Cocoa flavanols
EFSA-authorised endothelial-function claim at ≥200 mg flavanols/day, supported by the COSMOS RCT.
Why
Cocoa flavanols, principally (–)-epicatechin and procyanidins, have an EFSA-authorised health claim that 200 mg/day contributes to maintaining endothelial function. The COSMOS trial (Sesso JAMA Intern Med 2022, n=21,442) reported a non-significant 10% reduction in total cardiovascular events overall but a significant reduction in cardiovascular mortality and in those who adhered to the protocol. Effect on blood pressure is small but consistent in hypertensives.
How it works
(–)-Epicatechin activates endothelial nitric oxide synthase, increasing nitric oxide bioavailability and flow-mediated dilation. Independent effects on platelet function, insulin sensitivity, and LDL oxidation are mechanistically documented.
Expected onset · Endothelial function changes within 2–4 weeks; BP effects over 4–12 weeks
How to take
Dosage
200 mg cocoa flavanols/day (EFSA-claim threshold). Concentrated capsules deliver this without the sugar; equivalent in plain dark chocolate (70%+) is ~25–40 g/day.
Timing
Once daily with food
On the label
Stated 'cocoa flavanols' content per serving (Cocoavia and similar deliver 500 mg standardised flavanols). Cocoa powder varies widely; alkalised (Dutch-process) loses flavanols.
Ideal for
Adults with mild hypertension or pre-hypertension; people seeking cardiovascular-supportive nutrition without sugar load.
Safety
Evidence
EFSA-authorised health claim: 200 mg cocoa flavanols/day contributes to maintaining normal endothelium-dependent vasodilation. COSMOS 2022 large RCT (n=21,442 older adults): non-significant 10% reduction in total CVD events; significant reduction in CVD mortality in pre-specified analyses. Cochrane 2017 SR on cocoa for BP: small but consistent systolic BP reduction of 1.8 mmHg.
- EFSA Reg 851/2014 authorised claim, cocoa flavanols 200 mg/day and maintenance of normal endothelium-dependent vasodilation
- Sesso et al., Am J Clin Nutr 2022, COSMOS trial: cocoa extract and multivitamin in prevention of cardiovascular disease and cancer (RCT, n=21,442)
- Ried et al., Cochrane Database Syst Rev 2017, effect of cocoa on blood pressure
Where to get it
Shop Cocoa flavanols on AmazonSponsored · As an Amazon Associate, Healicus earns from qualifying purchases.