Food of the Gods: The use of chocolate in medicine

By Shahnia Surendran

Seen nowadays as an indulgence, for years, chocolate has been negatively associated with obesity, dental caries and, generally, an unhealthy lifestyle. However, historically, chocolate is much more than just a guilty pleasure. With its origins traced back to 1750 BC, having been discovered by the Olmec people in Mesoamerica (Lippi, 2015), it was brought over to the Western world in the 16th century for its nourishing and euphoriant qualities (Lippi, 2009). Even famed naturalist Carl Linnaeus was a fan, aptly naming the cocoa tree Theobroma cacao, the Greek Theobroma translating to “food of the gods” and cacao being the Mayan root word for the tree (Lippi, 2015). Chocolate has now been extensively studied, and has been shown to have anti-inflammatory, neuroprotective and cardioprotective properties. Furthermore, chocolate improves the bioavailability of nitric oxide, whose action improves the pressure, platelet function and viscosity of blood (Verna, 2013).

The Mayans were the first known people to cultivate the cacao plant, which is grown around the equator in an area known as the “cocoa belt”. Dried cocoa beans were ground into a bitter paste, and dissolved in water with cinnamon and pepper – the resulting concoction, known as xocolatl, was consumed for its stimulant effects (Verna, 2013). The drink gained traction as the Aztecs began to dominate the Mayan population in 1200 AD, believed to be a panacea that could cure a plethora of ailments, and which provided wisdom, strength and even fertility (Lippi, 2009). Emperor Montezuma was said to consume multiple cups of xocolatl a day in order to satisfy his numerous wives (Lippi, 2009), giving rise to the notion that chocolate is an aphrodisiac, explaining its popularity around Valentine’s Day. Cocoa also played a political role: cocoa beans were extremely valuable, and served as a means of exchange and a form of currency. The arrival of cocoa beans into the Western world was met with scepticism, with the Church stating that anyone fasting who drank chocolate was considered to have broken his religious fast (Lippi, 2013). During this period, chocolate was used solely for its medicinal benefits and pleasurable effects, although this was contested by physicians of the time, who had varying opinions regarding its efficacy.

In the 19th century, as a result of industrialisation and mass production, concern grew over substances and fillers that were added to chocolate, annulling chocolate’s natural medical benefits (Lippi, 2015). Chocolate was used therapeutically as a “vehicle” to ease the administration of bitter, unpleasant medications. The role of chocolate as food seemed to have overridden its role as a medicine, owing to the introduction of sweeteners and hydrogenated oils, which acted as fillers and preservatives. The high sugar content present in commercially available chocolate led to criticisms and a relationship linking its consumption to obesity, tooth decay and general ill health. 

However, in recent years, biomedical research has found evidence of chocolate’s benefits – demonstrating what medical practice had been advocating for centuries, from a scientific point of view, against cultural and socioeconomic biases (Wilson, 2012). Cocoa polyphenols have shown potentially beneficial effects on human health, particularly regarding cardiovascular and inflammatory diseases, metabolic disorders, cancer prevention, and brain function (Lippi, 2015). Theobromine, found in high concentrations in dark chocolate, promotes function of heart muscles and the nervous system. Other important components of chocolate include flavonoids, antioxidants that act against ageing; cocoa butter and caffeine, shown to improve lacklustre skin; and phenylethylamine, which contributes greatly to mood (Verna, 2013). Caffeine, theophylline and theobromine constitute a class of biochemicals known as methylxanthines. Methylxanthines are known to enhance the action of cyclic adenosine monophosphate (cAMP), a second messenger which plays a vital role in the transmission of intracellular signals (Verna, 2013). 

Flavanols have also been shown to play a cardioprotective role, specifically benefitting endothelium vasodilation by increasing nitric oxide formation,  modulating inflammatory markers, and decreasing platelet aggregation, lipid oxidation and insulin resistance (Garcia et al., 2018). Dark chocolate contains a higher concentration of flavanols and, when consumed in moderation, may been linked to improved outcomes in hypertension, coronary heart disease, heart failure, cerebrovascular accidents and peripheral vascular disease. Although flavanols and methylxanthines have also been associated with mood and cognition-enhancing effects, it is difficult to delineate an exact relationship as the specific mechanisms of how behaviour, cognition and mood modulation are not yet fully understood. The ‘mood pyramid’ concept describes how the general effects of flavanols, the more specific effects of methylxanthines and minor alkaloids, and the unique orosensory properties of chocolate interact synergistically in an extremely complex web (Tuenter, Foubert & Pieters, 2018). 

Although the antioxidant and anti-inflammatory properties of flavanols and dietary minerals in chocolate have a potential to benefit bone health, other components such as cocoa butter, sugar, and methylxanthines may have adverse effects on bone (Seem, Yuan & Tou, 2019). It should also be noted that the osteogenic effects of chocolate, like all other effects mentioned above, varies depending on the type of chocolate and the ingredients used in its production. Consequently, studies investigating the role of chocolate consumption on serum bone markers and bone mineral density have reported inconsistent findings.

Chocolate has had a consistent place in medicine and medical history. Despite the debate regarding its place in the medical world, chocolate has shown a promising effect on numerous health conditions. More thorough research is therefore necessary in order to assert the true extent of the nutritional function and therapeutic prowess of the so-called food of the Gods.

References:

Garcia, J. P., Santana, A., Baruqui, D. L. & Suraci, N. (2018) The Cardiovascular effects of chocolate. Reviews in Cardiovascular Medicine. 19 (4), 123-127. Available from: doi: 10.31083/j.rcm.2018.04.3187. [Accessed May 30, 2021]. 

Lippi, D. (2015) Sin and pleasure: the history of chocolate in medicine. Journal of Agricultural and Food Chemistry. 63 (45), 9936-9941. Available from: doi: 10.1021/acs.jafc.5b00829. [Accessed May 29, 2021]. 

Lippi, D. (2013) Chocolate in History: Food, Medicine, Medi-Food. Nutrients. 5 (5), 1573-1584. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708337/. Available from: doi: 10.3390/nu5051573. [Accessed May 29, 2021]. 

Lippi, D. (2009) Chocolate and medicine: dangerous liaisons? Nutrition (Burbank, Los Angeles County, Calif.). 25 (11-12), 1100-1103. Available from: doi: 10.1016/j.nut.2009.08.002. [Accessed May 29, 2021]. 

Seem, S. A., Yuan, Y. V. & Tou, J. C. (2019) Chocolate and chocolate constituents influence bone health and osteoporosis risk. Nutrition (Burbank, Los Angeles County, Calif.). 65 74-84. Available from: doi: 10.1016/j.nut.2019.02.011. [Accessed May 30, 2021]. 

Tuenter, E., Foubert, K. & Pieters, L. (2018) Mood Components in Cocoa and Chocolate: The Mood Pyramid. Planta Medica. 84 (12-13), 839-844. Available from: doi: 10.1055/a-0588-5534. [Accessed May 30, 2021]. 

Verna, R. (2013) The history and science of chocolate. The Malaysian Journal of Pathology. 35 (2), 111-121. [Accessed May 29, 2021]. 

Wilson, P. (2012) Chocolate as Medicine: A Changing Framework of Evidence Throughout History. Chocolate and Health. 1-16. Available from: doi: 10.1007/978-88-470-2038-2_1. [Accessed May 30, 2021].