Cocoa Extract

    Written by:
    Peter Woznik

    Fact-checked

    by:

    Giulia Guerrini, Molly Gregas
    Last Updated: April 24, 2025

    Cocoa, a powder that is rich in polyphenols, is used to make chocolate. Cocoa products can have effects like lowering blood pressure and inflammation and have resulted in small improvements to some outcomes in cardiovascular disease.

    119 references on this page
    2,240,861 participants in 48 trials and 15 meta-analyses

    What is cocoa?

    Cocoa powder is derived from the cocoa bean, which is the seed of cacao tree (Theobroma cacao), a plant that is indigenous to the Americas’ equatorial regions. Cacao is minimally processed, whereas cocoa has been further processed (roasted, alkalized) for palatability.[8][1]

    Cocoa is a rich source of antioxidants and has a higher flavonoid concentration and total antioxidant capacity than other flavonoid-containing sources such as red wine, green tea, and black tea.[30][31][17]

    What are cocoa’s main benefits?

    A large body of evidence shows that cocoa has small and somewhat consistent benefits in cardiovascular disease, in which it benefits certain outcomes such as blood pressure, HOMA-IR, and LDL-C.[2][1][3][5][8][27][25][28]

    Beyond cardiovascular disease, the benefits of cocoa are much less consistent. For example, the benefits of cocoa on cognitive function in older adults are inconsistent.[32][33] In exercise, although cocoa likely increases nitric oxide, cocoa did not improve exercise time-trial performance and time to exhaustion (though the results were of borderline statistical significance) in a 2021 meta-analysis of 4 randomized controlled trials.[34]

    Does cocoa reduce cardiovascular disease risk?Does cocoa improve cognitive health or mood?

    What are cocoa’s main drawbacks?

    Seven meta-analyses of randomized controlled trials (RCTs) examined adverse events from consumption of cocoa or chocolate, but the researchers did not find an increase in adverse events.[2][5][17][8][27][25][28]

    The variable sugar, saturated fat, and calorie content of chocolate could be drawbacks. For instance, a bar of dark chocolate that weighs 100 grams can contain approximately 500 calories, which can lead to an excess consumption of calories and weight gain. However, large meta-analysis of RCTs have shown no negative effects of cocoa on markers of anthropometrics (e.g., body weight, BMI, and waist circumference), glycemic control, or blood lipids.[2] In fact, cocoa is often associated with beneficial effects on various markers of glycemic control or blood lipids.[2][5][17][8][27][25][28] Furthermore, in a 2019 meta-analysis of 35 RCTs, there was no overall effect of cocoa on anthropometrics, but in subgroup analyses, there were reductions in body weight and BMI at cocoa/dark chocolate doses that exceeded a dosage of 30 grams per day and for durations of more than 4 weeks.[26]

    In pregnancy, polyphenol consumption that exceeded 125 mg per day might increase fetal complications.[20][21][22] Cocoa is a source of polyphenols, but the density varies. In one study, 10 grams (0.35 oz; 1 square in some chocolate bars) of 99% dark chocolate contained 65 mg of polyphenols,[23], but in another study, 10 grams of 83% dark chocolate contained 180 mg of polyphenols.[24] Therefore, consumption of cocoa in pregnancy is cautioned.

    Ingestion of chocolate can provoke migraine headaches in some people.[35][36][37] In particular, chocolate was one of the most common food triggers for migraine in one cross-sectional study.[38] However, the research on cocoa and migraines is inconsistent, as one cohort study showed that common migraine triggers such as caffeine and chocolate were associated with a reduced risk of migraine.[39]

    A majority of studies have found that the heavy metal content of chocolate was within the acceptable limits in a variety of countries.[40][41][42][43][44][45][46][47][48][49] A few studies have reported heavy metals at levels that exceeded the acceptable limits in a minority of the cocoa products examined.[50][51][52]

    Does chocolate contain dangerous levels of heavy metals?

    How does cocoa work?

    Plants such as the cacao tree (which is the source of cocoa) produce various flavonoids (a type of polyphenol) as byproducts of their metabolism. In these plants, flavonoids have roles in pigmentation, flavor, growth, reproduction, and pathogen resistance.[53][4] In humans, the flavonoids in cocoa likely increase the activation of nitric oxide (NO) and exert antioxidant and anti-inflammatory effects. These mechanisms potentially explain how cocoa improves endothelial function, reduces platelet aggregation and blood pressure, and improves glycemic control and blood lipids.[54][2][17][25][1]

    Specifically, cocoa may lower the activity of enzymes that break down arginine, thereby increasing the conversion of arginine to NO. Nitric oxide can cause a relaxation of the smooth muscle in blood vessels, thereby decreasing blood pressure, and NO can also decrease the aggregation of platelets, which reduces the formation of blood clots.[55][56][57][54][58][8] This increased blood flow might be how cocoa exerts cognitive benefits (though this benefit seems unlikely).[59][60] In addition, cocoa’s polyphenols have antioxidant effects that reduce inflammatory factors. These polyphenols may also inhibit angiotensin-converting enzymes (ACE), thereby decreasing blood pressure.[61][54][62][2][25][1] Cocoa also contains other active substances, such as magnesium, potassium, and theobromine, all of which may have their own effects on lowering blood pressure.[25][63]

    Despite its sugar content, chocolate may decrease insulin resistance via NO because insulin sensitivity is partly dependent on insulin-mediated NO release. Furthermore, dark chocolate can improve beta-cell function (i.e., insulin secretion).[64][65][54] Additionally, there are various hypotheses as to why cocoa might have beneficial effects on glycemic control, and many of them center around slowing the digestion and absorption of carbohydrates in the intestinal tract, increasing glucose metabolism, and reducing glucose synthesis.[5][8]

    Cocoa might have beneficial effects on blood lipids due to its fatty acid composition, even though much of the fat (butter) has been removed in cocoa powder. Cocoa butter is composed of 33% monounsaturated fat and 33% of the saturated fat stearic acid, and stearic acid may have a beneficial effect on blood lipids.[66][54][8] The procyanidins (another class of flavonoids) in chocolate may also inhibit the absorption of cholesterol and reduce the expression of LDL-C receptors.[67][68][69] In addition, cocoa might reduce cholesterol synthesis, reduce lipid synthesis, and increase lipid metabolism.[8][70][71]

    What are other names for Cocoa Extract?

    Note that Cocoa Extract is also known as:

    • Chocolate polyphenols
    • Cocoa polyphenols
    • Cacao polyphenols
    • Cacao extract
    • Chocamine
    • Theobroma cacao

    Cocoa Extract should not be confused with:

    • Chocolate (The extract paired with macronutrients)

    Dosage information

    Formulation:

    Cocoa is a powder that can be consumed in drinks, for example, or made into chocolate.[1]

    The flavanol content in cocoa varies based on the variety and ripeness of the cocoa beans and the processing steps applied. Dark chocolate contains larger amounts of cocoa (more than 50%) than milk chocolate (20%–30%).[1]

    Range of dosages studied:

    Dosages of 1 to 105 grams per day of cocoa or cocoa products (e.g., chocolate) have been studied.[1][2][3][4][5]

    Effective Dosages:

    All-cause mortality: Adults: 2 grams per day of dark chocolate reduced the risk of all-cause mortality the most, with no benefit beyond 5 grams per day.[3] A square of chocolate, a chocolate snack bar, and a bar of chocolate can weigh 10 grams, 50 grams, and 100 grams, respectively (with much variability);[6][3][7] therefore, eating one 10-gram square of dark chocolate approximately 1 to 3 times per week may benefit all-cause mortality.

    Cardiovascular disease: Adults: A variety of dosages of cocoa (70% or higher) or dark chocolate may benefit some outcomes in cardiovascular disease[2][5][8][1] and are associated with benefits in type 2 diabetes, heart attack, stroke, and congestive heart failure, but not atrial fibrillation,[9][10][11][12][13][14][15]; daily doses of approximately 2 to 10 grams of dark chocolate were associated with larger improvements in some meta-analyses.[3][16][6] A square of chocolate, a chocolate snack bar, and a bar of chocolate can weigh 10 grams, 50 grams, and 100 grams, respectively;[6][3][7] therefore, eating one 10-gram square of chocolate approximately 1 to 7 times per week, or every other day, may provide a benefit.

    Hypertension: Adults: Moderate dosages of dark chocolate (e.g., 70% or higher) or cocoa (e.g., 2 to 20 grams per day [17] have improved hypertension-related outcomes (e.g., flow-mediated dilation) more than higher or lower dosages in some meta-analyses.[4][18][4] However, another meta-analysis has shown the same effects with higher and lower dosages.[19] A square of chocolate, a chocolate snack bar, and a bar of chocolate can weigh 10 grams, 50 grams, and 100 grams, respectively;[6][3][7] therefore, eating two 10-gram squares of chocolate approximately 1 to 7 times per week, or every other day, may provide a benefit.

    Other Considerations:

    Pregnancy: Some evidence shows that polyphenol consumption that exceeds 125 mg per day might inhibit inflammatory factors and potentially contribute to a fetal heart complication (ductus arteriosis constriction).[20][21][22] Cocoa is a source of polyphenols, but the density of polyphenols varies. In one study, 10 grams (0.35 oz; 1 square in some chocolate bars) of 99% dark chocolate contained 65 mg of polyphenols,[23], but in another study, 10 grams of 83% dark chocolate contained 180 mg of polyphenols.[24] Therefore, consumption of cocoa in pregnancy is cautioned.

    Polyphenol/flavanol content: The evidence is mixed, but there is overall stronger support for a higher[2][25][26][27] or moderate[28][17][4][18] dosage of polyphenols (of which flavanols are the primary polyphenol) for improved cardiovascular outcomes, compared to a lower[19][29] dosage of polyphenols. Although polyphenol content is very rarely advertised in commercial chocolate or cocoa, higher-percentage dark chocolate and more minimally processed cocoa/dark chocolate tend to have higher concentrations of polyphenols.[1]

    Frequently asked questions

    What is cocoa?

    Cocoa powder is derived from the cocoa bean, which is the seed of cacao tree (Theobroma cacao), a plant that is indigenous to the Americas’ equatorial regions. Cacao is minimally processed, whereas cocoa has been further processed (roasted, alkalized) for palatability.[8][1]

    Cocoa is a rich source of antioxidants and has a higher flavonoid concentration and total antioxidant capacity than other flavonoid-containing sources such as red wine, green tea, and black tea.[30][31][17]

    What are cocoa’s main benefits?

    A large body of evidence shows that cocoa has small and somewhat consistent benefits in cardiovascular disease, in which it benefits certain outcomes such as blood pressure, HOMA-IR, and LDL-C.[2][1][3][5][8][27][25][28]

    Beyond cardiovascular disease, the benefits of cocoa are much less consistent. For example, the benefits of cocoa on cognitive function in older adults are inconsistent.[32][33] In exercise, although cocoa likely increases nitric oxide, cocoa did not improve exercise time-trial performance and time to exhaustion (though the results were of borderline statistical significance) in a 2021 meta-analysis of 4 randomized controlled trials.[34]

    Does cocoa reduce cardiovascular disease risk?

    Seven meta-analyses of randomized controlled trials (RCTs) have examined the effects of cocoa (compared to placebo or white chocolate as a control) on cardiovascular health and found somewhat consistent small benefits of cocoa on blood pressure, glycemic control (e.g., HOMA-IR), and blood lipids (e.g., LDL-C).[2][5][8][27][25][28] For example, a 2024 meta-analysis of 31 RCTs and 1,986 total participants reported improved blood pressure (improved by approximately 2 mmHg), LDL-C, total cholesterol, and fasting blood glucose, but not other markers of glycemic control or blood lipids or anthropometrics (body weight, BMI, waist circumference), and the quality of evidence was ranked as moderate.[2]

    An additional 6 meta-analyses of RCTs have examined cocoa’s effects on blood pressure or endothelial function specifically and reported improvements to blood pressure, arterial stiffness, and blood flow.[17][72][4][18][19] For example, in a 2017 Cochrane review, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were reduced by 1.8 mmHg, and the evidence quality was moderate. When only participants with hypertension were analyzed, there were larger improvements to SBP and DBP (4 mmHg and 2 mmHg, respectively).[1] In other studies, the effects were also found to be greater in adults over age 65, compared to adults over 45,[72] and at higher dosages (more than 36 grams per day).[4]

    To put these decreases in blood pressure into context, in the Framingham Heart Study, a decrease of 2 mmHg in diastolic blood pressure corresponded to a 6% reduction in the risk of coronary heart disease. Also, structured exercise of more than 150 min per week has been associated with blood pressure reductions of 3/1.5 mmHg, and the DASH dietary pattern has reduced blood pressure by 5.5/3 mmHg.[72]

    There are an additional 2 meta-analyses of RCTs in which the effects of cocoa on blood lipids were examined; they reported improvements to LDL-C and total cholesterol.[69][29] However, in one of the meta-analyses, a subgroup analysis of only high-quality trials showed no effect.[69]

    In one meta-analysis of cocoa and body composition[26] and one meta-analysis of cocoa and oxidative stress and inflammation, there were generally no effects, except for a moderate decrease in MDA (high-quality evidence) and a large increase in nitric oxide (low-quality evidence).[73][74]

    Additionally, a large body of observational studies has reported associations between dark chocolate consumption and improved cardiovascular disease. In 13 meta-analyses, dark chocolate consumption reduced the risk of cardiovascular diseases, including type 2 diabetes, congestive heart failure, heart attack, and stroke, but not atrial fibrillation. The risks were reduced by 10% to 45% when the participants consumed either a moderate amount or the highest amount of dark chocolate, compared to nonconsumers. The dosage that reduced the risk the most was approximately 2 to 10 grams a day (or 3 servings a week) in some studies.[3][16][6][9][10][11][12][13][14][15][75][76][7][3]

    Does cocoa improve cognitive health or mood?

    Cocoa has had inconsistent and/or small effects on cognitive function in older adults (e.g., average age of 60) in 2 meta-analyses of 7 to 11 randomized controlled trials. In one meta-analysis, eating dark chocolate for 1 to 6 months improved 2 of 7 outcomes, and it improved visual and language-based executive function (a combination of learning, memory and attention); a majority of the trials were graded as having an overall low risk of bias.[32][33]

    What are cocoa’s main drawbacks?

    Seven meta-analyses of randomized controlled trials (RCTs) examined adverse events from consumption of cocoa or chocolate, but the researchers did not find an increase in adverse events.[2][5][17][8][27][25][28]

    The variable sugar, saturated fat, and calorie content of chocolate could be drawbacks. For instance, a bar of dark chocolate that weighs 100 grams can contain approximately 500 calories, which can lead to an excess consumption of calories and weight gain. However, large meta-analysis of RCTs have shown no negative effects of cocoa on markers of anthropometrics (e.g., body weight, BMI, and waist circumference), glycemic control, or blood lipids.[2] In fact, cocoa is often associated with beneficial effects on various markers of glycemic control or blood lipids.[2][5][17][8][27][25][28] Furthermore, in a 2019 meta-analysis of 35 RCTs, there was no overall effect of cocoa on anthropometrics, but in subgroup analyses, there were reductions in body weight and BMI at cocoa/dark chocolate doses that exceeded a dosage of 30 grams per day and for durations of more than 4 weeks.[26]

    In pregnancy, polyphenol consumption that exceeded 125 mg per day might increase fetal complications.[20][21][22] Cocoa is a source of polyphenols, but the density varies. In one study, 10 grams (0.35 oz; 1 square in some chocolate bars) of 99% dark chocolate contained 65 mg of polyphenols,[23], but in another study, 10 grams of 83% dark chocolate contained 180 mg of polyphenols.[24] Therefore, consumption of cocoa in pregnancy is cautioned.

    Ingestion of chocolate can provoke migraine headaches in some people.[35][36][37] In particular, chocolate was one of the most common food triggers for migraine in one cross-sectional study.[38] However, the research on cocoa and migraines is inconsistent, as one cohort study showed that common migraine triggers such as caffeine and chocolate were associated with a reduced risk of migraine.[39]

    A majority of studies have found that the heavy metal content of chocolate was within the acceptable limits in a variety of countries.[40][41][42][43][44][45][46][47][48][49] A few studies have reported heavy metals at levels that exceeded the acceptable limits in a minority of the cocoa products examined.[50][51][52]

    Does chocolate contain dangerous levels of heavy metals?

    One of the 35 meta-analyses reviewed for the writing of this page commented on heavy metals. The authors read through the 31 randomized controlled trials that they included in the meta-analysis, but none of the studies mentioned the risk of contamination with heavy metals.[73]

    In individual studies of heavy metals in chocolate, studies in the United States,[40], Europe,[41], Poland,[42] Iran,[43] Bangladesh,[44] and India[45] have found heavy metals at acceptable levels. Furthermore, studies in countries such as Ghana and Brazil (major sources of global cocoa production) have found that heavy metals in cocoa are within the acceptable limits.[46][47][48][49]

    However, a few studies have reported elevated levels of cadmium or lead in cocoa products. For example, in Ecuador (a common producer of cocoa), 12 of 19 production sites were found to have cocoa with cadmium levels that exceeded the acceptable levels.[50]. In Japan, 4% of the chocolate products and 19% of the cocoa powder products that were tested in one study had cadmium (but not lead) levels that were higher than the guideline levels.[51][73] Furthermore, a 2024 study in the United States reported a higher prevalence of high heavy metal levels in cocoa products; 35%, and 43% of cocoa products exceeded the guideline levels of cadmium and lead, respectively. The researchers noted that consuming more than one serving per day of these cocoa products, or a combination of other sources of heavy metals (e.g., seafood), may add up to amounts that are higher than the guideline levels.[52]

    In other words, a majority of the studies that have examined the heavy metal content of chocolate from a variety of countries have found acceptable levels. Furthermore, in the studies that reported high levels of heavy metals in cocoa products, the researchers only found this to be the case in a minority of the products.

    How does cocoa work?

    Plants such as the cacao tree (which is the source of cocoa) produce various flavonoids (a type of polyphenol) as byproducts of their metabolism. In these plants, flavonoids have roles in pigmentation, flavor, growth, reproduction, and pathogen resistance.[53][4] In humans, the flavonoids in cocoa likely increase the activation of nitric oxide (NO) and exert antioxidant and anti-inflammatory effects. These mechanisms potentially explain how cocoa improves endothelial function, reduces platelet aggregation and blood pressure, and improves glycemic control and blood lipids.[54][2][17][25][1]

    Specifically, cocoa may lower the activity of enzymes that break down arginine, thereby increasing the conversion of arginine to NO. Nitric oxide can cause a relaxation of the smooth muscle in blood vessels, thereby decreasing blood pressure, and NO can also decrease the aggregation of platelets, which reduces the formation of blood clots.[55][56][57][54][58][8] This increased blood flow might be how cocoa exerts cognitive benefits (though this benefit seems unlikely).[59][60] In addition, cocoa’s polyphenols have antioxidant effects that reduce inflammatory factors. These polyphenols may also inhibit angiotensin-converting enzymes (ACE), thereby decreasing blood pressure.[61][54][62][2][25][1] Cocoa also contains other active substances, such as magnesium, potassium, and theobromine, all of which may have their own effects on lowering blood pressure.[25][63]

    Despite its sugar content, chocolate may decrease insulin resistance via NO because insulin sensitivity is partly dependent on insulin-mediated NO release. Furthermore, dark chocolate can improve beta-cell function (i.e., insulin secretion).[64][65][54] Additionally, there are various hypotheses as to why cocoa might have beneficial effects on glycemic control, and many of them center around slowing the digestion and absorption of carbohydrates in the intestinal tract, increasing glucose metabolism, and reducing glucose synthesis.[5][8]

    Cocoa might have beneficial effects on blood lipids due to its fatty acid composition, even though much of the fat (butter) has been removed in cocoa powder. Cocoa butter is composed of 33% monounsaturated fat and 33% of the saturated fat stearic acid, and stearic acid may have a beneficial effect on blood lipids.[66][54][8] The procyanidins (another class of flavonoids) in chocolate may also inhibit the absorption of cholesterol and reduce the expression of LDL-C receptors.[67][68][69] In addition, cocoa might reduce cholesterol synthesis, reduce lipid synthesis, and increase lipid metabolism.[8][70][71]

    Update History

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    Research Breakdown

    Examine Database References

    1. High-density lipoprotein (HDL) - Fraga CG, Actis-Goretta L, Ottaviani JI, Carrasquedo F, Lotito SB, Lazarus S, Schmitz HH, Keen CLRegular consumption of a flavanol-rich chocolate can improve oxidant stress in young soccer playersClin Dev Immunol.(2005 Mar)
    2. High-density lipoprotein (HDL) - Davison K, Coates AM, Buckley JD, Howe PREffect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjectsInt J Obes (Lond).(2008 Aug)
    3. High-density lipoprotein (HDL) - Grassi D, Lippi C, Necozione S, Desideri G, Ferri CShort-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy personsAm J Clin Nutr.(2005 Mar)
    4. High-density lipoprotein (HDL) - Muniyappa R, Hall G, Kolodziej TL, Karne RJ, Crandon SK, Quon MJCocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertensionAm J Clin Nutr.(2008 Dec)
    5. High-density lipoprotein (HDL) - Grassi D, Desideri G, Necozione S, Lippi C, Casale R, Properzi G, Blumberg JB, Ferri CBlood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolateJ Nutr.(2008 Sep)
    6. High-density lipoprotein (HDL) - Tokede OA, Gaziano JM, Djoussé LEffects of cocoa products/dark chocolate on serum lipids: a meta-analysisEur J Clin Nutr.(2011 Aug)
    7. Blood glucose - Almoosawi S, Fyfe L, Ho C, Al-Dujaili EThe effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjectsBr J Nutr.(2010 Mar)
    8. Blood glucose - Grassi D, Desideri G, Necozione S, Ruggieri F, Blumberg JB, Stornello M, Ferri CProtective effects of flavanol-rich dark chocolate on endothelial function and wave reflection during acute hyperglycemiaHypertension.(2012 Sep)
    9. Blood Lactate (Exercise) - Glen Davison, Robin Callister, Gary Williamson, Karen A Cooper, Michael GleesonThe effect of acute pre-exercise dark chocolate consumption on plasma antioxidant status, oxidative stress and immunoendocrine responses to prolonged exerciseEur J Nutr.(2012 Feb)
    10. Triglycerides - Tzounis X, Rodriguez-Mateos A, Vulevic J, Gibson GR, Kwik-Uribe C, Spencer JPPrebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention studyAm J Clin Nutr.(2011 Jan)
    11. Blood Pressure - Ottaviani JI, Balz M, Kimball J, Ensunsa JL, Fong R, Momma TY, Kwik-Uribe C, Schroeter H, Keen CLSafety and efficacy of cocoa flavanol intake in healthy adults: a randomized, controlled, double-masked trialAm J Clin Nutr.(2015 Dec)
    12. Fat Oxidation - Allgrove J, Farrell E, Gleeson M, Williamson G, Cooper KRegular dark chocolate consumption's reduction of oxidative stress and increase of free-fatty-acid mobilization in response to prolonged cyclingInt J Sport Nutr Exerc Metab.(2011 Apr)
    13. Blood Flow - Andrew B. Petrone, J. Michael Gaziano, Luc DjousséEffects of Dark Chocolate and Cocoa Products on Endothelial Function: A Meta-AnalysisCurrent Nutrition Reports.()
    14. Oxidative Stress Biomarkers - Carnevale R, Loffredo L, Pignatelli P, Nocella C, Bartimoccia S, Di Santo S, Martino F, Catasca E, Perri L, Violi FDark chocolate inhibits platelet isoprostanes via NOX2 down-regulation in smokersJ Thromb Haemost.(2012 Jan)
    15. Oxidative Stress Biomarkers - Zhu QY, Schramm DD, Gross HB, Holt RR, Kim SH, Yamaguchi T, Kwik-Uribe CL, Keen CLInfluence of cocoa flavanols and procyanidins on free radical-induced human erythrocyte hemolysisClin Dev Immunol.(2005 Mar)
    16. HbA1c - Balzer J, Rassaf T, Heiss C, Kleinbongard P, Lauer T, Merx M, Heussen N, Gross HB, Keen CL, Schroeter H, Kelm MSustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trialJ Am Coll Cardiol.(2008 Jun 3)
    17. Mitochondrial Protection - Pam R Taub, Israel Ramirez-Sanchez, Theodore P Ciaraldi, Guy Perkins, Anne N Murphy, Robert Naviaux, Michael Hogan, Alan S Maisel, Robert R Henry, Guillermo Ceballos, Francisco VillarrealAlterations in skeletal muscle indicators of mitochondrial structure and biogenesis in patients with type 2 diabetes and heart failure: effects of epicatechin rich cocoaClin Transl Sci.(2012 Feb)
    18. Blood Flow - Heinrich U, Neukam K, Tronnier H, Sies H, Stahl WLong-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in womenJ Nutr.(2006 Jun)
    19. Skin Dryness - Mogollon JA, Boivin C, Lemieux S, Blanchet C, Claveau J, Dodin SChocolate flavanols and skin photoprotection: a parallel, double-blind, randomized clinical trialNutr J.(2014 Jun 27)
    20. Skin Dryness - Yoon HS, Kim JR, Park GY, Kim JE, Lee DH, Lee KW, Chung JHCocoa Flavanol Supplementation Influences Skin Conditions of Photo-Aged Women: A 24-Week Double-Blind, Randomized, Controlled TrialJ Nutr.(2016 Jan)
    21. Peripheral Vascular Disease Symptoms - Hammer A, Koppensteiner R, Steiner S, Niessner A, Goliasch G, Gschwandtner M, Hoke MDark chocolate and vascular function in patients with peripheral artery disease: a randomized, controlled cross-over trialClin Hemorheol Microcirc.(2015)
    22. Peripheral Vascular Disease Symptoms - Loffredo L, Perri L, Catasca E, Pignatelli P, Brancorsini M, Nocella C, De Falco E, Bartimoccia S, Frati G, Carnevale R, Violi FDark chocolate acutely improves walking autonomy in patients with peripheral artery diseaseJ Am Heart Assoc.(2014 Jul 2)
    23. Adrenaline - Wirtz PH, von Känel R, Meister RE, Arpagaus A, Treichler S, Kuebler U, Huber S, Ehlert UDark chocolate intake buffers stress reactivity in humansJ Am Coll Cardiol.(2014 Jun 3)
    24. Arterial Stiffness - Charalambos Vlachopoulos, Konstantinos Aznaouridis, Nikolaos Alexopoulos, Emmanuel Economou, Ioanna Andreadou, Christodoulos StefanadisEffect of dark chocolate on arterial function in healthy individualsAm J Hypertens.(2005 Jun)
    25. Arterial Stiffness - West SG, McIntyre MD, Piotrowski MJ, Poupin N, Miller DL, Preston AG, Wagner P, Groves LF, Skulas-Ray ACEffects of dark chocolate and cocoa consumption on endothelial function and arterial stiffness in overweight adultsBr J Nutr.(2014 Feb)
    26. Blood glucose - Monahan KD, Feehan RP, Kunselman AR, Preston AG, Miller DL, Lott MEDose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adultsJ Appl Physiol.(2011 Dec)
    27. Blood glucose - Arisi TOP, da Silva DS, Stein E, Weschenfelder C, de Oliveira PC, Marcadenti A, Lehnen AM, Waclawovsky GEffects of Cocoa Consumption on Cardiometabolic Risk Markers: Meta-Analysis of Randomized Controlled Trials.Nutrients.(2024 Jun 18)
    28. Triglycerides - Engler MB, Engler MM, Chen CY, Malloy MJ, Browne A, Chiu EY, Kwak HK, Milbury P, Paul SM, Blumberg J, Mietus-Snyder MLFlavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adultsJ Am Coll Nutr.(2004 Jun)
    29. Triglycerides - Shiina Y, Funabashi N, Lee K, Murayama T, Nakamura K, Wakatsuki Y, Daimon M, Komuro IAcute effect of oral flavonoid-rich dark chocolate intake on coronary circulation, as compared with non-flavonoid white chocolate, by transthoracic Doppler echocardiography in healthy adultsInt J Cardiol.(2009 Jan 24)
    30. Triglycerides - Crews WD Jr, Harrison DW, Wright JWA double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adultsAm J Clin Nutr.(2008 Apr)
    31. Blood Pressure - d'El-Rei J, Cunha AR, Burlá A, Burlá M, Oigman W, Neves MF, Virdis A, Medeiros FCharacterisation of hypertensive patients with improved endothelial function after dark chocolate consumptionInt J Hypertens.(2013)
    32. Blood Pressure - Mogollon JA, Bujold E, Lemieux S, Bourdages M, Blanchet C, Bazinet L, Couillard C, Noël M, Dodin SBlood pressure and endothelial function in healthy, pregnant women after acute and daily consumption of flavanol-rich chocolate: a pilot, randomized controlled trialNutr J.(2013 Apr 8)
    33. Blood Pressure - Verawati Sudarma, Sri Sukmaniah, Parlindungan SiregarEffect of dark chocolate on nitric oxide serum levels and blood pressure in prehypertension subjectsActa Med Indones.(2011 Oct)
    34. Blood Flow - Loffredo L, Carnevale R, Perri L, Catasca E, Augelletti T, Cangemi R, Albanese F, Piccheri C, Nocella C, Pignatelli P, Violi FNOX2-mediated arterial dysfunction in smokers: acute effect of dark chocolateHeart.(2011 Nov)
    35. Low-density lipoprotein (LDL) - Hamed MS, Gambert S, Bliden KP, Bailon O, Singla A, Antonino MJ, Hamed F, Tantry US, Gurbel PADark chocolate effect on platelet activity, C-reactive protein and lipid profile: a pilot studySouth Med J.(2008 Dec)
    36. Platelet Aggregation - Luisa M Ostertag, Paul A Kroon, Sharon Wood, Graham W Horgan, Elena Cienfuegos-Jovellanos, Shikha Saha, Garry G Duthie, Baukje de RoosFlavan-3-ol-enriched dark chocolate and white chocolate improve acute measures of platelet function in a gender-specific way--a randomized-controlled human intervention trialMol Nutr Food Res.(2013 Feb)
    37. Platelet Aggregation - Pearson DA, Paglieroni TG, Rein D, Wun T, Schramm DD, Wang JF, Holt RR, Gosselin R, Schmitz HH, Keen CLThe effects of flavanol-rich cocoa and aspirin on ex vivo platelet functionThromb Res.(2002 May 15)
    38. Blood glucose - Grassi D, Necozione S, Lippi C, Croce G, Valeri L, Pasqualetti P, Desideri G, Blumberg JB, Ferri CCocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensivesHypertension.(2005 Aug)
    39. Blood glucose - Lívia de Paula Nogueira, Marcela Paranhos Knibel, Márcia Regina Simas Gonçalves Torres, José Firmino Nogueira Neto, Antonio Felipe SanjulianiConsumption of high-polyphenol dark chocolate improves endothelial function in individuals with stage 1 hypertension and excess body weightInt J Hypertens.(2012)
    40. Blood Pressure - Karin Ried, Peter Fakler, Nigel P StocksEffect of cocoa on blood pressureCochrane Database Syst Rev.(2017 Apr 25)
    41. Blood Pressure - Karin Ried, Oliver R Frank, Nigel P StocksDark chocolate or tomato extract for prehypertension: a randomised controlled trialBMC Complement Altern Med.(2009 Jul 8)
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