The

POWER OF

COCOACACAO

The Modern Problem

• Population is aging– Chronic illness

• Coronary heart disease

• Hypertension• Diabetes mellitus• Obesity• Strokes• Certain cancers• Arthritis• Depression• Dementia• Generalized

inflammation

Cardiovascular Risk Factors

smoking diabetes

High blood pressure

High cholesterol

Estrogen withdrawal

Oxidative stress decrease nitric oxide

Constriction of blood vessels

Blood clots and plaque formation

inflammation

Heart attack strokes

Obesity

Why ? How?

• Oxidation and inflammation

• Decay

When oxygen is burnt or used as fuel

Oxidation occurs forming

Free Radicals

CytokinesPlaque formation

Foam cell

Monocytes

LUMEN

MEDIA

INTIMA

Oxidized LDL

Adhesion molecules

Lp-PLA2

The role of Lp-PLA2 in vascular inflammation

Lyso-PCOxFA

Macrophage

Free Radicals

O O2 NO OH

Free RadicalsFree radicals have been associated with greater than 200 diseases

It is responsible for premature aging, wrinkling of the skin, hardening of the arteries, stiffening of joints, development of cancer

It sets us up for serious illnesses

Nature’s solutionNature has given naturally occurring fruits and vegetables which contain phytochemicals

The pigments, tastes, and colors serve to protect, reproduce, and benefit the plants

One group of phytochemicals are polyphenols and the largest category is flavonoids

The Future of Health

LET FOOD BE THY MEDICINE AND

MEDICINE BE THY FOOD

Hippocrates

The Bodies’ Own Defenses

– Natural anti oxidants– Natural enzyme processes

• Anti oxidants converts free radicals to harmless molecules

– Body needs extra anti oxidants• Exercise chronic illness fever stresses• Diet from natural food phytonutrients

The government is recommending 5-9 servings of fruits and vegetables

Dietary Flavonoids vs. CHD Mortality (Seven Country Study)

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FlavonoidsFlavonoids have the capacity to act as powerful antioxidants by stopping the free radical process and the oxidative process

They also chelate metal ions

Modulate cellular functioning

Testing

• ORAC oxygen radical absorbance capacity

• HORACNORAC

• SORAC

• Total phenolic

• Epicatechin and catechin

COCOA

• Dark unprocessed cocoa– Bitter is better the

highest ORAC value– It is very rich in

flavonoids especially (-)epicatechin (+)

catechin procyanidins

It is loaded with vitamins, minerals, essential fatty acids, fiber

Chocolate is a divine, celestial drink, the sweat of the stars, the vital seed, divine nectar, the drink of the gods, panacea and universal medicine

Geronimo Piperni, 1796

COCOA

• Dark Cocoa why not spoil bitter is better highest ORAC– Rich in flavonoids (-) epicatechin (+) catechin and procyanidins– Vitamins, minerals, essential fatty acids, fiber– Increases good cholesterol– Dilates blood vessels decreases BP platetes stops clots – Anti-inflammatory antihistamine– Helps the blood use insulin better – Helps with depression PEA – Theobromine no caffeine– Memory – Dental caries and gum disease– Arthritis energy

Modern Day Evidence

• Cocoa flavonoids have been associated in medical studies with decreasing

• Cancer• Cardiovascular diseases• Neurodegenerative diseases• Dental diseases• Depression• Inflammatory diseases

Epicatechin

• Properties– Insulin mimetic action– Protective effects on red blood cells( restores

the acetylcholinesterase activity)– Protects against lipid peroxidation– Inhibits platelet aggregration– Preserves pancreatic islet cells– Prevent the digestion and absorption of

carbohydrates– Help normalize blood sugars

(-)Epicatechin and (+) Catechin

• Improves blood flow• Reduce atherosclerotic plaques• Anti neurodegenerative effect protect

brain cells from amyloid beta protein development

• May impact Caco-2 cells (human colon adenocarcinoma cell line)

Cardiovascular healthdark cocoa

• Studies have found:– Stops the oxidative process

of the LDL (bad) cholesterol

– Increases nitric oxide (NO) dilating blood vessels and lowering blood pressure

– decreases platelet formation and clot development

– increases HDL (good) cholesterol and lowers triglycerides

JACN vol 23,No 3, 197-204 (2004)

↓Insulin resistance ↓Blood pressure

Study Design:•N=20, crossover, 15 dIntervention:•100 g dark chocolate bar vs. 90 g white chocolate barResult (dark chocolate):•45% ↓ insulin resistance 10 mm ↓ SBP

(-) Epicatechin vascular function

• Kuna Indians– Drink 4-5 cups of a high flavonoid rich

beverage a day• Decrease blood pressures• Low cholesterol levels• Improved cardiovascular health

• When they move away and stop drinking the beverage they develop cardiovascular diseases

Copyright ©2006 by the National Academy of Sciences

Schroeter, Hagen et al. (2006) Proc. Natl. Acad. Sci. USA 103, 1024-1029

Fig. 3. Proof-of-concept: Vascular response after oral ingestion of (-)-epicatechin

Zutphen Study

• Studied 470 men ages 65-84 and free of chronic illnesses over 15 years

• Those who ate at least 10 grams of dark chocolate a day had a 45-50% reduction in cardiovascular deaths and overall deaths

• They ate more calories overall but tended to be slightly less fat than those who didn’t

• Archives of Internal Medicine 2006 166:411-417

Meta Analysis boosts cocoa’s blood pressure lowering effects

April 2007 Archives of Internal Medicine• 173 participants Germany University of

Cologne• “The magnitude of the hypotensive effects of

cocoa is clinically noteworthy; it is in the range that is usually achieved with monotherapy of beta blockers or ACE inhibitors

• Better than green or black tea (it appeared they had no effect)

• A

Cocoa reduces LDL

• March 2007• 24% increase in HDL cholesterol with a

cocoa group versus 5% in a controlled group

• Showed a reduction in LDL oxidation

• Measured marked urinary increases in epicatechins and catechins

Reverse Blood Vessel Damage

• March 2007• Journal of Cardiovascular Pharmacology• “Within two days… showed a significant

improvement in blood vessel function and researcher noted that impairment of blood flow could almost be reversed with the high flavanol cocoa”

Heart Health and Exercise

• Journal of International Sport Nutrition and Exercise Metabolism

• Elite bicyclists exercised to exhaustion– Given chocolate milk– Gatorade – Carbohydrate replacement drink

• Exercised again • Chocolate milk was the winner

• Journal of International Sport Nutrition and Exercise Metabolism, 2006:16:78-91

Spatial Memory

• Mice study (Journal of Neuroscience)

– Four groups• Running wheel and epicatechins• Epicatechins• Running wheel and nothing else• The typical American lifestyle

– Results• Water maze the best• Running wheel and epicatechins

– Improved Spatial Memory– Showed increase blood vessel growth

–

Neurodegenerative diseases

• Several studies have looked at flavonoids and decreases in:– Parkinson’s disease– Dementia– Polyphenols have been found to delay onset of

Alzheimer's disease. A recent study showed older Japanese-Amercian men and women who drank fruit or vegetable juices three times a week had a 75% reduction of developing Alzheimer's disease. No benefit was seen with supplemental or dietary vitamins like E, C, or betacarotene.

– Neurology Reviews December 2005, pp.44-45.

Diabetes• Numerous studies have shown that the flavonoids in cocoa increase

insulin sensitivity

• ORIGINAL RESEARCH COMMUNICATION• Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a

decrease in blood pressure in healthy persons1,2,3 • Davide Grassi, Cristina Lippi, Stefano Necozione, Giovambattista Desideri and Claudio Ferri 1 From the Department

of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy. • Background: Numerous studies indicate that flavanols may exert significant vascular protection because of their antioxidant

properties and increased nitric oxide bioavailability. In turn, nitric oxide bioavailability deeply influences insulin-stimulated glucose uptake and vascular tone. Thus, flavanols may also exert positive metabolic and pressor effects.

• Results: HOMA-IR was significantly lower after dark than after white chocolate ingestion (0.94 ± 0.42 compared with 1.72 ± 0.62; P < 0.001), and QUICKI was significantly higher after dark than after white chocolate ingestion (0.398 ± 0.039 compared with 0356 ± 0.023; P = 0.001). Although within normal values, systolic blood pressure was lower after dark than after white chocolate ingestion (107.5 ± 8.6 compared with 113.9 ± 8.4 mm Hg; P < 0.05).

• Conclusion: Dark, but not white, chocolate decreases blood pressure and improves insulin sensitivity in healthy persons

• Tomaru , M Dietary Supplementation with Cacao Liquor Proanthocyanidins Prevents Elevation of Blood Glucose Levels in Diabetic Obese Mice Nutrition 2007 1:7

• Insulin sensitivity helping the body utilize sugars better

Neuropathy– recent report in Neurology Review outlines the results of a study

on how diabetes and high blood sugar cause damage to the body in particular causing nerve damage and nerve pain (neuropathy). The findings suggest that oxidative damage to the inner part of the cells cause the cells to die (apoptosis). This damage to the nerve cells cause burning and or numbness in extremities. This numbness further leads to ulcers in feet and often amputations. The oxidation in the body produces superoxide or free radicals which damage the nerve cells at the molecular level (mitochrondrial level). The oxidation is the result of high blood sugars. In one of the reviews of a study on rats that 20% of the nerve cells DNA were damaged only after three months of high blood sugars.

– Vincent AM, McLean LL, Backus C, Feldman, EL Short term

hypergylcemia produces oxidative damage and apoptosis in neurons, FASEB J 2005;19:638-640

Cancer and flavonoids

• Many studies have shown inhibition of cancer cells in lungs, oral, esophagus, stomach, colon, skin, prostate, and breast cancer

• The research is just beginning in this area

Substances found in edible fruits and vegetables ... that exhibit a potential for modulating human metabolism in a manner favorable for cancer prevention.” JADA. 95(4):493-496, 1995

Inflammation

• Studies have shown the flavonoids work like a COX inhibitor blocking the pathway stopping inflammation in the body

• The cocoa flavonoids act as anti histamine helping with asthma and stomach discomfort as well as a potent anti -diarrhea agent

Theobromine increases feeling of well being mild antidepressant

Stimulates muscular system

Not addictive

Opens up the lungs bronchodilator

Mood Elevation

Psychoactive chemicals in cocoa

PEA phenylethylamine love chemical

Anandamide bliss chemical

MAO inhibitorVitamins like magnesiumTryptophan

serotonindopamine

Decrease in depression Mood elevationAppetite depressant

Brain Power

• Study done found that chocolate– Increased verbal and visual memory– Improved impulse and reaction time– Overall enhanced cognitive performance

– Raudenbush, B Wheeling Jesuit University West Virginia soon to be published study, 2006

A Kiss is Just A Kiss

• April 2007• Heartbeats per minutes more than

doubled from eating chocolate than kissing and a more sustained reaction up to four times longer than by a kiss

• The feel good factor from serotonin

Neurobiology of Chocolate

• University of Nottingham Medical School 2007

• “Our study showed that acute consumption of flavanol-rich cocoa was associated with increased grey matter flow for two to three hours… it raises the possibility that cocoa maybe beneficial in enhancing brain function … helping with fatigue, sleep, deprivation, ageing, and even dementia”

Flavonoids improve mental health

• June 2007– Better cognitive performance done over 10

years– It improved the Mini Mental State

Examination

Aging

• Studies recently done with animals show improvement in aging with a diet high in flavonoids and antioxidants

• It slowed down the aging process• Prior USDA, 2005

Other Areas

• Flavonol rich diet may slash pancreatic cancer risks

• American Association for Cancer Research may cut risk by 25% up to 59% in smokers

• “Anti carcinogenic effects of flavanoids in general have been attributed to the ability of these constituents to inhibit cell cycle, cell proliferation and oxidative stress, and to induce detoxification enzymes and apotosis”

Other Medical Properties• Cocoa protects the sun from UV damage and

helps reducing wrinkles and skin damage• Cocoa has been found to help with diarrhea• Stop smoking cravings• Helps with inflammatory bowel diseases• Macular degeneration • Weight Loss (Bodybyxocolate.com)• Great during pregnancy and lactation –sweet

babies

Myths• Rarely are people allergic to chocolate• Does not increase acne• Does not cause migraine headaches• Does not increase acid reflux• Does not increase your weight• Does not cause insomnia• Pure cocoa beans have no to minimal

caffeine• Milk does not interfere with absorption

Fiber

• Cocoa Fiber– Feel fuller faster– Helps with irritable bowel syndrome– Lowers blood sugars– Lowers cholesterol– Colon

Cocoa Butter

• Made up of – Stearic acid (34%)– Oleic acid (34%)– Palmitic acid (25%)– Others (7%)

• Neutral in regard to lipid profile and weight gain

Dental Health

• Prevention and healing of gum disease

• Prevention of dental caries

• Two studies done this year in Japan showed decrease in oral bacteria counts resulting in improved breath

Should it be a Vitamin???Vitamin-C(ocoa)

• “Epicatechin could potentially get rid of

FOUR of the five most common diseases in the Western World –

In Kuna Indians 90% less risk of cancer, stroke, heart failure and diabetes

• Need a cocoa that is raw unprocessed cold pressed cocoa not heated– Without the added high glycemic sugars –

refined sugars, added fats, waxes, preservatives, tested for lead and bacteria

– Mixed with other high antioxidant fruits or products

– Avoid Dutching or alkalization

XOCAI

• Xocai has the great benefits of not only cocoa but Acai Omega 3 blueberries dark grapes

• The weighted benefits far outweight any minor problem with any individual component

Effectiveness of Cocoa Flavonoids

• “This does not preclude the possibility that flavonoids may accumulate in tissues where they might exert local antioxidant effects or that very low concentrations of flavonoids may modulate cell signalling, gene regulation, antiogenesis,and other biological processes by non-antioxidant mechanisms, which may explain the purported health benefits of flavonoids”

• Free Radical Biology and Medicine

Ideal Primary Prevention Agent• Natural dietary factor (not a

medicine)• Palatable—even tasty• Convenient• Affordable/available• Positive incentives to use regularly• Feasible for long-term adherence• Supplement or partial replacement• Maximizes positive elements• Minimizes negative elements• Scientifically established

– Benefits– Safety

The Antioxidant ParadoxOxidation promotes CVD, andLow CVD risk associates with:• A diet high in antioxidant-rich foods

associates with low CVD risk• High blood levels of antioxidants,

butAntioxidant vitamins do not lower

CVD risk!Why not?

Somehow the benefit is lost:• Other important antioxidants are

removed, and/or • Antioxidants need to be with other

factors in the food

WEIGH THE EVIDENCE

• For centuries cocoa was a medicine

• TODAY new studies are tipping the balance again in favor of flavonoids and especially cocoa phytonutrients combined with a balanced diet and active life

• FOR MORE INFORMATION:– The Power of Dark Chocolate by Steven Warren MD

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– www.mydrchocolate.com– www.healthchocolatetools.com

– Health Matters with Dr Steve TV this Fall