Botanically speaking, seeds are small embryonic plants—the whole plant stuffed inside a tiny seed, surrounded by an outer layer packed with vitamins and minerals and phytochemicals to protect the seedling plant’s DNA from free radicals. No wonder they’re so healthy. And by seeds, using the formal definition, we’re talking all whole grains—grains are seeds; you can plant them and they grow. Nuts are just dry fruits with one or two seeds. Legumes, beans, peas, and lentils are all seeds, too, as well as cocoa and coffee beans. So, finding health-promoting effects in something like cocoa, or coffee, should not be all that surprising. There is substantial evidence that increased consumption of all these little plants is associated with lower risk of cardiovascular disease.

Of course, much of chocolate research is just on how to get consumers to eat more. While it didn’t seem to matter what kind of music people were listening to when it came to the flavor intensity, pleasantness, or texture of a bell pepper, people liked chocolate more when listening to jazz versus classical, rock, or hip hop. Why is this important? So food industries can integrate specific musical stimuli in order to maximize their profits. For example, chocolate companies may incorporate their chocolate products with jazz-like background music to increase consumers’ acceptance. They cite an earlier study that demonstrated that people rated oyster consumption more pleasant in the presence of the ‘‘sound of the sea’’ than in the presence of ‘‘farmyard noises.’’

You’d think chocolate would just sell itself, given that it’s considered the most commonly craved food in the world. There is certainly not the same degree of interest among patients as to whether or not Brussels sprouts might provide similar cardiovascular protection. So it’s understandable to hope chocolate provides health benefits. Meanwhile, despite their known benefits, Brussels sprouts languish, unloved and unconsumed.

One of the potential downsides of chocolate is weight gain. Though cocoa has hardly any calories, chocolate is one of the most calorie-dense foods. Here’s 100 calories of chocolate, compared to 100 calories of strawberries, for example.

A few years ago, a study funded by the National Confectioners Association, which, among other things, runs the website, reported that Americans who eat chocolate weigh, on average, four pounds less than those who don’t. But maybe chocolate-eaters exercise more, or eat more fruits and vegetables. They didn’t control for any of that.

The findings of a more recent study, though, published in the Archives of Internal Medicine, were less easy to dismiss. No apparent ties to big chocolate; they reported that out of 1,000 men and women they studied in San Diego, those who consumed chocolate more frequently had a lower body mass index, and weighed less, than those who consumed chocolate less often—even after adjusting for physical activity and diet quality. It was a cross-sectional study, meaning a snapshot in time; so, you can’t prove cause and effect. Maybe not eating chocolate leads to being fatter, or maybe being fatter leads to not eating chocolate. Maybe people who are overweight are trying to cut down on sweets. What we need is a study in which people are followed over time, but there was no such prospective study, until now.

More than 10,000 people followed for six years, and a chocolate habit was associated with long-term weight gain, in a dose-response manner, meaning the greatest weight gain over time was seen in those with the highest frequency of chocolate intake. It appears that the reason the cross-sectional studies found the opposite is that subjects diagnosed with obesity-related illnesses tended to reduce their intake of things like chocolate in an attempt to improve their prognosis—explaining why heavier people may, on average, eat less chocolate.

And then the strongest type of evidence, an interventional trial, where you split people up into two groups, change half their diets and indeed, adding four squares of chocolate to people’s daily diets does appear to add a few pounds.

So, what should we tell our patients? Because many cocoa products are high in sugar and saturated fat, family physicians should refrain from recommending cocoa. That’s a little patronizing, though. I mean you can get the benefits of chocolate without any sugar or fat by, for example, adding cocoa powder to a smoothie, but too often doctors think patients can’t handle the truth. Case in point: if your patients inquire, ask them what type of chocolate they prefer. If they respond with milk chocolate, then it is best to answer that it is not good for them. If they say dark chocolate, though, then you can treat them as if they actually have a brain and lay out the evidence.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

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