Daily Archives: April 2, 2010

Largest Study to Date Links Chocolate to Lower Blood Pressure and Cardiovascular Risk

Just in the nick of time — before the Easter chocolate consumption begins, comes a study letting us know that a small amount of that dark Easter chocolate may be heart healthy. Just released is the largest observational study to date looking at the association between chocolate consumption and risk of cardiovascular disease. And the researchers have announced … drum roll please … that those who ate the most chocolate — around 7.5 g (about a quarter of an ounce) per day — had a 39% lower risk of MI and stroke than individuals who ate almost no chocolate.

Here are the details from an article in MedScape:

Lead author Dr Brian Buijsse (German Institute of Human Nutrition, Nuthetal, Germany) told HeartWire, “This shows that habitual consumption of chocolate is related to a lower risk of heart disease and stroke that is partly explained by blood-pressure reduction. The risk reduction is stronger for stroke than for MI, which is logical because it appears that chocolate and cocoa have a pronounced effect on BP, and BP is a higher risk factor for stroke than for MI.”

Buijsse and colleagues report their findings online March 31, 2010 in the European Heart Journal. However, Buijsse cautions that only small amounts of chocolate were associated with the benefits and it is too early to give recommendations on chocolate consumption.

“Maybe it’s a boring message, but it’s a little too early to come up with recommendations, because chocolate contains so many calories and sugar, and obesity is already an epidemic. We have to be careful.”

However, he added, that if people did want to treat themselves, they would be better off choosing small amounts of chocolate, preferably dark chocolate, over other sweet snacks. “We know it is the cocoa content in chocolate that is important, so the higher the cocoa content, the better.”

Dr Steffen Desch (University of Leipzig, Heart Center, Germany), who was not involved with this study but who has performed research on the effects of chocolate on blood pressure, told HeartWire, “This is an interesting study that adds to the growing body of evidence that flavanol-rich chocolate might be associated with health benefits. Several epidemiological studies (including the Zuphten Elderly Study, by the same first author) and even more physiological trials have been published before.”

“What is missing now is a large-scale randomized trial of flavanol-rich chocolate versus control. The most reasonable end point would probably be the change in blood pressure between groups.” However, Desch added, “the major problems in designing such a study are the lack of funding and finding an appropriate control substance. To the best of my knowledge, there is no commercially available flavanol-free chocolate that offers the distinct bitter taste and dark color inherent to cocoa-rich chocolate.”

But, the best news from this study is that the biggest chocolate consumers had the lowest blood pressure and half the risk of stroke.

“Our hypothesis was that because chocolate appears to have a pronounced effect on blood pressure, chocolate consumption would lower the risk of strokes and heart attacks, with a stronger effect being seen for stroke,” explained Buijsse.

The researchers found that lower baseline blood pressure explained 12% of the reduced risk of the combined outcome, but even after taking this into account, those in the top quartile still had their risk reduced by a third (32%) compared with those in the bottom quartile over the duration of the study.

To put this in terms of absolute risk, Buijsse said if people in the group eating the least amount of chocolate increased their chocolate intake by 6 g a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years.

He says it appears that flavanols in chocolate are responsible for the beneficial effects, causing the release of nitric oxide, which contributes to lower BP and improves platelet function.

Dr Frank Ruschitzka (University Hospital, Zurich, Switzerland) agrees. He said in a European Society of Cardiology statement, “Basic science has demonstrated quite convincingly that dark chocolate particularly, with a cocoa content of at least 70%, reduces oxidative stress and improves vascular and platelet function.”

NOTE: Only small amounts of chocolate were beneficial; so don’t eat too much.

Buissje said this work builds on his earlier small trial — the Zuphten Elderly Study — performed in 500 men in Holland, which showed that chocolate consumption lowered overall cardiovascular mortality.

“Due to the small size of this study, we were not able to differentiate between stroke and MI in this, but now we are able to look at stroke and MI separately, so it’s a nice addition,” he notes.

And the findings are in line with an intervention study that showed that eating around 6 g of chocolate a day — one small square of a 100-g bar — might lower CV disease risk, he says. “So the effects are achieved with very small amounts.”

British Heart Foundation dietician Victoria Taylor made the same point in a press statement: “It’s important to read the small print with this study. The amount consumed on average by even the highest consumers was about one square of chocolate a day or half a small chocolate Easter egg in a week, so the benefits were associated with a fairly small amount of chocolate.

“Some people will be tempted to eat more than one square; however, chocolate has high amounts of calories and saturated fat . . . two of the key risk factors for heart disease,” she noted.

Ruschitzka similarly urged caution: “Before you rush to add dark chocolate to your diet, be aware that 100 g of dark chocolate contains roughly 500 calories. As such, you may want to subtract an equivalent amount of calories, by cutting back on other foods, to avoid weight gain.”

April 1, 2010 (Nuthetal, Germany) — The largest observational study so far to examine the association between chocolate consumption and risk of cardiovascular disease has found that those who ate the most chocolate–around 7.5 g per day–had a 39% lower risk of MI and stroke than individuals who ate almost no chocolate (1.7 g per day) [1].
Lead author Dr Brian Buijsse (German Institute of Human Nutrition, Nuthetal, Germany) told heartwire : “This shows that habitual consumption of chocolate is related to a lower risk of heart disease and stroke that is partly explained by blood-pressure reduction. The risk reduction is stronger for stroke than for MI, which is logical because it appears that chocolate and cocoa have a pronounced effect on BP, and BP is a higher risk factor for stroke than for MI.” Buijsse and colleagues report their findings online March 31, 2010 in the European Heart Journal.
However, Buijsse cautions that only small amounts of chocolate were associated with the benefits and it is too early to give recommendations on chocolate consumption: “Maybe it’s a boring message, but it’s a little too early to come up with recommendations, because chocolate contains so many calories and sugar, and obesity is already an epidemic. We have to be careful.” However, he added, that if people did want to treat themselves, they would be better off choosing small amounts of chocolate, preferably dark chocolate, over other sweet snacks. “We know it is the cocoa content in chocolate that is important, so the higher the cocoa content, the better.”
Dr Steffen Desch (University of Leipzig, Heart Center, Germany), who was not involved with this study but who has performed research on the effects of chocolate on blood pressure, told heartwire : “This is an interesting study that adds to the growing body of evidence that flavanol-rich chocolate might be associated with health benefits. Several epidemiological studies (including the Zuphten Elderly Study, by the same first author) and even more physiological trials have been published before.”
“What is missing now is a large-scale randomized trial of flavanol-rich chocolate versus control. The most reasonable end point would probably be the change in blood pressure between groups.” However, Desch added, “the major problems in designing such a study are the lack of funding and finding an appropriate control substance. To the best of my knowledge, there is no commercially available flavanol-free chocolate that offers the distinct bitter taste and dark color inherent to cocoa-rich chocolate.”
Biggest Chocolate Consumers Had Lowest Blood Pressure
Buijsse and colleagues followed 19 357 people, aged between 35 and 65, who were participants in the Potsdam arm of the European Prospective Investigation into Cancer (EPIC). They received medical checks, including blood pressure and height and weight measurements at the start of the study (1994–1998), and they also answered questions about their diet, lifestyle, and health, including how frequently they ate 50-g bars of chocolate.
The research was conducted before the health benefits of chocolate and cocoa were recognized, so no differentiation was made between milk, dark, and white chocolate in the study. But in a subset analysis of 1568 participants later asked to recall their chocolate intake over a 24-hour period, 57% ate milk chocolate, 24% dark chocolate, and 2% white chocolate.
Participants were divided into quartiles according to their level of chocolate consumption. Those in the top quartile, eating around 7.5 g of chocolate a day, had blood pressure that was about 1 mm Hg (systolic) and 0.9 mm Hg (diastolic) lower than those in the bottom quartile.
In follow-up questionnaires, sent out every two or three years until December 2006, the participants were asked whether they had had a heart attack or stroke, information that was subsequently verified by medical records from general physicians or hospitals. Death certificates from those who had died were also used to identify MIs and strokes.
“Our hypothesis was that because chocolate appears to have a pronounced effect on blood pressure, chocolate consumption would lower the risk of strokes and heart attacks, with a stronger effect being seen for stroke,” explained Buijsse.
Those Eating Most Chocolate Had Half the Risk of Stroke
During the eight years, there were 166 MIs (24 fatal) and 136 strokes (12 fatal); people in the top quartile had a 27% reduced risk of MI and nearly half the risk (48%) of stroke, compared with those in the lowest quartile. The relative risk of the combined outcome of MI and stroke for top vs bottom quartile was 0.61 (p=0.014).
The researchers found that lower baseline blood pressure explained 12% of the reduced risk of the combined outcome, but even after taking this into account, those in the top quartile still had their risk reduced by a third (32%) compared with those in the bottom quartile over the duration of the study.
To put this in terms of absolute risk, Buijsse said if people in the group eating the least amount of chocolate increased their chocolate intake by 6 g a day, 85 fewer heart attacks and strokes per 10 000 people could be expected to occur over a period of about 10 years.
He says it appears that flavanols in chocolate are responsible for the beneficial effects, causing the release of nitric oxide, which contributes to lower BP and improves platelet function.
Dr Frank Ruschitzka (University Hospital, Zurich, Switzerland) agrees. He said in a European Society of Cardiology statement [2]: “Basic science has demonstrated quite convincingly that dark chocolate particularly, with a cocoa content of at least 70%, reduces oxidative stress and improves vascular and platelet function.”
Only Small Amounts of Chocolate Beneficial; Don’t Eat Too Much
Buissje said this work builds on his earlier small trial–the Zuphten Elderly Study–performed in 500 men in Holland, which showed that chocolate consumption lowered overall cardiovascular mortality. “Due to the small size of this study, we were not able to differentiate between stroke and MI in this, but now we are able to look at stroke and MI separately, so it’s a nice addition,” he notes.
And the findings are in line with an intervention study that showed that eating around 6 g of chocolate a day–one small square of a 100-g bar–might lower CV disease risk, he says. “So the effects are achieved with very small amounts.”
British Heart Foundation dietician Victoria Taylor made the same point: “It’s important to read the small print with this study. The amount consumed on average by even the highest consumers was about one square of chocolate a day or half a small chocolate Easter egg in a week, so the benefits were associated with a fairly small amount of chocolate.
“Some people will be tempted to eat more than one square; however, chocolate has high amounts of calories and saturated fat . . . two of the key risk factors for heart disease,” she noted in a statement [3].
Ruschitzka similarly urged caution: “Before you rush to add dark chocolate to your diet, be aware that 100 g of dark chocolate contains roughly 500 calories. As such, you may want to subtract an equivalent amount of calories, by cutting back on other foods, to avoid weight gain.”

How to Make Chocolate a Healthy Indulgence

The benefits of being a chocolate lover
From Health magazine
This ultimate feel-good food keeps your heart healthy, mood up, and body in great shape. Find out what all this natural ingredient can do for you.

Here’s a just-in-time-for-Easter article on the benefits of being a chocolate lover from Health magazine. This ultimate feel-good food, in moderation, can keep your heart healthy, your mood up, and your body in great shape. Read on to find out what all this natural health food can do for you.

Heart helper

Chocotini, anyone? A study in the Journal of Nutrition found that people who ate dark chocolate had less of a protein that indicates inflammation, which can lead to a heart attack. A more recent study showed that just one small square of chocolate a day can lower your blood pressure and reduce your risk of heart disease.

Mood booster

There’s a good reason we crave chocolate when we’re down. Its tryptophan ups mood-lifting serotonin in the brain. One study found that even the taste, texture, and smell make us happy.

Skin soother

For a spa treat, try this bath from Lauren Cox’s Eco Beauty: Combine 2 cups chocolate milk, 2 tablespoons mild liquid soap, and 1 tablespoon honey; pour mixture into the bathtub. The chocolate milk’s lactic acid and antioxidants smooth and soften your skin.

Cravings buster

University of Copenhagen researchers published a study showing that subjects felt fuller and craved fewer sweet, salty, and fatty foods when they snacked on chocolate (yes!). Be sure to choose dark chocolate: Its low glycemic index steadies blood sugar levels, cutting cravings.

And remember, too much of a good thing …

You can read my other blogs on chocolate here:

You can learn more about becoming happier and more highly healthy in my book 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy:

  • You can order a copy here.
  • You can look at the Table of Contents here.
  • You can read the first chapter of the book here.
  • And, if you’re part of a reading group or small-group, there’s a reader’s guide available here.

8 Easter Treats Under 80 Calories

Want to enjoy an Easter treat or two, while keeping rein on those calories? It’s hard to resist that innocent-looking chocolate bunny or all those pastel-colored sugary treats that appear every spring. So how do you keep from packing on extra pounds with bathing suit season just around the corner? Here are some tips from our friends at Health.com — what they call “no-guilt nibbles.” Eight healthy ways to indulge your sweet tooth that won’t ruin your beach bod.

No-guilt nibbles
From Health magazine
It’s hard to resist that innocent-looking chocolate bunny or all those pastel-colored sugary treats that appear every spring. So how do you keep from packing on extra pounds with bathing suit season just around the corner?
We’ve got eight healthy ways to indulge your sweet tooth that won’t ruin your beach bod.
  1. 19 Jelly Belly jelly beans (76 calories)
  2. 1 stick Passion Fruit Stick Candy (60 calories)
  3. 2 PEEPS Tulips (73 calories)
  4. 1/4 cup Ciao Bella Strawberry Sorbet (60 calories)
  5. 3 rainbow nonpareils (60 calories)
  6. Lemongrass DRY soda (50 calories)
  7. Crepe with apricot jam: Frieda’s French Style Crepe, 1/2 tablespoon Stonewall Kitchen Apricot Jam, powdered sugar, 5 blueberries (79 calories)
  8. Mini Lindt Gold Bunny (55 calories)

10 Easy Food Swaps Cut Cholesterol, Not Taste

Holiday weekends are not necessarily the easiest time to cut unhealthy and saturated fats. But, according to this practical article from Health.com, it couldn’t be easier to cut cholesterol without cutting taste. Many of my patients are afraid that any meals that are “good for my cholesterol” are meals that are joyless (and tasteless). However, a low-cholesterol diet doesn’t have to be all oat bran and tofu. If you want to know more, here are some simple substitutions that you can make to the food you already eat to help fight cholesterol painlessly.

1) Sprinkle walnuts, skip croutons

Carbohydrates can cause high levels of a type of low-density lipoprotein (LDL), also known as bad cholesterol. For a healthier salad, replace your carbo-laden croutons with walnuts, which are high in polyunsaturated fat—a good fat that can lower LDL while boosting HDL (aka good cholesterol).

2) Yes to edamame and nuts, no to cheese and crackers

For a predinner snack, skip the crackers and cheese, which are sky-high in saturated fat—one of the prime culprits behind high cholesterol. Instead, put out some almonds, which have been shown to lower LDL, and edamame, the boiled baby soybeans that are a common appetite whetter in Japanese restaurants. Edamame is low in saturated fat and one cup contains about 25 grams of soy protein, which is thought to actively lower LDL (although the evidence is conflicting). Buy them frozen, dump them into boiling water, and drain after 5 minutes: That’s all there is to it.

3) Vinegar and lemon juice beats salad dressing

As everyone knows by now, drenching a salad in high-fat salad dressing is like smoking cigarettes while jogging: It totally defeats the purpose. A low-fat alternative—such as our shallot and grapefruit dressing—is a step in the right direction, but the best option for lower cholesterol is drizzling your salad with balsamic vinegar or lemon juice.

4) Ditch the butter for margarine spread

One tablespoon of butter contains more than 7 grams of saturated fat—that’s more than a third of the recommended daily value. It also contains 10% of your daily value for dietary cholesterol, which, though it isn’t as harmful as was once thought, is one of the main sources of high cholesterol (and atherosclerosis). Switch the butter with a vegetable-oil-based spread such as Smart Balance or Olivio (which also contains olive oil); you’ll be replacing a bad fat with a good fat. And instead of using butter to grease the pan while cooking, try olive oil or white wine vinegar.

5) Use ground turkey, not ground beef

Red meat is a source of both saturated fat and dietary cholesterol—two of the main sources of blood cholesterol. Ground turkey contains half the saturated fat of 85% lean ground beef, and it can be substituted easily for beef in most recipes.

6) Quinoa is a tasty alternative to rice

“I’m keen, you’re keen, we’re all keen on quinoa!” People with high cholesterol will be singing this tune once they realize the benefits of quinoa (pronounced “KEEN-wah”), a South American seed that serves as a tasty and healthful stand-in for rice or couscous. One cup of cooked quinoa has 15% fewer carbohydrates and 60% more protein than a comparable amount of brown rice; it also has 25% more fiber, which can help lower blood cholesterol.

7) Chicken is OK, fish is better

While they have less saturated fat than red meat, turkey and chicken aren’t entirely without cholesterol. One of the best strategies for reducing cholesterol through diet is eating more fish, which is very low in fat and contains heart-healthy omega-3 fatty acids.

8) Munch on popcorn, not tortilla chips

Tortilla chips are often considered a healthy alternative to potato chips. They are certainly healthier, but an even better snack is homemade air-popped popcorn, which has 80% less saturated fat than tortilla chips and more than twice the fiber.

9) Skip the fatty sour cream, choose fat-free Greek yogurt

Whether it’s used as a garnish or in a sauce, sour cream adds a shot of saturated fat to otherwise heart-healthy meals. To cut out that excess fat without sacrificing taste or texture, swap the sour cream with no-fat Greek yogurt—one of the world’s healthiest foods. Just about any recipe that calls for sour cream can be made with Greek yogurt instead.

10) Sip red wine, not cocktails

Research suggests that moderate alcohol intake can produce a slight rise in HDL cholesterol (a so-called good cholesterol). But that won’t do you much good if you’re tossing back margaritas or mixed drinks with fruit juice, which contain carbohydrates. Switch to red wine; it has about a tenth of the carbohydrates of a margarita, and you’ll also get antioxidants such as flavonoids that are believed to lower LDL and boost HDL. Given the risks of alcohol, however, the American Heart Association recommends that you limit your daily intake to two glasses (for men) or one glass (for women).

So, here’s to some tasty swaps that are also highly healthy.

10 Best Foods for Your Heart

As we head into the Easter weekend, I wanted to offer you some blogs on healthier nutrition choices. Here are ten choices that you can make that will be heart healthy and are adapted from an article at Health.com.

1) Oatmeal

Start your day with a steaming bowl of oats, which are full of omega-3 fatty acids, folate, and potassium. This fiber-rich superfood can lower levels of LDL (or bad) cholesterol and help keep arteries clear. Opt for coarse or steel-cut oats over instant varieties—which contain more fiber—and top your bowl off with a banana for another 4 grams of fiber.

2) Salmon

Super-rich in omega-3 fatty acids, salmon can effectively reduce blood pressure and keep clotting at bay. Aim for two servings per week, which may reduce your risk of dying of a heart attack by up to one-third. “Salmon contains the carotenoid astaxanthin, which is a very powerful antioxidant,” says cardiologist  Stephen T. Sinatra, MD, the author of Lower Your Blood Pressure In Eight Weeks. But be sure to choose wild salmon over farm-raised fish, which can be packed with insecticides, pesticides, and heavy metals. Not a fan of salmon? Other oily fish like mackerel, tuna, herring, and sardines will give your heart the same boost.

3) Avocado

Add a bit of avocado to a sandwich or spinach salad to up the amount of heart-healthy fats in your diet. Packed with monounsaturated fat, avocados can help lower LDL levels while raising the amount of HDL cholesterol in your body. “Avocados are awesome,” says Dr. Sinatra. “They allow for the absorption of other carotenoids—especially beta-carotene and lycopene—which are essential for heart health.”

4) Olive oil

Full of monounsaturated fats, olive oil lowers bad LDL cholesterol and reduces your risk of developing heart disease. Results from the Seven Countries Study, which looked at cardiovascular disease incidences across the globe, showed that while men in Crete had a predisposition for high cholesterol levels, relatively few died of heart disease because their diet focused on heart-healthy fats found in olive oil. Look for extra-virgin or virgin varieties—they’re the least processed—and use them instead of butter when cooking.

5) Nuts

Walnuts are full of omega-3 fatty acids and, along with almonds and macadamia nuts, are loaded with mono- and polyunsaturated fat. Plus, nuts increase fiber in the diet, says Dr. Sinatra. “And like olive oil, they are a great source of healthy fat.”

6) Berries

Blueberries, raspberries, strawberries—whatever berry you like best—are full of anti-inflammatories, which reduce your risk of heart disease and cancer. “Blackberries and blueberries are especially great,” says Sinatra. “But all berries are great for your vascular health.”

7) Legumes

Fill up on fiber with lentils, chickpeas, and black and kidney beans. They’re packed with omega-3 fatty acids, calcium, and soluble fiber.

8) Spinach

Spinach can help keep your ticker in top shape thanks to its stores of lutein, folate, potassium, and fiber. But upping your servings of any veggies is sure to give your heart a boost.  The Physicians’ Health Study examined more than 15,000 men without heart disease for a period of 12 years. Those who ate at least two-and-a-half servings of vegetables each day cut their risk of heart disease by about 25%, compared with those who didn’t eat the veggies. Each additional serving reduced risk by another 17%.

9) Flaxseed

Full of fiber and omega-3 and omega-6 fatty acids, a little sprinkling of flaxseed can go a long way for your heart. Top a bowl of oatmeal or whole-grain cereal with a smidgen of ground flaxseed for the ultimate heart-healthy breakfast.

10) Soy

Soy may lower cholesterol, and since it is low in saturated fat, it’s still a great source of lean protein in a heart-healthy diet. Look for natural sources of soy, like edamame, tempeh, or organic silken tofu. And soy milk is a great addition to a bowl of oatmeal or whole-grain cereal. But watch the amount of salt in your soy: some processed varieties like soy dogs can contain added sodium, which boosts blood pressure.

So, use these tips to have a happy and highly healthy Easter … and make it a heart healthy one at that.