Prof. F.

Kwaku Addai, 23/09/2005

Regular Cocoa Consumption to Prevent/Control Diabetes Mellitus.

By Prof. F. Kwaku Addai, outgoing National President, Ghana Science Association.

The statistics on diabetes mellitus is grim. The global incidence of Type 2 diabetes
mellitus is projected to nearly double to 300 million by the year 2025, and many of those
affected will be young adults (SCIENCE, 21 January 2005). I am persuaded that regular
consumption of good quality cocoa products, combined with little lifestyle changes can
halt the onslaught of diabetes.
Biochemical analyses of a cocoa bean produces a typical content as follows: 50% fat
(cocoa butter), 20-25% carbohydrate, 5% water, 1.5% theobromine, tyramine (has action
similar to epinephrine or adrenalin), and 3.5% minerals and vitamins; including
magnesium (the largest natural source), potassium, copper (and associated chromium?),
calcium, iron, sodium, phosphorus, vitamin A, B1, C, D, and E, tryptophan (an essential
amino acid), and a host of chemicals known as neurotransmitters. In fact, scientists agree
that cocoa may contain more than three hundred chemicals; these appear to work in an
inter-related fashion to make the cocoa bean natures multinutrient tablet. Although the
exact amounts of these nutrients in the cocoa bean varies with the geographical site of
cultivation, prevailing farming practices, and processing methods, there is ample evidence
that most cocoa products give healthful benefits to consumers. Little wonder that Michael
Levine, a renowned nutrition researcher is quoted as saying, chemically speaking
chocolate is the worlds perfect food.
Folkloric and anecdotal records indicate that regular intake of cocoa either as beverage or
solid chocolate relieves symptoms and ill health associated with diabetes mellitus (DM).
This article presents some of the current scientific findings and reasoning that helps to
explain how cocoa can prevent/control DM.
How does Diabetes Mellitus develop?
Diabetes mellitus is of two types. There is juvenile or Type 1 or insulin-dependent DM,
and there is Type 2 or insulin-independent (formerly adult-onset) DM. Juvenile DM
results from destruction of a particular group of cells (beta cells) in a gland called
pancreas. The beta-cells produce the hormone insulin. They are destroyed in people with
1

Prof. F. Kwaku Addai, 23/09/2005

Type 1 DM because of inborn errors with their bodies defence (immune) system. In this
case the defective immune system fails to recognise the beta-cells as self and destroys
them just the same way it would destroy (non-self) cells from someone else; and the
process is called auto-immune destruction. The end result is that the Type 1 diabetic
patient does not produce adequate insulin needed to utilise glucose in his/her blood, so her
blood glucose level is high (a condition known as hyperglycaemia). Thus, type 1 DM is
characterised by low insulin and high glucose in blood.
How can coca help in Type 1 DM?
Nutrients in cocoa known as flavanol antioxidants have been shown to modulate immune
responses. It is conceivable therefore that the better health obtained by Type 1 diabetic
patients who consume cocoa benefit from intervention by flavanol antioxidants that may
prevent or slow down the auto-immune destruction of beta cells. Additionally, studies
show that healthy people who eat cocoa-flavoured foods produce more insulin than when
they eat the same foods with flavours other than cocoa.

This suggests that cocoa

consumption promotes the activity of the beta-cells, which would benefit Type 1 DM
patients.

Flavanol antioxidants, magnesium, and nitric oxide in cocoa have been

postulated as possible nutrients that mediate its promotional effects on insulin production
in the body.
What about Type 2 DM?
Type 2 DM develops when the body does not respond properly to insulin, as opposed to
Type 1 DM in which the pancreas produces little or no insulin at all. In healthy people,
insulin is released into the bloodstream each time they eat. The hormone helps tissues,
particularly muscles, to take up the glucose whose level rises after every meal. The
insulin released after meals also stops the liver from releasing any fat (as triglycerides)
into blood. This is necessary because triglycerides are also potential metabolic fuel and
their presence in blood when there is plenty of glucose after meals is dangerous. The
bodys principal way of getting rid of glucose (because it is toxic in excess) is to burn it.
The glucose that the body cannot burn it gets rid off by storing it as glycogen (animal
starch) in the liver and muscles. However, the body stores very little glycogen at any one
time. All the glycogen stored in ones liver and muscles cannot provide adequate energy
to last one active day! Once the glycogen stores have been filled, glucose is converted to

Prof. F. Kwaku Addai, 23/09/2005

saturated fat for storage. This explains why accumulation of abdominal fat (in particular)
is an indicator that you are heading for a diabetic rendezvous.
What does insulin do?
After a meal, most starchy foods (carbohydrates) are broken down into glucose, which is
the main source of energy (fuel) for the bodys cells. But the body cannot use glucose
without insulin, which helps the cells to take up glucose and convert it to energy. When
the pancreas does not make enough insulin (Type 1), or the body is unable to use the
insulin that is present (Type 2), the cells cannot use glucose. When excess glucose builds
up in the bloodstream, the stage is set for diabetes mellitus. Being fat or obese affects the
way insulin works in the body. Extra fat tissue can make the body resistant to the action
of insulin. By burning glucose (as glycogen) in muscle, physical exercise makes insulin
work well by making empty depots available to store more glycogen. Alternately, when
the glucose in the bloodstream remains higher than normal for prolonged periods, the
pancreas keeps up with the bodys demand for more insulin. In due course, however, the
gland loses its ability to secrete enough insulin in response to meals, and a condition
known as insulin resistance ensues. People with insulin resistance have high levels of
blood glucose and high levels of insulin circulating in their blood at the same time.
Insulin resistance and type 2 DM
When the bodys cells are exposed to high levels of insulin for prolonged periods, they fail
to respond (or become resistant to it). Cells become resistant because they are trying to
protect themselves from the toxic effect of high insulin. The cells reduce the number of
docking sites (receptors) where insulin must attach to make them respond to its presence.
The liver cells become resistant first, followed by muscle tissue, and finally fat cells.
Thus, in people who have insulin resistance, liver, muscle, and fat cells do not use insulin
properly. At the onset, the pancreas keeps up producing more insulin (in the hope that it
can reduce the high blood glucose that gave rise to the insulin resistance. Over time
(within 10 years or longer) the production of insulin starts to slow down, or the insulin
resistance goes up, then blood glucose becomes chronically elevated and the person
becomes diabetic (type 2). It is the fact that Type 2 DM takes a long time to develop that
makes it adult-onset; and also amenable to lifestyle adjustments such as increased
physical activity, weight loss, and low carbohydrate & high vegetable/fruit meals.

Prof. F. Kwaku Addai, 23/09/2005

How can cocoa help prevent type 2 DM?

Primarily, by making insulin that is produced more active and less likely to
become resistant. Although some studies have actually confirmed this, exactly
how cocoa powder in particular achieves this is yet to be fully understood. It has
been suggested that the flavanol antioxidants may play a role (probably by
promoting nitric oxide production in the body) in this remarkable benefit of cocoa.
Cocoa may also facilitate digestion of carbohydrates (including glucose) after
meals because of the high content of magnesium, a micronutrient that is necessary
for the proper functioning of most enzymes. This will eliminate the unnecessary
prolongation of elevated blood glucose that occurs after meals.

Another problem that high levels of insulin (that pre-stages and characterises type
2 DM) cause is high blood pressure. In part, this is attributable to the fact that
insulin resistance eliminates one role of the hormone, in storing magnesium.
Magnesium is therefore lost through the frequent urination caused by the elevated
blood glucose levels of Type 2 DM. Loss of magnesium causes blood vessels to
constrict (become narrow), raising blood pressure. As indicated above, cocoa has
the highest natural source of magnesium. A standard cocoa powder will contain
about 130% of the recommended daily allowance (RDA) of magnesium. Drinking
cocoa powder therefore ensures there is enough magnesium in the body to keep the
blood vessels from constricting. Indeed, several studies have shown that blood
vessels dilate (expand) with magnesium administration to people. In addition, the
flavanol antioxidants in cocoa promote production of another potent vasodilator,
nitric oxide that will enhance the effect of magnesium. Furthermore, cocoa is the
richest source of theobromine, a chemical whose good effect on smooth muscles in
the walls of blood vessels particularly those of the heart and brain- is
unsurpassed.

Elevated insulin levels associated with Type 2 DM causes retention of sodium,

which causes fluid retention that gives rise to high blood pressure and congestive
heart failure. Theobromine in cocoa is a diuretic (promotes frequent urination) that
facilitates sodium elimination and eliminates fluid retention, thereby preventing
heart failure. Numerous epidemiological studies have shown that societies where

Prof. F. Kwaku Addai, 23/09/2005

cocoa powder is consumed regularly as beverage, despite high salt (sodium)

intake, high blood pressure is rare and heart failure is unknown.
This article is by no means an exhaustive presentation on how cocoa can help to prevent
DM, especially Type 2. For instance, by increasing exercise tolerance people consuming
cocoa regularly can prevent insulin resistance since they can do more physical exercise.
Cocoas flavanol antioxidants also help to prevent the hardening of blood vessels with
age, which can by itself precipitate insulin resistance and Type 2 DM. It is hoped that the
present article convinces readers that there is everything to gain by way of improved
health if cocoa powder, and good quality products such as Golden Tree chocolates, will be
patronized on regular basis. A regular cup of pure natural cocoa powder beverage will
prevent health problems linked with high blood sugar, or insulin resistance, or Type 2 DM
such as kidney damage, blindness, amputations, and heart disease. The brands of natural
cocoa powder currently on the Ghanaian market that I can recommend are: Goodfood
(packaged by Kakawa enterprise for my promotional efforts), Brown Gold (packaged by
Hords Limited), Kings Virgin Cocoa Powder (packaged by Kings Cocoa Processing
Company Limited), Broma Cocoa powder (packaged by Allied Foods Ltd), Royale natural
cocoa powder (packaged by Cocoa Processing Company Ghana Limited), and Ekubanco
(packaged by Becostar Gh. Ltd.).
*Since the first publication of this article in the Ghanaian Times (October 2005), I have
introduced my own brand of Natural Unsweetened Cocoa powder under the brand name
Goodfood, packaged by a company I am in the process of registering (Kakawa
Enterprise). The name Goodfood is meant to emphasize the fact that cocoa powder is
food and not medicine. It should not be taken to replace prescribed medication, but taken
in addition to prescriptions as food supplement. With regular checkups, a diabetic patient
would be told by his/her doctor if the blood sugar level requires that s/he stops taking
medication. Only then can s/he stop taking medication but never without his/her doctors
advice.