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Ingredient Type: Botanical, Extract

Also Known As: Theobroma cocao extract, Cocoa extract, Cacao extract, Cocoa polyphenols, Cacao polyphenols, Cocoa seed extract

Cocoa beans are the seeds of a native Central and South American tree known as Theobroma cocao.  It’s believed that the Olmecs were the first group of people to discover that cocoa beans were edible and that they made that discovery sometime around 1500 BC.  Archaeological evidence indicates that they probably combined ground cocoa beans with water and spices to make a drink.  These cocoa drinks were likely used by the Olmecs, and later the Mayans and Aztecs, for medicinal purposes and as ritualistic beverages for religious ceremonies.  As cocoa was also used as a Mayan currency, more regular consumption of cocoa was generally limited to people in positions of power and prestige (1).

Cocoa drinks became popular elsewhere in the world after the Spaniards began trading cocoa beans worldwide in the 16th century (2).  These drinks, however, were generally consumed for enjoyment and not for medicinal purposes.  With the subsequent invention of mechanical cocoa bean processing in the 18th century other cocoa confections, often referred to as ‘chocolate’, also became common (3).

While most people are familiar with the culinary utility of cocoa, fewer may be aware of how it can be used to improve health.  Thanks to writings by a 16th-century Spanish priest who spent 60 years recording information about native Aztec culture, diet, and medicine, we actually know quite a bit about traditional medicinal uses for cocoa.  We also know about later medicinal uses for cocoa by English, French, and Spanish physicians of the colonial era (4).  More recently, clinical trials combined with research on the biochemical composition of cocoa have given us even greater insight into how one of the world’s most popular beans can potentially improve our health.

Cocoa bean extract refers to an extract of natural polyphenolics or “flavanols” derived from the cocoa bean.  These polyphenolics are thought to be the active substances that confer the health benefits associated with cocoa.


Based on the writings of the Spanish priest Bernardino de Sahagun, the indigenous peoples of Central America used cocoa beans to treat stomach and intestinal complaints and to invigorate the body.  They were also mixed with other botanical ingredients to: cure infections, treat childhood diarrhea, relieve fever and faintness, to reduce phlegm, and also improve the palatability of other medicinal herbs (4,5).  In colonial times cocoa beans were prepared for and given to treat everything from fatigue, fevers, constipation, anemia, gout, kidney stones, and low output of breast milk.  They were also used to promote weight gain and as stimulants for frail and lethargic patients (4).

Those intimately familiar with the history of cocoa have concluded that there are four consistent traditional medicine-related uses for the cocoa bean.  These are:

  • To stimulate the nervous system, especially in people who lack energy, or who suffer from “lassitude,” exhaustion or apathy
  • To calm those who are overstimulated or suffer from hyperactivity
  • To improve digestion or “weak and stagnant stomachs”
  • To improve weight gain in emaciated patients (4)


Cocoa Probably Lowers Blood Pressure:

A meta-analysis was done on 35 separate double-blind, placebo-controlled, clinical trials that investigated the effect of orally administered cocoa on blood pressure.  The authors of the analysis concluded that there is “moderate-quality evidence” for a small, but significant, blood pressure-lowering effect of flavanol-rich cocoa products in healthy adults.  They also pointed out that most of the trials were from 2 to 12 weeks long and that more studies are needed to establish whether cocoa has a beneficial effect on blood pressure long-term (6).

Natural Medicines Comprehensive Database, which claims to be an unbiased scientific information source on complementary and integrative therapies, states that cocoa is “possibly effective” for hypertension.  They reference 6 clinical trials that suggest that orally administered cocoa can lower blood pressure and that the effect may “occur more readily in hypertensive or pre-hypertensive individuals compared with normotensive individuals.”  As with the studies from the meta-analysis, the studies mentioned here used cocoa products with high (30-1080 mg) flavanol content (7).

Cocoa Might Affect Mood or Reactivity to Stress:

While there are relatively few clinical trials that have investigated the effect of cocoa on mood and stress, those that have been carried out are interesting.  One trial looked at the effect of a single oral dose of high flavanol cocoa compared to placebo on stress hormone levels following an acute psychosocial stress test.  Cortisol and epinephrine levels were both significantly lower, post stress-test, in the group that was given high flavanol cocoa compared to the placebo group.  This study did, however, only include 65 healthy adult men.  More trials are needed to determine the generalizability of these results in other populations and the longer-term effects of cocoa consumption on stress hormones (8).

Another double-blind, placebo-controlled trial looked at self-rated mood and cognition test scores following 30 days of orally administered treatment with a high flavanol (250 or 500mg) cocoa drink or placebo.  This study of 72 participants included healthy middle-aged men and women.  While cognition was unaffected by either high flavanol cocoa treatment, self-rated calmness and contentedness was significantly increased in the treatment groups relative to placebo at the end of the study (9).


Cocoa extract is likely safe for most people (“high level of reliable clinical evidence showing its safe use when used appropriately”) (7).



  • Some research suggests that cocoa can slow blood clotting.  It may, therefore, increase the risk of bleeding when used with antiplatelet or anticoagulant drugs like: Aspirin, Clopidogrel, Dalteparin, Warfarin, Heparin, etc (7).  Although there is currently very little data on supplement-supplement interactions, caution may also be warranted in taking cocoa with other supplements thought to slow blood clotting: Angelica, Ginkgo, Panax ginseng, etc (7).


  • Because coca likely reduces blood pressure it could increase the risk of hypotension when used with drugs that lower blood pressure like: Captoril, Enalapril, Losartan, Valsartan, etc.
  • Caffeine interacts with several different drugs.  Because cocoa does contain small amounts of caffeine, high doses of cocoa may interact with: Adenosine, Clozapine, Dipyridamole, Disulfiram, Estogens, etc (7).  Although there is currently very little data on supplement-supplement interactions, caution may also be warranted in taking cocoa with supplements known to interact with caffeine: Bitter orange, Ma huang/Ephedra, etc (7).


  • Cocoa does contain small amounts of caffeine and other related chemicals. These can be stimulating for some, but those who are sensitive might experience caffeine-related side effects like: nervousness, increased urination, sleeplessness, headaches, diarrhea, or a fast heartbeat.
  • Although rare, cocoa may cause intestinal discomfort, gas, or constipation.
  • Because some research suggests that cocoa may slow blood clotting caution should be taken by those with bleeding disorders (10).


  1. Inaforesta. History of cocoa. Accessed February 3, 2018.
  2. Wood G, Lass R. Cocoa. John Wiley & Sons. 2001. of cocoa&f=false. Accessed February 3, 2018.
  3. History of cocoa. World Cocoa Foundation. Accessed February 3, 2018.
  4. Dillinger TL, Barriga P, Escárcega S, Jimenez M, Salazar Lowe D, Grivetti LE. Food of the gods: cure for humanity? A cultural history of the medicinal and ritual use of chocolate. J Nutr. 2000;130(8S Suppl):2057S-2072S.
  5. Sahagun, B. General history of the things of new spain. The School of American Research and the University of Utah Monographs of the School of American Research and the Museum of New Mexico. 1590/1981.
  6. Reid K, Fakler P, Stocks N. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2017. doi:10.1002/14651858.CD008893.pub3.
  7. Monograph on Cocoa. Natural Medicines Comprehensive Database. Accessed February 15, 2018.
  8. Wirtz PH, Von Kanel R, et al. Dark choclate intake buffers stress reactivity in humans. J of the American College of Cardiology. 2014;63(21):2297-2299. doi:10.1016/j/jacc/2014.02.580.
  9. Pase MP, Scholey AB, Pipingas A, et al. Cocoa polyphenols enhance positive mood states but not cognitive performance: a randomized, placebo-controlled trial. J of Psychopharmacology. 2013;27(5):451-458. doi:10.1177/0269881112473791.
  10. Cocoa. WebMD. Accessed February 16, 2018.

See the entry for cocoa extract for more information.