Soltalk January 2019 | Page 44

Doctor’s notes
Dr Rik Heymans is a general practitioner in Nerja and writes on developments in the world of medicine
Gout
and Multivitamin Outcomes Study (COSMOS) will help
determine whether concentrated cocoa extract can help reduce
heart disease and stroke and whether commonly used
multivitamin supplements can help reduce the risk for cancer,
particularly in older women. It must be emphasized that the
cocoa supplement to be studied is a highly concentrated
extract of cocoa flavanols. This is, unfortunately, not a study
about eating chocolate! It is important to differentiate between
cacao, cocoa, and chocolate.
Gout is a disease which is generally associated with a good
lifestyle: rich and abundant foods, fowl, venison, shellfish and
cheese to name but a few, swallowed down with a good wine,
or liquor to top it all off. In my practice I see quite a lot of
patients with this - to put it mildly - discomforting condition.
The well-known and praised Mediterranean Diet, which is so
beneficial for the heart, is however a main factor in people
presenting with gout. And usually patient shrug it off, saying,
“it is only gout”, and assume some or other pain relief will be
enough to take care of it. However, these annoying crystals also
affect the rest of the body. A newly published study adds more
proof that gout should be managed like a chronic disease,
using a treat-to-target approach to uric acid levels. The
researchers looked at a cohort of almost 1200 patients
attending a gout clinic between 1992 and 2017. Of this cohort,
92% of the patients were men with a mean age of 60. The men
had gout for about 7 years and averaged three to four flares per
year. The study showed that the patients whose serum uric
acid levels were greater than 6 mg/dL were twice as likely to
die prematurely compared with those whose levels were below
6 mg/dL.
The raw seeds obtained from the Theobroma cacao tree are
referred to as cacao. The seeds of the cacao tree are rich in a
subclass of polyphenol antioxidants known as flavonoids,
specifically the flavanols catechin and epicatechin. Once these
seeds are processed by grinding or roasting them, the product
becomes cocoa. Further processing and the addition of
multiple other ingredients, including sugar and fat, result in
the solid edible product we call chocolate. The medicinal use
of cocoa has a long history dating back almost 500 years, when
Hernán Cortés first encountered the drink in Mesoamerica.
Even before Cortés, Mayans and Aztecs took beans from the
cacao tree and made a drink they called "xocoatl." Aztec Indian
legend relates that cacao seeds were brought from Paradise,
and that wisdom and power came from eating the fruit of the
cacao tree.
Optimizing uric acid levels has long been a goal in gout
management - in order to reduce long-term morbidity,
including cardiovascular and chronic kidney disease. The uric
acid crystals affect the kidneys and this then affects the rest of
the body, leading to a decreased life expectancy.
In light of studies suggesting that flavanol-rich chocolate may
confer cardiovascular benefits, should we consider cocoa to be
a cardiovascular nutraceutical? To the contrary, and important
warnings are in order. During the conventional chocolate
manufacturing process from fresh cocoa seeds to the final
product, the concentration of flavanols is markedly reduced.
And many other products are added. Finally, the high caloric
load of commercially available chocolate (about 500 kcal/100
g) may cause weight gain, which is itself a risk factor for
hypertension, dyslipidemia, and diabetes.
Chocolate
For as long as one can remember, chocolate has been
considered as a "no-no" for anyone trying to lose weight, or
indeed for anyone simply trying to live healthy. So what
underlies the latest hype about chocolate's health benefits? Is
there any truth to it?
Chocolate and its ostensible preventive effects on
cardiovascular disease (CVD) are being investigated in a study
conducted by medical institutions and organizations of
renown: the Brigham and Women's Hospital, the Fred
Hutchinson Cancer Research Center, and the Women's Health
Initiative. Started earlier this year, the 5-year, large-scale
randomized controlled trial is testing the effect of a
concentrated cocoa extract and multivitamin supplements in
reducing the risks for CVD and cancer. The Cocoa Supplement
While we await the results of this COSMOS study, the
scientific recommendation is to rely on exercise and diet to
enhance cardiovascular health. If you are a "chocoholic," it is
fine to eat dark chocolate, but at present solely for
enjoyment—not yet on the pretence that we are indulging for
medicinal benefits.
© Dr RIK HEYMANS
c/ Angustias 24, Nerja. Tel: [phone]
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