Cocoa

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What other names is Cocoa known by?

3,7-dihydro-3,7-dimethyl-1h-purine-2 6-dione, Beurre de Cacao, Cacao, Chocolat, Chocolat Noir, Chocolate, Cocoa Bean, Cocoa Butter, Cocoa Oleum, Cocoa Seed, Cocoa Semen, Cocoa Testae, Dark Chocolate, Dutch Chocolate, Fève de Cacao, Graine de Cacao, Theobroma, Theobroma cacao, Theobroma sativum, Theobromine, Théobromine.

What is Cocoa?

Cocoa is the plant from which chocolate is made. Bitter chocolate is produced by pressing roasted cocoa kernels (seeds) between hot rollers. Cocoa powder is produced by squeezing the fat (cocoa butter) from bitter chocolate and powdering the remaining material. Sweet chocolate is produced by adding sugar and vanilla to bitter chocolate. White chocolate contains sugar, cocoa butter, and milk solids.

Long regarded as a food treat, cocoa is now used by some people as medicine. Cocoa seed is used for infectious intestinal diseases and diarrhea, asthma, bronchitis, and as an expectorant for lung congestion. The seed coat is used for liver, bladder, and kidney ailments; diabetes; as a tonic; and as a general remedy. Cocoa butter is used for high cholesterol.

You've probably heard the buzz about the possible heart health benefits of chocolate, especially dark chocolate. In fact, the candy company Mars, Inc., plans to seek a health claim for chocolate from the Food and Drug Administration (FDA) in the next few years based on research they sponsored regarding the potential role of cocoa flavonoids in cardiovascular health. Flavonoids are chemicals that might lower blood pressure. Dark chocolate contains more flavonoids than milk chocolate or white chocolate. Mars, Inc. is also sponsoring research to see if cocoa flavonoids can help reduce age-related memory decline.

Some people apply cocoa butter to the skin to treat wrinkles and to prevent stretch marks during pregnancy.

In manufacturing, cocoa butter is used as a base for various ointments and suppositories made by drug companies.

Don't confuse cocoa with coca leaf (Erythroxylon coca).

Possibly Effective for...

  • High blood pressure. Most research shows that eating dark chocolate or cocoa products for 2-18 weeks can lower the top number in a blood pressure reading (systolic blood pressure) by 2.8-4.7 mmHg and the lower number (diastolic blood pressure) by 1.9-2.8 mmHg in people with normal blood pressure or high blood pressure.

Possibly Ineffective for...

Insufficient Evidence to Rate Effectiveness for...

  • Heart disease. Some research suggests that healthy elderly men who eat a large amount of cocoa from dietary sources have a lower average blood pressure compared to those who eat less. The chocolate eaters also have a lower risk of death from heart disease and all causes. Also, eating cocoa or chocolate seems to improve the function of the inner lining (endothelium) of blood vessels, which might reduce the risk of heart disease.
  • Chronic fatigue syndrome. Early research suggests that consuming 45 grams of chocolate daily for 8 weeks can reduce fatigue, anxiety, and depression and increase the overall ability to function in people with chronic fatigue syndrome.
  • Cirrhosis. Research suggests that consuming a liquid meal (Ensure Plus) in addition to dark chocolate (Lindt Excellence 85% Cocoa, Lindt & Sprungl Espana) can improve liver function in people with cirrhosis.
  • Mental function. Evidence on the effects of cocoa for improving mental function is not consistent. Some research shows that cocoa might improve some aspects of mental function. Other research suggests no benefit.
  • Constipation. Early research suggests that taking cocoa husks and beta-fructosans daily can reduce hard stools in children with constipation.
  • Diabetes. Early research suggests that cocoa might reduce insulin resistance and improve sensitivity. However, cocoa does not appear to affect blood sugar levels.
  • Insect repellant. Early research suggests that applying cocoa oil to the skin reduces black fly insect bites.
  • High blood pressure in which only the first number (systolic pressure) is too high (isolated systolic hypertension). Early research suggests that eating 100 grams of dark chocolate that is rich in cocoa flavonoids daily might slightly reduce systolic and diastolic blood pressure in elderly people with isolated systolic hypertension.
  • Parkinson's disease. Early research suggests that eating 200 mg of dark chocolate does not improve movement in people with Parkinson's disease.
  • Weight loss. Early research suggests that following a reduced-calorie diet, eating two squares of dark chocolate, and drinking a sugar-free cocoa beverage daily for 18 weeks does not increase weight loss.
  • Intestinal disease.
  • Diarrhea.
  • Asthma.
  • Bronchitis.
  • Lung congestion.
  • Liver.
  • Bladder and kidney ailments.
  • Preventing wrinkles.
  • Preventing stretch marks during pregnancy.
  • Other conditions.
More evidence is needed to rate the effectiveness of cocoa for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Quick GuideHow to Lower Blood Pressure: Exercise Tips

How to Lower Blood Pressure: Exercise Tips

How does Cocoa work?

Cocoa contains a variety of chemicals, including antioxidants called flavonoids. It is not clear how these might work in the body, but they appear to cause relaxation of veins. This could lead to lower blood pressure.

Are there safety concerns?

Eating cocoa is LIKELY SAFE for most people. Cocoa contains caffeine and related chemicals. Eating large amounts might cause caffeine-related side effects such as nervousness, increased urination, sleeplessness, and a fast heartbeat.

Cocoa can cause allergic skin reactions, constipation, and might trigger migraine headaches. It can also cause digestive complaints including nausea, intestinal discomfort, stomach rumbling, and gas.

Applying cocoa butter to the skin is also LIKELY SAFE for most people. It can, however, cause a rash.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Cocoa is POSSIBLY SAFE in pregnancy and during breast-feeding when used in moderate amounts or in amounts commonly found in foods. But be sure to monitor your intake.

Cocoa in larger amounts is POSSIBLY UNSAFE because of the caffeine it contains. Caffeine found in cocoa crosses the placenta producing fetal blood concentrations similar to the mother's levels. Although controversial, some evidence suggests that high doses of caffeine during pregnancy might be associated with premature delivery, low birth weight, and miscarriage. Some experts advise keeping caffeine consumption below 200 mg per day during pregnancy. Keep in mind that chocolate products provide 2-35 mg caffeine per serving and a cup of hot chocolate provides approximately 10 mg.

Caffeine is also a concern during breast-feeding. Breast milk concentrations of caffeine are thought to be approximately half the level of caffeine in the mother's blood. If the mother eats too much chocolate (16 oz per day), the nursing infant may become irritable and have too frequent bowel movements because of the caffeine.

Anxiety: There is a concern that the caffeine in large amounts of cocoa might make anxiety disorders worse.

Bleeding disorders: Cocoa can slow blood clotting. Consuming a lot of cocoa might increase the risk of bleeding and bruising in people with bleeding disorders.

Heart conditions: Cocoa contains caffeine. The caffeine in cocoa might cause irregular heartbeat in some people and should be used cautiously in people with heart conditions.

Diabetes: Cocoa seems to be able to raise blood sugar levels and might interfere with blood sugar control in people with diabetes.

Diarrhea. Cocoa contains caffeine. The caffeine in cocoa, especially when taken in large amounts, can worsen diarrhea.

Gastroesophageal Reflux Disease (GERD): Cocoa seems to hinder the effectiveness of the valve in the food tube (esophagus) that keeps the contents of the stomach from coming back into the food tube or the airway. This could make the symptoms of GERD worse.

Glaucoma: Cocoa contains caffeine. The caffeine in cocoa increases pressure in the eye and should be used cautiously in people with glaucoma.

High blood pressure: Cocoa contains caffeine. The caffeine in cocoa might increase blood pressure in people with high blood pressure. However, for people who already consume a lot of caffeine, it might not cause a big increase.

Irritable bowel syndrome (IBS): Cocoa contains caffeine. The caffeine in cocoa, especially when taken in large amounts, can worsen diarrhea and might worsen symptoms of IBS.

Migraine headaches: Cocoa might trigger migraines in sensitive people.

Osteoporosis: Cocoa contains caffeine. The caffeine in cocoa might increase how much calcium is released in the urine. Cocoa should be used cautiously in people with osteoporosis.

Surgery: Cocoa might interfere with blood sugar control during and after surgical procedures. Stop eating cocoa at least 2 weeks before a scheduled surgery.

Rapid, irregular heartbeat (tachyarrhythmia): Cocoa from dark chocolate can increase heart rate. Cocoa products might also make irregular heartbeat worse.

Are there any interactions with medications?



Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Major Do not take this combination.

Cocoa might slow blood clotting and increase bleeding time. Taking cocoa along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.



Adenosine (Adenocard)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. The caffeine in cocoa might block the effects of adenosine (Adenocard). Adenosine (Adenocard) is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop taking cocoa or other caffeine-containing products at least 24 hours before a cardiac stress test.



Alcohol (Ethanol)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. Drinking alcohol can increase caffeine levels in the blood, and the risk for side effects.



Clozapine (Clozaril)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down clozapine (Clozaril) to get rid of it. The caffeine in cocoa seems to decrease how quickly the body breaks down clozapine (Clozaril). Taking cocoa along with clozapine (Clozaril) can increase the effects and side effects of clozapine (Clozaril).



Dipyridamole (Persantine)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. The caffeine in cocoa might block the affects of dipyridamole (Persantine). Dipyridamole (Persantine) is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop drinking cocoa or other caffeine-containing products at least 24 hours before a cardiac stress test.



Ephedrine
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. Caffeine and ephedrine are both stimulant drugs. Stimulant drugs speed up the nervous system. Taking cocoa along with ephedrine might cause too much stimulation and sometimes serious side effects and heart problems. Do not take caffeine containing products and ephedrine at the same time.



Ergotamine (Ergomar)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. Caffeine can increase how much ergotamine (Ergomar) the body absorbs. Taking cocoa along with ergotamine (Ergomar) might increase the effects and side effects of ergotamine.



Estrogens
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down the caffeine in cocoa to get rid of it. Estrogens can decrease how quickly the body breaks down caffeine. Taking caffeine along with estrogens might cause jitteriness, headache, fast heartbeat, and other side effects. If you take estrogens, limit your caffeine intake.

Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.



Fluvoxamine (Luvox)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down the caffeine in cocoa to get rid of it. Fluvoxamine (Luvox) can decrease how quickly the body breaks down caffeine. Taking caffeine along with fluvoxamine (Luvox) might cause too much caffeine in the body, and increase the effects and side effects of caffeine.



Lithium
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body naturally gets rid of lithium. The caffeine in cocoa can increase how quickly the body gets rid of lithium. If you take products that contain caffeine and you take lithium, stop taking caffeine products slowly. Stopping caffeine too quickly can increase the side effects of lithium.



Medications for asthma (Beta-adrenergic agonists)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. Caffeine can stimulate the heart. Some medications for asthma can also stimulate the heart. Taking caffeine with some medications for asthma might cause too much stimulation and cause heart problems.

Some medications for asthma include albuterol (Proventil, Ventolin, Volmax), metaproterenol (Alupent), terbutaline (Bricanyl, Brethine), and isoproterenol (Isuprel).



Medications for depression (MAOIs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. Caffeine can stimulate the body. Some medications used for depression can also stimulate the body. Consuming cocoa with these medications used for depression might cause too much stimulation. This could cause serious side effects including fast heartbeat, high blood pressure, nervousness, and others.

Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.



Medications for diabetes (Antidiabetes drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, cocoa might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.



Medications for high blood pressure (ACE inhibitors)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa can affect how the body processes ACE inhibitors. Taking cocoa with ACE inhibitors might cause increased effects and side effects.

Some ACE inhibitors include benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik).



Medications that lower blood pressure (Antihypertensive drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa might lower blood pressure. Combining cocoa with other drugs that lower blood pressure might increase the chance of blood pressure going too low.

Some medications that lower blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.



Pentobarbital (Nembutal)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The stimulant effects of the caffeine in cocoa can block the sleep-producing effects of pentobarbital.



Phenylpropanolamine
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The caffeine in cocoa can stimulate the body. Phenylpropanolamine can also stimulate the body. Taking cocoa along with phenylpropanolamine might cause too much stimulation and increase heartbeat, blood pressure, and cause nervousness.



Riluzole (Rilutek)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down riluzole (Rilutek) to get rid of it. Consuming cocoa can decrease how quickly the body breaks down riluzole (Rilutek) and increase the effects and side effects of riluzole.



Stimulant drugs
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Stimulant drugs speed up the nervous system. By speeding up the nervous system, stimulant medications can make you feel jittery and speed up your heartbeat. The caffeine in cocoa can also speed up the nervous system. Consuming cocoa along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with cocoa.

Some stimulant drugs include diethylpropion (Tenuate), epinephrine, phentermine (Ionamin), pseudoephedrine (Sudafed), and many others.



Theophylline
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. Caffeine works in similar ways in the body as theophylline. Caffeine can also decrease how quickly the body gets rid of theophylline. Taking cocoa along with theophylline might increase the effects and side effects of theophylline.



Antibiotics (Quinolone antibiotics)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

The body breaks down caffeine to get rid of it. Some antibiotics might decrease how quickly the body breaks down caffeine. Taking these antibiotics along with cocoa can increase the risk of side effects including jitteriness, headache, increased heart rate, and other side effects.

Some antibiotics that decrease how quickly the body breaks down caffeine include ciprofloxacin (Cipro), enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar).



Birth control pills (Contraceptive drugs)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

The body breaks down the caffeine in cocoa to get rid of it. Birth control pills can decrease how quickly the body breaks down caffeine. Taking cocoa along with birth control pills can cause jitteriness, headache, fast heartbeat, and other side effects.

Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.



Cimetidine (Tagamet)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. The body breaks down caffeine to get rid of it. Cimetidine (Tagamet) can decrease how quickly your body breaks down caffeine. Taking cimetidine (Tagamet) along with cocoa might increase the chance of caffeine side effects including jitteriness, headache, fast heartbeat, and others.



Disulfiram (Antabuse)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

The body breaks down caffeine to get rid of it. Disulfiram (Antabuse) can decrease how quickly the body gets rid of caffeine. Taking cocoa (which contains caffeine) along with disulfiram (Antabuse) might increase the effects and side effects of caffeine including jitteriness, hyperactivity, irritability, and others.



Fluconazole (Diflucan)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. The body breaks down caffeine to get rid of it. Fluconazole (Diflucan) might decrease how quickly the body gets rid of caffeine. Fluconazole (Diflucan) might cause caffeine to stay in the body too long. Taking cocoa along with fluconazole (Diflucan) might increase the risk of caffeine side effects such as nervousness, anxiety, and insomnia.



Mexiletine (Mexitil)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Cocoa contains caffeine. The body breaks down caffeine to get rid of it. Mexiletine (Mexitil) can decrease how quickly the body breaks down caffeine. Taking mexiletine (Mexitil) along with cocoa might increase the caffeine effects and side effects of cocoa.



Terbinafine (Lamisil)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

The body breaks down the caffeine in cocoa to get rid of it. Terbinafine (Lamisil) can decrease how quickly the body gets rid of caffeine and increase the risk of side effects including jitteriness, headache, increased heartbeat, and other effects.



Verapamil (Calan, Covera, Isoptin, Verelan)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

The body breaks down the caffeine in cocoa to get rid of it. Verapamil (Calan, Covera, Isoptin, Verelan) can decrease how quickly the body gets rid of caffeine. Taking caffeine along with verapamil (Calan, Covera, Isoptin, Verelan) can increase the risk of caffeine side effects including jitteriness, headache, and an increased heartbeat.

Dosing considerations for Cocoa.

The following doses have been studied in scientific research:

BY MOUTH:
  • For high blood pressure: 46-105 grams/day of dark or milk chocolate, providing 213-500 mg of the active ingredients, cocoa polyphenols.
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Reviewed on 3/29/2011 12:35:40 PM

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