The medical community faces herculean challenges in the coming decades. The most notable of these is the rise of non-communicable diseases. In aggregate cardiovascular disease (CVD), cancer and diabetes where responsible for more than 23 million deaths in 2010 alone. (1)
Furthermore, the associated economic costs are vast: they are estimated to be trillions of dollars. (2, 20) As large as these amounts may seem, the burden these illnesses cause will only rise in the upcoming decades as the global population and average life expectancy rise in unison. Currently, the pharmaceutical industry is struggling with ever increasing developmental costs and long lead times to bring new compounds to markets. (20, 21) In short, the world is in desperate need of cost effective solutions to combat the seemingly unstoppable scourge of non-communicable disease.
Theobroma cacao, simply known as cacao, might be a part of the solution. Its scientific name, which has been derived from Greek, literally means “food of the Gods” and with good reason. (3) Cacao has long been celebrated by Mesoamerican and South American Indians for its curative properties and was seen as a divine elixir. (3) The Spanish conquistadors where quick to discover these properties and exported cacao to Europe. In the centuries that followed, medical manuscripts described no less than one hundred medical applications for cacao.3 In the beginning of the 19th century, the techniques needed to produce our modern day version of chocolate were discovered. Ever since then, cocoa has been eaten as a confectionery, nullifying many of its health benefits. As such, the medical community had lost interest in cacao and consumption of large amounts of chocolate are discouraged by physicians. (7)
Epidemiological studies of the Kuna Indians during the last decade sparked renewed interest in the medical properties of cacao. The Kuna Indians, who reside in an archipelago on the Caribbean Coast of Panama, have an exceedingly low rate of (occurrences of) cardiovascular disease, cancer and diabetes.4 The most striking feature of the Kuna that scientists found was a very high intake of minimally processed cocoa. (5) Scientific interest in cacao received a further boost when researchers discovered that cacao contains a host biologically active molecules, called flavanols. (6)
In recent years, a large body of research, including high-quality clinical trials, systematic reviews and meta-analyses, have shown that the consumption of flavanol-rich cacao has clinically significant effects on various markers of human health, such as blood pressure (8,9,10,11,12,14), vascular functions (9,13,14) and insulin sensitivity (9,11,12,13,14). Furthermore, mounting evidence suggest possible beneficial effects on cholesterol levels (9, 11, 12) and cognitive functions (11, 12, 15, 19). Lastly, there is little to no evidence suggesting significant adverse effects. (9, 16)
Although the research is exciting, cacao should by no means be seen a stand-alone treatment for disease. Instead, it could be a potential long-term addition to the standard treatment protocols of cardiovascular patients and diabetics or as a dietary recommendation for high-risk groups, such as the elderly or people with obesity. In this context, the therapeutic potential of cacao is considerable.
On a societal level, even incremental improvements in the treatment of chronic diseases could save thousands of lives and billions in medical costs. As a growing body of research indicates, cacao’s beneficial effects on various aspects of human health and its therapeutic potential warrant more attention from the medical community.
This TEDx-talk is a heartfelt call to action directed at the various influential stakeholders, including medical associations, patient societies, government organizations and insurance companies.
Specifically larger, long-term, and independently funded trials focusing on patient-oriented outcomes are required. (9, 16, 18, 19) It is very important that these future studies use cacao with standardized and well documented amounts of flavanols.
1. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15
2. The Global Economic Burden of Non-communicable Diseases (WEF, Harvard), 2011
3. Dillinger TL, Barriga P, Escárcega S, Jimenez M, Salazar Lowe D, Grivetti LE.
Food of the gods: cure for humanity? A cultural history of the medicinal and ritual use of chocolate. J Nutr. 2000 Aug
4. Bayard V, Chamorro F, Motta J, Hollenberg NK. Does flavanol intake influence mortality from nitric oxide-dependent processes? Ischemic heart disease, stroke, diabetes mellitus, and cancer in Panama. Int J Med Sci. 2007 Jan 27
5. Hollenberg NK, Fisher NDL, McCullough ML. Flavanols, the Kuna, Cocoa Consumption, and Nitric Oxide. Journal of the American Society of Hypertension : JASH 2009;
6. Natsume M, Osakabe N, Yamagishi M, et al, Analyses of polyphenols in cacao liquor, cocoa, and chocolate by normal-phase and reversed phase HPLC. Biosci Biotechnol Biochem. 2000
7. Latif R. Chocolate/cocoa and human health: a review. Neth J Med. 2013
8. Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2012
9. Hooper L, Kay C, Abdelhamid A, Kroon PA, Cohn JS, Rimm EB, Cassidy A. 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 Mar
10. Davison K, Berry NM, Misan G, Coates AM, Buckley JD, Howe PR. Dose-related effects of flavanol-rich cocoa on blood pressure. J Hum Hypertens. 2010 Sep
11. D. Mastroiacovo, C. Kwik-Uribe, D. Grassi. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial. The American Journal of Clinical Nutrition. January 6, 2015
12. Desideri G, Kwik-Uribe C, Grassi D, Necozione S. 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
13. Grassi D, Desideri G, Ferri C. Protective effects of dark chocolate on endothelial function and diabetes. Curr Opin Clin Nutr Metab Care. 2013 Nov
14. Larsson SC. Coffee, tea, and cocoa and risk of stroke. Stroke. 2014 Jan
15. Scholey A, Owen L. Effects of chocolate on cognitive function and mood: a systematic review. Nutr Rev. 2013
16. Schroeter H, Heiss C, Spencer JP, Keen CL, Lupton JR, Schmitz HH. Recommending flavanols and procyanidins for cardiovascular health: current knowledge and future needs. Mol Aspects Med. 2010 Dec
17. Martin MA, Goya L, Ramos S. Potential for preventive effects of cocoa and cocoa polyphenols in cancer. Food Chem Toxicol. 2013 Jun
18. Buitrago-Lopez A, Sanderson J, Johnson L, et al. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ : British Medical Journal 2011
19. Nehlig A. The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. British Journal of Clinical Pharmacology 2013
20. Bank of America Merrill Lynch, Thematic Investing: The Silver Dollar-Longevity Revolution Primer, 06 June 2014.
21. Scannell JW, Blanckley A, Boldon H, Warrington B. Diagnosing the decline in pharmaceutical R&D efficiency. Nat Rev Drug Discov. 2012 Mar 1
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Simon is the CEO and Editor-in-Chief of Foresight Investor. He has been following the markets passionately for over 7 years.