Cocoa is not included among the World's Healthiest Foods because it isn't a whole food or intact part of a plant (like a raw nut or seed). Cocoa is a processed food component. While it is made from seeds found within pods on the cacoa tree (Theobroma cacao), it's only after these seeds have been fermented, dried, and sometimes treated with other additives that the commercial product cocoa is formed.
Cocoa processing has a definite connection to the manufacture of chocolate, but the two processes are distinct. The production of cocoa powder and cocoa butter, which are used to make chocolate, requires additional processing steps after the initial processing of the cocoa.
As a processed food component, cocoa is less healthy than a whole natural food. Even so, cocoa is developing a more and more impressive research history with respect to its flavonoid content and heart-related benefits. Flavonols found in cocoa appear to be especially helpful in protecting the blood vessel linings. By helping protect these blood vessel structures, cocoa flavonols may also help prevent high blood pressure.
Studies of cocoa are mixed, however, in terms of the potential benefits for different age groups and for persons with and without existing chronic disease. For example, postmenopausal women with high cholesterol seem to obtain significant cardiovascular benefits from the consumption of cocoa. Aged men with diagnosed coronary artery disease, on the other hand, do not appear to derive these same benefits.
Product quality is very important when it comes to cocoa because residues of lead and other potential toxins may be present in non-organically produced cocoa. Organic cocoa powder, organic cocoa butter, and organic cocoa are labeling terms you should look for when purchasing cocoa-containing products.
Buijsse B, Feskens EJ, Kok FJ, et al. Cocoa Intake, Blood Pressure, and Cardiovascular Mortality: the Zutphen Elderly Study. Arch Intern Med. 2006;166(4):411-7.
Dinges DF. Cocoa Flavanols, Cerebral Blood Flow, Cognition, and Health: Going Forward. J Cardiovasc Pharmacol. 2006;47(Suppl 2):S221-3.
Engler MB, Engler MM. The Emerging Role of Flavonoid-Rich Cocoa and Chocolate in Cardiovascular Health and Disease. Nutr Rev. 2006;64(3):109-18.
Farouque HM, Leung M, Hope SA, et al. Acute and Chronic Effects of Flavanol-Rich Cocoa on Vascular Function in Subjects With Coronary Artery Disease: a Randomized Double-Blind Placebo-Controlled Study. Clin Sci (Lond). 2006;111(1):71-80.
Heiss C, Schroeter H, Balzer J, et al. Endothelial Function, Nitric Oxide, and Cocoa Flavanols. J Cardiovasc Pharmacol. 2006;47(Suppl 2):S128-35; discussion S172-6.
Lee KW, Kundu JK, Kim SO, et al. Cocoa Polyphenols Inhibit Phorbol Ester-Induced Superoxide Anion Formation in Cultured HL-60 Cells and Expression of Cyclooxygenase-2 and Activation of NF-KappaB and MAPKs in Mouse Skin in Vivo. J Nutr. 2006;136(5):1150-5.
Manton WI. Sources of Lead in Cocoa and Chocolate. Environ Health Perspect. 2006;114(5):A274-5; author reply A275.
Selmi C, Mao TK, Keen CL, et al. The Anti-Inflammatory Properties of Cocoa Flavanols. J Cardiovasc Pharmacol. 2006;47 Suppl 2:S163-71; discussion S172-6.
Tokuda Y, Kashima M, Kayo M, et al. Cocoa Supplementation for Copper Deficiency Associated With Tube Feeding Nutrition. Wang-Polagruto JF, Villablanca AC, Polagruto JA, et al. Chronic Consumption of Flavanol-Rich Cocoa Improves Endothelial Function and Decreases Vascular Cell Adhesion Molecule in Hypercholesterolemic Postmenopausal Women. J Cardiovasc Pharmacol. 2006;47(Suppl 2):S177-86; discussion S206-9.
Wang-Polagruto JF, Villablanca AC, Polagruto JA, et al. Chronic Consumption of Flavanol-Rich Cocoa Improves Endothelial Function and Decreases Vascular Cell Adhesion Molecule in Hypercholesterolemic Postmenopausal Women. J Cardiovasc Pharmacol. 2006;47(Suppl 2):S177-86; discussion S206-9.