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Caden Mitchell
Dr. Karpinski
NTD 411
November 13, 2015
The Effects of Dark Chocolate on Blood Pressure
I. INTRODUCTION
A.

Dark chocolate is a commonly found product in most grocery stores worldwide.


Typically it is consumed by itself in its solid state (room temperature) or semisolid state
(which occurs around 85 degrees Fahrenheit) as a topping or ingredient2. It is consumed
in a wide variety of cultures and is normally eaten as a snack but is sometimes consumed
for health reasons including blood pressure. The reasoning behind this, according the
British Journal of Nutrition, is a type of chemical compound called flavonol that naturally
occurs within the cocoa plant. Flavonols are a type of flavonoid that contain a 3hydroxyflavone backbone. These ketone-containing compounds are also functioning
anthoxanthins, which are known in the medical field to decrease arterial stiffness; in turn,
lowering blood pressure2. This happens in result of the nitric oxide dependent
vasodilation; a lack of this is often associated with hypertension1. It is for this reason it
can be hypothesized that the research will yield results in favor of dark chocolate
consumption lowering blood pressure, conditionally. The only caveat being that based on
the type and quality of the cocoa bean, the amount of flavonol differs. This would infer
that a low-flavonol dark chocolate may help significantly less than its counterpart.

II. REVIEW OF LITERATURE


.
A. The Impact of Flavonol-Rich Dark Chocolate on Blood Pressure and Vascular Function
in Healthy Subjects
a. Heuten, H. Van Ackeren, K. Hoymans, V. Wouters, K. Goovaerts, I.
Conraads, V. Vrints, C The Impact of Flavonol-Rich Dark Chocolate
on Blood Pressure and Vascular Function in Healthy Subjects. The
Journal of Hypertension. 2015;33(1).
doi:10.1097/01.hjh.0000467546.67897.69.
b.

Flavonoids are believed to have an effect on blood pressure, however,


most studies conducted up to this point focus on patients with pre-existing
conditions. Also, most of the current data is based on an acute time period, so this
study aimed to combat these problems by addressing both to serve as data with no
variables other than the raw effect of the flavonoids within the dark chocolate. To
carry out the study, 51 volunteer participants with no pre-existing blood pressure
conditions were selected and divided into two groups in a double blind fashion.
The first group (n=26) received 20g of high-flavonol dark chocolate daily; the

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second group (n=25) received low-flavonol dark chocolate and served as the
control. All participants were required not to take any blood pressure medication
during the duration of the 8 week study. After using a pretest-posttest method, the
results of the study concluded that there was no statistically significant drop in
blood pressure when comparing both groups. Although, there was significant drop
in the blood pressure overall in the participants as a whole from week one to week
8.
c.

Overall this article would be considered mediocre. The title is fitting in


length and description and the introduction accurately described the need for a
study to be conducted but the review of literature was slightly limited. The sample
size is also small and although it is larger than 35, it was not specified whether the
sample size is from a certain region and if any other factors could play a role in
effecting the outcome in terms of the sample. The results of the study are backed
by their data and type of tests conducted are standardized but again with a sample
size of only fifty-one the results could be called into question. Lastly, all the
participants were volunteers, which could bring volunteer bias into play.
B. Study 2
a. Grassi D, Desideri G, Necozione S et al. Cocoa Consumption DoseDependently Improves Flow-mediated Dilation and Arterial Stiffness
Decreasing Blood Pressure in Healthy Individuals. Journal of
Hypertension. 2015;33(2):294-303. doi:10.1097/hjh.0000000000000412.
b.

Flavonoids are often thought of as having a dietary effect on lowering


blood pressure and because of this the two are often looked at together. However,
this study was the first to look at dose-response effects and how a variety of
dosing over preset time frames could affect blood pressure after the study
concludes. To test this, the conductors of the study measured 20 participants
flow-mediated dilation or FMD which directly affects blood pressure rather than
simply measuring blood pressure itself. This was done to recieve a more accurate
measurement of the effect of the flavonoids and not just the effects of the other
components within the individuals diets. The results of the randomized, double
blind crossover study concluded that the experimental group receiving increasing
weekly doses of 0, 80, 200, 500 and 800mg daily of cocoa flavonoids in 10g of
cocoa saw a statistically significantly improvement in their flow-mediated
dilation. The control group, whose FMD value was measured at 6.2% throughout
the study can be compared to each weekly FMD value of the experimental group;
7.3%, 7.6%, 8.1% and 8.2% respectively.

c.

This article had a clearly defined purpose in the introduction which the
title identified and that was to find relevance between dark chocolate flavonoids
and blood pressure. Though its sample size was low at n=20, the addition of a
crossover was implemented to ensure validity of the results and according to the
results shown in the data it was successfully found that flavonoids appear to
increase FMD in this study, which is known to decrease blood pressure.
Additionally, the article provided more than adequate background research on the
topic and many reasons for the implementation of the study including the eventual

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possibility of incorporation into the diet of those suffering from hypertension.
Overall, this study showed a clear demonstration of the possible effects of
flavonoids, despite a sample size that would disclaim some of its legitimacy.
C. Study 3
a. West S, McIntyre M, Piotrowski M et al. Effects of Dark Chocolate and Cocoa
Consumption on Endothelial Function and Arterial Stiffness in
Overweight Adults. British Journal of Nutrition. 2013;111(04):653-661.
doi:10.1017/s0007114513002912.
b.

There is a known connection between dark chocolate and blood pressure


in result of the flavonoids present in high amounts in certain types of dark
chocolate. To further understand what causes this effect on blood pressure and
where specifically the effects are taking place the British Journal of Nutrition
conducted a randomized double blind, 4 week, placebo controlled, crossover
study. The 30 participants were all selected from a group of patients that fall
within the overweight category of the British medical standard obesity detection
scale known to some as the BMI scale. The experimental group contained 15
individuals both male and female and received 37g per day of dark chocolate
along with a sugar free cocoa beverage containing 22g per cup (1 cup was given
each day) totaling 814mg total flavonol (TF) each day. On the other hand the
control group (also 15 participants both male and female) received a similar
looking dark chocolate bar and cocoa-free drink with very low TF (3mg/day). All
of the products contained little or no sugar to minimize the effect of sugar on
blood pressure. What the study found was that the peak diameter and the basal
diameter of the branchial artery increased by 2mm (6%) and basal blood flow
volume by 22%. Additionally, arterial stiffness was significantly decreased but
only in women.

c.

This article was well described in the introduction and in the title and
accurately described what is already known about dark chocolate and high blood
pressure. Additionally, it provided reason for experimenting in that we still need
to better understand why this process happens. The methodology was sound and
used all appropriate and standardized testing methods to assess the participants
and did find the original hypothesis to be mostly true. What was not anticipated
was that only women would see a significant drop in arterial stiffness and an
explanation for this was provided. The data appears to be accurate in terms of
possibility and the conclusion states that they would like to conduct further
research to dig into their explanation for the arterial difference so other than
again, a small sample size (n=30) the study would seem valid and well conducted
without bias.

D. Study 4
a. Koli R, Khler K, Tonteri E, Peltonen J, Tikkanen H, Fogelholm M. Dark
Chocolate and Reduced Snack Consumption in Mildly Hypertensive

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Adults: An Intervention Study. Nutrition Journal. 2015;14(1).
doi:10.1186/s12937- 015-0075-3.
b.

Most of the research conducted on dark chocolate and hypertension has


been acute and focus on studies of four week time periods or less. The purpose of
this randomized, controlled, blind crossover study is to measure the change over a
longer period of time [8 weeks] using the entire group of 22 mildly hypertensive
participants (14 men and 8 women) as both the experimental and control group.
This was done by replacing the idea of each group (experimental and control)
with a time frame. To do this, each group followed an intervention pattern of four
weeks of reduced snacking (control period) and four weeks of replacing snacks
with dark chocolate in the amount of 49g/day. Data was collected by measuring
24 hour blood pressure (BP) and arterial stiffness index (AI) at the beginning and
end of each stage of the trial. What the data found was that the dark chocolate
consumption had no effect on either systolic (BP), diastolic (BP), or (AI).
However, the participants did see a drop in mean weight and BMI during the
control period of the experiment.
c.
This study accurately depicted its findings in the title and portrayed
preexisting trials in the introduction in similar studies. The hypothesis was wrong
though. Nevertheless, it was explained that the participants were told to follow the
strict guidelines of the study but were not tracked to ensure this happened. It was
also speculated that a dark chocolate with higher flavonol content would had a
different effect on their currently mild hypertension. The methodology and data
collection used within the study were all standardized processes and aid in
providing validity to the results even though they contrast what was found in
previous studies. In summary, the study used appropriate and accurate testing but
may have suffered from a small sample size although a cross over method was
applied to counteract this possible problem. It can also be speculated that other
extraneous variables such as the specific population may have played a role in the
outcome.
III. OVERALL SUMMARY/CONCLUSIONS
a. Overall, the research available typically contained small sample size studies
(n<35); however, the implementation of a crossover was common, increasing
validation the results, which exhibit a common trend. That trend indicates a direct
connection between the effect of flavonol within the dark chocolate and a drop in
blood pressure upon sustained consumption, validating the previously stated
hypothesis. This is shown in multiple studies both presented earlier and easy
located on any journal database, such as PubMed or Google Scholar. An area
where the possibility of more research could be beneficial is the effect of various
dosing amounts. This was only contained within one article present in the research
above, though it can be logically derived that a variety of dosing would have
different effects, some more conducive than others to reduction of blood pressure.
Currently, there are few adverse effects of consuming normal amounts of
dark chocolate (1-2 servings) unless the processing procedures include negative
additives so generally, the risks are very limited. This would be especially true
taking into account that if your consuming normal amounts of dark chocolate,

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youre most likely diminishing the urge to snack on less healthy options. This
would only lead to the clear deduction that dark chocolate is not only safe but
recommended to help treat those who suffer from hypertension. It can also be
concluded that healthy individuals will reap benefit from the substitution of dark
chocolate in place of the white or milk alternatives. The benefits may not be as
noticeable though, since the blood pressure of this group is already within the
healthy range.

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Refrences
1. Dharmashankar K e. Nitric oxide synthase-dependent vasodilation of human subcutaneous
arterioles correlates with noninvasive measurements of endothelial function. PubMed NCBI. Ncbinlmnihgov. 2015. Accessed November 13, 2015.
2. West S, McIntyre M, Piotrowski M et al. Effects of Dark Chocolate and Cocoa Consumption on
Endothelial Function and Arterial Stiffness in Overweight Adults. British Journal of Nutrition.
2013;111(04):653-661. doi:10.1017/s0007114513002912.