Come to the dark side - A review on the health-beneficial and disease-alleviating effects of cocoa-rich dark chocolate.

Cocoa that is abundant in dark chocolate is known for its anti-inflammatory effects that are mainly due to biologically active ingredients like polyphenols and methylxanthines. We here provide a comprehensive literature survey of both, in vitro and in vivo studies including clinical trials summarizing recent evidence on the immune-modulatory effects exerted by application of cocoa-rich dark chocolate or distinct cocoa-derived molecules. The survey revealed that dark chocolate and its derivatives could effectively dampen pro-inflammatory including oxidative stress responses in vascular diseases including atherosclerosis, hypertension, and decompression sickness, metabolic morbidities such as obesity and type 2 diabetes mellitus, celiac disease, chronic kidney diseases, and polycystic ovary syndrome, enhance gut epithelial barrier function, and modulate pain sensations. On the other hand, dark chocolate consumption intake was found to worsen acne symptoms. In conclusion, dietary supplementation with dark chocolate with high contents of biologically active polyphenols and methylxanthines might be promising adjunct immune-modulatory treatment options of distinct acute as well as chronic inflammatory morbidities that need to be evaluated in more detail in future in vivo including clinical studies.