Talk:Health effects of chocolate

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Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Gracellawson. Peer reviewers: Msw258.

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Copy-paste notice
Apparently on June 20, 2010, the contents of this article were moved out of the main article chocolate (diff) by User:Heroeswithmetaphors. I believe this is supposed to be announced prominently at the very least in an edit summary, but this notice should hopefully serve the same requirements of the GFDL. 71.182.220.113 (talk) 18:47, 18 July 2010 (UTC)

Obesity Risk Section
sounds heavy handed like some sort of food crusader had to put it in there. what's the point of citing something as unacademic as a catch phrase anyways? Just leave it out. I obviously am not going to edit anything, but it just doesn't seem to mesh with the quality standards typically imposed on wikipedia entries, and seems to represent a viewpoint. —Preceding unsigned comment added by 72.202.155.47 (talk) 04:56, 11 October 2010 (UTC)

Perhaps the section could be retitled and add some more information. Here are my suggested edits.

"Concerns of High Caloric Intake and Weight gain"

Although research on the effect of cocoa on weight gain is unclear. Excessive consumption of chocolate with high calories can lead to weight gain. This is a cause for concern not because of cocoa but due to the other ingredients that turn cocoa into cacao and then into chocolate: fat, milk and added sugar (Bauer, Ding, & Smit, 2011). The average chocolate bar contains 500 kcal per 100g of product. Added sugar in chocolate is also a concern. Approximately half the content of an average dark chocolate bar is sugar (Bauer, Ding, & Smit, 2011). Excessive sugar and calorie consumption will increase the risk of obesity followed by hypertension, dyslipidaemia and diabetes. Any possible benefits of cacao consumption may be countered by the calories in the finished chocolate product (Franco, Oñatibia-Astibia, & Martínez-Pinilla, 2013).

Sources:

Bauer, S. R., Ding, E. L., & Smit, L. A. (2011). Cocoa Consumption, Cocoa Flavonoids, and Effects on Cardiovascular Risk Factors: An Evidence-Based Review. Current Cardiovascular Risk Reports, 5(2), 120–127. https://doi.org/10.1007/s12170-011-0157-5 Franco, R., Oñatibia-Astibia, A., & Martínez-Pinilla, E. (2013). Health Benefits of Methylxanthines in Cacao and Chocolate. Nutrients, 5(10), 4159–4173. https://doi.org/10.3390/nu5104159

Gracellawson (talk) 00:09, 10 May 2018 (UTC)

lead [toxicity] section
the lead section seems misleading. There is no tolerable limit for lead present in bloodstream, but the WHO established that exposure to 4 µg/kg of bodyweight of lead per day in children wasn't associated with an increase in blood lead levels. See here:

http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/lead-plomb/iii-eng.php

Just because there's no safe level of lead in the blood doesn't mean there isn't a safe level of lead in diet. And at 3 or 4 µg/kg it would be virtually for an adult to consume enough lead from cocoa to raise blood lead levels (well upwards of 200g per day for a regular adult)

91.105.236.20 (talk) 23:23, 8 January 2011 (UTC)

Note that is a dead link to the Canadian website you posted. There is evidence in peer reviewed journals that finished chocolate products contain lead. Agarwal et al. reported that milk chocolate candy bars tested by the U.S. FDA contained an average of 27 ng of lead per gram of candy, which was the fourth highest concentration of lead reported for any food item. Heneman and Zidenberg-Cherr (PDF at https://ucanr.edu/repositoryfiles/ca6004p180-69375.pdf) showed that chocolate purchased at 3 supermarkets in Davis, California contained from 0.001 to 0.965 micrograms of lead per gram of chocolate, with the highest lead concentration found in dark chocolate pieces and the lowest concentration found in candy-coated chocolate. This is encyclopedic information and should be in the article. 173.85.247.19 (talk) 16:27, 3 April 2016 (UTC)

Also check this reference in an Elsevier peer-reviewed journal of analytic chemistry: "Children, who are big consumers of chocolates, may be at risk of exceeding the daily limit of lead; whereas one 10 g cube of dark chocolate may contain as much as 20% of the daily lead oral limit. Moreover chocolate may not be the only source of lead in their nutrition". Rinat Levi Yanusb, Hagit Selaa, Eitan J.C. Borojovicha, Yevgeni Zakonc, Magal Saphiera, Andrey Nikolskia, Efi Gutflaisa, Avraham Lorbera, Zeev Karpasa (2014). Trace elements in cocoa solids and chocolate: An ICPMS study. Talanta, Volume 119, 15 February 2014, Pages 1–4; http://www.ncbi.nlm.nih.gov/pubmed/24401377. 173.85.247.19 (talk) 17:00, 3 April 2016 (UTC)

Also this from J Agric Food Chem. 2014 Aug 27;62(34):8759-63. doi: 10.1021/jf5026604. Epub 2014 Aug 19. Cadmium and lead in chocolates commercialized in Brazil. Villa JE1, Peixoto RR, Cadore S. "The results showed that chocolate might be a significant source of Cd and Pb ingestion, particularly for children." http://www.ncbi.nlm.nih.gov/pubmed/19754118. I will put these into the article unless anybody objects. 173.85.247.19 (talk) 17:06, 3 April 2016 (UTC)

and cadmium
eg as in Cocoa_solids - Rod57 (talk) 17:16, 29 October 2017 (UTC)

Anandamide in chocolate
The following quote from the "Anandamide" Wikipedia page (http://en.wikipedia.org/wiki/Anandamide) shows that anandamide should not be included in the list of compounds found in chocolate.

In an attempt to find anandamide or anandamide type endocannabinoids, researchers in 1996 found N-oleoylethanolamine and N-linoleoylethanolamine which may act as cannabinoid mimics.[12] Later studies confirmed that anandamide is not found in chocolate and the two compounds reported earlier did not interact with cannbinoid receptors. The neurological basis of chocolate's appeal still remains elusive.[13] 131.118.248.2 (talk) 15:51, 26 July 2011 (UTC)

Potential references
--Ronz (talk) 21:56, 23 December 2011 (UTC)
 * Corti, R. et al. “Cocoa and cardiovascular health”, Circulation. Journal of the American Heart Association (2009),119(10):1433-1441.
 * Fraga, C. G. et al. ”Cocoa flavanols: effects on vascular nitric oxide and blood pressure”, Journal of Clinical Biochemistry and Nutrition (2011),48(1):63-67.
 * Rimbach, G. et al. “Chocolate: (un)healthy source of polyphenols?”, Genes & Nutrition (2011),6(1):1-3.
 * Buitrago-Lopez, A. et al. “Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis”, BMJ (2011),343:d4488. Editorial comment by Professor Johan P. Mackenbach.

Thank you for your opinion and suggestion.

These reviews (one study was not added by me) are meant for readers who would like to delve deeper into the subject. The reviews are placed in the “further reading” – section because the Wikipedia guideline for this section read: “… publications that would help interested readers learn more about the article subject. The Further reading section (…) should normally not duplicate the content of the References section” (WP:FURTHER).

The Wikipedia content guideline for “Identifying reliable sources (medicine)” (WP:MEDRS) read: “It is usually best to use reviews and meta-analyses where possible.”

The reviews in question reflect the latest research (last 10 years) in the field, they are scholarly and peer-reviewed, and they are published in academic journals. Granateple (talk) 22:58, 28 December 2011 (UTC)

Phytic acid in chocolate
Read that phytic acid causes decreased mineral absorbtion, chocolate contains alot of this. fed up with this, can't eat anything without it giving me cancer and causing my nuts to explode or dick to turn purple or some rubbish like that. Can someone find out the truth if it causes mineral deficiencys? — Preceding unsigned comment added by 78.147.95.241 (talk) 04:26, 19 April 2012 (UTC)


 * Mineral deficiencies from phytic acid may only be relevant for individuals in third world countries with extremely limited diets. People accustomed to a diet high in phytic acid can break down nearly 90% of it —apparently due to promoting gut bacteria that break it down.


 * Furthermore, there are documented benefits to phytic acid. Phytic acid has been found to improve copper absorption. Phytic acid can act as an anti-oxidant through its iron chelating properties —which may be related to why chocolate has anti-diabetic properties.


 * Iron chelation by phytic acid has also been linked to decreasing iron‐mediated colon cancer risk and lowering serum cholesterol and triglycerides.. Phytic acid itself has been linked to a decrease in calcification and kidney stone formation and on lowering blood glucose and lipids. While mineral deficiencies are a concern for those in developing nations with a limited diet, in general, the more phytate-rich foods people eat, the less disease they tend to have. The documented anti-cancer, anti-diabetic, anti-cancer and antioxidative properties of phytic acid and other mineral absorption inhibitors has made the term anti-nutritional factor obsolete—with some arguing that these phytochemicals are in fact essential nutrients. (JamesPem (talk) 20:38, 25 April 2015 (UTC))

Chocolate and Nobel prizes - a correlation
I'm quite amazed that I need to explain what the problem with including this paper in the article. It is a classic example of correlation, not causation as the author admits. WP:MEDRS applies to this article and this is of the lowest quality of evidence. User:Teapeat has suggested that we should refute it in the article rather than removing it, but I don't see the point - it's complete garbage (and deliberately so) and we should treat it as such. SmartSE (talk) 09:26, 8 May 2013 (UTC)


 * While there's no expectation of a direct causal link, it's not 'garbage', the data is not made up, it's a real world correlation, published in the formal literature and the paper has even been referenced by at least one other paper to my knowledge, and has appeared in the press.


 * By using the word 'garbage' you're clearly attempting to justify removing something that is actually notable.Teapeat (talk) 13:43, 8 May 2013 (UTC)


 * Your removal of the part about lead is pretty awful, if you check this reference for example, they explicitly state that there is believed to be no safe level for children, and this reference also says the same thing. Lead is a widespread, significant, environmental toxin, and its presence at fairly large levels in chocolate is notable, and concerning.Teapeat (talk) 13:43, 8 May 2013 (UTC)


 * I've said all there is to say about the Nobel and it doesn't seem we're going to agree so I'll ask some people from WP:MED to take a look as well.


 * The reference I removed makes no mention of chocolate whatsoever so it a classic case of synthesis to include it here. We should just stick to papers that explicitly discuss chocolate and lead. SmartSE (talk) 15:44, 8 May 2013 (UTC)


 * Far be it from me to point out that you have misfollowed the rules, but WP:Synthesis is when you make an extra claim such as 'levels of lead have no lower limit..so children should never be given chocolate' that the individual sources do not. Simply collating facts and letting the reader make their own conclusions is never synthesis. That's all article are, they're just collations of facts.Teapeat (talk) 20:40, 8 May 2013 (UTC)

I've just deleted the "Other research" section. It was built on inappropriate sources. Health, efficacy and safety claims must be supported by good "secondary" sources as outlined in Identifying reliable sources (medicine). --Anthonyhcole (talk · contribs · email) 16:50, 8 May 2013 (UTC)


 * No, it makes absolutely no health claims, and in fact that's the point, which you seem to have missed, and it has reliable secondary sources.Teapeat (talk) 20:40, 8 May 2013 (UTC)


 * The point of the study wasn't that the researchers thought that eating chocolate made you smart, they didn't think that at all, the point of the study was about the huge difference between correlation and causation, they thought that countries that ate a lot of chocolate had some factor that made them do better at Nobel prizes and predisposed them to eat chocolate as well. None of the researchers or any of the coverage in the reputable press stated anything different.


 * The fact that you both seem to think that this research makes health claims just shows that it needs to be in the article, because you obviously both don't get it!!!Teapeat (talk) 20:52, 8 May 2013 (UTC)


 * These are tiny studies that have nothing whatever to say about the health effects of chocolate (the subject of this article). Putting them here adds nothing relevant to the topic of the article and implies there may be some benefit with regard to muscle recovery or intelligence. We don't use primary sources like this. It misleads our readers. Why do you want to include this trivia in this article - "Health effects of chocolate" - if they say or imply nothing about health? (If I ignore your answer, please don't misread that as some kind of agreement.) --Anthonyhcole (talk · contribs · email) 04:11, 9 May 2013 (UTC)


 * This looks like a fun bit of trivia, but it doesn't belong here. If we have a list of examples of correlation and causation issues elsewhere, though, then I think this would be a cheerful addition.  WhatamIdoing (talk) 04:50, 10 May 2013 (UTC)

Effect on heart attacks and strokes
The section Health effects of chocolate says


 * ... there is no evidence of long-term cardiovascular health benefit.[9][10].... there is no good evidence to support an effect on heart attacks or strokes.[11][12]

The cited articles are dated from 2010 to 2013. But I distinctly remember reading an abstract around 2010 or 2012 or so which showed a strikingly lower incidence of adverse cardiovascular events for subjects taking a certain low-to-moderate level of dark chocolate, in a controlled large-scale study. Anyone know about that, and should this passage be updated? Loraof (talk) 15:41, 22 February 2016 (UTC)
 * If there's a better WP:MEDRS than we have, yes. But is there? A "controlled large-scale study" would be a primary source and not usable by itself. Alexbrn (talk) 16:01, 22 February 2016 (UTC)

Scientific studies cannot prove things
There's a problem under the "Sex" subsection, which reads: "It has been claimed that chocolate is an aphrodisiac, but there are no rigorous studies to prove this effect." I suggest we replace the word "prove" to "support" as science cannot prove anything; they only provide evidence to support things. 67.216.61.39 (talk) 03:42, 28 September 2019 (UTC)
 * Made this edit to reword and clarify. --Zefr (talk) 05:38, 28 September 2019 (UTC)
 * Thank you for your contribution. You've went beyond my call of duty. 67.216.61.39 (talk) 05:51, 28 September 2019 (UTC)

No health benefits?
The lede says that there are no health benefits. I just added a review article to the Research / Cardiovascular health section which shows that there are clear benefits to cardiovascular health. The lede needs to be fixed. --Isabela31 (talk) 19:31, 31 October 2021 (UTC)
 * That's one review in a journal with a low impact factor (2.9). It's a low-quality WP:MEDREV source, so shouldn't be overstated as your edit indicates. Zefr (talk) 19:35, 31 October 2021 (UTC)
 * This revert was justified because the source is highly misleading by stating that "antioxidants as polyphenols, especially flavanols present in cocoa, exert a favorable effect on endothelium vasodilation, modulate inflammatory markers, and decrease platelet aggregation, lipid oxidation and insulin resistance. Recent nutritional intervention trials and molecular studies demonstrate that consumption of cocoa, particularly rich in flavanols, is beneficial to promote cardiovascular health." 1) the fate of ingested polyphenols in vivo is unknown, as the parent compound is rapidly metabolized and excreted. No physiological effects can be assigned to ingested polyphenols. 2) there is no good evidence that polyphenols are in vivo antioxidants, and 3) all of the "favorable effects" listed in the quote are speculation from in vitro or animal studies. Such material fails WP:V as effects in humans ingesting chocolate. Zefr (talk) 19:47, 31 October 2021 (UTC)


 * There is nothing wrong with the Garcia review. WP:MEDREV does not compare one type of review article to another. All bona fide review articles in legitimate journals are counted equally.


 * The Garcia review is from 2018 and is one of the most current articles on the topic. The Cochrane review from 2017 that's currently in the article provides important caveats to the Garcia article on the topic of blood pressure. The two articles could be cited together. First, Garcia, to make the general statement that chocolate is good for cardiovascular health. Then, Cochrane, to bring the caveats related to the blood pressure findings.


 * The statement in the Garcia article about polyphenols is not related to its findings. Garcia cites a large number of articles, many of them are meta-analyses, to show that there is a positive effect on cardiovascular health. Why that effect occurs is not the point. The studies cited are human studies with human patients.


 * Please reconsider this revert. --Isabela31 (talk) 21:42, 31 October 2021 (UTC)


 * As is, the lede is clearly misleading. "there are insufficient studies to confirm any effect" This is not true. Garcia brings lots of studies that show an effect.
 * The abstract of the Garcia article is full of misinformation, as noted above. The article is not accessible to the general public (or me). The statement "insufficient studies to confirm any effect" is clearly accurate, as no effect is confirmed . Zefr (talk) 23:09, 31 October 2021 (UTC)


 * Another, even more recent review. "Regular consumption of cacao / cocoa is associated with protection against both CVD and its risk factors. Patients should be informed that commercially available chocolate-containing foods may be high in refined sugars, corn syrup, saturated fat, and dairy products which may have adverse health effects." --Isabela31 (talk) 01:29, 1 November 2021 (UTC)

@Zefr I propose that the current Heart and blood vessels section be replaced with the following. This uses three different recent review articles, quotes them almost verbatim in-context, and cites every single sentence. While just one article would suffice, I am bringing three. WP:MEDRS Please remember that Wikipedia is about verifiability, not truth. WP:NOTTRUTH Even if you think that the following information is false, that is no reason to delete it. Earlier, you took issue with the statement on flavanols, based on Health effects of phenols and polyphenols. All three review articles make that statement. Your objection to it may be WP:OR. --Isabela31 (talk) 14:30, 1 November 2021 (UTC)
 * The section below is an overstatement of the sources and conclusions. In my view, the Garcia source is unusable, as indicated above. I cannot read the fee-protected article in the AJM publication. The one Cochrane review concluded "flavanol‐rich chocolate and cocoa products cause a small (2 mmHg) blood pressure‐lowering effect in mainly healthy adults in the short term," which, although accurate to the studies reviewed, is an uncompelling result indicating little significance about cardiovascular health. I don't see much justification to change the article content, and ask that you work through WP:CON with other editors to justify a change or not. The only new text I would suggest for consideration is the 2012 EFSA conclusion (9 years out of date, and not further confirmed since) that "cocoa flavanols help maintain endothelium-dependent vasodilation, which contributes to normal blood flow. In order to obtain the claimed effect, 200 mg of cocoa flavanols should be consumed daily." Zefr (talk) 16:39, 1 November 2021 (UTC)

@Zefr With respect, here are my point-by-point responses.

That is not correct. The section below uses 3 recent review articles (now 4, I added the EFSA source that you suggested). It states the conclusions of these articles almost verbatim. Please show an example of where the section below is an overstatement.


 * 1) The section uses 4 different sources, all of which are in general agreement with each other. Aggarwal is in complete agreement with Garcia. The Cochrane review is in agreement with Garcia on the topic of blood pressure. EFSA provides a possible explanation for the effects noted in Garcia. Even if one of the sources is not as strong as you'd like it to be, it is being used in the context of several sources, all of which are in general agreement with each other.
 * 2) Earlier, you objected to Garcia based on the statement it makes on flavanols. Yet all three review articles make that statement. Your objection, which is based on another Wikipedia article (Health effects of phenols and polyphenols) may be WP:OR.
 * 3) WP:NOTTRUTH

To reach consensus, would you be OK with the section below, with the Garcia reference removed? Most statements would remain, since they are supported by other references as well.

I don't see how this is relevant. I can assure you that I am representing this reference accurately.


 * 1) I included this conclusion in the section.
 * 2) "uncompelling result indicating little significance" That's your opinion. WP:OR My description of the Cochrane review result accurately describes their conclusion.

I am working through WP:CON by responding to your points, by proposing a rewrite that removes the Garcia reference, and by incorporating the sources that you suggested (Cochrane and EFSA). I will continue to work on WP:CON.

I am incorporating this reference.

Have we reached consensus? Are you OK with the section below? Would you be OK with it if I remove the Garcia reference? --Isabela31 (talk) 18:15, 1 November 2021 (UTC)


 * I do not agree with your draft below. Consensus is not two editors agreeing, but several, and you do not have consensus here or on the WT:MED discussion. Your draft is WP:SYNTH and an exaggeration of minor results from preliminary research, in my opinion. If the effects you wish to write for the article were so clear, major clinical or regulatory organizations, like the European Medicines Agency, FDA or American Heart Association, would have public advisories to eat more chocolate to prevent cardiovascular diseases (doesn't exist), WP:MEDSCI. The main quality sources are the Cochrane review, EFSA statement, and two others currently in the article, leading to:
 * Reviews support a short-term effect of lowering blood pressure by a small amount from consuming cocoa products, but there is no evidence of long-term cardiovascular health benefit.[Cochrane review]. While daily consumption of cocoa flavanols (minimum dose of 200 mg) appears to benefit normal endothelium-dependent vasodilation,[EFSA] there is no good evidence to support an effect on heart attacks or strokes.[Arranz][Sudano]

Zefr (talk) 18:38, 1 November 2021 (UTC)
 * The best review to date on this subject is an umbrella review which looked at both randomized controlled trials and observational studies. Although chocolate consumption has been associated with reduced risk of cardiovascular disease this has only been found in observational studies on "weak evidence of credibility". Observational studies are not considered the best type of evidence because of the issue of confounding variables and other possible biases, I am not saying we should ignore observational studies but we must note this fact and take it into consideration. Umbrella reviews are the highest evidence we have and they have said the evidence is very weak. When they actually do controlled trials on this subject, the supposed effects of chocolate improving health outcomes do not appear to exist. If there is any evidence for anything on this topic it is very very weak at this point. More research needs to be done.
 * Also as far as I know no public health agency around the world is telling people to eat chocolate to reduce risk of CVD, that is ridiculous. In reality chocolate is a junk food, its ok as an occasional treat (I eat vegan chocolate once every few weeks) but this idea that eating some chocolate will reduce cardiovascular risk factors is nonsense, there is no strong evidence to support this. The statement "Overall, consumption of small quantities of raw cocoa or unprocessed dark chocolate is likely a reasonable approach to support cardiovascular health" is not accurate according to what best quality sources say on this topic. Psychologist Guy (talk) 20:46, 1 November 2021 (UTC)
 * I incorporated the umbrella review into the text below. I am also excluding the Garcia review.
 * My proposed text accurately reflects the findings of several recent reviews. The current text says that there is no effect, which is not the case. --Isabela31 (talk) 22:21, 1 November 2021 (UTC)
 * I looked up the chocolate flavanols myth. It seems that most of the flavanols are removed when they make chocolate. "In reality, many of these flavanols are removed during the manufacturing process. This means chocolate does not contain enough of these plant chemicals to be considered a health food". It seems to be a marketing strategy to sell chocolate claiming chocolate is flavanol-rich and associated with reducing disease risk when there is no strong evidence for these claims. Also there is no good evidence that chocolate reduces LDL, the best review I have seen on foods and LDL is this review  which concluded  "Overall, the evidence was considered very low for a small reduction in LDL cholesterol by chocolate and cocoa". This is not low evidence, it is very low. I believe food articles should be improved and I support adding the umbrella review but as the article currently says "there are insufficient clinical research studies to confirm any effect", I consider this accurate. Psychologist Guy (talk) 00:13, 2 November 2021 (UTC)

Cardiovascular health
The best available evidence suggests that consumption of dark chocolate and other flavanol‐rich chocolate and cocoa products is associated with reduced risk of cardiovascular disease death, acute myocardial infarction, stroke, and diabetes, although this was based on a weak evidence of credibility. Chocolate consumption is positively associated with flow-mediated dilation and insulin resistance markers. However, using the GRADE assessment, the evidence for these outcomes is low or very low.

The protective effect of dark chocolate is thought to be caused by its flavanols. Cocoa flavanols help maintain endothelium-dependent vasodilation, which contributes to normal blood flow. In order to obtain the vasodilation effect, 200 mg of cocoa flavanols should be consumed daily. This amount could be provided by 10 g of high-flavanol dark chocolate. Patients should be informed that commercially available chocolate-containing foods may be high in refined sugars, corn syrup, saturated fat, and dairy products, which may have adverse health effects.

There is moderate‐quality evidence that eating flavanol‐rich chocolate causes a small blood pressure‐lowering effect in mainly healthy adults in the short term, improving both systolic and diastolic blood pressure.

There is weak evidence to suggest that chocolate consumption may be associated with favorable health outcomes. Consumption of small quantities of raw cocoa or unprocessed dark chocolate is likely a reasonable approach to support cardiovascular health. However, commercially available chocolate-containing foods may be high in refined sugars, corn syrup, saturated fat, and dairy products, which may have adverse health effects.

Based on discussion, we can exclude this
Eating dark chocolate improves (decreases) the following cardiovascular risk factors: systolic blood pressure, diastolic blood pressure, blood pressure in patients with diabetes, total cholesterol, LDL cholesterol, and triglyceride levels; it decreases the chances of the following diseases: atrial fibrillation, coronary heart disease, heart failure, and cerebrovascular accident; in patients with peripheral vascular disease, it improves (increases) walking distance and walking time. Serving size of 50 g once a day or once every other day have been shown to help with all these conditions. The benefits for heart disease are maximized at about 150 g of dark chocolate per week, after which they begin to decrease and disappear completely at 350 - 500 g per week.

The most notable effects of chocolate on blood pressure reduction were seen in those patients with initially higher blood pressures who consumed the prescribed amount of chocolate for longer periods of time.

Acne
There are two recent reviews that mention chocolate and acne in the International Journal of Dermatology and. I think these might be better than citing some letter from 2010 written by two researchers from the Physicians Committee for Responsible Medicine. Psychologist Guy (talk) 16:46, 2 November 2021 (UTC)

Refs to consider

 * Morze 2020 PMID 30805697 reported that there are only weak conclusions and most of the studies have low or very low credibility.
 * Gianfredi 2018 PMID 29290347 reported correlation between higher consumption and lower cardiovascular disease.
 * Kwok 2015 PMID 26076934 reported same, plus reduced mortality.

I am not going to edit the article because of my past COI (employment and consulting). If anyone intends to tackle this, I recommend not getting into the biomarkers morass (blood pressure, flow-mediated dilation, lipids, platelets, etc.). At red wine and green tea articles, the reporting is limited to disease risk reduction rather than biomarkers. David notMD (talk) 20:01, 2 November 2021 (UTC)
 * I read two of those, there is a weak effect but it only appears in epidemiologic studies when they do properly controlled randomized trials the effect does not occur. I am not convinced there is any strong evidence on this subject, it's probably best to leave such studies off the article until stronger evidence is reported in the studies. Psychologist Guy (talk) 02:37, 4 November 2021 (UTC)

Suggested changes
I'm not sure an additional page for health effects of chocolate is needed (there is a very good chocolate page that could be expanded after all), but if it has to be, I think it definitely needs to include the effects of fat & sugar as well. The phytochemical content in chocolate is very variable - but in order to achieve the amounts of flavanols mentioned in recent systematic reviews for a potential beneficial effect (~600 mg), one would have to consume a huge amount of chocolate (about 1.5 kg, if the table is correct).

I'm happy to work on this a bit more provided that there is a consensus to be a bit more balanced about the negative effects (fat, sugar) and the lack of evidence for positive effects.

COI: I work in the field of polyphenols and have for the last 20 years, so I clearly have my opinions Ggux (talk) 16:43, 5 September 2022 (UTC)
 * I think this article should be merged into the chocolate article which has a section on "Effects on health" . There is only weak evidence on this topic, it needs many more years research. I don't think we need a stand alone article on this right now. Psychologist Guy (talk) 16:53, 5 September 2022 (UTC)
 * I agree! Ggux (talk) 18:36, 5 September 2022 (UTC)