Posted: March 18th, 2023
THE CACAO TREE (THEOBROMA CACAO)
WHAT IS IN THE COCOA BEAN?
MAKING AND EATING CHOCOLATE
State of the Art of Cocoa
Is Cocoa good for you?
Burden of Proof
CHOCOLATE AS A FAT
EFFECTS ON BLOOD LIPIDS
WHAT IS OK
CHOCOLATE AND HEALTH AND DISEASE
H. Immune Function
J. Other Disorders
N. Dental Caries
K. Heart Health
Pacemakers and vitamin pills are just among a few of millions of health products that are sold daily around the world. But one of the most easily accessible of all is right beneath our noses: chocolate. Cocoa, the plant from which chocolate is derived, has had a positive effect on today’s society because of its active role in daily health. The development and distribution of cocoa has had a positive effect on today’s society because of its active role in daily health.
Many people believe that chocolate is bad for you — that it’s calories outweigh its positive health benefits. Urban legends and common misconceptions concerning the use of chocolate have been rampant for hundreds of years — that it causes acne, retardation or even blindness. All of these accusations are baseless, to say the least, and, as I will go on to show, are, in fact, the opposite of the truth.
As chocolate is a prominent player in modern diet it is important to know the health aspects of it. Diet is what we take into our bodies, what we run off of. We would starve to death without food. When we eat healthy food we perform better, we are more productive members of society. When we eat unhealthy foods we are slow, sick and unproductive. Every aspect of your diet should be analyzed for you to live up to your potential. Food defines our actions, for without food no actions would be possible.
Cocoa takes it a step further though. Not only does it provide energy for our actions. It supplies chemicals for our personalities and moods. Modern psychology leads us to believe that every thought, every idea that pops into our head is simultaneously a biological reaction. This biological reaction takes the form of chemical processes within our brains. Our mind then interprets these chemical compounds as thoughts, ideas, smells, tastes, touch, etc. Our thoughts, or chemicals compounds within our brain can determine how we feel, our motivation, our goals, our entire lives hinge upon our thoughts, for what are we but what we do. And before we do anything, we must think it. We must have considered it at some point or been subconsciously predisposed to an action or idea.
If indeed we are our actions and our thoughts than what we take into our bodies is of the utmost importance, for our diets will help to shape our thought process. Our thought process shapes our mood and our actions simultaneously. Chocolate is a prominent figure in today’s diet and must be examined from all angles as has been done in this paper.
Getting back to the urban legends touched upon earlier, it is a commonly held that chocolate is a sweet and therefore you would be better off without it (Feldman, 1998).
Further in this paper I will prove that chocolate, in moderate doses, can actually improve the quality of you life in several different aspects, via the chemicals it can release to the brain.
A Brief Review of Cocoa
THE COCAO TREE (THEOBROMA CACAO)
Rampant throughtout our very existence the cocoa tree’s presence has been felt for four thousand years — cultivated, even, for the past ten centuries. It is indigenous to tropical Central and South America. Originating in the tropical rain forests of the Amazon or Orinoco basin in South America it later found its way to Mexico and Costa Rica. Currently, cocoa production and raising has spread to every corner of the globe, cultivated in the West Indies, Brazil, Venezuela, West Africa (Ghana, the Ivory Coast, and Nigeria), Madagascar, Sri Lanka, the Philippines and Malaysia, and even in the United States.
Originally, the Aztecs called cocoa “xocoatl,” which, to them and to many afterwards who tasted their concoction meant both physically and literally “bitter drink.” Later, the term xocoatl was intergrated into the modern term “chocolate.” Around this time, 100 beans held within its shells the value of an entire slave, the value of an entire human being. So powerful the natives believed this cocoa was they used it in multitudes of services and applications, from religious events to calculations and back again.
When Cortes delivered the beans to the Emperor between 1502 and 1528 cocoa was spilled unto a new shape, a new form — that of a beverage. Sugar and cinnamon interacted with cocoa to provide for exciting new venues. The secret recipe was then heated to improve the taste of the otherwise bitter Aztec drink. This mixture, this recipe, was held secret in deep depths of human contol for many a century until Spain introduced said ideas to their neighbors, the French in 1657. Shortly after England and its colonies became aware of the magic drink, no longer bitter in taste or in public. Baker founded his Massachusetts chocolate factory in 1765, which was to mark the beginning of chocolates influence on American culture.
WHAT IS IN THE COCOA BEAN?
They say that fine foods ripen with old age and the same holds true for the cocoa plant, taking it a full seven years to ripen and then continuing to produce for twenty years after that. The seeds, or the beans, are bitter because of their alkaloid (methylxanthines) content, and fermentation is necessary to acquire the chocolate flavor. The cocoa bean is approximately 31% fat, 14% carbohydrate and 9% protein. It is rich in the amino acids tryptophan, phenylatanine, and tyrosine that are norepinephrine and dopamine precursors.
The 400 chemicals that have been identified in the cocoa bean include, but are by no means limited to: polyphenols (6%) including pyrazines, quinoxolines, oxazolines, pyrroles (tannins), pyridines, and the fiavonol proanthocyanidin; the amphetamine-like phenylethylamine; the methylxanthines theobromine (2%) and caffeine (1%); and 2% salts and 1% acids. Similar chemicals are found in red wine, grapes, tea, onions, apples, and citrus fruits. The consumption of these chemicals has been related to a decrease in the risk of cardiovascular disease or cancer.
MAKING AND EATING CHOCOLATE
The production of chocolate manifests itself in tangents yet unriveled in originality and independence, for a cocoa tree yields 50 to 60 pods. Cut by hand, the ripe, melon-like cocoa pods are contain 20 to 40 seeds each — which are all removed by hand. The beans ferment under the sun for 4 to 6 days. They are then dried by the sun for 5 to 7 days. The dried beans are then roasted for 40 minutes at 100 [degrees] C. To 220 [degrees] C. To enhance the flavor. The shell is removed to yield the cocoa nib, which is milled by a mechanized process that was introduced during the Industrial Revolution. This is what made widespread distribution of chocolate possible, making it go from a noble delicacy to a common treat for the masses. The end product is solid and bitter. “Pressing,” a process invented by the Dutch Van Houten in 1828, separates the 45% cocoa solids or flaky cocoa powder (17% fat, 2.6% theobromine, 0.2% caffeine) from the remaining 55% golden stable cocoa butter. This separation allowed added ingredients such as fruits and nuts. In 1831, the chocolate came to be in the United States. Hershey started business circa 1900. Sugar and dry milk solids were added to the cocoa solids, producing milk chocolate, in the Swiss process introduced by Nestle in 1875. “Roller refining” of the chocolate for 72 hours reduced the particle size to a premium 10 [micro]m to 12 [micro]m. Tempering controls crystal formation. Extra cocoa butter can be added using a stirring or conching process introduced by Lindt. This improves smoothness and melting. Alkali is generally added next to cocoa to increase solubility and neutralize acids, making the flavor milder.
The FDA regulates the types of chocolate within U.S. bordes. Current types include: bitter, the chocolate liquor to which vanilla may be added; bittersweet, 35% (by weight) chocolate liquor with cocoa butter and sugar added and semisweet (chips) also containing 35% chocolate liquor and 27% cocoa butter; sweet chocolate, 15% chocolate liquor; milk chocolate (Swiss) with 10% chocolate liquor, 12% milk solids, condensed or whole milk, and 3% milk fat. White chocolate does not contain cocoa powder or its chemicals. Substitution of other fats for cocoa butter and the changing of proportions of ingredients has led to arguments among producers and countries that are currently unresolved. To be defined as chocolate the product must contain materials from the cocoa bean to which sugar and milk can be added. Chocolate must have only cocoa butter and a small amount of dairy butter. If not, terms such as “confectionery coating” are used.
Chocolate, as a food, is ingested primarily as a cocoa beverage or as chocolate used in a variety of confections and candies, desserts, snacks, and treats, such as chocolate bars, mixed with other candies, or coatings for ice cream bars — among other uses. Chocolate syrup and toppings, mousses and puddings, and baked goods contain chocolate and cocoa butter but also may contain butterfat or other saturated fat (tropical vegetable oils), so it is therefore important to read the labels to acquire a true list of the ingredients.
The United States leads the world in import and production of chocolate candy. The population consuming, on average, 10 lb of products per person, approximately one-third of which are chocolate. The highest percentage of consumption occurs in 16- to 19-year-olds and women between 40 and 49 years. 12- to 19-year-old males and 30- to 39-year-old women consume the highest amount in grams per day of chocolate candy. Most of this chocolate is not eaten as solid chocolate but as “panned, enrobed, molded” chocolate. For example, candies and coatings. The Swiss outdo Americans by eating an average of 22 lb of products per year per person. The Swiss also, however, invented milk chocolate.
CHOCOLATE AS A FAT
However, chocolate intake only accounts for about 1% of the total fat intake in the United States according to data from the 1987-1998 National Food Consumption Survey. To put this in perspective, the remaining fat intake can be broken down as such: 30% of dietary fat from meats, 22% from grains (in crackers, cookies, cakes, and pies) and 20% from milk and dairy products. The fat in chocolate, cocoa butter, is high in saturated fat (60%), half of which is stearic acid. Cocoa butter has more stearate than any other common fat or oil. Cocoa butter is a vegetable fat, which means that it does not contain cholesterol. Milk chocolate, which has added milk fat is therefore a source of cholesterol. The saturated fat content of common fats and oils shows that palm kernel and coconut oils are the highest in saturated fat, while cocoa butter is ranked third. If the content of the long chain of saturated fatty acids of 12 to 16 carbon chain length are ranked, cocoa butter moves to sixth place, below palm oil, butter oil, and beef tallow, resembling chicken fat. Chocolate, especially versions highest in fat, is a high-calorie food. To illustrate this, a 3-lb box of chocolates yields 6900 kcal.
EFFECTS ON BLOOD LIPIDS
In controlled feeding trials in humans, cocoa butter results in significantly lower levels of serum total and low-density lipoprotein (LDL) cholesterol compared with butter or beef fat, but it is not as hypolipidemic as olive oil. Stearic acid is termed a “neutral” fatty acid in terms of any effects on raising serum cholesterol or LDL cholesterol. This lack of effect is due, in part, to its poorer digestibility and lesser absorption in comparison to other long chain fatty acids. Stearate may raise the levels of serum triglycerides and decrease levels of high-density lipoprotein (HDL) cholesterol, which will result in no net change in the ratio of LDL:HDL cholesterol. There is also data which indicates that stearic acid increases the levels of Lp (a), a highly atherogenic variant of LDL, and increases the levels of fibrinogen, perhaps negatively affecting coagulation. Currently, it is not clear whether stearic acid is prothrombogenic, mainly because data in animal models may not be applicable to humans and no intervention trials have been undertaken.
Recently, as does red wine and other flavonoid-containing foods, cocoa has been shown to have antioxidant properties with regard to LDL, similar to vitamin E[5,6] One cup of hot chocolate containing two tablespoons of cocoa, and a 1.5-oz chunk of milk chocolate (41g) have 146 mg and 105 mg total phenol respectively, compared with 210 mg in 140 ml red wine. The extracted cocoa phenols inhibited LDL oxidation by 75%; the authors conclude “the pleasant pairing of red wine and dark chocolate could have synergistic advantages beyond their complementary tastes.” Before recommending chocolate to heart disease patients, however, these in vitro effects need be demonstrated in vivo, and heart disease rates should be examined in relation to chocolate/cocoa intake. In a follow-up study, such as the red wine study, oxidation of LDL with cocoa prolonged the oxidation lag time of LDL in a concentration-dependent manner. Volunteers consumed 35 g dilipidated cocoa, and LDL oxidation was measured in blood samples taken before and 3 hours after the cocoa consumption. It was found that LDL oxidation lag time was prolonged significantly (p < 0.005) at 2 hours. The results reiterate the idea of allowing moderate chocolate consumption for patients at risk of atherosclerosis or with coronary heart disease.
WHAT IS OK
The bottom line on chocolate as a part of your diet suggests that two to three chocolate bars per week, 1.5 oz each, or a daily cup of cocoa with added skim milk, is acceptable. Dark chocolate, which contains less fat, is preferable to the sweeter varieties, and cocoa is better in terms of calories and fat because it contains 10% to 22% fat compared with 58% in chocolate. Equivalent snacks in terms of calories are: 1 oz pretzels and a 12-oz soft drink, or 1 bag of potato chips and the 12-oz soft drink. The consumer can choose from among these, but take into consideration than chocolate serves as an occasional snack for diabetics and can as Step 1 of a cholesterol-lowering diet.
Chocolate has a unique “mouth feel” and melt-away behavior, a creamy texture, and a puzzling food flavor and aroma. The aroma coming from some 30 to 50 chemical compounds. Chocolate, quite literally, melts in your mouth (not in your hand), with cocoa butter liquefying abruptly at just above usual room temperature and completing the phase transition at body temperature.
CHOCOLATE AND HEALTH AND DISEASE
Chocolate has been associated with a large variety of adverse effects on health and bodily functions and diseases, from acne to premenstrual syndrome (PMS). For most of these medical problems, the association is weak and for even more the connection is non-existant. Many have been ruled out by properly designed investigation. Some remain as relatively minor problems for the population, although potentially serious for the affected individual. Chocolate has been used as a medicinal remedy over the years. It has also been in a treatise which recommended chocolate for many diseases, even going so far as to cite it as a cure for Cardinal Richelieu’s ills.
Table 1. Chocolate and diseases:
Acne Diabetes mellitus
Affective disorders Heartburn
Allergy Immune function
Blood clotting Infection
Blood lipids and heart disease Kidney stones
Cancer Migraine headaches
Dental caries and plaque Premenstrual syndrome
This list represents disorders for which references have been published in recent years, and most of which have been found to be without fact or base.
Chocolate craving is the most common craving in North America and affects 40% of women (more at the time of menstruation) and 15% of men. Craving is an aroma related element. It is independent of sweetness, texture, and calories. It relates to the content of phenylethylamine, an amphetamine-like substance that selectively increases tryptophan uptake in the brain. The result is an increase in brain levels of 5-hydroxytryptamine, a dopamine precursor. Dopamine has been theorized as an stimuli of “pleasure” feelings. Phenylethylamine has also has been implicated in the aphrodisiac qualities of chocolate, and proposed as the mediator of the “falling in love” emotion, perhaps equivalent to orgasm (assuming these responses are biochemical in origin). Montezuma, it is said, drank a golden goblet of cacao beverage before entering his harem where he encountered a new partner every night.
Recently, investigators extracted Nacylethanolamines (arachidonyl, linoleoyl, and oleoyl) from cocoa powder. Anandamide (the arachidonyl amine) is a brain lipid that binds to cannabinoid receptors with high affinity and mimics the psychoactive effects of plant-derived cannabinoid drugs. This may be an endogenous cannabinoid neurotransmitter or neuromodulator. These compounds are not found in white chocolate that contains only cocoa butter and milk, nor in brewed espresso coffee. The oleoyl and linoleoyl derivatives inhibit the breakdown of anandamide, therefore mimicking cannabinoids. Cannabinoid drugs heighten sensitivity and produce a so-called “euphoria.” These compounds may intensify the sensory properties of chocolate essential to craving, or interact with the methylxanthines in chocolate to produce transient feelings of well-being. Theobromine has caffeine-like properties, but the caffeine content of chocolate is extremely low (6 mg/oz), equivalent to that in a cup of decaffeinated coffee. Methylxanthines also interact with the adenosine receptors. Theobromine dawns many hats, acting as a myocardial stimulant, a diuretic, a smooth muscle relaxant, and a dilator of coronary arteries. Theobromine content is highest in baking chocolate and cocoa and lower in sweet and milk chocolate and chocolate syrup.
Women with eating disorders may fall under the classification of “chocolate addicts.” Studies of these self-described addicts have shown no improvement in depression, relaxation, or feeling content after eating chocolate — surpisingly, the women felt guilty after eating chocolate . Some 30% of psychiatric patients with mood disorders consume chocolate, but note that this is completely in synch with the general population which negates any correlation between the two. Chocolate interacts with monoaminoxidase inhibitor medications. These are used in the treatment of some psychiatric disorders. The response which is induced is similar to tyramine-containing foods; an example is hard cheese which may elevate blood pressure. This effect may be enhanced by the combination of chocolate and other foods such as yeast products, dry sausage, corned beef, broad beans and sauerkraut. Any of these prodcuts may potentially trigger a carcinoid syndrome reaction (flushing, diarrhea, bronchospasm, heart valve abnormalities that are the result of excessive serotonin secretion by carcinoid tumors).
Chocolate has long been viewed as a cause of migraine headaches. In 16% of migraineurs studied, the headache was precipitated by chocolate or cheese intake. Combining cheese and chocolate nearly always produces a headache. Also, the same subjects were known to develop a headache after the consumption of red wine or beer or the combination of alcohol and stress. Tension headaches have not been found to be related to chocolate intake. Chocolate can increase PMS in women with more severe symptoms.
The toxic effects of chocolate are unsubstantial. Infection with Salmonella, Yersinia, or Listeria have been reported. These are from contaminated confections or chocolate milk. In a 2-year study rats were fed cocoa powder (57-74 mg/kg body weight/day) corresponding to 50 times the 90th percentile of United States intake. This showed no adverse effect on reproduction nor any dominant lethal mutations. Basically, the survival of the rats was not affected. Abnormalities noted were reversible testicular atrophy at the highest. Benign mammary gland fibroadenoma incidence was increased to 24% compared with 16% in controls, with no evidence of carcinogenicity found.
Polyphenols in chocolate that have antioxidant function can modulate immune functions  when Cacao liquor polyphenols were prepared by extracting and concentrating defatted cacao liquor to obtain 50% polyphenols. Cacao liquor polyphenols (100 [micro]g/ml) have been noted to have an effect on lymphocyte and granulocyte functions, inhibiting reactive oxygen species (oxygen radicals and hydrogen peroxide) from activated granulocytes and lymphocytes. The extract inhibited lymphocyte proliferation and the production of immunoglobulin in response to mitogen, partly due to decreased production of interleukin-2 by T. lymphocytes. The effect is similar to that of vitamin E
Chocolate allergy has been observed, but most commonly in workers in confectionery plants. 31% have been noted to have immediate wheal skin reactions to skin prick with cocoa, with 6% reacting to cocoa beans and 12% to chocolate. Occupational asthma has been reported with IgE-dependent responses and immediate asthmatic allergic reactions of sneezing, rhinorrhea, wheezing, hives, severe headache, nausea, and cramps induced by a specific inhalation challenge, although it is not clear which proteins are responsible, a similar protein pattern was obtained in cocoa bean sheath, the internal bean content, and cocoa powder.
No significant correlation between cocoa consumption and acne has ever been found. A usual diet is more dental plaque-promoting than a chocolate-skim milk diet, just to promote a healthy perspective. Chocolate forwards the development of kidney stones. The ingestion of a 100-g chocolate bar can increase oxalate excretion threefold and also increased calcium excretion, similar to sucrose. Because these changes favor urolithiasis, stone-prone subjects need to avoid chocolate and to minimize urolithiasis. If chocolate is eaten it is advisable to drink a lot of water. Heartburn is common after eating chocolate. The lower esophageal sphincter relaxes with more gastric acid reflux noted in the esophagus. Therefore, it is strongly recommended that chocolate is avoided for patients with esophagitis.
The State of Art of Cocoa
An extensive literature search did not reveal any studies in which attention deficit hyperactivity disorder (ADHD) was observed as being associated with chocolate consumption38. Studies in the past, however, observed the effects of various foods, including chocolate, but none have focused solely on chocolate. The relationship between ADHD and ingestion of sugar, a major ingredient in sweetened chocolate, has been explored in depth. The Food and Drug Adminstration (FDA)39 found that “there is no substantive evidence that the consumption of sugar is responsible for behavior change in children or adults.”
Similar findings were revealed in another review of 11 double blind studies conducted between 1984 and 1991 of sugar and ADHD in both “sugar responders” and “non-sugar responders.”  No significant effect of sucrose on behavior in nine of the studies40/41/42/43/44/45/46/47/48. One study found decreased activity following sucrose challenge49 and one, the results of which were never replicated and has therefore been widely disregarded in the medical community, noted inappropriate behavior after sucrose consumption.50 A Surgeon General’s Report on Nutrition and Health noted limited data to support the idea that sugar causes uncontrolled behavior in children.
In 1994 another study contributed more overwhelming evidence that sugar does not affect a child’s behavior in any abnormal fashion51. In the double-blind trial twenty-five preschoolers and twenty-three young children (aged six to ten years) with a subjective history of sugar-induced behavior changes were fed each of three diets over a nine-week period. One of the diets contained sugar at twice the amount normally consumed by children. The second contained aspartame. The third contained saccharine. The diets were free of preservatives, food coloring, chocolate and caffeine so the experiment could be as accurate and controlled as possible. Activity, concentration and memory levels showed no effect whatsoever from any of the sweeteners.
Acne has been linked to rising testosterone levels during puberty. Sebaceous glands are enlarged, which lead to comedones, commonly referred to as blackheads. The American Academy of Dermatology stated that “acne is not a dietary disease and that following the strictest diet will not by itself clear the skin.”4
Yet the idea that diet, and specifically chocolate, is implicated in the etiology of acne has remained widespread throughout the medical profession and the general public until relatively recently. Researchers from the University of Missouri in the 1960s were among the first to question the link between chocolate and acne. Grant and Anderson5 attempted to induce an acne flare-up in eight individuals with mild to moderate acne by feeding them a large amount of chocolate. They failed. They then discredited the assertion that chocolate causes acne.
A larger study of 65 subjects reported that a substantial intake of chocolate and fat did not affect acne. Upon review of studies purporting to show that high carbohydrate or high fat diets aggravate acne, the authors stated that such proposals were preposterous as the sebaceous gland has a high degree of autonomy.6
Science has long held that damage done in the body by free oxygen radicals is linked to heart disease, certain cancers and physical degeneration maladies that are associated with the aging process. Antioxidants found in the blood stream help to eliminate free radicals. This reduces the risk of developing some serious diseases, such as heart disease.
Cocoa, dark and milk chocolates have high levels of polyphenol antioxidants compared to fruits and vegetables. In 1999, an analysis of chocolates polyphenol antioxidants using the Oxygen Radical Absorbance Capacity measurement technique found dark chocolate to contain more than twice the ORAC level of prunes. Prunes contain one of the highest levels of fruits and vegetables tested32/33.
Research that focuses on health benefits of polyphenols in chocolate has shown that polyphenols are absorbed into bloodstream. In a clinical trial that was conducted on the matter, eight of the subjects refrained from eating foods rich in polyphenols the day before the test until the study was completed. The subjects ingested chocolate with bread and water on two separate occasions: first consuming 40g of chocolate, and one week later, consuming 80g of chocolate (polyphenol intake from chocolate was 892 mg and 1783 mg, respectively). Samples of the subjects blood were drawn at intervals of one, two, three and four hours after consumption and directly before the intake. The analysis found heightened levels of polyphenol epicatechin after each chocolate sample, which signifies that a rapid absorption took place34. One study which focused on the beneficial effects of this phenomena found that a diet of 1% cocoa polyphenols for rabbits retarded low density lipoprotein (LDL) cholesterol oxidation in their blood, which, potentially, prevents the first step in the formation of atherosclerotic plaque35 while feeding 35g of cocoa powder to 12 male subjects demonstrated a significant increase in LDL cholesterol’s resistance to oxidation within two hours of the chocolate intake .
The health benefits of chocolate’s polyphenol content are still being explored in laboratories across the world. One such study fed controlled diets to 18 male and female subjects in PSU. This supports the protective effects of polyphenol antioxidants in chocolate and cocoa. Subjects consumed cocoa powder (22g) or dark chocolate (16g) in their daily diets. The conclusions of the study understood the fact that the subjects consuming the cocoa or chocolate had improved cholesterol ratios. Results also announced a higher ratio of high density lipoproteins (HDL) to LDL. This is generally associated with a lower risk for heart disease37.
One of the common ideas or medical ailments that encircles chocolate is that of tooth decay. The process commonly referred to as ‘tooth decay’ begins with simple bacteria, particularly Streptococcus mutants. These bacteria accumulate on the teeth in the absence of adequate oral hygiene, which then begin to form plaque. Bacteria metabolize fermentable carbohydrates, which then lead to an increase in the formation of acid and, consequently, a decrease in plaque’s pH level. A sustained drop in pH level will result in downward cycle of mineral deficiency for the enamel. This leads to caries. The etiology of caries is really a conglomeration of minutiae, not merely one aspect as chocolate haters would lead us to believe. These details include, but are not contained to: susceptible teeth, dental plaque, food and the length of time food remains in contact with the teeth69.
Thus, prevention of dental decay mandates the enactment of several counter-measures. Fluoride is a primary control for the prevention of dental caries and can significantly reduce caries69. This has been common knowledge for many years, since its induction into the general water supply. Control of fermentable carbohydrate intake, proper oral hygiene, and the application of plastic sealants are some of the many other prevention techniques.
It is true, or has been held to be so by several authorities, that there is a correlation between sugar and caries. It has also long been known that any food containing fermentable carbohydrates — including cooked starches such as bread, cereal, crackers, etc. — can and will promote caries formation71/72. Oft times it is under assumption that foods high in starch such as potato chips and bread are not factors in caries development. This myth is held aloft solely upon the basis that oral bacteria cannot break down starches into acids. How unfortunate. One must remember that saliva contains the enzyme “amylase” and that amylase converts starches into sugars, which the oral bacteria then can metabolize to acids.73 Most starchy foods are retained in the mouth long enough to mix with saliva. As the mind dwindles on upon this path, sugars such as sucrose and fructose tend to be less cariogenic than starch because they dissolve in water and saliva, and are then removed from the mouth more rapidly than there origins would have been had they been quickly ingested. High-starch snacks, highly processed as they are, whether gelatanized, baked or fried, produce as much acid in plaque as sucrose alone, but at a much slower rate74/75. Thus, it is shown, it is illustrated, it is then correlated and found that the cariogenicity of food is not necessarily related to its sugar content. In laymen’s terms, one could deduce from this grandiose logic that foods that are 50% sugar do not necessarily cause more tooth decay than foods that are 10% sugar.
Difficult as it is to categorize foods by degrees of cariogenicity, certain non-carbohydrate characteristics of a food (e.g., fat, protein, minerals, buffering capacity, water content, texture) can modify cariogenicity as can the sequence of food consumption69/76/77. An integral role upon and involved within the process happens to be the frequency of exposure to carbohydrate-containing foods. To further elaborate upon this spring of knowledge, taken into light the constant eater: if one were to eat more than six times a day and/or continuous nibbling or sipping of foods was present than said actions would provide no comfort with the exemption of the unpromising greenlands known as tooth decay, and even said greenlands are scarce comfort when sitting in a dentist’s chair, face to the heavens and mind stuck forever in a cloud of nitrous oxide72/78/79.
Also leaving little to no breathing room for our mutual friend and partner cariogenicity is the retention time that food remains against the tooth. Misleading, or, rather, misguiding is an excellent adjective that floats to the surface when addressing warnings against sticky foods. Initially, a food such as a caramel or a jelly bean is sticky but then quickly clears the mouth75. Kashket et al.80 found that cookies, crackers and potato chips were more retentive than chocolate bars, caramels, jelly beans and raisins, which hardly justifies, in fact the opposite occurs!, warning against caramel when downing crackers.
Cocoa is not intrinsically cariogenic because it does not contain significant fermentable carbohydrates. For that reason and that reason justifiably, unsweetened chocolate is not considered a contributing factor in the development of caries in animals or humans, or in measures of plaque formation, acidity, or enamel demineralization3. Chocolate’s lack of cariogenicity holds true when chocolate is sweetened. Researchers for the classic 1950s Vipeholm study in Sweden reported no statistically significant difference in the incidence of dental caries among a control group that consumed no sweets and another group that consumed chocolate81.
Countering the common misconception that sweetened chocolate is highly cariogenic are the results of several studies. Morrissey et al.82 measured and weighed the idea that the cariogenicity of several common snack foods on rats, and found solid milk chocolate among the lowest in cariogenicity of all the foods evaluated therby leaving the foresaid myth wanting. While specifically examining the food retention of chocolate bars, one found that they had cleared the mouth more rapidly than their nonfat counterparts namely for that tangent alone – because they contain fat, despite the fact that subjects rated chocolate bars as fairly sticky80.
Obesity, a condition that occurs when a person’s body is unable to balance energy intake with energy expenditure, is a common problem in the United States. In fact, more common than the general population would care to admit. The National Health and Nutrition Examination Survey (NHANES III) found that 22% of the U.S. adult population is obese and 55% of said American adults are obese or overweight102. Health risks associated with chocolate range fom coronary heart disease, hypertension, diabetes, certain cancers, gallstones to many, many others. Medical conditions related to obesity are second only to the habit of smoking in terms of loss of human life102/103.
Successful weight management requires lifestyle modifications; modern living techniques and healthy attitudes that include increased consumption of fruits, vegetables and grains – according to the American Dietetic Association. Also, a gradual increase in physical activity to at least 30 minutes a day104.
The research, on carbohydrate consumption and obesity in fact indicates that diets high in carbohydrates, including sugar, do not result in weight gain when they are consumed in smaller degrees than energy expenditure106/107/108. Studies have actually proven that groups of people intaking the most sugar have the lowest levels of obesity109, which some nutritionists believe is due to a decrease in fat intake as more sugar is consumed. In another recent study, 60 women considered to be overweight, consumed a low-fat, reduced-calorie diet that was either high or low in sucrose levels. After the six-week period of dieting, the high and low sucrose groups proved equally significant reduction of body weight and body fat110 percentage. While a preference for eating sweets appears to have little or no connection to obesity, preference for foods with high fat content may have a role in weight gain. Studies suggest that obese individuals actually prefer the same amounts of sugar in their diets as individuals in normal weight range, but they prefer higher concentrations of fat111. Whether it be saturated fat, monounsaturated or polyunsaturated fat, provides 9 kcal/g, twice the calories in carbohydrate (4 kcal/g). A diet made up of predominately fat-rich foods increases the possibility of surplus calorie consumption113. Studies of fat preferences among obese adults reveal a close relationship between preferred fat intake and resulting body fat111/113.
No scientific evidence exists proving that chocolate consumption is associated with obesity. On average, chocolate has been found to contribute only 0.7-1.4% of total daily caloric intake114. The sensory properties of chocolate as a pleasurable food, however, make it a desirable food which may generate feelings of guilt and associations with weight gain in some people. However, no single food causes obesity or weight gain. The complete diet, in addition to lack of appropriate energy expenditure or activity, is the underlying cause of weight gain.
The National Cholesterol Education Program has focused on increasing public awareness of the necessity to reduce intake of saturated fat.115. However, the relative effects of specific saturated fatty acids on blood lipids is not fully understood by most consumers.
Cocoa butter is the fat that is naturally found in cocoa beans. The U.S. government standards in identifying chocolate specify that cocoa butter is the only fat allowed in all types of chocolate with the exception of milk chocolate, which contains approximately 80% fat from this product and 20% from milk fat. Cocoa butter, as is the case with all fats, is made up of several fatty acids.
The percent make up of fatty acids in cocoa butter are as follows
Stearic Acid – 35%
Oleic Acid – 35%
Palmitic Acid – 25%
Linoleic Acid – 3%
Other – 2%
Stearic and palmitic acid are saturated fatty acids, with oleic being a monounsaturated fatty acid and linoleic a polyunsaturated fatty acid.
Unlike other saturated fatty acids, including palmitic acid, studies have depicted that stearic acid does not raise blood cholesterol. As discussed in a review of nearly 40 years of scientific research, cocoa butter has been shown to have a neutral effect on blood cholesterol levels, possibly because of its high stearic acid content116. Two metabolic ward studies in 1965 reported that diets containing high levels of cocoa butter had a neutral cholesterolemic effect117/118.
Researchers have hypothesized that cocoa butter’s anomalous effect on serum cholesterol may be a result of more than one factor. Theoretically, cocoa butter may not be as well absorbed by the body as other saturated fatty acids are119/120. Another theory suggests that absorbed stearic acids are simply converted to oleic acid, a monounsaturated fatty acid121.
Kris-Etherton and colleagues122 in their studies done at the Pennsylvania University concluded that not only cocoa butter but also milk chocolate. In their study, subjects were asked to consume 10 ounces of milk chocolate each day in the form of pudding and brownies, this supplied 80% of the approximately 37% of their dietary calories contributed by fat. The overall dietary nutrition was controlled in every other way. Despite the fact that the chocolate enriched diet was high in saturated fatty acids (approximately 20% of total calories), subjects experienced a cholesterolemic response that was neutral compared that of their usual diet which did not include chocolate and consisted of saturated fatty acids representing 14% of total daily caloric intake. When participants consumed diets rich in dairy butterfat on an equal fat and saturated fat calorie basis, their average levels of cholesterol were higher than when they participated in the diet enriched by milk chocolate. The study further demonstrated that stearic acid did not produce hypercholesterolemic effects compared to other long-chain saturated fatty acids such as myristic and lauric acid123.
In another study, the same researchers124 had subjects consume a National Cholesterol Education Program/American Heart Association Step-One Diet, including the daily substitution of a 1.6-ounce milk chocolate bar (a typical candy bar weighs 1.4 ounces) in place of a high carbohydrate snack. Consuming the chocolate bar did not adversely affect the low -density of theirlipoproteins, or LDL cholesterol levels. Including the chocolate bar resulted in an increased total fat content of the diet from 30 to 34% of total calories, but did not change the average LDL-cholesterol levels. The study did, however, demonstrate an increased high-density lipoproteins, or HDL-cholesterol level. This research would suggest that strategies to reduce dietary fat should emphasize reduction of only the atherogenic saturated fatty acids nd not the stearic acid.
Limiting restrictions to specific foods, thereby provides a greater flexibility in diet planning which enhances delectableness and promotes sticking to diets for the health-conscious individual125. Approaching dieting this way allows for moderation of intake of foods containing fat, with a greater stress on those higher in stearic acid or unsaturated fats. However, caloric consumption when greater than that of expenditure contributes to obesity and can have an increased effect on cholesterol level. Therefore, chocolate can be included within the diet in moderate amounts, in the occurrance that the overall diet falls within total calorie and saturated fat goals.
Because chocolate has a high fat content,, many theories about its’ effects have evolved. One of them is that chocolate may be the cause of migraines and headaches in some people, which just happens to be false. Dr. Dawn A. Marcus of the University of Pittsburgh Medical Center conducted a study of 63 women who suffer from migraines. Subjects were fed either chocolate or carob, a chocolate-like substance. The two groups reported an equal number of migraines over the following 12-hour period. Although the study was conducted using only women as subjects, the findings are applicable to men as well. “Most of the triggers and therapies for headaches in men and women are the same, so one would predict similar results with the male population,” Marcus says (Chocolate’s Not a Culprit 66). Women report dietary triggers of headaches more frequently than men, and women are more frequently beginning to suffer from migraines.
High cholesterol levels have also been blamed on chocolate. For many years it has been seen as an arterychoking low-density lipoprotein. Nutritionists are now observing that some saturated fats have no effect on cholesterol. One third of the fat in chocolate is a cholesterol-friendly saturated fat called stearic acid, while another third is considered and labeled as a healthy unsaturated fat known as oleic acid. In addition new research from wine chemists at the University of California at Davis reveals that cocoa contains similar antioxidants, known as flavonoids similar to those contained in red wine. These flavonoids aid in the fight against heart attacks by slowing down or inhibiting the oxidation of lipoproteins which would normally decompose into foam cells that block blood vessels.
It has also been reported that many women have cravings for chocolate similar to that of other addictions. Over a decade ago Massachusetts Institute of Technology began the search for a connection between the food one eats and the mood that they display. It was discovered that various foods high in sugar and starch boosted a potent brain chemical called serotonin which promote calm feelings and general stability within mood and emotions. They also found that women crave not only sugar for its calming effects, they also craved fat for its ability to elevate their mood. Fat was found to aid in endorphin release which energized the mind and lifted the spirit (Waterhouse 81). Chocolate, having the perfect combination half fat and half sugar, as well as many other qualities that account for it’s unmatched biological, physiological, and psychological experience, was found to be the food craved the most frequently. As research has also reported, a change in estrogen levels can also cause cravings and it can be noted women’s cravings are actually reflections of their biological needs.
In 1994 study found in a in French journal, Hormone and Metabolic research displayed that eating a single chocolate bar can raise the amount of oxalate in a subjects’ urine by 213%. High urinary oxalate levels can cause kidney stones in susceptible individuals. Linda K. Massey, R.D., Ph.D., a professor of food science and human nutrition at Washington State University in Punman, reported in the August 1993 journal of the American Diabetic Association that chocolate is one of only eight foods that has this significant of an increase in urinary oxalate excretion (Friedman 78), second only to Beets, rhubarb and spinach..
Indeed, the pick-me-up effect from eating chocolate is less as related to caffeine than to caffeine’s pharmacological cousin, theobromine. This little-investigated chemical seems to have similar effects to that of caffeine, and is present in much higher amounts in chocolate than in found to be the case in other foods. Whether one can form addiction-like behaviors due to theobromine has not been proved, but a 1991 University of Pennsylvania study published in the journal Appetite theorized that because theobromine has such a similar chemical structure to that of caffeine, it may very well be.
Most experts agree that there is a true biological chemistry behind the craving for chocolate. One psychiatrist, Michael Liebowitz, from Columbia University found a substance in cocoa called phenylethylamine that seemed to trigger euphoric feelings much like those associated with falling in love (Jaret 33). However, Liebowitz was forced to abandoned the theory when he couldn’t find any imperia cal evidence to support his theory about the euphoria chocolate may have created.
Adam Drewnowski, director of the human nutrition program at the University of Michigan, believes that when taste buds begin to tingle with the sensory delight of chocolate, endorphins are actually released, causing a much more pleasant feeling throughout the body due to these chemical reactions.
Whether it is prompted by theobromine, phenylethylamine, or endorphins, or a combination of the three, our brains’ signal pleasure at the first taste of chocolate. Perhaps it’s the perfect property that the melting point for cocoa butter just happens to be 98 degrees, which causes it to melt when it hits the tongue of the delighted consumer. The cocoa butter absorbs the heat and continues to add a cooling sensation, while releasing an array of complex combinations of flavors and aromas. It’s a sensation so unique that food chemists have never successfully duplicated it in laboratory experiments.
Clearly, new studies have shown that cocoa, used to make chocolate, actually has health benefits. As is the case with most all things in life, there are some negative effects, but those consequences can be argued in the case of cocoa products. The development and distribution of cocoa has had a positive impact on society because of the active role it plays in the daily and overall health of its consumers. This has been proven not only through the history of its distribution, but also it’s physical and mental effects on the human body as supported in various research and studies throughout the world. It has become a part of our religious society and will always have a special place in our hearts.
As presented during a symposium at the 17th World Congress of the International Society for Heart Research, the new research implies that consumption of specific chocolates can affect platelet function in a positive manner.
The research suggests that foods containing flavanols may positively affect mechanisms involved in the maintenance of cardiovascular health. The naturally-occurring components found in plant-based foods and beverages which make up these flavanoids include cranberries, peanuts, apples, tea, red wine and chocolate. Chocolate has proven especially interesting because it is abundant in a pattern of complex oligomers. These bigger molecules in chocolate are not commonly found in such abundance in other plant foods or beverages.
The recent human clinical trial was conducted by researchers at the University of California, Davis. Volunteers consumed either bread as a control or semi-sweet chocolate pieces with a high flavanol content in the amount of 25 grams. The chocolate pieces, manufactured by Mars Incorporated, were manufactured for this study and incorporated using proprietary methods to retain the natural goodness of the cocoa bean. The researchers took samples of blood from subjects at baseline, two and six hours following consumption. They then simulated an opening of a blood vessel and measured platelet function by testing the amount of time it took the platelets to fully close the opening. For subjects who had consumed the chocolate, closure time significantly increased in the two- and six-hour readings, where the was not a significant effect seen after the consumption of bread. The results support earlier research that suggests that acute consumption of flavanol-rich chocolate associated with an array of positive cardiovascular effects.
For years now, chocolate has been looked down upon as unhealthy. It has been deemed a candy, slapped with myths and fallacies and prohibited from small children. Through this paper, chocolate has been shown to lift depression, help your heart, and aid alertness among other benefits. Let us not go forward in the dark anymore. Rise, rise to the challenge of the chocolate and live the life that you have always wanted. Let chocolate help you with your daily activities. Let chocolate relax your mind after a long day. Let it smooth your wandering thoughts in a blissful release of endorphins, caffeine and flavanol. Modern chocolate is a medicine, bringing ease-of-living to our lives. Used properly, chocolate can be a delicacy and a medicine.
Chocolate Manufacturers Association, 1999.
The Surgeon General’s Report on Nutrition and Health. Washington DC: Public Health Service: 1988. U.S. Department of Health and Human Services. Public Health Service Publication No. 88-50210.
Fries JH. Chocolate: A review of published reports of allergic and other deleterious effects real or presumed. Annals of Allergy. 1978;41:195-207.
Acne. Schaumburg, IL: American Academy of Dermatology; 1986, revised 1991. Form No. TPAMO2-4/92.
Grant JD, Anderson PC. Chocolate as a cause of acne: A dissenting view. Missouri Med. 1965;62;459-460.
Fulton JE Jr., Plewig AM. Effect of chocolate on acne vulgaris. JAMA. 1969;210:2071-2074.
Shalita AR. Acne vulgaris: not curable but treatable. Mod Med. August 1,1975;66-76.
Acne patients fact. JAMA. 1977;237:622-628. Medical News.
Kaminester LH. Acne, When friends or patients ask aboutâ€¦JAMA. 1978.239:2171.
Food & Agricultural Organization of the United Nations. 1995. Report of the FAO Technical Consultation on Food Allergies, Rome, Italy, Nov. 13-14.
Ferguson A. Definitions and diagnosis of food intolerance and food allergy: consensus and controversy. J Pediatr. 1992;121:S7-S11.
American Academy of Allergy and Immunology Committee on Adverse Reactions to Foods and National Institutes of Allergy and Infectious Diseases. Adverse Reactions to Foods. July 1984. NIH Publication No. 84-2442.
Anderson J. In: Perkin J, ed. Food Allergies and Adverse Reactions. Gaithersburg: ASPEN Publishers, Inc. 1990.
Metcalfe D, Sampson H. Workshop on experimental methodology for clinical studies of adverse reactions to foods and food additives. J Allergy Clin Immunol. 1990;86:421-442.
Bock SA, Atkins FM. Patterns of food hypersensitivity during 16 years of double-blind, placebo-controlled food challenges. J Pediatr. 1990;117:561-567.
Van Arsdel P, Larson E. Diagnostic tests for patients with suspected allergic disease. Ann Inter-Med. 1989;110:304-312.
Freis JH. Food allergy: current concerns. Ann Allergy. 1981;46:260- 263.
Freis JH. The cocoa bean and the allergic child. Ann Allergy. 1966;24:484.
Maslansky L, Wein G. Chocolate allergy: a double-blind study. Conn Med. 1971;35:5-9.
Drelich JM, Anderson JA, Sears-Ewald DA. Chocolate allergy evaluated by double-blind, placebo-controlled food challenge (DBPCFC). J Allergy Clin Immunol. 1993;91:340.
Bock SA, Buckley J, Holst A, May CD. Proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children. Clin Allergy. 1977;7:375-383.
Bock, SA, Lee W-Y, Remigio L, Holst A, May CD. Appraisal of skin tests with food extracts for diagnosis of food hypersensitivity. Clin Allergy. 1978;8:559-564.
Bock SA, Lee W-Y, Remigio L, May CA. Studies of hypersensitivity to foods in infants and children. J Allergy Clin Immunol. 1978;62:327- 334.
Bernstein M, Day J, Welsh A. Double-blind food challenges in the diagnosis of food sensitivity in the adult. J Allergy Clin Immunol. 1982;70(3):205-210.
Zeitz H, Cato M, Lekach R, Thomas L, Jurmuszuk I, Samter M.. Reactions to specific foods in adults (I) chocolate (C ). J Allergy Clin Immunol. 1986;77:238.
Krummel D. Chocolate and food allergies: fact or fiction. Immunology & Allergy Practice. 1992;14(8):306/33-312/39.
Cantani A, Ferrara M, Vazzoler C. Case in point: allergy, intolerance or pseudoallergy to chocolate? Riv Eur Sci Med Farmacol. 1989;11(3):247-9.
Waterhouse AL, Shirley JR, Donovan, JL. Antioxidants in Chocolate. Lancet. 1996;348: 834.
Vinson JA Presentation to the American Chemical Society, March, March, 1999.
Sanbongi C, Osakabe N, Natsume M, Takizawa T, Gomi S, Osawa T. Antioxidative polyphenols isolated from theobroma cacao. J Ag Food Chem. 1998;46:454-457.
Arts IC, Hollman PC, Kromhourt D. Chocolate as a source of tea flavonoids. Lancet. 1999;354:488.
Adamson G, Lazarus S, Amitchell A, Prior R, et al. HPLC method for the quantification of procyanidins in cocoa and chocolate samples and correlation to total antioxidant capacity. J Am Chem Soc. 1999.
U.S. Dept. Of Agriculture, Can foods forestall aging? Ag Research. Feb. 1999;47:15-17.
Richelle M, Tavazzi I, Enslen M, and Offord, EA. Plasma kinetics in man of epicatechin from black chocolate. European J. Of Clin Nut. 1999;53: 22-26.
Natsume, et al. Annual meeting of the Japan society of biotechnology and agrochemistry, 1997.
Kondo K, Hirano R, Matsumoto A, et al. Inhibition of LDL oxidation by cocoa. Lancet. 1996;348:1514.
Kris-Etherton P. And Wan Y. Fifth international symposium on chocolate and cocoa nutrition. Tokyo, Japan; Sept. 1999.
Krummel DA, Seligson FA, Guthrie DA. Hyperactivity: Is Candy Causal? Critical Reviews in Food Science and Nutrition. 1996;36(1 and 2):31-47.
Glinsmann WH, Irausquin H, Park YK. Evaluation of Health Aspects of Sugars Contained in Carbohydrate Sweeteners. Report of Sugars Task Force, 1986. Executive Summary. Washington, DC: Division of Nutrition and Toxicology, Center for Food Safety and Applied Nutrition, Food and Dug Administration: 1986.
Gross MD. Effect of sucrose on hyperkinetic children. Pediatrics. 1984;74:876-878.
Wolraich M, Milich R, Stumbo P, Schultz F. Effects of sucrose ingestion on the behavior of hyperactive boys. J Pediatr. 1985;106:675-682.
Milich R, Pelham WE. Effects of sugar ingestion on the classroom and play group behavior of attention-deficit disordered boys. J Consult Clin Psychol. 1986;54:714-718.
Wender EH, Solanto MV. Effects of sugar on aggressive and inattention behavior in children with attention-deficit disorder with hyperactivity and normal children. Pediatrics. 1991;88:960-966.
Ferguson HB, Stoddart C, Simeon JG. Double-blind challenge studies of behavioral and cognitive effects of sucrose-aspartame ingestion in normal children. Nutr Rev. 1986;44:144-150.
Mahan LK, Chase M, Furukawa CT, et al. Sugar “allergy” and children’s behavior. Ann Allergy. 1988;61:453-458.
Rosen LA, Bender ME, Sorrell S, Booth SR, McGrath ML, Drabman RS. Effects of sugar (sucrose) on children’s behavior. J Consult Clin Psychol. 1988;56;583-589.
Roshon MS, Hagen RL. Sugar consumption, locomotion, task orientation, and learning in preschool children. J Abnorm Child Psychol. 1989;17:349-357.
Kruesi MJ, Rapoport JL, Cummings M, et al. Effects of sugar and aspartame on aggression and activity in children. Am J. Psychiatry. 1987;144:1487-1490.
Behar D, Rapoport JL, Adams AJ, Berg CJ, Cornblath M. Sugar challenge testing with children considered behaviorally “sugar reactive.” Nutr and Behav. 1984;1:277-288.
Goldman JA, Lerman RH, Contois JH, Udall JN. Behavioral effects of sucrose on preschool children. J Abnorm Child Psychol. 1986;14:565-577.
Wolraich JL, Lindgren SD, Stumbo PJ, et al. Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children. N Engl J. Med. 1994;330:301-307.
Position of The American Dietetic Association: Use of nutritive and nonnutritive sweeteners. J Am Diet Assoc. 1993;93:816-821.
A Scientific Status Summary by the Institute of Food Technologists’ Expert Panel on Food Safety & Nutrition. Chicago, IL: Institute of Food Technologists; 1987.
U.S. Department of Agriculture Handbook #8.
Wurtman RJ, Wurtman JJ. Carbohydrate cravings, obesity and brain serotonin. Appetite. 1986;7:99-103.
Christensen L, Redig C. Effect of meal composition on mood. Behav Neurosci. 1993;107:346-353.
Reid, M, Hammersley R. Effects of carbohydrate intake on subsequent food intake and mood state. Physiol Behav. 1995;58:421-7.
Hurst WJ, Martin RA, Zoumas, BL. Biogenic amines in chocolate: a review. Nutr Rep International. 1982;26:1081-6.
Koehler PE, Eitenmiller RR. High pressure liquid chromatographic analysis of tyramine, phenylethylamine and tryptamine in sausage, cheese and chocolate. J of Food Sci. 1978;43:1245-7.
Weingarten HP, Elston D. Food cravings in a college population. Appetite. 1991;17:167-75.
Rozin P, Levine E, Stoess C. Chocolate preference and craving. Appetite. 1991;17:199-212.
Hill AJ, Heaton-Brown L. The experience of food craving: a prospective investigation in healthy women. J Psychosom Res. 1994;38:801-14.
Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996;96:589-92.
Weingarten HP, Elston D. The phenomenology of food cravings. Appetite. 1990;15:231-46.
Vlitos ALP, Davies GJ. Bowel function, food intake and the menstrual cycle. Nut Res Rev. 1996; 9:111-134.
Michener W. And Rozin P. 1994. Pharmacalogical vs. Sensory Factors in the Satiation of Chocolate Craving. Physiol. Behav. 56,419-422.
Dalvit SP. The effect of the menstrual cycle on patterns of food intake. Am J. Clin Nutr. 1981;34:1811-5.
Lissner L, Stevens J, Levitsky DA, et al. Variation in energy intake during the menstrual cycle: implications for food intake research. Am J. Clin Nutr. 1988;48:956-62.
Greene JC, Louie R, Wycoff SJ. Preventive dentistry: Dental caries. JAMA. 1989;262:3459-63.
Mandel ID. Resistance to caries; The case for heredity. In: Changing Perspectives in Nutrition and Caries Research. New York, NY; Medcom, Inc.; 1979;28-29.
Bibby BG, Goldberg HJV, Chen E. Evaluation of caries-producing potentialities of various foodstuffs. J Amer Dent Assoc. 1951;42:491-509.
Kandelman D. Sugar, alternative sweeteners and meal frequency in relation to caries prevention: New perspectives. Brit J. Nutr. 1997;77:S121-S128.
Carbohydrates and tooth decay. Tufts University Diet & Nutrition Letter. 1986;4:1.
Mormann JE, Muhlemann HR. Oral starch degradation and its influence on acid production in human dental plaque. Caries Res. 1981;15:166-175.
Grenby TH. Snack foods and dental caries. Investigations using laboratory animals. Brit Dent J. 1991;353-361.
Alfno MC. Understanding the role of diet and nutrition in dental caries. In: Changing Perspectives in Nutrition and Caries Research. New York, NY: Medcom, Inc.; 1979;6-12.
Tinanoff N. Dental plaque in the carious process. In: Stewart RE, Barber TK, Troutman KC, Wei SHY, eds. Pediatric Dentistry, Scientific Foundations and Clinical Practice. St. Louis, MO: CV Mosby co; 1982;548.
Firestone AR, Schmid R, Muhlemann HR. Effect of the length and number of intervals between meals on caries in rats. Caries Res. 1984;18:128-133.
Gatenby SJ. Eating frequency: methodological and dietary aspects. Brit J. Nutr. 1997;77:S7-S10
Kashket S, Van Houte J, Lopez, LR, Stocks S. Lack of correlation between food retention on the human dentition and consumer perception of food stickiness. J Dent Res. 1991;70:1314-1319.
Gustafason B, Quensel CE, Lanke L, et al. The Vipeholm dental caries study: The effect of different levels of carbohydrate intake on dental caries activity in 436 individuals observed for five years. Acta Odontol Scand. 1954;11:232.
Morrissey RB, Burkholder BD, Tarka SM Jr. The cariogenic potential of several snack foods. J Amer Dent Assoc 1984;109:589-591.
Paolino VJ, Kashket, S. Inhibition by cocoa extracts of biosynthesis of extracellular polysaccharide by human oral bacteria. Arch Oral Biol. 1985;30:359-363.
Kashket, S, Paolino VJ, Lewis DA, Van Houte J. In-vitro inhibition of glucosyltransferase from the dental plaque bacterium streptococcus mutan by common beverages and food extracts. Arch Oral Biol. 1985;30:821-826.
Yankell SL, Emling RC, Shi X, Greco MR. Low cariogenic potential of mixtures of sucrose and chocolate, cocoa or confectionery coatings. J Clin Dent. 1988;1:28-30.
American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care. 1994;17:519-522.
American Diabetes Association. Nutritional recommendations and principles for individuals with diabetes mellitus: 1986. ADA Position Statement Diabetes Care. 1987;10:126-132.
Diabetes Care and Education, Tinker LF, Heins JM, Holler, HJ. Commentary and translation: 1994 nutrition recommendations for diabetes. JADA. 1994;94(5):507-11.
Cedermark G, Selenius M, Tullus K. Glycaemic effect and satiating capacity of potato chips and milk chocolate bar as snacks in teenagers with diabetes. Eur J. Pediatrics. 1993;152:635-9.
Gee JM, Cooke D., Gorick S, Worthley GM, et al. Effects of conventional sucrose-based, fructose-based and isomalt-based chocolates on postprandial metabolism in non-insulin-dependent diabetics. Eur J. Clin Nutr. 1991;45(11) 561-6.
The Food Guide Pyramid. Washington, DC: U.S. Department of Agriculture, Human Nutrition Information Service, 1992. Home and Garden Bulletin No. 252.
American Academy of Allergy and Immunology Committee on Adverse Reactions to Foods and National Institute of Allergy and Infectious Diseases. Adverse Reactions to Foods. July 1984. NIH Publication No. 84-2442.
Peatfield RC, Glover V, Littlewood JT, Sandler M, Clifford RF. The prevalence of diet-induced migraine. Cephalagia. 1984;4(4):179-183.
Moffet AM, Swash M, Scott DF. Effect of chocolate in migraine: a double-blind study. J Neurol, Neurosurg & Psychiat. 1974;37:445- 448.
Marcus DA, Schraff L, Turk DC. A double-blind provocative study of chocolate as a trigger of headache. Cephalagia. 1997;17:855-862.
Stewart W, Lipton R. Migraine epidemiology in the United States. In Olsen, J. (ed.), Headache Classification and Epidemiology. Raven Press, Ltd., New York, NY. 1994;239-246.
Rozin P, Levine E, Stoess C. Chocolate craving and liking. Appetite. 1991;17:199-212.
Blau JN, Diamond S. Dietary factors in migraine precipitation: the physician’s view. Headache. 1984;25:184-187.
Nattero G. Menstrual headache. In Critchley, M. (ed.), Advances in Neurology. 1982. Vol. 33. Raven Press, New York.
Schraff L, Turk DC, Marcus DA. Triggers of headache episode and coping responses of headache diagnostic groups. Headache. 1995;35:397-403.
Kohler T, Haimerl C. Daily stress as a trigger of migraine attacks: results of thirteen single-subject studies. J Consult Clin Psychol. 1990;58:870-872.
National Institutes of Health, National Heart, Lung and Blood Institute, 1998. Clincial Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults.
Flegal KM, et al. 1998. Overweight and obesity in the United Sates: prevalence and trends. 1960-1994. Int. J. Obesity. 22:39-47.
ADA reports: Position of the American Dietetic Association: Weight management. J Am Diet Assoc. 1997;Vol. 7: No. 1:71-74.
Hill JO and Peters, JC. Environmental contributions to the obesity epidemic. Science. 1998;280 (5368):1371-1374.
Willet WC. Dietary fat and obesity: an unconvincing relationship. Am J. Clin Nutr. 1998;68:1149-1150.
Rolls, BJ. And Hill JO. Carbohydrates and weight management. 1998; International Life Sciences Institute, Washington, D.C.
Nutall, F.Q. And Gannon, M.C. Carbohydrates and diabetes. IN: Franz, M.J. And Battle, J.P., eds. American Diabetes Assoc. Guide to Medical Nutrition Therapy. Am. Diabetes Assoc. 1999; 85-106.
Bolton, Smith C. And Woodward M. Patterns of food and nutrient intake in adults consuming high and low levels of table sugar in Dublin suburb of chronically high employment. Proceedings of the Nutrition Society 1994;48-132A.
Surwit RS. Et al. Metabolic and behavioral effects of a high-sucrose diet during weight loss. Am. J Clin Nutr. 1997;65:908-915.
Drewnowski A, et al. Sweet tooth reconsidered; taste preferences in human obesity. Physiol Behav 1995; 35:617-622.
Mela, DJ and Sacchetti, DS. Sensory preferences for fats in foods: relationships to diet and body composition. Am J. Clin Nutr. 1991; 53:908-915.
Green SM, Delargy HJ, Joanes D. And Blundell JE A satiety quotient: a formulation to assess the satiating effect of food. Appetite. 1997; 29:291-304.
Seligson FH, Krummel DA and Apgar JR. Patterns of chocolate consumption. Am J. Clin Nutr. 1994;60:S1060-S1067.
Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. U.S. Department of Health and Human Services, Public Health Service. National Institutes of Health; 1989. NIH Publication No. 89-2925.
Kritchevsky D. Effects of Triglyceride Structure on Lipid Metabolism. Nutrition Reviews. 1988;46:177-181.
Keys A, Anderson JT, Grande F. Serum cholesterol response to changes in the diet. IV. Particular saturated fatty acids in the diet. Metabolism. 1965;14:776-787.
Hegsted, DM, McGandy RB, Myers, ML, et al. Quantitative effects of dietary fat on serum cholesterol in man. Am J. Clin Nutr. 1965;7281-295.
Apgar JL, Shively CA, Tarka SM. Digestibility of cocoa butter and corn oil and their influence on fatty acids distribution in rats. J Nutr. 1987;117:660-664.
Mitchell DC, McMahon KE, Shively, CA, Apgar JL, Kris-Etherton PM. Digestibility of cocoa butter and corn oil in human subjects: a preliminary study. Amer J. Clin Nutr. 1989;50:983.
Bonanome, A, Grundy, SM, Effect of dietary stearic acid on plasma cholesterol and lipoprotein levels. N Engl J. Med. 1988;318:1244-1248.
Kris-Etherton PM, Derr JA, Mitchell DC, et al. The role of fatty acid saturation on plasma lipids, lipoproteins and apoliproteins. I. Effects of whole food diets high in cocoa butter, olive oil, soybean oil, dairy butter and milk chocolate on the plasma lipids of young men. Metabolism. 1993;42:121-129.
Derr JA, Kris-Etherton PM, Pearson TA, Seligson FH. The role of fatty acid saturation on plasma lipids, lipoproteins and apoliproteins. II. The plasma total and LDL-cholesterol response of individual fatty acids. Metabolism. 1993;42:130-134.
Kris-Etherton PM, Derr JA, Mustad VA, Seligson FH, Pearson TA. A milk chocolate bar/day substituted for a high carbohydrate snack increases high density lipoprotein cholesterol in young men on an NCEP/AHA Step One diet. Am J. Clin Nutr supplement. December 1994.
Cobb TK. Effects of dietary stearic acid on plasma cholesterol levels. South Med J. 1992;85:25-27.
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
There is a very low likelihood that you won’t like the paper.
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!
Place an order in 3 easy steps. Takes less than 5 mins.