Take two candy bars and call me in the morning?

Content provided by the Faculty of the Harvard Medical School

Take two candy bars and call me in the morning?

Adding plant sterols and flavanols to chocolate doesn't make candy bars a health food.

Sweet, rich, melt-in-your-mouth chocolate has always been something of a guilty pleasure for people with high cholesterol or those following a heart-healthy diet. The high-calorie combination of fat and sugar makes chocolate one of those "use sparingly" foods confined to the teeny tip of food pyramids.

But what if chocolate delivered substances that are good for the heart? Would that transform it into a health food you could eat with gusto? That's what Mars, the maker of M&M's, Snickers, Dove bars, and other sweet treats is hoping you'll think. The company has rolled out CocoaVia, a line of seven chocolates laced with plant sterols and flavanols for what Mars calls "real chocolate pleasure, real heart health benefits." Other companies are sure to follow with their own versions of supposedly good-for-the-heart chocolates.

According to Mars, eating these chocolate snacks will lower cholesterol and keep your arteries healthy. There's some truth to that — if you read the fine print. We provide a magnifying glass below.

Solid ground?

Chocolate is the latest in a string of foods to be beefed up with sterols or stanols, cholesterol-like substances made by plants. There is solid evidence that eating about 2 grams of plant sterols every day lowers cholesterol by a decent 10%. In fact, as of early 2006, national guidelines on cholesterol recommend doing this to help lower cholesterol. Keep in mind that plant sterols yield meaningful changes in cholesterol levels only in people with high cholesterol to begin with and must be consumed every day to make a difference.

What about flavanols? These are part of a larger family of plant-made compounds, the flavonoids. Flavanols are abundant in cocoa beans, although they are often lost or destroyed during the process that turns the beans into chocolate. A number of beneficial "anti" effects have been attributed to flavanols. The main one is antioxidant activity; others include possible activity against viruses, allergies, inflammation, and cancer.

A few small studies show that flavanols in cocoa may help keep healthy arteries flexible, but these were mostly done in healthy people and used substantial doses of cocoa. Studies looking at flavonoid intake and the risk of heart attack or stroke have yielded mixed results, with some showing no effect and others showing modest protection.

To summarize: Eating 2 grams of plant sterols every day lowers cholesterol an average of 10%. Eating 100 grams of flavanols may keep healthy arteries flexible, but there is scant evidence so far it will rejuvenate stiff arteries, lower blood pressure, improve cardiovascular health, or prevent a heart attack or stroke.

Candy isn't medicine

To Mars' credit, the eight products in the CocoaVia line are decent alternatives to the usual chocolate bar. In addition to developing a process to retain the natural flavanols in cocoa, the company worked hard to limit calories and saturated fat.

But when it comes to using fortified chocolate to lower cholesterol, there's a big catch: You must eat two portions of CocoaVia every day to get the necessary 2 grams of plant sterols. For the Original Chocolate Bar, that means a daily dose of sterols and flavanols comes with an extra 200 calories and 36% of the daily recommended limit for saturated fat.

If you don't cut back 200 calories somewhere else — or walk for an extra 45 minutes — that would translate into a 20-pound weight gain over the course of a year. That's more than enough to counteract any benefits from sterols and flavanols.

There are easier and less expensive ways to get plant sterols and flavanols. Since plant sterols must be taken every day in a fixed dose to reap their benefit, they are more like medicine than food, says Dr. Alice Lichtenstein, a professor of nutrition at Tufts University's Friedman School of Nutrition who heads the American Heart Association's nutrition committee. So it makes sense to buy sterols in capsule form. This costs less than chocolate, and doesn't deliver extra calories or saturated fat. You can get flavanols from tea, apples, raspberries, red wine, and other foods. (The USDA has assembled an extensive list of the flavonoid content of foods. You can view it at www.nal.usda.gov/fnic/foodcomp/Data/Flav/flav.html.) If you'd rather take a pill, you can also find flavanol supplements.

CocoaVia and other similarly fortified snacks may nudge the guilt out of eating chocolate, but they aren't health foods. There are cheaper, no-calorie ways to lower your cholesterol and protect your arteries. If you are a chocoholic, have a small piece of good chocolate every day and savor it for what it is — a delightful indulgence — rather than use it as medicine.

Last updated:	September 05, 2008