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Cacao

Cacao seed from the cacao tree is roasted, then pressed to extract cocoa butter, also known as theobroma oil. The remaining cocoa cake is ground into cocoa powder. Cacao contains 0.5% to 2.7% theobromine, 0.25% caffeine, and other methylxanthine alkaloids. Cocoa contains the antioxidant catechin. Unsweetened dark chocolate contains 47 mg of caffeine and 450 mg of theobromine per ounce. Milk chocolate contains about 6 mg caffeine and 45 mg of theobromine per ounce. Theobromine has weaker stimulant effects than caffeine but is a more potent diuretic, cardiovascular stimulant, and coronary dilator.

Benefits And Uses of Cacao

Cocoa powder and cocoa butter are widely used in food products; cocoa butter is also used as a base for moisturizers, cosmetics, and suppositories. Cocoa seed and cocoa seed coat are used to treat intestinal conditions; diarrhea; liver, bladder and renal disease; diabetes; and others.

Administration

Dosage varies with the preparation.

Side Effects of Cacao

Adverse effects associated with cacao include central nervous system (CNS) stimulation, tremor, insomnia, anxiety, tachycardia, aggravation of GI ulcers, irritable bowel syndrome, and exacerbation of gastroesophageal reflux disease.

Interactions are possible between cacao and the following:

• Acetaminophen, aspirin increased analgesic effects due to caffeine in cacao
• Alendronate decreased alendronate bioavailability .
• Barbiturates decreased caffeine effects because of increased metabolism and CNS depression .
• Beta agonists, such as albuterol, isoproterenol, or terbutaline increased CNS and cardiovascular stimulation .
• Cimetidine, disulfiram, fluoroquinolones (such as ciprofloxacin, enoxacin, or norfloxacin), mexiletine, oral contraceptives increased caffeine effects due to decreased metabolism .
• Clozapine increased clozapine levels due to caffeine, increasing the risk of adverse reactions .
• Iron, zinc decreased vitamin absorption lithium increased lithium clearance
• Monoamine oxidase (MAO) inhibitors, such as isocarboxazid, phenelzine, or tranylcypromine possibly, hypertensive crisis with excessive caffeine in take .
• Phenylpropanolamine increased caffeine effects due to additive sympathomimetic action (reports of manic psychosis with high doses of caffeine) .
• Terbinafine increased caffeine effects due to decreased metabolism .
• Theophylline decreased theophylline levels with excessive caffeine intake.
• Verapamil increased caffeine effects due to decreased metabolism .
• Caffeine containing herbs and herbal sympathomimetics, such as coffee, cola nut, ephedra, guarana, mate and tea, Ma huang possibly, increased stimulant effects of cocoa products .
• Grapefruit juice possibly, increased caffeine effects.

There are no known studies or reports regarding the effects of excessive chocolate consumption during pregnancy. However, theobromine has been shown to be teratogenic in animals when given in doses dozens to hundreds of times the equivalent of normal human consumption of chocolate. High doses of caffeine more than 300 mg per day have been associated with lower birth weight and higher risk of spontaneous abortion in some studies. Caffeine appears in small amounts in breast milk.

Clinical considerations

• Caffeine may interfere with phenobarbital and serum uric acid assay.
• Because cacao may caused decreased absorption of vitamins such as iron or zinc, these supplements should be taken 2 hours either before or after cacao.
• Cocoa butter may be allergenic and comedo genic.
• A suggested link between cacao use and migraine and tension headache is controversial.
• Use of cacao may worsen symptoms of irritable bowel syndrome.
• Chocolate contains relatively low amounts of caffeine compared with other food sources.
• Advise pregnant or breast-feeding patient to avoid excessive chocolate consumption.
• Instruct patient to promptly report adverse effects.
• Inform patient not to delay treatment for an illness that doesn’t resolve after taking cacao.
• Tell patient to remind prescriber and pharmacist of any herbal or dietary supplement that he’s taking when obtaining a new prescription.
• Advise patient to consult his health care provider before using an herbal preparation because a treatment with proven efficacy may be available.

Research summary

The concepts behind the use of cacao for medicinal purposes and the claims made regarding its effects have not yet been validated scientifically. One recent study found no evidence of a relationship between the consumption of chocolate and coronary heart disease.

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