Cocoa Extract (Theobroma Cacao)

The Disease-Fighting Power of Polyphenols
By Laurie Barclay, MD

Compelling new evidence reveals that a powerful way to protect aging arteries is to consume more plant polyphenols.

Published studies show how polyphenol compounds help improve endothelial function, which is a critical factor in preventing atherosclerosis. Polyphenols have also been shown to inhibit the abnormal platelet aggregation that cause most sudden heart attacks and strokes, while fighting inflammation and supporting healthy blood lipids.

Of particular interest are polyphenols derived from green tea, cocoa, apples, and black chokeberry—all of which may complement each other in bolstering the body’s defenses against ailments such as cancer, allergies, and cognitive decline. Here, we’ll explore the importance of how consuming diverse polyphenols can help safeguard one’s health against common ailments that plague aging adults.

Polyphenols: Healing Compounds From Nature’s Pharmacy

Throughout history, wellness enthusiasts have celebrated the medicinal potential of plants, looking to these botanical allies to promote vitality and restore good health. Modern science has borne out these theories, showing that edible plants are to be valued not only for their high vitamin and fiber content but also for their rich store of polyphenols—antioxidant compounds that give plants some of their color, flavor, and healing qualities.

Polyphenols are found not only in fruits and vegetables such as the blueberry, but also in cocoa, tea, and the exotic fruit known as the chokeberry. A number of studies show that consuming polyphenols from a variety of sources may be more healthful than limiting ourselves to plants foods typically found in the Western diet.

“Polyphenols are… a kind of chemical that may protect against some common health problems and possibly certain effects of aging,” Dalia Akramiene, a physiologist at Kaunas University of Medicine in Lithuania, told Life Extension. “Polyphenols protect cells and body chemicals against damage caused by free radicals—reactive atoms that contribute to tissue damage in the body. For example, when low-density lipoprotein (LDL) cholesterol is oxidized, it can become glued to arteries and cause coronary heart disease.”

In a Finnish study of 1,380 middle-aged men, high intake of flavonoids, or polyphenols, was linked to healthier carotid arteries with less obstruction from atherosclerosis.1 A large French study showed that people over 65 years of age who consumed a flavonoid-rich diet had less cognitive decline over a 10-year period.2 Polyphenols from different plants may work synergistically when consumed together, with benefits from the combination equaling more than the sum of the parts.

The 1st International Conference on Polyphenols and Health, held in 2005, reviewed impressive evidence strongly supporting a role for polyphenols in preventing degenerative diseases, especially cardiovascular disorders and cancer.3 Polyphenols are the most abundant antioxidants in the diet, and they promote health by a variety of mechanisms.

“Polyphenols can also block the action of enzymes that cancers need for growth and they can deactivate substances that promote the growth of cancers,” Dr. Akramiene said. “Increased consumption of polyphenols has been associated with a reduced risk of cardiovascular disease, and possibly cancer and stroke.”
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Cocoa: “Food of the Gods”

In Aztec culture, cocoa was so highly prized for its medicinal and stimulant value, as well as for its taste, that botanist Linnaeus termed it Theobroma cacao, or “food of the gods.” Unlike modern-day hot chocolate, Aztec cocoa was served without sugar and milk, which today add calories and saturated fat to an otherwise healthful libation.

Polyphenols in cocoa occur in higher concentration than in any other food, and have antioxidant activity much greater than that of broccoli or red wine. In fact, dark chocolate has about 10 times the antioxidant power of spinach as measured by the ORAC test (oxygen radical absorbance capacity). The catechins and procyanidins in cocoa also appear to lower the risk of cancer and heart disease.4

“Evidence derived from epidemiological surveys, retrospective studies, and follow-up studies as well as from experimental data, shows that cocoa reduces blood pressure, improves insulin sensitivity, and may slightly ameliorate the lipid profile,” Claudio Ferri, MD, a full professor of internal medicine at University of L’Aquila in Italy, told Life Extension. “All of the above must be considered for the insertion of cocoa in a healthy diet. Cocoa is not a junk food; it [is] a healthy and tasteful food; nevertheless, its high caloric content must be taken into consideration and its ingestion must be accompanied by careful reduction of calories from other sources.”

In a study by Dr. Ferri’s group,5 15 healthy volunteers were randomly assigned to eat either a 100-gram dark chocolate bar rich in polyphenols, or a 90-gram white chocolate bar, which does not contain polyphenols, every day for 15 days. After eating no cocoa or chocolate for a week, the volunteers then switched to the other type of chocolate. Compared with white chocolate, the dark chocolate was associated with lower blood pressure and with improvements in insulin resistance and insulin sensitivity, which are important markers for diabetes.

Of even greater clinical importance, Dr. Ferri’s group did a similar study in patients with high blood pressure and found that dark chocolate, but not white chocolate, decreased blood pressure and serum low-density lipoprotein (LDL) while improving blood flow and insulin sensitivity.6 Studies by other researchers suggest that cocoa proanthocyanidins prevent elevation of blood glucose levels in diabetic obese mice.7

Astoundingly, even small amounts of dark chocolate polyphenols, 30 mg a day or the amount found in a quarter bar of premium dark chocolate, may protect against high blood pressure, according to an 18-week study published this year in JAMA, the flagship publication of the American Medical Association.8 In individuals with mildly elevated blood pressure (130/85 to 139/89 mmHg), those receiving dark chocolate had a small decrease in average blood pressure, by 2.9 mmHg systolic and 1.9 mmHg diastolic. The percentage of this group classified as hypertensive also decreased from 86% to 68%. The group receiving white chocolate had no significant changes.

Although these blood pressure changes may seem small, they could translate to lower rates of stroke and heart attack and improved survival. When the investigators pooled information from their own and other published studies, they found compelling evidence that cocoa helped lower blood pressure.9 Some studies showed a dose-response effect, with greater improvements accompanying intake of larger amounts of dark chocolate polyphenols.9,10

In a Japanese study, individuals with high cholesterol had improvements in beneficial high-density lipoprotein (HDL), which protects against cardiovascular disease and atherosclerosis, as well as reduction in detrimental LDL when consuming a cocoa drink daily for four weeks.11

Similar findings hail from another Japanese study,12 with an 11.4% increase in HDL after only three weeks of consuming dark chocolate, and a 13.7% increase in the group receiving dark chocolate enriched with cocoa polyphenols. The group consuming white chocolate did not have these improvements in HDL, confirming that the benefit could be attributed to cocoa polyphenols, which are absent from white chocolate.

Cesar G. Fraga, PhD, a research professor of nutrition at the University of California at Davis, told Life Extension about several lines of evidence suggesting that the polyphenols found in cocoa, particularly epicatechin, could improve human health. Population studies in the Netherlands, home of renowned Dutch chocolate, show that eating chocolate is linked to improved survival and fewer deaths from cardiovascular disease.

“Cocoa consumption, especially cocoa containing high levels of polyphenols, protects vascular function and consequently can affect vascular disorders,” Dr. Fraga said. “Cocoa containing high levels of polyphenols can decrease blood pressure, [and] cocoa products decrease platelet aggregation and blood markers of inflammation. The regulation of nitric oxide present in the vasculature is currently the most accepted mechanism in which cocoa polyphenols can be involved.”
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  • Polyphenols found in fruits and vegetables are potent antioxidants, particularly those in cocoa, green tea, chokeberry, and apples.

  • Polyphenols also have beneficial effects on the endothelial lining of blood vessels by increasing the availability of nitric oxide, and by preventing the lipid oxidation underlying atherosclerosis.

  • The typical Western diet lacks sufficient amounts and variety of plant polyphenols to be of optimal benefit.

  • Polyphenols from different plants may work synergistically to protect against cardiovascular disease, cancer, diabetes, endothelial dysfunction, and other chronic diseases, without any known side effects.

Atherosclerosis, which clogs the arteries, ultimately resulting in heart attack or stroke, is aided and abetted by two culprits: abnormal platelet activation and endothelial dysfunction. Without platelets clumping together, we could bleed to death from a small cut, but when this normal function becomes overactivated, dangerous blood clots can ensue.

Overactivation of platelet aggregation may result from inflammation of the endothelium (the thin layer of cells lining blood vessels). Endothelial cells normally produce nitric oxide, which exerts a range of protective effects by controlling elasticity of the blood vessel wall, allowing the heart to contract normally, protecting blood vessels against injury, and helping prevent atherosclerosis.13-15 Depletion of endothelial nitric oxide with aging results in stiffening and blockage of arteries, which, if left unchecked, can cause heart attack and stroke.16-18

Polyphenols have been shown to positively influence nitric oxide production. Smokers are particularly prone to nitric oxide depletion in the endothelium, which may partly explain their increased cardiovascular risk. Smokers given a cocoa drink rich in polyphenols have improved levels of nitric oxide as well as improved blood flow.19 Even a single dose of a cocoa drink rich in flavanols transiently improves nitric oxide bioavailability in the blood and significantly reverses endothelial dysfunction.20

In the JAMA study described above, consumption of dark chocolate polyphenols, but not white chocolate, resulted in sustained improvement in nitric oxide-related blood markers of endothelial function.8

Cocoa polyphenols’ ability to regulate nitric oxide activity in the blood vessels might have benefits that extend beyond cardiovascular disease, since nitric oxide regulation is also important in other tissues. Although extensive clinical and population-based studies have not yet been done to determine the effects of cocoa polyphenols on other diseases, Dr. Fraga said they may help protect the body against cancer, diabetes, and degenerative brain disorders such as Alzheimer’s disease.

One common thread tying all these conditions together is inflammation, which interferes with cell and tissue function. Cocoa polyphenols tend to reduce inflammation by regulating proinflammatory mediators and controlling processes that oxidize LDL in the development of atherosclerosis.21 “Acute inflammation is evident and therapeutically treated; however, chronic inflammation is less evident and can silently accompany the individual for years, as in diabetes,” Dr. Fraga said. “This ‘silent’ inflammation could be targeted and ameliorated with diet. If the actions of cocoa polyphenols, as well as of the same polyphenols contained in other foods, are confirmed—and I consider that we are on the right track—the incorporation of reasonable amounts of cocoa products could be part of a healthy diet.”


1. Mursu J, Nurmi T, Tuomainen TP, et al. The intake of flavonoids and carotid atherosclerosis: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr. 2007 Oct;98(4):814-8.

2. Letenneur L, Proust-Lima C, Le GA, Dartigues JF, Barberger-Gateau P. Flavonoid intake and cognitive decline over a 10-year period. Am J Epidemiol. 2007 Jun 15;165(12):1364-71.

3. Scalbert A, Johnson IT, Saltmarsh M. Polyphenols: antioxidants and beyond. Am J Clin Nutr. 2005 Jan;81(1 Suppl):215S-7S.

4. Weisburger JH. Chemopreventive effects of cocoa polyphenols on chronic diseases. Exp Biol Med (Maywood). 2001 Nov;226(10):891-7.

5. Grassi D, Lippi C, Necozione S, Desideri G, Ferri C. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr. 2005 Mar;81(3):611-4.

6. Grassi D, Necozione S, Lippi C, et al. Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension. 2005 Aug;46(2):398-405.

7. Tomaru M, Takano H, Osakabe N, et al. Dietary supplementation with cacao liquor proanthocyanidins prevents elevation of blood glucose levels in diabetic obese mice. Nutrition. 2007 Apr;23(4):351-5.

8. Taubert D, Roesen R, Lehmann C, Jung N, Schomig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007 Jul 4;298(1):49-60.

9. Taubert D, Roesen R, Schomig E. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med. 2007 Apr 9;167(7):626-34.

10. Wang JF, Schramm DD, Holt RR, et al. A dose-response effect from chocolate consumption on plasma epicatechin and oxidative damage. J Nutr. 2000 Aug;130(8S Suppl):2115S-9S.

11. Baba S, Natsume M, Yasuda A, et al. Plasma LDL and HDL cholesterol and oxidized LDL concentrations are altered in normo- and hypercholesterolemic humans after intake of different levels of cocoa powder. J Nutr. 2007 Jun;137(6):1436-41.

12. Mursu J, Voutilainen S, Nurmi T, et al. Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med. 2004 Nov 1;37(9):1351-9.

13. Shaul PW. Endothelial nitric oxide synthase, caveolae and the development of atherosclerosis. J Physiol. 2003 Feb 15;547(Pt 1):21-33.

14. Shaw CA, Taylor EL, Megson IL, Rossi AG. Nitric oxide and the resolution of inflammation: implications for atherosclerosis. Mem Inst Oswaldo Cruz. 2005 Mar;100 Suppl 1:67-71.

15. Takimoto E, Champion HC, Li M, et al. Oxidant stress from nitric oxide synthase-3 uncoupling stimulates cardiac pathologic remodeling from chronic pressure load. J Clin Invest. 2005 May;115(5):1221-31.

16. Rubio AR, Morales-Segura MA. Nitric oxide, an iceberg in cardiovascular physiology: far beyond vessel tone control. Arch Med Res. 2004 Jan;35(1):1-11.

17. Sugawara J, Komine H, Hayashi K, et al. Effect of systemic nitric oxide synthase inhibition on arterial stiffness in humans. Hypertens Res. 2007 May;30(5):411-5.

18. Taddei S, Virdis A, Ghiadoni L, et al. Age-related reduction of NO availability and oxidative stress in humans. Hypertension. 2001 Aug;38(2):274-9.

19. Heiss C, Kleinbongard P, Dejam A, et al. Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol. 2005 Oct 4;46(7):1276-83.

20. Heiss C, Dejam A, Kleinbongard P, et al. Vascular effects of cocoa rich in flavan-3-ols. JAMA. 2003 Aug 27;290(8):1030-1.

21. Sies H, Schewe T, Heiss C, Kelm M. Cocoa polyphenols and inflammatory mediators. Am J Clin Nutr. 2005 Jan;81(1 Suppl):304S-12S.
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