HDL vs Chocolate

Just the other day, I reviewed a study looking at the benefit of high cocoa content chocolate on chronic fatigue syndrome.  Yesterday, I reviewed another study looking at the benefit of low carbohydrate caloric restriction on HDL levels.  In the skewed logic of my children, one might then ask whether high cocoa content chocolate might have an impact upon HDL.

In a small, short study published this month (and yes, I do review larger, longer studies, too), the authors randomized 12 participants with well-controlled Type 2 diabetes (average HgbA1c 6.4%) to placebo vs 15g three times daily of 85% cocoa content chocolate for 8 weeks, followed by a 4 week washout period, and then crossed over for a final 8 weeks.  This randomized double blind placebo controlled cross over study allowed each of the subjects to also serve as their own controls.  Parameters were checked at baseline, after the first 8 weeks randomization, after the 4 week washout & after the 8 week cross over.

The first bit of good news?  Despite adding 45g daily of chocolate, the participants did not gain weight, lose glycemic control, or worsen their insulin response.  More importantly, compared to their results from placebo, the consumption of high cocoa content chocolate increased HDL from 1.16mmol/L (45mg/dL) to 1.26mmol/L (49mg/dL) & lowered cholesterol:HDL ratio from 4.4 down to 4.1, both statistically significant findings. In fact, this 10% increase in HDL is equivalent to the results obtained from less tasty pharmacologic assistance.

What's this mean for our patients with T2DM?  Conventional wisdom has always stated that diabetics should avoid candy but this study throws that thought out the window.  High quality, eg 85% cocoa content, chocolate in moderation (15g three times daily) can be a healthy adjunct to their meals.  Given what we know about all the other benefits of this type of chocolate, there's really no reason to avoid it unless you're allergic.  In the meantime, I'll see if I can find a large, long-term study of low carbohydrate caloric restriction vs chronic fatigue syndrome.  But don't hold your breath!