04/11/2007
Drink of the Gods
My very first column (5/12/1999) under my nom de plume of Dr. Bortrum was titled “NO, NO, NO”. Its subject was the emerging realization that nitric oxide, NO, plays an important role in the body. In a flagrant attempt to capture an audience, knowing that sex sells, I cited NO as promoting blood flow as a consequence of taking Viagra. In a later column (11/27/2003), I discussed hot cocoa as a drink full of beneficial antioxidants and also mentioned the use of magnetic resonance imaging, MRI, to look at blood flow in the brain. Subsequently (9/1/2004), I wrote about studies suggesting that dark chocolate might be good for the heart and posing the possibility that nitrates in hot dogs might actually have some good qualities thanks to the formation of NO in the stomach.
Last week I noted that the late Paul Lauterbur shared the Nobel Prize in 2003 with physicist Sir Peter Mansfield of the University of Nottingham for their MRI work. This past week, I’ve learned of other studies at Nottingham, at Harvard and in Panama that tie together MRI, chocolate and nitric oxide. Chocolate has been in the news recently at least in part due to these studies.
At Nottingham, Ian Macdonald, President-Elect of the UK Nutrition Society, led a study that focused on the effect of drinking cocoa on blood flow in the brain. The work was reported in February at a meeting of the American Association for the Advancement of Science (AAAS) in San Francisco. The cocoa used in the study was not the mild type you would make at home or find at your local coffee shop. It’s not surprising that Mars, maker of M&Ms and other chocolaty delights, sponsored the Nottingham work as it has other research on chocolate and health for some 15 years. I found a wealth of information on chocolate on the Mars Web site.
“Chocolatl” was the drink imbibed by the Aztec and other Indians in Mexico dating back a thousand years or so. The hot cocoa that the Aztecs drank was not your namby-pamby drink of today. They considered it the food of the gods and combined it with chili peppers and other spices – not a particularly appealing drink to me. Montezuma introduced chocolate to Cortez, who carried it back to Europe, where it evolved into today’s milder drink and confection. In the process, many or most of the original flavanols and other beneficial ingredients have been lost or diluted.
However, the Kuna Indians of Panama have preserved the cocoa drink in a form that more closely approximates the Aztec drink of the gods. While the Aztecs were being destroyed by the Spanish conquerors, the Kuna apparently fled to the coast and a chain of islands known as the San Blas Archipelago. Today there are the San Blas Kuna and Kuna that have moved to the mainland, living in Panama City and its suburbs. The San Blas Kuna have kept more to their old ways and drink several cups a day of their cocoa. Mars has analyzed the cocoa and it contains much larger amounts of flavanols than the processed cocoa available here in the U.S. or in Europe. Mars has come up with “Cocoapro”, a cocoa that more closely approximates the cocoa drunk by the San Blas Kuna. The flavanol-rich Cocoapro has been used in some of the studies described below.
In the early 1990s, Norman Hollenberg, of Harvard Medical School and Brigham and Women’s Hospital, was interested in high blood pressure. He thought there might be genes that protect against high blood pressure and figured that if he could find an isolated group of people known to have low blood pressures, he might find such genes. The Kuna Indians fit the bill. However, Hollenberg was disappointed to find that the Kuna who moved to the mainland had blood pressures as high as others living in urban environments. The Kuna had no special protective genes. So, what is special about the San Blas Kuna?
Perhaps they eat less salt than their mainland counterparts? It turned out they might actually eat more salt on the islands. Hollenberg and his team found that the biggest difference in the lives of the two Kuna groups was that the islanders still drank their old-fashioned flavanol-rich cocoa. In a recent issue of the International Journal of Medical Sciences, Hollenberg and three colleagues, Vicente Bayard, Fermina Chamorro and Jorge Motta from the Instituto Commemorative Gorgas de Estudios de la Salud in Panama, published a very interesting study.
They took the death certificates for the San Blas and the mainland Kuna for the years 2000 to 2004 and calculated the death rates for cardiovascular disease, cancer and diabetes mellitus. The results were startling. Adjusted to a figure of deaths per 100,000, the rate for heart disease was 83 for the mainland Kuna and only 9 for the San Blas Kuna! For cancer, the numbers were 68 mainland and 4 San Blas and for diabetes mellitus, 24 and 7, respectively. The islanders are doing something right!
Hollenberg and his colleagues caution that these are “observational” studies and therefore can’t be considered “definitive”. But what is the reason for the apparent magical properties of cocoa? Could it be that the flavanol-rich cocoa is producing NO? On the Harvard Web site there’s an article by William Cromie about Hollenberg’s work and it says lab tests show that the cocoa used by the Kuna does indeed stimulate the body to produce nitric oxide, which we’ve already said promotes blood flow.
Lest you think I’ve forgotten Nottingham, Ian Macdonald and his team of Susan Francis, Kay Head and Peter Morris reported to the same AAAS meeting in February that they used MRI in work showing that flavanol-rich cocoa increases blood flow in the brain for 2-3 hours after drinking it. Macdonald suggests the flavanols might help to improve cognitive performance after sleep deprivation or in the elderly. Reduced blood flow has been associated with various diseases such as Alzheimer’s.
February also saw publication of an article by a team of German workers in the Journal of Cardiovascular Pharmacology that proclaimed the benefits of high-flavanol cocoa in a study of male smokers known to have problems with blood vessel function. Drinking high-flavanol cocoa improved blood flow by amounts proportional to the amount of flavanols drunk by the subjects. With several cups of cocoa a day the blood flow improved so much as to be similar to that of one with no cardiovascular problems. This held as long as the subjects drank the cocoa. When the subjects stopped drinking the cocoa, blood flows returned to the low values prior to the beginning of the study.
In a paper I found in the Proceedings of the National Academy of Sciences of January 24, 2006, Hollenberg and some of the same German authors joined forces to isolate a particular flavanol. They showed a direct correlation of drinking that flavanol and improved cardiovascular activity. This paper had two co-authors from the Mars company and the obvious conflict of interest was duly noted at the end of the paper. However, I was not aware of the wealth of research that has been done on cocoa/chocolate and NO and blood flow. I’m reasonably convinced that all this recent “chocolate’s good for your health” talk isn’t just hype.
After posting this column, I plan to celebrate with a couple of raisins covered with dark chocolate – as close as I can get to flavanol-rich cocoa at the moment.
Allen F. Bortrum
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