Book Review: Chocolate as Medicine

Chocolate as Medicine: A Quest Over the Centuries, by Philip Wilson and W. Jeffrey Hurst

By Jacob Schor, ND, FABNO

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We have reached the end of an anomalous period of history in which some distortion of the time space continuum appears to have turned things upside down, inside out, and backwards. We grew up and lived in a peculiar reality, during which chocolate was viewed negatively. For a good part of our lives, people have had a peculiar notion that chocolate was bad for you and either avoided eating it or felt guilty when they did.
Back when I considered myself a food scientist rather than a naturopathic physician, I put considerable time and effort into creating carob-based confections that could substitute for chocolate because they were healthier. How strange looking back 30 years at my unsuccessful carob vs chocolate taste panels. Obviously none of our taste panelists ever preferred carob over chocolate. Replacing even 5% of a carob coating with chocolate improved the taste enough to make it more palatable. While pretty much every person I tested preferred the taste of chocolate, no one questioned the underlying premise that chocolate needed to replaced with something healthier.

Chocolate in History

If we trace the history of chocolate back over the past thousand or so years, we find that at all other times in human existence, chocolate has been viewed in a supremely positive light. It was the food of the gods, a substance that could connect consumers with the divine elements of creation. It was the ultimate medicine—a profoundly nutritive food that alone could sustain a person for months.
How it came to be that in the short period of our lifetimes chocolate became a junk food is a mystery that we should not waste our time dwelling on. Suffice to say, public opinion can be fickle.
Luckily the world of science has awoken from this peculiar mindset and chocolate is once again appreciated as a near magic foodstuff, this time based on randomized controlled trials and not just mythologies and anecdotal reports. The stuff is good for your health. And with Valentine’s Day just around the corner, we should also note that chocolate may also be good for your love life.

In Praise of Chocolate

I’m chewing on these thoughts because I’ve just finished reading Chocolate as Medicine: A Quest Over the Centuries, by Philip Wilson and Jeffrey Hurst. Both are PhD’s; Wilson is an historian of science and medicine and a professor at Penn State College of Medicine; Hurst is an analytic chemist and a principal scientist at Hershey Foods. Between them, they know and awful lot about chocolate, history, and medicine.
For those of you who enjoy nibbling on morsels or tidbits of information, this book is chock full of them. With full access to Hershey’s archives and libraries, you can imagine the sort of details they bring to the table. While I am familiar with much of the recent scientific investigations about chocolate, I had no sense of chocolate’s earlier history. While reading I watched my preconceptions melt away.
The authors divide their information into four major epochs. First the early Meso-American use of chocolate up into the Mayan and Aztec period, then second, the Early European era, focused on the early chocolate shops, and pharmaceutical prescriptions. Then to the early 1900s, an era of widespread common use of chocolate as a general and complete nutritive food, especially once milk was added to increase the nutritional content. They skip over that odd era I grew up in when chocolate was considered a junk food and skip to our current era when many of the earlier believed benefits of chocolate are being confirmed by modern scientific research.

Back to the Beginning

Chocolate came to Europe from South America in the early 1500s. In his journal, Christopher Columbus’s son Ferdinand described seeing chocolate beans during their fourth voyage (1502–1504). Hernán Cortés started a cacao plantation in Mexico and brought both the cacao and the traditional method of preparation to King Charles of Spain in 1528. Shipments of cacao reached Europe in 1585. Chocolate was prepared as a drink with water (served hot in Spain, cold in the New World).
This is where we see Wilson, as the medical historian, take the lead as he explains the medical theories of the time and how chocolate was integrated into the existing Old World medical theories that date back to the Hippocrates. For European doctors, constitutional make-ups and derangements of the four bodily humors and their link to the four elements that make up the universe were still the basis of all understandings of disease and informed all treatments. These elucidations that Wilson contributes to the book are as interesting as the details pertaining to chocolate.
When it was introduced to European medicine, the cacao bean was considered to hold cold and dry qualities, so chocolate drinks were used to treat disorders with opposite qualities: diseases with hot and wet qualities, fevers especially. To counter these cold qualities, chocolate was served hot and warming spices were added. Melancholics (cold, dry, black bile temperaments) were prescribed lukewarm chocolate made with anise seeds instead of chiles. Phlegmatic temperament patients were given hot and spicy chocolate. Overheated people benefited from chocolate with hot spices (cinnamon, anise, and black pepper) to balance the cold nature of the cacao. And so on.

The Elixir of Love

As early as 1624, medical writers began alluding to an aphrodisiac effect created by chocolate. Joannes Rauch spoke of chocolate as a ‘violent inflamer of passions.’ Richard Cadbury was the first to put chocolate into heart-shaped boxes for Valentine’s Day in 1861. Yet chocolate’s association with the heart goes back to the prehistory of chocolate in the Meso-American cultures. The Aztec words for heart and blood were synonymous with their word for chocolate. The pods of the cacao tree were drawn as heart shaped in early illustrations.
This book sheds light on past beliefs and uses and may provide hints toward future applications.

Chocolate in the New World

In the early 1700s chocolate was considered a primary medicine to use in the treatment of smallpox. Benjamin Rush, MD, prescribed chocolate and biscuits to prepare patients for their smallpox inoculations and as a major constituent in the diet for all patients during recovery.
Seeing a potential business opportunity, James Baker, a Harvard trained minister and physician, hired John Hannon, an Irish chocolate maker, to start producing chocolate for the New England Colonies. In 1764, on the Neponset River outside of Boston, they started grinding chocolate beans using a water-powered gristmill. Thus the John Hannon Chocolate Company, the first serious producer of chocolate in colonial America, came into being, producing what we would now call a medicinal food. They sold hard bricks of ground, molded chocolate that were then melted in boiling water and prescribed as medicine. Hannon was lost at sea in 1779 on his way to the West Indies to buy cacao beans, so Baker took over the company in 1780 and renamed it Bakers Chocolate. This is the same Bakers Chocolate we still make brownies with.

Lost Knowledge

Considering the recent studies on chocolate and cardiovascular disease and this early prehistoric linkage of chocolate with heart, we must reconsider our modern dependence on randomized controlled trials and wonder how much medical knowledge we lose when we ignore medical knowledge from earlier cultures.
Wilson, the medical historian, contributes some rather intriguing side roads to the book, not just with regard to chocolate. He also delves into the history of medical research and the development of evidenced-based medicine. We take it for granted and rarely give it a thought that medical data should be subjected to mathematical analysis. Yet there was a time when only the most forward-thinking doctors considered applying math to medicine. John Millar was far ahead of his time when he “claimed in 1777 that ‘arithmetical calculation’ provided ‘incontestible evidence’ of one therapy’s benefit over another.”

Critique of the Book

If I were to find complaint with this book, it would be that there were too many facts, tidbits, and morsels. In all the detail, the larger story tends to get lost.
I would have liked it if the authors had devoted some space to the recent introductions of high-polyphenol chocolates by Mars, Callebaut, and Nestle. These are the materials being tested in the human trials published over the last few years. Do these special, medical-grade chocolates differ from the fancy chocolates sold in the health food stores? Are they even better than Bakers chocolate? Is this just part of the same tradition in which each manufacturer claims to produce a superlative product, a tradition that has existed for hundreds of years? If we are going to be guided by clinical trials it is of interest to understand the materials tested.
We have reached a new era in the medical utilization of chocolate. This book sheds light on past beliefs and uses and may provide hints toward future applications.

About the Author

Jacob Schor, ND, FABNO, is a graduate of National University of Naturopathic Medicine, Portland, Oregon, and recently retired from his practice in Denver, Colorado. He served as president to the Colorado Association of Naturopathic Physicians and is a past member of the board of directors of the Oncology Association of Naturopathic Physicians and American Association of Naturopathic Physicians. He is recognized as a fellow by the American Board of Naturopathic Oncology. He serves on the editorial board for the International Journal of Naturopathic Medicine, Naturopathic Doctor News and Review (NDNR), and Integrative Medicine: A Clinician's Journal. In 2008, he was awarded the Vis Award by the American Association of Naturopathic Physicians. His writing appears regularly in NDNR, the Townsend Letter, and Natural Medicine Journal, where he is the past Abstracts & Commentary editor.