While we often think “sweet” when we think of cocoa, it adds deep flavor and potential health benefits to many savory dishes, too.

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On Nutrition |

With Valentine’s Day not too far in the rearview mirror, odds are you’ve enjoyed some chocolate lately (unless chocolate’s just not your thing). Could cocoa be a delicious way to help promote heart and brain health? While research to date suggests yes, it looks like it’s too early to definitively “prescribe” chocolate for anything other than pleasure.

The idea of cocoa as a health food started hundreds of years ago, when the ancient Maya and Aztec peoples used cocoa powder to treat a variety of diseases. More recently, researchers discovered that indigenous people living in Panama and Columbia consume large amounts of cocoa daily and have healthier blood pressure and lower rates of heart disease than other people living in that region. That protection is probably due to cocoa flavanols.

Flavanols are a type of flavonoid, and flavonoids are a type of polyphenols, and polyphenols are one group of what we commonly call phytochemicals or phytonutrients. Many fruits and vegetables contain flavanols, but they are especially rich in tea, wine and cocoa. Some research suggests that they have anti-inflammatory and antioxidant properties and may help protect against cardiovascular disease, which affects both the heart and brain.

A 2015 study found that taking up to 2,000 milligrams of cocoa flavanols for six weeks made no significant difference in blood pressure in healthy adults. However, other research has been more promising, finding that even two weeks of eating of dark chocolate or other flavanol-rich cocoa products is better than a placebo for lowering blood pressure in people who already have high blood pressure, although it didn’t lower it below 140/80 mmHg.

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In 2013, the European Food Safety Authority approved the claim that cocoa flavanols help maintain normal blood pressure. The amount needed to achieve this effect is 200 milligrams of cocoa flavanols daily, about the amount in 2.5 grams of high-flavanol cocoa powder or 10 grams — about a third of an ounce — of high-flavanol dark chocolate. However, other research has found that a daily dose of 900 milligrams of flavanols may be necessary to decrease blood pressure in certain individuals.

Research also shows that flavanol-rich cocoa products, especially those that also contain cocoa fiber, can help lower blood sugar, and data from the long-running Physicians’ Health Study suggests that chocolate intake is associated with a reduced risk of developing type 2 diabetes in younger and normal-weight men. However, this was based on a single question about average yearly intake of chocolate, so take those findings with a grain of salt.

While a number of smaller studies have demonstrated that cocoa can help lower blood pressure, blood sugar and cholesterol, the big question is whether those payoffs will actually help prevent cardiovascular disease down the road. The COSMOS study being conducted from the Fred Hutchinson Cancer Research Center here in Seattle and Brigham and Women’s Hospital — an affiliate of Harvard Medical School in Boston — hopes to provide answers. COSMOS, or COcoa Supplement and Multivitamin Outcomes Study, is investigating whether taking daily supplements of 600 mg of cocoa flavanols or a common multivitamin reduces the risk for developing heart disease and stroke, as well as cancer. This randomized placebo-controlled, double-blinded trial (meaning the participants and researchers don’t know who is taking cocoa flavanols, the multivitamin, or a placebo pill while the study is going on) will follow 18,000 women aged 65 or older and men aged 60 or older for four years.

While all that research is going on, what does that mean for the average person who enjoys chocolate and hopes they’re getting some health benefit from it? Results from the large European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk) study suggest that the amount of flavanols that the average person in Europe or the United States consumes is unlikely to do much to reduce risk of cardiovascular disease.

Unfortunately for consumers, even though cocoa is a key ingredient in milk and dark chocolate, processing the cocoa bean affects its flavanol content. Packaging on commercially sold chocolate doesn’t provide information on its flavanol content, and you can’t assume that the “percent cacao” on the package is a good clue. Researchers who analyzed the flavanol content of 41 commercial chocolate brands found that the samples highest in cocoa content were not highest in flavanols.

Cocoa-Pistachio Crusted Salmon

Serves 4

This simple, flavorful entrée combines four heart-healthy foods: salmon (with its omega-3 fatty acids), cocoa (with its flavanols), pistachios (healthy fats, vitamin E, polyphenols and carotenoids), and olive oil (monounsaturated fats and assorted phytonutrients). While we often think “sweet” when we think of cocoa, it adds deep flavor to many savory dishes, too.

4 4- to 6-ounce fresh salmon fillets, with skin
½ cup shelled pistachios, finely chopped
2 teaspoons unsweetened cocoa powder
¼ teaspoon salt
⅛ teaspoon ground cardamom
⅛ teaspoon ground black pepper
1 to 2 tablespoons olive oil
Chopped fresh parsley (optional)

1. Preheat oven to 375 degrees. Line a baking sheet with parchment paper and set aside. Rinse the salmon and pat dry with paper towels. Set aside.
2. In a small bowl, stir together the chopped pistachios, cocoa powder, salt, cardamom and pepper; set aside.
3. Brush salmon generously with oil. In a large nonstick skillet, cook salmon, flesh side down, over medium-high heat for 1 to 2 minutes or until light brown. Carefully transfer the salmon, flesh side up, to the prepared baking sheet and place in the oven.
4. Bake the salmon for 10 minutes. Remove from oven and top salmon with pistachio-cocoa mixture, pressing it down firmly. Bake for another minute or so, until the salmon flakes easily with a fork. Sprinkle with chopped parsley, if desired, and serve immediately.