Episode 3 of Foods for Mood Series: Cacao.

Cacao (pronounced kuh·kau) is a nutrient-dense, magical bean that serves as the base for one of the best things in life. CHOCOLATE!

Chocolate, despite being categorized as candy, is host to several nutrients that help us fight off disease, but did you know that chocolate can also boost your mental health?

Okay, okay. Maybe you knew that, too, but have you ever wondered why? And I bet you didn’t know there are long-term mental health benefits when we regularly consume cacao products!

Let’s start with some basics.

About Cacao

History

Chocolate has been a luxury food since ancient times, with its origins being traced as far back as 400 AD (1)!

The Mayan, Toltec, and Aztec peoples, in what is now known as Central America, first discovered the bean which they used as currency and made into a cerimonial drink.

Then, around 1500, Christopher Columbus and other Spanish pioneers discovered this product which they brought back to Spain, where it was incorporated into their cultural diet and shared amongst the world.

Consumption of Chocolate

Consumption of chocolate varies by culture. According to Statista, Switzerland leads the world in chocolate consumption with 11.6 kg (or approx 25 pounds) per capita (or per person) (2). “Mmmm, swiss chocolate…”

Making Chocolate

Chocolate comes from the fruit of the Theobroma cacao tree, which, in Latin, means ‘Food of Gods’. I mean, of course, it does… chocolate is heavenly.

Each fruit contains up to 60 cacao seeds surrounded by a white sticky pulp (1). In this state, ‘chocolate’ is inedible, and the beans must undergo several processes before becoming the familiar products we know and love.

Turning Cacao into Chocolate

Making chocolate is a multi-step process that begins with fermentation. Fermentation of the beans occurs over a period of days, and its purpose is to bring out the flavor of the cacao bean.

Next, the beans are dried and roasted, removing all water content. Once dried, the shells are removed, and we are left with what is called ‘nibs.’

Nibs are then ground and refined into cacao liquor (not to be confused with an alcoholic liqueur beverage).

This cacao liquor contains both cacao solids and cacao fat (also known as cocoa butter). Sometimes, the cacao liquor is used as-is, and sometimes, it’s separated.

In the first scenario, the liquor is heated and stirred. In fancy food alchemy terms, it’s conched and tempered. These two processes stabilize and emulsify the fat, which expands the flavor and mouthfeel of chocolate products.

However, before we see that chocolate bar, other ingredients, like sugar or milk, are added. Sugars are important because they counter the bitter taste of cacao liquor. Dark chocolate, for example, has the least amount of sugar and therefore remains bitter tasting, while milk chocolate has the highest percent of added sugar plus milk and other flavorings. White chocolate is traditionally made using only cocoa butter (fat) and loads of sugar, and no cacao solids.

I’ll get into the nutrient composition in a minute, but to conclude, this complex process is an art. Much like coffee, any variation in these steps can result in different flavor experiences, mouthfeel, and nutrient profiles.

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Cacao vs. Cocoa: Are they the same?

Due to their similar spelling and reference to a similar product, these terms are often ambiguous. One person might say cacao and another cocoa. However, they are not equal, especially when in powder form.

Cacao (kuh·kau) Cacao is generally used to describe the raw product used to create chocolates. However, it can also be used to describe cacao liquor (finely ground nibs) and the solids after they are separated.

Cocoa (ko·ko) is generally used to refer to the products obtained from cacao liquor. After it is separated, we use the term cocoa.

To confuse the matter more, there are two different types of powder: CACAO powder and COCOA powder. Cacao powder is what remains after the liquor is separated. If, during tempering, the cacao is heated to a certain temperature, the term switches to cocoa.

Key Nutrients in Cacao

The compounds in chocolate can vary slightly due to plant species, growing conditions, and processing techniques, but generally, the cacao bean is high in fat and rich in polyphenols. Processing the beans may result in the loss of some of the polyphenols and definitely adds carbohydrates (3).

Fat

The fats found in chocolate are all essential fatty acids. They include both saturated (palmitic, stearic) and unsaturated fats (arachidic and linoleic acids) as well as pentadecanoic acid (which is a rare saturated fatty acid found in nature).

The fat content in chocolate is essential to the entire experience of chocolate, contributing to both its mouth feel and flavor.

For reference, three Lindt Chocolate Truffles (Dark or White) contains 18 grams of fat.

Polyphenols

Polyphenols are a class of plant-based compounds that offer health benefits. There are thousands of these compounds, which may also be called ‘phytochemicals’ or ‘anti-oxidants’ (3).

In chocolate, the most notable polyphenols are catechins, anthocyanidins, and proanthocyanidins, but content may vary by growth conditions, harvest time, and processing techniques. Generally, polyphenol content is highest in cacao nibs and cacao powder.

Trace Elements

Cacao also contains many other minerals, including:

• Iron
• Copper
• Magnesium
• Zinc
• Phosphorus

Methylxanthines – Caffeine & Theobromine

Methylxanthines are a class of nutrients known for their stimulatory effects on the central nervous system. They also promote vessel dilation and increase heart rate and pressure. Chocolate has two: caffeine and theobromine.

Caffeine, which we often associate with coffee, is also naturally occurring in the cacao bean but at much lower concentrations.

Theobromine is the compound, similar in structure to caffeine, responsible for chocolate’s bitter flavor (prior to adding sugar, of course).

Total caffeine and theobromine content in cacao beans can increase as the fruit ripens making harvest timing an important factor. Still, one fun-size special dark Hersheys bar can contain roughly 7 mg caffeine and 77 mg theobromine.

Health Benefits of Cacao

It probably isn’t news to you that chocolate, particularly dark chocolate, offers health benefits but let’s look a little closer at what systems benefit and how. Then we’ll discuss how the nutrients contained within chocolate affect our mental health.

Cardiovascular Benefits

Dark chocolate has a unique ability to improve markers of inflammation and risk factors associated with metabolic and cardiovascular disease.

According to a 2018 study, which looked at specific risk factors such as lipid levels (i.e., LDL cholesterol), A1c (diabetes risk factor), and c-reactive protein (indication of chronic inflammation) found, when compared to the control group, daily consumption of 30 grams of 84% cacao dark chocolate (the common measure was 4 mini Hershey’s bars), significantly reduced all risk factors (5).

Studies looking at morbidity (risk of death) support chocolate’s cardiovascular benefits (1).

Both the polyphenols and their metabolites influence various risk factors involved in cardiovascular health, particularly related to inflammation. In addition, research has identified that chocolate consumption may also reduce blood pressure (6).

A review investigating the effect of chocolate consumption on hypertension (high blood pressure) found modest evidence to support that the consumption of flavanol‐rich chocolate and cocoa products causes a small (2 mmHg) blood pressure‐lowering effect in healthy adults in the short term (6).

Cancer

Chocolate may also offer us protection again cancer. The two proposed mechanisms relate to the polyphenol and methylxanthines (the simulatory compounds in chocolate, caffeine, and theobromine). Polyphenols act as antioxidants, and methylxanthine may exert both antioxidant and anti-microbial activity. These effects theoretically prevent damage to DNA, thereby reducing the risk of cancer.

However, there is insufficient evidence to support a direct correlation between chocolate consumption and the incidence of cancer.

Gut

Our guts have a larger impact on our overall health than you might realize, and a healthy one significantly reduces our disease risk. New understandings, such as the gut-brain axis, are shedding light on the complex interplay between helpful bacteria in our guts and health outcomes. A healthy gut equals a healthy life, some might say.

Polyphenols in chocolate, and their metabolites, offer us protection from disease. They reduce inflammation, fight free radicals, and promote the growth of beneficial bacteria, such as Lactobacillus and Bifidobacterium in addition to reducing the number of bad bacteria, such as Clostridium perfringens (2, 8, 9).

Furthermore, fiber (yes, chocolate contains small amounts of fiber) and sugar act as food for good bacteria. As they break down these nutrients, they produce byproducts like vitamin K or short-chain fatty acids, which our body uses in a variety of ways, all of which promote optimal function in cells.

Diabetes

For people living with diabetes, eating sweets can be bittersweet. There is good news, though! A modest amount of dark chocolate is one of the few desserts we (dietitians) suggest for people with diabetes!

As discussed above, modest consumption of dark chocolate can improve biomarkers associated with chronic inflammation and metabolic disease, particularly type 1 and type 2 diabetes (2, 7). This likely relates to the action of polyphenols on the pancreatic cells that produce insulin, resulting in improved insulin production and lowered A1c.

Skin

Chocolate’s relationship with our skin is complex and unclear. It’s been implicated as one of the causes of acne but also supposedly protects our skin from aging. How can it do both?!

The fat content of chocolate may contribute to worsening acne, but research on the matter is conflicting. Many studies have linked the two, but just as many have debunked it. The debate about whether or not chocolate causes acne continues.

While it can’t turn back the clock, the polyphenols in cacao/dark chocolate might slow skin aging in two ways. First, some polyphenols found within chocolate have an affinity for skin cells and exert their antioxidant activity there. Secondly, polyphenols’ influence on the gut can improve overall health and cell function across all body systems, including our skin (8).

Weight

What do you think? Eating chocolate leads to weight gain or weight loss?

Insert sarcastic “Surprise!” The answer is not so simple.

Weight loss. Chocolate contains calories in addition to those health-promoting components, which, if consumed in excess, can contribute to weight gain. However, modest consumption (around 30 grams of 85% cacao chocolate) may actually aid in weight loss.

The polyphenols found in chocolate might exert the following actions:

• Improving insulin sensitivity (7, 11).
• Impacting our gut microbiome and influencing the production of satiety and hunger hormones, particularly the hunger hormone, grehlin.
  • One interesting study of 12 women found that smelling and eating dark chocolate decreased appetite and reduced levels of ghrelin, the hormone that stimulates hunger (7, 8). Additionally, other studies have found that when compared to milk or white chocolate, the consumption of dark chocolate results in fewer overall calories (11).
• Enhancing mood (11). This theory is based on the idea that polyphenols and their metabolites can either promote or inhibit neurotransmitter production or influence the communication pathways between neurons.

However, while plausible and interesting, more data is needed to confirm these findings.

Weight gain. Many of the commercially available chocolate products contain added sugar oradditional fat. Further, while the portions may seem small, they are much larger than they should be.

Due to the calorie content and the ease of overconsumption, chocolate could very likely be a contributing factor in weight gain and obesity.

While there have been many studies indicating modest chocolate consumption can improve our health, it is important to understand the difficulties associated with controlling for the numerous other factors which can also influence our health. Factors such as alcohol consumption, regular diet choices, exercise, stress, and genetics can positively and negatively impact the results of almost any human study and researchers can control only so much. Knowing this, unless there is irrefutable evidence and established guidelines, the medical community may be hesitant to give recommendations around food or food components, like polyphenols.

Chocolate and Mental Health

Ya know how chocolate just makes you feel better sometimes? Yeah, me too! I love chocolate. Chocolate is just positively magical. It’s medicine on a bad day and a treat on a good day. But I digress…

Effects of Cacao on Mood

Short-Term Effects of Cacao

The immediate effect of eating chocolate on mood or stress levels likely relates to endorphins(12, 13).

Endorphins are released when we do things that are pleasurable, including consuming things that are smooth and sweet, like chocolate. Circulating endorphins then bind to opioid receptors within the brain and stimulate the production and release of dopamine. Dopamine makes us feel good, or in the case of eating chocolate, better than we did 2 minutes before.

This is the same pathway implicated in addiction, though chocolate consumption alone has not been linked to dependence. That said, we can still experience cravings for chocolate, but this most often occurs when our mood is down and we really just want a little hit of dopamine (12, 13).

Another immediate action of chocolate involves vasodilation. In vasodilation, we have increased blood flow, including to the brain. Increased blood flow to the brain boosts nutrient and oxygen exchange and promotes the optimal function of our neurons. We can thank the caffeine and theobromine in chocolate for this effect (12, 13).

Long-term Effects of Cacao

Over time, regular intake in moderate amounts may have a positive influence on our moods (12). A 2019 studying using data collected from 13,626 adults (≥20 years) participating in the National Health and Nutrition Examination Survey (NHANES) found a correlation between dark chocolate consumption and depressive symptoms. More specifically, those who consumed 104–454 g/day had 57% lower odds of depressive symptoms than those who reported no chocolate consumption. Long-term studies are needed to confirm these findings (14).

Here are the deets on how this might be possible.

1. The first theory suggests the polyphenols present in chocolate influence salivary cortisol, which is known to affect the hypothalamic-pituitary-adrenal axis. This axis plays an important role in managing the neurotransmitters implicated in depression and anxiety (12).

2. The second theory for how chocolate might improve symptoms of depression and anxiety involves the gut microbiome and its effects on neurotransmitter production and cellular communication pathways (12).

Effects of Cacao on Cognition

Cognition may also be impacted, both acutely and over time.

A 2013 review of the literature found evidence that chocolate can improve working memory and executive function up to two hours after consumption (15). However, more robust studies must be done to establish dosing and understand the interactions between various ingredients in chocolate.

Another study, using a slightly younger population (< 25 years old), noted increased cerebral blood circulation and improved cognitive performance skills with regular intake of up to 1 gram per day. As we know, the caffeine and theobromine in cacao promote vasodilation and is likely one of the factors involved in cognitive function but, over time, the polyphenols found in dark chocolate might also provide benefits. The authors noted a connection between regular intake of high polyphenol chocolate and neurotrophin production (things that stimulate the regeneration of nerve cells), a meaningful factor in neuroplasticity, cognition, and age-related degenerative diseases like Alzheimer’s (16).

my Recommendations

While many studies indicate the polyphenols found in cacao, particularly dark chocolates, have positive health effects, it’s important to understand there are limits to all things, good and bad, and moderation is the key.

Unfortunately, consuming this delicious treat can have negative effects. To summarize these ill effects,

• Caffeine and Theobromine in cacao may increase blood pressure or make you feel nervous or jittery, especially if consumed in large amounts.
• Calories from fat and added sugars may contribute to weight gain. Choosing higher percent cacao products and consuming smaller amounts may reduce this risk.
• Components in chocolate can exacerbate acne in some people.

Most of the research supporting favorable effects uses somewhere between 10-30 grams per day. Amounts above 30 grams daily may lead to the above negative effects and increase your risk of heart disease or diabetes (Morze). Knowing this, here are my recommendations.

1. Keep intake to 30 grams per day. 30 grams is equal to one ounce of chocolate or approximately 4 “mini” bars measuring 0.25” x 1.5” x 0.75”). It is also equivalent to about four heaped teaspoons of cacao powder.
2. Choose higher percent cacao when possible.
3. Minimize (don’t eliminate something if it brings you joy) milk chocolate and white chocolate.
4. Choose chocolate products or recipes that limit added sugars.
5. For the love of all things holy, ENJOY your food!

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