Medicinal Benefits of Theobroma cacao: Contemporary Studies of Chocolate as a Health Food and the Historical Use of Cacao in Healing

Food was the first medicine. From relieving indigestion to combating infections and fevers, humans relied primarily on their environmental resources as holistic remedies to alleviate suffering and prolong lifespan. Chocolate holds a particularly long history of use in medical practices, and was used heavily in the civilizations of Mesoamerica—and post-Conquest, in European cultures. Natural therapies have always been prevalent, though the introduction of modern medicine pushed these long-standing customs aside as the leading form of treatment. These monumental leaps in discovery created a rift between the fields of medicine and dietetic practices (Wilson). However, as of late, the use of chocolate and other natural resources has seen a marked resurgence in contemporary health methods. Recent studies have shown that chocolate (when consumed in moderation) may assist in minimizing cardiovascular disease, reducing hypertension, and can even help fight cancer and diabetes (Howe 43). These are bold claims that should be received with skepticism, thus solidifying the need for further research to evaluate the long-term benefits of chocolate consumption in modern diet.

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These are but a few examples of organic chocolate brands that appeal to customers as healthy.

 

In this essay, the medical benefits of chocolate will be explored through recent studies conducted over the past few decades, while also putting current societal notions in the context of the chocolate’s complicated history. This renaissance of medicine via cuisine poses many questions: why are we seeing a huge shift into holistic medicine when science is making so much progress in the medical field? Is the public growing disenchanted with drug over-prescription and their side effects, as the cost of healthcare is ever rising? Does the movement in producing less processed, more pure chocolate have a direct effect on the public’s consumption of “healthy” candy, and by association, better overall health? Perhaps we simply want our cake and to eat it too. Yet the answer is not so easily determined, as all of these issues could be refueling this fascination with the medical benefits of chocolate.

Before we can examine the contemporary healing notions of chocolate, we must gain a deeper understanding of the rich cultural history of cacao as medicine. From the time of its discovery by the Olmecs of Mesoamerica in 1500 B.C., Theobroma cacao has served many functions, used primarily as a source of food (Coe & Coe 34). Grown in pods attached to the trunk of a rather peculiar looking tree, the Olmecs recognized that there was more than met the eye to this peculiar plant. As they cracked open the pod to reveal a sweet, gelatinous pulp, they took more notice of the seeds within the milky substance, and began to process those seeds to create the very first iteration of cacao, or “kakawa” (Coe & Coe 35). As empires rose and fell, the subsequent Mesoamerican civilizations of the Izapan, Maya, Toltecs, and Aztecs also coveted cacao for its properties. Consumed primarily in the form of a frothed drink, it was a prized possession and available only to the elite—for it was godly potion that would grant energy and power, and was used in many rituals to appease their deities (Coe & Coe 34). These attributes were considered more than simply advantages; in these times, food and prayer were the only sources of medicine (Lippi).

Maya
Section of the ‘Codex’ style The Princeton Vase, A.D. 670-750, depicting a Mayan woman preparing a bitter chocolate drink by pouring the drink from one vase to another, thus creating the coveted “froth” (Martin, Lecture 2.3.16)

Cacao was administered to treat a variety of maladies, many times paired with corresponding incantations by the practitioner. Documents such as The Badianus Codex (1552), the Florentine Codex (1590), and the Princeton Codex (1965, otherwise known as The Ritual of the Bacabs), have served as the primary sources for researchers to study these ancient medical rituals (Dillinger 2060S). From gastrointestinal issues such as stomach pains, constipation, and diarrhea to life threatening cases of infection, fever, and seizures, the usage of chocolate was integrated into many medicinal tonics (Lippi 1573). The beans were the most utilized part of the cacao tree, yet other parts were used for medicinal purposes as well: bark, leaves, and cocoa butter were all important (Dillinger 2060S). Other components such as honey, vanilla bean, pepper and tobacco juice were also used as part of treatment. In one instance, cacao flowers were used in a perfumed bath to cure fatigue for high-ranking officials (Dillinger 2060S). In a more social respect, the famed Aztec leader Montezuma was rumored to drink large amounts of cacao beverages to properly prepare him for sexual intercourse with his many wives (Lippi 1573). Clearly, current notions of chocolate as an aphrodisiac were also somewhat recognized in Mesoamerica.

When Spanish travelers found their way to the Americas, they were initially resistant to cacao as a food, especially in the native preparation (as it was too bitter and spicy for their European palate) (Coe & Coe 110). Though the invading Europeans made use of the cacao bean as a form of currency with the native culture, time passed and hybridization occurred, prompting a larger interest for cacao as a food. For instance, the Spanish monk Bernardino de Sahagún provided both words of encouragement and caution for the consumption of cacao: he hailed its energizing and revitalizing properties, but warned of drinking too much green cacao (made from unroasted beans), as it was intoxicating to the recipient (Lippi 1573):

“[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 1590, Part 12: 119–120) (Lippi 1573).

As European voyages took cacao and other local commodities across the Atlantic, they were introduced to Spanish royalty and the elite. Apart from the consumption native foods, King Philip II of Spain learned of the medicinal uses of local plants. In 1570, he sent the Royal Physician Francisco Hernandez across the Atlantic to assess the native herbal remedies (Coe & Coe 122). In the 16th century (and as it had been for almost two millennia), European medicine was based in Hippocratic-Galenic theories of the four humors: blood, phlegm, yellow bile, and black bile; to remedy ailments or imbalances of each humor, physicians would prescribe drugs and particular diets in either hot or cold, moist or dry categories (Lippi 14).

four-humors-granger
A 16th century German woodcut of the four temperaments: phlegmatic, sanguine, choleric, and melancholic, which were related to the states of cold, moist, hot, and dry, as well as the four elements and their zodiacal signs (Coe & Coe 127)

James Howe wrote his own perspective on Hollenberg’s widely acclaimed study, providing a critical review of Hollenberg’s findings. In his article “Chocolate and Cardiovascular Health: The Kuna Case Reconsidered,” Howe recounts his many visits with the Kuna people, disparaging the oversimplification of Hollenberg’s depiction of their lifestyle, noting that the Kuna in fact consumed a variety of drinks of which cocoa was indeed a large part of; they also incorporated coffee, oatmeal, bananas, plantains, and even soursop fruit (Howe 46). His overall concerns with the initial Kuna studies were that Hollenberg created a caricature of the true Kuna culture to advance his findings, and even if those results do hold merit, his investigation was truly skewed (Howe 50).

Food was also categorized in this manner, and cacao was subject to this classification when Hernandez made his way to the New World. Through this lens, cacao was categorized differently in its various forms (they would be highly debated and contested over time) (Lippi 14). Hernandez claimed that the cacao seed was “temperate in nature,” but leaned toward “cold and humid,” and was therefore ideal for hot weather and for subsiding fevers (Coe & Coe 122). In 1591, doctor Juan de Cárdenas revisited the cacao classification and stated that “green cacao” was detrimental to one’s health, and only the roasted bean was beneficial (Lippi 14). Cárdenas’s evaluation states that chocolate has three parts: a “cold,” “dry,” and “earthy” part; an oily aspect associated with air which “warm and humid;” and finally, a very “hot” part, bitter to the taste, causing headaches (Coe & Coe 123). What is particularly interesting in Cárdenas’s evaluation is that at this point in time, there was no understanding of the chemical composition of chocolate. In modern times, the presence of caffeine in chocolate is widely known, as is its ability to cause unsavory side effects to those with sensitivity. Coe and Coe suggest that perhaps this, paired with theobromine withdrawal, was the cause of the headaches Cárdenas laments in his description (125).

These are but a few of the medical evaluations executed by the Spaniards on the humoral nature of cacao, as it was firstly introduced to them primarily as a drug. After gaining popularity as a recreational drink in Spain, chocolate was introduced to other European cultures, such as Portugal, Italy, France, and England. Cacao was met with much controversy and suspicion, but despite that caution, chocolate drinks spread like wildfire during the Baroque Age (Coe & Coe 168). As years passed and medical advancements were made, the conception of chocolate as medicine continued to be questioned and reassessed in light of changing theories. From the 17th century doctors such as the Spanish Barolomeo Marradon and the English Dr. Henry Stubbe to the 18th century practitioners Antonio Lavedan and Carl von Linné (also known as Linnaeus, who in 1753, classified chocolate as Theobroma cacao, or “food of the gods”) there were both new manners of using chocolate as medicine and reinforcements of old practices as well (Lippi 19). Note but a few of those prescriptions in the table below, as detailed by Dr. Donatelli Lippi:

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Dr. Lippi continues to describe the eventual schism that occurred in the late 18th century due to the French Enlightenment, where cooking and dietetics were separated from medical texts to develop their own unique literature (20). This included the use of chocolate as medicine, and the next few centuries saw a huge departure from those beliefs; instead, chocolate became a Western candy phenomenon, inciting a gargantuan industry spreading across Europe and the Americas (Albala). It was not until the last few decades that chocolate resurfaced as a legitimate source for health, prompting new scientific studies and research to evaluate the benefits in the biological makeup of the substance.

The 19th and 20th centuries saw huge departures from the ideology of “food as medicine” in the Western world. Due to leaps in modern medicine, the boom of industrialization and mass-production, and the commercialization of chocolate as a luxury (to name a few), chocolate became a sweet commodity (Coe & Coe 233). Though research was still conducted to assess the chemical compositions and health benefits during the 20th century in particular, these studies were produced within the lens of the chocolate industry (Wilson). For instance, in the 1950s, the chief chemist of the Hershey Company hailed the nutritional benefits of chocolate (of course, there is no bias here!):

All “activities of the human body” were known to “require a constant expenditure of energy” and an “interchange of material”. Chocolate products—particularly Hershey’s chocolate products—were offered to the public “with the knowledge that they contain the highest grade ingredients prepared under rigid sanitary conditions and … [prepared with] the finest [chocolate] that can be made”. Noting these products to be “sources of highly concentrated food energy”, chocolate was deemed to have earned a “rightful place” alongside “all well-known and well-prepared foods” (Wilson).

Following this claim, the U.S. Chocolate Manufacturers Association further reinforced chocolate as an integral part of a balanced diet in 1975, when they supported its inclusion to “maintain a daily balance when combined with other foods such as milk, almonds, peanuts and peanut butter” (Wilson). Since the 1990s there has been growing scrutiny towards this sort of promotion, prompting a new era of scientific research dedicated to the plausibility of chocolate as a health food. Researchers are focusing on the chemical composition of cocoa, more specifically on the positive effects of its polyphenols (Castel 266). These polyphenols include flavanols such as catechin, epicatechin, and pro-cyanidins, as they are the source of chocolates antioxidants (as seen across food markets, the buzz term “antioxidants” is widely popular in marketing health) (Wilson).

Also of note are the tannins present in cocoa, which can also be antioxidants and can assist with both heart and digestive health (tannins can also be found in wine, pomegranates, tea, and certain berries); however, the effectiveness of the antioxidants have been disputed when the addition of milk of milk is factored in (Castel 266). Chocolate also contains many chemicals that affect our mood, such as caffeine, theobromine, tyramine, and phenylethylamine—these have been linked to raising serotonin and endorphin levels, thus creating a pleasant effect (Castel 269). As Dr. Castel states, these results are not unanimous. Other claims she mentions include the enhancement of antioxidant defenses quickly after ingestion, and in vitro anti-inflammatory and anti-tumoral effects (Castel 265).

In 2009, the New York Times published an article focusing on a Swedish study finding evidence that those who consumed chocolate had higher heart attack survival rates. These 1,169 participants consisted of non-diabetic men and women who took part in an eight year study, where researchers took note of characteristics such as age, sex, smoking, and obesity. As promising as these results were, Nicholas Bakalar (the author) cautions readers that the study was observational rather than randomized, and it did not account for other variables such as the type of chocolate, the mental health of the participants, or for the quantity of chocolate consumed. A co-author of the study, Dr. Kenneth J. Mukamal of Harvard University, also warns that while the findings are promising, chocolate should still be consumed with moderation and in supplementation of a healthy, balanced diet.

Another paper published in 2009 by Dr. Normal Hollenberg of Harvard Medical School and Boston Brigham and Women’s Hospital, follows a study of the indigenous Kuna (or Tule) population of the Caribbean Coast of Panama to research chocolate’s effects on hypertension. Hollenberg was struck by how low their blood pressure was in relation to the great amount of cocoa they drank per week and the large of amount of sodium they incorporated into their diet (Howe 46). After visiting them in the 1990s—and after noting the different sub-populations within the Kuna—he came to the conclusion that good genetics was not the cause of their low blood pressure, but rather, it was the environment (Hollenberg). After performing randomized controlled clinical trials on both island-living Kuna and urban-living Kuna, Hollenberg asserted that there was definite merit to be assigned to the flavanoids in chocolate— epicatechin, in particular.

Led by Dominique Persoon, the famed Belgian chocolatier, this video shows two Kuna preparing a chocolate drink.

James Howe wrote his own perspective on Hollenberg’s widely acclaimed study, providing a critical review of Hollenberg’s findings. In his article “Chocolate and Cardiovascular Health: The Kuna Case Reconsidered,” Howe recounts his many visits with the Kuna people, disparaging the oversimplification of Hollenberg’s depiction of their lifestyle, noting that the Kuna in fact consumed a variety of drinks of which cocoa was indeed a large part of; they also incorporated coffee, oatmeal, bananas, plantains, and even soursop fruit (Howe 46). His overall concerns with the initial Kuna studies were that Hollenberg created a caricature of the true Kuna culture to advance his findings, and even if those results do hold merit, his investigation was truly skewed (Howe 50).

In critique of resurgence of the “miracle power of chocolate,” Harvard Women’s Health watch published “Is chocolate really a health food? in 2015. The article explores the wide variety of claims recent studies have marketed towards consumers. Before the article begins, there is a note to the reader cautioning that the “treat is fine in small quantities, but its benefits for heart and brain health are still unproven” (HWH). The text does acknowledge the studies that link flavanols in chocolate to cardiovascular health and reductions in dementia, while offering readers chocolate options that portray just how many flavinols are present in each product.

In addition, it offers insight from Dr. JoAnn Manson, chief of the Division of Preventive Medicine at Harvard-affiliated Brigham and Women’s Hospital on the logical next steps, calling for a large-scale randomized trial to assess their effectiveness (HWH). Her study is enrolling 18,000 participants of women 65 or older and men 60 or older who will be administered 750 milligrams of cocoa flavanols per day (or a placebo). This experiment, named the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), will take four years to complete and will look at the total amount of heart attacks, strokes, and deaths of their subjects (HWH). Where the article succeeds is that it seeks to educate its readers on future steps of this research, as well as how to best find products which contain these positive traits. Most importantly, it does so without pushing the oversimplified belief that “chocolate is good for you.”

These studies are but a few in a large pool of research, much of which is still taking place today. With all these factors considered, how is one to believe the results of current studies when there are no definitive answers? Just as the likes of Stubbe and Linnaeus struggled to define cocoa in medical context, current researchers are facing the same questions amongst their peers concerning the validity of chocolate as an actual health food. While modern conceptions of medicine are greatly more advanced than those of the 17th and 18th century doctors, results are still being contested for the large amount of uncontrollable variables that disvalue current findings. The only way to come to some sort of definitive conclusion is to continue the work that has taken place for over two millennia. Perhaps our hope of finding a food that is both as nutritious as it is seductive is held in vain, but as long as the chocolate industry reigns supreme, we will always try to justify our penchant for cocoa goodness.

 

Works Cited:

Albala, Ken. “The Use and Abuse of Chocolate in 17th Century Medical Theory.”Food and Foodways 15.1-2 (2007): 53-74. Web.

Bakalar, Nicholas. “In One Study, a Heart Benefit for Chocolate.” The New York Times. 14 Sept. 2009. Web.

Castell, Margarida, Francisco Jose Pérez-Cano, and Jean-François Bisson. “Clinical Benefits of Cocoa: An Overview.” Chocolate in Health and Nutrition (2012): 265-75. Web.

Coe, Sophie D., and Michael D. Coe. The True History of Chocolate. New York: Thames and Hudson, 1996. Print.

Dillinger, Teresa L., Patricia Barriga, Sylvia Esgarcega, Martha Jiminez, Diana Salazar Lowe, and Louis E. Grivetti. “Food of the Gods: Cure for Humanity? A Cultural History of the Medicinal and Ritual Use of Chocolate.” The Journal of Nutrition 3.2 (July 2004). Web.

“Is Chocolate Really a Health Food?” Harvard Women’s Health Watch. Harvard Health Publications/Harvard Medical School, 1 Oct. 2014. Web.

Healthy Chocolate Brands [Image]. (n.d.). Retrieved from http://thehealthybrands.com/healthiest-chocolates-the-9-best-brands-for-the-healthy-chocoholic/

Howe, James. “Chocolate and Cardiovascular Health: The Kuna Case Reconsidered.” Gastronomica: The Journal of Food and Culture 12.1 (2012): 43-52. Web.

“Kuna Indians & Chocolate Dress Dominique Persoone.” YouTube. Web. 05 May 2016.

Lippi, Donatella. Table 2.1. Digital image. History of the Medical Use of Chocolate. R.R. Watson Et Al. (eds.), Chocolate in Health and Nutrition, Nutrition and Health 7. Web.

Lippi, Donatella. “History of the Medical Use of Chocolate.” Chocolate in Health and Nutrition (2012): 11-21. Web.

Neptune, B. (n.d.). Juanita with her Cocoa Bean [Photograph found in SAID’s Development Credit Authority]. Retrieved from http://www.mito-e.com/wp-content/uploads/2015/03/cacao-1-750×335.jpg

Norman, Hollenberg K., M.D., Ph.D., Naomi D.L. Fisher, M.D., and Marjorie L. McCullough, Sc.D., R.D. “Flavanols, the Kuna, Cocoa Consumption, and Nitric Oxide.” Journal of the American Society of Hypertension 3.2 (2009): 105-12. HSS Public Access. Web.

The Princeton Vase, Late Classic, Maya (‘Codex’ Style). A.D. 670–750. Ceramic with red, cream, and black slip, with remnants of painted stucco. Princeton University Art Museum, Nakbé Region, Mirador Basin, Petén, Guatemala.

Wilson, Philip K. “Chapter 1. Chocolate in Science, Nutrition and Therapy: An Historical Perspective.” Chocolate and Health: 1-27. Web.

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