Cocoa

Scientific Name(s): Theobroma cacao L. subspecies cacao . Family: Sterculiaceae

Common Name(s): Theobroma , cacao . Compounds derived from this product include cocoa, chocolate, and cocoa butter.

Clinical Overview

Uses of Cocoa

Cocoa products are used in foods and cosmetics. The primary alkaloid has activity similar to caffeine. Ingestion of chocolate, when following a low-cholesterol diet, is being investigated to determine the effect on cholesterol levels.

Cocoa Dosing

Cocoa flavonoids and procyanidins have been administered at doses from 150 to 250 mg daily in studies of platelet function and eicosanoid synthesis. Cocoa bran has been used at 25 g per day to protect colon health. 1 , 2 , 3

Contraindications

Patients with irritable bowel syndrome should omit cocoa products from their diet.

Pregnancy/Lactation

Generally recognized as safe or used as food. Avoid dosages above those found in food because safety and efficacy are unproven. Caffeine content should be restricted. 4

Cocoa Interactions

None well documented.

Cocoa Adverse Reactions

Children consuming large amounts of chocolate and caffeinated beverages may exhibit tics or restlessness. Large amounts of cocoa products may be fatal to pets. Ingredients in chocolate may precipitate migraine headaches.

Toxicology

Cocoa usually is nontoxic, when ingested in usual amounts.

Botany

The cocoa tree grows to heights exceeding 8 meters. The fruits are berry-like and are borne on the trunk and branches with the seeds imbedded in a sticky pulp. The fruits are large and football shaped, and the seeds are the size of a quarter. The seeds are referred to as cocoa beans. Cacao is often used to describe the crude material, while cocoa is used to describe the processed products. Although several varieties of cacao exist, the forastero variety from West Africa accounts for more than 90% of world production. 5

History

Cortez described the preparation and use of a beverage called chocalatl, based on the seeds of T. cacao , among the members of the Aztec court. The Mayan word cacao entered scientific nomenclature in 1753 and the words theo broma are Latinized Greek; theo is “god” and broma is “nectar” or “food.” In the 1600s it was argued that chocolate should be called a medicine because it changed a patient's health. At that time, physicians also stated that all that was necessary for breakfast was chocolate as it yielded good nourishment for the body. 6

Cacahuatl (cacao) beans, resembling the almond, have been used for commerce. Chacah (medicinal chocolate) mixed with 2 peppers, honey, and tobacco juice has been ingested to treat a variety of illnesses, such as skin eruptions, fever, and seizures. 6

The 3 main commercial products obtained from cacao seeds are cocoa powder, cocoa butter, and cocoa extracts. Following curing and fermentation, the beans are dried and roasted to yield the desired flavor, color, and aroma.

Chemistry

The nib, which contains about 55% cocoa butter, is ground into a liquid mass called chocolate liquor, from which the butter is removed by hydraulic pressing. The remaining cocoa cake is dried and ground to a fine powder to yield cocoa powder with a fat content of 22% or more. Specially treated cocoa powder, called alkalinized cocoa, is considered to have improved color, flavor, and dispersability over unalkalinized powder. Cocoa butter (also known as theobroma oil) may have a faint chocolate odor that may be removed following further purification. Cocoa contains more than 300 volatile compounds. The important flavor components are aliphatic esters, polyphenols, aromatic carbonyls, and theobromine. 5 These phenolics also prevent the rancidity of the fat in chocolate. 7

Cocoa contains the alkaloids theobromine (0.5% to 2.7%), caffeine (approximately 0.25% in cocoa), trigonelline, and others. 5 , 8 A standard chocolate bar (40 to 50 g) contains theobromine (86 to 240 mg) and caffeine (9 to 31 mg). 9 The characteristic bitter taste of cocoa is generated by the reaction of diketopiperazines with theobromine during roasting. Theobromine is produced commercially from cocoa husks. 5

Cocoa butter contains triglycerides consisting mainly of oleic, stearic, and palmitic acids. About 75% of the fats are present as monounsaturates. 5 Cocoa butter has a high digestibility, similar to that of corn oil, with a digestible energy value of approximately 37 kJ/g in humans; therefore, it cannot be considered low-calorie. 10 However, one randomized trial demonstrated that supplementation of chocolate with 0.9% calcium (0.9 g/day) reduced the absorption of cocoa butter, thus reducing the digestible energy value. 11

A substantial amount of polyphenols are in the form of procyanidin (ie, epicatechin and catechin) oligomers. 12 , 13 , 14 , 15 , 16 Epicatechin has been shown to scavenge free radicals and to inhibit lipid peroxidation. 17 , 18

Cocoa Uses and Pharmacology

Theobromine is a weak CNS stimulant, with only one-tenth the cardiac effects of other methylxanthines (eg, caffeine, theophylline). 19 , 20

Theobromine, the primary alkaloid in cocoa, has activity similar to that of caffeine (ie, increases in energy, motivation to work, and alertness). 9

Theobromine, when ingested in the form of a large chocolate bar, did not cause any acute hemodynamic or electrophysiologic changes in the hearts of young, healthy adults when results from echocardiographic data were obtained. 20 Theobromine pharmacokinetics were found to be similar after administration in healthy males when measured after 14 days of abstention from all methylxanthines and then after 1 week ingestion of high levels of theobromine (6 mg/kg/day) in the form of dark chocolate. 21 However, the results of these studies cannot be extrapolated to patients with any condition(s) or disease(s), nor to the effects of chronic chocolate consumption.

An interesting use of chocolate as an inhaler has been studied. This edible inhaler, the Chocuhaler , was shown to produce a clinical effect when used to administer albuterol. 22

Cocoa butter has been reported to be a source of natural antioxidants. 5 This antioxidant activity has been attributed to the oligomeric flavonoids known as procyanidins.

Research reveals little or no data on the antioxidant/cholesterol-lowering properties of cocoa.

It has been reported that the polyphenols in cocoa are similar to the phenol in red wine, which has been shown to inhibit the oxidation of LDL. Thus, it has been shown that dark chocolate and cocoa inhibit LDL oxidation and increase HDL-cholesterol concentrations, thereby potentially decreasing the risk of cardiovascular disease. 23 , 24 , 25 However, the relation between chocolate consumption and risk of coronary heart disease remains controversial. 26 , 27

Cocoa butter has a higher content of stearic acid than any other fat, and has been useful for studying the effects of this saturated fatty acid on cholesterol. Substitution of a milk chocolate bar for a high-carbohydrate snack in healthy young men on a blood cholesterol-lowering diet (eg, National Cholesterol Education Program [NCEP]/American Heart Association [AHA] Step 1 Diet) did not adversely affect the low-density lipoproteins (LDL)-cholesterol and increased high-density lipoprotein (HDL)-cholesterol levels. 28 , 29

Research reveals no animal data on the use of cocoa in mood disorders.

A study in which a depressive mood was induced demonstrated a correlation with an increase in chocolate craving. It has been demonstrated that thoughts of chocolate are overpowering and prey on the mind. Questionnaires filled out by study subjects have shown that there is a weakness for chocolate in individuals who are under emotional stress, bored, upset, or feeling down. 30 A study that followed changes in brain activity related to eating chocolate demonstrated that one area of the brain is involved when there is motivation or craving to eat chocolate, while another area is involved when the desire to eat chocolate is decreased or becomes unpleasant. A similar result also has been shown with cocaine craving. Studies are needed to test the importance of this activity related to eating disorders and obesity. 31

Researchers at the Neurosciences Institute in La Jolla, CA, have found 3 substances in dark chocolate and cocoa powder that could act as cannabinoid mimics either directly (by activating cannabinoid receptors) or indirectly (by increasing anandamide levels). 32 , 33 , 34

The magnesium contained in cocoa has been shown, in rats, to prevent and correct chronic magnesium deficiency. 35 , 36 Low intakes of magnesium may be responsible for some cardiovascular alterations and renal, GI, neurological, and muscular disorders. 35 , 36 The use of cocoa to treat or prevent magnesium deficiency in humans has yet to be explored.

Cocoa products are used extensively in the food and pharmaceutical industries. Cocoa powder and syrup are used as flavorings. Cocoa powder and butter are important components of chocolate, where they are mixed with chocolate liquor (ground cacao nibs), sugar, milk, and other flavors.

Cocoa butter is used as a suppository and ointment base, as an emollient, and as an ingredient in various topical cosmetic preparations. 37 Cocoa butter suppositories have been used since the early 1900s to relieve hemorrhoids, and as an ointment applied to the breasts of nursing women. 6

The procyanidins contained in chocolate have shown platelet inhibition by suppressing epinephrine-induced platelet activation. 38 A study in rabbits also has shown that the procyanidins cause endothelium-dependent relaxation by activating endothelial nitric oxide synthase. 39

Potential immune modulator effects of cocoa procyanidins by inhibiting cytokine transcription have been demonstrated. Therapeutic effects have not been studied. 40

Dosage

Cocoa flavonoids and procyanidins have been administered at doses from 150 to 250 mg daily in studies of platelet function and eicosanoid synthesis. Cocoa bran has been used at 25 g per day to protect colon health. 1 , 2 , 3

Pregnancy/Lactation

Generally recognized as safe or used as food. Avoid dosages above those found in food because safety and efficacy are unproven. Caffeine content should be restricted. 4

Interactions

None well documented.

Adverse Reactions

Caffeine from the ingestion of large amounts of chocolate, along with 2 to 4 caffeinated beverages, was shown to be correlated with the appearance of tics in 2 children. 41

Cocoa butter may be allergenic and have comedogenic properties in animals.

Patients diagnosed with irritable bowel syndrome who experience reflux esophageal symptoms should eliminate from their diet foods that decrease lower esophageal sphincter pressure, such as chocolate and cocoa-containing products. 42

Cocoa has caused occupational asthma in patients working in a confectionery factory. 43 A high prevalence of chronic respiratory symptoms has also been recorded in workers exposed to cocoa. 44

Conflicting results were demonstrated when chocolate was tested as an initiator of migraine headaches. Phenolic flavonoids, which are present in red wine and chocolate, may have a role in precipitating a migraine headache. 45 , 46 , 47

Toxicology

Although cacao is not considered to be toxic in typical confectionery doses, at least 1 report of animal toxicity has been published. A dog that ate 1 kg of chocolate chips suffered hyperexcitability and convulsions, and collapsed and died, most likely because of acute circulatory failure secondary to theobromine/caffeine toxicity. 48

The plant has been reported to contain small amounts of safrole, a carcinogen banned by the FDA. 49

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