The Command of Cacao

I have finished exams, so it is time to get behind the computer and start researching my superfoods again! Yippee! I hope you enjoyed the last post on Spirulina – please feel free to post your comments and questions so that I can improve these posts to facilitate both your and my learning of all foods magical! 🙂 The post that follows today is on the cacao bean (i.e. what goes into that bar of Lindt chocolate) and how it has incredible ability to prevent disease and support neuropsychological function. Furthermore, it is one of the ingredients in my favourite package of magic: WAZOOGLES Superfood Protein Powder Chocolate Moondust! I will post a link in my blog so that you can purchase some magic too – future blog posts will explore a lot of the ingredients found in the unicorn-branded, stellar-crafted, passion-injected package of LIVE food. Check it out!

So let’s get to it…


Cacao products come from the cacao bean, which is the fruit seed of the cacao tree (Theobroma cacao). Cacao contains flavonoids, namely epicatechin, catechin and procyanidin, making up 12-18% of it’s dry weight – higher levels than most fruit and vegetables. Flavonoids, which are derived from plant products, provide free racial scavenging properties, the ability to reduce the production of free radicals, and the inhibition of lipid peroxidation in endothelial cell membranes (blood vessels essentially) (1). Reactive oxygen species have been associated with various cardiovascular risk factors as a result of the endothelial damage as well as the predisposition to atherosclerosis secondary to the oxidation of low density lipoproteins (LDL) within the blood vessel wall (2). Furthermore, flavonoids have been shown to interact with signalling pathways to inhibit neuronal apoptosis (cell death) secondary to toxicity by reactive oxygen species, thus improving cognitive function and preventing diseases such as Alzheimer’s (3). Unfortunately, this does not mean we can reach for the Dairy Milk – the antioxidant properties decrease with further processing of the cacao bean as well as with the addition of milk (4). Thus, getting your dose of cacao in the form of the raw powder or nibs is the best way to go – a tablespoon a day will do the trick.

Let’s get into the meat of how cacao has shaped up in the research…

Antioxidant: the structure of flavonoids (A and B aromatic rings bound together by an oxygenated C-ring) allows for rapid donation of hydrogen ions (protons) in order to stabilise free radicals (molecule with an unpaired electron) (2). Cellular DNA, proteins, and lipids that are damaged through free radicals, have been implicated in various diseases. Of note, the oxidation of LDL particles with subsequent engulfment by immune cells has been believed to be the pathogenesis behind the formation of fatty streaks in blood vessels and the development of atherosclerosis (1). These antioxidant effects were shown to be increased with increasing concentrations of procyanidin and epicatechins, which are predominant in cacao products (1).

Endothelial function: cacao flavonoids have been shown to activate nitric oxide synthase, which results in increased production of nitric oxide – a potent vasodilator (2). Epicatechin has also been shown to preferentially decrease the formation of nitric oxide-ralted oxidation reactions simultaneously, thus enabling vasodilation without the risk of inflammation due to free radical production (2). Vasodilation reduces the risk of high blood pressure as well as the risk of shear stress and the resultant damage to the endothelial wall. Furthermore, it has been shown that blood pressure may also be reduced through the angiotensin 1 converting enzyme inhibitor action of cacao flavonoids (2) – ACE-inhibitors are drugs given to hypertensive patients to reduce the production of a molecule that causes salt and water retention as well as vasoconstriction.

Platelet function: cacao flavonoids have demonstrated inhibition of platelet aggregation through 2 proposed mechanisms – the production of nitric oxide as well as the the production of prostacyclin (2). Platelet dysfunction has been implicated in cardiovascular risk, which is why many patients receive aspirin – interestingly, one study conducted comparing cacao and aspirin showed identical effects on platelets, with cacao being superior in the speed at which markers of platelet activation were reduced (1).

Anti-inflammatory: cacao flavonoids inhibit the production of NF-kappa-B which binds to genes which encode for the production of pro-inflammatory cytokines (2). In contrast, tumour necrosis factor alpha, has been shown to increase on exposure to cacao flavonoids – this cytokine is believed to prevent against microbial infection and the formation of tumours (1).

Hyperglycaemia and insulin resistance: the insulin-sensitive GLUT-4 transporter on skeletal muscle and adipose tissue regulates glucose homeostasis; the translocation of this transporter to the cell membranes can be promoted by the ingestion of cacao flavonoids thus improving glucose tolerance (5).

Neurocognitive effects: the pathophysiology behind Alzheimer’s, Parkinson’s, and stroke is believed to be largely inflammatory-mediated. The neuroprotective effect of cacao flavonoids is linked to their ability to modify the microglial and astrocyte-mediated (both supporting cells of neurons) inflammation via various intracellular protein kinase and lipid kinase signalling pathways (3). In Alzheimer’s, it is believed that the production and deposition of amyloid beta peptide leads to activation of microglia (neurone supporting cells), and the subsequent immune system activation leads to the dysfunction and death of neurons (3). It has been shown that nitric oxide, increased by cacao flavonoids as mentioned earlier, up regulates the production of alpha-secretase and down regulates the production of beta-secretase, thus limiting or suppressing the production of amyloid beta peptide (3). Furthermore, the relationship between chocolate and total antioxidant consumption have been observed to be inversely related to the risk of stroke (3). In terms of the effect on cognition, although the precise mechanism is not fully understood, the few trials that have been conducted suggest a relationship between cacao flavonoids and improved memory and learning, due to improved blood flow to different neural tissues (3).

Phew! I’m glad I had a good old Chocolate Moondust Wazoogles Smoothie Bowl before starting this research! It took a while but clearly I was well supplemented to take on the challenge – some great learning took place and I am excited to carry this through in helping my family, friends, patients, and fellow health nuts. Med school doesn’t teach you about food and its ability to prevent disease – med school teaches you to treat the disease once it has happened with drugs and surgery. Yes, there is definitely a place for these modalities, but there is an immense power in food that we are failing to promote as a way to prevent disease before it even starts. I hope that through my own learning and my journey on being a more holistic doctor, I can inspire you to take control of your own health through healthy food and exercise.

Cacao products have an immense ability to support optimal function and prevent cardiovascular disease and neurocognitive decline through their antioxidant, anti platelet, vasodilatory, anti-inflammatory, glucose stabilising, and memory and cognition-enhancing effects. I encourage you to invest in some cacao powder or cacao nibs (or even better, some Wazoogles with even more superfoods chucked in!) to take advantage of the amazing properties of this superfood! Let me know how if you have any questions!

P.S. you can get 200g of cacao powder from Wellness Warehouse or Dischem for around R90-110 – a serving of 15g means it will last you 2 weeks… which is probably longer than that bar of chocolate! And it actually has the benefits! I hope to post my recipe for homemade chocolates with cacao and coconut oil very soon!


  1. Engler, M. & Engler, M. The vasculoprotective effects of flavonoid-rich cocoa and chocolate. Nutrition Research. 2004;24(9): 695-706
  2. Engler, M. & Engler, M. The Emerging Role of Flavonoid-Rich Cocoa and Chocolate in Cardiovascular Health and Disease. Nutrition Reviews. 2006;64(3):109-118
  3. Nehlig, A.The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. British Journal of Clinical Pharmacology. 2013;75(3):716-727
  4. Lamuela-Raventós, R., Romero-Pérez, A., Andrés-Lacueva, C., & Tornero, A. Review: Health Effects of Cocoa Flavonoids. Food Sci Tech Int. 2005; 11(3):159–176
  5. Yamashitaa, Y., Okabea, M., Natsumea, M., & Ashida, H. Cacao liquor procyanidin extract improves glucose tolerance by enhancing GLUT4 translocation and glucose uptake in skeletal muscle. Journal of Nutritional Science. 2012;1(e2)

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