Chocolate: food for the soul . . . and the body

If only my late mother had subscribed to the Journal of the American Medical Association. I forgive the old girl this lapse – there were few working-class JAMA subscribers in 1970s Belfast. Still, Mum would have learned that chocolate neither causes nor exacerbates acne, sparing me lectures on the relationship between her cooking chocolate and my spots.

In 1969, dermatologist Albert M Kligman reported to the journal the results of a study in which 65 volunteers with moderate acne ate either a bar stuffed with 10 times more chocolate than a typical one, or an identical but chocolate-free bar. In addition, five acne-free individuals munched two chocolate-enriched bars every day for a month.

The doctor’s conclusion: excessive chocolate and fat intake did not alter the composition or output of pore-blocking sebum.

Mum’s cooking chocolate probably contained low concentrations of cocoa solids and high concentrations of lard, but today’s chocolate is better, with Irish and UK citizens the joint third-biggest chocolate consumers in the world (after Switzerland and Germany), munching almost 7.4kg each year.

In the Badianus Manuscript: An Aztec Herbal, 1552, from Mexico, Martinus de La Cruz records that chocolate treated many diseases including angina, constipation, dysentery and gout. More recently, in 2011, the journal Maturitas cited studies suggesting a protective effect of chocolate against atherogenesis, the process that deposits fatty plaques inside arteries. It notes that "dark chocolate seems more protective than milk or white chocolate".

"When I opened my shop 10 years ago, 80 per cent of the sales were milk chocolate. But today it's 50-50 between milk and dark," says Benoit Lorge, an award-winning master chocolatier based in Bonane, Co Kerry. "Eighteen to 40 year olds prefer dark chocolate, and in my workshops I explain dark chocolate's many health benefits.

“But, as with food and wine, moderation is good in all things. A healthy daily consumption should be around 30g a day.”

Chocolate contains compounds called flavonoids. It’s thought that particular flavonoids, especially catechins, exert anti-oxidant, anti-hypertensive, anti-atherogenic and anti-inflammatory effects.

Writing in the journal Clinical Nutrition, Dr James Greenberg of Brooklyn College considers links between chocolate intake and diabetes risk: "Short-term human trials have shown that daily ingestion of dark chocolate and high-flavanol cocoa can improve insulin sensitivity in humans".

Greenberg also reports from a long-term study of 15,000 middle-aged participants from four communities in the US: “In conclusion, the risk of diabetes decreased as the frequency of chocolate intake increased, up to two to six servings [1 ounce] per week.” However, “consuming equal to or greater than one serving per day did not yield significantly lower relative risk.”

Italian researchers who studied the relationship between chocolate consumption and glycaemic control in young patients with type 1 diabetes found that those who ate 25g of dark chocolate per day, two to five times per week had better glycaemic control than patients who consumed the same amount of milk chocolate or neither dark nor milk chocolate.

Unsurprising results

These results won’t surprise Dr Komli-Kofi Atsina, formerly of the University of Ghana Medical School, in the world’s second biggest cocoa-exporting region. Dr Atsina is now chief executive of the Atsina Charity Medical Clinic in Accra.

“I’ve used the powder as an adjunct to my treatment of hypertension and diabetes in my clinic for a very long time,” he says. “I have also found use for it in the case of malaria, both as part of my acute treatment regime and as prophylaxis. Perhaps my wife’s habitual use of the beverage is why she has not encountered any malaria, acute or chronic, for more than five years.

“Not once has any patient being managed by me for hypertension and diabetes with natural cocoa powder complained to me about signs and symptoms of malaria.”

Still, isn’t chocolate consumption fattening?

Spanish researchers were the first to examine the association of chocolate consumption and markers of fatness in young people. Reporting in the journal Nutrition, in 2014, they described their investigation of 1,458 adolescents from nine European countries: "Our results demonstrate that a higher chocolate consumption was associated with lower total and central fatness in European adolescents."

Some of chocolate's lauded health benefits may depend on how it is consumed. In 2003, researchers reported in Nature that "consumption of plain, dark chocolate results in an increase in both the total antioxidant capacity and epicatechin content of blood plasma, but these effects are markedly reduced when the chocolate is consumed with milk or if milk is incorporated as milk chocolate." It is possible that milk blunts some of dark chocolate's beneficial effects.

And what about chocolate and the mind? It's known that dietary flavonoids can improve cognitive function. In 2012, the New England Journal of Medicine published a slightly tongue-in-cheek report from Dr Franz Messerli called Chocolate Consumption, Cognitive Function and Nobel Laureates.

Messerli describes a “close significant linear correlation between chocolate consumption per capita and the number of Nobel laureates per 10 million persons in a total of 23 countries.”

Of course, correlation doesn’t necessarily equal causation, but Messerli speculates: “That receiving the Nobel Prize would in itself increase chocolate intake countrywide seems unlikely, although perhaps celebratory events associated with this unique honour may trigger a widespread but most likely transient increase.”

With the announcement that Prof William C Campbell is Ireland’s most recent Nobel Laureate, Benoit Lorge may expect more orders.

Lubricant for the soul?

For a wider audience, is chocolate a universal lubricant for the soul?

"We use chocolate to modulate the anxiety associated with having laser eye surgery," says Harley Street surgeon Dan Reinstein of the London Vision Clinic. "The brain's natural heroin neurotransmitters are called endorphins. There is clear evidence that eating chocolate leads to endorphin release.

“ In addition, there is a deep psychological effect of chocolate, which in most is associated with ‘reward’ and ‘comfort’.”

However, a 2006 study in the Journal of Affective Disorders concluded that chocolate provides its own hedonistic reward by satisfying cravings when we feel low. However . . . when it is "consumed as a comfort eating or emotional eating strategy [it] is more likely to be associated with prolongation rather than cessation of a dysphoric mood".

Well, nothing’s perfect. Still, chocolate does come close.