The Family Health Guide

Take two candy bars and call me in the morning?

Sweet, rich chocolate has always been something of a guilty pleasure for people with high cholesterol or those following a heart-healthy diet. But what if chocolate contained substances that are good for the heart? Would that transform it into a health food? That's what Mars, the maker of M&M's, Snickers, and other sweet treats, is hoping you'll think. The company has rolled out CocoaVia, a line of seven chocolates laced with plant sterols and flavanols for what Mars calls "real chocolate pleasure, real heart health benefits." According to Mars, eating these chocolate snacks will lower cholesterol and keep your arteries healthy. There's some truth to that - if you read the fine print.

Chocolate is the latest in a string of foods to be beefed up with sterols or stanols, cholesterol-like substances made by plants. There is solid evidence that eating about 2 grams of plant sterols every day lowers cholesterol by a decent 10%. Keep in mind that plant sterols yield meaningful changes in cholesterol levels only in people with high cholesterol to begin with and must be consumed every day to make a difference.

What about flavanols? Flavanols are abundant in cocoa beans, although they are often lost or destroyed during the process that turns the beans into chocolate. A number of beneficial "anti" effects have been attributed to flavanols. The main one is antioxidant activity; others include possible activity against viruses, allergies, inflammation, and cancer.

A few small studies show that flavanols in cocoa may help keep healthy arteries flexible, but these were mostly done in healthy people and used substantial doses of cocoa. Studies looking at flavonoid intake and the risk of heart attack or stroke have yielded mixed results, with some showing no effect and others showing modest protection.

To summarize: Eating 2 grams of plant sterols every day lowers cholesterol an average of 10%. Eating 100 grams of flavanols may keep healthy arteries flexible, but there is scant evidence so far it will rejuvenate stiff arteries, lower blood pressure, improve cardiovascular health, or prevent a heart attack or stroke.

To Mars' credit, the eight products in the CocoaVia line are decent alternatives to the usual chocolate bar. In addition to developing a process to retain the natural flavanols in cocoa, the company worked hard to limit calories and saturated fat.

But when it comes to using fortified chocolate to lower cholesterol, there's a big catch: You must eat two portions of CocoaVia every day to get the necessary 2 grams of plant sterols. That means a daily dose of sterols and flavanols comes with an extra 200 calories and 36% of the daily recommended limit for saturated fat.

If you don't cut back 200 calories somewhere else that would translate into a 20-pound weight gain over the course of a year. That's more than enough to counteract any benefits from sterols and flavanols.

There are easier and less expensive ways to get plant sterols and flavanols. Since plant sterols must be taken every day in a fixed dose to reap their benefit, they are more like medicine than food, says Dr. Alice Lichtenstein, a professor of nutrition at Tufts University's Friedman School of Nutrition. So it makes sense to buy sterols in capsule form. You can get flavanols from tea, apples, raspberries, red wine, and other foods. If you'd rather take a pill, you can also find flavanol supplements.

CocoaVia and other similarly fortified snacks may nudge the guilt out of eating chocolate, but they aren't health foods. There are cheaper, no-calorie ways to lower your cholesterol and protect your arteries.

March 2006 update