Cocoa: benefits, dosage, contraindications
Scientific name(s)
Theobroma cacao
Family or group:
Plants
Active ingredients:
Caffeine
Catechins
Theobromine
Indications
Scoring methodology
EFSA approval.
Cardiovascular diseases ✪✪✪✪✪
Clinical studies and meta-analyses reveal the efficacy of cocoa flavanols in the management of cardiovascular disease. A major clinical trial in adults without cardiovascular disease showed that daily intake of a specific cocoa extract containing 500 mg of flavanols, including 80 mg of epicatechins, for approximately 3.5 years reduced the risk of death from cardiovascular disease by 27%, although it did not reduce the risk of major cardiovascular events or overall mortality. In 2023, the FDA approved a qualified health claim stating that very limited scientific evidence suggests that cocoa flavanols in high-flavanol cocoa powder, for products containing at least 4% naturally preserved cocoa flavanols, may reduce the risk of cardiovascular disease. Furthermore, meta-analyses have shown that cocoa consumption significantly improves flow-mediated dilation and reduces systolic and diastolic blood pressure. Recent systematic reviews have also found that cocoa improves markers of vascular function, insulin resistance, and cholesterol levels, confirming the beneficial impact of cocoa on cardiovascular health through its antihypertensive, anti-inflammatory, and antioxidant effects. EFSA (European Food Safety Authority) has evaluated health claims regarding cocoa flavanols. In its scientific opinion, EFSA recognizes that cocoa flavanols help maintain the elasticity of blood vessels, which contributes to healthy blood circulation, provided that at least 168 mg of cocoa is consumed per day, yielding at least 88 mg of cocoa flavanols.
Posologie
Orally
168 mg
standardized extract
Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study
Effect of cocoa flavanol supplementation for the prevention of cardiovascular disease events: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial
Scientific Opinion on the substantiation of health claims related to cocoa flavanols and protection of lipids from oxidative damage (ID 652, 1372, 1506, 3143), and maintenance of normal blood pressure (ID 1507) pursuant to Article 13(1) of Regulation (EC) No 1924/2006
Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies
Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study
Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies
High blood pressure ✪✪✪✪✪
Clinical research shows that daily consumption of chocolate or cocoa containing 25 to 1080 mg of flavonoids modestly reduces blood pressure in hypertensive patients. Meta-analyses indicate that daily consumption of commercially available dark chocolate or cocoa products enriched with flavanols for 2 to 8 weeks decreases systolic blood pressure by about 4 mmHg and diastolic blood pressure by about 2 mmHg in hypertensive patients compared with control products with low levels of flavanols or without flavanols. This reduction in blood pressure appears to be more pronounced in hypertensive or prehypertensive individuals compared with normotensive individuals. Cocoa consumption may also reduce the risk of developing hypertension in normotensive patients.
Posologie
Oral administration
168 - 1080 mg
standardized extract
Effect of cocoa on blood pressure
Effects of Cocoa-Rich Chocolate on Blood Pressure, Cardiovascular Risk Factors, and Arterial Stiffness in Postmenopausal Women: A Randomized Clinical Trial
Consumption of cocoa-containing foods and risk of hypertension in French women
Cognitive performance ✪✪✪✪✪
Research on the effects of cocoa on cognitive decline shows mixed results. Although some studies have not found a significant effect of cocoa or chocolate on cognition with chronic administration, other research suggests potential benefits, particularly related to improved cerebral blood flow and brain activity in specific regions. For example, clinical studies indicate that consuming dark chocolate rich in flavanols may improve visual contrast sensitivity, spatial memory, and reduce the time needed to detect motion in healthy young adults. Other work suggests a modest improvement in certain cognitive functions in adults over 60 years of age after subchronic consumption of varied doses of cocoa.
Posologie
Orally
45 mg
standardized extract
Acute effects of cocoa flavanols on visual working memory: maintenance and updating
A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults
Acute cocoa flavanols intake improves cerebral hemodynamics while maintaining brain activity and cognitive performance in moderate hypoxia
Consumption of cocoa flavanols results in acute improvements in mood and cognitive performance during sustained mental effort
Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people
A combined DHA-rich fish oil and cocoa flavanols intervention does not improve cognition or brain structure in older adults with memory complaints: results from the CANN randomized, controlled parallel-design study
Effects of cocoa-rich chocolate on cognitive performance in postmenopausal women. A randomized clinical trial
Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study--a randomized controlled trial
Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial
Wrinkles ✪✪✪✪✪
Preliminary clinical research in adults with aging skin shows notable improvements in fine lines, sun damage, and skin elasticity after daily intake of a product containing cocoa extract and other nutrients, combined with a tazarotene cream over 90 days. In addition, drinking a cocoa beverage rich in flavanols for 24 weeks improved wrinkle depth and skin elasticity. Cocoa flavanols also contribute to endogenous photoprotection, improve dermal blood flow, and positively influence skin elasticity and texture.
Posologie
Oral administration
100 mg
standardized extract
Cocoa Flavanol Supplementation Influences Skin Conditions of Photo-Aged Women: A 24-Week Double-Blind, Randomized, Controlled Trial
Emotional balance ✪✪✪✪✪
Chocolate is known for its various psychological effects, notably the improvement of alertness, the stimulation of well-being and euphoria, and the induction of cravings. These impacts are partly attributed to chocolate's sensory properties, such as its taste, smell and texture, as well as to pharmacologically active substances like tyramine and phenylethylamine, which can modulate mood by influencing dopaminergic and noradrenergic neurotransmission. Studies also suggest that cocoa flavanols can improve calmness and contentment, contributing to better emotional balance when consumed regularly.
Posologie
Oral administration
500 mg
standardized extract
Properties
Antioxidant
Cocoa flavanols, such as catechin and epicatechin, contribute to its powerful antioxidant effect. These compounds reduce the oxidation of low-density lipoproteins (LDL), a risk factor for cardiovascular disease, by neutralizing harmful free radicals in the body.nn
Cardiovascular
Cocoa has cardiac stimulant, vasodilatory, and diuretic properties thanks to theobromine, which has one-tenth of the cardiac activity of caffeine. Cocoa flavanols, such as epicatechin, improve vasodilation by increasing circulating nitric oxide (NO), which promotes arterial dilation and improves microcirculation. This activation of NO results in better vascular reactivity and an increased flow-mediated dilation response, which is essential for cardiovascular health. Flavanols also reduce platelet activation and alter the production of pro-inflammatory cytokines, which may decrease the risk of cardiovascular disease.nn
Usages associés
Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials
Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial
Antihypertensive
Cocoa flavanols have been shown to reduce systolic and diastolic blood pressure. A 2012 Cochrane review analyzed 20 studies involving 856 adults who were mostly healthy, revealing that a flavanol-enriched chocolate supplement for 2 to 18 weeks reduced mean systolic blood pressure by 2.77 mmHg and mean diastolic blood pressure by 2.20 mmHg. These effects were observed in various groups, including normotensive individuals with mild hypercholesterolemia and patients with hypertension. In addition, clinical trials have shown that regular cocoa consumption can improve other cardiovascular risk factors, such as serum lipids and vascular function. For example, a double-blind controlled study found that daily consumption of 100 g of dark chocolate, containing about 500 mg of polyphenols, for 15 days reduced diastolic blood pressure, improved flow-mediated dilation, and increased insulin sensitivity in patients newly diagnosed with essential hypertension. These benefits are attributed to the antioxidant effect of flavanols and an increase in nitric oxide synthesis, which improves endothelial function and reduces insulin resistance.
Usages associés
Neurological
Cocoa stimulates the central nervous system, and preliminary research suggests that cocoa flavanols may improve certain measures of cognitive function in adults over 60 years old with mild memory impairment without signs of dementia. Proposed mechanisms include increased cerebral blood flow and perfusion due to vasodilation, reduced oxidative stress, improved glycemic control, and effects on intracellular signaling pathways in the brain. nnEpicatechin, a cocoa constituent, is thought to induce angiogenesis and neurogenesis in the brain. In addition, epicatechin and catechin protect cell membranes from beta-amyloid-induced neurotoxicity, suggesting neuroprotective effects. A study in rats demonstrated that daily administration of a cocoa polyphenolic extract improves age-related cognitive deficits, urinary free dopamine levels, and longevity.nn
Usages associés
Antiplatelet agents/Anticoagulant
Dietary intervention studies in humans and animals show that flavanol-rich foods and beverages, such as cocoa, can reduce platelet reactivity and improve vascular function. Cocoa flavanols and procyanidins inhibit platelet activation and have an aspirin-like effect on primary hemostasis shortly after consumption. nnA controlled study demonstrated that regular consumption of dark chocolate significantly decreases collagen-induced platelet aggregation, potentially by modifying eicosanoid synthesis.nn
Dermatological effect
Cocoa extracts are used in dermatological products for their beneficial effects on the skin, particularly against aging. Studies show that cocoa polyphenols improve signs of aging such as wrinkles, roughness, and skin elasticity. They also inhibit the activation of cyclooxygenase-2 and the production of inflammatory mediators, while increasing dermal blood flow. Regular consumption of cocoa enriched in flavanols enhances the skin's resistance to UV-induced erythema and reduces transepidermal water loss, thereby improving skin hydration and density.
Usages associés
A single center, pilot, double-blinded, randomized, comparative, prospective clinical study to evaluate improvements in the structure and function of facial skin with tazarotene 0.1% cream alone and in combination with GliSODin(®) Skin Nutrients Advanced Anti-Aging Formula
Cocoa Flavanol Supplementation Influences Skin Conditions of Photo-Aged Women: A 24-Week Double-Blind, Randomized, Controlled Trial
Cocoa polyphenols and their influence on parameters involved in ex vivo skin restructuring
Mood effect
Cocoa contains phenylethylamine and tyramine, stimulants that modulate mood, as well as methylxanthines such as caffeine and theobromine, which affect alertness and well-being. Compounds like N-oleoylethanolamine, related to anandamide (the "internal happiness chemical"), might activate cannabinoid receptors, although their concentration in cocoa is too low for notable central effects. nnA study showed that daily consumption of 500 mg of cocoa polyphenols for 30 days significantly improves calmness and satisfaction, suggesting that cocoa could help reduce stress through its effects on mood and overall well-being.nn
Usages associés
Consumption of 85% cocoa dark chocolate improves mood in association with gut microbial changes in healthy adults: a randomized controlled trial
Cocoa polyphenols enhance positive mood states but not cognitive performance: a randomized, placebo-controlled trial
Safe dosage
Adult: 168 mg (standardized extract)
Consumption of cocoa is considered safe when used appropriately by mouth. However, cocoa naturally contains caffeine, and doses of more than 400 mg of caffeine per day can be dangerous.nnStudies suggest that an effective dose of dark chocolate is about 40 to 100 g or 15 to 30 g of cocoa powder, providing about 200 to 500 mg of polyphenols, with beneficial effects more likely from the use of cocoa powder or dark chocolate containing more than 60% cocoa. Note that, sometimes, cocoa extract is standardized to 10% theobromine.nnThe European Food Safety Authority (EFSA) has concluded that a daily intake of 200 mg of cocoa flavanols from food sources such as cocoa and dark chocolate does not pose a safety concern for healthy adults. nn
Plantes ou autres actifs
Cocoa: strong interaction
The polyphenols present in cocoa can reduce iron absorption, with a cocoa drink containing 100 to 400 mg of total polyphenols per serving having been shown to reduce iron absorption by about 70%. It is therefore recommended not to consume cocoa at the same time as iron-rich foods or iron supplements to avoid a reduction in iron absorption.
Precautions
Children: use with caution
Data on dosing of cocoa in children are limited. It is recommended to consult a healthcare professional before giving cocoa in medicinal amounts to children, particularly to children under 2 years of age. Children should avoid high doses of cocoa because of the caffeine and heavy metal content.nn
Pregnancy: use with caution
Consumption of cocoa is probably safe when used orally in moderate amounts. However, the caffeine content of cocoa should be closely monitored during pregnancy to ensure moderate intake. Doses up to 300 mg per day can be consumed without an increased risk to pregnancy. nn
Breastfeeding: use with caution
Consumption of cocoa is probably safe when used in moderate amounts or in the amounts commonly found in foods. However, the caffeine content of cocoa should be closely monitored during breastfeeding. Moderate consumption of cocoa would likely lead to very low caffeine exposure for the breastfed infant.
