A growing number of clinical studies have shown that the regular consumption of flavanol-rich cocoa products is inversely associated with coronary artery disease incidence and mortality. Beneficial physiological effects linked to cocoa and chocolate include: high antioxidant activity, vascular vasodilation, blood pressure reduction, inhibition of platelet activation and aggregation, and decreased inflammation.2-4 Recently, it has been reported that chocolate may also have beneficial effects on mood5;6 and cognitive performance.7
The aim of this study carried out by researchers at the University of Oulu, and University Hospital in Oulu, Finland was to assess the role of chocolate on health and psychological well-being among elderly men.
This study was conducted via a postal survey sent to the survivors of a 1964-1974 study that evaluated cardiovascular risk factors in a cohort of healthy men born in 1919-1934. In 2002-2003, 1,374 men with an average age of 76 years responded to a survey that included questions about psychological well-being as well as questions regarding their frequency of candy consumption their preferred sugar confectionary (chocolate, licorice, other candy).
Of the survey respondents, 108 men reported that they did consume candy. Of the 1,259 men who reported they did consume candy, 860 preferred chocolate while 399 preferred other sugar confectionary.
Although not all differences in responses to questions related to psychological well-being and attitudes towards life were statistically significant, the data clearly demonstrated a better sense of overall well-being in the chocolate group as compared to the other candy group. Consumers of chocolate rated their health significantly better, felt themselves happier and less lonely, and had a better ZUNG depression score (a self-rated depression scale that is widely used in epidemiologic studies). Those respondents who preferred chocolate also reported more often to have plans for the future when compared to the other candy group.
The results of this study suggest that elderly men who consume chocolate in preference to other candy have better health and psychological well-being.
Although these findings did not stem from a study involving patients with heart failure, the clinical implications of cocoa/chocolate for patients with heart failure are noteworthy.
Many studies have shown that clinically significant depression is common in patients with heart failure. The prevalence of depression among patients with heart failure is estimated to be as high as 1 in every 5 patients, a rate higher than expected among other elderly, chronically ill patients.8 Furthermore, co-morbid depression has been linked to several adverse outcomes in this patient population, including an increased risk of mortality, more severe heart failure symptoms, increased functional impairment, increased hospital readmission, as well as poorer adherence to medical regimens.8;9
A recent study by Macht et al.5 demonstrated that consumption of a small amount of paletable chocolate (5 grams) has the potential to improve negative mood immediately.
Another serious, but less frequently investigated, aspect of the quality of life of patients with heart failure is cognitive functioning. A systematic review and meta-analysis including 2,937 heart failure patients and 14,848 control subjects revealed a 62% increased risk of cognitive impairment in patients with heart failure. Significant reductions in memory, attention, and mental flexibility scores were noted in patients with heart failure compared to controls.10
The consumption of cocoa flavanols has been demonstrated to positively influence a number of physiological processes, including endothelial function and cerebral blood flow, that can improve cognitive function.11;12 Scholey et al.7 recently reported results from a double-blinded, placebo-controlled, crossover study showing that participants consuming dairy-based cocoa drinks containing 525 mg or 994 mg of cocoa flavanols significantly improved mood and cognitive performance on mentally demanding tests when compared to participants who consumed a matched control drink.
The pathophysiological relationship between cognitive impairment, depression and heart failure is becoming well-recognized. Given the evidence suggesting significant improvement in cognitive function and mood among patients who have received clinical treatment10, the beneficial effects of cocoa/chocolate, especially as part of a therapeutic strategy for the treatment of heart failure, is promising.
- Strandberg T, Strandberg A, Pitkala K et al. Chocolate, well-being and health among elderly men. European Journal of Clinical Nutrition 2008;62:247-253.
- Engler MB, Engler MM. The Emerging Role of Flavonoid-Rich Cocoa and Chocolate in Cardiovascular Health and Disease. NUTR REV 2006;64:109-118.
- Katz DL, Doughty K, Ali A. Cocoa and chocolate in human health and disease. Antioxidants & Redox Signaling 2011;15:2779-2811.
- Shrime MG, Bauer SR, McDonald AC et al. Flavonoid-Rich Cocoa Consumption Affects Multiple Cardiovascular Risk Factors in a Meta-Analysis of Short-Term Studies. The Journal of Nutrition 2011;141:1982-1988.
- Macht M, Mueller J. Immediate effects of chocolate on experimentally induced mood states. Appetite 2007;49:667-674.
- Parker G, Parker I, Brotchie H. Mood state effects of chocolate. Journal of Affective Disorders 2006;92:149-159.
- Scholey AB, French SJ, Morris PJ et al. Consumption of cocoa flavanols results in acute improvements in mood and cognitive performance during sustained mental effort. J Psychopharmacol 2010;24:1505-1514.
- Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in Heart Failure: A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes. J Am Coll Cardiol 2006;48:1527-1537.
- Johnson TJ, Basu S, Pisani BA et al. Depression Predicts Repeated Heart Failure Hospitalizations. J Card Fail 2012;18:246-252.
- Vogels RLC, Scheltens P, Schroeder-Tanka JM, Weinstein HC. Cognitive impairment in heart failure: A systematic review of the literature. European Journal of Heart Failure 2007;9:440-449.
- Fisher NDL, Sorond FAM, Hollenberg NKM. Cocoa Flavanols and Brain Perfusion. [Article]. Journal of Cardiovascular Pharmacology 2006;47 Supplement 2:S210-S214.
- Francis STP, Head KB, Morris PGP, Macdonald IAP. The Effect of Flavanol-rich Cocoa on the fMRI Response to a Cognitive Task in Healthy Young People. [Article]. Journal of Cardiovascular Pharmacology 2006;47 Supplement 2:S215-S220.