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Background Chronic fatigue syndrome/myalgic encephalomyelitis ( CFS/ ME) is characterised by unexplained fatigue for at least 6 months accompanied by a diverse but consistent set of symptoms. Diet modification and nutritional supplements could be used to improve patient outcomes, such fatigue and quality of life. We reviewed and discussed the evidence for nutritional interventions that may assist in alleviating symptoms of CFS/ ME. Methods Medline, Cinahl and Scopus were systematically searched from 1994 to May 2016. All studies on nutrition intervention were included where CFS/ ME patients modified their diet or supplemented their habitual diet on patient-centred outcomes (fatigue, quality of life, physical activity and/or psychological wellbeing). Results Seventeen studies were included that meet the inclusion criteria. Of these, 14 different interventions were investigated on study outcomes. Many studies did not show therapeutic benefit on CFS/ ME. Improvements in fatigue were observed for nicotinamide adenine dinucleotide hydride ( NADH), probiotics, high cocoa polyphenol rich chocolate, and a combination of NADH and coenzyme Q10. Conclusions This review identified insufficient evidence for the use of nutritional supplements and elimination or modified diets to relieve CFS/ ME symptoms. Studies were limited by the number of studies investigating the interventions, small sample sizes, study duration, variety of instruments used, and studies not reporting dietary intake method. Further research is warranted in homogeneous CFS/ ME populations. [ABSTRACT FROM AUTHOR]

Background: Unsweetened natural cocoa has antimalarial properties. Unsweetened natural cocoa powder (UNCP), obtained as a result of the removal of cocoa butter from a cocoa bean protects against malaria episodes. Cocoa powder, which is prepared after removal of the cocoa butter, contains about 1.9 % theobromine and 0.21 % caffeine. Concomitant consumption of cocoa and artemether/lumefantrine (A/L) is a common practice in Ghana, West Africa. This study seeks to determine the elemental composition of UNCP and its protective effect on the heart and kidney against (A/L) administration. Methods: Energy dispersive x-ray fluorescence spectroscopy was used to detect the quality and quantity of the elemental composition in UNCP. Thereafter, 30 nonmalarious male guinea pigs were divided into five groups of six animals each. One group was administered with 75 mg/kg body weight A/L only and another group distilled water (control group). The rest received 300 mg/kg, 900 mg/kg and 1500 mg/kg body weight UNCP for 14 days orally and A/L for the last 3 days (ie day 11 to day 14). Biochemical and histopathological examinations were carried out after euthanisation of the animals. Results: A total of thirty-eight (38) micro and macro elements were detected with the ED-XRF. Macro elements like sodium (Na), magnesium (Mg), aluminium (Al), phosphorus (P), chlorine (Cl), potassium (K), calcium (Ca), manganese (Mn) and iron (Fe) and micro elements like chromium (Cr), copper (Cu), zinc (Zn), arsenic (As), and lead (Pb) were identified and evaluated. Biochemical analysis revealed increases in HDL levels (p>0.05) while there were decreases in LDL levels (p>0.05), creatine kinase and AST levels (P<0.05) in animals that received UNCP compared to A/L only administered group. Urea levels reduced significantly by 53 % (p<0.05) in group that received 1500 mg/kg UNCP. Histopathological examinations of the heart and kidney buttressed the protective effects of cocoa administration. Conclusion: The percentage of recommended daily allowance of UNCP for chromium is 3750 % for men and 5250 % for women while % RDA for copper corresponds to 103.6 % in both sexes. UNCP proved to possess cardioprotective and renoprotective potential during artemether-lumefantrine administration. [ABSTRACT FROM AUTHOR]

Background: The purpose of this research was to study the effectiveness of the overall dietary intervention rather than a single nutrient on children with attention deficit hyperactivity disorder (ADHD). Methods: This is a randomized controlled trial conducted at a child psychiatry clinic in Iran. Participants were 106 children and adolescents with ADHD. One group received methylphenidate plus dietary recommendations, while the other group only received methylphenidate. ADHD DSM-IV checklist was used to assess inattentiveness and hyperactivity/impulsivity scores at baseline and at the end of the trial. Results: The results revealed no significant difference between the two groups regarding mean age, gender ratio, body mass index, baseline inattentiveness score, and baseline hyperactivity score. Linear regression analysis considering the covariant variables showed that the inattentive score at the end of the trial was significantly associated with the mean change of favorite diet scores. Conclusion: This is the first clinical trial examining the effect of overall dietary characteristics rather than a single nutrient on the children formally diagnosed with ADHD. According to the results, un-favorite diet had no effects on inattentive or hyperactivity/impulsivity score. Encouraging the children with ADHD to increase their intake of recommended diet markedly improves their attention. Trial registration: The trial was registered at the Iranian Clinical Trials Registry (Irct ID: IRCT201311303930N29). [ABSTRACT FROM AUTHOR]

Theobromine, a caffeine derivative, is the primary methylxanthine produced byTheobroma cacao. We previously showed that methylxanthines, including caffeine and theophylline, have antitumor and antiinflammatory effects, which are in part mediated by their inhibition of phosphodiesterase (PDE). A member of the PDE family, PDE4, is widely expressed in and promotes the growth of glioblastoma, the most common type of brain tumor. The purpose of this study was to determine whether theobromine could exert growth inhibitory effects on U87-MG, a cell line derived from human malignant glioma. We show that theobromine treatment elevates intracellular cAMP levels and increases the activity of p38 mitogen-activated protein kinase and c-Jun N-terminal kinase, whereas it attenuates p44/42 extracellular signal-regulated kinase activity and the Akt/mammalian target of rapamycin kinase and nuclear factor-kappa B signal pathways. It also inhibits cell proliferation. These results suggest that foods and beverages containing cocoa bean extracts, including theobromine, might be extremely effective in preventing human glioblastoma. [ABSTRACT FROM PUBLISHER]

Introduction. The aim of this study was to assess the vascular benefits of dark chocolate in healthy and young individuals. Methods. A randomized and controlled trial was carried out involving 60 healthy volunteers, randomized into two groups: control group (CG; n = 30) and intervention group (IG; n = 30). The IG ingested a daily dosage of 10 g of dark chocolate (>75% cocoa) for a month. Blood pressure (BP), flow-mediated dilation (FMD), arterial stiffness index (ASI), aortic pulse wave velocity (PWV), and pulse wave analysis (PWA) were assessed at baseline and one week after the one-month intervention period. Results. Arterial function improved after intervention in the IG, with PWV decreasing from 6.13 ± 0.41 m/s to 5.83 ± 0.53 m/s (P = 0.02), with no significant differences observed in the CG. A significant decrease in ASI (0.16 ± 0.01 to 0.13 ± 0.01; P < 0.001) and AiX (-15.88 ± 10.75 to -22.57 ± 11.16; P = 0.07) was also depicted for the IG. Endothelial function improved in the IG, with the FMD increasing 9.31% after the 1-month intervention (P < 0.001), with no significant variation in the CG. Conclusion. The daily ingestion of 10 g dark chocolate (>75% cocoa) during a month significantly improves vascular function in young and healthy individuals. [ABSTRACT FROM AUTHOR]

Epidemiologic evidence supports that diets rich in polyphenols promote health and may delay the onset of colon cancer. Cocoa and chocolate products have some of the highest polyphenolic concentrations compared to other polyphenolic food sources. This study tested the hypothesis that a diet including dark chocolate can protect against colon cancer by inhibiting aberrant crypt foci (ACF) formation, downregulating gene expression of inflammatory mediators, and favorably altering cell kinetics. We also investigated whether bloomed dark chocolate retains the antioxidant capacity and protects against colon cancer. Forty-eight rats received either a diet containing control (no chocolate), regular dark chocolate, or bloomed dark chocolate and were injected subcutaneously with saline or azoxymethane. Relative to control, both regular and bloomed dark chocolate diets lowered the total number of ACF (P= 0.022). Chocolate diet-fed animals downregulated transcription levels of COX-2 (P= 0.035) and RelA (P= 0.045). Both chocolate diets lowered the proliferation index (P= 0.001). These results suggest that a diet including dark chocolate can reduce cell proliferation and some gene expression involving inflammation, which may explain the lower number of early preneoplastic lesions. These results provide new insight on polyphenol-rich chocolate foods and colon cancer prevention. [ABSTRACT FROM AUTHOR]

The article presents an overview of the different clinical trials that have been conducted to determine the impacts of dark chocolate on blood pressure in patients suffering from hypertension. The study conducted by Taubert and colleagues in 2003 for around thirteen patients proved that dark chocolate favorably affect blood pressure in hypertension patients. However, additional factors need to be considered in further studies for better results.

Procyanidins are thought to be effective for prevention of hyperglycemia. To clarify the degree of polymerization (DP) of procyanidins on anti-hyperglycemic effects, we prepared low-DP (DP S 3) and high-DP (DP > 4) procyanidin fractions from cacao liquor, and examined whether these procyanidin fractions prevent hyperglycemia in vitro. We found that both fractions promoted glucose uptake in L6 myotubes in a dose-dependent manner accompanied by translocation of GLUT4 to the plasma membrane. Moreover, both fractions stimulate phosphorylation of AMP-activated protein kinase (AMPK). In these beneficial effects, low-DP fraction was more effective than high-DP one. On the other hand, high-DP fraction showed greater inhibitory effect of intestinal a-glucosidase activity than low-DP fraction in a cell free-incubation system. In conclusion, cacao liquor procyanidins have anti-hyperglycemic activities and low-DP procyanidins mainly contribute to stimulate glucose uptake by glucose transporter 4 translocation through AMPK-dependent pathway in skeletal muscle while high-DP procyanidins mainly contributes to inhibit the a-glucosidase activity in small intestine. [ABSTRACT FROM AUTHOR]

It has been reported that ingestion of cocoa or chocolate reduces blood pressure in the subjects with hypertension. To clarify the hypotensive activity of cocoa, we carried out the research on microcirculation using intravital microscopic technique. First, we estimated the influence of repeated treatment of cocoa on microcirculation. Male rats fed normal diet (ND) or 15% fat containing high fat diet (HFD) or 0.2% flavan-3-ols containing HFD for 6weeks. Under anesthesia, the arteriole function of mesentery in rat was observed under physiological condition. Vasocontraction induced by the phenylephlin was significantly reduced in the HFD group compared with that in ND group, there was not such change in the HFD with cocoa group. Endothelium dependent vasodilatation stimulated by acetylcholine was significantly decreased in the HFD group compared with that in ND group. On the other hand, endothelial dysfunction of arteriole induced by HFD was not shown in cocoa group. In addition, single oral administration of cocoa or its flavan 3-ols on microcirculation in skeletal muscle was estimated. Cocoa (100 mg/kg) or flavan-3-ols derived from cocoa (10 mg/kg) was administrated through a feeding tube to the animals, velocity of red blood cells in precapillary arteriole and the number of newly recruited capillary in cremaster muscle were significantly increased by the treatment of cocoa or flavon-3-ols compared with vehicle, accompany with elevation of heart rate and blood pressure. These research has revealed that the ingestion of cocoa improves endothelial dysfunction of arterioles which is major determining of blood pressure induced by the high fat diet and single oral administration of flavan 3-ols in cocoa altered microcirculation in skeletal muscle and general circulation. These acute effects might be related with the preventive action of flavan-3-ols on cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background. Hypertension and excess body weight are important risk factors for endothelial dysfunction. Recent evidence suggests that high-polyphenol dark chocolate improves endothelial function and lowers blood pressure. This study aimed to evaluate the association of chocolate 70% cocoa intake with metabolic profile, oxidative stress, inflammation, blood pressure, and endothelial function in stage 1 hypertensives with excess body weight. Methods. Intervention clinical trial includes 22 stage 1 hypertensives without previous antihypertensive treatment, aged 18 to 60 years and presents a body mass index between 25.0 and 34.9 kg/m2. All participants were instructed to consume 50 g of chocolate 70% cocoa/day (2135 mg polyphenols) for 4 weeks. Endothelial function was evaluated by peripheral artery tonometry using Endo-PAT 2000 (Itamar Medical). Results. Twenty participants (10 men) completed the study. Comparison of pre-post intervention revealed that (1) there were no significant changes in anthropometric parameters, percentage body fat, glucose metabolism, lipid profile, biomarkers of inflammation, adhesion molecules, oxidized LDL, and blood pressure; (2) the assessment of endothelial function through the reactive hyperemia index showed a significant increase: 1.94 ± 0.18 to 2.22 ± 0.08, P = 0.01. Conclusion.In individuals with stage 1 hypertension and excess body weight, highpolyphenol dark chocolate improves endothelial function. [ABSTRACT FROM AUTHOR]

The article discusses a study to evaluate whether dark chocolate consumption represents an effective and cost effective means of preventing cardiovascular disease among patients with the metabolic syndrome (without diabetes). The study concluded that the blood pressure lowering and lipid effects of dark chocolate could represent an effective and cost effective strategy for the prevention of cardiovascular disease in patients with the metabolic syndrome (and no diabetes).