I believe that many underestimate the far-reaching consequences of diabetes. Not many will link stroke and heart attack to diabetes. Yet these events are also linked to persons with diabetes. It is therefore worthwhile to share this article by the American College of Cardiology titled “Could Cocoa Be A Healthy Treat For Diabetic Patients”, published June 3, 2008, Journal of American College of Cardiology (JACC).
The research was conducted some time ago but the results are very relevant to contemporary health care practice. The research noted that the consumption of flavanol-rich cocoa actually helps blood vessels to function better and needs to be considered part of a healthy diet for the prevention of cardiovascular disease.
Flavanols in cocoa (also found in tea, red wine, and certain fruits and vegetables) are responsible for the identified health benefits. It is important to stress that flavanol-rich cocoa is a stronger antioxidant that red wine and tea. According to the Journal of the American College of Cardiology (JACC), after diabetic patients drank specially formulated high-flavanol cocoa for one month, blood vessel function went from severely impaired to normal. It is important to stress that the high flavanol cocoa refers to either pure natural cocoa powder (usually referred to as bitter cocoa) or dark chocolate with a minimum of 70% cocoa solids.
The improvement seen is comparable to what is observed with exercise and many common diabetic medications, the researchers noted. The finding is striking in that adding a mug of flavanol-rich cocoa to existing treatment programmes can make very significant impact on treatment outcomes.
These researchers added that the findings indicate that it is time to think not just outside the box, but inside the cup, for innovative ways to ward off cardiovascular disease—the number one cause of death in diabetic patients.
The ensuing message from the American College of Cardiology (ACC) is striking-medical treatments alone often do not prevent complications of diabetes that are associated with atherosclerosis and cardiovascular disease. The health care professional should therefore look at lifestyle changes and new approaches to help in addressing the cardiovascular risks associated with diabetes.
The study itself first tested the feasibility of using high-flavanol cocoa to improve cardiovascular health by observing, on three separate days, the effects of cocoa with varying amounts of flavanols on blood vessel function in patients with stable type 2 diabetes.
The second, larger part of the study tested the effectiveness of long-term, routine consumption of high-flavanol cocoa in comparison with low-flavanol cocoa in patients with stable type 2 diabetes. Patients were assigned to drink flavanol-rich cocoa or cocoa with low flavanol per serving for 30 days. The flavanol-rich cocoa had about 320mg of flavanols while the cocoa low flavanol had 25mg flavanol per serving. Each type of cocoa was administered for three times a day for 30 days.
Blood vessel function was tested on the first day before the patients consumed any cocoa and again two hours after drinking the beverage. The test was repeated before and after cocoa consumption on day 8 and day 30.
The researchers found that patients with type 2 diabetes had a severely impaired flow-mediated dilation (FMD) response at the beginning of the study. Two hours after drinking high-flavanol cocoa, the FMD response had improved. Flow-mediated dilation (FMD) refers to dilation of an artery when blood flow increases in that artery.
With time the FMD values improved further. After patients drank high-flavanol (320mg flavanol per serving) cocoa three times daily for eight days, there was further improvement in FMD. By day 30, the FMD response had improved even further.
There was not significant change in FMD in the diabetic patients given the low flavanol cocoa (25mg) when compared to the high flavanol cocoa consumers over the same time frame.
FMD measurements can provide valuable information about a person’s cardiovascular health. Previous studies have shown that people with an impaired FMD response have an increased risk of heart attack, need for bypass surgery or catheter procedure to open clogged coronary arteries, and even death from heart disease.
Cocoa flavanols improve FMD response by increasing the production of nitric oxide, the chemical signal that tells arteries to relax and widen in response to increased blood flow. Relaxation of the arteries takes stress off of the heart and blood vessels.
The takehome message is for people with diabetes to fit flavanol-rich cocoa in their diet to prevent heart disease.The emphasis is on cocoa products with high flavanols such as pure natural cocoa powder (bitter cocoa) or dark chocolate with a minimum of 70% cocoa solids.
The JACC noted that diabetics are an ideal population in which to study the effects of flavanols on arterial function, because high blood sugar damages the endothelium and because these patients have a high risk of cardiovascular disease.Any therapy that helps the lining of the arteries to function better is potentially important.The endothelium (blood vessel lining) is one of the largest organs in the body. It maintains the health of the arteries and prevents blockages that can cause heart attacks, strokes and limb loss.
The study is important and thought-provoking in terms of the weight of the evidence that flavanol-rich cocoa has a positive effect on the health of the arteries. There is an incentive for a larger study to look at the risk of heart attack, stroke, and other serious forms of cardiovascular disease.
The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research.
If you are living with diabetes, the evidence is that consume more cocoa with high flavanols to safeguard your heart.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
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