Accurate Education - Chocolate

An Anti-Inflammatory Diet:

Chocolate (and Carob)

Chocolate is one of the most popular foods in the world. it is made from ground cacao beans and has been used as a source of food for at least 5,300 years, starting with the Mayan culture in what is present-day Ecuador.

Most chocolate is sweet chocolate, a combination of cocoa solids, cocoa butter, and added milk products, sugar and flavorings. Milk chocolate is sweet chocolate that additionally contains milk powder. White chocolate contains cocoa butter, sugar, and milk, but no cocoa solids. Dark chocolate has a higher cocoa percentage and has a more bitter and intense flavor than other types of chocolate.

Chocolate, particularly dark chocolate, compared with other foods has the highest concentration of flavonoids, with over 10 percent of the weight of cocoa powder coming from flavonoids, It is these flavonoids that are believed to contributes to cocoa having many health promoting properties. Flavonoids belong to a group of natural substances with phenolic chemical structures, referred to as polyphenols, that are found in fruits, vegetables, grains, bark, roots, stems, flowers, tea and wine.

When discussing chocolate, one should not overlook carob, a somewhat similar product to chocolate with some distinct differences that some may prefer. See: Carob below.

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Definitions and Terms Related to Pain

Chocolate

Please note: All values noted below regarding the amounts of a nutrient are always estimates that represent likely averages. In any natural product, the amounts of any particular nutrient is going to vary based on a near-infinite number of variables that cannot always be identified or measured.

What is chocolate?

Chocolate is made from cacao beans(actually seeds) from the cacao tree. This plant produces large, pod-like fruits, each containing 20–60 beans surrounded by a sticky, sweet-tart white pulp. The term “cacao” is generally used when referring to the pods, beans and ground-up contents of the beans, while “cocoa” refers to the powder left after pressing the fat out of the ground beans. Cocoa powder is then processed into chocolate products. For more information on how cacao beans are processed into chocolate, see below.

Potentially “healthy?”

Chocolate, particularly dark chocolate, compared with other foods contains the highest concentration of flavonoids, with over 10 percent of the weight of cocoa powder coming from flavonoids, It is these flavonoids that contributes to cocoa having many health promoting properties. Flavonoids are natural substances belonging to a family of compounds called polyphenols that are found in fruits, vegetables, grains, bark, roots, stems, flowers, tea and wine.

Flavonoids are associated with a broad spectrum of health-promoting effects because of their antioxidant, anti-inflammatory, anti-mutagenic and anti-carcinogenic properties coupled with their capacity to modulate key cellular enzyme functions.

The polyphenols found in cacao include procyanidin flavonoids, catechin, and epicatechin have been found to be very nutritious and potent antioxidants. These antioxidants improve blood flow, lower blood pressure, raise HDL (“good” cholesterol), and protects against LDL (“bad” cholesterol) against oxidation, lowers the risk of cardiovascular disease and improves blood flow to the brain. Cocoa flavanols help maintain endothelium-dependent dilation of blood vessels, which contributes to normal blood flow. In order to achieve this benefit, 200 mg of cocoa flavanols should be consumed daily. This amount could be provided by 2.5 gms (@ 1 tsp) of high-flavanol cocoa powder or 10 gms of high-flavanol dark chocolate as part of a balanced diet.

Several epidemiological studies suggest a strong correlation between daily cocoa intake and better cardiovascular outcome in different populations. Cocoa consumption has also been demonstrated ] to lower BP in healthy subjects, in patients with risk factors and hypertension, and in patients with coronary heart disease and heart failure.

The best studied polyphenols in chocolate are the flavonols: catechins and epicatechins (including catechin, epicatechin, epigallocatechin, epicatechin gallate, and epigallocatechin gallate) which increase the total antioxidant capacity (TAC) of blood but this capacity is markedly reduced when the chocolate is consumed with milk or if milk is incorporated into the chocolate.

In addition to polyphenols, chocolate and cocoa powder contains theobromine, which can stimulate the production of neurotransmitters like serotonin and endorphins which may improve mood, reduce stress, and enhance cognitive function.

Theobromine

Theobromine is the primary alkaloid found in cocoa and chocolate but cocoa butter contains only trace amounts of theobromine. Theobromine is a heart stimulator and diuretic but has no significant stimulant effect on the human central nervous system. It is a bronchodilator and causes relaxation of vascular smooth muscle. It is available as a prescription drug in South Korea.

The amount of theobromine found in chocolate is small enough that chocolate can, in general, be safely consumed and there are usually higher concentrations in dark than in milk chocolate. There are approximately 60 mg of theobromine in 28 grams (1 oz) of milk chocolate while the same amount of dark chocolate contains about 200 mg. Cocoa beans naturally contain approximately 1% theobromine.

Dosing of flavonols in Chocolate

Research has evaluated the therapeutic effects of chocolate for cardiovascular benefits including reducing blood pressure, lowering LDL cholesterol, improving vascular function and insulin sensitivity and enhancing cognitive functioning. Although studies differ widely in methodology, dosage, duration, and target population, beneficial effects of flavanol-rich cocoa-based consumption have been found at doses ranging from 45.3 mg/day to 1078 mg/day, especially on cardiovascular health and cognitive function, with greater doses generally providing greater benefits.

Summary of recent research:

In a recent systematic review of research on polyphenols and oxidative stress, four studies reported statistically significant improvements in markers of oxidative stress and inflammation after flavanol-rich cocoa intake.
A significant reduction in oxidative stress occurred when dark chocolate was administered to smokers as opposed to milk chocolate.
A high dose (472.5 mg) of flavonoids from cocoa powder led to reduction in all oxidative and inflammatory markers in type 2 diabetics

The optimal dose of daily flavanol intake is still unclear. The European Food Safety Authority (EFSA) recommends consuming 200 mg of cocoa flavanols per day, provided by 2.5 gms of high-flavanol cocoa powder or 10 gms of high-flavanol dark chocolate, in the context of a balanced diet, One study concluded higher doses were recommended to obtain cardiovascular benefits: 900 mg of total flavanols and 100 mg epicatechin per day. Another resource advised that for heart health, include daily in their diet:

1 tsp (@ 2.5 grams) of high-flavanol cocoa powder (see: Good & Gather brand below)

(Note that one tablespoon of cocoa powder is about 6 grams and 1/4 cup of cocoa powder is about 25 grams). or

10 grams (0.4 ounces) of high-flavanol dark chocolate (1/4 of a medium bar)

According to Consumer Labs, not a peer-reviewed medical journal but somewhat reputable, and not inconsistent with available research, the amount of daily consumption of flavanols should be:

Cardiovascular health: 200 to 900 mg per day
Blood sugar/insulin improvement: 200 mg to 600 mg per day
Memory/cognitive function: 500 to 900 mg per day
Skin elasticity/wrinkles: 300 – 400 mg per day

Quantity of flavonols in Cocoa Powder and Chocolate

The flavanol content of cocoa and cacao products can vary tremendously and most products do not list their flavanol content. Understand that there may lot-to-lot variation in products, particularly natural products so even testing may not be consistent. Also, manufacturers may change ingredients and label information at any time, so review product labels carefully before purchasing.

According to ConsumerLab’s reporting,

Tests of popular brands of unsweetened cocoa powder show that a tablespoon (5-6 grams) provides from 37 to 130 milligrams of cocoa flavanols, depending on the brand.
Tests of popular sweetened dark chocolates found that a 40 gram serving (the size of a medium bar) provides from 136 mg to 440 mg of flavanols depending on the brand.
A 40 gram serving of unsweetened dark chocolate provides up to 592 mg of flavanols.

Cocoa Powder

So, a tablespoon of cocoa powder rich in flavanols will provide about as many milligrams of flavanols as an entire bar of the weakest dark chocolate or just one-quarter of a bar that is rich in flavanols, depending on the product. Cocoa powder has a higher concentration of flavanols per serving because chocolate has added sugar and higher fat content from the cocoa butter, which significantly increases its calorie count compared to plain cocoa powder.

Dutch Processing

Beware though: “unsweetened cocoa powder” refers to the general category of cocoa powder with no added sugar, while “Dutch processed cocoa powder” is a specific type of unsweetened cocoa powder that has been treated with an alkalizing agent, making it less acidic and darker in color, with a milder flavor compared to regular unsweetened cocoa powder but also substantially less flavanols. Dutching reduces levels by about 60%, medium Dutching by about 75%, and heavy Dutching by about 90% according to one study. For example, Hershey’s Cocoa Special Dark (Dutch processed with alkali), as well as 365 and Valrhona, tend to have low flavanol levels. In addition, the Hershey’s product also has been tested high in cadmium levels.

Selecting a Cocoa Powder Product

Although reliable testing is limited and difficult to verify, there is a wide range of flavanol content found in commercially available cocoa powders. Unsweetened cocoa powder varies widely in flavanol content, ranging from 6.1 mg/gm or 37 mg /tbsp (6 gm) [or less] up to 18.4 mg/gm or 92 mg /tbsp (6 gm).

Good and Gather 100% unsweetened cocoa powder is one recommended brand that has tested very high in flavanols and very low in cadmium and lead. It sells (80z.) for @$4 at Target but for more than $15 on Amazon. Beware that Hershey’s 100% unsweetened cocoa powder has been alkalized and has a very low flavanol content.

Ways to add cocoa to one’s diet include:

- Hot/cold cocoa: Mix cocoa powder with dairy or nondairy milk for chocolate milk or shake. Surprisingly, adding the unsweetened powder is quite nice and doesn’t seem to need any sugar, so this comes guilt-free with no sugar/sweeteners and only 15 calories!
- Smoothies: Cocoa can be added to a smoothie recipe to give it a richer, chocolatey taste.
- Puddings: One can add raw cocoa powder (not Dutch) to homemade puddings like chia breakfast puddings or rice pudding.
- Vegan chocolate mousse: Process avocado, cocoa, almond milk and a mild sweetener like dates for a thick vegan chocolate mousse.
- Sprinkle over fruit: Cocoa is particularly fine sprinkled over bananas or strawberries.

Dark Chocolate

A benefit of choosing a dark chocolate rich in flavanols is that you’ll get those flavanols while minimizing calories. If opting for dark chocolate, select one with a high cocoa percentage (70% or higher) to maximize the health benefits. Unfortunately, one cannot determine flavanol content from reading product labels because flavanols are rarely listed and even the “% cacao” shown on some labels is not a reliable indicator.

Safety

Be aware that the caffeine and theobromine in cocoa products may cause side effects as well as interfere with the actions of certain drugs. Cocoa and dark chocolate products may also trigger migraine headache in some people as well as eczema or allergic contact dermatitis in nickel-sensitive individuals. People with milk allergies should be aware that dark chocolate bars may contain milk.

In light of current cocoa/chocolate research, it would be beneficial to include a small piece of dark chocolate (equal to 30-40 calories) or a cocoa beverage as part of the daily food intake.

Dark Chocolate

The greater the cacao percent, the higher the catechin content, with 100% cacao chocolate being one of the highest food sources. In the production of chocolate, higher catechin content is found in unroasted vs roasted coffee beans but the difference ranges only from 4-30% greater. Other differences in catechin content can be explained by factors such as plant variety, geographical region, degree of maturity and post-harvest conditions.

At the extreme end of dark chocolate with percentages of cacao in the chocolate exceed 70-80%, the chocolate becomes notably less sweet and more bitter. With 100% cacao dark chocolate, catechin content is maximal. Of note, one commercial 100% dark chocolate bar is labeled as sugar free with a 25 gm serving that provides 7 gms of fiber and 3 gms of protein @ 125 calories. Unfortunately, milk chocolate offers little catechin benefit and high content of sugar.

A Sample Nutritional look at Chocolate (100 gms)

Dark chocolate (100% cacoa):

358 kcal, 27.6 grams of proteins, 21.8 grams of carbohydrates, and 11.6 grams of fats
Glycemic load = 4.4 (low).

Dark chocolate (85% cacoa):

539 kcal, 6.2 grams of proteins, 48.2 grams of carbohydrates, and 34.4 grams of fats.
Glycemic load = 9.6 (low).

Dark chocolate (70% cacoa):

549 kcal, 9.1 grams of proteins, 36.0 grams of carbohydrates, and 39.0 grams of fats.
Glycemic load = 9.0 (low).
Catechin content: 46-61 mg

Milk chocolate (10% – 50% cacoa):

(Varies): 535 kcal (2238 kJ), 8.0 grams of proteins, 59.0 grams of carbohydrates, and 30.0 grams of fats.
Glycemic load = 28.9 (high).
Catechin content: 0 mg

White chocolate – cocao butter (0% cacoa):

539 kcal, 5.9 grams of proteins, 59.2 grams of carbohydrates, and 31.1 grams of fats.
Glycemic load = 26 (high).
Catechin content: 0 mg

Choice of Chocolate Bars

It is beyond the scope of this site to make broad recommendations for specific brands but some variables to weigh in include flavonol content, roasted versus unroasted coffee beans, and Fairtrade chocolates.

Flavanol content:

It is beyond the scope of this site to make recommendations for specific brands. However, aside from flavor, perhaps the most important variable in choosing a chocolate product is its level of flavonols. Publicly available reviews of flavonols in branded chocolates are very limited but are available when one has a membership to consumer lab.com. Although one might assume that higher levels of cocoa percentage would correlate with higher levels of flavonol’s, this is not necessarily true although one might expect it to provide a trend towards accuracy.

One reason that “% Cocoa” is not reliable for prediction of flavonol content is that the confectionery industry defines “% Cocoa” content to include cocoa liquor, cocoa powder and cocoa butter. Cocoa butter does not have any flavanols in it but it has more calories than cocoa powder, so if the cocoa butter content is higher, it suggests greater flavonol content, but it will actually have more calories, but less flavanols.

It is recommended to review the websites of the chocolate manufacturers prior to purchasing their products. While one can report anything on their website regardless of truth, it nevertheless offers some insight as to their pride in the qualities of their products.

Unsweetened Chocolate Bars

Montezuma’s Dark Chocolate Absolute Black — 100% Cocoa has been tested as having a very high flavanol content (14 mg/gm), higher than most other brands. It is relatively high priced but in terms of cost of flavanols per gram of chocolate, it is still one of the lowest.

Sweetened Chocolate Bars

Ghirardelli® Intense Dark 72% Cacao Dark Chocolate has been tested as having a very high flavanol content (13 mg/gm), higher than most other brands. Have a relatively low cacao content, it is a relatively mild dark chocolate, and perhaps one of the best choices to begin exploring dark chocolate.

Roasted vs Unroasted Chocolates:

Roasting chocolate beans reduces the levels of flavanols, so one might consider selecting brands using unroasted chocolate beans such as Raaka chocolate products. However, roasting chocolate beans also enhances certain flavors that may be preferred.

Fairtrade Chocolates:

Fairtrade is an international movement in partnership with farmers and workers in more than 1,900 producer organizations, across 68 countries, to improve their living standards, invest in their communities and businesses, and protect the environment and also to pay fair prices and uphold fair production standards and practices. Fair prices provide an immediate lifeline for farmers and workers struggling with low incomes and disadvantages of global trade.

Flavanol Supplements

When drinking green tea or eating cocoa or chocolate products are not appealing, one can turn to the use of supplements. However, a word on safety of polyphenol supplements including those associated with cocao and green tea. Research does confirms that there is ample evidence that a flavonoid-rich diet promotes good health. However, one is discouraged from carelessly taking excessively high amounts of flavonoids with the common misconception that if something is good then more is better. It is reported that ingesting excessively large amounts of highly concentrated supplements (at doses 10 to 20 times what can be consumed through dietary means) may be hazardous..

It is estimated that the daily dietary intake of mixed flavonoids is in the range of 500 to 1000 mg. Therefore one would have to consume from 5000 to 20,000 mg of flavonoids to exceed 10 to 20 times the equivalent to the typical dietary intake. These levels are very high and even with supplementation, are quite unrealistic. As a precautionary measure however, it is recommended that one take no more than 1 gm per day of flavonoids in the form of supplements. This dose is not associated with any side effects. Flavonoids are fully metabolized without significant breakdown products accumulating in the body, which is likely why they have low toxicity.

Commercial Supplements

One flavonol supplement derived from cocoa is CocoaVia™ Memory that is ConsumerLab approved confirming safe levels of cadmium and lead. It is promoted as having 750 mg cocoa-derived flavanols per serving.

How Cacao Beans Are Processed

Raw beans from the sticky matrix of the cacao pod don’t taste like chocolate, they need to be processed through several steps:

Fermentation: The beans with the sticky pulp are put into bins and covered for a few days so microbes that feed on the pulp can ferment the beans. This fermentation starts to develop the distinctive chocolate flavor and aroma.
Drying: After fermentation, the beans are dried for several days then sold to chocolate makers.
Roasting: Roasting develops the chocolate flavor more fully and gives them some sweetness. However, some chocolate makers prefer using unroasted cacao beans to preserve their distinctive flavor. Also, unroasted cacao beans have a somewhat higher concentration of catechin antioxidants compared to roasted.
Source of commercial unroasted chocolate products: Raakachocolate.com
Crushing: The beans are crushed and separated from their outer hulls, resulting in broken cacao pieces called “nibs,” which are the beans without the outer shell.
Grinding: The nibs are then ground, producing a non-alcoholic liquid paste (“liquor”) which is roughly half fat in the form of cocoa butter. It is then pressed to remove most of the cocoa butter to be ready to be made into chocolate products.
Production of dark chocolate: For the production of dark chocolate, the basic ingredients are cocoa liquor, sugar, cocoa butter, and emulsifiers. Milk and other ingredients may be added, mixed and then refined to reduce the particle sizes of solids.
Conching: After refining, the conching operation begins, which consists of the agitation of the chocolate mass at high temperatures which provides better dispersal of the solids in the fat, ensuring that they are covered with the butter, which improved the texture of the chocolate. In addition, the chocolate develops a better flavor as some of the unwanted volatile odors and tastes are removed along with excess moisture. The average conching time for 100% dark chocolate can range from 6 to 24 hours depending on the quality of the chocolate and the equipment used, with higher quality chocolate often requiring longer conching times, sometimes reaching up to 72 hours. Most chocolate makers will aim for a conching time between 4-6 hours. It is argued by some chocolatiers that there are more aromas and tastes to keep, such as the aromatic compounds of vanilla, fruity or caramel-like flavors than to take away from the original product.
Tempering: After conching, the chocolate is tempered which consists of heating, cooling and mixing for the development of the final texture and flavor.

The percentage of cacao, cocoa or dark chocolate in a chocolate product is how much combined cocoa powder and cocoa butter are present.

Carob

The carob tree (Ceratonia siliqua L.) is a flowering evergreen shrub widely cultivated in the Mediterranean and Middle East. The carob or carob pod is the edible fruit produced by the carob tree. It has a unique chemical composition with health-promoting properties. Carob is a similar tasting alternative to cocoa with natural sweetness that is commonly used as a substitute for chocolate.

Nutritional benefits of carob

Compared with cocoa, carob is higher in fiber, lower in fat and calories, and contains no caffeine. Cocoa contains oxalates, compounds that reduce your body’s ability to absorb calcium. A diet high in oxalates also increases your risk of developing kidney stones and carob powder contains no oxalates.These nutritional benefits may make it a healthier alternative to chocolate. However, while carob powder contains virtually no fat, it’s higher in sugar and carbs than cocoa powder and, unlike cacao, roasted carob powders have higher polyphenols levels than unroasted powders.

Carob is an abundant source of several beneficial substances, including dietary fiber, minerals, and polyphenols, including flavonoids (catechin, epicatechin, myricetin, quercetin and apigenin), and tannins. These polyphenols are natural antioxidants that can protect cellular components from oxidative damage and, as a result, reduce the risk of a variety of degenerative diseases related to oxidative stress. In particular, a reduction in cholesterol along with beneficial effects on the lipid profile of human blood have been reported in human trials. The purported anti-cancer, anti-diabetic, and neuroprotective properties of carob are mainly attributed to its polyphenols.

Nutrition of Carob (100 gms)

Carob Powder (100%):

212 kcal (887 kJ), 4.4 grams of proteins, 78.0 grams of carbohydrates, and 1.0 grams of fats.
Glycemic load = 11.7 (medium GL food).
Catechin content:

Source of commercial carob bars, included unsweetened versions: CarorbMe.com & www.missyjs.com

More Food Sources of Catechins (mg/100 gms)

Note Carob flour vs Cocoa powder:

Carob flour – Catechin 50 mg, Epicatechin 3-gallate 30 mg, Epigallocatechin 3-gallate 109 mg
Cocoa dry powder (unsweetened, processed with alkali) – Catechin 36.7 mg, Epicatechin 3-gallate 56.7 mg

Apples, Red Delicious (raw.with skin) – Epicatechin 9.8 mg
Blackberries (raw) – Catechin 37 mg, Epicatechin 4.7 mg
Cherries, sour, red (raw) – Epicatechin 3.8 mg
Cherries, sweet, red (raw) – Epicatechin 5 mg
Cranberries (raw) – Epicatechin 4.4 mg
Nectarines (raw) – Catechin 3 mg, Epicatechin 2.5 mg
Peaches (raw) – Catechin 5 mg, Epicatechin 2.3 mg
Plums, black diamond (raw with peel) – Catechin 17.6 mg, Epicatechin 2.4 mg, Epigallocatechin 13 mg
Plums (raw with peel) – Catechin 2.9 mg, Epicatechin 3.2 mg
Raspberries (raw) – Catechin 1.3 mg, Epicatechin 3.5 mg
Pecans – Catechin 7.2 mg, Epigallocatechin 5.6 mg, Epigallocatechin 3-gallate 2.3 mg

Note: Berries such as raspberries, blackberries and blueberries are typically sold in clear, square plastic containers that hold 6 oz (170 gms) of fruit.

Purchasing Supplements

To purchase supplements reviewed on this web site or discussed with Dr. Ehlenberger, a discount can be applied to usual commercial pricing by purchasing from Accurate Clinic’s online Supplement Store after acquiring the discount code from Accurate Clinic. Please note that Dr. Ehlenberger does not receive any financial rewards from sales through this store, it has been set up as a means to allow purchase of quality supplements more accessible and more affordable for his patients.

Accurate Clinic’s Supplement Store or, call Toll-Free: 877-846-7122 (Option 1)

Resources:

Online Resources for Nutritional Information

MyFoodData.com

MyFoodData.com provides nutrition data tools and articles to empower you to create a better diet. All data is sourced from the USDA Food Data Central.This site includes many tools related to nutrition including one that allows you to look up any food for a nutritional analysis, including commercial products,

The Nutrition Source

www.Nutrition.gov
Nutrition.gov provides easy access to vetted food and nutrition information from across the federal government. It serves as a gateway to reliable information on nutrition, healthy eating, physical activity, and food safety for consumers. Since dietary needs change throughout the lifespan, specialized nutrition information is provided about infants, children, teens, adult women and men, and seniors. Users can find practical information on healthy eating, dietary supplements, fitness and how to keep food safe. The site is kept fresh with the latest news and features links to interesting sites.

National Association to Advance Fat Acceptance
Founded in 1969, the National Association to Advance Fat Acceptance (NAAFA) is a non-profit, all volunteer, civil rights organization dedicated to protecting the rights and improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through advocacy, public education, and support.

Journals & Newsletters

Books

“Dopamine for Dinner”

by Joan Borsten, 2014
Available online at Amazon.com: Kindle subscriber: free; Kindle book: $9.95 Paperback: $149.00

“Dopamine for Dinner,” is the first Malibu Beach Recovery Diet Cookbook, based on their famous low-glycemic diet. The recipes developed by four accomplished chefs are both pleasant eating as well as healthy. Based on the use of low glycemic index foods, the recipes emphasize nutritious eating in a manner that promotes maintaining high brain levels of dopamine and serotonin as a means of supporting healthy brain chemistry.

Educational Resources:

Food – Chocolate

Theanine

Polyphenols

Dietary Supplement Testing and Safety:

Food

Food – Carob

Information on Herbal and Dietary Supplements:

Genetically Modified Food

Misc.

Simopoulos AP. The importance of the ratio of omega 6/omega 3 essential fatty acids. Biomed Pharmacother. 2002 Oct;56(8):365-379.
LeGendre O, et al. (-)-Oleocanthal rapidly and selectively induces cancer cell death via lysosomal membrane permeabilization. Mol Cell Oncol. 2015 Jan; 2(4):e1006077.
Carvajal-Zarrabal O, et al. Effect of dietary intake of avocado oil and olive oil on biochemical markers of liver function in sucrose-fed rats. Biomed Res Int. 2014;2014:595479.
Unlu NZ, et al. Carotenoid absorption from salad and salsa by humans is enhanced by the addition of avocado or avocado oil. J Nutr. 2005 Mar;135(3):431-436.
Irandoost P, et al. Does grape seed oil improve inflammation and insulin resistance in overweight or obese women?. Int J Food Sci Nutr. 2013 Sep;64(6):706-710
Del Gobbo LC, et al. ω-3 ω-3 polyunsaturated fatty acid biomarkers and coronary heart disease pooling project of 19 cohort studies. JAMA Intern Med. 2016 Aug; 176(8):1155-66.
Carvalho M, et al. Human cancer cell antiproliferative and antioxidant activities of Juglans regia L. Food ChemToxicol. 2010 Jan; 48(1):441-447.
Deol P, et al. Soybean oil is more obesogenic and diabetogenic than coconut oil and fructose in mouse: Potential role for the liver. PLOS One. 2015 June.
O’Keefe S, et al. Levels of trans geometrical isomers of essential fatty acids in some unhydrogenated U. S. vegetable oils. J Food Lipid. 1(3):165-176.
Kritchevsky D, et al. Lectin may contribute to the atherogenicity of peanut oil. Lipids. 1998 Aug;33(8):821-3.

Emphasis on Education

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

For more information, please contact Accurate Clinic.

Supplements recommended by Dr. Ehlenberger may be purchased commercially online

Please read about our statement regarding the sale of products recommended by Dr. Ehlenberger.