How we rate
“Strong” = several concordant meta-analyses or systematic reviews. “Moderate” = one synthesis, or several controlled trials. “Limited” = early trials only. The rating is about the quality of the studies, not about how useful the supplement is.
Cocoa flavanols
Cocoa extract at 500 mg of flavanols: in the COSMOS trial, no fewer total cardiovascular events but 27% fewer cardiovascular deaths; nothing on diabetes or cognition.
Benefits
- Cardiovascular deaths: 27% fewer among 21,442 seniors followed for 3.6 years with 500 mg of flavanols per day (secondary endpoint of the COSMOS trial).
- Blood pressure: about 2 mmHg lower across 35 trials of flavanol-rich cocoa taken for two weeks or more, more so in hypertensive individuals.
- Hypertension: 24% fewer new cases among seniors whose systolic pressure was normal at baseline.
- Vessels: arterial dilation (FMD) improves, with a maximum effect around 710 mg of flavanols per day.
- Inflammation: CRP drops by 8.4% per year compared to placebo, over two years, in 598 COSMOS seniors.
- Exercise capacity: in 68 healthy seniors, 500 mg twice daily for 30 days adds 190 mL/min of maximal oxygen consumption and removes 5.4 mmHg of systolic pressure.
- Memory: across 3,562 seniors followed for three years, no average gain, but better memory in those whose diet was poor in flavanols at baseline.
- Skin: fewer wrinkles and more elastic skin in women with sun-damaged faces, with 320 mg per day for 24 weeks.
Precautions
Tolerance: up to 2000 mg of flavanols per day for 12 weeks, adverse effects remained mild and no more frequent than with the control product. Digestive disorders: digestive complaints and nausea in 1% of participants taking cocoa, versus 0.4% under placebo. Long-term safety: no safety issues noted in the COSMOS trial over 3.6 years. Limitations: in COSMOS, total cardiovascular events (infarctions, strokes, bypasses, etc.) did not drop significantly: 410 under cocoa versus 456 under placebo. No fewer type 2 diabetes cases over 3.5 years, no fewer hypertension cases across all participants, nor fewer fractures or AMD. No effect on global cognition over three years in 2,262 seniors, nor on the onset of mild cognitive impairment or dementia. Trials on vessels are heterogeneous and at risk of bias.
Recommended dosage
500 mg of flavanols per day in the COSMOS trial; up to 2000 mg per day well tolerated for 12 weeks.
How to take it
- For whom: the large trials involve seniors (women aged 65 and over, men aged 60 and over) without cardiovascular disease.
- Dose: 500 mg of flavanols per day, including 80 mg of epicatechin, in the COSMOS trial.
- Extract or chocolate: COSMOS used a cocoa extract as a dietary supplement; the meta-analysis on blood pressure mixes chocolate and cocoa products.
- Duration: from 30 days to 3.6 years depending on the trials.
- Post-workout: 830 or 1245 mg taken right after exercise did not accelerate muscle recovery.
Did you know?
Across 3,562 seniors followed for three years, 500 mg of cocoa flavanols per day did not improve memory on average, but restored it in those whose diet contained little of it at baseline.
What the studies say
This meta-analysis of 31 randomized controlled trials examined the effect of cocoa consumption on cardiometabolic risk markers in adults. Cocoa consumption (extract or dark chocolate ≥70%) showed protective effects, reducing total cholesterol, LDL-c, fasting blood glucose, as well as systolic and diastolic blood pressures. These results suggest that cocoa consumption has a clinical impact on reducing cardiovascular risk.
Arisi TOP, da Silva DS, Stein E, Weschenfelder C, de Oliveira PC, Marcadenti A, Lehnen AM, Waclawovsky G. — Nutrients (2024) — View the source study
For information only: not a substitute for medical advice. Dietary supplements are not a replacement for a varied, balanced diet. Learn more