Chocolate intake and risk of type 2 diabetes: prospective cohort studies

https://www.bmj.com/content/387/bmj-2023-078386

by gnabgib • 2 years ago

83 95 2 years ago

m348e912• 2 years ago

Key Takeaway:

Participants consuming ≥5 servings of dark chocolate per week had a significantly lower risk of T2D (21% lower) compared to those who consumed little or none.

julianeon• 2 years ago

This is useful because, at a glance, most people would probably assume chocolate is a candy and candy is bad and the study just added another drop to that bucket of evidence.

robertlagrant• 2 years ago

Milk chocolate is very different. Don't take the wrong lesson from this.

markus_zhang2• 2 years ago

I always wonder how much is one serving? 1 ounce? Why can't they just say 1 ounce or xx grams? Same goes to "cup", guess it's an American thing.

scrozier2• 2 years ago

You're right about the "serving" thing. But in the US, at least, a cup in a culinary context means precisely eight ounces.

magicalhippo• 2 years ago

Brian Regan had a good one on that[1].

[1] https://www.youtube.com/watch?v=LBko_3wT44Q

JoshTko2• 2 years ago

Investigator initiated grants from Mars Edge i.e. the Chocolate candy company. Mars edge a health focused dept which has like a cocoa based health supplement.

Pigalowda• 2 years ago

Good catch! This is too much conflict for me to take seriously. Like the beverage and tobacco industry studies.

Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the National Institutes of Health for the submitted work. JEM reports receiving investigator initiated grants from Mars Edge. EBR is on the scientific advisory board and has received research funding from the US Department of Agriculture/US Highbush Blueberry growers commodity group.

Wolfenstein98k3• 2 years ago

What is the proposed mechanism for Mars getting the outcomes to be positive?

I understand the implied incentives, but either there is fraud in the paper, or the methodology should reveal how the scientists contrived false outcomes.

Otherwise, why does the paper conclude that milk chocolate - Mars' biggest source of revenue from chocolate - has no association with good outcomes and has association with weight gain?

szundi4• 2 years ago

Not getting the next grant is hurting your income. So obvious.

JoshTko2• 2 years ago

P hacking is easy. Get test and control groups. Measure 40 health attributes. Give test group your special compound. Measure 40 health attributes again. Keep only results that show positive benefit (avg. around 2 by random chance). Publish, profit. Data would be clean and does not need to be manipulated. The overall scientific process is rife to be corrupted as long as tester and measurer are the same party, especially when there is financial incentive.

UniverseHacker• 2 years ago

As an academic PI I would not feel the slightest inclination or pressure to produce results favorable to a company just because I got a research grant from their foundation. Most such places use volunteer external reviewers to avoid a conflict of interest in who gets funded- and I have also served in that role for private foundations before.

szundi4• 2 years ago

Also plausible to think that THEREFORE you are not getting any grants from Mars.

meiraleal• 2 years ago

Added: /s

idontwantthis• 2 years ago

Perhaps people who enjoy less sweet foods don’t eat too much sugar.

jey• 2 years ago

This sounds extremely confounded by lifestyle, socioeconomic status, and overall diet. The kinds of people who eat dark chocolate are clearly a self-selected bunch of outliers. Even though they tried to correct for some of these covariates, I'm personally going to take these results with a pinch of salted chocolate.

To be fair, the authors do acknowledge these limitations of their methodology, and these kinds of studies are a useful part of the overall enterprise of science to explore and propose hypotheses.

First, we cannot entirely rule out the role of confounding in our observed associations. We controlled for multiple lifestyle and dietary covariates that might confound the associations of interest, although residual or unmeasured confounding, or both, may still exist owing to the observational nature of the analysis.

Regardless, I'll go ahead and take this finding as a further justification to keep eating dark chocolate.

mrsilencedogood• 2 years ago

I'm also suspect for similar reasons, but this at least seems consistent with lots of other stuff we're finding out about the random things humanity has been imbibing for millennia (coffee, tea, cacao, etc). Anything that's anti-inflammatory seems to help fix a lot of stuff, as long as whatever you do to get that anti-inflammatory effect doesn't have too many downsides.

For instance, I wonder if we'll eventually find an NSAID that isn't hard on the liver, and low doses end up in things like vitamins. (My understanding is that that's the main reason you can't just constantly take small doses of advil - the marginal positive effects of reduced inflammation are outweighed by your kidneys and liver being made to constantly work harder).

akira2501• 2 years ago

To arrive at a conclusion which suggests you should always just add a fixed amount of some substance to your diet seems generally flawed to me. It treats bodies like they're all average machines with fixed inputs and predictable results and zero emergent properties.

If wonder if we'll eventually improve genetic and blood testing to the point where everyone can have customized daily information to help them make the best individual choice.

FriedPickles• 2 years ago

Hopefully there will be a follow up RCT. I volunteer for the test group.

fire_lake3• 2 years ago

Dark chocolate often has very high sugar levels. You might try to self correct but corporations are always on your heels.

WoodenChair• 2 years ago

Dark chocolate often has very high sugar levels.

Milk chocolate usually has higher sugar levels than dark chocolate.

RankingMember2• 2 years ago

If you're going to eat chocolate, dark has by far the lowest sugar content among chocolate types.

Tarsul• 2 years ago

Dark chocolate cannot have more sugar than 100% minus how much cacao is inside. And usually if we're talking dark chocolate then we're talking 60%+ chocolate. My personal suggestion is to go for nothing less than 80-85% chocolate, which certainly does not trigger my sugar addiction (meaning it suffices to eat one or two pieces); even more it appears to reduce my appetite (similar to tea). And also makes me feel happy (there are articles about these effects, but I don't know how good the studies behind it are, but certainly worth a mention!). Truly a gift.

apothegm• 2 years ago

Depends on the specific dark chocolate. Yeah, Hershey's dark chocolate is mostly sugar. But a lot of people prefer dark chocolates with much higher cacao ratios.

85% dark chocolate has something like 3-4g sugar per serving. That’s less than what’s in a typical slice of bread in the US. Which may say more about the bread than about the chocolate — but the point is that you’re probably getting more sugar in your “healthy” lunch sandwich than in the morsel of dark chocolate you have for dessert afterwards.

(P.S. the chocolate also has more fiber than the bread!)

ricardobeat• 2 years ago

This is always the top comment on these studies, but come on, it’s a medical journal. As you already pointed out they did adjust for confounding factors, you simply cannot exclude them completely with a single study.

Projectiboga• 2 years ago

Yes, this also measures how well of these individuals are as Chocolate is a luxury product. This needs to be examined sorting into economic cohorts.

helph67• 2 years ago

Just a few of the many benefits... "Dark chocolate is packed full of important minerals, including iron, magnesium, zinc, copper and phosphorus. In your body, these minerals are used to support factors such as immunity (zinc), can help keep your bones and teeth healthy (phosphorus), and contribute to better sleep quality (magnesium)." https://health.clevelandclinic.org/dark-chocolate-health-ben...

alehlopeh• 2 years ago

Whenever I see a sentence claiming something is “packed” with stuff, I wonder why they didn’t just say it contains stuff. My conclusion is that it was written by marketers to try and sell something.

vixen99• 2 years ago

Perhaps because 'packing' kind of implies adding a few extras to what's already there. We can assume your conclusion is always true.

Modified3019• 2 years ago

Dark chocolate also tends to be “packed” with lead, arsenic and cadmium.

Funny enough, “organic” certified kinds can end up worse on the spectrum. Sometimes the source of the issue is the soil, other times it gets contaminated during processing.

Spices have the same problem. As well as anything concentrated, like protein powders.

lifesaverluke• 2 years ago

Got a (reliable) source?

leptons2• 2 years ago

Dark chocolate isn't any more likely to have lead, arsenic or cadmium, that simply isn't how it works. Dark chocolate is a result of mixing the cocoa powder with alkali, and the more it is processed with alkali, the darker it gets. All cocoa powder starts out a light brown color. The cacao beans are where the lead, arsenic and cadmium come from, as those metals are present in the soil, and it affects chocolate of any darkness.

litoE• 2 years ago

The dietician at the UCLA Cardio Rehab Center recommended trying 95% Cocoa chocolate if you have chocolate cravings because it has much less sugar than regular chocolate. My experience (sample size N=1) is that if I get a craving for chocolate I can eat a single square of the stuff and, because of the high cocoa content, it feels like I just ate a whole box of regular chocolates.

neeleshs• 2 years ago

95%! Isn't that too bitter? One square of 72% works best for me, 85% is pushing it.

programLyrique• 2 years ago

I mostly eat 90% and now find 85% too sweet (but 100% too bitter). I think our taste just adapts to the level of sweetness after some time.

djtango• 2 years ago

Ymmv 99+ with some black coffee is delightful for me

technothrasher• 2 years ago

Depends upon the bar. I find some 99% bars very enjoyable, and some 70% bars not worth eating, and vice versa. I tend to stay away from any bar with too much sugar, or with adjuncts like dairy, salt, chili, mint, orange, etc (because I find they hide the natural flavors in the chocolate itself), and then don’t worry about the percentage as much.

plorkyeran• 2 years ago

The quality of the chocolate matters a lot more when you don't have sugar covering up the problems.

tptacek• 2 years ago

85 is the optimal %.

worik3• 2 years ago

95%! Isn't that too bitter? One square of 72% works best for me, 85% is pushing it.

Agreed. But I like embedded almonds too

Tagbert• 2 years ago

For me, those high cocoa chocolates taste unbalanced and unsatisfying. I quickly stop easting them and look for something else. If all I taste is dry and bitter, that is not what I am looking for. I want a little cocoa butter smoothness and a little sweet, too.

justsomehnguy• 2 years ago

For me a high cocoa chocoalte tastes unbalanced... and this is why I like it. The only problem I have it's sold at the same size with 50/50 sugar cocoa chocos and that means I'm set after a few chips and the rest is wasted sitting in the corner till be disposed.

I would be fine with ~25g one (even at the 1/2 of the cost of a 'full' bar) but looks like noone is interested.

nytesky• 2 years ago

Really depends on quality of chocolate. Trader Joe’s 85% is okay but a German bar from Lidl at 85% is amazing.

I find in all cases, mixing dark chocolate with peanut butter even without additional sugar evokes a memory of my lifetime enjoyment of Reese’s and it is delightful. I suspect hazelnut or almond are good options too, and reduce sugar ratio further.

gbasin3• 2 years ago

i eat half a bar of it per day, amazing brain fuel

2OEH8eoCRo0• 2 years ago

Dark chocolate covered coffee beans are nice

markus_zhang2• 2 years ago

Just curious how much is half a bar? I bought a few 100% but they look large...

krackers• 2 years ago

If you're eating that much, be careful about cadmium and lead.

sgt• 2 years ago

For dark choc, going for 70% is enjoyable yet also healthy.

mksreddy• 2 years ago

I found this Simple way to stop chocolate craving, don’t have one at home.

bdangubic2• 2 years ago

they don't have chocolate outside of your home where you live? you have access to them only at your house?

bdangubic2• 2 years ago

"smoking improves short-term memory" - study sponsored in part by Philip Morris

loehnsberg• 2 years ago

For all those screaming confounds, you can run experiments. Just please keep sampling until you get good results for milk chocolate as well.

kjhughes2• 2 years ago

On the other hand, Lead and Cadmium Could Be in Your Dark Chocolate:

https://www.consumerreports.org/health/food-safety/lead-and-...

slwvx• 2 years ago

On the other other hand rat poop, bug bits, mice hair can be in your chocolate. And an asteroid can destroy earth tomorrow. I don't think any of these things should be especially worrying.

https://www.cnn.com/2019/10/04/health/insect-rodent-filth-in...

derefr• 2 years ago

Unlike those other things, which are external contaminants that find their way in due to non-sanitary processing conditions, cadmium and lead in chocolate come from the soil the cocoa trees grow in, and end up in the beans themselves, in a way that is effectively impossible to extract from them.

Also, from what I've read in other sources, the higher the cocoa content in chocolate, the higher the mineral content (including these "bad minerals") in the chocolate.

And also — frustratingly — the soil that has these soil minerals, is also the soil that imparts what people generally consider to be more interesting/tasty terroir into the chocolate. The single-source, ethical, sustainable chocolate? Highest heavy-metal content.

autoexec• 2 years ago

It's disturbing to think about, but there is a "safe" level of rat shit, bug parts, and mouse hair while there is no safe level of lead and while food contaminated with feces can make you sick, heavy metal poisoning can make you measurably dumber which is more frightening to me.

ASalazarMX• 2 years ago

We are tiny motes of meat briefly living in a thin layer around an insignificant wet rock circling a mediocre star in the backwaters of a mediocre galaxy.

The universe is incredibly, unimaginably stupidly big; how significant is eating a little bit of dirt in your chocolate compared to that?

kjhughes2• 2 years ago

That CNN article is a light-weight review of select food defects allowed, not measured, by the FDA and chosen by the author for their yuck factor. I wouldn't let any of it justify a dismissiveness of heavy metals in dark chocolate.

The Consumer Reports article presents investigative results that measured actual heavy metals levels in dark chocolate. It's worth considering by anyone encouraged to increase their dark chocolate consumption by the diabetes study.

yosito• 2 years ago

Well, this explains why I haven't developed type 2 diabetes, my dark chocolate addiction!

GrantMoyer• 2 years ago

From the results section:

In the age and calendar time stratified Cox proportional hazards models, no significant associations were observed between total chocolate consumption and risk of T2D in the pooled dataset (table 3). After adjusting for lifestyle and dietary risk factors, we found that participants who consumed ≥5 servings/week of any chocolate showed a 10% (95% CI 2% to 17%; P trend=0.07) lower relative risk of T2D compared with those who never or rarely consumed chocolate.

To me, this sounds like there was no correlation, but after weighing the data by other factors (including BMI, according to the methods section) a correlation appears. Does that mean if members of a subgroup eat lots of chocolate, but also have much higher BMIs, because they also eat lots of everthing else, they could have a lower adjusted risk for type 2 diabetes, even if they actually have a higher incidence of type 2 diabetes? Am I misinterpreting?

ivewonyoung• 2 years ago

Does that mean if members of a subgroup eat lots of chocolate, but also have much higher BMIs, because they also eat lots of everthing else, they could have a lower adjusted risk for type 2 diabetes, even if they actually have a higher incidence of type 2 diabetes

They have a lower risk compared to others with similarly high BMI but don't consume dark chocolate.

BMI is a risk factor for T2D so to tease out the effectiveness of a given proposed remedy, you need to compare like to like, i.e compare people of similar BMI that eat dark chocolate and don't eat dark chocolate.

riehwvfbk• 2 years ago

But since dark chocolate is not exactly a staple, what this is actually selecting for is "people who eat a variety of foods in big quantities" vs those who "gained all their weight from frozen pizza". It seems a no-brainer that the former is the relatively healthier choice. But that's not science. Science apparently is picking one variable at a time, blanking the rest of you mind, and drawing a conclusion.

Wolfenstein98k3• 2 years ago

The people who consume dark chocolate (harder to overeat, and suggests less of a sweet tooth) are less likely to have Type 2 Diabetes.

What a surprise!

zamadatix2• 2 years ago

Once you start with "people who tend to eat variants of foods lower in carbs and higher in fiber tend to be less likely to have Type 2 Diabetes" you can come up with any further supposition of why.

aucisson_masque2• 2 years ago

Did anyone ever looked at the back of a chocolate? They are usually around 50% sugar, 50% fat.

Even black chocolate contains quite a bit of sugar and it doesn't negate the fact that chocolate is very fat.

I don't need scientific studies to know that eating brown chocolate will make you fat and diabetic while dark chocolate will make you only big. It's nutrition 101.

worik3• 2 years ago

This bar of Whittaker's Dark Almond (https://www.whittakers.co.nz/en_AU/products/dark-almond/bloc...):

Average Quantity

Serving size

Energy 2300kJ

Protein 11.4g

Fat - total 35.3g

Saturated 14.6g

Carbohydrates - total 45.8g

Sugars 32.4g

Sodium 16mg

Yum!

tomalbrc• 2 years ago

Why is fat bad

aucisson_masque2• 2 years ago

Fat is very caloric, fat makes you... Fat.

It's not inherently bad, it's just that when you are already overweight like for instance 60% something American, you better avoid fat.

worik3• 2 years ago

This is what I want to hear. Must be true....

robomartin2• 2 years ago

participants who consumed ≥5 servings/week of any chocolate

Outside of what I've come to refer to the "food should be food" group, if you regularly consume five or more servings per week of any food, you will do damage to your body in one of many ways. Ice cream, processed shit, hyper-sugar-content anything, soft drinks, almost anything at fast food joints, Starbucks and more.

I adapted the "food should be food" idea from Dr. Pradip Jamnadas' "bread should be bread" statement in one of his lectures [0]. Good foods include: Meat, poultry, seafood, vegetables, fermented foods (plain yogurt, kimchi, etc.), etc. Most good food items do not need a label.

People are hurting themselves every day with highly processed industrialized food to such an extent that eating five servings of chocolate per week (of any kind) is irrelevant. In other words, this study is about noise, not signal. And, in general terms, no one food item --unless consumed to a ridiculous excess-- is responsible for negative or positive effects of note.

In other words, if you eat shit food, you are not going to fix it by taking a bunch of vitamins, magic pills, injecting yourself with the latest magical drug or eating a few servings of a magical food purported to fix all your problems.

And then there's exercise. There's a massive difference between sitting in front of a computer all day and being active.

As I got older, learned about and tried a number of approaches to health maintenance I have come to believe that most of what's out there is harmful noise. The formula is simple:

  - Be active
  - Eat real food in moderation
  - Avoid sugar (in its many forms) like your life depends on it
  - Eat fruit in moderation and when it is in season
  - Be highly selective when eating fruit:
      - There's a huge difference between bananas and avocados
  - Reject highly processed foods
  - Avoid foods with nutrition labels full of crap you don't understand

For example, peanut butter should consist of peanuts and a very small amount of salt, nothing more, anything else should stay on the shelf. Yogurt should not be full of sugar.

[0] https://www.youtube.com/watch?v=uAJ6-X3ESS4&list=PLN4uKfvSU2...

zamadatix2• 2 years ago

If you eat a serving of grilled chicken 5 times a week as part of an overall balanced diet you will not damage your bodily due to horrible eating... though you may find the other ~16 meals a week you're eating something without a serving of grilled chicken suddenly a lot more interesting.

"Eat a balanced diet of healthy foods" is good advice but whether or not you've achieved that has nothing to do with whether you had 5 servings of the same thing or not. You can have an extremely healthy diet and still regularly eat something many times a week, just don't try to make that something a McDonalds shake.

robomartin2• 2 years ago

Either you took my comment out of context or I did not do a good job in communicating the idea. I said:

"Outside of what I've come to refer to the "food should be food" group, if you regularly consume five or more servings per week of any food, you will do damage to your body in one of many ways"

Clarified, in simpler terms, this means: Do not eat highly processed shit food.

Restated, if you regularly consume five or more servings of shit food per week, you will do damage to your body.

There's nothing whatsoever good about these foods. Some of the damage isn't immediately visible. This is particularly true of maintaining healthy gut bacteria. The well documented connection between gut bacteria and the nervous system means that damage to gut bacteria can have far reaching consequences.

Furthermore, it takes time to repair damage such as rebuilding gut flora, fatty liver, insulin resistance, etc. There's nothing whatsoever good about regularly eating highly processed foods. Nothing.

My greater point is that health is a complex multivariate problem. The internet is full of single variable "fixes" that are nothing less than ridiculous. Eating five servings of chocolate, drinking wine once a day, drinking coffee, various supplements, etc., etc., ad nauseum. All of it nonsense. Eat real food in moderation and exercise. It's that simple.

I also recoil at some of these research projects, because, for some strange reasons, they always seem to reach ridiculous conclusions and the idea of the studies are ridiculous to start with.

Among these none has caused more damage to society than the government-pushed dietary guidelines published in the late 1970's. Since then, obesity and extreme obesity have absolutely exploded. Not to mention the whole menu of metabolic diseases that have come with a likely 10-fold increase in the consumption of sugar per capita and cocktails full of truly harmful substances.

I could go on. All I'll say is I am glad RFK is involved in potentially disrupting the way we deal with some of the things that have become leading causes of death in societies around the world.

This isn't a bad presentation on the subject:

https://www.youtube.com/watch?v=SOgH9LDwBzY

Chocolate intake and risk of type 2 diabetes: prospective cohort studies

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