Diabetes / Primary Care

Chocoholics Rejoice

August 26, 2016
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By Seema Gupta, MD, MSPH
Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine,
Marshall University, Huntington, WV

Dr. Gupta reports no financial relationships relevant to this field of study.

SYNOPSIS: This study shows that consumption of chocolate can potentially improve liver enzymes, guarding against insulin resistance and diabetes onset.

SOURCE: Alkerwi A, Sauvageot N, Crichton GE, et al. Daily chocolate consumption is inversely associated with insulin resistance and liver enzymes in the Observation of Cardiovascular Risk Factors in Luxembourg study. Br J Nutr2016 May;115:1661-1668.

The leading cause of death around the world is cardiovascular disease (CVD). In the U.S.A, deaths from CVD outnumber deaths caused by cancer, respiratory diseases, and accidents combined, and account for nearly one-third of all yearly mortalities. Potential modifiable risk factors for the disease include diabetes, metabolic disorders like obesity, hypertension and high cholesterol. Earlier population-based studies have demonstrably confirmed that type two diabetes patients have higher rates of CVD morbidity, CVD death and all-cause mortality. There is also growing evidence, however, that hyperinsulinemia even in non-diabetics is associated with increased risk for CVD and numerous other diseases and conditions like central adiposity, hypertension, and dyslipidemia. As one of the key lifestyle factors in determining metabolic health, dietary intake can have an integral role in the management and prevention of cardiometabolic disorder.

Polyphenols are found in many plants, and cocoa plants are no exception. This is important as many polyphenols have demonstrated potential in the prevention of cardiometabolic disease. Recently, chocolate consumption has been shown to improve human health, offering antihypertensive, anti-inflammatory, antiatherogenic, antioxidant and antithrombotic effects, in addition to a host of other potential benefits.  Researchers have reason to suspect that these health benefits derive, at least in part, to the polyphenols abundantly present in cocoa. Furthermore, there is evidence that cocoa, and particularly dark chocolate, is actually more beneficial to long-term health (with regards to antioxidant concentration) than red wine or teas due to the high levels of flavonoids present in a single serving. A prior limited study on the short term effects of chocolate consumption revealed a significant decrease in blood pressure as well as an increase in insulin sensitivity among hypertensive, glucose-intolerant patients.  

The authors initially hypothesized that the consumption of chocolate could produce benefits for patients’ liver enzymes and insulin sensitivity. As such, Alkerwi et al collected data from 1,153 patients previously enrolled in the Observation of Cardiovascular Risk in Luxembourg study, a nationwide survey concerning CVD risk factors. A self-administered questionnaire provided the details on the participants’ chocolate consumption. Blood glucose and insulin levels obtained by the researchers formed the basis of each patient’s homeostasis model assessment of insulin resistance (HOMA-IR), while hepatic biomarkers like serum gamma-glutamyl transpeptidase (GGT), serum alanine transaminase (ALT) and serum aspartate transaminase (AST) were gleaned with standard laboratory assays.

To avoid confounding factors, the authors excluded subjects taking antidiabetics from the study considerations, adjusted final results for age, sex, lifestyle, education, and dietary factors. The researchers discovered that consumption of 100 grams of chocolate daily correlated to a reduction in HOMA-IR of 0.16, in serum insulin levels of 0.16 μg/l, and in liver enzymes like GGT and ALT of greater than 0.10 mg/L. Each of the aforementioned findings were significant. There were no significant associations, however, between chocolate consumption and fasting plasma glucose or HbA1c.

Alkerwi et al concluded their study by asserting that there is an inverse relationship between chocolate consumption and levels of HOMA-IR, liver enzymes and insulin in adults. Such a finding suggests that chocolate consumption could be an effective secondary option to improve liver enzymes and protect against the development of insulin resistance.