Skip to content

Cocoa

Cocoa is the plant from which chocolate is made. Dark chocolate is made by pressing roasted cocoa beans between two rollers. Cocoa powder is made by pressing the fat or cocoa butter out of the dark chocolate and grinding the remaining material into powder. Sweet chocolate is made by adding sugar and vanilla to dark chocolate. White chocolate contains sugar, cocoa butter and milk solids. Long regarded primarily as a culinary delicacy, cocoa is increasingly being used as a medicine. Cocoa seeds are used for intestinal disorders, diarrhea, asthma, bronchitis and as an expectorant for congested bronchial tubes. The shell of the seeds is used for liver, bladder and kidney problems, as a tonic and as a general remedy. Cocoa butter is used to treat high cholesterol levels. Recently, we have been reading more and more about the potential health benefits of chocolate and the confectionery manufacturer Mars is trying to get permission to advertise the health benefits of chocolate by supporting studies investigating the potential role of cocoa flavonoids in cardiovascular health. Flavonoids are chemicals that may lower blood pressure. Dark chocolate contains more flavonoids than milk chocolate or white chocolate. There is further research trying to find out if cocoa flavonoids could help reduce age-related memory decline. Some people apply cocoa butter directly to the skin to treat wrinkles and prevent stretch marks during pregnancy. In industrial production, cocoa butter is used as a base for various ointments and suppositories.

How does cocoa work?

Cocoa contains a variety of chemicals including antioxidants and flavonoids. It is not clear how these might work in the body, but they appear to cause blood vessels to relax. This could lead to lower blood pressure.

How effective is cocoa?

Cocoa may be effective for high blood pressure. Several studies have shown that eating 46 to 105 grams of dark chocolate or milk chocolate reduced systolic (upper) blood pressure by 4.7 mmHg and diastolic (lower) blood pressure by 2.8 mmHg in people with normal or high blood pressure.

There is not enough scientific data to make a statement about the effectiveness of cocoa in the following applications:

  • Heart disease: Some research suggests that healthy older men who consume a large amount of cocoa in their diet have lower average blood pressure compared to other men who eat less cocoa. Chocolate eaters also have a lower risk of death from heart disease and all causes of death.
  • Improving memory: Some research suggests that cocoa drinks enriched with high concentrations of flavonoids may help reduce the memory loss that occurs as we age.
  • High blood pressure where only the systolic (upper) blood pressure is too high (isolated systolic hypertension): Preliminary evidence suggests that consuming 100 grams of dark chocolate per day, which is rich in flavonoids, may slightly lower systolic and diastolic blood pressure in older people with isolated systolic hypertension.

There is also not enough scientific data on the effectiveness of cocoa for high cholesterol levels, intestinal disorders, diarrhea, asthma, bronchitis, bronchial congestion, liver disease, bladder and kidney disease and diabetes, as well as for the prevention of wrinkles and stretch marks during pregnancy. Further scientific research is needed to evaluate the effectiveness of cocoa in all these applications.

Safety and side effects

Consuming cocoa is probably safe and harmless for most people. Cocoa contains caffeine and related chemicals. Consuming large amounts of cocoa could cause caffeine-related side effects such as nervousness, increased urination, insomnia and rapid heartbeat.

Cocoa can cause allergic skin reactions and constipation and could trigger migraine headaches. It can also cause digestive problems including nausea, stomach rumbling and flatulence.

The use of cocoa butter on the skin appears to be safe and harmless for most people. However, it may cause a skin rash.

Precautions and warnings

Pregnancy and lactation: Cocoa may be safe during pregnancy and lactation if consumed in moderate amounts or in amounts normally found in food. However, intake should be controlled. In large quantities, cocoa may not be safe due to the caffeine it contains. The caffeine in cocoa can cross the placenta and reach blood concentrations in the fetus that are comparable to those of the mother. Although controversial, there is evidence to suggest that high doses of caffeine during pregnancy may be associated with premature births, low birth weight and miscarriages. Some experts therefore recommend keeping caffeine consumption below 200 mg per day during pregnancy. Keep in mind that chocolate products provide between 2 and 35 mg of caffeine per serving and a cup of hot chocolate contains 10 mg of caffeine. Caffeine is also a cause for concern during breastfeeding. Caffeine levels in breast milk are believed to be about half of the caffeine levels in the mother's blood. If the mother is too much chocolate (several hundred grams per day), the breastfed baby could become irritable and have too frequent bowel movements due to the caffeine.

Anxiety: There are concerns that the caffeine contained in large amounts of cocoa could exacerbate anxiety disorders.

Diabetes: Cocoa appears to raise blood sugar levels and could affect blood sugar control in diabetics.

Diarrhea: Cocoa contains caffeine. The caffeine in cocoa can worsen diarrhea, especially when consumed in large amounts.

Irritable bowel syndrome: Cocoa contains caffeine. The caffeine contained in cocoa could - especially if consumed in large quantities - exacerbate the symptoms of irritable bowel syndrome in addition to worsening diarrhea.

Gastroesophageal reflux disease: Cocoa appears to reduce the effectiveness of the esophageal obstruction that prevents stomach contents from passing back into the esophagus. This could worsen the symptoms of gastroesophageal reflux disease.

Migraine headaches: Cocoa could trigger migraines in sensitive people.

Surgeries: Cocoa could affect blood sugar control during and after surgery, so cocoa should be avoided during the last 2 weeks before planned surgery. Fast, irregular heartbeat: Cocoa from dark chocolate can increase the heart rate. Cocoa products can make an irregular heartbeat worse.

Interactions

Caution should be exercised when using cocoa in conjunction with the following medications:

Adenosine

Cocoa contains caffeine. The caffeine in cocoa could block the effects of adenosine. Adenosine is often used by doctors to perform a test of the heart called a cardiac stress test. Due to the possible interactions, you should stop consuming cocoa and other caffeine-containing products at least 24 hours before such a test.

Dipyridamole

Cocoa contains caffeine. The caffeine contained in cocoa could block the effects of dipyridamole. Dipyridamole is often used by doctors to perform a test of the heart called a cardiac stress test. Due to the possible interactions, you should stop consuming cocoa and other caffeine-containing products at least 24 hours before such a test.

Ergotamine

Cocoa contains caffeine. Caffeine can increase the amount of ergotamine absorbed by the body. Taking cocoa in combination with ergotamine could increase the effects and side effects of ergotamine.

Oestrogens

The body breaks down the caffeine contained in cocoa in order to excrete it. Estrogen can reduce the rate at which the body breaks down caffeine. Taking estrogen in combination with caffeine could cause shakiness, headaches, rapid heartbeat and other side effects. For this reason, you should limit your caffeine intake if you are taking estrogens.

Lithium

The caffeine in cocoa can increase the rate at which the body excretes lithium. If you consume products that contain caffeine and are taking lithium, you should slowly reduce your intake of caffeine-containing products. Stopping caffeine intake too quickly can increase the side effects of lithium.

Asthma medication (beta-adrenergic agonists)

Cocoa contains caffeine. Caffeine can stimulate the heart. Some asthma medications can also stimulate the heart. Taking caffeine in combination with some asthma medications could stimulate the heart too much and cause heart problems.

Medication for depression (monoamine oxidase inhibitors / MAOI)

Cocoa contains caffeine. Caffeine can stimulate the body. Some medications used for depression can also stimulate the body. Consuming cocoa in conjunction with these medications could result in excessive stimulation. This could cause serious side effects including rapid heartbeat, high blood pressure, nervousness and more.

Diabetes medication

Cocoa could increase blood sugar levels. Diabetes medications are used to lower blood sugar levels. By increasing blood sugar levels, cocoa could reduce the effectiveness of diabetes medication. For this reason, blood sugar levels should be carefully monitored. It is possible that the dosage of diabetes medication may need to be adjusted.

Phenylpropanolamine

The caffeine contained in cocoa can stimulate the body. Phenylpropanolamine can also stimulate the body. Consuming cocoa in combination with phenylpropanolamine could result in excessive stimulation and increase the heart rate, raise blood pressure and cause nervousness.

Theophylline

Cocoa contains caffeine. Caffeine acts in a similar way to theophylline. In addition, caffeine can reduce the rate at which the body breaks down theophylline. Consuming cocoa in conjunction with taking theophylline may increase the effects and side effects of theophylline.

Caution should be exercised when using cocoa in conjunction with the following medications:

Antibiotics

The body breaks down the caffeine contained in cocoa in order to be able to excrete it. Some antibiotics can reduce the rate at which the body breaks down caffeine. Taking these antibiotics in combination with caffeine can increase the risk of caffeine side effects including shakiness, headaches, increased heart rate and more.

The contraceptive pill

The body breaks down the caffeine contained in cocoa in order to excrete it. The contraceptive pill can reduce the rate at which the body breaks down caffeine. Taking cocoa in combination with the contraceptive pill can cause shakiness, headaches, rapid heartbeat and other side effects.

Cimetidine

The body breaks down the caffeine contained in cocoa in order to be able to excrete it. Cimetidine can reduce the rate at which the body breaks down caffeine. Taking cimetidine with cocoa may increase the risk of side effects including shakiness, headaches, increased heart rate and others.

Fluconazole

The body breaks down the caffeine contained in cocoa in order to excrete it. Fluconazole can reduce the rate at which the body breaks down caffeine. Taking fluconazole with cocoa may increase the risk of caffeine side effects including insomnia, shakiness, headaches, increased heart rate and more.

Mexiletine

The body breaks down the caffeine contained in cocoa in order to excrete it. Mexiletine can reduce the rate at which the body breaks down caffeine. Taking mexiletine in combination with cocoa can increase the effects and side effects of caffeine.

Dosage

The following studies have been carried out as part of scientific research: Oral:

  • For high blood pressure: 46-105 grams of dark chocolate or milk chocolate per day, which provides 213 to 500 mg of cocoa polyphenols.

References

  1. Abernethy DR, Todd EL. Impairment of caffeine clearance by chronic use of low-dose oestrogen-containing oral contraceptives. Eur J Clin Pharmacol 1985;28:425-8.
  2. American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk (RE9403). Available at: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;108/3/776.pdf.
  3. Aqel RA, Zoghbi GJ, Trimm JR, et al. Effect of caffeine administered intravenously on intracoronary-administered adenosine-induced coronary hemodynamics in patients with coronary artery disease. Am J Cardiol 2004;93:343-6.
  4. Arts IC, Hollman PC, Kromhout D. Chocolate as a source of tea flavonoids (Letter). Lancet 1999;354:488.
  5. Baron AM, Donnerstein RL, Samson RA, et al. Hemodynamic and electrophysiologic effects of acute chocolate ingestion in young adults. Am J Cardiol 1999;84:370-3.
  6. Bracken MB, Triche EW, Belanger K, et al. Association of maternal caffeine consumption with decrements in fetal growth. Am J Epidemiol 2003;157:456-66.
  7. Briggs GB, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998.
  8. Brown NJ, Ryder D, Branch RA. A pharmacodynamic interaction between caffeine and phenylpropanolamine. Clin Pharmacol Ther 1991;50:363-71.
  9. Bruinsma K, Taren DL. Chocolate: Food or Drug? J Am Diet Assoc 1999;99:1249-58.
  10. Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med 2006;166:411-7.
  11. Burnham TH, ed. Drug Facts and Comparisons, Updated Monthly. Facts and Comparisons, St. Louis, MO.
  12. Carbo M, Segura J, De la Torre R, et al. Effect of quinolones on caffeine disposition. Clin Pharmacol Ther 1989;45:234-40.
  13. Cardiovascular Benefits Claimed For Cocoa Flavonoids. www.medscape.com/reuters/prof/2000/02/02.21/dd02210b.html (Accessed February 21, 2000).
  14. Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet 2000;39:127-53.
  15. Connor WE. Harbingers of coronary heart disease: dietary saturated fatty acids and cholesterol. Is chocolate benign because of its stearic acid content? Am J Clin Nutr 1999;70:951-2.
  16. Desideri G, Kwik-Uribe C, Grassi D, et al. Benefits in cognitive function, blood pressure, and insulin resistance through cocoa flavanol consumption in elderly subjects with mild cognitive impairment: the Cocoa, Cognition, and Aging (CoCoA) study. Hypertension 2012;60:794-801.
  17. Dietrich R, Paglieroni TG, Wun T, et al. Cocoa inhibits platelet activation and function. Am J Clin Nutr 2000;72:30-5.
  18. Eskenazi B. Caffeine-filtering the facts. N Engl J Med 1999;341:1688-9.
  19. Fernandes O, Sabharwal M, Smiley T, et al. Moderate to heavy caffeine consumption during pregnancy and relationship to spontaneous abortion and abnormal fetal growth: a meta-analysis. Reprod Toxicol 1998;12:435-44.
  20. Flammer AJ, Hermann F, Sudano I, et al. Dark chocolate improves coronary vasomotion and reduces platelet reactivity. Circulation 2007;116:2376-82.
  21. For Dieter, Nearly the Ultimate Loss. The Washington Post. Available at: www.washingtonpost.com/wp-dyn/articles/A33421-2000Mar17.html (Accessed March 19, 2000).
  22. Friedman G. Diet and the irritable bowel syndrome. Gastroenterol Clin North Am 1991;20:313-24.
  23. Fuhr U. Drug Interactions with Grapefruit Juice. Drug Saf 1998;18:251-72.
  24. Grassi D, Lippi C, Necozione S, et al. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr 2005;81:611-14.
  25. Grassi D, Necozione S, Lippi C, et al. Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 2005;46:398-405.
  26. Hagg S, Spigset O, Mjorndal T, Dahlqvist R. Effect of caffeine on clozapine pharmacokinetics in healthy volunteers. Br J Clin Pharmacol 2000;49:59-63.
  27. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343:1833-8.
  28. Harder S, Fuhr U, Staib AH, Wolff T. Ciprofloxacin-caffeine: a drug interaction established using in vivo and in vitro investigations. Am J Med 1989;87:89S-91S.
  29. Healy DP, Polk RE, Kanawati L, et al. Interaction between oral ciprofloxacin and caffeine in normal volunteers. Antimicrob Agents Chemother 1989;33:474-8.
  30. Heiss C, Dejam A, Kleinbongard P, et al. Vascular effects of cocoa rich in flavan-3-ols. JAMA 2003;290:1030-1.
  31. Hollenberg NK, Fisher ND. Is it the dark in dark chocolate? Circulation 2007;116:2360-2.
  32. Hooper L, Kay C, Abdelhamid A, et al. Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials. Am J Clin Nutr 2012;95:740-51.
  33. Hu FB, Stampfer MJ, Manson JE, et al. Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J Clin Nutr 1999;70:1001-8.
  34. Joeres R, Klinker H, Heusler H, et al. Influence of mexiletine on caffeine elimination. Pharmacol Ther 1987;33:163-9.
  35. Klebanoff MA, Levine RJ, DerSimonian R, et al. Maternal serum paraxanthine, a caffeine metabolite, and the risk of spontaneous abortion. N Engl J Med 1999;341:1639-44.
  36. Kockler DR, McCarthy MW, Lawson CL. Seizure activity and unresponsiveness after hydroxycut ingestion. Pharmacotherapy 2001;21:647-51.
  37. Kris-Etherton PM, Derr J, Mitchell DC, et al. The role of fatty acid saturation on plasma lipids, lipoproteins, & apolipoproteins: I. Effects of whole food diets high in cocoa butter, olive oil, soybean oil, dairy butter, & milk chocolate on the plasma lipids of young men. Metabolism 1993;42:121-9.
  38. Mester R, Toren P, Mizrachi I, et al. Caffeine withdrawal increases lithium blood levels. Biol Psychiatry 1995;37:348-50.
  39. Mustad VA, Kris-Etherton PM, Derr J, et al. Comparison of the effects of diets rich in stearic acid versus myristic acid and lauric acid on platelet fatty acids and excretion of thromboxane A2 and PGI2 metabolites in healthy young men. Metabolism 1993;42:463-9.
  40. Nix D, Zelenitsky S, Symonds W, et al. The effect of fluconazole on the pharmacokinetics of caffeine in young and elderly subjects. Clin Pharmacol Ther 1992;51:183.
  41. Peirce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York, NY: William Morrow and Co, 1999.
  42. Pollock BG, Wylie M, Stack JA, et al. Inhibition of caffeine metabolism by estrogen replacement therapy in postmenopausal women. J Clin Pharmacol 1999;39:936-40.
  43. Sklar S, et al. Drug therapy screening system. Indianapolis, IN: First Data Bank 99.1-99. 2 eds.
  44. Taubert D, Berkels R, Roesen R, Klaus W. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA 2003;290:1029-30.
  45. Taubert D, Roesen R, Lehmann C, et al. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA 2007;298:49-60.
  46. Taubert D, Roesen R, Schomig E. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 2007;167:626-34.
  47. The National Toxicology Program (NTP). Caffeine. Center for the Evaluation of Risks to Human Reproduction (CERHR). Available at: http://cerhr.niehs.nih.gov/common/caffeine.html.
  48. Underwood DA. Which medications should be held before a pharmacologic or exercise stress test? Cleve Clin J Med 2002;69:449-50.
  49. Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3.
  50. Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al. Effect of dark chocolate on arterial function in healthy individuals. Am J Hypertens 2005;18:785-91.
  51. Wallach J. Interpretation of Diagnostic Tests. A synopsis of Laboratory Medicine. Fifth ed; Boston, MA: Little Brown, 1992.
  52. Zheng XM, Williams RC. Serum caffeine levels after 24-hour abstention: clinical implications on dipyridamole (201)Tl myocardial perfusion imaging. J Nucl Med Technol 2002;30:123-7.