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The Calming Effect of Chocolate in Late Stage Alzheimer's

 Chocolates

The Medical Director’s Association (AMDA) publication “Caring for the Ages” for February 2011 contains a most interesting article on Chocolate and Alzheimer’s. The article is by Dr. Jeffrey Nichols and is entitled: “The Allure – and Importance – of Chocolate”. This article in turn references a story in the New York Times of 31 December 2010 headlined: “Giving Alzheimer’s Patients Their Way – Even Chocolate.

This article describes a nurse in the Beatitudes Nursing Home in Phoenix, AZ. This account tells of a nurse who “was reported to carry chocolate in her pocket to give residents who were agitated.”  It also described a case history of “one resident whose behavior and general well-being seemed to benefit”.

Dr. Nichols then describes a significant body of scientific literature on the topic of chocolate and Alzheimer’s disease. “Chocolate contains caffeine, which in turn is a neurostimulant that has been shown to increase neurotransmitter levels, including those of acetylcholine, and to improve memory and executive function. Dark chocolate contains much larger quantities of the obromine and other methylxanthines that lower blood pressure and might inhibit beta-secretase. That’s the enzyme that produces the beta-amyloid in the brain plaques that characterize Alzheimer’s disease. Chocolate also contains substantial quantities of flavonoids. These antioxidants have been shown in a peer reviewed article to improve function in Alzheimer’s model mice”.

Agitated behaviors in dementia are generally “about” something rather than simply a behavioral manifestation of that disease. To the extent that we can identify what a patient wants and needs we can modify his or her behaviors. It might not be clear whether the resident was simply hungry, a lifelong chocoholic needing a fix, or simply feeling neglected or lonely, and so responding to the pleasant flavor and underlying psychological association that food is love. What is clear is that the chocolate was being used as an element of the nonpharmacologic modalities that often are effective in this setting….”

“Perhaps the bottom line here is that we need to look at our residents not just as patients, but as people. If the adorable 3-year old in you life lights up at the  sight of a chocolate chip cookie and finishes his dinner with alacrity, why not the adorable (or even not so adorable) 90 year old dementia patient? The real excitement in the chocolate story was the possibility that even with advanced age and frailty there still can be joy.”

I would change the doctor's last statement to read: “The real excitement in the chocolate story is the possibility that even with advanced Alzheimer’s there may be moments of joy.

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Dark Chocolate’s Heart Advantages

Jennifer J. Brown, PhD, Everyday Health, 30 July 2014…Evidence is building that products of the cacao plant, especially dark chocolate, are good for your heart. Medical studies show that people who eat dark chocolate have healthier cardiovascular systems, boasting better blood circulation and lower blood pressure and cholesterol levels. Cardiologist and Everyday Health columnist T. Jared Bunch, MD recommends chocolate as part of your strategy to keep the world's No. 1 killer disease at bay. “Dark chocolate should be included in a life plan that includes exercise, eating healthy foods that are largely plant-based, getting adequate sleep, stress reduction, and maintenance of weight,” says Dr. Bunch…

Seeds of the Theobroma cacao plant, the source of dark chocolate, are rich in active compounds known as antioxidants. Dark chocolate is in the top 10 dietary sources of antioxidants, along with seasonings like cloves, mint, anise, cacao powder, and berries like black chokeberry and black elderberry, according to the "European Journal of Clinical Nuitrition". Dark chocolate is also rich in bioactive flavanols and theobromine. These have good effects on the cells of our hearts and blood vessels, found researchers at the University of Mississippi. A caveat if you are watching your fat intake: One ounce of dark chocolate, though low in cholesterol at only 2 mg, has about 9 gm of fat. “In general, the health benefits outweigh the risk of the additional calories,” says Bunch. “When you consume dark chocolate that is more than 70 to 80 percent pure, the calories are relatively low," he adds. In less concentrated forms of chocolate — such as white or milk chocolate — other ingredients add lots of calories, and there are no documented heart benefits.

More evidence for the antioxidant benefits of dark chocolate comes from a recent clinical study carried out in Rome, and published in July, 2014, in the "Journal of the American Heart Association". The research showed that eating dark chocolate helped people who have peripheral artery disease, PAD, walk farther and longer. PAD decreases blood flow to the arms and legs. Because of this, patients often have painful cramping and difficulty with exercise, even with walking. In the study, people with PAD who ate 40 gm (1.5 oz.) of dark chocolate a day were able to walk 11 percent farther and for 15 percent longer than people who ate the same amount of milk chocolate. The dark chocolate used in the study contained more than 85 percent cacao and was rich in active compounds known as polyphenols. Researchers looked at markers of oxidative stress in the blood, and found improvement for those who had the dark chocolate. 

New data shows eating chocolate comes with a lower risk of stroke, according to researchers in Finland. Stroke is a major health concern for many, especially people with atrial fibrillation. Their stroke risk is five times that of people who don't have afib, according to the National Stroke Association. When a blood clot forms in the brain, or a blood vessel bursts, the result is stroke — a leading cause of disability in the United States. In the Finnish study, researchers followed a group of more than 37,000 men for 10 years and counted instances of stroke. The numbers showed that those who ate about 63 grams (2 oz.) of chocolate per week had a lower risk of stroke, compared with those who ate no chocolate. And five additional studies also showed lower stroke risk — on average by about 20 percent for chocolate eaters. “Dark chocolate helps reduce blood pressure and may have a role in coronary artery disease stability and diabetes," says Bunch. "So dark chocolate may help lower stroke risk." However, warns Bunch, don't stop taking a prescription blood thinner or anticoagulant — the only treatments proven to prevent stroke — and eat chocolate instead. 

If you're struggling to get your cholesterol under control, studies on blood cholesterol levels and chocolate are heartening. In one trial, people with high blood pressure ate 100 grams (about 3 1/2 ounces) of either dark chocolate or white chocolate. Those who had the dark chocolate saw an average drop of 12 percent in their LDL cholesterol, which is known as “bad cholesterol” and linked to higher risks of heart disease. In a Dutch trial, people who ate dark chocolate had a significant increase in HDL or “good cholesterol." Researchers credited these healthy changes to theobromine, a compound found in cacao.

An often overlooked, but very real, risk factor for heart disease is stress. You'll be happy to know that the solace provided by dark chocolate is not limited to its good taste. Eating dark chocolate helped people cope with stressful situations, found a recent study. Researchers measured people's stress hormones — cortisol and epinephrine. Then they challenged people to do things like figure out a difficult math problem in their heads. Those who had the dark chocolate had lower levels of stress hormones circulating in their blood after the stress test. They also reported that they felt less stress. Blunting the effects of stress on the body is yet another way dark chocolate can protect heart health — good news even for people with a heart condition. “Dark chocolate has been shown to favorably impact some of the risk factors for atrial fibrillation, such as high blood pressure, body inflammation, and the response of the body to stress,” says Bunch.

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“Delicious Reasons to Eat Dark Chocolate”, Beth W.Orenstein. Reviewed by Pat F Bass, III, MD, MS, MPH, found in “Everyday Health”, 27 October 2014.

“Chocolate tastes sinfully sweet, but you may no longer need to feel guilty about indulging in an ounce or two a few times a week. A growing number of studies show that chocolate, especially antioxidant-rich dark chocolate, has health benefits that put it squarely on the latest list of superfoods. A key reason chocolate has so many health benefits is that it is rich in flavonoids, which are naturally occurring substances found in plants that can provide a serious boost in antioxidant action for you.

Studies show that the darker the chocolate, the better. Eat only less-processed chocolate that contains at least 65 percent cacao, recommends Joy DuBost, PhD, RD, an American Dietetic Association spokeswoman. Not only does dark chocolate have a higher concentration of antioxidants than milk chocolate, but milk chocolate is also higher in added sugar and unhealthy fats. Still, the daily dose of antioxidants in dark chocolate doesn’t give you license to indulge in a dessert free-for-all — dark chocolate is still loaded with fat and calories — so eat a max of 1 to 2 ounces a day. If you do, research says you’ll reap…benefits.

It Can Improve Memory Loss: "Can’t remember where you put your keys or why you walked into a particular room? Chocolate may help: Recent research suggests that antioxidants called flavanols found in cocoa can help. Participants in the study were placed on a special diet high in raw cocoa flavanols called epicatechin. At the end of the three-month period they scored significantly higher on memory tests than the control group."

But before you run out and stock up on chocolate bars, it’s important to note that you’d have to eat about seven bars a day to ingest the 138 milligrams of epicatechin given to the study participants. A healthy portion of dark chocolate is about 1.5 ounces. However, the results do suggest an important link between the compound and memory-loss. Certain supplements contain healthy doses of epicatechin, and the antioxidant can also be found naturally in apples, blackberries, and green tea.

Scientists believe when we eat plant foods (luscious dark chocolate comes from the cacao plant) rich in flavonoids and antioxidants, their benefits are passed on to us. Antioxidants protect our cells from damage caused by free radicals, which are unstable oxygen molecules thought to be responsible for aging and some diseases. “When you have too many free radicals in your body, they start to attack your cells, and that can lead, over time, to low-grade inflammation and to some diseases — cancer, heart disease, and Alzheimer’s,” DuBost says.

Additional Reasons to enjoy Dark Chocolates: "The complete article also tells of the many other values of dark chocolate:  in preventing heart disease, decreasing stroke risk, improving good cholesterol, lowering blood pressure, improving vision, as a mood bootser, helping to prevent cancer and may even help one to live longe!."

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June and Chocolates 

June loved chocolates. However at the time June was in a nursing home in her late stages of Alzheimer's, chocolate was the last thing on my mind as an item for her diet. I regret that this information concerning chocolate was not a part of my knowledge during those bleak days. Perhaps it might have brightened her days just a little bit. Of course in the very late stages when her food was pureed, it might have been more difficult to utilize.

The below photo of June was taken in November 2005 during her birthday celebration at the Wellstead of Rogers, an Alzheimer's facility. June first arrived at the Wellstead on March 16th, 2005. It was four months later than the November photo (March 2006) that June's food requirements were such that her food was to be pureed to resist choking or swallowing difficulties. In this November 2005 photo, June's usual million dollar signature smile is weak and her face has a faded look. I find it hard to look at this picture of June without getting very emotional.

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 June Berg 2005 at Wellstead

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Reader's Comments

Louise Ann Howard  - Batemans Bay, New South Wales, Australia - (6 August 2014): "I  Love chocolate. Use it for my DBT therapy. Dialectical behaviour therapy. Mindfulness stuff. Use it as a stay in the moment technique, a very pleasure calming thing. Thanks Stanton...reading all dark chocolate labels now. Plus enjoying some chocolate at nearly 2.30am in the morning!!!!.. (29 October 2014): " Been having daily dark chocolate Stanton mate."

Lynn Gibson  - High Wycombe, Buckinghamshire, United Kingdom - (6 August 2014): "Mum buys loads of chocolate bars all the time! And eats the lot!!!"

Isabel Harper  - Belfast, United Kingdom - (6 August 2014): "Stimulates the release of endorphins good for body, mind and spirit."

Lorraine Robson  - Edinburgh, United Kingdom - (28 October 2014): "I've always been a fan of the healing properties of food.... ok chocolate! Thank you for this info. I'll share a bar with mum next visit."

Gretchen Berg  - Minneapolis, Minnesota - (28 October 2014): "There's always a positive to eating chocolate."

Humberto Ruiz  - Salem, New York - (28 October 2014): "Yummy! Thank you! We will indulge religiously on a weekly basis !"

Lin Schmidt  - Anoka, Minnesota - (28 October 2014): "I love it because I LOVE dark chocolate!   I saw this in the paper today, too,  and it made me just happy!"

Kathy Williams  - Huntsville, Texas - (29 October 2014):  "Thank you sooo much for sharing these articles and your experience I can't tell U how much help u have been!" .

Ann Napoletan  - Columbus, Ohio - (29 October 2014): "When nothing else made my mom smile, there were two things - chocolate and ice cream - that worked just about every time. It's fitting that the last thing she ate before she died was chocolate ice cream. She hadn't eaten for days, and I thought I'd try a spoonful of ice cream. She never opened her eyes, but ate the entire little cup."

June's Passing

June 1994

After an almost 12 year journey into the shadows of Alzheimer's, early one morning in late October 2008, an exhausted June felt God's gentle touch on her shoulder and heard the words: "Come Home June!" As June lay like a wounded soldier on a battlefield, it was God's Angels that ushered June into a Heavenly Kingdom and into Jesus presence to the sound of a chorus of Angels...and June's new home, a "Mansion on the Hilltop", where there is no pain, nor illness nor tears...June's funeral notice as published in the Minneapolis Star in October 2008 can be seen on this website in the drop down menu under the "In Memoriam" label - just Click on:

"June K. (Rolstad) Berg - In Memoriam"