Chocolate Is a Health Food, But Only If You Hate Chocolate

Chocolate was a recent addition to the Western diet, but today has a devoted following: the average American eats about a pound of chocolate a month, a habit that adds up to nearly $200 (and 50,000 calories) per year. Chocolate does provide healthful molecules, but the chocolate studied in the lab and the chocolate we eat in real life are quite different. This gap should give pause to anyone feeling good about their nightly bar of dark chocolate, but also provides the 5% of Americans that hate chocolate with a way to enjoy its health advantages without actually enjoying chocolate.

Long before chocolate evolved into candy, it was a bitter, foamy drink reserved for warriors in Mesoamerica. The Maya first worked out to grow and then ferment beans which produced the base for a thick ceremonial brew they called xocolatl/cacahuatl. The Aztecs later adopted cacao, and declared it a divine gift. Moctezuma II, the Aztec emperor, was said to drink dozens of jars of cacao from golden cups to improve his energy and as an aphrodisiac.

When chocolate reached Spain in the 1500s, Europeans tamed the bitterness with sugar, cinnamon, and later milk, transforming a ritual, medicinal brew into a sweet social drink that would have been unrecognizable by Moctezuma. Industrial processing of cacao further transformed the drink into solid bars, the mass-produced products that now fill the candy aisle of grocery stores. Somewhere along this journey, the cacao plant's complex mix of polyphenols and alkaloids became our "chocolate", a confection with lashings of sugar, fat, and flavorings, a transition that still creates confusion about the health benefits of chocolate.

Peer reviewed medical research has documented that chocolate can lower blood pressure and possibly improve cognition, but the experimental intervention isn't a Hershey bar or truffle. Instead, clinical trials use capsules containing standardized high-flavanol powders, or "cocoa beverages" laced with such powders, an approach that allows precise control of the dose of epicatechin and related flavanols. Occasionally the intervention is a specially formulated "study chocolate bar" which is engineered to be high (experiment) or low (control) in flavanols while matching calories, fat, and sugar. A recent meta-analysis of randomized trials of flavanol-fortified cocoa products¹ found that fortification with several hundred milligrams of flavanols per day can acutely lower blood pressure and improve vascular function over a period of weeks. In individual trials, a single high-flavanol chocolate bar or drink has reduced systolic and diastolic blood pressure and improved flow-mediated dilation compared with flavanol-poor controls, even in sleep-deprived or otherwise stressed subjects.¹ Another randomized trial tested the effects of "chocolate" on mood, fatigue, and cognition, but again using a pill, not a dessert.²

Observational epidemiology finds similar, but more modest, effects. In large prospective cohorts a meta-analysis found that higher chocolate consumption within a calorie-balanced diet was associated with lower overall, cardiovascular, and heart disease mortality.³ More recent work suggests that higher dark, but not milk, chocolate intake tracks with lower risk of type 2 diabetes. Higher milk chocolate intake, by contrast, is neutral for diabetes risk but is linked to weight gain.⁴ Taken together, these findings suggest that cocoa flavanols and related compounds do have small but measurable vascular and metabolic effects in humans, especially at the doses and in the formulations used in trials.⁴

But does this have anything to do with the chocolate in your pantry?

Cocoa beans are biochemical powerhouses, rich in flavan-3-ols such as epicatechin, catechin, procyanidins, and in methylxanthines like theobromine. Unfortunately, every step that makes cocoa palatable and shelf-stable (fermentation, drying, roasting, alkalization, and aerating) reduces these active compounds. Fermentation and drying are necessary for flavor development, but they are associated with substantial losses in total phenolics; some studies report reductions as great as 20 to 25 percent. Roasting enhances those "chocolatey" Maillard flavors that we love, but it further reduces flavanol levels by up to 40. Dutch processing (alkalization), used to darken color and mellow bitterness in cocoa powder is even worse, and can reduce flavanol content by 60 to 90 percent⁵, yielding a product that looks richer and smoother but is largely depleted of the very compounds that provide health benefits. The story is discouraging: even though the starting plant is a pharmacologic juggernaut the finished product ranges from "still interesting" to "mostly candy," depending on how it was created.

Several analytical studies have tried to quantify flavanol content in commercial chocolate and to test whether labels like "70% cocoa" or simply "dark chocolate" actually predict the bioactive dose seen in clinical trials. A few consistent themes emerge. Dark chocolate usually contains more flavanols than milk chocolate, but the variability is enormous. In one analysis of commonly consumed dark chocolates, total flavanols ranged from roughly 90 to over 650 mg per 100 g, with all dark chocolates containing more flavanols than the milk and white products tested. But even among dark bars, a higher labeled cocoa percentage did not consistently translate into higher flavanol content; some 70–85% bars were surprisingly low in flavanols, while some lower-percentage products did reasonably well.⁶

Chemically, epicatechin appears to be a better marker than the front-of-pack "% cacao." Across products, epicatechin tracks tightly with total flavanol content, whereas calculated non-fat cocoa solids or cocoa percentage are less accurate proxies. Unfortunately, labels rarely tell you what you need to know. Most commercial chocolate does not list flavanol content, so consumers cannot reliably infer polyphenol levels from front-of-pack claims, color, or even ingredients lists. Studies of dozens of brands found that chocolates with the highest stated cocoa solids were not necessarily the richest in flavanols.

The story is similar with cocoa powder. Natural, non-alkalized cocoa powder can be a relatively concentrated source of flavanols, especially if not baked at high temperatures for long periods. Dutch-processed cocoa, by contrast, may have lost the majority of these compounds while maintaining the deep color and smooth flavor that make it popular in baking. To the naked eye these products look interchangeable, but chemically, they are altogether different products.

The "dosage" of chocolate is also critical. Many intervention trials use 400 to 900 mg of cocoa flavanols per day, supplied by carefully engineered drinks, tablets, or bars that keep sugar and saturated fat modest while maximizing epicatechin. To reach a similar flavanol intake using typical dark chocolate, would require 40 to 100 g of a high-flavanol bar daily. That usually means an extra 250 to 600 calories, along with unhealthy doses of saturated fat and sugar. Milk chocolate, with its lower cocoa content and higher sugar, would require even larger portions. In practice, the amount of chocolate required to "dose" yourself like a study participant would bring along caloric and metabolic baggage that is simply unrealistic.

Taken together, the human data on cocoa flavanols are encouraging but restrained. Meta-analyses and large real-world cohorts suggest that moderate chocolate intake is associated with modestly lower cardiovascular disease risk and overall mortality, especially when the chocolate is dark and when overall calories are limited. Clinical trials confirm that high-flavanol cocoa preparations can lower blood pressure and improve endothelial function as well as some cardiometabolic biomarkers. But because chocolate from the supermarket isn't what's used in clinical research, the DIY approach to chocolate therapy of simply picking up a pint of Ben and Jerry's chocolate fudge brownie ice cream instead of a pint of B&J's strawberry ice cream isn't likely to lower your blood pressure or lengthen your life. Note, however, that ice cream is itself a health food.⁷

So, the science says that cocoa flavanols have biologically meaningful effects, and certain high-cocoa, minimally processed products can be included in an overall healthy diet. But what we can't claim is that chocolate is a cardiometabolic panacea. So, if you love chocolate, this is not a message of abstinence but of recalibration.

Sensible advice would be to think of chocolate as a pleasure, not a supplement. The strongest data support cocoa flavanols as functional compounds, but unfortunately chocolate is a particularly inefficient delivery vehicle that brings along a lot of caloric baggage. Enjoy it because you enjoy it, not because it is your primary cardiovascular strategy. To tilt your chocolate habit in a more health-aligned direction choose dark chocolate with a high cocoa percentage from manufacturers who emphasize minimal processing. Even then, assume wide variability and avoid magical thinking. A small piece of good-quality dark chocolate, say 10 or 20 grams, can fit comfortably into an overall diet that prioritizes fruits, vegetables, whole grains, nuts, and physical activity, all of which have far stronger evidence for improving long-term health than any single "superfood". Even chocolate.

Note that dark chocolate and milk chocolate are nutritionally different products. Higher dark chocolate intake tracks with lower diabetes risk, whereas milk chocolate shows no such benefit and is a marker of higher sugar intake. From a flavanol standpoint, milk chocolate is best classified as candy. More broadly, chocolate consumption is a rounding error compared to the effect of a healthful balanced diet. No amount of chocolate can compensate for smoking, inactivity, or a highly processed diet.

It's likely that these facts will disappoint those who want to believe that chocolate is secretly a health food. The modern chocolate bar, while delicious, is only distantly related to the formulations tested in clinical trials. Whatever health halo remains around that bar is mostly marketing and wishful thinking.

But the good news is that you needn't give up chocolate, just give up the halo. Enjoy chocolate as a small, dense pleasure, ideally in a form that preserves at least some of the chemistry that first drew scientists' attention. Appreciate that there are indeed molecules in cacao that do interesting things to endothelial cells and blood pressure curves. But recognize, too, that calling dessert a wellness intervention is more marketing than medicine. The hard facts are that the downsides of 100 grams of chocolate (weight gain, higher fasting glucose, and higher triglycerides) are much greater than the modest 2–3 mmHg BP improvement and small endothelial gains conferred by cocoa flavanols.

Post Script: For People Who (Inexplicably) Hate Chocolate

For the few Americans who do not like chocolate, the situation is tragic but not hopeless. One needn't like chocolate to consume it, because from a physiological perspective it doesn't matter whether the healthful molecules arrive as an expensive bar or a bland capsule. If your goal is to capture the benefits of cocoa flavanols without joy, concentrated cocoa-flavanol supplements are workaround that mimics laboratory conditions.

A recent trial (COSMOS)⁸ found that a daily cocoa extract capsule containing 500 mg of flavanols reduced cardiovascular deaths by 27%, and possibly reduced all-cause mortality. A subsequent study³ found that daily cocoa extract did not improve memory. A separate meta-analysis of cocoa interventions on blood pressure found a 4 mm reduction in systolic blood pressure among hypertensive patients.

So why aren't we all taking cocoa extract capsules? Expense is one reason: if taken every day as the research seems to require, a month's supply of capsules providing research daily levels of cocoa flavanols (500 mg.) runs about $2/day. Which may seem expensive, but is less than the real stuff. The 100 g of chocolate daily required to provide research grade flavanols (along 500–600 kilocalories, and lashings of saturated fat) would cost about twice as much as joyless capsules. And don't think you can create your own cut rate capsules using coco powder, because cocoa powder is so processed that it's particularly flavanol depleted. :-(

The bottom line seems to be that those who hate chocolate can enjoy cacao's healthful chemistry with just a daily capsule or two, secure in the quiet satisfaction that they're paying half what their chocolate crazed friends are paying for what amounts to a different sort of satisfaction.

¹ Ried, K., Fakler, P., & Stocks, N. P. (2017). Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews, 4(4), Article CD008893. https://doi.org/10.1002/14651858.CD008893.pub3

² Baker, L. D., Manson, J. E., Rapp, S. R., Sesso, H. D., Gaussoin, S. A., Shumaker, S. A., & Espeland, M. A. (2023). Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial. Alzheimer's & Dementia, 19(4), 1308–1319. https://doi.org/10.1002/alz.12767

³ Golomb, B. A., Koperski, S., & White, H. L. (2012). Association between more frequent chocolate consumption and lower body mass index. Archives of Internal Medicine, 172(6), 519–521. https://doi.org/10.1001/archinternmed.2011.2100

⁴ Montagna, M. T., Diella, G., Triggiano, F., Caponio, G. R., De Giglio, O., Caggiano, G., Di Ciaula, A., & Portincasa, P. (2019). Chocolate, "Food of the Gods": History, science, and human health. International Journal of Environmental Research and Public Health, 16(24), Article 4960. https://doi.org/10.3390/ijerph16244960

⁵ [Reference no longer available: PMID 18831521]. Originally accessed from PubMed.

⁶ Langer, S., Marshall, L. J., Day, A. J., & Morgan, M. R. (2011). Flavanols and methylxanthines in commercially available dark chocolate: A study of the correlation with nonfat cocoa solids. Journal of Agricultural and Food Chemistry, 59(15), 8435–8441. https://doi.org/10.1021/jf201398t

⁷ Osler, T. (2024, December 12). Now on our health food menu: Ice cream topped with maple syrup? QOR360 Blog. https://qor360.com/blogs/blog/now-on-our-health-food-menu-ice-cream-topped-with-maple-syrup

⁸ Sesso, H. D., Manson, J. E., Aragaki, A. K., Rist, P. M., Johnson, L. G., Friedenberg, G., Copeland, T., Clar, A., Mora, S., Moorthy, M. V., Sarkissian, A., Carrick, W. R., Anderson, G. L., & COSMOS Research Group. (2022). Effect of cocoa flavanol supplementation for the prevention of cardiovascular disease events: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial. The American Journal of Clinical Nutrition, 115(6), 1490–1500. https://doi.org/10.1093/ajcn/nqac055