Cocoa Flavonoids & Avocados May Protect Against Cardiovascular Death

The COSMOS study, sponsored by Pfizer and Mars Candies, looked at the effect of Cocoa flavonoids on cardiovascular events such as a heart attack, cardiovascular deaths and consumption of cocoa flavonoids and green tea. There were 21,442 U.S. adults in the study followed for 3.6 years.

The experimental group received cocoa and green tea. While there were just as many cardiovascular events in the study group as in the control group, the number of deaths dropped by 27%. The study was published in the American Journal of Clinical Nutrition and was commented on by David Rakel, MD, FAAFP in the online medical journal Primary Care.

Flavonoids are found in dark colored grapes and berries, apples, pears, green tea and dark chocolate. If you eat 1/4 of a dark chocolate bar you are getting the same dosage the experimental group was given in this study.

Dr. Rakel suggested that Flavonoids maintain the flexibility of the blood vessels as we age. Recent related studies indicate a handful of blueberries or cranberries daily have similar effects. A glass of red wine with a square of dark chocolate and some dark berries suddenly sounds like a healthy snack!

Avocados apparently convey cardiovascular protection as well. In a study published in the March 30, 2022 Journal of the American Heart Association researchers followed 110,00 adults for 30 plus years and found that those who consumed two or more servings of avocado a week had a much lower risk of developing cardiovascular disease then non consumers.

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Chocolate and the Risk of Coronary Artery Disease

Chayakrit Krittanawong, MD, of the Baylor College of Medicine, was part of a group of physician scientists conducting an observational study involving regular chocolate consumption and the risk of developing coronary artery disease. Their research was recently published in the European Journal of Preventive Cardiology. In what was called “a systematic review and meta-analysis” they analyzed data from 336, 289 participants, participating in six studies, looking at chocolate consumption, coronary artery disease, acute coronary syndrome and acute myocardial infarction.

If you consumed chocolate 3.5 times or more a month, or more than one time per week, you were considered a high chocolate consumer. High chocolate consumers turned out to have a lower risk of coronary artery disease of about 8%.

This is great news for chocolate lovers. However, readers must remember this is an observational study and cannot link cause and effect. It did not factor in obesity, lipid levels, presence of diabetes, cigarette smoking history, activity level, family history of premature coronary artery disease or other dietary habits.

Is it possible that chocolate lovers eat more fruits and vegetables than non-chocolate consumers? Could it be that chocolate lovers eat a healthy Mediterranean Diet more frequently than non-chocolate consumers?

This study clearly didn’t answer those questions. What it does say to me is that if you reduce your cardiovascular risk factors, as best you can, eating chocolate occasionally may not hurt.

Chocolate as a Cough Suppressant

Well before Valentine’s Day, and conspicuously in the middle of cold and flu season, Alyn Morice of the University of Hull in Yorkshire, England published a study showing that dark chocolate derivatives may be more effective than codeine in suppressing a cough. In a small study of 163 individuals, each with a cough due to an infection, her group randomly assigned them to a group receiving a codeine based cough syrup or a chocolate cocoa based syrup called Rococo. Their results showed that within two days the chocolate based recipients felt significant improvement in their cough compared to the codeine based group. A similar study had previously been performed at the imperial College in London showing that theobromine, a product in cocoa, is superior to suppressing coughs over codeine.

Professor Morice believes the properties in cocoa are demulcent and help relieve irritation and inflammation. “This simply means it is stickier and more viscous than standard cough medicines, so it forms a coating which protects nerve endings in the throat which trigger the urge to cough. This demulcent effect explains why honey and lemon and other sugary syrups help.” They believe chocolate has additional helpful ingredients so much so that they advise sucking on a piece of dark chocolate as a mechanism of relieving a cough. We now have some science to back mom’s hot chocolate and hot cocoa for a cold and a cough.

Fish Consumption and Reduction of Risk of Developing Breast Cancer

MedPage, the online medical journal of the University of Pennsylvania School Of Medicine reviewed an article published in the British Medical Journal concerning a relationship between consumption of marine fish oil from fish and a reduction in the risk of developing breast cancer. The study was published by Duo Li, MD, a professor of nutrition at Zhejiang University in Hangzhou, China. They reviewed data from 21 “prospective cohort studies involving nearly 900,000 people”. According to their data, eating just one or two portions a week of salmon, sardines, mackerel or other fish rich in marine n-3 polyunsaturated fatty acids is associated with a 1 % reduced risk of breast cancer in later life. Their data came from questionnaires that asked about patients’ intake of fatty acids and from blood levels measured in several studies. When they looked at similar fatty acids which come from plants not fish, such as alpha linoleic acid, they could not see a similar protective effect.

The study was critiqued by Alice H Lichtenstein, DSc, director for the cardiovascular nutrition lab at Tufts University. She had numerous questions and concerns about the methodology and conclusions but did support the need for future prospective studies to examine this question. While I have neither the credentials nor experience of Dr. Lichtenstein in evaluating this type of data I believe strongly in the KISS (keep it simple stupid) principle. Fleshy fish provides fish oils which are felt to be beneficial to our health. The same cannot be said for fish oils which you receive in pills and preparations.

My advice is to eat fish two or three times per week. Prepare it simply in a Mediterranean diet style and obtain the benefits that research seems to consistently show for this eating pattern.

pH Testing For GERD May Save Money

Heartburn and dyspepsia are common conditions exacerbated by being overweight, eating too much, eating certain types of foods (red sauces, berries, alcohol, fatty foods, caffeinated beverages, chocolate) reclining after eating, wearing constrictive clothing at the belt line and a host of other items. The heartburn is supposed to be due to the reflux of acidic digestive juices from the stomach into the gullet or esophagus. There is no true physical barrier between the stomach and the lower esophagus like a trap door but there are a group of muscles known as the lower esophageal sphincter. These muscles are supposed to recognize that the stomach contains food and acidic digestive juices and contract and prevent the stomach contents from kicking back up the esophagus and producing heartburn symptoms.

The treatments of choice are; avoiding those foods that produce the heartburn, wearing less constrictive clothing and, medications. The gold standard of medications is the PPI’s or proton pump inhibitors. These would be medicines like Prilosec, Nexium, and Prevacid. The product inserts suggests we take these medications for eight weeks and no longer. Most patients continue to take the medications long after the recommended eight weeks.

In an interview in MedPage, the online journal of the University Of Pennsylvania School Of Medicine, David Kleiman, MD of Weill Cornell Medical College in New York City proposes that at eight weeks patients be given a pH test or what used to be called the “Bernstein Test”.

With the pH test, a thin plastic tube is inserted through the nose and placed so the tip is at the lower portion of the esophagus adjacent to the stomach. You then sample and test the fluid for acidity by measuring its pH. The test costs under $700 and is fairly accurate and safe.

According to Dr. Kleiman, he examined patients with GERD who continued to take PPI’s beyond eight weeks and almost 1/3 of them did not have any signs of acidic material refluxing into the esophagus. When looking at the lower dose PPI’s sold over the counter, versus the prescription items, the average weekly cost of PPI’s varies from $29 to $107. This translates to a cost of between $2000 and $7,300 a year on medicines not needed.

While the idea of inserting a tube to measure acidity as a way to distinguish who should continue PPI’s has its merits, the practical question is “How available is the test and who is doing it?”.

It is always a good idea to discontinue medications you do not need – especially expensive ones. The availability of the testing in local communities may preclude this approach.

Increasing Dietary Fiber Decreases Your Stroke Risk

Diane Threapleton, MSC, of the University of Leeds, England, and colleagues reported in the online version of Stroke that eating more dietary fiber may modestly reduce your chances of having a stroke. Additional grams of dietary fiber intake was associated with a 7% lower risk of hemorrhagic or ischemic stroke.  She said a 7 gram per day increase in fiber is easy to achieve being the equivalent of two servings of fruit like apples or oranges or an extra serving of beans.

United States guidelines call for the average man to consume 30 – 38 grams of fiber per day while the average women should consume 21-25 grams.  We fall far short of that with the average male consuming only 17 grams of fiber per day and the average woman only 13 grams.

Researchers note that soluble types of fiber form gels in the stomach and bowels, slowing the rate of absorption of foods and slowing gastric emptying. This slowed emptying increases our feelings of being full so we consume less food. They additionally noted “bacterial fermentation of resistant starch and soluble fibers in the large intestine producing short chain fatty acids which inhibit cholesterol synthesis by the liver and lowering serum levels.”

Once again, nutritional common sense prevails. Eating healthy, including more fresh fruits, vegetables and whole grain products results in more fiber ingested and fewer health issues occurring.

Coffee Consumption May Lead to Safer Driving Trips

It is no secret that for decades men and women have been drinking caffeinated beverages to wake up or stay awake. This is especially pertinent when it comes to driving an auto or a truck and trying to stay alert and awake. Researchers in Australia decided to take a look at the question of whether ingesting caffeine in the form coffee or tea led to fewer accidents. Lisa Sharwood, PhD, of the University of Sydney reported in the British Medical Journal that long haul truckers who reported consuming caffeine to stay awake had a 63% reduced likelihood of crashing than control subjects. Their study looked at 530 long-haul truck drivers who had an accident between December 2008 and May 2011 in Australia. They compared them to 517 controls that had no accidents in the same 12 month period.

Case drivers drove about 1,700 miles in the week before their accident. Controls drove somewhat more, about 2,400 miles, in the week before their interview. 43% of the case drivers admitted to drinking caffeinated beverages specifically to stay awake. Only 3% admitted using illegal substances such as amphetamines or cocaine to stay awake.

The practical side of the study is that if you must operate a motor vehicle and you feel fatigued then stopping for a caffeine containing beverage definitely helps reduce the likelihood of a crash.

Multivitamins in the Prevention of Cancer in Men

Vitamin, mineral and supplement use in the United States is a multi-billion dollar industry. Despite many testimonials extolling the benefits of supplemental vitamins, there has been very little research that actually provides evidence that these supplements are beneficial. However, there is abundant evidence that over consumption of the fat soluble vitamins, A, E, D and K results in accumulation of the substances and eventual toxicity.  The 2010 Dietary Guidelines for Americans says, “For the general, healthy population, there is no evidence to support a recommendation for the uses of multivitamin or mineral supplements in the primary prevention of chronic disease.”

The Physicians Health Study II (PHS II), a randomized controlled study, followed 14,641 male U.S. patients initially aged 50 or older for a median of 11.2 years. Their results showed that “daily multivitamin supplementation modestly but significantly reduced the risk of total cancer.”  The study could not clarify or specifically define which nutrient or nutrients in their supplemental multivitamin were responsible for the effect in reducing cancer.

The study used the multivitamin Centrum Silver.  However, it did not examine the effect of multivitamins in women.  Nor, did it did allow participants to consume additional vitamins, minerals, supplements or herbs.

The message to individuals is clear. Eat a healthy and balanced diet that is prepared in a manner that does not destroy the nutrients.  A multivitamin such as Centrum Silver will reduce your risk of cancer minimally. There is no proof that taking additional products with the multivitamin will have a more positive effect.

Do Tomatoes Prevent Strokes?

The University of Pennsylvania Department Of Medicine online magazine Medpage Today published a synopsis of an article that appeared in the October 9^th issue of the Journal of Neurology. Written by Jouni Karppi, PhD, of the University of Eastern Finland, and colleagues, it discusses how tomatoes and tomato based products may lower the risk of strokes in men. The key ingredient seems to be lycopene. Lycopene is a carotenoid that acts as an antioxidant.

The study looked at 1,031 Finnish men between the ages of 42 and 61 who were followed for 12 plus years. The researchers used statistical techniques to eliminate the influence of variables such as hypertension, tobacco usage, lipid levels and other risk factors of strokes. The research showed that the individuals with the highest levels of lycopene in their serum had the lowest risk of stroke compared to individuals with lower levels. Tomatoes do contain several types of carotenoids such as alpha-carotene, beta-carotene, alpha–tocopherol and retinol, but it is the lycopene that is the difference maker.

Nancy Copperman, MS, RD from the North Shore- Long Island Jewish Health System was quoted as saying, “This study supports the recommendation of eating more servings of fruit and vegetables a day. Foods such as tomatoes, guava, watermelon and grapefruit are good sources of lycopene. When a tomato is cooked, the heat processing actually increases the levels of cis-lycopene – which is easily absorbed by the body.”

This explains why tomato sauce is felt to be such an excellent source of anti-oxidants. Lycopene is believed to have numerous additional health benefits including “reducing inflammation, blocking cholesterol synthesis, boosting immune function, and inhibiting platelet aggregation and thrombosis.”

Hot Cocoa And Other Foods May Boost Brain Power

G. Desideri, PhD, of the University of L’Aquila in Italy performed a controlled double blind study that looked at the effects of cocoa flavonoids on cognitive function in seniors who were mildly cognitively impaired.  The data was presented in the online journal Hypertension and reviewed in the University Of Pennsylvania School Of Medicine online journal MedPage.  Existing “evidence” suggests eating flavonoids, polyphonic compounds from plant-based foods, may confer cardiovascular (heart and blood vessel) benefits.  Flavonols are a type of compound found in abundance in tea, grapes, red wine, apples and cocoa products including chocolate.

Desideri and associates looked at 90 seniors diagnosed with minimal cognitive impairment (MCI) who were randomly assigned to drink cocoa for eight weeks containing high, intermediate and low levels of flavanols per day.  They found improvement in the cognitive performance of those in the high and intermediate flavanol intake groups.   They additionally noted improvements in blood pressure and insulin resistance for these same groups. Systolic blood pressure decreased 10 mm in the high intake group and 8.2 mm in the intermediate group. A drop in diastolic blood pressure was noted as well.     There was no elevation of blood cholesterol or triglyceride levels in any of the groups and blood sugar actually decreased in the high and intermediate intake groups.

They concluded that “regular dietary inclusion of flavanols could be one element of a dietary approach to maintaining and improving not only cardiovascular health but also, specifically, brain health.”

Clearly more research is needed but initial studies like this certainly encourage clinicians to feel comfortable suggesting that a cup of hot cocoa, a glass of red wine (in moderation), red grapes and dark chocolate are healthy as well as pleasurable.