Chocolate Is Medicine?

It’s official. Food Is Medicine can now take chocolate under its wings. It only took five years, but the FDA has rendered regulatory judgment to officially permit the following claim for the health benefits of chocolate:

“Cocoa flavanols in high flavanol cocoa powder may reduce the risk of cardiovascular disease, although FDA has concluded that there is very limited scientific evidence for this claim.”

What’s the Meaning of This?

This is what FDA calls a qualified health claim. It’s what marketers call a useful tool to help consumers rationalize more consumption of chocolate. “Eat up. It’s good for you.” Added consumption is good for revenue and profit growth, too.

On one hand, it is indeed true that flavanols in cocoa may reduce the risk of cardiovascular disease. The COSMOS study, published recently in AJCN, found mixed results on this question. This was a randomized, controlled study of capsules containing cocoa flavonols. The primary outcome, a composite of cardiovascular events and deaths, fell short of being statistically significant. But on cardiovascular deaths alone (a secondary outcome) researchers found a 27 percent reduction that was significant.

But does this mean chocolate is medicine? Hardly. What it does mean is that you can extract substances from cocoa that may prevent some deaths from heart disease. If you take it in the right dose, in a capsule.

Chocolate Is Not Medicine

There’s a certain dark (chocolate) humor in all of this. People seem content to accept the medicalization of chocolate with a little wink. We can be pretty sure that chocolate treats don’t have much real medicinal value. But the rationalization seems to be easy – what’s the harm?

On the other hand, we hear many serious health advocates fret about admitting that obesity is a complex chronic disease. “If a medical model takes over, people will forget all about prevention,” they say.

Medicalization is in the eye of the beholder. Depending upon personal wishes and biases, it’s either A-OK or an insidious moral hazard.

In this case, our vote is to drop the silliness of chocolate as medicine and enjoy it in moderation.

Click here for the COSMOS study, here for more perspective on FDA’s recent decision, and here to dive into the details of their decision. For more of our thoughts on this, click here.

Chocolate Pudding, photograph by Ted Kyle / flickr

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February 14, 2023