Most of us would love to hear that our favorite foods have medicinal qualities. So it’s not surprising that studies that attribute health benefits to foods like chocolate and red wine attract so much attention.
There’s probably no better example than the handful of well-publicized studies that link chocolate to better cognition and brain health.
Interest in techniques for improving or maintaining brain health is entirely rational. Our brains, after all, are arguably our most important organs. As defined by the American Psychological Association (APA), cognition is “all forms of knowing and awareness, such as perceiving, conceiving, remembering, reasoning, judging, imagining, and problem solving.” These are things that we all want to do better.
Moreover, age-related cognitive decline, otherwise known as dementia, ranks at or near the top of most people’s medical fears. And there are, in fact, 33 scientifically proven ways to improve and preserve cognition. The most promising, including exercise and several common foods, are included in the Great Age Reboot program and Reboot Your Age App. Nevertheless, seeking other (potentially delicious) options is probably good evidence of cognitive competency.
So the fruit of the cacao tree has been investigated as a means of improving or maintaining brain function, with some very promising data. A 2019 review article, Chocolate, “Food of the Gods”: History, Science, and Human Health, IJERPH, 2019, summarizes several encouraging trials that seemed to show chocolate improves cognition. One four-year longitudinal study indicated that chocolate reduced the risk of cognitive decline in subjects at least 65-years-old. Data from the long-running Maine-Syracuse Longitudinal Study show that subjects aged 23 to 98 who report more frequent chocolate consumption linked have better cognition.
Sounds great but both of these studies, however, are observational meaning they are based on analysis of data collected from a target population. The studies clearly link better cognition with chocolate consumption, but there’s a reason you so often hear the aphorism “correlation is not causation” in scientific circles.
Historically, even strong correlations have often been found to be coincidental and misleading. That’s why scientists consider randomized controlled trials (RCTs) the gold standard of research. RCTs start with a population and randomly assign participants to groups that receive either the treatment being tested or a control. The control can be either a placebo or a standard treatment. Ideally, RCTs are blinded to minimize the impact of bias in the participants and scientists administering the trial. A good paper on the topic is available here.
Unfortunately, a 2021 review published in the journal Nutrients, The Health Effects of Chocolate and Cocoa: A Systematic Review, failed to confirm the hints of chocolate’s cognitive benefits found in observation studies. Limiting their analysis to RCTs, the authors found evidence that chocolate and control groups “showed no clear differences.”
That’s why we were excited to see another RCT published in the journal Alzheimer’s & Dementia. This placebo-controlled three-year study tested whether daily administration of cocoa extract (containing 500 mg/day flavanols) versus placebo and a commercial multivitamin-mineral versus placebo improved cognition in 2,262 older women and men.
Its title, Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial, contains an important spoiler. The study’s primary endpoint, meaning the result they were primarily focused on testing, was change in cognition following 3 years of cocoa extract use.
Unfortunately, however, cocoa extract had no effect on global cognition. Fortunately, the secondary endpoint of the trial, the impact of daily multivitamin-mineral supplementation, relative to placebo, resulted in a statistically significant benefit on global cognition. Global cognition is rated based on a battery of tests that measure cognition as defined above by the APA. This result was especially strong in participants with a history of cardiovascular disease.
The following graphic shows the results of global cognition test scores. It should be noted that there was an expected testing effect, which refers to the fact that subjects tested for cognition tend to improve over time as they become familiar and practiced with the testing procedures. However, it’s obvious that this effect diminished over time in the cocoa group while the MVM group significantly outperformed the practice effect in this three-year test.
Multivitamin-mineral benefits were also observed for memory and executive function. Executive function refers to higher level cognitive skills used to control behaviors to achieve goals.
This is, frankly, great news. Multivitamin-mineral supplements are inexpensive and easy to use. You can access the study online and the abstract is included below. Other benefits judged valid by our Scientific Advisory Board cited in our Reboot Your Age App of a multivitamin-multimineral for those over age 50 include a decrease in risk of cancer (18%), a decrease in recurrent cancers (23%) and of cardiovascular disease (25%) when the multivitamins are taken for 20 or more years.
Back to this week’s new data: That is not to say, however, that chocolate has no health benefits. Great Age Reboot recommends chocolate, but the dose is important. As is the case with wine, which has benefits at low doses for many people, it’s very easy to consume more chocolate than is optimal.
Based on a review of prospective cohort studies, it appears that optimal dark chocolate consumption is about 45 grams per week, which is a little more than one and a half ounces. That’s about one standard size chocolate bar. Eating more than that reduces the benefits and at about 100 gram or 3.5 ounces, chocolate’s impact appears to be detrimental.
Multivitamin-minerals are not as enjoyable as chocolate, but this study indicates that they’re much more effective.
The bottom line
The Great Age Reboot Scientific Advisory Board recommends you discuss with your practitioner, and most should take half a USP certified DV multi-multi twice a day. But this recommendation should only be considered after discussing with your practitioner as there are people who should not do this due to interactions with other habits, food, medications, or supplements.
Thanks for Reading!
Dr. Mike and Patrick Cox, PhD