dark chocolate helps with periph arterial dz

recent article on the impressive role of dark chocolate in improving walking for patients with PAD (see PAD dark chocolate JAmHrtAssn2014 in dropbox, or doi: 10.1161/JAHA.114.001072) -- i can'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 (>85% cocoa) vs 40 g of mild chocolate (<=35% cocoa) in single-blind cross-over design study, checking the MWD and MWT at baseline and 2 hours after chocolate ingestion. and...

    --dark chocolate increased MWD by 11% (p<0.001) and MWT by 15% (p<0.001). MWD increased from 110.7m to 122.2m, MWT  from 124.8 to 142.2 seconds. also flow-mediated dilation doubled (p=0.003)
    --dark chocolate also increased serum NOx​ by 57% (p<0.001) and decreased serum isoprostanes by 23% (p=0.01), and sNOX2-dp by 37% (p<0.001)
    --no change in above after milk chocolate

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 serum nitrite and nitrate, or NOx) play 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 -- above study measured the sNOX2-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.

of note, these very positive changes were after only 40 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, just raises the possibility of combo therapies -- eating dark chocolate instead of smoking, or eating dark chocolate while walking...

will send around again some of my older but still very important blogs on chocolate.  

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