Chocolate – Friend or Foe? Sugar – Friend or Foe?

By Dace L. Trence, MD, FACE

This time of year calls for celebrations with get-togethers, gift exchanges (often food-based) and sharing of meals. Many of these activities are linked to family tradition, or just the pleasures of tasting what the season has to offer. We see treats that might not be available at other times of the year, as well as food that we might bypass at other times, and they are simply too tempting to say no to during the holidays.

One of these tasty treats is chocolate – think cocoa and fudge, but also think added pounds, heart disease and higher cholesterol. But, wait, wasn’t there a study that said chocolate was “good for you?”

Blood pressure (BP)

In a small study of 44 adults (24 women, 20 men) ranging in age from 56 through 73, who had upper normal range or slightly high blood pressure (ranging from between 130/85 to 160/100 mm Hg), eating dark chocolate daily resulted in lowering of both systolic (upper blood pressure number) and diastolic (lower blood pressure number) results.

The study span was 18 weeks, and the daily amount of chocolate eaten by the study group was minimal – approximately 1-1/2 sugar cubes. This study did not include the effects of white chocolate. While the study included willing participants, the criteria for being accepted were very restrictive, i.e., participants should not be taking blood pressure medications, have no history of previous heart problems, and should have normal cholesterol levels.

Although the decrease in blood pressure was minimal, the results of this study shouldn’t be ignored. It’s been estimated that a 3-mm Hg (three-point) reduction in systolic blood pressure would decrease the relative risk of dying from stroke by 8 percent, dying from coronary artery disease by 5 percent, and from all-cause mortality by 4 percent.

Furthermore, blood pressure reductions were in the same range as reported in a different study in which elderly men also had a daily cocoa intake of an average of just over one sugar cube. However, in that study, the goal was to observe the decreased risk of heart disease. The results suggested a relative risk reduction of about 50 percent in death associated with heart disease or all-cause mortality, which indirectly suggested that cocoa, or other unidentified components in cocoa, may be associated with heart disease protective effects that would extend beyond a decrease in blood pressure.

Data supports that chocolate might have an antioxidant effect, and anything that has an antioxidant effect is positive for health.

The most exciting finding of the earlier study is that small amounts of commercial chocolate candy can show a similar blood pressure-lowering potential that matches much more aggressive dietary changes that have been shown scientifically to decrease cardiovascular events. Major or aggressive changes in diet can be very difficult to maintain over time. Just think about how many times you personally might have started a diet and how long it lasted.

People need consistent nudging, monitoring and encouragement to eat fruits and vegetables and fewer processed foods, red meat and other not-so-healthy foods. Now there is scientific support for the benefit of small amounts of cocoa added to your daily diet. It’s amazing that something so pleasurable can be helpful in lowering blood pressure in those whose blood pressure is elevated. The key is to have chocolate in moderation. However, more data is needed to determine if everyone benefits. (Are you willing to volunteer?)


What is it about the end of the year that results in the availability of so much sugary foods? Cookie exchanges, the often-maligned fruitcake, the list goes on and on. So what does science say about sugar’s effect on one’s health?

Surprisingly, evidence suggests that added sugars, not salt, may be the dietary culprit for causing high blood pressure. In a study of people without diabetes, 56 percent of individuals with proven arteriosclerosis (thickening and hardening of the arteries) had abnormal glucose tolerance (defined as abnormal, but not yet diabetes-level blood sugars), suggesting that there is a link between higher-than-normal blood sugar levels and atherosclerosis. The researchers found that a diet high in sugar led to an increase in the level of all major types of lipids (blood fats).

Another study concluded that “…modest intake of dietary sucrose (table sugar) is associated with cardiovascular adaptations that may further burden a heart already compromised by the presence of systemic hypertension.” Simply stated, eating sugars may not only lead to high blood sugar, but also to cardiovascular disease.

Drinking fruit juice daily, which is primarily composed of simple sugars, is also associated with a higher blood pressure. Several animal and human studies have shown that a diet high in sucrose (common table sugar) or fructose (fruit sugar) can increase blood pressure.

Evidence from a meta-analysis of randomized, controlled trials showed that a diet high in sugar for just a few weeks, as compared with a lowsugar diet, causes an increase in blood pressure of approximately 7.6 points in the systolic pressure and 6.1 mm Hg or point in the lower diastolic pressure reading. Therefore, a diet high in added sugars leads to numerous metabolic problems such as water retention, decrease in the ability of insulin to work as it should in the body, and hypertension.

Women who participated in the Nurses Health Study, a study that has followed the health status of female nurses for decades, as well as their risk factors leading to disease, has shown an association between an intake of sugars and the increased development of diabetes. It is important to note that there is a difference between sugars and starches, which convert into glucose for energy through the digestive process. For example, cereals with high fiber were actually protective against developing diabetes, so choose your sugars wisely.

Healthy Eating During Holidays Is Just the Beginning

Everyone knows the importance of a good diet, but is there evidence that this really makes for better health over time? The short answer is, yes. Recent studies with that specific question in mind underscores the importance of maintaining consistent healthy eating patterns over time. A study published in July 2017 by the Harvard T.H. Chan School of Public Health was the first to show that improving diet quality over at least a dozen years is associated with an 8 to 17 percent reduction in the risk of death, depending on diet quality. Conversely, worsening diet quality was associated with a 6 to 12 percent increase in the risk.

A significant improvement in the diet was due to increasing intake of nuts and legumes (peas, beans, chickpeas, lentils, soybeans, peanuts) from zero servings to 1 serving per day and decreasing intake of red meat and processed meats like bologna from 1.5 servings per day to rarely.

This underscores the importance of maintaining healthy eating patterns over the long term. So, as you are tempted with all sorts of goodies during this holiday season, remember that “tasting” is different than “eating,” and portion size control can be your friend.

Looking To Reduce Your Sugar Intake? Here Are Some Ideas To Spice Up Your Food

Although sugar is affordable, easily accessible and sweetens a dish without any other effect on the dish’s flavor profile, with multiple studies pointing to sugar as a contributing factor for high blood pressure, cardiovascular disease and diabetes, it might be time to consider some options for healthy eating.

Perhaps surprisingly, there are a number of alternatives that can reduce the amount of sugar in a dish without compromising flavor.

New York-based baker, food writer, blogger and 2016 James Beard Award nominee Sam Seneviratne illustrates this brilliantly in her book, “The New Sugar & Spice: A Recipe for Bolder Baking.”

In the book, Seneviratne details the history of sugar in foods, noting that it once was considered a spice and was difficult to come by. As such, people incorporated it in their cooking that way, using it sparingly and only for special occasions.

Using that knowledge and her love of spices as a jumping off point, Seneviratne’s book offers more than 80 innovative dessert recipes – such as FiveLayer Honey Cream Cake, Sour Cherry Almond Pie and Portugese Custard Tarts with Passion Fruit and Blueberries – for spice-centric sweets featuring ingredients like cinnamon, peppercorns, vanilla, cardamom and freshly grated nutmeg that play a bigger role than sugar to provide flavor in her recipes.

Honey, brown sugar, molasses and agave nectar can be used as healthier substitutes to granulated sugar when a touch of sweetness is key to your dish. And there are flavorful substitutes for more savory dishes as well: sauteeing and sweating onions in oil on a low heat will cause them to carmelize into a perfectly sweet flavor. Root vegetables like yams, parsnips and carrots, along with mashed fruits such as apricots and apples, can also be used to add sweetness to dishes.

Even the most diligent eater can be derailed when trying to avoid foods that contain sugar. Fortunately, you don’t have to choose between tastiness and health. Adding flavor with herbs, spices and other items can make food taste better, and adding spices in particular to foods makes it easier to reduce added sugars without compromising flavor. There’s no need to sacrifice flavor for good nutrition.