Indulge, Overindulge, and Equalize: The (Un)Changing Pattern of Cacao in Medicine

Poseidon taking chocolate from Mexico to Europe in Chocolata Inda by Antonio Colmenero de Ledesma, 1644. Source: U.S. National Library of Medicine under CC BY 4.0.

The story of cacao is an impressive one: its biology, its uses, its meanings, and the evolution of each thread over centuries and continents have woven an elaborate narrative for the modern observer. Despite its geographic and cultural leaps, however, cacao’s evolution from a divine, elite, indigenous foodstuff, “essential to…[one’s] physical, social and spiritual well-being” (Martin, 2016a), to teetering on banishment within a deeply apprehensive Christian Europe, to a now-essential cultural food of the masses has interestingly always included a cyclical pro- and anti-medicinal pattern. For all of its permutations between the Old World and the New, the changing perceptions and traditions of cacao – first as healthy and medicinal, then as unhealthy and dangerous, and returning once again as healthy and medicinal – have actually fluctuated very little within a historically demonstrated tendency to indulge (excitement in the new), overindulge (demonize the unknown), and then equalize (an ‘everything-in-moderation’ approach).

According to similar Mayan and Aztec creation myths, cacao had its roots firmly planted in the realm of the divine, with its earthly application ranging from a crude yet nutritional gruel or pleasurable drink of the male elites, to use in ritualistic ceremonies such as weddings and death rites (Martin, 2016a), to widespread therapeutic and medicinal application throughout Mesoamerica. The examination of iconographic historical sources such as “the Badianus Manuscript, the Princton Codex and [Sahagún’s]…Florentine Codex” (St. Jean, 2015, para. 33) reveal a massive list (upwards of 300) of therapeutic and medicinal applications of cacao in Mesoamerica, “provid[ing] a critical understanding of…disease, nutritional problems and healing techniques” (Lippi, 2013b, p. 1576) of the region and culture. Interestingly, despite its widespread perception as nutritional, pleasurable, and therapeutic as meticulously cataloged by both the Spanish friars and the indigenous peoples themselves, Sahagún made a point to caution against the overuse of certain types of cacao, ultimately settling on an ‘everything in moderation’ approach:

[Green cacao] makes one drunk, takes effect on one, makes one dizzy, confuses one, makes one sick, deranges one. When an ordinary amount is drunk, it gladdens one, refreshes one, consoles one, invigorates one. Thus it is said: ‘I take cacao. I wet my lips. I refresh myself.’ (Sahagún, 1951-1969, pp. 119-120)

Title page from Daniel Duncan’s Wholesome advice against the abuse of hot liquors, published in London in 1706. Source: Folger Shakespeare Library under CC BY-SA 4.0.

Making its way across the Atlantic and into the mouth of King Charles of Spain in 1528 by way of the Spanish conquistador, Hernán Cortés, by the close of the sixteenth-century, “the first botanical descriptions of the chocolate tree appeared in print in Europe and the first designated shipment of cacao reached Seville, paving the way to the spreading of the use of chocolate in the Old World” (Lippi, 2013b, p. 1574). While still a pleasure of the elites alone in the New World, the concept of cacao as medicinal gained significant traction based upon its rumored therapeutic and pleasurable usages in Mesoamerica. Simultaneously, cacao’s introduction to Christian Europe was also met with suspicion and religious reluctance due to the possible affects on one’s morality, echoing “profound concerns about how to incorporate this exotic, Creole product “of pagan origin” into a shored up Catholic Church” (Martin, 2016b). When the Church declared the drinking of cacao as no threat to the Christian tradition in the late seventeenth-century, chocolate was somewhat corralled into a medicinal-use-only system, whereby the theory of ‘Humoralism’ (Martin, 2016b) from the Hippocratic-Galenic medical tradition took the lead on how cacao could be used. Intriguingly, the Hippocratic-Galenic ‘hot/cold, wet/dry’ medical tradition and cacao’s place in it were not so different from the one encountered by the Spanish upon their arrival in the New World, as “the Mexica medical world was based on paired terms, such as “hot/cold”…“humidity/drought”…[and] health was perceived as “balance,” whereas illness and disease were “imbalance”” (Dillinger et al., 2000, p. 2059S).

Advert for Fry’s Chocolates. Source: Miami University Libraries under CC0.

While initially consumed in liquid form by the elite in both the Old and New Worlds with an emphasis placed on its nutritional and medicinal ‘cure-all’ qualities, developing industrialized methods for processing cacao in the nineteenth-century began once again to shift the emphasis, beginning with C.J. Van Houten’s hydraulic press. Van Houten’s press extracted the not-so-soluble cocoa butter from cacao – leaving a compressed, cocoa cake that was easily incorporable into other liquids and solids – effectively reducing the cost of cocoa, and making it widely available to the masses (Coe & Coe, 2013). As such, Van Houten’s press and the subsequent series of nineteenth-century inventions transformed “what had been little more than a gruel of cocoa and additives…into a delicious drink and an attractive candy bar by 1900” (Satre, 2005, p. 14). The simultaneous and explosive rise of milk, sugar, and other additives in chocolate throughout the nineteenth- and twentieth-centuries also brought about a change in our perception of dietetics versus medicine, and cacao’s station in one over the other:

In the past, when no effective therapeutic means existed, the best possibility for a patient to recover from disease was the use of lifestyle and diet as strategies to ensure physical and mental wellbeing. In this regard, chocolate was used for many purposes; however, when dietetics separated from medicine, chocolate acquired the role of excipient, being associated with different health problems. (Lippi, 2013a, para. 3)

Thus chocolate’s perception in both the public and the scientific/medical community suffered greatly in the twentieth-century, heavily demonized as an unhealthy food; the Old World notion of chocolate-as-medicinal becoming evermore trumped by chocolate-as-junk-food.

The redemption of chocolate’s reputation as medicinally beneficial once again resurfaced in the late twentieth-century with the expansion of clinical studies, the results showing a “richness in carbohydrates, fat and phytonutrient flavonoids, confirming the benefits of dark chocolate in cardiovascular diseases, gastrointestinal and respiratory disorders and mental health…[as well as] its antioxidant and anti-inflammatory properties” (Lippi, 2013b, p. 1582). While few foods have gone through such historical iterations of medicinal pros and cons as cacao has (beautifully outlined in The Journal of Nutrition‘s Tables 1, 2, and 3), the gradual if not predictable return of Theobroma cacao to its ancient place as the ‘food of the gods’ with healing powers may finally be one that’s coming full circle, yet again.



Coe, S. D., & Coe, M. D. (2013). The true history of chocolate. London: Thames & Hudson Ltd.

Dillinger, T. L., Barriga, P., Escárcega, S., Jimenez, M., Lowe, D. S., & Grivetti, L. E. (2000). Food of the gods: Cure for humanity? A cultural history of the medicinal and ritual use of chocolate. The Journal of Nutrition, 130(8), 2057S-2072S. Retrieved from

Folger Shakespeare Library. (2008). Wholesome advice against the abuse of hot liquors [Online image]. Retrieved from

Lippi, D. (2013a). Chocolate as medicine: a quest over the centuries [Review of the book Chocolate as medicine: a quest over the centuries, by P. K. Wilson & W. J. Hurst]. Retrieved from

Lippi, D. (2013b). Chocolate in History: Food, Medicine, Medi-Food. Nutrients, 5(5), 1573-1584.

Martin, C. D. (2016a, February). Lecture 2: Mesoamerica and the “food of the gods.” E-119: Chocolate, Culture, and the Politics of Food. Lecture conducted from Harvard University, Cambridge, MA.

Martin, C. D. (2016b, February). Lecture 4: Sugar and cacao. E-119: Chocolate, Culture, and the Politics of Food. Lecture conducted from Harvard University, Cambridge, MA.

Miami University Libraries. (2008). Advert for Fry’s Chocolates [Online image]. Retrieved from

Sahagún, B. d. (1951-1969). Book 10: The people. In A. J. O. Anderson, & C. E. Dibble (Eds.), Florentine codex: General history of the things of new spain [Historia general de las costas de Nueva España] (A. J. O. Anderson, C E Dibble Trans.). (2nd Edition ed., pp. 119-120). Salt Lake City, Utah: University of Utah Press (Originally written in 1575-1577 or 1578-1580).

Satre, L. J. (2005). Chocolate on trial: Slavery, politics, and the ethics of business. Athens, Ohio: Ohio University Press.

St. Jean, J. (2015). Medicinal and ritualistic uses for chocolate in mesoamerica. Heritage Daily. Retrieved from

U.S. National Library of Medicine. (1993). Poseidon taking chocolate from Mexico to Europe in Chocolata Inda by Antonio Colmenero de Ledesma, 1644 [Online image]. Retrieved from


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