Heart disease is the #1, equal opportunity, killer in the US.1 Suboptimal diet quality, including low nut consumption, is also a leading cause of death.1 Observational and interventional studies have demonstrated that chocolate and almonds, separately, yield cardiometabolic benefits. Numerous nutritional bioactives exist in these foods, but the key players are thought to be unsaturated fats in almonds and flavanols in dark chocolate.

A recent study by Lee et al. explored the individual and combined effects of dark chocolate, cocoa and almonds consumption on coronary heart disease (CHD) risk factors.2 A rigorous study design- randomized, controlled, crossover feeding trial- was conducted in overweight and obese individuals (48 randomized; 31 completed the study) aged 30-70 years. Each of the 4 isocaloric diets lasted 4 weeks, with a 2-week break between each diet. Participants were provided weight maintenance diets based on their individual calorie needs. The control diet was an average American diet (AAD), while the treatment diets incorporated:

  • ALD: 42.5 g/day of almonds (253 kcal/day)
  • CHOC: 18 g/day of cocoa powder and 43 g/day of dark chocolate (251 kcal/day)
  • CHOC+ALD: all 3 treatment foods (504 kcal/day)

Compared to the AAD:2

  • ALD reduced total cholesterol (C) by 4%, non-HDL-C by 5% and LDL-C by 7%
  • ALD resulted in a greater reduction in large buoyant LDL particles
  • CHOC+ALD produced a greater reduction in small dense LDL particles and Apolipoprotein B/ApoA1 ratio
  • CHOC+ALD decreased ApoB by 5%
  • No significant differences were observed for vascular and oxidative stress measures

Therefore, 4 weeks of almonds alone or a combination of almonds plus dark chocolate and cocoa (without exceeding daily energy needs) resulted in favorable lipid, lipoprotein, and apolipoprotein changes in overweight and obese adults.2 Although the study design was robust and there were comprehensive measures of cardiovascular disease risk, limitations include a moderately high dropout rate (35%) and the inability to maintain participants’ baseline weights in the first phase of the diet, suggesting that the diet quality of the AAD was superior to the subjects’ diets prior to the study.

Why is this Clinically Relevant?

  • Targeted diet improvements are needed to reduce heart disease risk factors
  • Incorporating almonds, dark chocolate and cocoa in appropriate quantities determined by the clinician without exceeding daily energy requirements may help patients improve their lipid profiles, potentially reducing CHD risk


Link to article


  1. Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics- 2016 update: a report from the American Heart Association. Circulation. 2016;133:447-454.
  2. Lee Y, Berryman CE, West SG, et al. Effects of dark chocolate and almonds on cardiovascular risk factors in overweight and obese individuals: a randomized controlled-feeding trial. J Am Heart Assoc. 2017;6(12):pii:e005162.

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