We often take a black and white view toward the foods we eat, classifying them as either virtuous or vices. Kale? Virtuous. Deep-fried Oreos? Vice. You get the picture.
But consensus breaks down somewhere on the cusp of virtue and vice. That is, there are indulgent foods with some healthy attributes that we can argue either way. Fans justify eating these foods by focusing on the evidence supporting a health benefit, whereas detractors point to the possible ill effects of this same food to argue against it.
Red wine is a great example. There is plenty of good data to support certain health benefits associated with regular, moderate intake of red wine. Yet few doctors would dream of recommending that a non-drinker start drinking red wine if they didn't already drink to begin with. That's because there are also good—and conflicting—data that show even moderate alcohol intake of any kind is associated with increased risk of breast cancer in women and some digestive system cancers as well.
Some people would group chocolate in the same category, but I do not. I think chocolate is a virtuous food that gets an undeserved bad rap as a vice—possibly as a hangover effect from three decades of Cathy comic strips hammered into our collective consciousness. In fact, I would go so far as to suggest that if you're not already eating 3 ounces of dark chocolate per week, perhaps you should be.
There are several long-term, observational studies that consistently point to an inverse association between chocolate consumption and cardiovascular disease risk: higher chocolate intake, lower risk. The scientific literature includes studies of very large populations (tens of thousands of people each)—involving both men and women—that followed participants over time to see who developed cardiovascular diseases like heart attack, stroke, and coronary heart disease (CHD) and who did not. While the particulars of each study vary, a common theme emerges: People who consume a moderate amount of chocolate regularly seem to have a lower risk of these diseases compared with people who consume no chocolate at all, when controlling for a variety of other relevant factors such as weight, smoking, and family history of disease.
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There are many fewer controlled, interventional research studies that point in this same direction, mainly because it's harder to measure outcomes like disease risk in the relatively short period of time available for this type of research. Still, there are some. These tend to measure immediately observable outcomes like changes in blood pressure and insulin sensitivity in response to eating chocolate (or not). Since these outcomes can be considered indicators of cardiovascular disease risk, the data remain relevant to a consideration of chocolate's merits.
Here, too, chocolate seems to have a benefit. When study participants with high blood pressure and pre-diabetes are given small doses of dark chocolate, they generally experience a reduction in blood pressure and an improvement in insulin sensitivity compared with participants given equivalent portions of white chocolate. (White chocolate isn't really chocolate at all, but rather a combination of cocoa butter and sugar. It contains none of cacao's potent flavonoid compounds presumed to be responsible for chocolate's observed health benefits.)
Adverse side effects of moderate dark chocolate intake, as one would expect, have not been reported to my knowledge—though perhaps swooning in delight could present a risk if one were to fall while doing so.
With such a robust and variegated body of literature, it can be difficult to nail down the exact amount of dark chocolate most likely to yield optimal cardio-protective effects without contributing excessively to calorie intake. Indeed, effective chocolate "doses" vary by study, but in general they seem quite low; many large studies show a substantial protective effect at an average intake of just 2.5 ounces per week! In most studies, a moderate portion of 1 ounce per day, two to three times per week, appears adequate to achieve a significant health benefit. Unfortunately, more does not seem to be better. Anything much beyond this does not appear associated with improved results (though one can still hope for new data that will suggest otherwise!); indeed, a few studies even suggest the possibility that exceeding these levels might be associated with negative cardiovascular consequences.
Skeptics may argue that eating chocolate regularly could contribute to caloric excess, weight gain, and ultimately an increased risk of obesity-related conditions that worsen cardiovascular health. And while this is certainly possible in theory, my experience thus far has not borne this out.
One ounce of dark chocolate has about 170 calories, placing it roughly on par with an equivalent portion of nuts—another heart-healthy food many of us seek to eat regularly. So here's a question: If you were "prescribed" this dose of chocolate three times per week, what might you give up in your diet to accommodate it?
In my own practice, I've found that many of my weight-loss clients are able to employ dark chocolate "defensively" to prevent them from snacking on empty-calorie cookies, cakes, candy, and ice cream when the afternoon munchies strike or they crave something sweet after dinner. When I direct them to eat a specific dose of dark chocolate several times per week, many of my patients report that the permission to indulge in something so satisfying on a daily basis makes it easy for them to resist temptation by higher-sugar, higher-calorie snack foods that have been their undoing in the past.
In other words, that 170-calorie serving of chocolate actually saves them from a much higher calorie indulgence and rarely represents an incremental calorie intake for the week. In the past year, I've had multiple obese patients lose weight even while adhering to a regular, daily chocolate regimen. The trick is to make room for the chocolate in your diet.
What about the saturated fat in chocolate? Doesn't that raise levels of bad cholesterol, and increase risk of heart disease? In fact, it does not. An irrefutable sign that there must be a God and that he loves us dearly (and wants us to eat chocolate) is that the type of saturated fat in chocolate—called stearic acid—is unique among saturated fats in that it does not affect LDL cholesterol levels.
As it is metabolized, the saturated bond in stearic acid's 18-carbon chain is readily converted to an unsaturated bond, resulting in an unsaturated fat called oleic acid. The same cannot be said for the milkfat found in milk chocolate, which is another reason to stick to the dark stuff.
What better time to take on some chocolate therapy than February? It's heart disease awareness month and Valentine's Day! If you're ready to start making room for an ounce of chocolate in your regular rotation, you'll want to note that one ounce is 28 grams. Not all marketers use this standard portion size on their nutrition facts label or when scoring their bars into squares; some companies market "mini-bars" that are larger at 1.2 ounces. If you're aiming for a 1-ounce portion, you'll need to read labels to see how many squares of your bar represent this serving size and divide it accordingly.
A few caveats: White chocolate is NOT chocolate and does not count toward a healthful daily dose. It has not been associated with any health benefits. Milk chocolate, while it has been associated with some of the same benefits as dark, contains fewer of the active beneficial compounds than dark, and a lot more sugar. In terms of health bang for your calorie buck, you'll get a lot more from dark than from milk.
I recommend seeking out products with 70 percent cocoa or higher. If this is too bitter for your sweeter, milky palate, start with a semisweet chocolate and gradually work your way up. To help you acclimate, seek out a diverse sampling of high-quality, semi-dark, and dark chocolates from all over the world and in different forms. From Brooklyn artisans to legendary Swiss producers, such creations come as cacao nibs and bars, as single-origin chocolate, in which the cacao beans come from the same area, to regular blends. You're almost certain to find a dark chocolate that hits your own personal sweet spot.
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Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.