Sunday, August 4, 2013

Chocolicious Statin: One Week "on" 100g/day of 70% Dark Chocolate Improves Cholesterol Profile and Reduces Waist Circumference in "Skinny Fat" Women

With the average German eating 9-10kg of chocolate per year we should be pretty heart healthy... well, if more than 10g of those were dark chocolate, I suppose.
You know what? I am pretty enervated by the reverberations of the notorious "chocolate makes Nobel Laureates" study. Even now, month after the publication, the media hype and the head-shaking on part of anyone who does have the slightest idea of the difference between association and causation, it's still all over the place.

On my part this has lead to a "desensitization" with respect to the word "chocoloate" in medical journals, so that I had almost missed this ground-braking study from the Department of Neuroscience at the University of Tor Vergata in Rome, the National Institute for Mediterranean Diet and Nutrigenomic in Cosenza and the UOS of Pharmacology, Department of Pharmacology at the University Magna Graecia,Roccelletta di Borgia in Catanzaro, Italy (di Renzo. 2013)

Chocolate for the skinny fat

As if it was not already enough that this is a "non-Nobel-Laureate-infected" study on chocolate consumption, it's also study on skinny fats: 15 women in the age of 20-40 years with a normal BMI, but high total body fat mass (FM) percentage (FM% > 30%) and significantly higher values of proinflammatory cytokines, such as IL-1, IL-6, IL-8 and TNF-α. SuppVersity reader what else can you ask for?

Well, ok.... probably you could ask what the study was all about. So, the intervention was pretty simple:After a dark-chocolate-free (DC) washout period, the subjects received 100g of dark chocolate per day for 7-days (50g in the morning another 50g as an afternoon snack or at dinner).The dark chocolate contained (only) 70% cocoa and was provided as an unrestricted gift from Valrhona, Tain l’Hermitage, France. Of the 70% cacao in it, 42.5% were cacao butter with a fatty acid composition of 64.6% saturated fats, 34% monounsaturated fats and only 4.4% PUFA. The sugar in the chocolate was almost exclusively saccharose.
Chronic diet = skinny fat!? (learn more)
Did you know? In previous studies, di Renzo et al. found that 10% of the Italian women fall into the "skinny fat", or as they put it "normal-weight obese" category. These women had similar increased cardiovascular disease (CVD) risk indexes values, as their pre-obese peers, but did not manifest the metabolic syndrome, despite a cluster of metabolic and genetic features associated with increased CV mortality (di Renzo. 2006, 2009, 2010; Marques-Vidal. 2010).
Moreover, the chocolate contained 2% polyphenols, and 0.7% theobromine, as well as 444mg/kg naturally occurring catechins, 908mg/kg epicatechin and 20, 20 and 40mg/kg epigallocatechin gallate epicatechin gallate, Epigallocatechin, respectively.

Improved blood lipids, improved body composition, improved....

The main outcomes of the study were the changes in body composition (DXA), blood pressure, anthropometric measurements, biochemical parameters and plasma levels of some cytokines within the 7-day intervention period.
Figure 1: Changes in lipid and glucose metabolism during the 7-day chocolate intervention (di Renzo. 2013)
And as you can see in figure 1, the results were ambiguous. We have the great and statistical signifcant improvement on the cholesterol side of things, as well as a reduction in specific markers of infallamtion, i.e. IL-6 (-33%), TNF-α (-19%) and IL-1Ra (-33%) and a 1cm reduction in waist circumferene. On the other hand, we do also see increases in fasting insulin and insulin resistance, which did not reach statistical significance, but remind me of the inverse effects on lipid and glucose metabolism we see with so many other agents with cholesterol lowering effects.

Still if we rely on statistics, the overall effects is a beneficial one, but...

There is another string attached, though, due to which I still cannot wholeheartedly recommend to add those 100g of chocolate to your diet, because the scientists did not have the funds for a control group... that's a major bummer. After all, we don't really know if the changes were not brought about by the standardization of the diet, which took place at the beginning of the DC abstinence period and of which the authors write:
Did you know? In another study 40g of dark chocolate consumed on a daily basis for 2 weeks were able to reduced the urinary excretion of the stress hormone cortisol and catecholamines and partially normalized stress-related differences in energy metabolism in 30 human subjects, who were classified in low and high anxiety traits using validated psychological questionnaires. (Martin. 2009)
"Total daily energy content of the diet was determined on an individual basis, calculated using De Lorenzo et al. prediction equation for the Italian population. Initial caloric levels were adjusted, when necessary, to maintain the body weight. All subjects received about 1700 kilocalories/day. The recommended composition of the dietary regimen was as follows: carbohydrates, 55% to 60%; proteins, 15% to 20% (of which about 50% was comprised of vegetable proteins); total fat, 25% (saturated fat acids (SFA), less than 10%, and cholesterol consumption, less than 300 mg per day), and 30 g of fibre.

[...] The composition of the diet in terms of foods and food combinations was planned to obtain an animal to vegetable protein ratio as close to 1:1 as possible. The Italian Recommended Dietary Allowances were incorporated to ensure proper vitamin and mineral intake."
Otherwise, the subjects were were advised "not to consume any other chocolate for the duration of the study" and to make "no further changes to their diet and lifestyle habits" (di Renzo. 2013).

Bottom line: I do not question the value of adding a chunk of dark chocolate to your diet from now to then and I believe the beneficial effects on your blood lipids is well-established enough to even suggest the supplementation with "pure" chocolate (90%+) just for this porpose.

The EDC Program - Exercise + Diet + Chocolate (learn more)
The question is yet, do you need that? If you are skinny fat, probably. If you work out regularly and have your diet in check, unlikely. So, why would you want to run the risk of being among those of the ladies in the study at hand who must have experienced pretty extreme elevations in fasting insulin. If we were talking about something that happened across the board to all of them, the data would be statistical significant. The way it is, my best bet is that the increase in circulating free fattty acids in response to the combination of catechins + theobromine may be to blame. And this response can very well be very different from one individual to the other. But who knows, maybe it was just the dietary switch (?) to an up to 60% carbohydrate diet that was to blame for these results!?

References:
  • Di Renzo L, Bigioni M, Bottini FG, Del Gobbo V, Premrov MG, Cianci R, De Lorenzo A. Normal Weight Obese syndrome: role of single nucleotide polymorphism of IL-1 5Ralpha and MTHFR 677C-->T genes in the relationship between body composition and resting metabolic rate. Eur Rev Med Pharmacol Sci. 2006 Sep-Oct;10(5):235-45. 
  • Di Renzo L, Gloria-Bottini F, Saccucci P, Bigioni M, Abenavoli L, Gasbarrini G, De Lorenzo A. Role of interleukin-15 receptor alpha polymorphisms in normal weight obese syndrome. Int J Immunopathol Pharmacol. 2009 Jan-Mar;22(1):105-13.
  • Di Renzo L, Galvano F, Orlandi C, Bianchi A, Di Giacomo C, La Fauci L, Acquaviva R, De Lorenzo A. Oxidative stress in normal-weight obese syndrome. Obesity (Silver Spring). 2010 Nov;18(11):2125-30.
  • Marques-Vidal P, Pécoud A, Hayoz D, Paccaud F, Mooser V, Waeber G, Vollenweider P. Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation. Nutr Metab Cardiovasc Dis. 2010 Nov;20(9):669-75.