1. Miracle, Vickie A. RN, EdD, CCRN, CCNS, CCRC

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Sometimes I believe I was either born too late or too ahead of my time. I would have made a great Scarlet O'Hara and enjoyed the glory days of the south before the Civil War. I realize the reasons for the Civil War and do support them; however, I do remember a gentler, kinder hospitality of the south. I have attended several costume parties dressed as Scarlet O'Hara in either the green dress she wore to the barbecue or the green drape dress she wore when she visited Rhett Butler in prison. In fact, I own a copy of the drape dress. I would have been a great southern belle (not like the ones on the reality television show).


Then there are times I believe I was born too early. I have been proclaiming chocolate as a health food since I was 6 years old! I do confess to being a chocoholic and proud of it. Now science has caught up with my theory. Chocolate does health benefits. These benefits have been reported in the literature for more than 10 years.1 While the history of the cacao plant and chocolate is very interesting, it is not the intent of this editorial to discuss this. Rather, this editorial will explain why chocolate may have health benefits, some of its benefits, its disadvantages, and current recommendations for those who enjoy eating chocolate.


The cocoa bean is high in polyphenols, also found in green teas. The compound known as flavanols is a subclass of polyphenols. Various polymeric combinations act as antioxidants.1,2 Antioxidants counteract some of the damaging effects of free radicals that oxide low-density lipoprotein cholesterol, a common substance found in atherosclerotic plaque.2-4 These atherosclerotic plaques lead to acute coronary syndrome. Free radicals also play a role in platelet activation and other inflammatory responses. Furthermore, this oxidation process may lead to other degenerative processes common in aging.3 Another key component found in chocolate is phenylethylamine. Several small amounts will lead to an increase in dopamine levels, which further leads to more energy and an enhanced mood and sense of well-being.3


There are many potential health benefits of eating chocolate in moderation. They are as follows1-5:


* may reduce depression


* creates a sense of euphoria


* reduces inflammatory response


* increases antioxidant levels


* increases high-density lipoprotein cholesterol levels


* decreases low-density lipoprotein cholesterol levels


* may decrease platelet activation


* may improve insulin sensitivity and resistance


* may decrease blood pressure


* may aid vascular protection


* causes me to be less cranky (all right, this is not in the literature, but I did my own controlled study)



Now as with anything else, there are some disadvantages to eating too much chocolate. These include the following3,6,7:


* may lead to hyperuricemia associated with gout, stroke, and kidney disease


* has higher sugar content


* may cause weight gain


* causes higher calorie intake


* some believe chocolate is not healthy


* may act as a stimulant similar to caffeine or other energy drinks



So we now realize that with everything in healthcare, there are advantages and disadvantages associated with chocolate. Recommendations concerning the eating of chocolate include1,3,4,6,7:


* Use in moderation.


* Dark chocolate (30%-80% cocoa) has more benefits to your health.


* Small amounts such as one 10-oz bar of dark chocolate than 40-oz bars.


* Remember to keep 5 servings of fruits and vegetables while enjoying your chocolate as well. This way, we can still get the nutrients we need from fruits and vegetables and the benefits from chocolate.


* Incorporate chocolate into a well-balanced, healthy diet.


* Persons with diabetes can also enjoy chocolate in moderation.


* Include small amounts of chocolate, especially dark chocolate, into your daily diet, allowing for greater flexibility and increased adherence to a healthier diet. Telling someone he/she cannot eat a certain food ever again only intensifies his/her desire for that food. Moderation is the key.



In conclusion (and please remember I am a devoted chocoholic), more research is needed on this topic. I would gladly participate in research as a subject or investigator on this research. However, the first reports concerning the health benefits of chocolate do look promising. I promise to keep eating dark chocolate in moderation. Then when chocolate is finally vindicated and celebrated for its contribution to health, I will say, "I told you so!"


Vickie A. Miracle, RN, EdD, CCRN, CCNS, CCRC


Editor, DCCN, and Lecturer,


Bellarmine University


School of Nursing


Louisville, KY




1. Cooper KA, Donovan JL, Waterhouse AL, Williamson G. Cocoa and health: a decade of research. Br J Nutr. 2008;99(1):1-10. [Context Link]


2. Ariefdjohan MW, Savalano DA. Chocolate and cardiovascular health: is it too good to be true? Nutr Rev. 2005;63(12):427-430. [Context Link]


3. Lee R, Balick MJ. Chocolate: healing "food of the Gods." Altern Ther Health Med. 2001;7(5):120-122. [Context Link]


4. Steinberg FM, Bearden MM, Keen CL. Cocoa and chocolate flavonoids: implications for cardiovascular health. American Dietetic Association. J Am Diet Assoc. 2003;103(2):214-215. [Context Link]


5. Barclay L. Dark chocolate may provide some health benefits. Association of Operating Room Nurses. AORN J. 2005;81(6):1341. [Context Link]


6. Halliwell B. Health benefits of eating chocolate? Nature. 2003;426(18):787. [Context Link]


7. Davis C. Sweet solution? Nurs Stand. 2007;21(14-16):21-23. [Context Link]