THE TRUTH ABOUT CHOCOLATE & HEART HEALTH

Valentine’s Day is a big chocolate holiday.  With the frequent chocolate-is-good-for-you stories in the media we might think we are doing our health a favor by digging into a box of chocolates.  But, is chocolate really good for us?  Pure cocoa bean powder, the nonfat portion of the bean is rich in healthy antioxidant flavanols.  However, the amount of pure cocoa in your favorite chocolaty treats is likely not enough to help your health while the amount of cocoa butter (the fat component of the cocao bean), fats and sugar does add up to a serious serving of calories and cholesterol raising saturated fats.

The cocao bean is one of the richest food sources of a group of plant substances called flavanols.  Other foods, such as tea, red wine, berries, and some fruits, especially the skins of apples, contain flavanols but none is as high concentrations as the cocoa bean.   Chocolate, as we know it, is a combination of cocoa bean powder, cocoa butter and other fats, and sugar.  In the finished product, there is actually not that much cocoa bean powder.  And, unfortunately, the flavanol content takes a hit when raw cocoa beans are converted into chocolate. How big a hit depends on how the cocoa is processed. 

A closer look at the research on chocolate & health…

© Blood Flow:  There is good evidence that consumption of large amounts of flavanols consistently improves blood vessel wall function in individuals regardless of whether they are young and healthy or have coronary artery disease, diabetes or high blood pressure.  It appears that flavanols increase the body's ability to synthesize nitric oxide, which triggers the dilation (relaxing) of arteries and allows for increased blood flow.  When arteries do not dilate but are stiff the heart has to work harder. In a study funded by chocolate maker Hershey, researchers found that blood flow in the arteries increased within two hours after older people consumed high doses of flavanols (180, 465, or 1,095 mg), but not in those who got 70 mg.

© Blood pressure.  A 2012 review of 15 randomized controlled trials that lasted from 2 to 18 weeks concluded that a high consumption of flavanols (an average of 560mg per day which is equivalent to the amount in almost 3 Hershey's Dark Chocolate bars) can lower blood pressure by 2-3 mm Hg in the short term.

© Weight Loss: There have been some observational surveys that have sampled individuals and found that those who weigh less also report consuming more chocolate.  This has led some to conclude that chocolate helps with weight loss.  However when the persons in the studies who have a weight-associated illness such as diabetes or heart disease are excluded from the analysis, the association of chocolate eating with less weight disappears.  Researchers hypothesize heavier participants are eating less chocolate because they're trying to eat healthier given their health problems.   

And, in studies that happen over a period of time, the opposite trend emerges – with higher chocolate consumption comes more weight gain.  For example, more than 12,000 U.S. residents aged 45-64 were weighed in the late 1980s and were asked, among other things, how often they ate a serving of chocolate. Six years later, they were weighed and asked about chocolate again. In this study over time, greater chocolate consumption was linked to greater weight gain and those eating the most chocolate gained the most weight.  People who consumed just an ounce of chocolate at least once a week gained an average of 2.4 pounds over the six years. 

Getting your flavanols fix...

So, while getting at least 200mg of flavanols per day can improve blood flow and blood pressure, eating chocolate will not necessarily add that many flavanols to your diet because processing cocoa beans destroys flavanols. How much is lost depends on the beans and the processing.  Labeling a chocolate bar as having, say, “70% cacao” is not a reliable guide to the amount of flavanols because one cannot tell how heavily that cocoa was fermented or processed, both of which destroy flavanols.

How to get 200 mg? Two ounces of dark chocolate would probably do but keep in mind it comes with an average of more than 300 calories.  Many cocoa mixes contain cocoa that has been "processed with alkali" (also called "Dutch-process") and this process effectively destroys the all flavanol content.  Milk chocolate has less cocoa and more sugar than dark chocolate, so it would take 10 ½ oz. (almost 1,600 calories' worth) to give you 200 mg of flavanols! 

A better calorie option is half an ounce of baking chocolate for 70 calories or two tablespoons of an unsweetened pure cocoa powder (like Hershey's or Nestle Toll House, which have around 20 calories). Try mixing these into your coffee, warm milk, oatmeal, or yogurt. Also, Mexican mole sauces are a flavorful way to incorporate unsweetened cocoa into your diet.

Article adapted from: Nutrition Action Healthletter, December 2013, pg.8-11.

GUT BACTERIA MAY IMPACT BODYWEIGHT

Evidence is mounting of the importance of our gut bacteria to not only to our digestive health but that of all our body systems.  Interestingly, several recent studies suggest the composition of gut bacteria in our systems influence the likelihood of becoming obese.  For example in a recent study coordinated by Dr. Dusko Ehrlich researchers monitored the gut bacteria of 169 obese and 129 non-obese individuals.  They found that the gut bacterial in the obese people were less diverse and had more metabolic irregularities than in those at a healthy weight.  Even more striking, those with the least diverse gut bacteria gained more weight.  In another study from France, researchers monitored gut bacteria in 49 overweight and obese people when they were put on a weight loss diet that was low in fat and high in protein and fiber-rich fruits and vegetables.  Before the dietary intervention the participants had relatively low diversity within the their gut bacteria but with the dietary changes, the bacteria make-up of the overweight and obese persons diversified and came to more closely resemble the bacteria of lean persons. 

The relationship between gut bacteria and weight gain remains unclear but the research suggests that the metabolisms of the gut bacteria themselves are connected to the overall metabolism in the humans where they live. This means that disruption of the bacteria in the gut by use of antibiotics or eating foods that help only particular bacteria grow can have effects upon our entire bodies and how we gain weight. 

What to do:  While our understanding of the role gut bacteria play in weight gain and other health problems is still in its infancy, there no question healthy bacteria are essential to our digestive systems' function.  Eating a plant-rich diet appears to support a healthy mix gut bacteria.  Eating a diet rich in healthy probiotics (foods containing healthy bacteria) such as lowfat/nonfat yogurt also helps to support the population of healthy bacteria in your gut.

Adapted from article available at:

http://www.nlm.nih.gov/medlineplus/news/fullstory_140159.html

Sources:

Le Chatelier E,  Nielsen T, Qin J, et al. Richness of human gut microbiome correlates with metabolic  markers.  Nature 500, 541-546. (Aug. 29, 2013).  Available at:  http://dx.doi.org/10.1038/nature12506.

Cotillard A, Kennedy SP, King LC et al.  Dietary intervention impact on gut microbial gene richness.  Nature 500, 585-588 (29 August, 2013).  Available at:  http://dx.doi.org/10.1038/nature12506.

MEDITERRANEAN DIET RICH IN OLIVE OIL HELPS PREVENT DIABETES

A large recent study from Spain reports that sticking to a Mediterranean-style diet rich in olive oil, nuts, fish, beans, fruits and vegetables helps reduce the risk for Type 2 diabetes, even when people don’t lose weight or increase exercise levels.

The study included 3,541 men and women ages 55-80 who were at high risk for heart disease but did not have diabetes.  Participants were assigned to one of three diets: a Mediterranean diet supplemented with two ounces (approximately 3 tablespoons) of extra-virgin olive oil daily, a Mediterranean diet supplemented with 1 oz. (about 1/4 cup) of nuts daily, or a control group directed to eat a lowfat diet. 

After 4 years, compared with the control group, and after adjusting for health and socioeconomic factors, compared to the control group the risk for diabetes was 40% lower with the Mediterranean diet supplemented with olive oil and 18% lower for the diet supplemented with nuts.

What to do:  Consume a diet rich in nuts, fruits, vegetables, beans, fish, and lean poultry.  Aim to minimize your intake of full-fat dairy, heavy meat, refined grains, and sugary products.  Nuts and olive oil are special standouts but still keep portions moderate to prevent weight gain.  While this study points out that healthy diet choices even without weight loss can reduce the risk of diabetes, maintaining a healthy weight and regular activity are still the most important ways to prevent diabetes. 

Adapted from articles at:

http://www.webmd.com/diabetes/news/20140106/mediterranean-diet-alone-may-lower-diabetes-risk

http://well.blogs.nytimes.com/2014/01/13/mediterranean-diet-for-diabetes/?_php=true&_type=blogs&_r=0

http://www.medicalnewstoday.com/articles/270839.php

Source:

Salas-Salvadó J, Bulló M, Estruch R, et al. Prevention of diabetes with Mediterranean diets: A subgroup analysis of a randomized trial. Annals of Internal Medicine. 2014 Jan;160(1):1-10.

IMPORTANT NUTRIENTS WE LACK #4: VITAMIN B-12

Vitamin B12 is a nutrient that helps keep the body's nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 is also very important in the body's use of folic acid.  Numerous studies suggest low B12 status contributes to cognitive decline and memory problems in the elderly. 

It is believed that as much as 40% of persons over 50 in the US have insufficient or deficient levels of B12.  B12, found in all animal-based foods including meat, fish, poultry, dairy, and eggs, is plentiful in the American diet, but people who are elderly and/or taking medicines for acid reflux are at risk for low vitamin B12 because of inadequate digestion of the nutrient.  Two steps are required for the body to absorb vitamin B12 from food. First, hydrochloric acid in the stomach separates vitamin B12 from the food proteins.  Next, vitamin B12 combines with a substance made by the stomach called intrinsic factor. Only then can it be absorbed by the body.   So, persons with reduced stomach acid have compromised B12 absorption.

Some researchers theorize that one of the ways low B12 contributes to cognitive problems is that B12 is required to metabolize supplemental folic acid.  The US wheat supply has been fortified with folic acid since 1998 so intake of the vitamin is often quite high.  Without adequate vitamin B12 to process supplemental folic acid, it is believed that the unmetabolized folic acid may be depositing on neural tissue and contributing to mental declines.

What to do:  The most common bloodwork tests of B12 levels are known to be quite inaccurate as B12 is stored in the liver.  If you take medicine for acid reflux, the diabetes drug Metformin, or are over 50 discuss taking a supplement with your healthcare provider.  The supplemental form is easily absorbed regardless of your stomach acid production.  If supplementing, choose one that dissolves under the tongue.

IMPORTANT NUTRIENTS WE LACK #3: MAGNESIUM

Every organ in the body -- especially the heart, muscles, kidneys, pancreas, and bones -- needs the mineral magnesium. Many large observational studies have found that low magnesium intake is linked to higher rates of type 2 diabetes.  While excess weight is by far the most important risk factor for type 2 diabetes, inadequate magnesium appears to also be a contributing factor.  For example, two landmark studies in the US that tracked over 127,000 people for up to 18 years found that those with higher magnesium intake were 27% less likely to get diabetes than those with lower magnesium intake.  Higher magnesium intake has also been linked to lower levels of inflammation in the body and this may be one way that it reduces risk of type 2 diabetes.

What to do:  It is recommended that women get 320mg of magnesium and men get 450mg.  Most Americans are falling short.  The best dietary sources of magnesium include seeds, nuts, dark greens, beans, bran, and fish.  Be sure to check with your health care provider before taking magnesium supplements.  The most absorbable forms are magnesium citrate, magnesium gluconate, and magnesium lactate.

IMPORTANT NUTRIENTS WE LACK #2: VITAMIN D

Studies suggest adequate levels of vitamin D are important not only in maintaining healthy bones but also in reducing the risk for cancer, heart disease, stroke, diabetes, hypothyroid, and autoimmune diseases.  Vitamin D is actually a hormone that the body produces when exposed to the sun.  Persons who are older, obese, and/or have darker skin have less capacity to make vitamin D.  Also, those living in colder climates such as New York have reduced exposure to the sunlight.   And too much sun exposure can also be risky as it increases skin cancer rates.  An estimated 40%-75% of Americans have insufficient vitamin D levels.   

Low vitamin D levels are linked to a number of risk factors for cardiovascular. It is believed Vitamin D reduces blood vessel inflammation and therefore is an important ingredient in the prevention of heart disease.  A recent review of 75 research studies on Vitamin D and heart disease concluded there is evidence low vitamin D levels are associated with unhealthy blood pressure, insulin resistance, and coronary artery disease. 

What to do:  Next time you get blood work, request that your doctor check your vitamin D level.  This way you can know if you are deficient or not and how much to supplement with.  Food sources of vitamin D include fortified products such as milk, fish with bones such as sardines, and fish liver oils.  If supplementing, be sure to choose vitamin D3 , not vitamin D2 which is less well used by the body.  

IMPORTANT NUTRIENTS WE LACK #1: POTASSIUM

Potassium is a key mineral that helps to counterbalance the effects of sodium on blood pressure.  Adequate intake has also been linked to better bone health and reduced rates of kidney stones.  However, it is estimated that 90% of American men and 99% of American women do not consume the recommended 4,700 mg per day. 

One out of every four Americans has high blood pressure. Certainly, lifestyle changes such as being physically active, quitting smoking, moderating alcohol intake, and losing excess weight help to control blood pressure.  Diet composition also has a significant effect on blood pressure.  Most people know to focus on lowering sodium intake, but do not realize that increasing potassium is also very important.  There are many large observational studies indicating low potassium intake is associated with higher blood pressure and increased rates of strokes and heart attacks.  It is believed potassium lowers blood pressure by increasing the elasticity of large blood vessels like the aorta and carotid and dilating small blood vessels. 

The best dietary sources of potassium are fresh fruits and vegetables.  In plant foods, potassium usually occurs in the form of potassium citrate and it is now being recognized that the citrate is also helpful in lowering blood pressure.  It is the citrate that helps to reduce kidney stones by binding to calcium that otherwise are able to bind to oxalates producing calcium oxalate stones.   It is also believed that the citrate in potassium citrate contributes to bone health by reducing urinary calcium losses. 

What to do:  Taking potassium supplements can be dangerous for persons with kidney disease or those taking blood pressure medicines that prevent potassium excretion.  Only supplement if advised to do so by a physician.  The best way to increase potassium intake is to consume a diet rich in fresh fruits and vegetables (especially good options are dark greens, yams, winter squash, bananas, kiwis, cantaloupe, papaya, avocados, and citrus), dairy, beans, and whole grains.