December 6, 2023

Cacao Extract to Help Middle-Aged Women’s Mood States

Could daily cacao consumption improve mood?
Drinking a daily flavanol-rich cacao drink may improve mood in middle-aged women.


Murakami R, Natsume M, Ito K, Ebihara S, Terauchi M. Effect of flavanol-rich cacao extract on the profile of mood state in healthy middle-aged Japanese women: a randomized, double-blind, placebo-controlled pilot study. Nutrients. 2023;15(17):3843. 

Study Objective

To investigate the effect of flavanol-rich cacao extract on fatigue and mood in healthy, middle-aged Japanese women who have existing fatigue and high oxidative status at baseline

Key Takeaway

Daily consumption of a cacao extract may improve mood in peri- and postmenopausal women over an 8-week span.


Randomized, double-blind, placebo-controlled, parallel-group pilot study


A total of 108 healthy Japanese women were eligible to participate in the study. Of these, 60 were included in the study based on baseline fatigue severity and/or oxidative status. Specifically, the 60 women with the highest levels of fatigue and measurable oxidation remained in the study. In addition, these 60 participants all met the following criteria. They: 

  • Were aged 40–60 years,
  • Had fatigue in their daily life,
  • Had a body mass index (BMI) of 18.6–30 kg/m2, and
  • Had missed a menstrual cycle by ≥1 week or had ≤5 years of amenorrhea since the last menstrual period.


For 8 weeks, from the day of the pre-intake test to the day before the post-intake test, each participant consumed either a beverage containing cacao flavanol or a placebo. Specifically, “The cacao-flavanol content of the placebo beverage was <0 mg/200 mL, and that of the cacao beverage was 240 mg/200 mL,” the authors state. “The cacao beverage contained 120 mg of catechin, epicatechin, procyanidin B2, procyanidin B5, procyanidin C1, and cinnamtannin A2 according to a high-performance liquid chromatography (HPLC) analysis of the ingredients. Flavanol-rich cacao extract also contains methylxanthines. The cacao beverage contained 19 mg of caffeine and 106 mg of theobromine.”

Study Parameters Assessed

Initial parameters assessed that were not repeated included: BMI, blood pressure, and oxidative stress (the derivatives of reactive oxygen metabolites [d-ROMs]).

Investigators measured fatigue using the Chalder Fatigue Scale (CFQ), a 14-item, self-administered questionnaire that evaluates fatigue-related symptoms with 4 possible responses: “better than usual,” “no more than usual,” “worse than usual,” and “much worse than usual.”

Investigators assessed menopausal symptoms using the Menopausal Health-Related Quality of Life (MHR-QOL) Questionnaire, a modification of the Women’s Health Questionnaire. The MHR-QOL contains 38 items scored on a 4-point or binary scale covering 4 major domains of a woman’s health during menopause: physical health, mental health, life satisfaction, and social involvement.

Investigators assessed mood with the Profile of Mood States 2nd Edition (POMS 2) Brief. They measured autonomic nervous system with an acceleration plethysmography (Artett C, U-Medica, Osaka, Japan).

There were 3 time points: a pre-intake test (week 0), a midpoint test (week 4), and a postintake test (week 8). In all 3 tests, investigators evaluated subjective fatigue. At weeks 0 and 8, they measured participants’ mood states and autonomic nervous system activity.

Primary Outcome

Participant scores for fatigue and mood conditions

Key Findings

Compared to the intake of a placebo beverage, the consumption of a beverage containing flavanol-rich cacao extract significantly improved the participants’ negative mood and promoted positive mood, according to the POMS 2 questionnaire. 

There was no difference in CFQ scores between the cacao and placebo groups. In both groups, there were significantly lower CFQ scores compared to baseline (P<0.001).

There were no significant differences between or within the groups for autonomic system activity.


This study received funding from Meiji Co Ltd, the company that manufactured the test beverage and the placebo used in this study. In addition, authors RM, KI, and MN are employees of Meiji Co Ltd. Author MT has received research consulting fees from Meiji Co Ltd.

Practice Implications & Limitations

Flavonoid-rich foods are well-known for their health benefits.1 Cacao contains mostly flavanol, one of the many types of flavonoids found in plant foods. Cacao beans have strong antioxidant properties, along with other polyphenols and phytochemicals that may synergize with each other in the whole-bean extract. In this study, females with fatigue, sleep disturbance, psychological problems, and vasomotor disturbances were recruited. As mentioned in the Key Findings section, the cacao extract had no effect on fatigue after 8 weeks. The authors propose that this may have been due to the use of a fatigue questionnaire suited for chronic fatigue, making it less sensitive for this otherwise healthy female population.

Cacao beans have strong antioxidant properties, along with other polyphenols and phytochemicals that may synergize with each other in the whole-bean extract.

This study was a randomized, double-blind, placebo-controlled, parallel-group trial, which is a rigorous design. It was performed between March 19 and August 19, 2021, in a single clinic in Tokyo, Japan. The authors did not share the contents of the placebo in the study, which have been relevant to this commentary since both arms seemed to derive some relief in symptoms over the 8-week study. 

After 8 weeks, the group of women having a daily cacao flavanol drink appeared to experience improvements in negative mood and promotion of positive mood, both of which improved their active lives. Which component of the cacao extract was responsible for this difference is not clear in this study.

It is important to point out that the study did not include a daily dietary control from the participants, which could certainly affect the overall results. However, this study’s strength was in the use of a double-blind, placebo-controlled trial design, which is not usually done to test how foods may affect health. Also, many variables would need to be considered when working with the symptoms presented by the participants, especially the psychological symptoms. Overall, this study was informative in showing some benefit from a whole-food extract of cacao in women who have symptoms such as fatigue or mood issues in the middle of their life.

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  1. Billowria K, Ali R, Rangra NK, Kumar R, Chawla PA. Bioactive flavonoids: a comprehensive review on pharmacokinetics and analytical aspects. Crit Rev Anal Chem. 2022;1-15. Online ahead of print. doi: 10.1080/10408347.2022.2105641.