Cacao, often celebrated as a superfood, contains powerful compounds that offer numerous health benefits, from antioxidants to mood-enhancing neurotransmitters. However, its potent effects also mean it is not suitable for everyone. Certain medical conditions, medication use, and individual sensitivities can make cacao consumption risky. Understanding these potential contraindications is crucial for safely enjoying its benefits.
Medical Conditions and Cacao Consumption
For individuals with pre-existing medical conditions, the compounds in cacao can interact with or exacerbate symptoms. Consulting a healthcare professional before incorporating cacao into your diet is always recommended, especially if you have a history of chronic illness.
Heart Conditions
Cacao contains theobromine and caffeine, which are stimulants that affect the cardiovascular system. While theobromine generally offers a gentler effect than caffeine, it can still be problematic for people with serious heart problems or irregular heartbeats. The vasodilating effect of cacao can also quickly drop blood pressure, which may cause complications for those with very high blood pressure.
Gastrointestinal Issues
If you suffer from digestive problems, cacao can worsen your symptoms. For example, cacao can relax the lower esophageal sphincter (LES), the muscle that prevents stomach acid from flowing back into the esophagus, which is a known trigger for gastroesophageal reflux disease (GERD). The caffeine in cacao can also worsen diarrhea and other symptoms associated with Irritable Bowel Syndrome (IBS), especially in large quantities.
Anxiety Disorders
Since cacao contains stimulants like caffeine and theobromine, large amounts can potentially worsen anxiety disorders. While some find cacao's mood-boosting compounds like serotonin to be beneficial, those with a sensitivity to stimulants may experience increased nervousness, restlessness, or agitation.
Bleeding Disorders
Cacao can slow blood clotting, and consuming a lot of it might increase the risk of bleeding and bruising in individuals with bleeding disorders. This effect should be a key consideration for anyone with such conditions or who is on medication that affects blood clotting.
Diabetes
Some evidence suggests that cacao can raise blood sugar levels and interfere with blood sugar control, which is a concern for people with diabetes. Monitoring blood sugar levels closely is essential if you have diabetes and choose to consume cacao.
Kidney Disease and Gout
Cacao is noted for containing purine compounds. For individuals with kidney disease and gout, consuming cacao is not recommended as these compounds can lead to the accumulation of uric acid in the body, which can further aggravate their condition.
Migraine Sufferers
For some individuals prone to migraines, chocolate and pure cacao can be a trigger. Although the evidence is mixed and some research suggests cacao may have protective effects, those who know chocolate is a personal trigger should be cautious. Histamine and tyramine sensitivity can play a significant role here.
Medication and Supplement Interactions
Interactions between cacao and certain medications can be severe, potentially altering the drug's effectiveness or causing adverse reactions. Always consult your doctor or pharmacist if you are on medication before consuming cacao.
Antidepressants (MAOIs & SSRIs)
Individuals taking monoamine oxidase inhibitors (MAOIs) should avoid cacao, as the tyramine in cacao can cause a sudden, dangerous spike in blood pressure known as a hypertensive crisis. For those on selective serotonin reuptake inhibitors (SSRIs), the serotonin-enhancing effects of cacao, combined with the medication, may increase the risk of serotonin syndrome, a potentially life-threatening condition.
Blood Thinners
As cacao can slow blood clotting, combining it with anticoagulant or antiplatelet drugs (like warfarin or aspirin) may increase the risk of bruising and bleeding. Close monitoring and medical consultation are necessary.
Stimulant Drugs
Combining cacao with other stimulants, such as ephedrine, ADHD medication, or certain asthma medications, can cause over-stimulation of the heart and nervous system, leading to dangerous heart problems and high blood pressure.
Diabetes Medications
Cacao's potential to affect blood sugar means it can interfere with diabetes medications. Metformin, for instance, has a documented interaction with the caffeine in cacao.
Other Interactions
Cacao's caffeine content can interact with numerous other medications, including birth control pills, certain antibiotics (quinolones), and asthma medications like theophylline. The stimulant can also increase eye pressure, making it risky for those with glaucoma. Before a cardiac stress test, consuming cacao should be stopped at least 24 hours prior, as it can block the effects of test medications like adenosine and dipyridamole.
Comparing Cacao to Other Products
Cacao vs. Coffee vs. Processed Chocolate
| Feature | Cacao (Pure) | Coffee (Brewed) | Milk Chocolate (Processed) |
|---|---|---|---|
| Caffeine Content | Low to moderate (12-35 mg/serving) | High (80-135 mg/serving) | Very low (5-25 mg/serving) |
| Theobromine Content | High | Trace amounts | Present, but less than cacao |
| Stimulant Effects | Gentle, sustained energy boost | Quick, intense, and often jittery | Minimal |
| Antioxidants | Very high (Flavanols) | Present, but varies | Lower due to processing |
| Sugar/Additives | Minimal (when raw) | None (when black) | High |
| Heavy Metals | Potential risk, depending on source | Minimal | Potential risk |
| Digestive Impact | Can worsen GERD/IBS | Can exacerbate digestive issues | Can worsen GERD/IBS |
Specific Populations: Pregnancy, Breastfeeding, and Children
Pregnancy
While moderate amounts are often considered possibly safe, high consumption of cacao during pregnancy is potentially unsafe. The caffeine crosses the placenta, and high doses are linked to low birth weight, premature delivery, and miscarriage. Additionally, excessive polyphenols in the third trimester have been shown to affect fetal circulation in some studies. The potential presence of heavy metals like lead and cadmium is another serious concern.
Breastfeeding
Large amounts of cacao are possibly unsafe during breastfeeding due to the caffeine content, which passes into breast milk. This can cause irritability and frequent bowel movements in the infant. Therefore, limiting intake is advisable.
Children
Children, especially young children, are more susceptible to potential issues from heavy metals like lead and cadmium that may be present in cacao, particularly in high-cacao products. Given the developmental risks, limiting children's intake is a prudent measure.
Precautions for Safer Consumption
- Consult a Professional: If you have any health concerns, are pregnant, breastfeeding, or on medication, speak with a doctor before consuming cacao.
- Start with Small Doses: If you are new to cacao, begin with a small amount (around 10-20g) to assess your sensitivity.
- Choose High-Quality Products: Opt for brands that test for heavy metals like lead and cadmium to minimize risk.
- Avoid Evening Consumption: The stimulant effects of theobromine can disrupt sleep patterns, so it's best to consume cacao earlier in the day.
- Monitor Your Body's Response: Pay close attention to any adverse reactions like headaches, digestive upset, or increased anxiety and adjust your intake accordingly.
Conclusion
Cacao offers a wealth of potential health benefits, but its potent compounds mean it's not a universal health panacea. Individuals with heart conditions, gastrointestinal disorders, and anxiety issues, as well as those on certain medications, should approach cacao with caution. Pregnant and breastfeeding individuals and young children also face particular risks. By understanding who should not consume cacao and taking sensible precautions, you can make an informed decision about whether it is a safe addition to your diet. The key lies in moderation, awareness of your body's specific needs, and professional medical advice when in doubt. For additional information on medication interactions, WebMD offers a comprehensive guide.
