The Cardiovascular Benefits of Cacao

//The Cardiovascular Benefits of Cacao

“Cacao is a Health Food!”

During a recent visit to Costa Rica, I somewhat reluctantly took a day off from high adrenaline activities to visit a family run Cacao plantation. As it turns out, this was one of the highlights of my vacation. Surrounded by cacao trees with their colorful pods dangling, one of the farm’s proud owners walked us through the process of creating chocolate. As if he needed an additional marketing strategy to convince us to become chocolate lovers, he proclaimed cacao to have many health benefits. I began to wonder if these health benefits were robust enough to justify my daily chocolate consumption. After all, I know many wine lovers who have done exactly that!

Another interesting tidbit I learned that day was that “cacao” was not just a funny way that some people pronounce “cocoa”. In fact, cacao refers to the natural product, while cocoa is formed after varying degrees of processing with heat and chemicals.

Fresh cacao seeds prior to fermentation and drying

So, How Do they Make This Stuff from a Tree?

While most chocolate production takes place in large factories, we got to experience “pod to mouth” in its most authentic form . Cacao pods turn bright colors of reds and yellows once they are ripe, when they are then cracked open to reveal moist seeds covered with a whitish fruit coating. These are set aside to ferment for about five days, and then to dry for two to three weeks. Once dried, they are ground into cacao nibs which can be purchased at many health food stores.

To produce cocoa, the nibs are then roasted and processed further to ultimately become the chocolate we all love.  Unfortunately the roasting and processing removes many nutrients and antioxidants from a naturally healthy superfood.

Is Cocoa Really Good for Us?

Most studies attempting to answer this question looked at people consuming varying amounts of cocoa and chocolate rather than cacao. It would reason that chocolate with a higher percentage of cacao has fewer additives and is thus a healthier variety. Pure cacao in the form of nibs or cacao powder likely provides the greatest health benefits.

Two populations in particular have demonstrated profound cardiovascular benefits associated with cocoa consumption. The Kuna Indians in Panama, known for their abundant consumption of cocoa, rarely develop high blood pressure, and have a cardiovascular death rate that is roughly 10% that of other Panamanian citizens.(3) A Dutch study showed similar findings as those that consumed the most cocoa again had lower blood pressures and a 50% lower risk of cardiovascular death compared to those who consumed the least amount of cocoa.(4)

What Secret Ingredient in Cocoa Makes it So Healthy?

Dried cacao beans prior to roasting

In speaking of the many health benefits of a plant based diet, we often mention the fact that plants are full of phytonutrients. What the heck is a phytonutrient? These are simply plant chemicals which are responsible for the bright colors of foods like fruits, vegetables, green tea, red wine, and black rice. Cacao has a class of phytonutrients called Flavanols, which not only account for the bitter taste of unprocessed cocoa, but are also responsible for the many health benefits. If you’re interested in learning more about Flavanols, this is a great reference page.

Epicatechins, one of the major flavanols in cacao, are associated with numerous health benefits

So How do These Flavanol Things Prevent Heart Attacks and Strokes?

The inner lining of our blood vessels is not an inert barrier, but a functional organ which produces a substance called nitric oxide (NO). NO is responsible for causing blood vessels to dilate which increases blood flow to muscles and vital organs when it is needed. NO is also an anti-inflammatory, it thins the blood by reducing platelet stickiness, and it prevents “hardening of the arteries” by minimizing growth of smooth muscle cells in the artery walls.  When our blood vessels are exposed chronically to things like high blood pressure, high cholesterol, diabetes, and toxins in tobacco and highly processed foods, the inner lining becomes damaged and can no longer produce an appropriate amount of NO to meet the demands of physical and mental stress.

Cacao nibs are chopped up dried cacao beans

Flavanol-rich foods such as cacao have been shown to fix some of the damage that occurs to the blood vessel, allowing it to make more appropriate amounts of NO. There are many studies in both people and animals which have confirmed these beneficial effects.(1, Table 2) I’m guessing no animals were harmed in those studies if they were fed chocolate!

It’s that Antioxidant word…Again!

Free radicals are molecules in our body which result from toxic environmental exposures such as fried foods, tobacco smoke, pesticides, and pollutants, but are also formed as waste products of normal metabolic processes in our bodies. Free radicals are unstable molecules which, in an attempt to become stable, can damage our cells and even our DNA. Damage to cells in our blood vessels can lead to cardiovascular disease, and damage to DNA can contribute to different forms of cancer. Antioxidants help to stabilize these free radicals before they wreak havoc. Read more about antioxidants here. This is another informative page.

After the cacao beans were fermented and roasted, we ground them by hand using the covered grinder at the end of the table

The Oxygen Radical Absorbance Capacity (ORAC) index is a way of measuring antioxidant capacities of various foods.  Cocoa powder is a powerful antioxidant with an ORAC score of 55,653 as per the 2018 Food Antioxidant Database.

Of no surprise, there are a number of published studies which confirm these antioxidant effects. One demonstrated that the Flavanols in cocoa reduced oxidation of LDL, a particularly dangerous form of bad cholesterol which penetrates the inner lining of blood vessels and contributes to cardiovascular disease.(5) Other studies have shown that consumption of cocoa reduced blood levels of oxidized LDL in patients with high cholesterol (6), improved ability of the blood vessels to dilate in smokers (7), and reduced platelet stickiness in heart transplant patients.(8)

Instead of an Aspirin a day…can I have cocoa?

Platelets are small circulating blood cells important in forming blood clots. When we cut ourselves, we count on our platelets to work quickly to stop the bleeding. In someone having a heart attack or stroke, these cells become inappropriately active, leading to blood clot formation in the arteries of that supply blood to the heart and the brain. Aspirin reduces the risks of heart attacks and strokes by inhibiting this process.

The flavanols in cocoa have also been found to reduce platelet stickiness by effecting some of the natural substances in the body which promote platelet clotting.  Studies have shown that ingestion of dark chocolate was found to reduce platelet aggregation (sticking to each other) and platelet adhesion (sticking to the wall of the blood vessel) in healthy people and in smokers, respectively.(9,7)

Note: This is not intended to suggest that people with cardiovascular disease should stop their daily aspirin in favor of chocolate!!

Fresh ground cacao powder

Under Pressure

As referenced earlier, a Dutch study demonstrated lower systolic blood pressures (the top number of the blood pressure reading) of nearly 4mmHg in those that consumed the greatest amounts of chocolate compared to those consuming the least amount of chocolate. (4) In another study, daily consumption of dark chocolate reduced systolic blood pressure by nearly 3mmHg in patients with prehypertension or stage I hypertension.(10) An analysis of numerous studies involving 173 people also showed a drop in systolic blood pressure by 4.7 mmHg. In total, these studies showed cocoa consumption to have a similar effect on blood pressure to what we might see if someone were to start taking a low dose blood pressure pill. The lower blood pressures were felt to be due to higher levels of NO production. This has possibly significant health implications as high blood pressure plays a major role in causing cardiovascular disease.

High Cholesterol and Diabetes…a Deadly Duo

Hot cacao made with our freshly-ground powder

Small studies in  those with high blood pressure as well as healthy patients demonstrated that consumption of flavanol rich dark chocolate reduced LDL cholesterol (bad cholesterol) by more than 10% and increased HDL (good cholesterol) up to 14%.(11,12) Because of its antioxidant function, cocoa consumption also reduced LDL oxidation (12), a process which makes the LDL particle more likely to contribute to vascular disease.

Cocoa has also been found to reduce insulin resistance in small studies(11), thus improving control of diabetes. This effect is felt to be in part related to enhancing NO as well as the antioxidant properties of the flavanols.

Recipes and Food Ideas

Please visit the “Recipe” page to see how to incorporate cacao into delicious foods

I love to sprinkle cacao nibs on oatmeal, chia pudding, and even toast with nut butter. You can also blend nibs or cacao powder into your favorite smoothie.

Follow this link to for even more great ideas or to purchase raw cacao nibs


  1. Corti et. al, Cocoa and Cardiovascular Health, Circulation, 2009; 119:1433-1441
  2. Haper et al, Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials, Am J Clin Nutr, 2012;95:740-751
  3. Bayard V, Chamorro F, Motta J, Hollenberg NK. Does flavanol intake influence mortality from nitric oxide-dependent processes? Ischemic heart disease, stroke, diabetes mellitis, and cancer in Panama. Int J Med Sci. 2007;4:53-58.
  4. Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med. 2006;166:411-417.
  5. Waterhouse, AL, Shirley JR, Donovan JL. Antioxidants in Chocolate. Lancet. 1996;348:834.
  6. Baba S, Natsume M, Yasuda, et. al. Plasma LDL and HDL cholesterol and oxidized LDL concentrations are altered in normo- and hypercholesteremic humans after intake of different levels of cocoa powder. J Nutr. 2007;137:1436-1441
  7. Hermann F, Spieker LE, et. al. Dark chocolate improves endothelial and platelet function. Heart. 2006;92:119-120.
  8. Flammer AJ, Hermann F, Sudano I, et. al. Dark chocolate improves coronary vasomotion and reduces platelet reactivity. Circulation. 2007;116:2376-2382.
  9. Innes AJ, Kennedy G, Mclaren M, et. al. Dark chocolate inhibits platelet aggregation in healthy volunteers. Platelets. 2003;14:325-327.
  10. Taubert D, Roesen R, Lehmann, et. al. Effects of low habitual cocoa intake onblood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007;298:49-60.
  11. Grassi D, Necozione S. et. al. Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilatation in hypertensives. Hypertension. 2005;46:398-405.
  12. Mursu J, Votilainen S. et. al. Dark chocolate consumption increases HDL cholesterol concentration and cocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med. 2004;37:1351-1359.