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07.04.2018 Feature Article

COCOA- For Optimal Health, Eat Cocoa Daily

COCOA- For Optimal Health, Eat Cocoa Daily
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Cocoa is cultivated in Ghana, mostly for export, to earn foreign exchange.

Theobroma cacao, is the scientific name for the cocoa tree.

Cocoa has been called 'food for the gods', due to their health benefits that results from consuming cocoa products daily.

Cocoa beans are fermented for 5-7 days, dried for another week and are ready for the market.

Dry beans are brown on the inside, instead of purplish.

To bring out the chocolate color and flavor, the dried beans are roasted. The roasted beans are then grinded and separated into cocoa powder and cocoa butter.

Cocoa butter is processed further into dark chocolates and body cream and lotions.

Unfermented cocoa beans do not develop the chocolate flavor, when roasted, and they are bitter to taste. Fermenting cocoa beans for 5-7 days, helps with the development of the chocolate flavor and dark color. Fermentation, thus, yield good quality beans.

Cocoa Flavanols:
Cocoa beans, like other plant products, contain pigmented polyphenol compound known as the flavonoids.

The main type of flavonoids in cocoa beans are the flavanols.

The flavanols have anti-inflammatory, anti-tumor, anti-oxidative, anti-clotting, anti-adhesive effects and also cause improvement in blood circulation by relaxing the muscles in blood vessels. (1)

Cocoa has the highest flavanol content of all foods on this planet, pound for pound.

Flavanols give cocoa, the bitter taste; the more flavanols in cocoa products, the bitter the taste. The flavanols include catechin, epicatechin, leucocyanidin and anthocyanin.

The most important flavanol in cocoa beans is Epicatechin, which form up to 35% of the phenols. The health benefits are directly proportional to the amount of epicatechin consumed daily.

A minimum of 100mg of epicatechin must be consumed daily for healthy blood flow. (2)

Fermentation, drying, alkalization and roasting all reduce the polyphenol, especially epicatechin content of the cocoa beans.

Cocoa with too high polyphenol content is undesirable, since that would impart high bitterness and astringency to the finished chocolate and mask the chocolate flavor.


The highest antioxidant and scavenging activity was observed for Ghanaian cocoa beans, followed by Ivory Coast, Malaysian and Sulawesi cocoa beans (3)

The phenolic antioxidants block free radicals and lipid oxidations


The polyphenols are digested in the duodenum and absorbed from the small intestine, into the general circulation. Once absorbed from the intestines, Epicatechin stays in the circulation for 2 hours before it is eliminated in urine.

Cocoa has more polyphenols and higher antioxidant capacity than green tea (2-3times), black tea (4-5 times) and red wine (2times). (4)

For maximum health benefits, cocoa must be consumed daily.

Those living in cocoa growing areas, can keep part of their dry cocoa beans at home. Roast the beans like groundnuts, or roast in ovens, at medium temperatures. Unroasted but dry beans are still, chewable.

Cocoa Nibs, are broken up cocoa beans
Cut or break the roasted beans into the Nibs and store them in air-tight containers or Ziploc bags at room temperature. For long periods, like 1-2years or longer, cocoa nibs can be refrigerated or stored in deep freezers.

Cocoa nibs are slightly bitter and may be sweetened with honey or used in baked goods. A 1-oz serving of raw cocoa nibs contain 36% of daily fiber requirement or 9 grams.

A tablespoonful or 2, may be sprinkled on oatmeal, soup, food, like rice, waakye, porridge, stew, or chewed with dry coconut.

Chewing about 5 cocoa beans a day is great for maximum health benefits.

Raw cocoa powder is available on the market.
One tablespoon of unsweetened Cocoa Powder, has 12 calories, 1gram protein and one tenth of a gram of sugar.

Naturally unsweetened cocoa powder, has 196mg of the Epicatechin in every 100gram of the powder.

Place a tablespoonful (equivalent weight of 5 gram) in warm water, and drink as tea. Drinking cocoa tea. 2-3 times a day will provide the daily polyphenol requirements.

If too bitter to drink, add Milo, Ovaltine, 1 tablespoonful to 1 tablespoon of raw cocoa powder and mix in warm water and drink as cocoa tea.

Kuna Indians live on an island along the coast of Panama. They grind their cocoa and mix that with ripe banana. They drink cocoa tea, to the equivalent of about 5 servings a day. The Kuna Indians, have much lower rates of Heart attacks, Strokes, Diabetes and Cancers than their relatives on the mainland cities and suburbs, who do not consume cocoa.

a.) Epicatechins and Nitric Oxide:
Epicatechins inhibit processes that breakdown Nitric Oxide, in the endothelium of blood vessels, keeping Nitric Oxide levels elevated at all times.

Nitric Oxides relaxes blood vessels and improve vascular functions.

b.) Epicatechins and the Renin-Angiotensin system:

Epicatechins inhibits Angiotensin converting enzyme activity, blocking the conversion of angiotensin 1 to angiotensin 11, which is a potent vasoactive and inflammatory peptide. In this case, cocoa phenols act like the BP medication, known as the ACE inhibitors.

c.) Epicatechins as Antioxidants and Anti-free radicals.

Free oxygen-radicals deplete Nitric Oxide levels and facilitate endothelial dysfunction.

The first step in the formation of arterial plaques is the oxidation of LDL-Cholesterol.

Epicatechins act as scavengers of the various free radicals, inhibit Lipid oxidation and chelate metal ions.

Cocoa Epicatechins enhances plasma antioxidant capacity and protects cell membranes from lipid peroxidation.

d.) Anti-Inflammation
Cocoa polyphenols inhibit Pro-inflammatory cytokines: Interleukin-1 (IL-1) IL-6, IL-2, Tumor necrosis factor (TNF), gamma-interferon (IFN-gamma), Lipoxygenase, intracellular and vascular adhesions molecules, metalloproteinases

Anti-leukotrienes: Phenols inhibit 5-lipooxygenase enzymes, which confer Anti-inflammatory, vasoprotective and Anti-bronchoconstriction capabilities. This is because, the principal metabolite of 5-lipoxygenase is leukotriene B4, which promotes inflammation

e.) Anti-cholesterol plaque formation, Modulation of Lipid profile.

Peroxidation of LDL-Cholesterol initiates arterial plaque formation.

The epicatechins inhibit oxidation of LDL-cholesterol and decrease LDL oxidative susceptibility. By this mechanism, cocoa polyphenols prevent the formation of cholesterol plaques in blood vessels.

For those with prediabetes and metabolic syndrome, studies have shown that, Epicatechins

1.) decrease plasma levels of LDL-cholesterol,
2.) decrease levels of Triglycerides
3.) reduce LDL Oxidation,
4.) Increase HDL-Cholesterol and apo-lipoprotein-A levels.

Cocoa polyphenols and Cancers.
Polyphenols interfere with the Initiation, Promotion and Spread of cancers.

Polyphenols do that through:
a.) Scavenging of free radicals
b.) Inhibition of chronic inflammation,
c.) inhibition of cellular proliferation,
d.) Cause the rapid death of cancer cells,
e.) inhibit the formation of new blood vessels, (needed to supply nutrients to cancer cells) by blocking tumor necrosis factor- a protein that promotes new blood vessels formation, and

f.) prevent spread of cancer cells.
The polyphenols lower the activation of Nucleic Factor–KB (NF-KB), a molecule involved in the development and progression of cancers, including Breast cancers, melanomas, leukemias, pancreatic cancers, B-cell Lymphomas and multiple myeloma.

Animals Studies
Compounds known to induce certain types of cancers were injected into animals: mice, rats after which cocoa products were administered daily. The animals were, then monitored for cancer development.

Research results, indicate that Cocoa may prevent various cancers including Prostate cancers, Bladder cancers, Colon.

Other cancers studies, have shown positive outcome with polyphenol intervention and they include:

Exocrine pancreatic tumors (Yamaagishi et al., 2002)

Lung and Thyroid cancers (yamagishi et al., 2003)
Leukemia (Papiez et al., 2011)
Liver cancer (Sunderesan and Subramanian, 2008)
None of the tests have been extended to humans. However, it is appropriate to assume that Cocoa consumption helps prevent cancers from developing and spreading.

Cocoa and kidney function
Research done in Germany, from 2012 to 2013, and published in the clinical journal of American Society of Nephrology December 17 2015, indicated that drinking a beverage rich in cocoa flavanols, improved vessel function and reduces diastolic blood pressure in individual with kidney failure.

In the study, 20 patients, average age of 65, and who were undergoing kidney dialysis three times weekly, were given cocoa flavanols, at a daily dose of 200mg/day. The drink dramatically improved the kidney blood flow, and lowered their diastolic BP, in all the patients within a month. (5)

Prehypertension and Hypertension
Regular consumption of cocoa lowers blood pressure. Epicatechins mediated the release of Nitric oxide in arteries and prevent nitric oxide breakdown by free radicals. Nitric oxide relaxes arterial smooth muscles, causing vasodilatation.

Epicatechins also inhibit the renin-angiotensin enzymes, leading to drop in blood pressures.

Heart Health
Apart from lowering blood pressure and preventing arterial plaques formation, Epicatechins help in improving heart reperfusion, in the setting of cardiac infarction. (6)

FLAVIOLA Health Study published on 09/09/2015 by researchers in University of Dusseldorf, showed that, consuming 450 mg of cocoa flavonoids twice daily, significantly improved endothelial blood flow, plasma lipids and blood pressure. There was significant decrease in the 10-year risk of coronary artery disease and the chances of death from such diseases.

Diabetes and prediabetes
In a randomized crossover trial with 19 persons who had hypertension and impaired glucose tolerance, Consumption of 100g/day of dark chocolate for 15 days, led to

. Decrease insulin resistance, decrease blood pressure, decrease total and LDL-cholesterol

. Increase insulin sensitivity, increase Beta-cell function.

Regular consumption of cocoa helps lower blood sugar and prevents the development of diabetes complications like cataracts.

Memory Booster
Research investigating the relations between cocoa and cognition shows, in a dose-dependent fashion, Flavanols help to sustain cognitive performance, leading to improvements in general cognition, attention, processing speed and working memory. Acute ingestion of cocoa flavanols has immediate cognitive-enhancing effect, sustaining performance in cognitively demanding conditions. (7)

Cocoa Drinks Help Asthma.
Cocoa polyphenols, by inhibiting 5-lipoxygenases, inhibit the production of leukotriene B4, that causes inflammation in the bronchial airways. By this action, the phenols assume anti-bronchoconstriction properties. Research Studies indicate that, an increase in flavanols intake is beneficial for asthma.

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1.Flavoniods: a review of action and potential application. Amj clin Nutr 2001 74(4) p418-421

2. Eu- cocoa flavanols-health claim 'should be revised'-confectionery news.

3.Antioxidant capacity and phenolic content of cocoa beans. Food chemistry, 100 (4) 1523-1530

4.cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine.

5.vasoprotective effects of dietary cocoa flavanols in patients on hemodialysis.

6. Epicatechin on myocardial ischemia-reperfusion injury.

7.enhancing human cognition with cocoa flavonoids-NCBI-NIH

Alex Sarkodie MD
Alex Sarkodie MD, © 2018

Alex Sarkodie,MBChB has over 30 years experience in the field of MedicineColumn: AlexSarkodie

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