This March, the British Heart Foundation is asking people to “give chocolate the finger” and embark on a strict no-chocolate “dechox” regime.
There can be no denying that it is a worthy cause, with cardiovascular disease accounting for almost a third of deaths worldwide, and representing one of the most significant healthcare challenges faced by our generation (World Health Organization. Cardiovascular diseases: fact sheet No 317. WHO, 2007). Furthermore, as the prevalence of obesity and the metabolic syndrome increase, we can expect a corresponding rise in diabetes mellitus and cardiovascular disease. These facts set the scene for the latest in the recent onslaught of charity campaigns promoting self-deprivation in a bid to encourage donations.
In support of their Dechox campaign, the British Heart Foundation suggest that cutting out just three chocolate bars a week could result in significant health benefits, including weight loss of up to 5kg in one year. In a poll of 3000 people, they found chocolate was regarded as more difficult to give up than other common vices, such as alcohol, caffeine, and sex. Interestingly, there seems to be an associated element of guilt as 43% had hidden chocolate wrappers to hide the extent of their habit and 33% confessed to secretly eating chocolate on their daily commute.
However, while weight loss is certainly a positive step for those at risk of cardiovascular disease, the British Heart Foundation may have been a little hasty in choosing this sweet adversary. Although much commercial chocolate is high in sugar and fat, a study of healthy females consuming a supplementary 41g of dark chocolate for six weeks found no detrimental effects, and crucially no weight gain. Indeed, the potential cardioprotective effects of chocolate remain a very active area of research.
Polyphenolic antioxidants, most notably flavanoids, found in dark chocolate, have been shown to have antihypertensive effects, as well as reducing insulin resistance, oxidative stress and inflammation, improving endothelial and platelet function and, in animal models, enhancing thermogenesis and lipolysis resulting in reduced white adipose tissue weight gain.
Of course, in order to make informed decisions, consumers need to know the type and amount of chocolate tested. A 2012 best case analysis in The BMJ suggested that consumption of dark chocolate or cocoa products with a polyphenol content of 500-1000mg would represent cost-effective primary prevention for those at high risk of cardiovascular disease, on the basis of antihypertensive and metabolic effects. However, milk chocolate has not been shown to confer the same benefits as dark chocolate, with studies suggesting that milk proteins might interfere with in vivo absorption of antioxidants, thereby negating any potential benefit. The UK consumer’s predilection is for milk chocolate, with 73% reporting milk chocolate consumption compared with 37% for dark chocolate, in a survey by Mintel.
Still, you might wonder why the British Heart Foundation didn’t target, for example, sugar-laden soft drinks. UK consumers guzzle an average 230 litres of soft drinks every year, with carbonates (at 103 litres) the largest single market category. People who regularly consume 1-2 cans of sugary drink have a 26% increased risk of developing type 2 diabetes, and just one can a day could increase the risk of having or dying from myocardial infarction by up to 20%.
If taking on the corporate beverage giants was too intimidating a task, then why not pick on the humble bacon sandwich instead? A study of more than 37000 men in Sweden found that men eating three or more slices of bacon a day were twice as likely to die from heart failure. Not to mention the association between processed meat consumption and a range of GI cancers. (See also here, here, and here.)
So why did the British Heart Foundation choose chocolate? Perhaps the magnitude of the challenge—giving up something that is universally enjoyed—might prompt more donations. Nevertheless, for those seeking to improve heart health the answer is not as simple as cutting chocolate out completely. Sensible weight loss, a diet rich in fruit, vegetables and plant-based antioxidants, coupled with regular exercise and the avoidance of a sedentary lifestyle continue as the mainstays of lifestyle advice. Those who cannot or indeed don’t want to give up chocolate may consider a switch from milk to dark chocolate, knowing that one day it may be conclusively shown that this confers greater benefit than abstinence.
Emma Rourke is a foundation year 2 doctor working at Kingston Hospital.
Competing interests: None declared.