{"id":408,"date":"2014-09-29T17:05:43","date_gmt":"2014-09-29T17:05:43","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=408"},"modified":"2017-08-21T12:09:40","modified_gmt":"2017-08-21T12:09:40","slug":"primary-care-corner-with-geoffrey-modest-md-dark-chocolate-helps-with-peripheral-arterial-disease-pad","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/09\/29\/primary-care-corner-with-geoffrey-modest-md-dark-chocolate-helps-with-peripheral-arterial-disease-pad\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Dark Chocolate helps with peripheral arterial disease (PAD)"},"content":{"rendered":"<p><span style=\"color: #993300\">A recent article on the impressive role of dark chocolate in improving walking for patients with PAD\u00a0(see\u00a0<strong>DOI: 10.1161\/JAHA.114.001072<\/strong>). I can&#8217;t resist it: so many bad things going on around the world and here is a chance to trumpet a universal (or nearly so) positive. So, in this remarkably important study (albeit small, with only 20 patients, mean age 69, 85% with hypertension, 30% diabetes, 90% dyslipidemia, 80% former smokers, 60% on ACE-I, 100% on statins, 95% on anti-platelet drugs), they measured maximal walking distance (MWD) and maximal walking time (MWT) in those randomly given 40 g of dark chocolate (&gt;85% cocoa) vs. 40 g of mild chocolate (&lt;=35% cocoa) in single-blind\u00a0cross-over design study, checking the MWD and MWT at baseline and\u00a02 hours after chocolate ingestion. And&#8230;<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #993300\"><a style=\"color: #993300\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2014\/09\/Chocolate_-_stonesoup.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-409 size-medium\" src=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2014\/09\/Chocolate_-_stonesoup-199x300.jpg\" alt=\"Chocolate_-_stonesoup\" width=\"199\" height=\"300\" \/><\/a><strong>&#8211;dark chocolate increased MWD by 11% (p&lt;0.001) and MWT by 15% (p&lt;0.001). MWD increased from\u00a0110.7m to 122.2m, MWT \u00a0from 124.8 to 142.2 seconds. also flow-mediated dilation doubled (p=0.003)<\/strong><\/span><br \/>\n<strong><span style=\"color: #993300\">&#8211;dark chocolate also increased serum NOx\u200b\u00a0by 57% (p&lt;0.001) and decreased serum isoprostanes by 23%\u00a0(p=0.01), and sNOX2-dp by 37%\u00a0(p&lt;0.001)<\/span><\/strong><br \/>\n<strong><span style=\"color: #993300\">&#8211;no change in above after milk chocolate<\/span><\/strong><\/p>\n<p><span style=\"color: #993300\">There are some data suggesting that oxidative stress as well as endothelial dysfunction, reduced glucose-oxidation, accumulation of toxic metabolites, impaired nitric oxide generation (above study measured the metabolic endproducts of\u00a0serum nitrite and nitrate, or\u00a0NOx)\u00a0play a role in intermittent claudication. Cocoa is rich in polyphenols, which induce arterial dilation (by lowering activation of NOX2, catalytic substrate of NADPH oxidase, which acts as a vasoconstrictor &#8212;\u00a0above study measured\u00a0the\u00a0sNOX2-dp, the serum NOX2-derived protein). This study suggests that dark chocolate down-regulates NOX2-mediated oxidative stress (perhaps mediated by the polyphenols). Other data note increased arterial dilation in smokers with dark chocolate.<\/span><\/p>\n<p><span style=\"color: #993300\">Of note, these very positive changes were after only\u00a040 g of dark chocolate. Just imagine the effects of a much higher dose? Continuous infusion? This study does not undermine the most important PAD therapies: stopping smoking and exercise; it just raises the possibility of combo therapies &#8212;\u00a0eating dark\u00a0chocolate instead of smoking, or eating dark chocolate while walking.<\/span><\/p>\n<p><span style=\"color: #993300\">Geoff<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dark Chocolate helps with peripheral arterial disease (PAD) [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/09\/29\/primary-care-corner-with-geoffrey-modest-md-dark-chocolate-helps-with-peripheral-arterial-disease-pad\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-408","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/408","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=408"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/408\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}