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Counterpoints in Science

Rx Chocolate
Take orally as needed

Jerold Lowenstein

chocolate bar rx
photo by dong lin

I'm a lifelong chocoholic. As a kid I was an enthusiastic consumer of Mars bars, Baby Ruths, Mounds, Mr. Goodbars, Hersheys with almonds, and my mother's delectable, enamel-dissolving fudge. In recent years, I've favored dark chocolate: the more cocoa solids in the confection, the better.

Or so I thought until, in Berlin a couple of years ago, I came across a chocolate emporium featuring bars marked with the percentage of cocoa in them. Seventy percent or greater was a bit strong even for my jaded taste buds. But perhaps I should get used to it. It turns out that the strong stuff can actually be a healthy addiction.

There is no Chocoholics Anonymous, one aficionado wrote, because nobody wants to quit. The original consumers of chocolate, the Olmecs, Mayans, and Aztecs of Mexico, liked their potion strong and unsweetened. The sacred drink, limited to Aztec royalty, was not discovered by Europeans until Hernan Cortés in 1519 fought his way into Tenochtitlán (now Mexico City). There, he observed the Aztec ruler Montezuma quaffing as many as 40 cups a day.

The sixteenth-century Spanish went to Mexico seeking gold, but in chocolate they found something even better. When they first tried it, they found it bitter and repugnant. Eventually, after drinking it hot and sweetened with cane sugar, they were hooked. After the conquest of Mexico and Peru, chocolate proceeded to conquer the Old World and create industrial empires far wealthier than those the conquistadors had destroyed.

Theobroma cacaofirst reached Spain around 1544. The Spanish court loved the hot sweet chocolate drink concocted by the Creole Spaniards of Mexico. From Spain the habit radiated out to neighboring lands. The Grand Duke Cosimo III de' Medici of Florence was served huge cups of it while visiting Spain and became one of the greatest chocoholics of all time. Cosimo's physician created an exclusive recipe for jasmine chocolate made from fresh jasmine flowers, crushed cacao beans, white sugar, perfect vanilla beans, perfect cinnamon, and ambergris, a fatty biliary concretion from the intestines of sperm whales (now used mainly in perfumery for its violet-like fragrance).

Cosimo's craving for chocolate was exceeded only by that notorious Frenchman the Marquis de Sade, write Sophie and Michael Coe in The True History of Chocolate(Thames and Hudson 1996). The Marquis's biographer Maurice Lever writes, Chocolate inspired an irresistible passion. He loved it in all its forms. Even from prison, the list of demands de Sade sent to his long-suffering wife included boxes of ground chocolate, chocolate pastilles, large chocolate biscuits, and cacao butter suppositories, which he used as a remedy for hemorrhoids.

In Spain, Italy, and France, chocolate remained a drink strictly for the aristocracy. Unfortunately, considering the murderous politics of the time, the strong taste of chocolate also made it an ideal vehicle for poisons. After Pope Clement XIV suppressed the Jesuits in 1773 he became morbidly afraid of assassination. Despite the extreme precautions he took to protect himself, he couldn't resist drinking chocolate. One day he told his servant that the chocolate had a bad taste and asked him to try it. A few days later both men died after showing similar symptoms.

By a strange historical coincidence, all three great alkaloid-bearing drinks, tea, coffee, and chocolate, from three separate continents (Asia, Africa, and America respectively) arrived in England around the same time, in the mid-seventeenth century. Chocolate drinking soon became a craze. It was available in coffee houses to anyone who could pay for it.

After 3,000 years of being a royal prerogative, chocolate became democratized. Soon, the New World alone could no longer satisfy the demand. Today, the leading producers of chocolate are Ivory Coast, Brazil, Ghana, Malaysia, Indonesia, Nigeria, and Cameroon. Mexico now accounts for less than two percent of the world supply.

What makes chocolate so habit-forming? Steve Almond explains why in his book Candyfreak (Algonquin Books, 2004). He writes that chocolate

...remains the single most complex natural flavor in the world. Flavorists have been trying to reproduce the taste for decades— and they're nowhere near doing so. This is because chocolate is made up of more than 1,200 chemical components, many of which give off distinct notes of honey or roses or even spoiled fish. There's even one chemical in chocolate that's cyanide-based. This is to say nothing of chocolate's oft-touted psychoactive ingredients, which include caffeine, theobromine (increases alertness), phenylalanine and phenylethylamine (both known to induce happiness) and anandamide, which is similar to THC (yes, stoners, that THC).

Although chocolate remained a popular drink in the decadent courts of Catholic Europe, it took the Protestant countries and the Industrial Revolution to turn chocolate into everybody's favorite snack. In 1828 Dutch chemist Coenraad Van Houten invented a process for powdered chocolate now known as dutching. His hydraulic press reduced the fat content and made the chocolate darker in color and milder in flavor. Treatment with alkaline salts helped it mix better with water. This product is what we now call cocoa.

Next, in 1847, Dr. Joseph Fry of Bristol, a member of an old Quaker family, used Watt's steam engine to grind cacao beans, mixed a blend of cocoa powder, sugar, and melted cacao butter into a paste that could be cast into a mold, and created the world's first eating chocolate. Fry became the largest chocolate manufacturer in the world, closely pursued by John Cadbury, another Quaker. The Swiss François Cailler and Philippe Suchard opened chocolate factories on Lake Geneva, where Henri Nestlé invented milk chocolate.

The infatuation of kings became a cheap munch for the masses.

Finally, chocolate came back to America—this time to the United States. Milton Snavely Hershey (1857-1945) was called the Henry Ford of Chocolate Makers, though I prefer to think of him as Mr. Goodbar. The Hershey Food Corporation still controls 70 percent of the American candy market. The rest is history, and dentistry.

The medical reputation of chocolate goes all the way back to the Aztecs, who considered it an aphrodisiac. But as the Coes remark, one wonders whether there has ever been a consumable substance that did not have this reputation in some time or place. French doctor Hervé Robert, in his 1990 book Les vertus thérapeutique du chocolat, maintains that caffeine, theobromine, serotonin, and phenylethylamine make chocolate a tonic, antidepressant, and enhancer of pleasures, including, naturellement, l'amour.

Recent research, largely sponsored by Hershey's great rival, the Mars Corporation, is providing marvelous rationalizations for us guilt-ridden chocolate-noshers.

The new Mars-funded research focuses on compounds called flavonoids. These are the same compounds suspected to be responsible for some of the health benefits of diets rich in fruits and vegetables. Numerous studies in the United States and Europe have found that higher flavonoid consumption is associated with a decreased risk of heart attacks.

One particular group of flavonoids, the flavonols, seems to be especially effective. Some flavonols are antioxidants: they counteract the destructive effects of oxygen, which can attack tissues and especially the lining of blood vessels.

Mary Engler, a professor of nursing at the University of California, San Francisco, says chocolate helps keep the cardiovascular system in shape by expanding the arteries, as shown by ultrasound. Carl Keen, of the University of California, Davis, observed that flavonols in cocoa affect blood platelets much like aspirin, reducing blood clots. Norman Hollenberg of Harvard University discovered that flavonols stimulate production of nitric oxide in blood vessels, which increases blood flow to the extremities and the brain. Since nitric oxide is also the basis of the erectile efficacy of Viagra, it's possible that some of the tales about chocolate's potency as an aphrodisiac may have a basis in physiology.

Cornell University researchers noted that flavonols inhibit the growth of colon cancer cells. And in Finland, men with the highest dietary intakes of flavonols were less likely to develop lung cancer than those with the lowest intakes.

A small recent study at Imperial Hospital, London, showed theobromine from cocoa to be a better cough suppressant than codeine, currently considered the standard medicine. Unlike codeine, which is addictive and causes constipation, theobromine had no demonstrated side effects.

And all this time we thought chocolate was unhealthy!

Sadly, in the form consumed by most of us, it probably is. Cocoa butter, often served as white chocolate, is all fat and has no redeeming health benefits. The high sugar and fat content of milk chocolate is undoubtedly helping to fuel the epidemic of obesity and clogging arteries, and the healthy flavonols are mostly removed in ordinary processing. They're only present in dark chocolate and in some of the new brands sold by Mars via the Internet.

Milk chocolate is still the public's overwhelming favorite. The best-selling chocolate bar in Great Britain is Cadbury's Dairy Milk; Britons munch their way through an estimated 660,900 tons a year. In 1995 the Scottish Daily Record reported a new fad for deep-fried Mars bars. Suspecting this was an urban myth, two Scottish physicians (as reported in The Lancet, Dec. 2004) surveyed 627 fish-and-chips shops and found about a hundred serving this delicacy, though many complained that it spoiled the frying equipment.

With or without flavonols or deep-frying, chocolate is here to stay. I'm glad the kind of chocolate I like best seems to be good for me. Still, it's undeniable that a pinch of guilt, like those alkaloids mentioned by the French doctor, can also enhance life's pleasures.

I'm sure Montezuma experienced no guilt as he sipped the drink of the gods five hundred years ago and used chocolatl in rituals involving human sacrifices. The pale-faced conquistadors with their horses and guns destroyed his kingdom, took his life, filched his gold, and stole the secret of Theobroma cacao. Yet Aztec cosmology holds that the world continually recycles itself. If so, a transubstantiated Montezuma, watching his magic potion conquer the empires of the conquerors might have the last Snickers after all.


Jerold M. Lowenstein is professor of medicine at the University of California, San Francisco. He can be reached at jlowen@itsa.ucsf.edu