Cacao & Cocoa
Cocoa and cacao: what the COSMOS trial of 21,442 adults found for a cocoa extract supplement, and why chocolate and cocoa powder are not the same as a flavanol supplement.
Content last updated . This page has not been medically reviewed.
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Overview and identity
Cocoa comes from the cacao bean. This page is about cocoa as a food or supplement ingredient. Cocoa butter, the fat used in skin products, is a separate guide: Cocoa butter. We did not find a source we could read defining "cacao" versus "cocoa" labeling, so we make no claim about the difference.What the research shows
The largest trial we read is the COSMOS randomized trial of 21,442 US adults (women aged 65 and over and men aged 60 and over), who took a cocoa extract supplement providing 500 mg of flavanols a day (including 80 mg epicatechin) or placebo for a median of 3.6 years. Total cardiovascular events did not differ significantly (hazard ratio 0.90, 95% CI 0.78 to 1.02), though cardiovascular death was lower (HR 0.73), and per-protocol analyses supported a lower risk of total events (HR 0.85). The authors reported no safety concerns and concluded that additional research is warranted. [1]What this does and does not mean
The trial tested a standardized extract, not chocolate, cocoa powder or a cocoa drink; its results cannot be assumed for those. The main result was not statistically significant. We make no health claim for cocoa products. We found no readable source on caffeine, heavy metals or interactions in cocoa products, so we say nothing about them.Frequently asked questions
Is cocoa good for your heart?
In a large randomized trial of a cocoa extract supplement, total cardiovascular events did not differ significantly from placebo, though cardiovascular death was lower. [1]
References
- Sesso HD, et al. Effect of cocoa flavanol supplementation for the prevention of cardiovascular disease events: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial. Am J Clin Nutr. 2022;115(6):1490-1500. PubMed 35294962. 21,442 US adults.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.