Food · Misleading · 被健康光环包装的甜食
Dark Chocolate & Cocoa
可可里的类黄酮 (flavanols) 确实对血管有一点点好处，但真实效应很小、而且大多在加工中被去掉，况且它总是和糖、脂肪、热量打包在一起卖。一句话：一小块 70% 以上的黑巧或无糖可可粉是可以的享受，但它不是保健品。
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Story path
- 1The claim · 'chocolate is a health food'The claim · 'chocolate is a health food'
- 2What flavanols are · mostly lost in processingWhat flavanols are · mostly lost in processing
- 3Evidence grade · limited in the big trialEvidence grade · limited in the big trial
- 4Mechanism · flavanols → nitric oxide → vasodilationMechanism · flavanols → nitric oxide → vasodilation
- 5Reality check · sugar, fat, calories, portionReality check · sugar, fat, calories, portion
- 6What to do · a treat, not a supplementWhat to do · a treat, not a supplement
Chapter 1
The claim · 'chocolate is a health food'
The claim · 'chocolate is a health food'
Let's untangle something easily muddled first: cocoa beans do contain a class of molecules that are mildly good for blood vessels, called flavanols; but the bar of chocolate in your hand is flavanols packaged together with a lot of sugar, fat, and calories. Pinning the modest benefit of the former onto the whole candy bar of the latter is the core trick behind the 'healthy chocolate' claim.
In recent years, headlines love to say: dark chocolate 'protects the heart', 'lowers blood pressure', 'improves mood', 'is antioxidant', even 'protects the brain'. So chocolate transformed from a sweet into a 'functional food' you can eat with a clear conscience — especially the ones labeled high-cacao, dark, or 'raw cacao', which sell for more.
This narrative bundles several assertions:
Dark chocolate is good for the heart and lowers blood pressureIt is rich in antioxidants and fights agingIt is a 'healthy sweet' you can eat freely
This chapter separates the genuinely somewhat useful component in cocoa from the candy bar it is packed into: how strong the flavanol evidence really is, how large the effect is, and why most retail chocolate has already processed that benefit away.
In recent years, headlines love to say: dark chocolate 'protects the heart', 'lowers blood pressure', 'improves mood', 'is antioxidant', even 'protects the brain'. So chocolate transformed from a sweet into a 'functional food' you can eat with a clear conscience — especially the ones labeled high-cacao, dark, or 'raw cacao', which sell for more.
This narrative bundles several assertions:
Dark chocolate is good for the heart and lowers blood pressureIt is rich in antioxidants and fights agingIt is a 'healthy sweet' you can eat freely
This chapter separates the genuinely somewhat useful component in cocoa from the candy bar it is packed into: how strong the flavanol evidence really is, how large the effect is, and why most retail chocolate has already processed that benefit away.
Chapter 2
What flavanols are · mostly lost in processing
What flavanols are · mostly lost in processing
To discuss 'chocolate is healthy', first know which molecule the benefit comes from, and how fragile it is.
The vessel-friendly components in cocoa beans are a class of flavan-3-ols, of which the most studied is epicatechin. All the evidence for 'cocoa protects blood vessels' is about these, not about cocoa butter or sugar.
The key problem: these molecules are heavily lost across the long journey from cocoa bean to chocolate. Fermentation, roasting, and especially alkalization (Dutch processing) — which darkens the color and softens the taste — all degrade flavanols. Miller 2008 directly measured retail cocoa powders: natural cocoa powder has the highest flavanols, while alkalized cocoa powder has sharply lower flavanols and antioxidant capacity, with heavy alkalization losing more than half.
This leads to a counterintuitive reality:
Dark, smooth, non-astringent chocolate is often exactly the kind whose flavanols were processed away the mostConversely, flavanol-rich cocoa is bitter and astringent — precisely the taste the processing works to removeSo the labels dark and high-cacao do not guarantee the flavanols are still there
In other words: cocoa's small genuine merit is real, but easily processed out before you even buy it. The next scene looks at how large an effect this remaining flavanol actually produces in clinical trials.
The vessel-friendly components in cocoa beans are a class of flavan-3-ols, of which the most studied is epicatechin. All the evidence for 'cocoa protects blood vessels' is about these, not about cocoa butter or sugar.
The key problem: these molecules are heavily lost across the long journey from cocoa bean to chocolate. Fermentation, roasting, and especially alkalization (Dutch processing) — which darkens the color and softens the taste — all degrade flavanols. Miller 2008 directly measured retail cocoa powders: natural cocoa powder has the highest flavanols, while alkalized cocoa powder has sharply lower flavanols and antioxidant capacity, with heavy alkalization losing more than half.
This leads to a counterintuitive reality:
Dark, smooth, non-astringent chocolate is often exactly the kind whose flavanols were processed away the mostConversely, flavanol-rich cocoa is bitter and astringent — precisely the taste the processing works to removeSo the labels dark and high-cacao do not guarantee the flavanols are still there
In other words: cocoa's small genuine merit is real, but easily processed out before you even buy it. The next scene looks at how large an effect this remaining flavanol actually produces in clinical trials.
机制 · 为什么越顺滑，类黄酮越少
苦、涩、酸这几种被工艺极力去掉的味道，恰恰是类黄酮还在的信号。把这条对应关系拆开，你以后靠嘴就能大致判断。先说碱化在化学上做了什么。 碱化就是往可可里加碱、把 pH 提上去。黄烷醇分子上挂着好几个酚羟基（苯环上的 —OH），它们在碱性环境里很容易被夺走氢；失去氢之后的分子活泼得多，一碰到氧就被氧化，然后两个、三个地互相接起来，聚成大块的褐色色素。所以颜色变深和类黄酮变少根本不是两件事，它们是同一个反应的两头：你看到的那层深褐，有一部分就是原本的类黄酮变成的。
再说涩为什么能当指示剂。 涩不是味觉，是触觉。黄烷醇进到嘴里会去抓唾液里的富脯氨酸蛋白——唾液本来靠这类蛋白在口腔表面铺一层滑膜，被抓住之后蛋白团聚、沉出絮状物，滑膜就散了。舌头和上颚失去润滑、互相摩擦，你感觉到的发紧、发涩就是这个。所以嘴里那股涩，几乎是这类分子还在不在的直接读数。
于是货架上的判断可以反过来做：
乌黑、入口即化、毫无涩感的可可制品，多半经过重度碱化，类黄酮所剩不多颜色偏红棕、闻着发酸、入口发涩发苦的天然可可粉，反而是留得最多的那种包装上的黑、高可可、生可可都是配方或工艺的描述，没有一个字在承诺活性成分
这也是这一章最省力的一条实用结论：与其比标签，不如比嘴里那一口涩。
Chapter 3
Evidence grade · limited in the big trial
Evidence grade · limited in the big trial
Cocoa flavanol evidence is better than most 'superfoods', but reading it correctly means watching two things: the direction of the effect, and its size.
The COSMOS trial (Sesso 2022, evidence A): the largest to date, with over 20,000 older adults randomized to either a 500 mg cocoa-flavanol supplement daily or placebo, followed for about 3.6 years. The honest result: the primary endpoint of total cardiovascular events did not fall significantly; only in the secondary measure of cardiovascular death was the cocoa group about 27% lower (hazard ratio 0.73). A secondary-endpoint signal must be read cautiously and cannot be treated as a nailed-down 'protects the heart' conclusion.
Blood pressure (Ried 2017 Cochrane, evidence A): pooling dozens of randomized trials, flavanol-rich cocoa lowers blood pressure slightly, with systolic pressure dropping about 1.8 mmHg on average. Real, but small — far less than weight loss, salt restriction, exercise, or blood-pressure drugs.
Endothelial function (Flaviola, Sansone 2015, evidence B): in healthy people, a higher daily dose of cocoa flavanols improved the vessel's flow-mediated dilation (FMD). This is mechanistic support, but it used purified high-dose flavanols, not just any bar of chocolate.
Evidence summary: lowering blood pressure is a real A-grade but very small effect; lowering cardiovascular death is only a secondary-endpoint signal; and all of this used high-dose flavanols, which is not the same as eating more chocolate.
The COSMOS trial (Sesso 2022, evidence A): the largest to date, with over 20,000 older adults randomized to either a 500 mg cocoa-flavanol supplement daily or placebo, followed for about 3.6 years. The honest result: the primary endpoint of total cardiovascular events did not fall significantly; only in the secondary measure of cardiovascular death was the cocoa group about 27% lower (hazard ratio 0.73). A secondary-endpoint signal must be read cautiously and cannot be treated as a nailed-down 'protects the heart' conclusion.
Blood pressure (Ried 2017 Cochrane, evidence A): pooling dozens of randomized trials, flavanol-rich cocoa lowers blood pressure slightly, with systolic pressure dropping about 1.8 mmHg on average. Real, but small — far less than weight loss, salt restriction, exercise, or blood-pressure drugs.
Endothelial function (Flaviola, Sansone 2015, evidence B): in healthy people, a higher daily dose of cocoa flavanols improved the vessel's flow-mediated dilation (FMD). This is mechanistic support, but it used purified high-dose flavanols, not just any bar of chocolate.
Evidence summary: lowering blood pressure is a real A-grade but very small effect; lowering cardiovascular death is only a secondary-endpoint signal; and all of this used high-dose flavanols, which is not the same as eating more chocolate.
证据 · 内皮功能这一层到底在测什么
还有第三类结果没放进上面：血管内皮功能。健康人摄入较高剂量的可可类黄酮，血管的舒张功能有所改善；它同样用的是提纯的高剂量类黄酮，不是随便一块巧克力。这一层值得单独讲，因为它最容易被读成比实际更强的结论。这个指标是怎么量出来的。 做法是在手臂上绑一个袖带，充气把血流压停几分钟，然后猛地放开。血液回冲的那一下会重重刷过血管内壁，健康的内皮会因此放出信号分子，让动脉当场松开、变宽；用超声测出这一下变宽了多少，就是血流介导的舒张 (FMD)。所以它量的不是血管有没有病变，而是内皮那条放松的通路还灵不灵。
它算哪一档证据。 这是一个过程指标：通路更灵是好事，也确实说明类黄酮真的作用在了机制预测的那个地方。但从通路更灵到少得一次心梗、多活几年，中间还隔着很多步，而那些步骤只能靠硬终点试验来验——恰恰是那项规模最大的试验，在硬终点上没看到整体获益。
所以整章的证据级别可以这样收：降血压是真实但很小的效应；降心血管死亡只是一个次要指标信号；内皮功能改善是一个过程指标；而这三条用的全是高剂量提纯类黄酮，都不等于多吃巧克力。
顺带记住这条通用的读法：一项研究越是拿过程指标说事，你越该追问一句那个更靠后的、真正关心的结果，测了吗、结果如何。营销最爱引用的往往正是过程指标，因为它们更容易做出漂亮数字。
Chapter 4
Mechanism · flavanols → nitric oxide → vasodilation
Mechanism · flavanols → nitric oxide → vasodilation
The small genuine benefit of cocoa flavanols has a fairly clear mechanism, landing on your blood-vessel lining.
The inner layer of a vessel has endothelial cells that produce a signaling molecule called nitric oxide (nitric oxide: A small signal molecule from the vessel lining that relaxes the vessel-wall muscle so the vessel widens.). NO relaxes the smooth muscle in the vessel wall, so the vessel dilates and widens, blood pressure drops a little, and blood flows more smoothly. The epicatechin in cocoa raises the available NO in the endothelium, producing that measurable but small vasodilation and blood-pressure effect (this is exactly how Ried 2017 explains it).
Spelling out the mechanism also exposes several marketing overreaches:
A valid mechanism does not mean a large effect: the NO pathway is real, but the flavanols in a bar of chocolate give a millimeters-of-mercury blood-pressure drop, not a 'replace your BP drug' drop'Antioxidant equals anti-aging' is an over-extrapolation: flavanols have antioxidant activity in a test tube, but 'eating them slows aging' is a different claim lacking reliable human hard-endpoint evidenceThe trials used purified high-dose flavanols with zero sugar and fat; the chocolate you eat is low in flavanols and high in sugar and fat — the two cannot be equated
So the mechanistic conclusion is: cocoa flavanols travel a real but gentle vascular pathway — they can make vessels a bit more comfortable, but this is a nice bonus, not a rescue.
The inner layer of a vessel has endothelial cells that produce a signaling molecule called nitric oxide (nitric oxide: A small signal molecule from the vessel lining that relaxes the vessel-wall muscle so the vessel widens.). NO relaxes the smooth muscle in the vessel wall, so the vessel dilates and widens, blood pressure drops a little, and blood flows more smoothly. The epicatechin in cocoa raises the available NO in the endothelium, producing that measurable but small vasodilation and blood-pressure effect (this is exactly how Ried 2017 explains it).
Spelling out the mechanism also exposes several marketing overreaches:
A valid mechanism does not mean a large effect: the NO pathway is real, but the flavanols in a bar of chocolate give a millimeters-of-mercury blood-pressure drop, not a 'replace your BP drug' drop'Antioxidant equals anti-aging' is an over-extrapolation: flavanols have antioxidant activity in a test tube, but 'eating them slows aging' is a different claim lacking reliable human hard-endpoint evidenceThe trials used purified high-dose flavanols with zero sugar and fat; the chocolate you eat is low in flavanols and high in sugar and fat — the two cannot be equated
So the mechanistic conclusion is: cocoa flavanols travel a real but gentle vascular pathway — they can make vessels a bit more comfortable, but this is a nice bonus, not a rescue.
机制 · 表儿茶素怎么把 NO 抬上去
上面说了表儿茶素能提高内皮里 nitric oxide: A small signal molecule from the vessel lining that relaxes the vessel-wall muscle so the vessel widens. 的可用量，但怎么提高才是这条链真正的一环。内皮里的 NO 有一个产量、有一个损耗，表儿茶素两头都动了一下。产量这一头。 造 NO 的是内皮细胞里的一台酶，叫 内皮型一氧化氮合酶 (eNOS)。它平时是半停着的，需要被磷酸化——也就是在酶身上挂一个磷酸基团，相当于把开关从待机拨到工作档——才全速运转。表儿茶素能推动这一步，于是同样一批酶，单位时间放出的 NO 更多。
损耗这一头。 NO 是个极不安分的分子，出厂之后还得穿过一段距离才能走到平滑肌。这一路上如果撞见 超氧阴离子（一种带着多余电子、见谁抢谁的活性氧），两者几乎瞬间就反应掉，NO 还没到岗就没了。血管有炎症、血糖长期偏高、抽烟的人，超氧阴离子多，NO 就是这样被半路吃掉的。类黄酮的抗氧化活性在这里派上用场：它先替 NO 挡掉一部分超氧阴离子，NO 的存活时间就长一点，能走到平滑肌的份额也就多一点。
合起来看外在表现。 一边多造、一边少赔，内皮周围能用的 NO 上去，平滑肌松开，血管口径变宽一点；同样的心跳推同样多的血，管子宽一点，压强就低一点。那个毫米汞柱级的效应，全部来路就在这里。
这也划清了一条常被越过的界。 它调的是血管张力——一个可以随时松紧的旋钮；它并不去动已经长在血管壁里的斑块。旋钮拧一点，血压读数就动一点；斑块该在还在。所以改善血管功能和逆转血管病变是两句完全不同的话。
还有一个顺带被澄清的说法：这里的抗氧化是替 NO 挡掉超氧阴离子这件有落点、有后果的具体事，不是笼统的清除自由基所以能抗衰老。前者说得出发生在哪里、结果是什么、怎么测；后者是把一个局部机制放大成了全身承诺。
Chapter 5
Reality check · sugar, fat, calories, portion
Reality check · sugar, fat, calories, portion
Eating chocolate as a 'health food', the biggest problem is not the flavanols but the things packaged in with them.
A typical milk chocolate bar is roughly half sugar and cocoa butter with almost no flavanols left, and commonly 500 to 600 kcal per 100 g. Even dark chocolate is not low in sugar or calories — just more bitter with slightly less sugar. Using 'it has flavanols' to rationalize 'eat more chocolate' means swallowing a lot of sugar and calories for a tiny vascular benefit — usually a losing trade.
A few contrasts to hold in mind at once:
High cacao does not mean high flavanols: as noted, alkalization and heavy processing strip flavanols; the label percentage refers to cocoa-solids share, not active flavanolsTrial dose is not snack dose: COSMOS used a 500 mg purified-flavanol capsule daily. Eating that much via chocolate would bring a large load of sugar and fat alongThe cost of the health halo: once people believe it is 'healthy', they tend to eat more with less guilt, so net sugar and calorie intake actually rises
The honest positioning: dark chocolate is a slightly better sweet than many sweets — usually lower in sugar, with a lasting satisfaction from its bitterness — and is perfectly fine as a treat. But 'a slightly better sweet' and 'a food you should eat for health' are two entirely different categories.
A typical milk chocolate bar is roughly half sugar and cocoa butter with almost no flavanols left, and commonly 500 to 600 kcal per 100 g. Even dark chocolate is not low in sugar or calories — just more bitter with slightly less sugar. Using 'it has flavanols' to rationalize 'eat more chocolate' means swallowing a lot of sugar and calories for a tiny vascular benefit — usually a losing trade.
A few contrasts to hold in mind at once:
High cacao does not mean high flavanols: as noted, alkalization and heavy processing strip flavanols; the label percentage refers to cocoa-solids share, not active flavanolsTrial dose is not snack dose: COSMOS used a 500 mg purified-flavanol capsule daily. Eating that much via chocolate would bring a large load of sugar and fat alongThe cost of the health halo: once people believe it is 'healthy', they tend to eat more with less guilt, so net sugar and calorie intake actually rises
The honest positioning: dark chocolate is a slightly better sweet than many sweets — usually lower in sugar, with a lasting satisfaction from its bitterness — and is perfectly fine as a treat. But 'a slightly better sweet' and 'a food you should eat for health' are two entirely different categories.
误区 · 健康光环怎么把账算反
这一幕压掉了两条对照，各自都值得单独摊开。第一条：可可含量高 ≠ 类黄酮高。 包装上那个百分比说的是可可固形物在整块里占的比例——可可粉加可可脂的份额，是一个配方数字，不是活性成分含量。它既不区分这批豆子发酵烘焙得重不重，也不区分可可粉有没有被碱化过。所以两块标着同样可可含量的巧克力，实际类黄酮可以差出好几倍，而你从标签上一个字也看不出来。真正相关的线索在嘴里：入口发涩、回味发苦的那块，多半留下的更多。
第二条：健康光环会把账算反。 一样东西一旦被贴上健康的名头，人对分量的感觉就松了：伸手拿第二块时的犹豫少了，也更不容易记得自己今天已经吃过。于是健康这个标签一边减少负罪感，一边放大实际吃进去的量，净摄入的糖和热量反而比不贴标签时更高。这不是意志力的问题，是标签改写了你对这算不算多的判断。
两条合起来，解释了一个看似矛盾的现象：一块黑巧的营销越强调它的好处，读者从中拿到的净收益越可能是负的。好处那一头是毫克级的，而且还不一定留在你买到的那块里；代价那一头是克级的糖和脂肪，并且会随着它健康这个念头一起变多。
所以对付健康光环最实在的一招，不是记住哪块巧克力更好，而是把它重新归类：先当甜食去算它的糖和热量，再考虑它带来的那点额外好处。顺序反过来，账就算错了。
Chapter 6
What to do · a treat, not a supplement
What to do · a treat, not a supplement
Pulling this chapter into take-away judgments:
Not supported: chocolate is a health food, can be eaten freely, fights aging — all overstated. Cocoa flavanol benefits are real but small, and mostly lost in processing.
Partly real but amplified: high-dose cocoa flavanols do slightly lower blood pressure and improve endothelial function (Ried 2017 / Sansone 2015); but that comes from purified flavanols, not from the candy bar.
The real positioning: a treat slightly better than most sweets, not a supplement.
Actionable low-risk steps:
Eat it if you want, as a treat: a small square of 70% to 85% dark chocolate, eaten slowly, is satisfying and relatively lower in sugarIf you are genuinely after the flavanols, unsweetened natural cocoa powder is the more honest source — mixed into water, oatmeal, or yogurt, low in sugar and caloriesPrefer non-alkalized (natural) cocoa powder; alkalization processes the flavanols awayDo not use 'it's healthy' to give yourself a bigger portion; portion size and total sugar and calories are what actually move weight and metabolismTo manage blood pressure, rely first on salt restriction, weight loss, exercise, and your doctor's plan, and put chocolate back in the 'occasional pleasure' box
Atlas connections: for how sugar and calories affect weight, see the related sugar-and-metabolism chapters; for how another health-halo food gets marketed, see the superfoods debunk.
Not supported: chocolate is a health food, can be eaten freely, fights aging — all overstated. Cocoa flavanol benefits are real but small, and mostly lost in processing.
Partly real but amplified: high-dose cocoa flavanols do slightly lower blood pressure and improve endothelial function (Ried 2017 / Sansone 2015); but that comes from purified flavanols, not from the candy bar.
The real positioning: a treat slightly better than most sweets, not a supplement.
Actionable low-risk steps:
Eat it if you want, as a treat: a small square of 70% to 85% dark chocolate, eaten slowly, is satisfying and relatively lower in sugarIf you are genuinely after the flavanols, unsweetened natural cocoa powder is the more honest source — mixed into water, oatmeal, or yogurt, low in sugar and caloriesPrefer non-alkalized (natural) cocoa powder; alkalization processes the flavanols awayDo not use 'it's healthy' to give yourself a bigger portion; portion size and total sugar and calories are what actually move weight and metabolismTo manage blood pressure, rely first on salt restriction, weight loss, exercise, and your doctor's plan, and put chocolate back in the 'occasional pleasure' box
Atlas connections: for how sugar and calories affect weight, see the related sugar-and-metabolism chapters; for how another health-halo food gets marketed, see the superfoods debunk.
实操 · 可可粉怎么挑、怎么喝
如果你决定绕开糖、直接去拿类黄酮，可可粉这条路值得说细一点。挑的时候看一个词。 优先选标着未碱化 (non-alkalized / natural) 的可可粉；反过来，包装上写着碱化处理(也叫荷兰工艺, Dutch processed)、或者只写深色可可粉的，多半就是被碱化过的那种。前面说过，碱化会把类黄酮加工掉，而且颜色越乌黑、口感越顺滑，被加工掉的往往越多。所以这里的挑法和挑巧克力是反的：颜色偏红棕、闻着发酸、冲出来发涩的那种，才是留得多的。
喝的时候注意别把糖加回去。 可可粉本身几乎不含糖，一杯的热量很低；但热可可这个喝法一旦按传统配方走，糖和奶加下去，就又变回一杯甜饮料了。想保住这条路的意义，就用水或无糖的奶冲开、直接接受它的苦，或者干脆把可可粉撒进燕麦、酸奶、咖啡里，让其它食物去提供口感。
别把它当药。 换成可可粉之后，收益依然是那个毫米汞柱级的小效应——它值得做，是因为代价几乎为零（不带糖、不带脂肪、也不额外花钱），而不是因为收益变大了。判断一件事值不值得做，看的是收益减掉代价，不是收益本身；这一章从头到尾其实都在教这个算法。
相连的话题：想理解糖和热量如何影响体重，可以看相关的糖与代谢章节；想看另一种被健康光环包装的食物如何被营销，可以去看超级食物的拆穿。
References · 4
- Sesso, H. D., Manson, J. E., Aragaki, A. K., Rist, P. M., Johnson, L. G., Friedenberg, G., et al. (2022). Effect of cocoa flavanol supplementation for the prevention of cardiovascular disease events: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial. The American Journal of Clinical Nutrition, 115(6), 1490-1500. In 21,442 older adults, a 500 mg/day cocoa-flavanol supplement did not significantly reduce total cardiovascular events (primary endpoint) but reduced cardiovascular death (secondary) by 27% (HR 0.73). 10.1093/ajcn/nqac055
- Miller, K. B., Hurst, W. J., Payne, M. J., Stuart, D. A., Apgar, J., Sweigart, D. S., & Ou, B. (2008). Impact of alkalization on the antioxidant and flavanol content of commercial cocoa powders. Journal of Agricultural and Food Chemistry, 56(18), 8527-8533. Natural (non-alkalized) cocoa powder had the highest flavanols and antioxidant capacity; alkalization (Dutch processing) sharply reduced flavanols, with heavy alkalization losing the majority. 10.1021/jf801670p
- Ried, K., Fakler, P., & Stocks, N. P. (2017). Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews, 4, CD008893. Meta-analysis of ~40 RCT comparisons (~1,804 participants) found flavanol-rich cocoa lowered blood pressure by a small amount (systolic ~1.8 mmHg), attributed to flavanol-driven endothelial nitric oxide. 10.1002/14651858.CD008893.pub3
- Sansone, R., Rodriguez-Mateos, A., Heuel, J., Falk, D., Schuler, D., Wagstaff, R., et al. (2015). Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial (the Flaviola Health Study). British Journal of Nutrition, 114(8), 1246-1255. Twice-daily cocoa flavanols (~450 mg each) improved flow-mediated dilation and lowered estimated cardiovascular risk in healthy adults, using purified high-dose flavanols rather than chocolate. 10.1017/S0007114515002822