Advanced Mediterranean Diet

“Doc, I Hardly Eat Anything And I Still Can’t Lose Weight!”

Saturday, January 31st, 2009

Every now and then an overweight patient tells me he can’t lose weight even though his typical daily food intake is two pieces of plain toast, a cup of grapes, a hard-boiled egg, and three celery stalks. That’s 530 calories. Most adults eat between 1200 to 3000 calories a day.

Even if he lays around on a couch all day watching TV with a remote control channel changer, I know my patient’s basal metabolism requires at least 1,000 calories daily to keep him alive. He says he’s eating only 530. His body must have, and will get, the extra 470 calories from his fat stores. Over time, he must lose weight as his body converts his fat into basal metabolic energy to keep him alive.

Yet he swears he’s not losing weight, and, in fact, may be gaining. I don’t believe he’s lying to me. What’s going on here?

The answer is suggested by a study published in the New England Journal of Medicine. Ten similar “diet resistant” obese people - nine women, one man, average weight 189 pounds (86 kg) - were carefully studied by a team of researchers. They were taught to record all food intake over time in a diary. When the foods eaten were totaled up, average self-reported intake was 1,000 calories daily.

A highly accurate method of measuring calorie expenditure, called “doubly labeled water,” proved that average calorie intake was actually 2,000 calories daily. Furthermore, they over-reported their physical activity by 50 percent. The authors of the study note that while many people under-report their caloric intake, the degree of under-reporting is greater in obese people. They admit that “the mechanisms responsible for this phenomenon are not well understood.”

Their conclusion:

How can we overcome this tendency? One solution is to keep a food journal.

Reference: Lichtman, Steven, et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. New England Journal of Medicine, 327 (1992): 1,893-1,898.

Posted in Weight Loss | 4 Comments »

Informercial Superstar Kevin Trudeau Fined Over $37 Million for False Claims About Weight-Loss Book

Wednesday, January 28th, 2009

In October last year I blogged about the Federal Trade Commission’s judgment - over $5 million - against twice-convicted felon Kevin Trudeau. He is the author of The Weight Loss Cure “They” Don’t Want You to Know About.

Who are “they”? The Federal Trade Commission, apparently.

The FTC objected to Trudeau making false claims in his infomercials for the book.

On November 4, 2008, federal judge Robert W. Gettleman amended the judgment to $37,616,161, the amount consumers paid in response to the deceptive infomercials.

I always wondered how much money those infomercials could rake in. That’s not pure profit, of course: Trudeau had to pay for production costs, air time, etc.

What if he can’t pay the fine? Jail time?

Don’t feel sorry for him. His false claims were so egregious that the $37 million he collected from customers is tantamount to theft. $19.95 at a time, plus shipping and handling.

Don’t be surprised if Turdeau cites this judgment as proof that the government and weight-loss industry have conspired to suppress his weight loss cure.

It warms my soul to know that there is indeed some justice in this life. To the FTC and Judge Gettleman: thank you.

Reference: January 15, 2009 FTC news release: Marketer Kevin Trudeau Violated Prior Court Order

Posted in Quackery | 1 Comment »

“South Beach Diet” Review

Monday, January 26th, 2009

The South Beach Diet:The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss was written by Arthur Agatston, M.D., and published in 2003.

Dr. Agatston’s theory to explain overweight is that we eat too many sugars and starches. The detrimental carbohydrates are concentrated sugars—such as soft drinks, some fruits, and commercial fruit juices—and over-processed low-fiber starches, such as enriched white flour and white rice. These are his “bad carbs.”

According to his theory, bad carbs increase insulin levels sharply, leading to increased fat storage (especially abdominal fat) and increased cravings for carbohydrate as the insulin eventually causes abnormally low blood sugar levels a few hours after the carb intake. Then you eat more carbs to raise your sugar level back to normal. Dr. Agatston spends much time explaining the glycemic index, a measure of how rapid and high a spike in blood sugar is seen after ingestion of particular foods.

This “bad carb” theory is not original or exclusive to Dr. Agatston. Remember “Sugar Busters”? The “bad carb” theory has been popular since around the turn of the century, even though Dr. Robert C. Atkins and others wrote about it many years earlier.

Figuring less prominently in Dr. Agatston’s scheme are his “bad fats”—saturated fats and trans fats. Some of the “good fats” to eat are olive oil, canola oil, peanut oil, and omega-3 fatty acids.

Phase One of South Beach lasts two weeks and eliminates nearly all concentrated carbs, like the Atkins diet Induction Phase. You eat lean meats, fish, nuts, eggs, low-fat cheeses, healthy oils, legumes, and limited vegetable juices and high-fiber vegetables. Saturated fats are eaten in low to moderate amounts. In Phase One, your craving for bad carbs—sugars and starches—is cured, according to the author. In just two weeks.

Phase Two lasts two weeks. “Good carbs” are gradually reintroduced: low-fat milk and yogurt, sweet potatoes, whole grain bread and pasta, most fruits, brown rice, more high-fiber vegetables. Red wine is allowed. Starches are still eaten only sparingly.

Phase Three starts after you have reached your “ideal weight” and lasts the rest of your life. It is similar to Phase two, except even more of the good carbs are allowed. It is close to a Mediterranean diet, although lower in carbs and higher in protein (in eggs, chicken, lean beef, and especially fish). If you gain weight, you cut back carb intake as in the Atkins diet.

The author had intended to produce a diet with few rules, yet he tells you exactly what and when you will eat for 6 straight weeks. The recipes are prepared from readily available ingredients. How much do you eat? “The meals should be of normal size—enough to satisfy your hunger, but no more than that.” So the author never says how many calories you will eat. Although he says it is not a low-carb diet, it is. Especially the first four weeks.

Strongest points?

The composition of South Beach is generally reasonable and would tend to improve health and longevity while controlling weight, compared to the usual Western developed-world diet.
The recipes look tasty and relatively easy.
High-fiber, minimally processed carbohydrates are indeed healthier than pure sugars and refined starches.
Plenty of people say it has worked for them.
Food variety.
South Beach is an improvement over Atkins, especially to the extent that the author moves Atkins toward a Mediterranean-style diet. [By the way, Agatston never claims his diet is Mediterranean.]

Weakest points?

Six weeks of prescribed eating, leaving no room for flexibility.
Exercise is recommended—essentially a brisk walk for 20 minutes daily—but is not stressed nearly enough.
There is certainly no scientific consensus that sugars and starches—“bad carbs”—have caused our obesity epidemic.
There in no reference section and very few references are given. You cannot read for yourself the scientific journal articles, if any, that support the author’s opinions.

An improvement to South Beach would move it further away from Atkins and even closer to the time-honored healthy Mediterranean diet of the mid-20th century, in which more “good carbs” and fewer proteins would be encouraged. And myriad benefits of exercise should not be taken lightly.

Posted in Diet Reviews | 1 Comment »

Oldways Unveils Updated Mediterranean Diet Pyramid

Thursday, January 22nd, 2009

Fifteen years ago, Oldways Preservation Trust introduced its highly influential Mediterranean diet pyramid to the United States. In view of soaring global rates of obesity and diet-related chronic disease, Oldways convened a panel of experts last November to update the pyramid based on new scientific research.

The traditional Mediterranean diet is rich in fruits, vegetables, legumes, nuts, whole grains, fish, olive oil, judicious amounts of wine, with minimal saturated fats. Dairy products are mostly cheese and yogurt. Other characteristics are daily fresh fruits, seasonal locally grown foods with minimal processing, less than four eggs per week, small amounts of red meat, poultry in low to moderate amounts, and concentrated sugars only a few times per week.

Major modifications to the original pyramid are 1) the grouping of all plant foods together at the base of the pyramid to emphasize their health benefits, 2) the addition of “mostly whole” to the recommendation of grains since whole grains deliver health benefits not present in refined grains, and 3) the addition of herbs and spices to the base of the pyramid, reflecting new research on their health benefits.

Prominent Mediterranean spices are cumin, paprika, turmeric, cinnamon, ginger, coriander, anise, Spanish saffron, lemon, mint, parsley, garlic, dill, pepper, and sumac.

Also recommended are 1) consumption of fish at least twice per week, and 2) advice to drink water regularly instead of less healthy beverages.

The press release from Oldways quotes Frank Sacks, M.D., Professor of Cardiovascular Disease Prevention, Dept. of Nutrition, Harvard School of Public Health and Harvard Medical School and co-chair of the scientific committee:

Amen, brother.

Posted in Food | Comments Off

If Dark Chocolate Is Healthy, What’s The Right Dose?

Monday, January 19th, 2009

Antioxidant flavonoids and other phytonutrients in dark chocolate are thought possibly to improve health, primarily through reduction in cardiovascular diseases such as heart attacks and strokes. I previously blogged about these and other potential health benefits of dark chocolate.

In terms of a medicinal agent, we have not been sure of the therapeutic “dose.” A recent study out of Italy provides a clue.

Researchers at Catholic University, Campobasso, Italy, surveyed residents in southern Italy regarding chocolate intake and measured their C-reactive protein (CRP) levels. CRP is a marker of inflammation and a predictor of coronary artery disease such as heart attacks. Generally, higher levels of CRP are associated with higher risk of heart attacks. If you have a choice, go for lower levels of CRP.

Methodology

Participants in the study were selected by simple random sampling from city hall registries and were at least 35 years old. Researchers were looking for healthy people, so the following were excluded from the study: those who reported known cardiovascular disease, eating a special diet, or on drug therapy for high blood pressure, diabetes, or adverse blood lipids. Twenty percent of initial recruits refused to participate. Of the 10,994 initial recruits, 4,849 men and women made it into the final study.

Of the 4,849 subjects, two subgroups were identified: 1) a control group of 1,317 (27%) who never ate any type of chocolate, and 2) a test group of 824 (17%) subjects who regularly ate dark chocolate only.

Interviewers administered questionnaires to the subjects to document clinical and personal information such as dietary habits, socioeconomic status, physical activity, medical history, risk factors for cardiovascular disaese and tumors, family history of cardiovascular disease, drug use, etc.

Regarding chocolate consumption, participants were asked about frequency - daily, weekly, or monthly - of a “standard dose” (20 grams) and about type of chocolate: milk, dark, nut chocolate, or any type. Someone eating more than one type of chocolate was classified as “any type.”

Other measurements: blood pressure, weight, height, waist circumference, blood glucose, serum lipids (various cholesterols and triglycerides), and high-sensitivity C-reactive protein.

Findings

Age-adjusted CRP levels were lower in dark chocolate users (1.13 mg/L) than in the nonconsumers of chocolate (1.30 mg/L).

Dark chocolate eaters were divided into thirds: the lowest third of average consumption, the middle third, and the highest third. The lowest third ate under 19 grams per week. The middle third ate between 19 and 47 grams per week. The highest third ate over47 grams per week. The chocolate-related reduction in CRP was lost in people who were in the highest third (or tertile), i.e., eating more than 47 grams a week or 20 grams every three days. People in the lowest tertile of dark chocolate consumption had a CRP reduction the same as the middle third.

Systolic blood pressure in dark chocolate consumers was 3 mmHg lower than the pressure in nonconsumers. No difference in diastolic pressures.

Discussion

The researchers cite two clinical trials that investigated the effect of cocoa on markers of inflammation but did not find any association. They wonder if those studies enrolled too few participants, or whether the relatively high doses of chocolate masked the effect. In the present study, the lowering of CRP was seen in consumption of up to 20 grams every three days, but seemed to disappear at higher doses.

The authors write that:

The authors are careful to point out that this study does not prove that low-dose dark chocolate lowers CRP levels. It’s an association. “Additional studies are necessary to explain the mechanisms linking dark chocolate consumption and regulation of serum CRP concentrations.”

My Comments

The healthy dose of dark chocolate may be quite small: no more than 20 grams every three days, and perhaps quite a bit less. This is not much by U.S. standards. The serving size listed on many bars here is 40 grams. Forty grams has about 200 calories. Twenty grams twice a week translates to 29 calories a day.

The authors of this study don’t address whether 40 grams a week would be just as healthy as 80 grams every two weeks.

Eating more, on average, than 20 grams every three days may entirely wipe out the healthy effects. This effect is like wine’s: a little is probably good for you, too much is either neutral or harmful.

I’m sorry to be so wishy-washy on this issue, but that’s the state of the science today. The study at hand may help us optimize dark chocolate’s effect on C-reactive protein. But dark chocolate’s other healthy effects may require other doses, higher or lower.

The next step is to take 20,000 middle-aged people, give half of them various doses of scheduled dark chocolate, give the other half placebos, then record rates of diseases and death over the next 10 years. Who would pay for this multi-million dollar study? Either government or chocolate manufacturers.

Reference: Di Giuseppe, Romina, et al. Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population. Journal of Nutrition, 138 (2008): 1,939-1,945.

Posted in Cardiovascular Disease, Chocolate | 5 Comments »

Is the Advanced Mediterranean Diet Adaptable By Vegetarians?

Friday, January 16th, 2009

In a word . . . Yes.

Would it still be the Mediterranean diet? That’s debatable. We could call it a Vegetarian Mediterranean diet.

The traditional Mediterranean diet is rich in fruits, vegetables, legumes, nuts, whole grains, fish, olive oil, judicious amounts of wine, with minimal saturated fats. Dairy products are mostly cheese and yogurt. Other characteristics are daily fresh fruits, seasonal locally grown foods with minimal processing, less than four eggs per week, small amounts of red meat, poultry in low to moderate amounts, and concentrated sugars only a few times per week.

There are many varieties of traditional Mediterranean diet, based on proximity to the sea, local climate and soils, regional customs, religious proscriptions, transportation networks, etc. Some cultural subsets in the region have relatively high meat and saturated fat intake.

Overall, however, the traditional Mediterranean diet is much lower in animal-origin foods compared to the standard American diet. It’s plant-based. But it’s not a vegetarian diet.

In the Advanced Mediterranean Diet, I teach readers how to emulate or approximate the Mediterranean diet by recommending specific servings of grains, vegetables, fruits, fats (overwhelmingly plant-derived), milk products, and proteins (animal and plant origin).

A list of the available foods is here (see Grocery Shopping List).

A lacto-ovo vegetarian - who eats milk products and eggs - could easily use the AMD for weight loss, choosing beans, nuts, peanut butter or tofu as proteins (discussed on page 144).

Vegans, who eat no animal-derived foods, are a little harder to accommodate because of the “milk products” category. Cheese and yogurt are time-honored components of the traditional Mediterranean diet, although not typically in large amounts.

The milk products category is also an acknowledgment that calcium and vitamin D, abundant in milk products, may be very helpful in prevention and treatment of osteoporosis. Milk products are also good sources of high quality proteins. Page 168 discusses non-animal substitutes for milk products.

Browsing at Amazon.com yesterday, I ran across a pertinent book, The Mediterranean Vegan Kitchen by Donna Klein. Published in 2001, it is still selling well.

PS: Any text in this blog post below this point is unauthorized spam. [I guess spam by definition is unauthorized.] I appreciate your patience as I work to solve the problem.

Posted in Shameless Self-Promotion, Vegetarianism | Comments Off

To My Readers at Amazon.com, Regarding Spam

Monday, January 12th, 2009

This healthy lifestyle blog based on the Mediterranean diet is reproduced by syndication at Amazon.com. To view it, click here.

Many of my blog posts show up at Amazon.com followed by long lists of hyperlinks to websites selling drugs or other products or services. These links are not in the original posts and, as far as I know, I am not responsible for them.

Note that I do not endorse any of the products, services, or companies promoted by these hyperlinks. I recommend you not click on them.

You can subscribe to the uncontaminated original blog by RSS.

I am working with Amazon to eliminate the problem.

Update Jan. 15, 2009: Spam appeared at the Amazon.com syndication today, three days after my original posting. Please ignore and don’t click any hyperlinks that appear after this line.

Posted in Quackery, Drugs | 8 Comments »

Dark Chocolate: Love It Or Hate It?

Friday, January 9th, 2009

I have friends who can take a good-sized bite out of a raw jalapeno, chew it, and enjoy it. If I tried that, I would turn fire engine red, sweat profusely, and smoke would seep from my ears. I like jalapeno, but can tolerate only small amounts.

I was reminded of differences in taste when my family was experimenting with different strengths of dark chocolate bars, starting with 65% cacao, then 70%, 72%, 86%, and finally 100%. I enjoyed all of it except for 100% (which is made for cooking).

On the other hand, Mrs. Parker and my daughter had to spit all of it out, and my daughter wiped her tongue with a paper towel hoping it would rid her of the taste.

If sugar is listed as the first ingredient, you may be eating the wrong kind of chocolate for potential health benefits. Dark chocolates tend to have chocolate listed first, as either chocolate, unsweetened chocolate, bittersweet chocolate, or semi-sweet chocolate. Generally, dark chocolates have 60 to 75% of total calories derived from fat. As the cacao and fat percentages rises, you often see less sugar contributing to total calories in a serving. And the bitterness factor rises, thanks to polyphenols. Bitter, acrid, pungent - it’s all the same to me. Sugar and fat counteract the bitterness.

The heat of a jalapeno and the bitterness of dark chocolate are detected by different taste receptors on our tongues.

The best-known bitterness receptor detects the chemical called PROP (6-n-propylthiouracil). One fourth of us can’t taste it; half of us are moderate tasters; one fourth of us are supertasters. Supertasters can detect PROP in minute concentrations undetectable to others and find it repulsive.

But PROP receptors are not the only bitterness detector. So far, about 25 have been identified from human genome sequences. For example, PTC (phenylthiocarbamide) is another bitter chemical taste controlled by genetics.

ScienceDaily on Feb. 5, 2001, reported on a study in women that found no difference from PROP tasters and non-tasters in evaluation or enjoyment of white, bittersweet, or bitter chocolate. Researchers noted that fat and sugar counteract bitterness.

Nevertheless, I suspect my wife’s and daughter’s strong aversion to dark chocolate is genetic rather than a simple preference or “I can take it or leave it” attitude. Must be in one of those 24 other bitter-detection genes.

For further exploration of chocolate’s aesthetic features, check out The Chocolate Life: a community for chocophiles - and aspiring chocophiles - to explore, learn, and share.

Mark Stibich, Ph.D., wrote “How to Taste Chocolate” at About.com. Why not invite over some friends and have a tasting party?

Reference: University Of Washington (2001, February 5). Researchers Show That The Human Genome Is Helpless In The Face Of Chocolate. ScienceDaily. Retrieved January 5, 2009, from http://www.sciencedaily.com /releases/2001/02/010205074522.htm

Additional resources:

Chocolate Production article at Wikipedia.org.

Seventypercent.com. “A resource, information and community site dedicated to fine quality chocolate.”

Posted in Chocolate | Comments Off

Bariatric Surgery Versus Diet and Exercise

Tuesday, January 6th, 2009

Nicholas Yphantides, M.D., wrote in a brief article January 5, 2009, at Diabetes Self-Management about his reduction to an ideal weight after starting at 467 pounds (212 kg) through diet and exercise. The focus of the article is on the risks of bariatric surgery.

In my Advanced Mediterranean Diet book I write that women over 300 pounds and men over 350 pounds ” . . . infrequently have success with self-help methods . . .” That’s still true.

Dr. Yphantides is one of the exceptions that give hope to others.

Posted in Bariatric Surgery | 1 Comment »

Health Benefits of Dark Chocolate

Sunday, January 4th, 2009

Theobroma cacao, the cocoa tree, has been cultivated in Central and South America for over 3000 years. Cocoa is derived from the tree’s seed, also known as the cocoa bean.

Chocolate is a product of the processed cocoa bean. Sweet chocolate is chocolate combined with sugar. Milk chocolate is sweet chocolate combined with milk powder or condensed milk. Dark chocolate typically has no added dairy products, has at least 65% cocoa content, and has much more of the potentially healthy chemicals from the cocoa bean as compared with milk chocolate. White chocolate is cocoa butter (aka cacao fat), milk solids, and sugar without the cocoa solids or mass; in many countries it is not considered chocolate.

It’s been a little over 10 years since we first read in a medical journal about cocoa and chocolate as potential sources of antioxidants for health. What have we learned since then?

Phytochemicals are chemicals produced by plants, and there are hundreds of thousands of them. Polyphenols are a subset of phytochemicals. Flavonoids, with strong antioxidant properties, are a subset of polyphenols. And a subset of flavonoids, called flavonols, have particularly potent biological effects in humans. Prominent flavonols in dark chocolate are flavan-3-ol, catechin, and epicatechin. Also metabolically active are proanthocyanidins, which are polymeric condensation products of flavan-3-ol.

Are you bored yet? Have I convinced you of my authority on the subject? Say yes, or I’ll keep going! [Please say yes: I’m boring myself!]

Note that some chocolate manufacturers process the cocoa beans to remove some of the polyphenols, which reduces bitterness or pungency.

Other rich sources of flavonols are wine, tea, and various fruits and berries.

How could dark chocolate, especially its flavonoids, be healthful?

Flavonoids are antioxidants that protect from injury caused by free radicals
Enhanced nitric oxide production, leading to relaxation of arteries (vasodilation), leading to reduced blood pressure: up to 6 mmHg systolic and 3 mmHg diastolic
Elevation of HDL cholesterol, with no effect on total and LDL cholesterol
Inhibition of platelet aggregation and activation, leading to fewer blood clots that cause heart attacks and strokes
Decreased inflammation
Reduction of C-reactive protein, a marker of inflammation
Decreased neutrophil (white blood cell) activation. White blood cells play a role in inflammation
Decreased LDL cholesterol oxidation, leading to fewer atherosclerotic complications
Improved function of the cells that line blood vessels (endothelium)
Possible enhanced insulin sensitivity
May act as anti-carcinogens and neuro-protective agents
May act as an antidepressant

Note also that low-fat natural non-alkalized cocoa powder is also a rich source of antioxidant flavonoids.

Bottom line? Dark chocolate, especially because of flavonoids, may well be protective against cardiovascular disease such as heart attacks and strokes.

[Did you notice I’m waffling . . . may be protective.]

What’s in dark chocolate other than flavonoids?

A 40 gram serving of a fine dark chocolate bar has:

Calories: 200
Calories from fat: 150
Fiber: 4.5 grams (dark chocolate is a good source of fiber on a “per calorie” basis)
Sugar: 11 grams
Saturated fats: 10 grams

But aren’t saturated fats bad for me?

The fats in dark chocolate are 1/3 oleic (healthy monounsaturated, as in olive oil), 1/3 stearic (saturated, but no effect on cholesterol levels, unlike some other saturated fats), and 1/3 palmitic (saturated, and could increase cholesterol levels and heart risk). So it’s sort of a wash.

[I’m not getting into the diet-heart hypothesis now. Don’t bait me.]

What’s the healthy “dose” of dark chocolate?

No one is sure. It’s certainly no more than 100 grams (3.5 ounces) a day, and the optimal dose may be as low as 20 grams every three days. If you eat too much, it will make you fat. 100 grams is 500 calories; that’s probably way too much. Even if you start eating 20 grams - 100 calories - every three days, you will gain weight unless you give up some other food or exercise a little more.

Parker, why are you waffling?

Because no one has ever done a study to see if adding dark chocolate actually reduces death rates or sickness from specific diseases in humans. I think it probably does, but who knows for sure? Nobody. What we need is a randomized, controlled trial of dark chocolate as a supplement in 10,000 middle-aged adults followed over the course of 10 years. I’d sign up for that in a heartbeat. Just don’t give me the placebo.

Additional Resources:

Clay Gordon, author of the book Discover Chocolate, kindly critiqued an early version of this blog post here. If the link doesn’t work, go to The Chocolate Life and search “Health Benefits of Chocolate” in the Forums.

References:

Erdman, J.W., et al. Effects of cocoa flavanols on risk factors for cardiovascular disease. Asian Pacific Journal of Clinical Nutrition, 17 supplement 1 (2008): 284-287.

Farouque, H.M, et al. Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study. Clinical Science, 111 (2006): 71-80.

Heptinstall, S., et al. Cocoa flavanols and platelet and leukocyte function: recent in vitro and ex vivo studies in healthy adults. Journal of Cardiovascular Pharmacology, 47 supplement 2 (2006): S197-205.

Keen, C.L., et al. Cocoa antioxidants and cardiovascular health. American Journal of Clinical Nutrition, 81 supplement 1 (2005): 298S-303S.

Mehrinfar, R. and Frishman, W.H. Flavanol-rich cocoa: a cardioprotective nutraceutical. Cardiology Reviews, 16 (2008): 109-115.

Engler, M.B, and Engler, M.M. The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease. Nutrition Reviews, 64 (2006): 109-118.

Lippi, G. et al. Dark chocolate: consumption for pleasure or therapy? Journal of Thrombosis and Thrombolysis, September 23, 2008 (Epub ahead of print).

Hooper, L, et al. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 88 (2008): 38-50.

Cooper, K.A., et al. Cocoa and health: a decade of research. British Journal of Nutrition, 99 (2007): 1-11. Epub August 1, 2007.

Aron, P.M., and Kennedy, J.A. Flavon-3-ols: nature, occurrence and biological activity. Molecular Nutrition and Food Research, 52 (2008): 79-104.

Buijsse, B, et al. Cocoa intake, blood pressure, and cardiovascular mortality [in men]: the Zutphen Elderly Study. Archives of Internal Medicine, 166 (2006): 411-417.

Ding, E.L., et al. Chocolate and prevention of cardiovascular disease: a systematic review. Nutrition and Metabolism, 3 (2006): 2.

Posted in Cardiovascular Disease, Chocolate | 3 Comments »