Can eating dark chocolate help to reverse type 2 diabetes?
Epicatechin in chocolate is another dietary tool to help combat type 2 diabetes. This week, I've been exploring ways to consume more of it without resorting to supplements.
Listening to my latest audio book, 'Nature Wants Us to Be Fat' by Dr. Richard J. Johnson, he discusses people who seem to have natural defence against activating what he calls 'the survival switch'. This switch is what he suggests is a primary cause of obesity and metabolic syndrome. The medical condition, essential fructosuria affects less than 1 in 100,000 people who are not able to make fructokinase. This means they can eat sugar without most of the usual health implications. This is because fructose is excreted in urine before it gets chance to be metabolised by the liver. This prevents the usual fat synthesis, uric acid production and oxidative stress that contributes to insulin resistance. It is widely seen as a benign medical condition, and in a way it provides a natural immunity to type 2 diabetes and other metabolic illnesses. There are no documented cases of people with essential fructosuria having developed obesity or type 2 diabetes. KHK (fructokinase) inhibitor drugs are currently in development and will possibly be able to mimic essential fructosuria by blocking the metabolism of fructose in the liver. This could be a game-changing drug for preventing and treating type 2 diabetes but these are likely to be a long way off, and dietary interventions are still going to be preferable and less risky than any new drugs.
Epicatechin - nature's anti-diabetes drug?
Dr. Johnson also discusses the Kuna Yala people of the San Blas Islands, off the coast of Panama, who were known to have unusually low risk of developing high blood pressure. Norman Hollenberg set out to investigate possible genetic causes of this protection, but found that Kuna who had moved to Panama City on the mainland seemed to have higher rates of high blood pressure and other ailments associated with metabolic syndrome than those who still lived on the islands. This led him to look at potential lifestyle factors that could be causing the health benefits for the islanders. Norman found that despite a fairly high daily salt and sugar intake, the Kuna seemed to be protected from hypertension, cardiovascular disease and type 2 diabetes because of the 5-10 cups of cocoa they were drinking per day. The cocoa contains epicatechin, a flavonoid that stimulates mitochondria growth and the production of nitric oxide. Nitric oxide helps to increase vascular dilation, which is the most likely contributor to the protection against high blood pressure. It also helps to improve glucose tolerance and insulin sensitivity as well as reducing inflammation. It has even been shown to regenerate damaged pancreatic beta-cells in rat studies. The Kuna regularly drink cocoa because the islands don't have a convenient supply of regular fresh water so adding the cocoa to boiled water makes it more palatable.
Unfortunately, the extraordinarily resilient Kuna people are having to move to the mainland in increasing numbers due to loss of land from rising sea levels, increasing pollution, and pressures from extensive tourism. Like many other indigenous populations in the Americas, the Kuna become more susceptible to high blood pressure and other illnesses arising from metabolic syndrome when exposed to a Western diet and sedentary way of life. Hopefully they will be able to keep their cocoa and other cultural traditions alive for future generations.
Dr. Johnson and his team carried out a study on people with metabolic syndrome and high triglyceride levels, providing the test group with a 100mg daily epicatechin supplement for four weeks. The epicatechin group showed improved triglycerices and inflammation markers, and there was also an improvement in fasting glucose levels in the individuals with insulin resistance. The study showed that epicatechin could effectively block the harmful effects of fructose on liver cells by protecting mitochondria from oxidative stress and providing some protection against the development of metabolic syndrome by turning the survival switch off, or at least reducing it's impact.
How to incorporate more epicatechin into your diet
What most of us think of as 'chocolate' in Western culture is more chocolate-flavoured sugar. Especially with the increasing cost of cocoa, most ultra processed (UPF) chocolate bars we find in supermarkets isn't going to have the health benefits that the Kuna experience. This is because the volume of fructose in these products is going to cause much more damage than the epicatechin is going to be able to combat. So, sadly this isn't a good argument for eating as much UPF chocolate as you want.
Dark chocolate is generally recommended "in moderation" for people with type 2 diabetes. I've seen recommendations of both 70% and 85% cocoa as being okay. Personally, I avoid anything less than 85% and even this, I would consider as a sugary treat rather than a healthy food option. This is just my opinion, but I think a sensible approach to leveraging epicatechin for trying to reverse type 2 diabetes is to stick to 100% dark chocolate. It's not common in supermarkets, but some brands are starting to appear and it's worth shopping around to find good quality 100% dark chocolate.
The other way to include epicatechin into your diet is to use cacao nibs. These are crushed, raw cocoa beans. They can be added directly to yoghurt or salads. but they tend to be a bit fibrous and gritty, so I find making a cup of cocoa is the best way to use them (much like the Kuna). Here's my basic recipe:
- Grind two tablespoons of cacao nibs per mug (as fine as possible to help absorption) in a coffee grinder. Adding a small amount of cinnamon can help to improve the flavour and has also been shown to help reduce blood glucose levels in people with type 2 diabetes.
- Place the ground nibs and cinnamon to a glass jug or coffee pot and pour in 300ml of hot (80-90 degrees Celsius) water per mug (boiling water can damage the epicatechin)
- Stir for about five minutes
- Strain into a mug using a sieve (the cacao grains are quite large so will block coffee filter paper)
- You will get a silty residue so I'd avoid drinking the last mouthful in the bottom of the mug.
- The protein in milk is thought to bind to the epicatechin making it less bio-available, so although you can add milk, or use it as an alternative to water, this will likely reduce the health benefits.
This is too much cinnamon - about a quarter of this would be ideal. Two tablespoons of cacao nibs would give roughly 28mg of epicatechin per mug of cocoa.
I'm currently trying to have two pieces of dark chocolate twice a day and two mugs of cocoa. This works out very approximately at 58mg of epicatechin per day. Dr. Johnson's trial involved 100mg daily dose in the form of a supplement. 100% dark chocolate is definitely not easy to overconsume as it is very rich and the bitter taste can take some getting used to. I'm going to see how my blood glucose responds in the next few weeks and I'll add to progress updates in future newsletters.
