Brain Health and Wellness Center®Newsletter© 2012 HealthCare Insights
In This Issue
Sign Alzheimer Petition!
Shower your Valentine with Dark Chocolate
Cancer Drug Helps Alzheimer’s Mice
Food of the Gods – Chocolate
How did the Food of the Gods Become Unhealthy? Restoration?
Types of Chocolate
Basic Nutrition Facts for Different Types of Chocolate
Scientific Studies Relating Chocolate to Brain Health
See Dr. Emerson Lombardo in Person
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Joanne Koenig Coste

Eric Reardon, Nutritionist

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Featured Article For the Love of Chocolate
For the love of Chocolate!!!
Issue: # 20 February 2012
Nancy Emerson Lombardo red headshot

Dr. Nancy Emerson Lombardo, Ph.D.

Happy Valentines Day!
In this newsletter we wrote about something that almost everybody loves but might think they need to stay away from, chocolate. We discuss which types of chocolate are actually good for your heart and your brain and will tell you why.  Also we let you know which types of chocolate you should eat minimally if at all.  Cacao FlowerAlso, for fun, learn a bit about the origins of chocolate as a sacred “Food of the Gods” for South/Central American Mayans, Aztecs and other American natives. Learn how it starts as delicate pink flowers, then cacao beans in pods on trees in tropical forests, how it is farmed and processed, and the challenge for cocoa’s sustainability (we all have a stake in this!). We also offer a brief history of how chocolate went from being an extraordinarily healthy drink to unhealthy confections and how we might chose  healthful forms today. Scientific studies of chocolate and the brain are few; see our review.This has been an exciting week on the Alzheimer’s front. First, came a breakthrough in finally elevating Alzheimer’s disease to a national priority (see Article below) and opportunity for YOU to let the President and Congress know you want ACTION (sign petition).Second, a major new avenue of research was published today, reporting that an established skin cancer drug had amazing results in Alzheimer’s mice, removing most of the problematic A-beta/beta amyloid protein from their brains resulting in enhanced cognitive performance, in just 3 days!  Actually the speed of that action unsettles me, with the question of what else is happening in their brains and what are the long term effects. It is somewhat reassuring that the drug apparently works by boosting the action of ApoE, a natural human protein that helps transport lipids in the brain and elsewhere, and known to be problematic in some Alzheimer’s patients.   Meanwhile, as my readers may know from our August 2011 newsletter featuring Cinnamon, Israeli researchers reported that cinnamon extract achieved similar results (drastic reduction of amyloid beta, removal of plaques, and improved cognition of AD mice), though over a longer time period, and through other mechanisms.  Other botanical substances have been reported to reduce beta amyloid load while improving cognitive performance of Alzheimer’s mice.
However, mice are not men (or women) and until all the promising botanicals and drugs are tested in Phase III trials in a variety of human beings, we won’t know whether substances that look promising in mice are either effective or safe in treating humans.

Luckily $50 million new research dollars has just been authorized because there are so many promising new areas of research that need to be pursued, and each Phase II and Phase III clinical trial costs millions. The $50 million is really a drop in the bucket, but a very important BIG drop. $50 million represents a 10% immediate increase in annual funding for Alzheimer’s research which today is only $500 million.

PetitionSign Alzheimer’s Petition – National Alzheimer’s Project Act!
Dear Friends,From Act to ActionI just signed a petition to President Obama asking him to fulfill the potential of the National Alzheimer’s Project Act. Now it’s your turn to make a difference. It’s easy and only takes a few moments.’s is devastating to families from every walk of life. It is the 6th leading cause of death in the U.S., and there is no way to cure, prevent or even slow its progress. The economic cost in this country is staggering: $183 billion a year and this will skyrocket to $1 trillion by 2050. We need a commitment from the government to help us end Alzheimer’s.

With your help, our message will be heard that Alzheimer’s can’t wait.

Thank you!

See below for the US HSS Press Release Feb 7 2012 on “We Can’t Wait”

cantwait “We Can’t Wait” U. S. Action Plan for Alzheimer’s

Obama Signing NAPA Jan 2011February 8, 2012 The Obama administration announced new efforts in the fight against Alzheimer’s disease, committing to:

-immediately making an additional $50 million available to Alzheimer’s research

-boosting Alzheimer’s funding for the 2013 budget by an additional $80 million
-adding $26 million in caregiver support, provider education and public awareness funds.  For more, read the HHS

Fact Sheet.

The President’s announcement is part of the National Alzheimer’s Project Act, calling for a national, coordinated Alzheimer’s disease plan towards preventing and treating Alzheimer’s disease by 2025. Without efforts like these, the United States will face a public health crisis as our aging population increases.

For those of us in the Alzheimer’s movement, whether a year, a decade, or like myself, since 1979, this is a huge moment, when our national government has finally committed to making Alzheimer’s a national priority, develop a plan which, if carried out, might help us be better prepared for, or even partially avert, the crisis ahead when today’s baby boomers reach their 80′s.  If nothing changes, over the next 20-30 years, half the baby boomers will develop Alzheimer’s or another dementia, overwhelming our nations ability to provide or pay for their care.

WhyLeadShower your Valentine with Dark chocolate

by Nancy B. Emerson Lombardo, Ph.D.  ©2012

Does the Brain and Heart Love Chocolate? Something sweet for you and your 70% Dark Chocolatesweetheart that is good for your brain and heartCan chocolate be a brain and body health food? Absolutely! IF you eat it in moderation and IF it is dark chocolate that is ideally at least 60-70% cocoa (the higher the percent (%) cocoa, the more health benefit).  A recommended daily serving size is 1.0 oz (28 grams) to 1.6 oz (40 grams) *[1]/day of dark chocolate which is 170 to 230 calories/day.  The maximum daily amount noted by some studies is 3.5 oz, which is a lot of calories (550-600) which might cause one to either gain weight, or not eat the needed variety of other healthy foods.  Eating excess dark chocolate adds too much saturated fat, sugar, and calories to one’s diet.   Overdoing the amount of even dark chocolate can erase the health benefits.Keep in mind that chocolate is an extremely complicated topic when it comes to health research, in part because there are so many different kinds and in part because it is so important in human usage, with lots of strong beliefs about its benefits or harm.  It will take a while for nutrition and medical science to check them all out.  In the meantime, here is some of what people have concluded based on multiple studies. 

Dark Chocolate’s benefit for the brain is both direct and indirect, through improved heart and blood sugar-related health.

Theo Dark Chocolate with Coconut

Heart health: Clinical research trials suggest that dark chocolate and pure cocoa are as powerful as spices, tea, red wine, and berries in enhancing some aspects of heart health. Most of the health benefits from dark chocolate come from the potent antioxidant phytonutrients it contains, namely flavonoid compounds (a type of polyphenol) which include the monomer forms epicatechins and catechins, as well as the polymer forms, called procyanidins  or proanthcyandins, and several other nutrients including stimulants theobromine and caffeine. (To learn more about these cocoa antioxidants see ) To put the antioxidant potency of pure cocoa in perspective, the ORAC value of pure natural cocoa powder is about the same per weight as several dried herbs such as basil and parsley, and about 1/3 that of several ground spices such as cinnamon.

The flavonoid nutrients promote health by increasing the blood flow in arteries and the heart, lowering blood pressure[1], lowering LDL (“bad”) cholesterol,[2] improving the health of endothelial cells,[3] and improving blood sugar control.[4] To view a list of recent clinical trials using cocoa products, see clinical trials.

The amount of the important antioxidants decrease a factor of 10, in descending order, from pure natural cocoa powder (the highest), milk chocolate to the least (chocolate syrup) among brown-colored chocolate products available to consumers.[5] And white chocolate having virtually none. The more the natural cocoa content, and the less sugar and added dairy fat, the better for health.  The “dutch processed” chocolate, the kind typically used in beverages, and pastries, removes the key antioxidants; heavily dutched chocolates have only 10% of the original, although that is still way better than white chocolate.  In addition, some chocolates are made in a sustainable manner, some use organic ingredients, and some manufacturers pursue fair trade practices, all which impact on healthfulness and taste of the resulting confections. Trade Joe’s, acting as a retailer who sole sources and arranges with manufacturers and suppliers to create or deliver a variety of mostly healthy foods, now offers a considerable variety of reasonably priced varieties of quality dark chocolate.  I find their established Trader Joe’s “Dark Chocolate” in the 1.75 oz bars, manufactured for them in Belgium, as still the most delicious of their offerings for flavor and smooth texture, and wish it were more than 54% cacao.    They are also now offering a fair trade SPICY hot chocolate mix. See TJ's spicy cocoa

We also think highly of Theo Chocolates, a relatively new U.S. manufacturer, originally from Cambridge, MA and now located in Seattle, WA, which reports they are the first US manufacturer to use only organic ingredients AND practice fair trade; their products are mostly vegan and use high quality ingredients. They also offer a spicy hot cocoa mix.  We discovered Theo researching for this article, at Debra’s Gourmet in Concord, MA. Theo chocolates are also carried by Whole Foods and selected other stores, and sold on line.   See below for description of our taste tests and

See article below for more about the different kinds of chocolate and their nutrient content.

Dark ChocolateHow dark chocolate may help the brain: Cross Sectional[7] Studies suggest that regular intake of dark chocolate (about 10g/day) is associated with better cognitive performance in the elderly. ( ) So far there haven’t been clinical trials similar to those in the heart health field to verify this finding for older adults, although more recent clinical trials have shown positive results for younger adults in selected cognitive areas such as visual-spatial and decision reaction time. (see for more on this topic)

Chocolate also contains many minerals important for brain and body health such as magnesium, calcium, and potassium. 1 oz of 70% dark chocolate contains 65 mg magnesium (18% daily requirement),  87 mg phosphorus (12% daily requirement), 21mg calcium(2% daily requirement),  and 203 mg potassium (4% daily requirement).

One well known medical scientist at Yale University, David Katz, MD concludes his review of the science to date[8] “Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks.

Cautions: People with migraine headaches often avoid chocolate of all kinds because it is thought to trigger migraines in some people.  In addition, chocolate does contain caffeine (about 24 mg/oz – about 1/8 to ¼ amount in a cup of coffee) so those very sensitive to caffeine may limit their intake, especially in the evening.

SAVE YOUR DOGS FROM DEATH BY CHOCOLATE: No Chocolate for DogsAlso, chocolate and cocoa products are indeed poisonous to dogs and some other pets, so please keep them out of reach.

[1] 3.5 oz (100 grams) is the typical size of a flat dark chocolate candy bar.   1.0 oz would be a few squares or 1/4 of that bar.

[2] Grassi D, Desideri G, Ferri C. Blood pressure and cardiovascular risk: what about cocoa and chocolate?  Arch Biochem Biophys. 2010 Sep 1;501(1):112-5. Epub 2010 Jun 1.

[3]Shrime MG, Bauer SR, McDonald AC, Chowdhury NH, Coltart CE, Ding EL. Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies.  J Nutr. 2011 Nov;141(11):1982-8. Epub 2011 Sep 28.

[4] Engler MB, Engler MM, Chen CY, Malloy MJ, Browne A, Chiu EY, Kwak HK, Milbury P, Paul SM, Blumberg J, Mietus-Snyder ML.  Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr. 2004 Jun;23(3):197-204.

[5] Grassi D, Desideri G, Necozione S, Lippi C, Casale R, Properzi G, Blumberg JB, Ferri C. Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate.  J Nutr. 2008 Sep;138(9):1671-6.

[6] Miller KB, Hurst WJ, Flannigan N, Ou B, Lee CY, Smith N, Stuart DA. Survey of commercially available chocolate- and cocoa-containing products in the United States.  J Agric Food Chem. 2009 Oct 14;57(19):9169-80.

[7] Nurk E, Refsum H, Drevon CA, Tell GS, Nygaard HA, Engedal K, Smith AD. Intake of flavonoid-rich wine, tea, and chocolate by elderly men and women is associated with better cognitive test performance. J Nutr. 2009 Jan;139(1):120-7. Epub 2008 Dec 3.

[8] Katz DL, Doughty K, Ali A. Cocoa and chocolate in human health and disease. Antioxid Redox Signal. 2011 Nov 15;15(10):2779-811. doi: 10.1089/ars.2010.3697. Epub 2011 Jun 13.

CancerDrugSkin Cancer Drug Helps Alzheimer’s Mice-Important New Research Avenue
Alzheimer’s Association commentaryIn Mice, Cancer Drug Reduces Beta-Amyloid and Helps MemoryA report published online by Science Expresson Feb. 9, 2012, describes a research study in mouse models of Alzheimer’s disease of an FDA-approved cancer therapy called bexarotene. The researchers believe that drug will enhance clearance of an abnormal protein associated with Alzheimer’s (beta amyloid protein) from the brain by increasing levels of another protein, known as ApoE. The scientists found that the orally-administered drug rapidly lowered levels of soluble beta amyloid and amyloid plaques in both young and older test animals, and also improved some cognitive and behavioral deficits. This study is exciting because it investigates a possible new approach to treating Alzheimer’s disease.Bexarotene is used to treat cutaneous T-cell lymphoma (CTCL, a type of skin cancer) in people whose disease could not be treated successfully with at least one other medication.This study, while very interesting, is also very preliminary. Mouse models of Alzheimer’s are limited in how closely they represent human Alzheimer’s. We are still far away from knowing if this has potential as a therapy for people with Alzheimer’s. However, it is intriguing preliminary research that deserves further study.

People with Alzheimer’s and their caregivers should not ask their doctor for this drug to treat Alzheimer’s disease. That said, investigating an already FDA-reviewed and -approved therapy may mean that the drug development process takes a somewhat shorter time because the drug has already been tested in people. There is still a great deal to learn. For example, without trials in people with Alzheimer’s, we know nothing yet about dose levels or how this compound may interact with approved Alzheimer’s drugs.


Six months before this research was published, the Alzheimer’s Association awarded the senior scientist on this article, Gary Landreth of Case Western Reserve University, Cleveland, our prestigious Zenith Award in 2011 for research that will follow on from this study to investigate this drug and how and why it works in this way, perhaps setting the stage for trials in people.

We need to create more treatment targets for Alzheimer’s disease and the only way to do that is with more research, especially basic research into the causes and progression of the disease. The Alzheimer’s Association commends the Obama Administration for dedicating new resources in the fight against Alzheimer’s in a uniquely challenging fiscal year in advance of the first ever National Alzheimer’s Plan. The Alzheimer’s Association will continue to support the process underway to develop the first National Alzheimer’s Plan led by Health and Human Services Secretary Kathleen Sebelius. This will help ensure the nation is equipped to overcome Alzheimer’s the public health crisis of this century and meet the goal set forth by the Administration to prevent and effectively treat Alzheimer’s disease by 2025

HistoryFood of the Gods by Nancy B. Emerson Lombardo, Ph.D. and Samantha Turner ©2012
Cacao Flower There is one food that almost no one can deny when it is handed to them, Chocolate. The Latin word for chocolate is Theobroma cacaowhich means “food of the gods.” Chocolate is derived from a cacao tree, where the fruit from the tree, cacao, is taken and put through various processes to create chocolate.Its history can be traced back 2000 years or more to the Aztecs and Mayans, who from the start believed the cacao bean to be divine, or even magical. Aztecs and Mayans so prized the cacao bean they featured it in rituals of birth, marriage, and death.In recognition of the origins of chocolate, the National Museum of the American Indian is sponsoring a Chocolate Festival this month in Washington, DC. or see attached pdf file)Cacao trees originally grew in northwestern South America, in the rainforests. For the trees to bloom, they require year round moisture and steady temperatures needs between 70ºF and 90ºF.

When cacao beans were first found by native peoples, they were considered so valuable they were used as currency. Avocados could be bought with 3 cacao beans or with 100, a turkey could be purchased.

After the seeds are ripe and harvested they have to go through several steps before they become chocolate; this process was first developed by the native peoples. First they are allowed to ferment for 4 to 7 days. The longer the seeds are allowed to ferment, the higher quality of chocolate will be achieved. After they ferment the seeds are dried out in the sun for about a week. Following the drying process they will be roasted and then ground into a paste. This paste is called chocolate liquor even though it contains nCacao Beano alcohol. After creating the chocolate liquor is made it can be used in various ways to create different types of chocolate.

The cacao bean was often transformed into a savory chocolate drink which was seasoned with vanilla, chilies (hot peppers!) and other spices. Many Aztecs liked to have their chocolate drink cold, where the Maya liked theirs hot. When the Spanish explorers were first served this drink they were not as taken with it. But they returned with the cacao bean to Spain where honey and sugar were mixed into the drink creating a slightly sweetened chocolate closer to what we are familiar with. After this alteration to the drink it was quickly favored in Spain, and to this day there are chocolate shops in Madrid and elsewhere, similar to coffee shops, that feature only liquid and solid chocolate, mostly dark and bittersweet.

Sustainability of Chocolate and Cacao Beans

What is the future of chocolate we wonder? One thing many do not know is that almost all cacao beans are grown by small individual farms in Africa and South and Central America, often small family plots of a few acres, and not mass produced. This is because of the delicate nature of the cacao plant needing particular growing conditions (e.g. the shade of larger trees, in a moist, warm forest) and not conducive to mass production (which may be a good thing as it avoids other problems typical of large scale farming).  Production and farm yields are in fact falling as the demand for chocolate worldwide increases.  One factor is that cocoa farmers do not have the education, the knowledge or the financing to be able to improve their situation. Also some plots are losing their fertility. All these factors result in low productivity which in turn perpetuates low incomes for the farmers. Research shows that by 2020 at least one million more metric tons will need to be produced to meet with the growing demand.  But without help and support for these small farms, this may prove to be impossible.  To be able to help the industry the farmers will need help from the government, food manufacturers, and other interested parties.  To see learn more about the sustainability challenge for cacao bean farming, fermentation, processing and distribution, and how is helping the cacao farmers check out their website. The newer “bean-to- bar chocolate-only company Theo Chocolates headquartered in Seattle is 100% dedicated to following sustainable and fair trade practices. See

UnhealthyHow Did the Food of the Gods Become Unhealthy? What Can Be Done to Restore? by Nancy Emerson Lombardo ©2012
Milk ChocolateFor the first 100 years or more in Europe, the chocolate drinks were very healthy, as they used pure natural cocoa beans, with just a little sugar and/or honey added for sweetness. Later the French added more sugar, and a Dutchman named Coenraad Johannes van Houten invented a process using alkalis that removed much of the strong antioxidants and natural acids in the cocoa bean, to make it a smoother, less strong tasting confection (see next article). His father had invented a process for taking out some of the fat (which made it a great drink but limited its other uses). Modern cocoa powder, with some of fats and antioxidants removed, is more easily used in baking, pastries and other uses…but it has lost many potent health benefits, though not all of them. And it won’t melt with most of the fat removed!When Chocolate was first introduced to the US (in Boston! Baker Chocolate was one of several early companies), it was still considered a health drink. The original co-owner of what became Baker Chocolate company in Dorcester Lower Mills, was himself a physician.   (’s_Chocolate_(brand)Baker Chocolate) got some of Boston’s leading medical doctors, including some at MGH, to lend their name to advertising verifying the healthfulness of chocolate and hot chocolate drinks.In the 1800 and 1900′s people drank hot  chocolate from special hot chocolate pots that were usually a little more decorative than a porceGrandmother Jessie's Chocolate Potlain coffee or tea pot.  ( Here is a photograph of one painted by Dr. Emerson Lombardo’s artist and educator grandmother Jessie Snively Fink)But as the popularity of chocolate continued, and people stopped thinking about maximizing its health potential, and concentrated on sales… companies such as Hershey’s and Mars created new confections by using smaller amounts of the heavily dutched cocoa, adding tons of sugar, and also milk and milk fat to create what are no longer healthy products: milk chocolate and worse, white chocolate.This writer would like to see Chocolate restored towards its original potency for health benefits. If a chocolate product is 70% natural cocoa, the natural antioxidants are so powerful they can still lower blood sugar and cholesterol even though the other 30% is sugar and more cocoa butter!

Knowing about its history, one is tempted to see how chocolate tastes with cayenne pepper in the mix, and more spices.Ginger and Nut Truffle

See our Truffles recipes on our website. (1) and(2) (Chocolate, Coconut & Cherry Truffle. (We’re working on one that adds a bit of cayenne to see what happens!

Just today in fact I found a wonderfully delicious (and nutritious!) THEO chocolate bar that has “70% cacao” dark chocolate with cayenne and chili powders, CINNAMON!, a bit of orange zest and oil, and vanilla bean.  Theo Dark Chocolate w ChileHurrah! I am reading the label as I write this, it is ORGANIC, FREE TRADE, non GMO certifed,and MADE IN USA. And no dairy or gluten!  The label says they are the first free trade AND Fair for Life chocolate maker in the US. So visit their website at Samantha Turner and I also sampled their “Toasted Coconut” 70% cacao Dark Chocolate product and both loved it.  Next I have to try their dark cholocate with almonds as well as their 84% Dominican chocolate.  Ah the trials and tribulations (actually delights) of researching brain healthy foods for our readers.

Companies like Theo will challenge the major manufacturers such as Mars and Hershey’s to also pursue higher standards and, probably most important for the future of chocolate’s availability world wide, support the small farmers who cultivate and harvest this delicate “food of the Gods,”

TypesTypes of Chocolate – Which are the Best and Worst for You? by Nancy B. Emerson Lombardo, Ph.D. ©2012
The best chocolate for you is any type made with at least White, Milk, and Dark Chocolate70% pure cocoa (organic is even better) and that has NOT been “dutched.”   The unhealthiest is white chocolate, and among the dark colored chocolates or syrups would be those made from heavily dutched chocolate and which contain a small percent cocoa powder, to which a lot of sugar, milk fat and other products have been added.Here are the details:Chocolate comes in many different forms, types and flavors, with the differences created by varying the quantities and types of different ingredients.  The flavor and texture of the chocolate can also vary by the time and temperature for roasting the cacao beans, as well as the particular fermentation process used. (Yes your chocolate originated with fermented cacao beans, with the fermentation process usually done in the country of origin)The healthiest part of the chocolate is the antioxidants in the original cacao beans, as mentioned in “Shower Your Valentine” article.

Jute Bag of Cacao Beans

What Does the % Cocoa on the Label Mean Exactly?

As far as we could determine, the “% cocoa” on typical chocolate product labels means the percentage of cocoa in the chocolate, defined as chocolate liqueur (ie the ground up whole natural roasted cocoa bean) together with any added (natural) cocoa butter.  The higher the percentage of cocoa, the less sweet, and healthier, the chocolate is.

The amount of the important cacao antioxidants decreases by a factor of 10, in descending order, from pure natural cocoa powder (the highest), to unsweetened baking chocolate, dark chocolate, semisweet baking chips, milk chocolate to the least (chocolate syrup) among brown-colored chocolate products available to consumers.[1]

“Dutch (alkali) processed” chocolate, the kind typically used in beverages, ice cream and pastries, has significantly reduced amounts of the healthy antioxidants, so look for undutched (i.e. made with natural cocoa) or lightly dutched chocolates (which have 40% of original antioxidants).  Heavily dutched cocoa/chocolate has only 10% of the original.  Some may want to balance the best “taste and texture” with the healthiest ingredients.  The dutching method (developed by a Dutchman named Coenraad Johannes van Houten in the early 1800s) renders cocoa powder smoother, less bitter, but also less healthy.  To make things more complex for the consumer, not all labels tell you whether the chocolate is dutched/alkalized or not. Some manufacturers may or may not use the word natural to specify it is NOT dutched.  So technically, we think, a product could be labeled with high % cocoa (good) but made with heavily alkalized cocoa (not good). Our research didn’t settle this question, so any knowledgeable readers please weigh in!

Here is more information about the types of chocolate you may have heard of.

  • Cocoa nibs are simply the fermented and roasted cacao bean broken up into little bits and pieces.  They are crunchy, just like roasted nuts. (You may buy nibs in many natural foods stores or on the web. Since they contain no sugar, you can eat some of them when you’ve had you chocolate limit for the day. Quoting for a website, “Nibs are incredibly versatile, and lend themselves to both sweet and savory recipes. Use them as you would nuts or chocolate chips: bake into breads and cookies, Sprinkle over oatmeal, top oven roasted vegetables, toss into trail mix and salads, incorporate in meat rubs and sauces. The possibilities are endless! ( )
  • “Chocolate liquor” or “liqueur” is – the liquid or paste that is produced when cacao beans (also called cocoa beans) are roasted and ground; the basis of all chocolate.

The pure, ground, roasted cocoa beans impart a strong, deep chocolate flavor but by themselves might taste slightly strong, slightly acid and sometimes bitter, and surprisingly not sweet at all, because they contain no sugar.

  • Cocoa powder is made from the chocolate liqueur or nibs, by removing most of the cocoa butter.  Cocoa powder can be natural or processed (usually by “alkalizing” as described above).  There can be low fat and higher fat forms of cocoa powder.
  • “Unsweetened chocolate”, also known as “bitter”, “baking chocolate” or “cooking chocolate” is pure chocolate liquor mixed with some form of additional fat, ideally just extra cocoa butter, to produce a solid substance.

With the addition of sugar, cocoa powder and/or unsweetened or “bakers” chocolate, serves as the base for candies, cakesbrowniesconfections, and cookies.

  • “Dark chocolate”, also called “plain chocolate” or “black chocolate”, is produced by adding fat and sugar to cocoa. It is chocolate with zero or much less milk than milk chocolate. The U.S. has no official definition for dark chocolate but European rules specify a minimum of 35% cocoa solids.[2] (adapted from Hershey website)

Consumers have to read the labels to see if the amount of cocoa content is included. These days, if no percentage is given, you can assume it is probably below 50%.

Types of Dark Chocolate:  Again, there are no clear definitions or standards for the commonly used subcategories of Dark Chocolate so it is best to read the nutrition facts and list of ingredients on any chocolate you are considering.  Here are a couple of traditional descriptions:

Traditionally, for example, as used by the Hershey Company, the term “dark” has been synonymous with “semisweet” chocolate, and “extra dark” with bittersweet, although the ratio of cocoa butter to solids may vary with the brand and product.  Both are used in baking and also can be eaten as is.

o   “Semisweet chocolate” is a dark chocolate with (by definition in Swiss usage) half as much sugar as cocoa, beyond which it is “sweet chocolate.”

o   “Bittersweet chocolate” is chocolate liqueur (i.e. the ground up whole cocoa beans) to which some sugar (less than a third), more cocoa butter, vanilla and sometimes other ingredients have been added. It has less sugar and more cocoa.

Milk chocolate was developed in the United States and tends to use heavily “dutched” chocolate to which additional sugar, milk and milk fats have been added.  Milk chocolate is no longer a purely “plant based” food, and introduces unhealthy animal saturated fats containing some cholesterol to the much healthier cocoa butter, a purely plant based food with no cholesterol.  Many nutritionists consider that milk chocolate and milk-based cocoa drinks are no longer healthy drinks since the ingredients with negative impact on health (sugar and animal saturated fats) outweigh the ability of the few remaining cocoa anti-oxidants to counter the negative ingredients.

So-called “white chocolate” is thought to have little to NO health benefits since it has practically NONE of the antioxidants described above, and consists primarily of sugar (55%) and fat (24%) (20% cocoa butter and 4% milk fat). (See www. Healthcare insights for scientific references and description of the different kinds of chocolate, as well as detailed nutritional content of cocoa powder and dark chocolate).

This is not to say that cocoa butter by itself is bad for you.  There is increasing thought based on recent nutritional research, that plant based saturated fats are not nearly as unhealthy as those coming from animal or poultry fat, including dairy, and that some may actually be GOOD for you, including cocoa butter and coconut oil.

Although a biased source, Hershey’s website outlines some of the reasons cocoa butter is now considered a healthy food,

“About 36 percent of the fat in the cocoa bean is “good fat” – either mono- or polyunsaturated fat, of which oleic acid (the fatty acid also abundant in olive oil) makes up the largest proportion. Of the saturated fat content in cocoa butter, over half comes from stearic acid. Stearic acid has been shown in numerous studies to have a neutral impact on blood cholesterol. In fact, the 2010 Dietary Guidelines Advisory Committee recommended that stearic acid should be excluded from other “cholesterol-raising” saturated fats and states that foods high in stearic acid are not problematic for managing blood cholesterol levels.

Why? The main reason may be that stearic acid converts from a saturated fat to an unsaturated fat when metabolized in the body. Studies have been conducted where participants fed chocolate daily for two weeks showed no change in blood cholesterol when total calories in the diet were kept the same.”

Some of you may also have questions about what is “real chocolate” and what isn’t.  To give equal time to two major Chocolate manufacturers, here is a useful description from the website

Question: How Do You Tell If It’s Real Chocolate?  Answer: Just read the package. For 100% real, authentic chocolate, look for the words “milk chocolate,” “semi-sweet chocolate,” or “bittersweet chocolate” on the package. It’s probably not the real thing if you see the words, “chocolate flavor,” “chocolate coating,” “chocolaty,” or “made with chocolate.” And don’t be fooled by packaging that implies chocolate, but doesn’t even mention it by name. (

The U.S. government has also set standards for what can be called chocolate in all of its different forms Link:

To learn more:  Understandably, the major chocolate companies have helped pioneer research into the potent antioxidants in cocoa and chocolate, and some are vigorously defending their patented processes for retaining more of the flavanols which earlier practices removed from the natural cocoa beans. (see for example ), Mars related website for reporting research results ( and summary of cocoa related clinical trials on government website.

Below are a couple of charts (or links on the website) of the key nutrients in the different types of chocolate.  We’ll highlight where there are key differences.

A chart from the Hershey website showing how the “dutching” or alkalizing process removes the beneficial flavonoids from natural cocoa powder. Hershey’s plain natural cocoa powder is close to the positive anti-oxidant values of what the scientists conducting this analysis term “commercial natural cocoa” i.e. NOT treated with alkalis.  From this table one can also quickly discern that Hershey’s “Special Dark’ cocoa powder must be heavily alkalized and otherwise treated, since the content of anti-oxidants and flavanols is below even the heavily dutched/alkalized standard products. While this refers to a type of Hershey’s cocoa powder, it might be a safe guess that this is what goes into Hershey’s “Special Dark” chocolate bars and therefore they won’t be as healthy for us as other bars labeled with the actual content of natural cocoa powder.

See Chart on our Website.

[1] Miller KB, Hurst WJ, Flannigan N, Ou B, Lee CY, Smith N, Stuart DA. Survey of commercially available chocolate- and cocoa-containing products in the United States.  J Agric Food Chem. 2009 Oct 14;57(19):9169-80.

NutritionBasic Nutrition Facts (Macro Nutrients) for Different Types of Chocolate by Nancy B. Emerson Lombardo, Ph.D. ©2012
ChocolateWe created a table comparing the calories, protein, fat, fiber and sugar content of 1 oz (28.35/8 grams) of 6 kinds of chocolate, using USDA websites. (  We also show the % RDA for each of the nutrients.  There is no RDA for sugar since it is not considered necessary for life and in fact is an unhealthy food substance when ingested in excess.At a glance, one can see that the alkalizing or dutching process does not change the macro nutrients for cocoa powder, i.e. calories, protein, fat or sugar.  It might surprise our readers to realize that dry cocoa powder (from which most of the fat has been removed) has substantial fiber and protein counts. 1 oz or 1/3 cup of plain cocoa powder can supply over 5 grams of protein (10% daily requirements), and 8-9 grams of fiber for a whopping 1/3 daily requirement.  Of course the powder would be so dry and strong tasting that most of us are not going to consume 1 oz of pure cocoa powder. But this knowledge should encourage us to shake some in our coffee, or use real cocoa powder in cooking or desserts.  And if we use the natural cocoa powder we’ll also get all those potent brain and body healthy Flavonoids. One note: you can’t melt most pure cocoa powder to make chocolate syrup; you’ll have to add fat to do that. Pensey’s Spices does carry a high fat content natural cocoa powder (i.e. more of natural cocoa butter left in the powder) that might work better in some recipes.To make a chocolate confection from cocoa powder, cocoa butter or other fats are added back into the mix, together with a sweetener (usually sugar).  Thus, compared to the pure cocoa powder, for each ounce the calories more than double, the protein is reduced to between 1 ¾ grams to 2 ¼ grams (still for all 4 confections, even white chocolate, about the same as a slice of white bread, 1.9 grams). The fiber is even more drastically reduced to 12% RDA in 70% plus dark chocolate, 9% in 60% plus dark chocolate to only 4% in milk chocolate to a negligible amount in white chocolate.At the same time the amount of sugar increases from a low of 6.8 g in the 70% plus dark chocolate, to 10.4 g in the 60% dark chocolate, to a whopping 14.6 grams in milk chocolate, and 16.7 grams in white chocolate. This is just part of the negative side of milk and white chocolate.

It should be noted that dark chocolate, both kinds, actually has more fat and calories from fat than either milk or white chocolate, but all of this fat is cocoa butter i.e. plant fats which we have pointed out are relatively healthy fats. The animal fats in milk and white chocolate carry with them a small amount of cholesterol, typically 7 mg in milk chocolate and 6 mg in white chocolate.  Some dark chocolates contain a small amount of milk and if so they will show trace amounts of cholesterol as well; chocolates made from purely plant sources will contain zero amount of cholesterol as cholesterol is an animal phenomenon (a constituent of every cell in our bodies and brains!), absent from all plants.

To see the table go to our website.

ScienceBrainScientific Studies Relating Chocolate to Brain Health – Cognition and Mood by Nancy B. Emerson Lombardo, Ph.D. ©2012
Dark Chocolate Relating to MoodIn brief, stay tuned because there are no definitive clinical trials as yet identifying whether dark chocolate and cocoa powder actually improve cognition and/or mood.   Some preliminary studies are quite interesting.Pilot studies about cocoa and cognition:Scientific study about cocoa and chocolate and its effect on cognition is preliminary but intriguing.the single pilot 6 week study published to date[1], funded by the Hershey company, did not find any differences between well educated healthy older adults taking dark chocolate vs. those taking placebo products, but the study had several limitations that explain their negative findings.   84% Dark Choc from Dominican RepublicThese null results lend weight to the suggestion that dark chocolate may be most dramatically helpful in those with abnormal blood pressure or blood sugar readings, and who aren’t eating an otherwise healthy diet.  For those currently cognitively and physically healthy, it may take a longer clinical trial longer than 2-6 weeks to determine if cocoa/dark chocolate would by itself lower risk of cognitive and/or heart problems.  Also, it is notoriously difficult to see cognitive changes in even a year’s time using the type of standard neuropsychological tests chosen for this trial; most of the ones used were vulnerable to learning effects.

hence the movement toward more sensitive cognitive tests and biological measures such as brain scans, and measurement of ABeta and other problem proteins in the blood or spinal fluid.  A further limitation may be that the placebo used actually had some treatment effect since it contained a small amount of the active flavanoids, though less than 1/10th of the amount in the active treatment. Authors also speculate that the dose of cocoa or active flavanoids may not have been high enough to see an effect in a short period of time.

A more recent study[2] demonstrated positive acute test results in younger adults using a higher dose of cocoa flavonoids vs. White chocolate using a 1 week cross-over design and selected vision and special cognitive tests less subject to learning effects.  The study found significant improved performance from those consuming the dark chocolate in vision tests featuring contrast sensitivity and motion sensitivity as well as visual-spatial memory and performance on some aspects of the choice reaction time task.

No clinical trials yet about chocolate and mood.  And the major epidemiological studies are not conclusive, because of chocolate cultural reputation and popular use as a comfort food when people are depressed.  Usually we use epidemiological studies to suggest which foods are linked to absence of disease and therefore recommend eating more of such foods, because people who did, tended not to have x y and z illnesses. And we recommend against high saturated fat content because people who eat it in excess have higher rates of cardiovascular, brain and body illnesses.  These findings become hyptheses for clinical trials;  Clinical trials where people actually ate more of the good or bad foods and then were compared to similar people randomly assigned to eat different food (or placebo foods) can help us test the hypotheses.  For instance, Dr. Craft’s group in Seattle has shown in a preliminary 4 week clinical trial that people who eat excess saturated fat and high glycemic index foods (e.g sugar and WHITE refined flour/bread/pasta/rice) had significantly poorer cognition and worse levels of the problem A-beta protein in their blood, than those who ate low saturated fat, low glycemic index foods.

If we used the same logic for epidemiological or “circumstantial” evidence related to chocolate, we would conclude that chocolate caused people to become depressed.

Many people believe chocolate helps boost our moods, perhaps by increasing endorphins.  In any case, one cross-sectional (epidemiological) study[3] showed that people who tested high on measures of depression, consumed considerably more  chocolate (all types, including those high in sugar and low in flavanoids), than those who tested below cut off levels for depression. Chocolate, along with cigarettes and caffeine is considered to be a “self-medicating” substance for depression.  So far there are no clinical trials of high quality dark chocolate to see if it does help improve mood.

[1] Crews WD Jr, Harrison DW, Wright JW. A double-blind, placebo-controlled,

randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults. Am J Clin Nutr. 2008;87:872-80.


[2] Field DT, Williams CM, Butler LT. Consumption of cocoa flavanols results in an acute improvement in visual and cognitive functions.  Physiol Behav. 2011 Jun 1;103(3-4):255-60. Epub 2011 Feb 12.

[3] Rose N, Koperski S, Golomb BA. Mood food: chocolate and depressive symptoms in a cross-sectional analysis. Arch Intern Med. 2010 Apr 26;170(8):699-703.

Public invited to presentations by Dr.
Emerson Lombardo on
Feb 16th, March 21st and April 25th
Dr. Nancy Emerson Lombordo See Dr. Emerson Lombardo in Person February 16th, 2012: Brain Healthy EatingThis free event will be held at the Salem Senior Center, 1 Sally Sweet Way, Salem NH 03079.  This event will run from 1:00-2:00pm. Light refreshments will be served.  Sponsored by Methuen Village.  For more information check out the events page at 21st, 2012: Brain Healthy EatingThis free event will be held the Amesbury Council on Aging, 9 School St, Amesbury, MA 01913.  This event will run from 3:00-4:00pm. Sponsored by Methuen Village. Please RSVP to Annmary I Connor, LICSW at For more information check out the events page at

April 25th 2012:  Annual ASAP Nurses Seminar

This event will be held at Courtyard Boston Marlborough, 75 Felton St, Marlborough MA 01752.  This event will run from 11:30-1:00pm. Lunch will follow presentation.  Please RSVP with Lois Stillman at For more information check out the events page at

Nancy is available to answer your questions via e-mail or telephone. Look for her monthly column in the South Shore Senior News!For brain health consultations for yourself, your family, or your organization contact Nancy for further information or to book an appointment. 978-621-1926 or email at 


Nancy Emerson Lombardo, PhD
HealthCare Insights, LLC
P.O. Box 2683 , Acton , MA 01720

© 2012 HCI

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