October 17, 2007

The Truth About Chocolate

I am not sure what the Adventist Church teaches about chocolate consumption. I hear some say it is good, and others that Ellen White said we shouldn’t eat it. Can you shed light on this for me?

What Ellen White wrote is often different from what people think or report she wrote.

Actually, we have not found anything mentioned about chocolate by Mrs. White, so we doubt very much that she was concerned about it—particularly as an examination of her grocery lists (the ones available) shows she purchased chocolate.
Much of the debate comes from repeated assertions that chocolate contains caffeine. In fact, the caffeine content is in no way comparable to that in tea, coffee, or caffeinated beverages, being of a magnitude of one-tenth to one-fifteenth as much. Some of the factors in chocolate may actually be very healthful.
The problem is that, to date, studies on chocolate have been small in size and—consequently—less capable of solving the issue. Of course, if a person already has an opinion they wish to promote, they often give more credence to such studies. We frequently see that, especially in situations in which a person looks for studies to buttress an opinion they already hold.
We recommend fruits and vegetables for their phytochemicals and, in particular, their polyphenols, which are thought to play a role in lowering blood pressure.
2007 1529 page24Apart from fruits and vegetables, dark chocolate (not white or milk chocolate) is a major contributor to the population’s total polyphenol intake. Cocoa contains these polyphenols, which are most concentrated in cocoa syrup.
Chocolate is rich in sugar and fat, and regular consumption of large amounts will contribute to problems with obesity.
The polyphenols in dark chocolate are called flavanols, which are felt to influence blood pressure.
Several small studies have shown benefits of consuming 100-gram doses of dark chocolate to lessen cardiovascular risk. A recent study, however, looked at one piece of chocolate a day (i.e., 6.3 grams of dark chocolate), and compared it with white chocolate. No noted weight gain was experienced in this study, yet the dark chocolate group showed a reduction in blood pressure. The study was small and far from definitive, but it suggested the mechanism may be through an effect on the lining of the blood vessels—the endothelium. A nitric oxide cycle is involved in blood pressure regulation, and it is postulated that small doses of chocolate may favorably influence this pathway.
Adventist Church members, fortunately, focus more on biblical theology than chocolate confectionary, though more comprehensive discussions of this and many other topics will occur at the Nutrition Conference at Loma Linda University Medical Center in early 2008. If you are interested, you should attend!


I am under the impression that stress makes my heart beat irregularly. My wife says I am a natural-born “worrywart,” but can stress hurt my heart?

Stress is more of an internal reaction than a quantifiable external event. So your wife may have a point. People who have a greater level of anxiety are more stressed than others, and you may live in a state of anxiety. Such people are prone to panic attacks, but episodic stress can produce changes in the cardiovascular dynamics.

Evidence exists that atrial fibrillation can be triggered by stress, though there is probably an underlying problem. Ventricular fibrillation, which is much more serious, can also be triggered by acute distress. Myocardial ischemia, or reduced coronary blood flow, also can occur in response to stress. A condition in which multiple extra beats of the heart occur may also be a response to stress.

It is important for you to learn relaxation techniques and to analyze the cause of your stress and your reaction to events. Professional help can give good insights. Your doctor may consider giving you medication to dampen the effects of adrenalin-like compounds. These medications, called B-blockers, may not only bring a sense of relief from stress but actually reduce the response of your heart to your distress—especially when you are in an acutely stressful situation



My cholesterols seem to be within the normal range, but I have elevated triglycerides. What does this mean?

High serum triglycerides (blood fats) may be a result of abnormal factors, such as obesity, diabetes, insulin resistance, low levels of high-density lipoproteins (HDL, the good cholesterol)—even a diet high in refined carbohydrates.

Triglycerides interact with the HDL, and whether the relationship between heart disease and triglycerides is a direct result of the high triglycerides or a result of the lowered HDL is an often-debated subject.
It is suggested that women may have greater risk from high triglycerides.
Whatever all these discussions produce, we do know that when triglyceride levels are between 150 and 1,000 milligrams per deciliter (mg/dl), a big increase in the risk of heart attack results.
So you need to cut your saturated and total fat intake, and your refined carbohydrate intake. Whole grains and increased fiber are important. Exercise also is essential. Medications may be indicated, but your doctor can tell you of these.
The usual medication combination is of a “statin,” or cholesterol-lowering, medication, plus niacin—which is a vitamin in the B group.




My daughter has had several urinary tract infections. She is only 4 years old, and I am concerned. The doctor does not appear concerned.

Little girls are more prone to urinary tract infections (UTIs) than boys, because their urethra (the tube from the bladder) is shorter and allows bacteria to ascend into the bladder more easily. Urinary tract infection is not uncommon, and in the under-6 age group about 3 to 7 percent of girls get infected. This compares to about 1 to 2 percent of boys.

The American Academy of Pediatrics recommends in children under 2 years of age that after a first UTI, a diagnostic imaging of the bladder and urinary tract should be done to rule out a condition whereby urine reverses up the tubes coming from the kidneys (ureter). This is called vesico-ureteral reflux, and is present in about 30 to 40 percent of children with UTI. If it is diagnosed, usually prophylactic antibiotics (i.e., daily antibiotics, even when not infected) are prescribed. Recent evidence suggests such anti-biotic treatment may actually cause antibiotic resistance and may not provide a lot of protection. It may be that the degree of reflux is a factor that has to be considered. Of course, an acute infection needs treatment.
Evidence exists that youngsters may not completely empty their bladders, which could also contribute to infection.
Some little pointers that may be helpful are the following:
• Check with your doctor to be sure your daughter does not have pinworms. Irritation from their presence may result in scratching, which may play a role.
• Be sure she has learned from you to practice good bathroom hygiene.
• Encourage the drinking of lots of water. Cranberry juice in particular can be good to drink as well, as it contains elements that diminish the risk of urinary tract infections.
If the X-rays show serious reflux, you should have your child see a pediatric urologist.
Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.