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Thursday, 24 November 2011

Chocolate and Paracetamol.

No, it's not a new recipe for pain relief, although thinking about it may have some merit.

Chocolate has been investigated for it's efficacy as a medicine, primarily as an anti-hypertensive, but also for it's possible use in many cardiometabolic disorders. This is especially good news, for those who desire chocolate almost, if not more than sex, as a number of women have told me (although that may be a reflection of my lack of personal attraction). Hey-Ho. But yes, there is at least some statistically significant evidence that even the obese can benefit. It is important that it is dark chocolate and in my interpretation, that with the highest cocoa mass would be the one to go for, although above 85%, it does tend to be somewhat bitter, although as cocoa mass increases, sugar decreases. Always remember as sucrose intake increases, so does plasma glucose and insulin.

85% cocoa mass chocolate yields (per 100grammes);-
Protein - 9.70 g
Carbohydrates - 17.00 g
(of which sugar is 5.80 g)
Fat - 51.40 g
(of which monounsaturates is 17.90 g)

Putting aside the sugar content, for the non-diabetic that is quite small and provided consumption is kept to 25 or 50 grammes per day is unlikely to yield much harm whilst at the same time providing a healthy fat intake and of course the flavanoids that produce the improved endothelial function. The study published in the BMJ seems quite convincing although as a meta-analysis and largely observational study, it does have confounding factors and the cohorts had little heterogeneity. Nonetheless for the relatively healthy it's a somewhat better 'medicine' than most of the drugs peddled by 'Pharma' and I have myself, despite my indifference to chocolate (what you say!) started to consume 25 g per day, some time ago.

In the responses there are some detractors, mainly those who are frightened of 'fat' despite the fact that high cocoa mass fats largely comprise monounsaturates with a small polyunsaturates content which the 'mainstream' generally view as healthy. I'd prefer mine with lard to be honest, but I'll leave that for frying my egg yolks and bacon, oh and my 97% meat content, organic sausages. I'll eat my chocolate with a glass of good red wine instead.

Paracetamol (acetaminophen) was in the news recently although if you blinked you may have missed it. This is largely because even in doses that are often prescribed by Doctors in Hospitals (yes really) they can be somewhat dangerous. It does have a cumulative effect especially if taken at maximum dosage for a number of days and in some cases for weeks. The effect on the liver is quite toxic and can often be fatal, especially in those with reduced function in that organ, such as those with even mild alcoholic or non-alcoholic fatty liver disease. Even mild overdose due to timing of intake can be hazardous, and the study in the British Journal of Clinical Pharmacology warned that prolonged usage presented more problems in treatment, and risk of death than did single overdoses. It is easy to forget that no more than 4 doses (of 2x500mg) in 24 hours should be taken, when those doses are taken at 4 hour intervals.

The data is not exactly new and the phenomena well known for some time,  but most was for single excessive doses, a number of which were intentional, although I could think of better ways to end it all than the multi organ failure that often is the outcome. The important lesson, which was not very well reported, is that this is an easy trap in which to fall into. You do not have to be much outside the 'normal' dose parameters to cause fatal consequences, and that is for healthy people. The elderly, children, and underweight and malnourished recipients are particularly vulnerable and it is so easy for people to view this over the counter analgesic, as eminently benign. It isn't, it is potentially fatal at quite low levels. The antidote, N-acetylcysteine, (NAC) another OTC supplement used in some cough medicines, has to be administered pretty rapidly to save lives, although for this problem intravenously by rapid infusion. The window for saving lives is tight, generally eight hours.

Personally, I never take paracetamol, well not any more, as I have known of its dangers for many years. If I'm in any serious pain, which is usually due to arthritis, I use a topical NSAID, such as Ibuprofen gel and even then rarely. The lesson is plain. Over the counter paracetamol and its combination forms (aspirin, ibuprofen and codeine) can be lethal, just as lethal as some potent drugs.


  1. The problem is that the alternatives also have their risks. Keep taking opiates such as tramadol or codeine and you risk becoming addicted; and keep taking NSAIDs and you risk getting a stomach ulcer. On the other hand, if you don't take painkillers, you may find yourself instinctively avoiding certain movements in painful joints, which may make them worse.

    I think it's a question of moderation in everything.

  2. Just hand over the big box of choccies and forget about pimples in the morning!

  3. Sorry Anon, where did I advocate the consumption of the 'big box of choccies' (sic)? As for the pimples, well such an inflamatory response to chocolate consumption of the type I advocated, in small doses is unlikely, and is more likely related to the n-6 and n-9 content of cheap filled chocolates to which you refer, together with a diet high in sugar and carbohydrates.

    The other 'Anon'. There are many and better alternatives available for pain,depending upon how it manifests and to what it is attributed. My own arthritic pain was virtually eliminated over time by a high intake of Omega-3's. I then moved onto a maintenance regime of 700g a day of DHA/EPA in concentrated form to avoid too many capsules.

    Back pain I eliminate with the Mackenzie technique, when it strikes. However if I had to choose something for severe sudden pain that I knew to be short lived I would choose an Ibuprofen/Codiene combination, for a very short time and suffer the constipation. If I had terminal cancer, well the opiates are really the only things that would work.

    My objective in the post was not to warn off anyone from using acetominophen, but to make them aware of the dangers in use of something that is viewed generally as benign and 'popped' in millions. When in truth it can be fatal if not treated with extreme caution.

  4. You can get 85% Moser Roth chocolate at Aldi. Only 99 pence a bar for 125 gms making it half the price of Lindt.

    Being a 6 bar a week person, it makes a difference. The only sugar in my diet.

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