Chocolate

Finally we have some really good news from the world of medical research.  Not just good news, like a drug that cuts the risk of heart attack or a procedure that saves lives.  But really great news.

On September 15th, the New York Times reported on a landmark study involving the salutary effects of a novel therapy on the recovery of patients following a heart attack.  The study, published in the September issue of the Journal of Internal Medicine, assessed the effect of chocolate consumption on the risk of death following a first heart attack.

That’s right: chocolate.

I love to see research like this.  For our entire lives we are lectured on how much fish and legumes we have to consume, what type of food pyramid we have to adhere to, even how many of glasses of water we must imbibe daily.  We are told forego tasty food and snacks and reach for enticing handfuls of celery and carrots when we have the munchies.  I can’t really blame people for believing that we doctors want nothing more for the whole population than to have them run a marathon every day on nothing more than a handful of spinach for calories.

I, of course, am as guilty as the rest of the profession, as my previous blog posts will attest.  We who are responsible for health care delivery want you (who are, in the end, responsible for your own health) to remain fit, and therefore must be the bearers of all the grim news: bad food and poor exercise habits will kill you in the end.  We are obligated to deliver this ominous and unpleasant information because that’s what science provides to us.  It’s really hard to argue against a well-run, double-blinded, placebo-controlled study involving thousands of patients that spits out the conclusion that a diet of vegetables is better for your body than one of Twinkies.

But, at last, we have some really good news we can sink our teeth into (and savor as it melts into warm sweetness in our mouths).  It appears that those who eat chocolate after their heart attack live longer than those who don’t.

The research, done in Sweden (known more for Smörgåsbord and lutfisk than chocolate—I guess not even a Swede could inflict a diet of salted whitefish mixed with lye on patients who’ve already gone through enough with a heart attack), was an observation study rather than a prospective, randomized trial.  This means they polled numerous Svens and Ingmars on their eating habits following the heart attack.  Those who reported higher chocolate consumption were found to live longer.  They also factored in other variables, such as obesity and other dietary habits, to strengthen their conclusion that it was, indeed, the chocolate that imparted the protective effect.  They wisely excluded diabetic patients from their cohort knowing that something as obviously heaven-sent as chocolate simply can’t be good for a diabetic patient.

This isn’t the first time that the link between chocolate and heart health has been studied.  Just this year the esteemed journal Circulation published an expansive review of the cocoa/cardiology literature authored, appropriately, by a team of Swiss cardiologists.  The prevailing theory is that a chemical in cocoa (with the not-so-savory name of epicatechin) exerts an antioxidant effect that protects the heart against the untoward effects of LDL cholesterol.  The dark, least-sweetened, most fat-free variety of chocolate seems to be the healthiest.

Still, all good critics of scientific trials will tell you that we can’t begin to change our clinical practice based on the findings of a solitary observational study.  They’ll explain that rigorous testing must follow before we can translate these findings into general guidelines.  The next step in the process should be the creation and performance of a large prospective study involving thousands of patients to really put the chocolate hypothesis to the test.

This is where we come in.  I propose we launch a massive prospective study to evaluate the effects of chocolate consumption on, well, everything.  We can look at maintenance of heart health, decreasing risk of cancer, prevention of dementia, treatment of depression, etc.  We could seek funding from Hershey or Lindt or  Nestlé and run the study  for four or five years, enrolling ourselves and everyone we know.  Half the group would get rich, dark, delicious chocolate, and the other half would get carob (I’ll make sure you and I get randomized to the good stuff).  We can present the findings to the European Society of Cardiology next time they convene in Zurich.

So next time your sweetheart gives you a box of chocolates for Valentine’s Day, don’t turn up your nose and reach for a celery stick.  Thank them for having your best health in mind as you pick the darkest piece of the bunch and pop it into your mouth with a clean conscience.