Healthy hot cocoa

Natural (not dutched, or processed with alkali) cocoa is chock full of antioxidants. Plenty of recent studies show that even moderate increases in cocoa consumption can reduce the risk of heart attacks and stroke.

But most of the ways of eating chocolate are full of sugar and fat. And the forms of chocolate and cocoa we like the best have been processed with alkali (dutched), to make them less bitter -- and that destroys some of the antioxidants.

But if you enjoy a cup of black coffee, you can enjoy a cup of black cocoa.

Just stir a tablespoon of natural unsweetened cocoa powder (Hershey's or Ghirardellis are easy to find) into eight ounces of warm water or warm milk. Add a little cinnamon if you like, up to 1/8 of a teaspoon, for an extra burst of sweet flavor, and even more antioxidants.

Too bitter? Add some of your favorite low-calorie sweetener, like stevia (truvia and other brands), or your favorite sweetener packet.

This warming drink won't throw off your calorie count or your blood sugar. In fact, it can help your body regulate its blood sugar, reduce inflammation, and help fight arterial disease.

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How to Eat More Chocolate for your heart, part II

I'm an avid read of Monica Reinegel's NutritionData Blog, because I love data about nutrition. As I was reading Eating chocolate for your heart, I noticed a comment from another of her readers, asking Monica for more information about which brand of chocolate is best for the heart. I had asked myself the same thing a few months back, so I posted my own comment, as chock full of references as cocoa is chock full of useful flavanols. Which the website immediately rejected as spam, on account of all those useful links. A comment like that probably belongs on my own blog. So here it is. In How to Eat More Chocolate for your heart, I decided the easiest way is simply to stir a tablespoon of unsweetened natural cocoa into a bowl of oatmeal or a mug of hot water or milk one to three times a day, for 200 to 600mg of cocoa flavanol (CF). This is because:

• 1 T (5g) Hershey unsweetened natural cocoa PROBABLY has about 200mg CF and 20 Cal, and you can drink it like coffee.
• 1/2 ounce of baking chocolate (100% cacao) PROBABLY has 230-300mg CF and 70 Cal, but it is not much fun to eat.
• 1 1/2 ounces of Ritter Sport Halbbitter (50% cacao) has 200mg CF and 200 Cal -- delicious, if you aren't worried about the extra sugar/fat calories.

I found this out by searching on "cocoa", and "antioxidant". I saw answers at the USDA, pubmed, the American Cocoa Research Institute, Hershey's, and Mars. I learned words like polyphenol, flavan-3-ol, flavanol (not to be confused with flavonol), and proanthocyanidin. I read chocolate-makers' websites, requested research papers they cited at their websites, and asked about the flavanol content of their products. And then I had to make some sense of it.

• Hardly anybody will give you even an approximate flavanol content for their product if it isn't already on the package. It costs money to test flavanol content. It must cost even more to assure that a product always has a certain minimum flavanol content. It might cost them a lot to say a product usually has a certain flavanol content, then get sued when a certain batch had less.
• A paper from Arkansas gave me my best rule of thumb -- as long as the cocoa isn't dutched, the content of antioxidants is proportional to the percentage of nonfat cocoa solids (NFCS) in the product. That's pretty simple. A Hershey PR rep. sent me a copy of the paper, and I found out how much NFCS and antioxidants were in a number of unidentified grocery-store products.
• The USDA has produced a proanthocyanidin database, that shows that cinnamon, grape seeds, and cocoa are highest in proanthocyanidins
• Ritter Sport shared the CF content of their Halbbitter bar with researchers in 2004 -- about 500mg CF per 100g.

How to Eat More Chocolate For Your Heart

Red wine with that burger, please -- study shows flavanols can neutralize some bad chemicals right in the stomach.

Edited 5 Feb 2009 to fix broken links

References

• Gu et al. Concentrations of proanthocyanidins in common foods and estimations of normal consumption.J Nutr. 2004 Mar;134(3):613-7.
• USDA Proanthocyanidin database http://www.ars.usda.gov/Services/docs.htm?docid=5843


• The Hershey Company. Antioxidant activity and polyphenol and procyanidin contents of selected commercially available cocoa-containing and chocolate products in the United States. J Agric Food Chem. 2006 May 31;54(11):4062-8.
• Gu et. al. Procyanidin and catechin contents and antioxidant capacity of cocoa and chocolate products. J Agric Food Chem. 2006 May 31;54(11):4057-61. Hershey emailed a copy on my request.
• Taubert, et al. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA. 2003 Aug 27;290(8):1029-30. (Cocoa polyphenol content of Ritter Sport Halbbitter)
• Taubert et al. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med. 2007 Apr 9;167(7):626-34
• Aron, et al. Flavan-3-ols: Nature, occurrence and biological activity. Mol Nutr Food Res. 2008 Jan;52(1):79-104 -- A review of the chemistry and health effects of flavanols.

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Cocoa after every meal?

As I learned while writing a post two weeks ago, a lot of damage to your arteries can get done right after a meal. When your blood sugar goes way up after a meal, the insulin level follows, and after that your triglycerides go up, and your blood gets "thicker". At the same time, free radicals form, which can cause cholesterol to oxidize, which can lead to arterial plaque. And inflammation can cause plaques to rupture. A ruptured plaque is what caused Tim Russert's heart attack. A ruptured plaque could just as well cause a blockage in an artery of the neck or head, which could cause a stroke...

So, to reduce the risk of a heart attack, it seems like it would be a good idea to reduce plaque formation, and reduce the risk. And, if a lot of this dangerous oxidation and inflammation is happening right after meals that cause a rise in insulin, it would seem that anything you could do to reduce blood sugar or insulin or high blood pressure or triglycerides or inflammation or oxidation would help you a lot. Which is why I wonder, when I read the abstracts of some of the clinical trials of cocoa, chocolate, and cinnamon, exactly when everyone is eating their chocolate. Because it seems to me that the time you need the anti-oxidant the most is when you've got the worst threat of oxidation. And the time you need the insulin mimetic in cinnamon the most is right when you're getting that spike in blood sugar. The time you need something to relax your blood vessels in just when they're getting tense. That seems like a fair series of hypotheses.

I'd like to see someone do a meta-analysis of the papers to see if there is any correlation between when the particiapants are consuming their cocoa or cinnamon supplements and how much effect they get from it. Maybe the difference wouldn't show up in a short-term study.

But, if bad metabolism after meals really increases the risk of coronary artery disease, then maybe a long-term study of coronary artery disease progression and cocoa consumption would turn something up. And, if a little red wine with a meal can counter the oxidation chemicals in a meal, then why not a cup of cocoa, containing 200mg polyphenols after the meal? And why not a little cinnamon after the meal?

I'd like to see a clinical study of the effect of having 200mg of polyphenols during or directly after each of the main meals of the day. Three meals, 600mg in a day. Still less than the Kuna people drink, but quite a lot none the less.

Makes me wish I lived near one of these groups doing cocoa or cinnamon studies. Wouldn't it something to get involved in designing one of those experiments?

Because either cocoa and cinnamon are the greatest discovery since sliced bread (and to be highly recommended to anyone who regularly eats bread or other easily-digested carbohydrates) or they aren't. And I'd really like to know which it's going to be.

• J Agric Food Chem. 2008 Jun 10. PMID: 18540628. The Stomach as a "Bioreactor": When Red Meat Meets Red Wine. Gorelik S, Ligumsky M, Kohen R, Kanner J.

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Good for your heart is good for your head

Take care of your heart if you want to stay smart. Heart disease is bad for your brain. If you can reduce your risk of heart disease, you can reduce your risk of cognitive decline. I just figured that out this week. It was Bix's consideration of cognitive decline in heart disease patients that prompted me to put two and two together...

Lately, I've been focusing on how cinnamon, cocoa, and fish oil are good for the heart. I've been ignoring information about how they're supposed to help your brain stay sharp as you age. Is there a connection? Well, if your coronary arteries are clogging up, other arteries are probably clogging up, too. Like the ones in your head.

Bypass surgery can save your life, and the mild cognitive damage, it causes is usually temporary. But heart surgery can't fix the arteries in your brain. Researchers followed seniors with vascular disease for several years. They all showed cognitive decline over that time, whether or not they had surgery. Seniors with vascular disease all did worse than heart-healthy seniors.

So an anti-inflammatory diet full of choices that improve cholesterol and blood sugar isn't just good for your heart. It's good for your head, too.

• Nature Clinical Practice Neurology (2006) 2, 538-547 (doi:10.1038/ncpneuro0294) Vascular cognitive impairment Ola A Selnes and Harry V Vinters.
• Ann Thorac Surg. 2008 May;85(5):1571-8. Absence of cognitive decline one year after coronary bypass surgery: comparison to nonsurgical and healthy controls. Sweet JJ, Finnin E, Wolfe PL, Beaumont JL, Hahn E, Marymont J, Sanborn T, Rosengart TK.
• Ann Neurol. 2008 May;63(5):581-90. Cognition 6 years after surgical or medical therapy for coronary artery disease. Selnes OA, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, McKhann GM.

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Cinnamon Chocolates for your heart

Cassia Cinnamon is an even more concentrated source of flavanols than cocoa. So, if, like the Kuna, you wanted 900mg of flavanols to your diet, you could eat 2 1/2 tablespoons of cocoa. or only 3 teaspoons of cinnamon. But you shouldn't eat 3 teaspoons of cinnamon, because Cassia cinnamon contains coumarin. The German government has decided .1mg of coumarin per kg of body weight per day is safe. There are about 2.8mg of coumarin in every gram of Cassia Cinnamon. If you weigh over 124 pounds, you should be safe with 2g (1/2 tsp) of cinnamon per day, as long as you aren't eating any other foods with coumarin in them. If you weigh 185, you can tolerate 3 g (3/4 teaspoon)...

Here's a recipe that's not exactly haute cuisine. It makes four servings of a slightly sweet, strongly cinnamon/cocoa patty. It is not smooth like fine chocolate, because it is made with cocoa powder and cinnamon. All that conching destroys flavanols, anyway. One quarter of this recipe has about 500mg of flavanols, including 3/4 teaspoon of cinnnamon per serving, which provides over 200mg of flavanols and 8.4 mg of coumarin. It should be perfectly safe for someone weighing over 190 pounds who isn't eating other sources of coumarin or other blood thinners. If you weigh less, you can divide the recipe into more, smaller servings to get less cinnamon and flavanols. Of course, you would want to discuss this with your doctor. If you'd prefer to leave out the cinnamon altogether, try the recipe for Cocoa Chocolate Patties

Chocolate, Cocoa, and Cinnamon Patties

Recipe By: Family Nutritionist
Serving Size: 4
Cuisine:
Main Ingredient:


-= Ingredients =-
1 oz Baking chocolate ; 100% cacao, unsweetened
3 teaspoon Cinnamon
4 teaspoon Honey
3 tablespoon Cocoa powder

-= Instructions =-
Gently warm baking chocolate until you can stir it.
Stir in the cocoa, cinnamon and honey. Allow to cool to a dough, then divide into 4 pieces and form into balls or patties. Cool on the baking chocolate wrapper.

Do not take with milk, butter, or other dairy products.

Serving: .11 cups (24g), Calories: 81: Fat: 5g : Sodium: 3mg
Protein: 2g, NetCarbs: 9, K: 194mg
SatFat: 3g, PolyFat: 0g, MonoFat: 2g, Chol: 0mg
TotCarbs: 14g, Fiber: 5g, Sugars: 6g
Calories: 56.0% from fat, 69.1% from carbohydrates 02.5% from protein

NFCS: 6.54g Cinnamon: 3.0g : Fats: .84: Sweets: 0.4
PA: 512.35 mg, 1-3 mers: 128.45 mg

German government guidelines for safe daily consumption of Cassia Cinnamon, assuming no other sources of coumarin in the diet. Talk to your doctor to discuss what is safe for you.

Body Weight(pounds)	Cinnamon (g)	Cinnamon(tsp)	flavanols(mg)
60	0.97	0.24	78.97
61.6	1.00	0.25	81.08
110	1.79	0.45	144.79
123.2	2.00	0.50	162.16
130	2.11	0.53	171.11
184.8	3.00	0.75	243.24
190	3.08	0.77	250.08
200	3.25	0.81	263.25

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How Much Cocoa do the Kuna Drink?

I finally came across a piece of information I've been looking for -- how much flavanoid do the Kuna get from their daily cocoa. Right in the abstract of a 2007 paper from NK Hollenberg (who has done a lot of cocoa research in conjunction with the MARS(TM) nutritional research team), it says that the Kuna living in the San Blas islands get more than 900 mg/day of flavonoids. So if cocoa flavanols really are the factor preventing hypertension, heart attacks, diabetes, and cancer in the San Blas, then the effective dose must be 900mg/day or less. That is potentially a lot of cocoa....

The researchers observed that Kuna populations living in the San Blas had strikingly lower incidence of death from heart disease, stroke, cancer, and diabetes millitus than Kuna living on the Panama mainland.

Of course, cocoa consumption is not the only difference between the two Kuna populations and the information on their death certificates. The authors propose several other potential contributing factors:

• Differential diagnosis -- medical care is not as good on the islands, so some cases of these diseases may have been missed on the islands furthest from hospitals and clinics
• Stress is slightly lower in the islands
• There might be other dietary differences besides cocoa between island and mainland Kuna
• Island inhabitants may have a higher level of physical activity.
• The air and water might be more polluted on the mainland, especially in and near the city.

How to eat more chocolate for your heart -- and how to drink cocoa black

Does Flavanol Intake Influence Mortality from Nitric Oxide-Dependent Processes? Ischemic Heart Disease, Stroke, Diabetes Mellitus, and Cancer in Panama. Vicente Bayard, Fermina Chamorro, Jorge Motta, and Norman K. Hollenberg. Int J Med Sci. 2007; 4(1): 53–58.

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