Cachexia

Rachel Nall wrote . . . . . . . .

Cachexia is a condition that causes extreme weight loss as well as muscle wasting. The name comes from two Greek words: kakos, meaning “bad,” and hexis, meaning “condition.”

The condition is a symptom or side effect of chronic conditions, such as cancer, type 1 diabetes, HIV, and multiple sclerosis. Older individuals with “failure to thrive” syndrome may also develop cachexia. According to one study, an estimated 5 million Americans have the condition.

There are other conditions that cause a person to lose weight, but cachexia is different in that a person loses weight even if they are still eating. Usually a person who does not eat enough will lose fat, but a person with cachexia will lose both fat and muscle mass.

Causes

People with cachexia have incorrect levels of certain substances in their body. It is these imbalances that cause the weight loss and muscle wastage.

People with cachexia may also have decreased levels of testosterone in their body.

The substances that prevent muscle growth and contribute to the muscle wasting include elevated levels of insulin-like growth factor I (IFG-I), increased levels of the hormone myostatin, and high levels of glucocorticoids, which are hormones made by the kidneys.

The weight loss is caused by increased levels of cytokines, which are inflammatory substances that can contribute to weight loss. The increased levels of cytokines in the blood can develop as a result of having one of a number of long-term health conditions that are related to cachexia.

The conditions linked to cachexia may also cause reduced appetite or inability to eat without feeling nauseated.

Researchers are still studying the many links and other potential causes that can lead to cachexia.

Risk factors

There are certain chronic conditions that have been linked with cachexia. If a person has one of these conditions, they should talk to their doctor about steps they can take to prevent cachexia from developing and to live well.

Examples of these conditions include:

  • AIDS
  • Cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic renal failure – according to one study, an estimated quarter of all people with chronic renal failure are malnourished
  • Congestive heart failure
  • Crohn’s disease
  • Cystic fibrosis
  • Rheumatoid arthritis

Symptoms

Not all people with cachexia may look as if they are malnourished. It is possible that a person with cachexia was overweight before they developed a chronic illness. While they may look like they are of average size, it is possible that they could actually have lost a significant amount of weight.

Because cachexia is sometimes difficult to recognize, doctors use a variety of criteria to diagnose it.

To diagnose a person with cachexia, the person must have experienced the following:

  • Unintentionally losing more than 5 percent of their body weight.
  • Having a body mass index (BMI) of less than 20 in a person less than 65 years old, or a BMI of less than 22 in a person older than 65 years.
  • Having less than 10 percent body fat.
  • Having increased levels of cytokines in the blood is a marker of inflammation in the body. When cytokine levels are elevated in the blood, they activate a compound that reduces the creation of new muscle in the body. They also activate a process in the body that stimulates the breakdown of muscles known as hypercatabolism. The results of these processes can cause symptoms like malaise, fatigue, and poor energy levels.
  • Having an albumin level of less than 35 grams per liter. Albumin is a protein made in the liver that helps maintain fluid balance in the body. The loss of albumin that is associated with cachexia can also result in edema or swelling. Because the body can’t balance fluid levels properly, a person can experience swelling, often in the ankles.

Complications

The fat and muscle wasting associated with cachexia is very serious and can potentially lead to death. According to the book, Cachexia and Wasting: A Modern Approach, losing an estimated 66 percent of a person’s body weight is a predictor of death, regardless of the cause of the weight loss.

Some of the complications of cachexia include:

  • Diminished quality of life
  • Impaired response to treatments such as anticancer treatments
  • Lowered immunity
  • Worsened symptoms of the underlying chronic condition

A person who experiences severe weight loss and lacks muscle and fat can develop a number of unwanted complications and symptoms, including fatigue, malaise, and swelling.

All people rely on nutrients from food and glucose to survive. Fat and muscle are two of the places where the body stores these nutrients. When the body no longer has anywhere to store the nutrients, a person’s life will be severely impacted. Ultimately, cachexia can cause a person’s body systems to shut down, resulting in death.

Treatments

Treatments for cachexia can include medications to reduce the cytokines in the body, stimulate appetite, or block hormones associated with causing cachexia.

Examples of appetite stimulants include dronabinol and megesterol acetate. Corticosteroids, such as dexamethasone, methylprednisolone, and prednisolone, also stimulate appetite.

However, dietary changes are rarely enough to reverse the incidences of the muscle wasting associated with cachexia. Muscle mass can be built up through exercise. If physically able, a person may try resistance training by lifting weights, using resistance bands, or using a person’s bodyweight.

Sometimes, doctors will prescribe growth hormone, such as Serostim or Norditropin FlexPro.

Can cachexia be prevented?

Because cachexia is usually a side effect of an underlying medical condition, the focus should instead be on preventing these conditions whenever possible. Some conditions such as COPD or AIDS may be preventable for some people. However, other conditions such as cancer, rheumatoid arthritis, or Crohn’s disease are largely unavoidable.

What is cancer anorexia cachexia syndrome?

Cancer-related anorexia/cachexia syndrome (CACS) is a condition seen in cancer patients that results in muscle and fat loss associated with cachexia.

According to one study, an estimated 15 to 40 percent of patients with cancer experience significant weight loss associated with cachexia. Unfortunately, weight loss due to excessive cytokines is associated with a poor outlook and early death.

Symptoms of CACS include:

  • Affected quality of life
  • Mental fatigue
  • Physical deterioration
  • Significant weight loss
  • Weakness

When a person has cancer, the tumor cells may release cytokines that reduce a person’s appetite. Treatments for cancer, such as chemotherapy and radiation, can also affect appetite. When a person doesn’t eat enough and also has inflammatory compounds present, fat and muscle start to waste away. As a result, the cancer cells start to use up a person’s energy.

Treatments for CACS are similar to those of cachexia treatments for other conditions. Intervening as soon as possible to reduce the effects of cachexia can help to reduce the serious effects it has on people with cancer.

Sometimes, when a person is in the advanced stages of cancer, a doctor may recommend palliative care. Palliative care is a shift from trying to treat or cure the disease and instead focuses on making a person comfortable and enhancing their quality of life.

Although the decision to switch to a palliative care mindset can be a difficult one, it can often provide peace and additional support to a person in the final stages of their life.

According to the Ohio State University, an estimated 80 percent of patients with advanced cancer have CACS. The condition is estimated to be the cause of anywhere from 20 to 40 percent of all cancer deaths.

Source: Medical News Today


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Hair Loss Cures – Here’s What Really Helps and What to Skip

Sally Wadyka wrote . . . . . . . . . .

It’s normal to lose up to 150 hairs a day. “But by age 60, about 80 percent of men and 40 percent of women will have a measurable amount of hair loss,” says Shilpi Khetarpal, M.D., a dermatologist at the Cleveland Clinic.

The cause is usually genetic: male- and female-pattern hair loss. In men, hormones called androgens cause strands to fall out too early. In women, the action isn’t as clear, though androgens may play a role for some.

Thyroid problems, stress, trauma, autoimmune disease, and nutrient deficiency can also cause hair loss.

Should you try one of the over-the counter or prescription products touted to help? Here’s the lowdown.

Over-the-Counter Help for Hair

You might see the following products on drugstore shelves and online:

Topical minoxidil (Rogaine and generic): This OTC drug, applied to the scalp daily, stimulates hair follicles and pushes more hair into the growing phase.

Worth trying? Probably. A 2016 review of six studies by the independent Cochrane Collaboration found that twice as many women who used minoxidil experienced at least moderate hair regrowth compared with those who used a placebo.

And a review published in 2017 in the Journal of the American Academy of Dermatology (AAD) found that men using the topical twice daily had an average increase of nearly 15 hairs per square centimeter (with 5 percent minoxidil) and eight hairs (with 2 percent minoxidil).

Supplements: Many dietary supplements are marketed for hair growth, most with high levels of the B vitamin biotin.

Worth trying? Probably not. A 2017 review of studies found little evidence that biotin offsets hair loss except in the rare instance of biotin deficiency.

Low-level laser or light therapy: These combs, caps, and headband devices are said to stimulate follicles.

Worth trying? Maybe. “Low-level lasers do stimulate hair growth, and the at-home devices available might be helpful in some cases,” says Elise A. Olsen, M.D., director of the Hair Disorders Research and Treatment Center at the Duke University Medical Center in Durham, N.C.

Some data supports their effectiveness, but none have been compared with topical minoxidil or finasteride. And they don’t undergo the same rigorous testing that medications do.

Parsing the Prescription Products

Your doctor may prescribe an oral drug along with topical minoxidil. “The combination is often better than a single treatment alone,” Olsen says. Here are the options.

Finasteride (Propecia, Proscar, and generic): Approved for men (and prescribed off-label for women), this daily pill prevents testosterone from converting to a type of androgen that contributes to hair loss.

Worth trying? Maybe. The AAD says it helps slow hair loss in most men and stimulates regrowth in many. But it’s most effective early on. “It won’t help regrow hair that’s been gone for three or more years,” Khetarpal says.

Finasteride can affect libido and cause erectile dysfunction and birth defects. So it shouldn’t be used by premenopausal women who aren’t using an effective contraceptive.

Spironolactone (Aldactone and generic): This oral blood pressure drug, used off-label for hair loss in women, blocks the androgen receptor in hair follicles, stopping actions that lead to hair loss.

Worth trying? Maybe, especially if you have elevated androgen levels. We found no clinical trials, but in a survey of 166 women, published in 2015 in the Journal of the American Academy of Dermatology, 74 percent of those taking the drug reported that hair loss had stabilized or improved.

But it has caused tumors in lab animals, can affect blood pressure and kidney function, and may lead to higher than normal potassium levels. Have your potassium levels checked after starting this drug, and talk with your doctor about limiting dietary potassium. And because it can, like finasteride, cause birth defects, it shouldn’t be used by premenopausal women who aren’t using an effective contraceptive.

Platelet-rich plasma injections: PRP—where plasma from your blood is isolated and reinjected—is approved for injuries such as elbow tendinitis. It’s used off-label for hair loss, with monthly scalp injections for three months, a round at six months, and then treatment every few months.

Worth trying? Maybe. It may kick-start dormant hair follicles into producing new strands, says Joel L. Cohen, M.D., a dermatologist in Denver. Large-scale studies are lacking, but a small study, published in 2016 in the journal Dermatologic Surgery, found that it increased hair density after six months by about 13 hairs per square centimeter. The researchers say that more study is needed to confirm those findings.

Source: Consumer Reports


Today’s Comic

1 in 9 U.S. Adults Over 45 Reports Memory Problems

Steven Reinberg wrote . . . . . . . .

If you’re middle-aged and you think you’re losing your memory, you’re not alone, a new U.S. government report shows.

In fact, one in nine Americans aged 45 and older say they are experiencing thinking declines. According to the U.S. Centers for Disease Control and Prevention, noticing a decline in your mental abilities (“cognitive decline”) is one of the earliest signs of impending Alzheimer’s disease or dementia.

“Symptoms of confusion and memory loss are not a normal part of aging,” said lead researcher Christopher Taylor, a CDC epidemiologist. “Adults with confusion or memory loss should talk to a health care professional who can evaluate their symptoms and discuss possible treatments, management of other co-occurring chronic health conditions, advance care planning, and caregiving needs.”

One Alzheimer’s expert noted the findings point to an even larger issue.

“This survey is an indicator of the future problem and burden of dementia, and what public health officials should start addressing now,” said Matthew Baumgart, senior director of public policy at the Alzheimer’s Association.

“This issue is not going away — we are continuing on a path of a huge problem in the United States, and unless we do something, it’s not going to be reversed,” said Baumgart.

The CDC researchers also found that more than half of those reporting cognitive decline have difficulty doing everyday things like cooking, cleaning or taking medications.

Baumgart stressed that many people who experience memory lapses will not go on to develop Alzheimer’s disease or dementia.

“But many will,” he said. “It’s a warning sign that something isn’t right.”

For the study, the researchers used data from the 2015 and 2016 Behavioral Risk Factor Surveillance System surveys.

The investigators found that 11 percent of people aged 45 and older reported having mental decline, and half of those people also said they had limitations performing daily tasks.

Among those aged 45 and older who were living alone, 14 percent said they were suffering from declines in mental function. Among those suffering from a chronic disease, 15 percent reported some cognitive decline, the report showed.

The researchers also found that a greater percentage of people aged 75 and older reported cognitive decline than those aged 45 to 74.

Moreover, only 45 percent of those who said they had memory or other mental issues had spoken about their condition with a doctor, the findings showed.

This is unfortunate because some memory problems are reversible, Baumgart said. In addition, there are things you can do if you have memory problems even if they may not be reversible.

“But if you don’t talk to a health care professional about those memory problems in the early stages, you’re missing a key window of opportunity,” Baumgart said.

On the other hand, more than half of those who had functional limitations said they had talked with their doctor, compared with less than one-third of those without limitations.

This finding suggests that limitations in ability to perform basic tasks of daily living might be a catalyst for people to discuss their problem with a doctor.

Some people might be reluctant to talk about their mental problems because they see these as a normal part of aging, which is a mistaken belief, the researchers pointed out. Having a discussion about possible mental decline is vital, because it can be the first step in planning care options and can help patients manage their health care.

One problem with the study is that the data was self-reported, which can result in inaccuracies, as people incorrectly remember or omit information, the study authors acknowledged.

Dr. Sam Gandy is director of the Mount Sinai Center for Cognitive Health in New York City. He said, “We know that amyloid plaque, a hallmark of Alzheimer’s disease, begins in the 40s, especially in carriers of the APOE4 gene.”

Next, Gandy said, doctors need to be able to predict risk among those with the APOE4 gene if amyloid plaque is present.

“If APOE4 and amyloidosis are both present, the likelihood of cognitive decline is substantial,” he said.

The most potent interventions that are believed to slow progression of dementia include optimizing cardiac health and adopting a heart-healthy lifestyle, including diet and exercise, according to Gandy, who was not involved with the new study.

“But the evidence supporting the benefits of diet and lifestyle is mixed. What this really cries out for are trials of amyloid-reducing agents beginning at age 45 or 50,” Gandy added.

The report was published in the CDC’s Morbidity and Mortality Weekly Report.

Source: HealthDay

Wearable Device Can Predict Older Adults’ Risk of Falling

Emily Scott wrote . . . . . . .

Every year, more than one in three individuals aged 65 and older will experience a fall.

Falls are the most common cause of injury in older adults, and can create ongoing health problems. But treatment and awareness of falling usually happens after a fall has already occurred.

As a part of the NIH’s Women’s Health Initiative, researchers wanted to see if they could predict an individual’s risk of falling so that preventative measures could be taken to reduce this risk.

New analysis has now made this prediction a reality.

The study involved 67 women, all over the age of 60, who were tested on their walking ability and asked about the number of falls they had experienced in the past year. Participants also wore a small device with motion sensors that measured their walking patterns for one week.

Bruce Schatz, head of the Department of Medical Information Science in the University of Illinois College of Medicine at Urbana-Champaign and faculty member of the IGB’s Computing Genomes for Reproductive Health research theme, was asked to analyze the data from the study. He worked with colleagues from the Women’s Health Initiative, including David Buchner from the Department of Kinesiology & Community Health, while supervising Illinois graduate students Andrew Hua and Zachary Quicksall, associated with the University of Illinois College of Medicine.

They found that data extracted automatically from the devices could accurately predict the participants’ risk of falling, as measured by physical examinations of unsteadiness in standing and walking. Their findings were published in Nature Digital Medicine.

“Our prediction showed that we could very accurately tell the difference between people that were really stable and people that were unstable in some way,” Schatz said.

Studies have shown that older individuals fall differently than younger individuals. Younger people fall if they misjudge something, such as a slippery surface. But older adults fall because their bodies are unstable, causing them to lose balance when walking or become unsteady when standing up and sitting down.

This difference gave researchers the idea that they might be able to measure this instability. The device they used, called an accelerometer, was able to measure the user’s walking patterns and how unsteady they were. They combined this measurement with the individual’s fall history to determine the risk of falling in the future.

Being able to predict the fall risk is significant because many older adults often don’t pay attention to the fact that they are unstable until after they fall. But if they know they’re at risk, they can do rehabilitation exercises to increase their strength and reduce their chance of falling.

Schatz sees the successful outcome of this research as a sign that, in the future, more wearable devices, or even smartphone apps, will be able to measure walking patterns and warn users of their fall risk.

Most cellphones today already have an accelerometer, the same sensor that was used in this study. Schatz envisions a future where everyone over 60 would have a phone app that constantly records their motion, requiring no input from the user. If the user’s walking becomes unstable, the app could notify the user or their doctor, and they could begin preventative exercises.

“I work a lot with primary care physicians, and they love this (idea), because they only see people after they start falling,” Schatz said. “At that point, it’s already sort of too late.”

This research relates to the larger idea of preventative medicine — health care that can warn patients about health problems so they can take action and better manage the problem.

Predictions like these are difficult to make, but research experiments like this one make Schatz hopeful that progress is being made. More federally funded studies monitoring larger populations are being conducted more often, so predictive models developed for existing studies, such as the Women’s Health Initiative, are important for future research. Additionally, wearable devices like those used in this study are becoming cheaper and more widely available.

These developments give Schatz hope that a future with successful predictive medicine is coming.

“The question is: is it known how to take the signal, how to take whatever comes out of (a device), and predict something that’s useful?” he said. “I believe strongly the answer is yes.”

Schatz sees value in doing fundamental research that could solve major health problems, like falls in older adults. Most people are aware that it’s a common problem, but Schatz said there is a sense of hopelessness about this issue — if it happens to so many older adults, then what can be done?

“There is a solution which is completely workable and isn’t very expensive, but requires different behavior,” Schatz said. “That message is not getting out.”

He predicts that the quality of life among older adults will improve as medicine and health care become more predictive and effective.

“The future is different,” Schatz said. “And it’s because of projects like this.”

Source: University of Illinois at Urbana-Champaign


Today’s Comic

Long Read: Is Dark Chocolate a Health Food?

Julia Belluzwrote . . . . . . . . .

A year after James Cadbury, the 30-something great-great-great-grandson of the British chocolatier John Cadbury, launched his luxury cocoa startup in 2016, he introduced an avocado chocolate bar.

Cadbury Jr.’s newest confection loaded just about every buzzy health trend into a fresh green-and-white package: vegan, ethically sourced, organic dark chocolate and creamy, superfood avocado. The company promised to deliver the nutrition of avocados — in a chocolate bar. Journalists were dazzled.

Wait, what? Make no mistake: This vegan avocado chocolate bar is candy. With nearly 600 calories and 43 grams of fat per 100-gram serving, the bar packs more fat and calories than Cadbury Dairy Milk, and just a little less sugar.

So how in the world could a chocolate bar be convincingly sold as a health food? You can thank a decades-long effort by the chocolate industry.

Over the past 30 years, food companies like Nestlé, Mars, Barry Callebaut, and Hershey’s — among the world’s biggest producers of chocolate — have poured millions of dollars into scientific studies and research grants that support cocoa science.

Industry funding in nutrition science is not uncommon — grape juice makers and walnut growers sponsor studies showing these foods improve driving performance or cut diabetes risk. But Big Chocolate’s foray into nutrition research is a great case study in how industry can steer the scientific agenda — and some of the best minds in academia — toward studies that will ultimately benefit their bottom line, and not necessarily public health.

Here at Vox, we examined 100 Mars-funded health studies, and found they overwhelmingly drew glowing conclusions about cocoa and chocolate — promoting everything from chocolate’s heart health benefits to cocoa’s ability to fight disease. This research — and the media hype it inevitably attracts — has yielded a clear shift in the public perception of the products.

“Mars and [other chocolate companies] made a conscious decision to invest in science to transform the image of their product from a treat to a health food,” said New York University nutrition researcher Marion Nestle (no relation to the chocolate maker). “You can now sit there with your [chocolate bar] and say I’m getting my flavonoids.”

Amid a historic obesity epidemic, this new niche of nutrition science has helped build a solid aura of health around chocolate — and grow consumer demand. Chocolate retail sales in the US have risen from $14.2 billion in 2007 to $18.9 billion in 2017, the market research group Euromonitor International found, at a time when candy sales overall have been waning.

Big Chocolate’s investment in health science was a marketing masterstroke, catapulting dark chocolate into the superfood realm along with red wine, blueberries, and avocados — and helping to sell more candy.

Health-conscious consumers now increasingly seek out “premium” dark and gourmet chocolate, Euromonitor found, the success of which “stems partially from the health benefits associated with a higher cocoa content.”

But despite the industry effort to date, cocoa still has never been proven to carry any long-term health benefits. And when it’s delivered with a big dose of fat and sugar, any potential health perks are very quickly outweighed by chocolate’s potential harm to the waistline.

That’s something consumers all too easily forget in the face of delights like the vegan avocado chocolate bar.

How Mars helped turn chocolate into a heart healthy snack

In 1982, Mars Inc. — the company that has brought us M&M’s, Snickers, and Twix — established the Mars Center for Cocoa Health Science in Brazil to study, in part, the biology of cocoa and its impact on human health.

Since then, mainly through the company’s scientific arm Mars Symbioscience, established in 2005, it has flooded journals with more than 140 peer-reviewed scientific papers.

Mars’ initial focus on studying the health benefits of chocolate has shifted to studying a group of compounds called flavanols. Flavanols are micronutrients found in many fruits and vegetables, including cocoa. These “phyto” — or plant-derived — chemicals have antioxidant properties and seem to promote vascular health (more on that later). Researchers suspected flavanols might be one of the reasons fruits and vegetables are so good for the body.

Companies selling flavanol-rich products have been on a quest to find out what flavanols do — and how they can be hyped. One of the earliest Mars papers, published in the Lancet, demonstrated that chocolate was a great source, even compared to flavanol-rich tea. “As a result,” the candy company claims on its website, “Mars started a research program to identify and isolate flavanols from cocoa, and to use these cocoa flavanols in the study of human health benefits.”

In addition to the science Mars generates, the company has also endowed a chair in nutrition science at the University of California Davis, and sponsored research conferences that focus on subjects like “The Potential Use of Cocoa Flavanols in Preventing Cardiac and Renal Disease.”

To find out what kind of conclusions Mars-sponsored studies come to, Vox searched the health literature and identified 100 original cocoa health studies funded or supported by the chocolate maker over the past two decades. (We also found dozens more Mars-supported cocoa studies that weren’t health-related and systematic reviews of the research evidence.)

Among the findings in the Mars-sponsored health studies: Regularly eating cocoa flavanols could boost mood and cognitive performance, dark chocolate improves blood flow, cocoa might be useful for treating immune disorders, and both cocoa powder and dark chocolate can have a “favorable effect” on cardiovascular disease risk. The institutions that received Mars support stretch across the US and all over the world — from UC Davis to Harvard and Georgetown universities, from Heinrich Heine University in Düsseldorf, Germany, to the University of Buenos Aires, Argentina.

All told, nearly every one of the studies came to positive and favorable conclusions about cocoa or chocolate.

Such overwhelmingly positive findings suggest this area of industry-funded nutrition science may be biased. “By spending a lot of money on one topic but not another, [it] can sort of create a publication bias,” said Richard Bazinet, a University of Toronto nutrition researcher. In other words, companies pouring money into studying a certain food and a specific set of questions about that food pushes the research agenda in a particular direction — one that the food companies favor. (In the Cochrane review of chocolate research, studies funded by companies with a commercial interest in the results tended to report effects on blood pressure that were larger than the independent studies, “indicating possible bias.”)

Tying up researchers’ hours on cocoa — which may or may not have marginal health benefits — also means other, more important studies aren’t getting done. “Mars is controlling the research agenda in its corporate self-interest,” said NYU’s Nestle. “But think about the kinds of projects that might get done if an equivalent amount of money was available for investigator-initiated research that might have nothing at all to do with selling food products and everything to do with promoting health.”

Bias can seep into research in other ways, as we explained in a story about industry-funded nutrition research. Industry may chose to fund researchers with favorable views about their products, and researchers may consciously or unconsciously tweak the design of their studies or their interpretation of results to arrive at more positive conclusions.

Mars would not disclose how much it’s invested in cocoa science, saying it is a private company, and this information is not publicly available. Vox also asked Mars to comment on the concerns of independent researchers, and it responded: “We are always clear that chocolate is a treat, not a snack, food, or meal replacement, and market our products accordingly,” adding, “we do not translate or communicate the outcomes of our cocoa flavanol research program in the context of chocolate.”

Its cocoa flavanol research instead supports its CocoaVia line of supplements and bars that are marketed as health foods, a spokesperson added. CocoaVia’s products, which “promote healthy blood flow from head to toe,” have been dinged by the Advertising Self-Regulatory Council for these health claims.

Mars is certainly not alone in the chocolate industry’s effort to steer the academic research agenda. The Swiss cocoa producer Barry Callebaut, along with Hershey and Nestlé, has also funded many studies showing cocoa is healthy. Like Mars, Nestlé has been sponsoring “Nestlé chairs” at research institutions, such as the Swiss École polytechnique fédérale de Lausanne, to study energy metabolism and neurodevelopment. Nestlé has veto power over who gets the chair appointment.

How the media feeds chocolate hype

The resulting cocoa and chocolate studies are catnip for journalists, who often write about them under headlines like “Good news for chocolate lovers: The more you eat, the lower your risk of heart disease,” or simply “Chocolate is good for you.”

In one example, a Columbia University researcher, Adam Brickman, led a Mars-funded study, looking at how cocoa flavanols might affect the dentate gyrus, a region of the brain whose deterioration with age is associated with memory decline. His paper concluded that flavanols may improve dentate gyrus function, according to specific cognitive ability tests.

But the university public relations team and the media hyped the findings, and turned a small flavanol supplement study into a big chocolate study.

Columbia University’s newsroom touted the research as demonstrating that “dietary flavanols reverse age-related memory decline” — even though the study was small and preliminary. The research was then picked up by media outlets, including the New York Times, which trumpeted chocolate as a memory aid.

“We [were] very careful about not referring to [the cocoa flavanols] as chocolate,” said Brickman. “Nothing was more upsetting than seeing the headlines along the lines of ‘eating chocolate cures Alzheimer’s,’ which was not what our study was about.”

Fawning cocoa coverage is so pervasive, one journalist even created a bad chocolate study, suggesting the candy promotes weight loss. His goal was to fool the media into picking it up and make a point about how easy it is to do so. (It worked.)

So is chocolate good for your health? In a word: no.

In our review of cocoa health science published to date, we found that the most compelling (and best-studied) effect has to do with cocoa’s effects on blood pressure.

There’s promising evidence showing cocoa flavanols can increase the synthesis of nitric oxide in the blood vessels, which boosts blood flow (or vasodilation) and reduces blood pressure. Lower blood pressure has been linked with a lower risk of cardiovascular events like heart attack, stroke, and cardiovascular mortality. According to a Cochrane systematic review of the cocoa research on blood pressure, flavanol-rich chocolate and cocoa products “cause a small (2 mmHg) blood pressure-lowering effect in mainly healthy adults in the short term.”

Chocolate’s heart health benefits are extremely appealing at a time when heart disease is still the leading cause of death in America. When researchers have run big, high-quality observational studies, following many people’s diets, they’ve found associations between chocolate eating and a lower risk of cardiovascular problems — and many of these studies weren’t funded by the industry.

Here’s the hitch, though: Cocoa’s effects on blood flow have never been directly linked to a lowered risk of cardiovascular events. So cocoa may impact blood pressure in the short term, but it’s never been proven to reduce the risk of heart disease or heart attacks. And observational studies can only show correlations between phenomena — not that eating chocolate caused the reductions in heart problems. It may be that chocolate eaters are wealthier or have other characteristics, aside from their chocolate-eating habit, that protect them from disease.

What’s more, while fresh cacao beans are rich in flavanols, the nutrient can get destroyed during chocolate processing, so most candy bars don’t deliver the potentially blood-boosting stuff. (Mars now markets its CocoaVia products as being made with “gently handled” cocoa beans that “preserve and protect the cocoa flavanols inside.”)

Researchers are now trying to sort out whether the promising smaller trials and observational studies on cocoa and heart health translate into fewer clinical events like heart attacks through a major randomized controlled trial called COSMOS, run by researchers at Brigham and Women’s Hospital, an affiliate of Harvard Medical School, and the Fred Hutchinson Cancer Research Center in Seattle.

Interestingly, that study focuses on the effects of cocoa supplements, not chocolate, since supplements are a better flavanol delivery vehicle. COSMOS and its ancillary studies also happen to be funded by Mars Symbioscience, as well as Pfizer Inc. and the National Institutes of Health — the culmination of its decades-long investment in searching for chocolate’s health attributes.

Chocolate is just one of America’s favorite sugar delivery devices

Mars frames its foray into cocoa science as an effort to better understand the prized cacao fruit. Outside observers view it as a marketing ploy.

Michael Coe, a Yale University chocolate historian and co-author of the book The True History of Chocolate, views Big Candy’s investment in cocoa science as an effort to counterbalance the negative publicity that came out of the fair trade movement, which highlighted the cocoa industry’s dependence on child and slave labor, as well as the evidence suggesting the obesity epidemic is being driven by sugar.

In 2015, Americans’ consumption of added sugars was 358 calories per day, or about 94 grams, up from 235 calories per day in 1977-’78. There’s a mountain of research on all the ways a sugar-heavy diet can harm our health: Increased risks of obesity, Type 2 diabetes, tooth decay, and heart disease are just some of the most well-established examples.

Pie, cake, cookies, and candies — including chocolate — are still some of the leading sources of added sugar in the American diet. The Euromonitor data shows Americans will consume nearly 1.4 million metric tons of chocolate sold through retail in 2017. That’s about 30 Titanics’ worth of chocolate, or 9 pounds of chocolate per American. (Holidays are always big for the chocolate industry, with Halloween representing peak chocolate.)

“[Funding cocoa science] is quite clearly a sales thing to sell more chocolate because [the studies] suggest it’s not all that bad for you,” Coe said. “Chocolate companies can say they have scientifically proven that chocolate will lower your blood pressure, keep you from heart attacks.”

Their investment appears to have paid off. “Premium chocolate,” like the vegan dark chocolate avocado bar, is helping drive growth in the chocolate market, Euromonitor found in an analysis of the US chocolate industry. Americans are increasingly looking for “healthy indulgences” as they become more aware of nutrition — and turning to snack bars like Kind, or dark chocolate with fruits and nuts, for their fix.

“I don’t want to be cynical — a lot of their science is good; it’s put in peer-reviewed journals,” Coe added. “But just keep in mind that too much of anything is not really good. If you’re hooked on chocolate, you’re hooked on sugar.”

Industry funding can warp our perceptions of chocolate

When you look at industry-funded studies, one thing becomes clear: They tend to focus on the health attributes of cocoa: its impact on cardiovascular health or cognitive function. But they don’t address the role the cocoa delivery mechanism — sugary chocolate — may play in obesity. Most Mars and Hershey chocolates also contain very small amounts of the cocoa that supposedly promotes heart health — along with lots of fat, sugar, and calories.

“Dark chocolate probably has some beneficial properties to it,” said Salt Sugar Fat author Michael Moss, “but generally you have to eat so much of it to get any benefit that it’s kind of daunting, or something else in the product counteracts the benefits. In the case of chocolate, it’s probably going to be sugar.”

The chocolate-industrial-research complex also distracts us from really important avenues of nutrition research, like better understanding what in our food may be contributing to the parallel obesity and diabetes epidemics, and how we can solve vexing problems like malnutrition. Chocolate certainly isn’t the solution here.

“It’s a great business to fund studies whose conclusions provide candy makers with the ability to promote people’s favorite foods as healthful,” said obesity doctor Yoni Freedhoff, “and while maybe not everyone will believe their candy bars are the ticket to health, I bet plenty, consciously or unconsciously will think [chocolates are] not as bad for them as they thought and buy them more often.”

“The idea that dark chocolate is healthy has worked its way into the mainstream psyche,” said NYU food historian Amy Bentley, adding that even the very restrictive Paleo dieters sanction dark chocolate because of its “numerous health benefits.”

There is a case for high-quality cocoa science

Some researchers argue that we really do need high-quality studies on nutrition, even if they are funded by Big Chocolate. Referring to the Mars-funded COSMOS trial, Stanford University health researcher John Ioannidis said he thought the effort was not a waste since this is a health question people care about.

“We have already spent billions of dollars and tens of thousands of studies trying to address [nutrition] questions with observational data and small, biased trials that really get us nowhere. At least these large trials can be definitive,” he said, and put all the noise from smaller studies to rest. (He did add, “If I have to bet, I believe that these trials will almost always give conclusively negative results regarding major health benefits.”)

Bigger, better studies may find that cocoa is in fact a health elixir, so we should keep doing them. “It’s important to understand whether something as simple and low-risk as increasing a nutrient in the diet could also have health benefits,” said JoAnn Manson, a Harvard nutrition researcher. “[Cocoa] has looked promising in small-scale randomized controlled trials and in observational studies, so it’s worth moving now to more conclusive and large-scale randomized controlled trials.”

Manson also noted that she’ll be publishing the results of the COSMOS randomized trial regardless of the outcomes — whether they prove cocoa is a health food or not — which would help combat the kind of publication bias Bazinet was worried about.

Perhaps the COSMOS trial will end the debate about cocoa’s true effects on the body. Until then, it’s important to keep in mind that there’s rarely clear evidence that specific foods have miraculous health effects. Instead, healthy eating patterns seem to matter much more than how much of any one food you consume. And a diet heavy in chocolate is a diet heavy in sugar, calories, and fat.

Source: Vox