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Peripheral arterial disease (PAD), a narrowing of the blood vessels outside the heart and brain, is caused by the buildup of atherosclerotic plaques. This narrowing promotes arterial insufficiency – a reduction in overall blood flow. More than 8.5 million people living in the United States have PAD. A recent study suggests that drinking a cocoa beverage rich in flavanols improves symptoms associated with PAD.

Cocoa contains the flavanol epicatechin, a bioactive food component that exerts antioxidant, anti-inflammatory, and anti-cancer properties. Previous work has demonstrated that cocoa in dark chocolate improved endothelial function and lowered blood pressure in people who were overweight.

This double-blind, randomized clinical trial involved 44 adults with PAD (average age, 72 years) who drank either a cocoa beverage or a placebo beverage once daily for six months. The cocoa beverage contained 15 grams of cocoa (> 85 percent cacao) and provided 75 milligrams of epicatechin. The authors of the study assessed changes in physiological parameters associated with a 6-minute walk performed immediately after and 24 hours after consumption of the beverage.

The data revealed that the participants who drank the cocoa beverage showed marked improvement in their walking performance, increasing their walking distance by nearly 43 meters immediately after consumption of the beverage and by nearly 18 meters 24 hours afterward. Those who drank the placebo decreased their walking distance by more than 24 meters. These findings held true regardless of the participants' race, smoking status, or body mass index.

The participants' plasma levels of epicatechin and its related metabolites were higher among those who drank the cocoa beverage. Furthermore, biopsies of the participants' calf muscles revealed that cocoa improved mitochondrial function, blood flow, and capillary density, compared to the placebo, suggesting that cocoa shows promise as a therapeutic strategy for people who have PAD.

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