When the health world started reporting that chocolate might actually be good for us, lovers of the sweet stuff rejoiced. However not all chocolate is created equal. In fact, there’s a significant difference between raw cacao and processed cocoa found in most chocolate treats. Raw cacao powder is made by cold pressing cacao beans, which preserves the living enzymes and removes fat. It is also high in antioxidants and known for inhibiting cell-damaging free radicals.

Cocoa powder, found in most consumer products, in comparison, is made by roasting cacao beans at high temperatures – a process that changes the molecular structure, thus reducing enzymes and nutritional value. The good news is that with many recipes, such as baking and in smoothies, cacao can be used in place of cocoa for a nutritional punch. Another important distinction is that when studies like those below, refer to cocoa instead of cacao they’re discussing isolated and purified compounds from cocoa.

Cacao is well studied in relation to cardiovascular health and diabetes. Studies suggest that the effects of lower oxidative stress and anti-inflammatory activity that come from antioxidants means that “cocoa may have beneficial effects in a number of chronic disease conditions including cardiovascular disease and other inflammation and oxidative stress-driven pathologies.” Another study showed that the flavonols in cacao “resulted in a significant lowering of 10-year risk for coronary heart disease.” And yet another study found that physicians who regularly consume cacao are at lower risk for heart disease.

Beyond its antioxidant properties, the benefits of cacao are also being studied in relation to cognition and fatigue.

Active constituents
Flavonoids, phenolic acids, isoflavones, anthocyanins, proanthocyanidins, theobromine



In this study, researchers procured food samples from countries worldwide and assayed the samples for their total antioxidant content using a modified version of the FRAP assay. The results found that “mean antioxidant contents increased with increasing content of cocoa in the chocolate product” from this sample.

Carlsen, Monica H et al. “The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide.” Nutrition journal vol. 9 3. 22 Jan. 2010, doi:10.1186/1475-2891-9-3

Cardiovascular Health and Diabetes

In this review, the author critically summarizes available data on the cardioprotective and anti-inflammatory activities of cocoa and cocoa-derived phytochemicals. The research indicates that “cocoa may have beneficial effects in a number of chronic disease conditions including cardiovascular disease and other inflammation and oxidative stress-driven pathologies.”        

Joshua D. Lambert. "Cocoa and Human Health." Molecular Nutrition and Food Research 57.6 (2013): 933.

A number of studies showed that the addition of cocoa had the following effects: reduction of oxidative stress, inhibition of low-density lipoprotein oxidation, platelet aggregation, vasodilates blood vessels, immunomodulatory and anti-inflammatory activity. The evidence supports “a cause and effect relationship between consumption of cocoa flavonoids and the maintenance of normal endothelium-dependent vasodilation, which contributes to normal blood flow.”

Arranz, Sara et al. “Cardioprotective effects of cocoa: clinical evidence from randomized clinical intervention trials in humans.” Molecular nutrition & food research vol. 57,6 (2013): 936-47. doi:10.1002/mnfr.201200595

Studies suggest a benefit with respect to the following parameters: blood pressure, lipids, and inflammation. The mechanisms by which this might happen include: improved nitric oxide bioavailability and improved mitochondrial structure and function.

Higginbotham, Erin, and Pam R Taub. “Cardiovascular Benefits of Dark Chocolate?.” Current treatment options in cardiovascular medicine vol. 17,12 (2015): 54. doi:10.1007/s11936-015-0419-5

Ingestion of cocoa flavonols resulted in a significant lowering of 10-year risk for coronary heart disease. The risk of heart attack and cardiac-related mortality was reduced. This was also true for low-risk patients.

Sansone, Roberto et al. “Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study.” The British journal of nutrition vol. 114,8 (2015): 1246-55. doi:10.1017/S0007114515002822

This meta-analysis shows an improvement in lipoprotein levels with cocoa consumption.

Berends, Lindsey M et al. “Flavan-3-ols, theobromine, and the effects of cocoa and chocolate on cardiometabolic risk factors.” Current opinion in lipidology vol. 26,1 (2015): 10-9. doi:10.1097/MOL.0000000000000144

This publication outlines that flavanols may increase the “good” HDL-cholesterol, and how insoluble fibre and theobromine are associated with anti-inflammatory and blood sugar lowering effect.

Sarriá, Beatriz et al. “Effects of bioactive constituents in functional cocoa products on cardiovascular health in humans.” Food chemistry vol. 174 (2015): 214-8. doi:10.1016/j.foodchem.2014.11.004

This study shows a lower risk of heart failure in physicians that consume chocolate on a regular basis.

Petrone, Andrew B et al. “Chocolate consumption and risk of heart failure in the Physicians' Health Study.” European journal of heart failure vol. 16,12 (2014): 1372-6. doi:10.1002/ejhf.180

Cocoa flavonoids may improve insulin resistance and endothelial dysfunction with possible benefits in the prevention of cardiometabolic diseases.

Grassi, Davide et al. “Cocoa, glucose tolerance, and insulin signaling: cardiometabolic protection.” Journal of agricultural and food chemistry vol. 63,45 (2015): 9919-26. doi:10.1021/acs.jafc.5b00913

This study suggests that cocoa may protect the retina from diabetic complications involving oxidation and resultant damage to the retina.

Duarte, Diego A et al. “Polyphenol-enriched cocoa protects the diabetic retina from glial reaction through the sirtuin pathway.” The Journal of nutritional biochemistry vol. 26,1 (2015): 64-74. doi:10.1016/j.jnutbio.2014.09.003

This reports researchers found that cocoa flavonols are involved in reducing the inflammation associated with atherosclerosis.

Khan, Nasiruddin et al. “Cocoa polyphenols and inflammatory markers of cardiovascular disease.” Nutrients vol. 6,2 844-80. 21 Feb. 2014, doi:10.3390/nu6020844


There is ongoing research on the effects of cacao as it relates to the following health concerns:


It’s suggested that consumption of cocoa flavonols improves cerebral perfusion and therefore cognition.

Lamport, Daniel J et al. “The effect of flavanol-rich cocoa on cerebral perfusion in healthy older adults during conscious resting state: a placebo controlled, crossover, acute trial.” Psychopharmacology vol. 232,17 (2015): 3227-34. doi:10.1007/s00213-015-3972-4

This dietary intervention study shows a reduction in age-related cognitive decline, perhaps due to improving insulin sensitivity.

Mastroiacovo, Daniela et al. “Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study--a randomized controlled trial.” The American journal of clinical nutrition vol. 101,3 (2015): 538-48. doi:10.3945/ajcn.114.092189


Consuming dark chocolate may improve the symptoms of chronic fatigue syndrome, this study finds.

Sathyapalan, Thozhukat et al. “High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome.” Nutrition journal vol. 9 55. 22 Nov. 2010, doi:10.1186/1475-2891-9-55