested and most people seem to be enjoying each other.

            Some of us, like me could shut up more, but of all of Dr Greger’s sites, this is the only one which bonded passionately and people are sharing enough to bond, but every single day everybody goes back to the science and that is do special.

            Nancy, you taking the Daily Dozen challenge is special!

            I am doing most of it. Eating the beans is the easiest part. I still keep forgetting the flaxseeds.

            1. Fan,

              I want to apologize to you for writing too much, even now.

              I don’t want you to feel ganged up on.

              I have brain problems and over-process information and I know that this site is useful to me more because people are social enough that I like them and trust them and understand who they are and what their biases are so that I canevaluate their information.

              You find the opposite thing useful and I am sorry that I have spent too much time trying to present it from my side.

              Purely intellectual sites are more intimidating to me and feel colder and less safe and I don’t tend to learn as much.

              Please forgive me for challenging what you were communicating too much because I don’t want you to feel not welcome either.

              Next year, there might be too many comments for any of us to read. Some year, it is likely to happen. Some year, Dr Greger could close his comments completely or limit each of us to 30 words – busy doctors do that.

              I wave a white flag and say that I already am only writing when something comes up and I will try to not give my side next time you give your side.

              Peace to you.

              1. Eventually, the young culture will take over all of it and they will value different things than both of us.

                1. Deb, you are an inspiration to many of us! I’m so glad your dog is still alive! That is one lucky dog! (Lucky to have you taking care of him!)

        1. Agreed, Barb. I see it as Dr. G & staff making suggestions & giving a framework with the DD but not giving advice.

          I missed my oatmeal the other day (Friday?), so was back to square one on the flaxseeds. This time my goal will be 35 days or more!

  16. Do all forms of sugar and fat negatively affect the study results in the same way? For example, are brownies made with nuts and nut butter for fat and dates for sweetness red, yellow, or green light foods?

    1. This is an excellent question.

      Desserts made with those ingredients are richer in nutrients although they are still high in calories which does not make them a good choice for people trying to loose weight.
      This healthy dessert is for occasional days as other desserts.

      I hope this helps.

      Yared, Health Suppor Volunteer

  17. Dear Dr. Greger,
    thank you for your great work. Your scientific approach in advertising a vegan lifestyle, convinced me 5 years ago to switch from my then ovo / lacto vegetarian diet to vegan.
    Intermittent fasting is becoming more and more popular lately, do you have any new information about fasting combined with a plant based diet?
    Intermittent fasting is often recommended in combination with a low carb or ketonic diet which I think is a diet you would not propagate.
    Kind regards
    Hans Fusswinkel

    1. Hans, Dr. G has mentioned that they’re working on a series videos for intermittent fasting. We’re all waiting patiently & hope to see them soon!

  18. Question regarding cocoa powder and improved arterial function.
    I believe that Viagra (Sildenafil) is used because it improves blood flow. One research paper I found from 2002 for FMD increase of 15% using 25mg Viagra (Diabetes Care. 2002 Aug;25(8):1336-9.) – I don’t have the full study but it appears that 9% improvement was the baseline from the placebo – so about 6% improvement related to the drug effect.

    The papers presented here suggest ~5.5% improvement in FMD with the highest intake of cocoa. Is this comparable in reverse? Would 26g of cocoa have erectile dysfunction effects similar to low dose Viagra?

    1. aidanWM, it depends on how the cocoa will be used, and also each manufacturer could have a proprietary process, but in general I think cocoa is fermented, roasted, had the cocoa butter removed and is ground. Dutched cocoa powder has also had the ph adjusted for a smoother taste. Most cacao beans are fermented.

      I buy cacao beans and grind them myself in a coffee grinder.

    2. Hi aidanWM – Thanks for your great question! The difference can often be very confusing, especially when there is not complete agreement on when to use each of the terms.

      In general, raw cacao is the term used to describe ground up raw cacao beans that have not been roasted. After the raw cacao is roasted, the term “cocoa” is generally then used. Here is one link that goes into more detail that you may find helpful! https://www.healthline.com/nutrition/cacao-vs-cocoa#terminology

      -Janelle RD – Registered Dietitian & NutritionFacts.org Health Support Volunteer

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