Ceremonial cacao and health: what science says

Flavanols and blood vessels

Cacao is naturally rich in flavanols, plant compounds that have been studied for their effect on blood vessels. In 2012 the European Food Safety Authority (EFSA) gave a positive opinion that 200 mg of cocoa flavanols a day helps maintain normal elasticity of the blood vessels (normal endothelium-dependent vasodilation). That amount was equated with about 2.5 g of high-flavanol cocoa powder or 10 g of high-flavanol dark chocolate [1].

How many flavanols a cacao contains depends on the beans and on how they are processed, so not every cacao or chocolate delivers the same amount.

Blood pressure

A Cochrane review from 2017 combined 35 trials with 1,804 mostly healthy adults. Flavanol-rich cocoa products lowered blood pressure by about 1.8 mmHg on average in the short term, a small effect. The evidence was rated as moderate quality, and the authors called for longer studies [2].

Heart health: the largest study so far

The COSMOS trial followed 21,442 adults aged 60 and over for a median of 3.6 years. Half took a cocoa extract with 500 mg of flavanols a day in capsules, the other half a placebo. Total cardiovascular events were 10% lower in the cocoa group, but this main result was not statistically significant. Deaths from cardiovascular disease were 27% lower, which was significant [3]. The researchers asked for cautious interpretation, and the study used concentrated capsules, not a cacao drink [4].

Theobromine: a gentle lift

The main stimulant in cacao is theobromine. Many people describe its effect as a gentler, longer-lasting lift than coffee [5]. It can also raise the heart rate [6]. Cacao contains a little caffeine too, so it is best not drunk late in the evening if you are sensitive.

Mood, magnesium and other claims

Cacao is often said to be rich in magnesium [5]. Claims that ceremonial cacao opens the heart, works as an aphrodisiac or is psychedelic are not supported by research. Compounds such as anandamide are present only in small amounts and are poorly absorbed [6]. Many people do feel calmer and more connected after a cacao ceremony, but this most likely comes from the setting, the intention and the people around them [5].

Things to be careful about

• Stimulants. Theobromine and caffeine can affect sleep, heart rate and some medications. Start with a small cup.
• Cadmium. Cacao can take up cadmium from the soil it grows in. The EU sets maximum levels, for example 0.80 mg/kg for chocolate with at least 50% cocoa solids and 0.60 mg/kg for cocoa powder sold to consumers [7]. Good makers test their cacao and can tell you the results.
• Pets. Theobromine is toxic to dogs and cats. Keep cacao out of their reach.

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More guides

• What is ceremonial cacao?
• Cacao varieties: Criollo, Nacional and rare white cacaos