February brings us Valentine’s Day which got me thinking about chocolate. Chocolate and Valentine’s Day are kind of a synonymous pair. Personally, I have a love for dark chocolate. It is rich in nutrients including phosphorus and potassium, which is why it is usually on the “do not eat” list if you are on dialysis. This can be tough, especially if you are a chocolate lover like I am! We also hear a lot about the benefits of dark chocolate, that it is high in anti-oxidants and good for your blood pressure and heart. Sounds like something that could be beneficial for someone with chronic kidney disease (CKD). So, what’s the real deal? Can dialysis patients eat chocolate?
First, let’s look at what recent research is telling us about dark chocolate.
1. Chocolate: High In Anti-Oxidants, Anti-Inflammatory Compounds
Both cocoa and dark chocolate are rich in polyphenols (1). What are polyphenols? They are compounds naturally found in plant foods that act as powerful anti-oxidants. There are thousands of different types of polyphenols. Flavonoids are a category of polyphenols which are present in cocoa in very high amounts. These polyphenols provide protection against cell damage, reduce oxidative stress, are important mediators for anti-inflammatory responses in the body, potentially helping to fight chronic diseases.
2. Chocolate and Cardiovascular Health
Cardiovascular disease (CVD) is a major risk factor for people on dialysis. In fact, CVD is present in more than 50% of people undergoing dialysis (2). Protecting your heart health becomes important.
Flavonols (a type of flavonoid) found in dark chocolate and cocoa stimulate the lining of the arteries to synthesize nitric oxide (a compound produced naturally by your body) causing vasodilation (3). This relaxation of the arteries can help improve blood flow and lower blood pressure.
These same flavonols have also been found to inhibit blood platelet aggregation (4). Why is that a good thing? Platelets can form when there’s injury to a blood vessel which can happen in an artery affected by atherosclerosis (a build up of cholesterol plaque in the walls of arteries causing obstruction of blood flow). The platelets cause blood clots in an already injured artery. Preventing this from happening is beneficial.
There have been a number of studies on the effects of cocoa and high-polyphenol chocolate on cholesterol (5). These studies have showed a positive decrease in LDL (low-density lipoprotein, “bad cholesterol”) while increasing HDL (high-density lipoprotein, “good cholesterol”). These two types of lipoproteins carry cholesterol throughout the body. High levels of LDL cholesterol raise your risk for heart disease and stroke, while high levels of HDL are protective as they absorb cholesterol and transport it back to the liver.
Cocoa consumption might also improve insulin sensitivity (6). Controlling your blood sugar metabolism can help lower your risk for CVD and diabetes.
3. Chocolate And Improved Gut Health?
Gut health and your microbiota are a super important aspect in your overall health and immunity. I talk more about your microbiota (gut microbes that live mostly in your large intestine) in my blog article Top 10 Nutrition Tips For Living A Healthy Life On Dialysis.
Dark chocolate and cocoa flavonols are not well absorbed in the small intestine. Most find their way to the large intestine where your gut microbiota can metabolize them. During this process, one study found these flavonols had a significant effect on the growth of specific strains of bacteria which increased anti-inflammatory pathways in the body(7). This suggests cocoa has a prebiotic benefit just like foods rich in soluble fiber.
4. Chocolate Makes Your Brain Happy
It’s so true! Chocolate contains phenylethylamine which helps regulate mood. Eating chocolate also stimulates the production of the neurotransmitter serotonin which produces feelings of happiness. Another neurotransmitter called dopamine is released when you experience anything that you enjoy. Our brain creates a memory of this experience which is another reason why we might have chocolate cravings.
The ability of the flavonols in dark chocolate and cocoa to cause vasodilation helps increase blood flow to the brain. Caffeine and theobromine – natural stimulants found in cocoa and chocolate – can also contribute to increased blood flow, memory and learning (8).
Concerns About Chocolate And Kidney Disease
By now you’re probably thinking…..give me some chocolate already, I’m sold! But, despite the potential benefits of cocoa and dark chocolate there are a few concerns and things to be aware of.
High In Potassium And Phosphorus
Chocolate is definitely a rich source of potassium and phosphorus. If you are on dialysis, keeping your potassium and phosphorus levels in safe range is important. You can do this if you are cautious about the type of chocolate you consume and, of course, how much you consume which brings me to the next point.
Most chocolate products have a lot of added sugars. Even if you don’t have diabetes, controlling your sugar intake is important. Too much sugar in your diet can lead to inflammation and increased risk for certain diseases. Watching your portions and choosing dark chocolate products with lower sugar content is a good idea.
Fat And Calorie Content
There is also a fair amount of fat and calories in chocolate. Cocoa butter, the source of fat in chocolate, contains both monounsaturated (mostly oleic acid, also found in olive oil) and saturated fatty acids (stearic and palmitic acid). Despite stearic acid being a saturated fat, it does not appear to have much of an affect on cholesterol. Managing your saturated fat and overall calorie intake is still important though.
The Importance Of Quality
All of the research finding potential health benefits to eating chocolate were not looking at Snickers bars or M & M’s! In fact, most of the chocolate the average American consumes is not high polyphenol dark chocolate. It is typically highly processed chocolate loaded with sugar and other additives. No real health benefit there.
High In Oxalate
Another concern is that chocolate is high in oxalate. Oxalate is an organic acid found in plants and can also be made by the body. If you have a history of getting kidney stones (especially the calcium oxalate kind), you are usually told to avoid foods high in oxalate. Chocolate is definitely on that list, but so are a lot of other healthy fruits and vegetables. Moderately limiting these foods may be beneficial, but cutting them out completely is not the solution – especially in the long term. When you eat foods high in oxalate it’s good to pair it with a food rich in calcium. This makes it more likely that calcium and oxalate will bind during digestion before they reach the kidneys.
Tips On What To Look For
Now let’s get to the good stuff! So, you’ve decided to include some chocolate into your life. Here are a few guidelines.
- Choose dark chocolate . White chocolate and milk chocolate are made with milk and are typically higher in phosphorus and sugar. White chocolate doesn’t even contain cocoa, so it does not provide any real health benefit. Dark chocolate contains a higher amount of cocoa, nutrients, fiber, and typically less sugar than milk chocolate. For the most health benefit, ideally you would want to choose chocolate that is at least 70% cocoa.
- Avoid chocolate that has too many extra ingredients. The main ingredients should be chocolate or cocoa liquor, sugar, cocoa butter, soy lecithin (used as an emulsifier), and vanilla. Since you are already getting a good amount of potassium and phosphorus I would avoid chocolate that contains nuts.
- There is no set ideal amount, but try to limit your portion to 30g (1 oz) if you are having a bar (which is usually 1/3 of a bar).
- Avoid alkali processed “dutched” cocoa (if you’re trying to get the benefits from chocolate). This is a type of processing used to lower the acidity or bitterness and make it a darker color. Unfortunately, a lot of the flavonol/anti-oxidant properties are lost during this processing.
- You can search long and hard, but the phosphorus content will almost always not be listed on the label. Just assume that it contains a fair amount and will vary by brand and ingredients. If you decide to enjoy this treat, definitely take your phosphorus binders with it so you can cheat responsibly! Potassium, on the other hand, should be listed on the label. Compare amounts per serving to find the lowest one.
Cacao or Cocoa?
Is cacao the same as cocoa? Good question! They are both very similar and come from beans from the cacao plant. Once the beans are separated from the cocoa butter, they are fermented (to add flavor). This is the point at where they differ. After fermentation, cocoa beans go on to be roasted at high temperatures whereas cacao beans are not roasted and are processed at much lower temperatures. This results in a powder that is more bitter in taste but essentially higher in nutrients and anti-oxidants.
A Few Recommended Options
There are many options out there, but here are a few products I recommend:
*Disclaimer: As an Amazon Associate I earn from qualifying purchases.
Lindt Excellence 70% cocoa bars*. A 30g serving (3 pieces) contains 190 calories, 9g sugar, 2g fiber, and 147 mg* potassium (*updated: potassium amount confirmed by Lindt). I knew 1 mg of potassium was too good to be true! Still, an acceptable amount per serving.
Valrhona Guanaja 70% Dark Chocolate Bar. 1/2 bar (35g) contains 210 calories, 11g sugars, 4g fiber, 210 mg potassium. Definitely more potassium than the Lindt bar, so be mindful of portion size.
Ghirardelli Chocolate 72% Cacao Dark Chocolate Premium Baking Chips. 44 chips (30g) contains 160 calories, 8g sugar, 4g fiber, 180 mg potassium.
Although not 70% cocoa – it is close….and it’s good. Chocolove Ginger Crystallized Dark Chocolate. 1/3 bar (30g) contains 140 calories, 12g sugars, 3g fiber, 160mg potassium. I also like their no added sugar option XO Mint in 60% Dark Chocolate.
Other options that may not have the % cocoa in it, but helps fix those chocolate cravings:
- Julie’s Real Certified USDA Organic Paleo Dark Chocolate Brownie Mix*
- Annie’s Organic Double Chocolate Brownie Mix
- ChocZero Sugar Free Chocolate Syrup
- Viva Naturals Certified Organic Cacao Powder*. Add 1 Tbsp to a cup of hot water with some monkfruit sweetener and a splash of unsweetened almond/coconut creamer.
- I saved the best for last. Arctic Zero Purely Chocolate Ice Cream. A non-dairy ice cream made from faba beans. They actually put phosphorus on the label! And it’s 0%!! Potassium is listed at only 5 mg with 5g sugar, 4g fiber per 1/2 cup serving. A guiltless chocolate treat? You’re welcome!
So, can dialysis patients eat chocolate? The answer really depends on the person. In general, it can be eaten, but the key is in the right amount and choosing quality over quantity. Will your blood pressure suddenly improve and cholesterol drop? Don’t count on it. The amount you would need to consume to see true benefit is more than what your limited portions will provide. That being said, I think it can be a beneficial addition to other high antioxidant foods you consume in your diet. And a fun addition at that!