Effects of chocolate consumption on the health and performance of football players: A systematic review

Objective: Chocolate, renowned for its abundance of bioactive flavonoid compounds, is recognized as a delectable food option with purported benefits for both athletes and general population. Nevertheless, there is no consolidated overview detailing the effects of chocolate consumption specifically among football players. This review aims to elucidate the diverse impacts of chocolate consumption on football players.

Methods: A systematic search adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines studies that met the inclusion criteria was conducted in the databases of Google Scholar, PubMed (MEDLINE), Scopus, Embase, and Web of Science to April 01, 2024. Forthy-eight articles were retrieved, of which nine studies met the inclusion criteria.

Results: The findings of these studies indicate that chocolate consumption is associated with a decrease in diastolic blood pressure, mean blood pressure, plasma cholesterol, Low-density lipoprotein cholesterol, malondialdehyde, urate, platelet count, mean platelet volume, and platelet distribution width. It was found to reduce intestinal permeability as well as muscle damage biomarkers such as creatine kinase, lactate dehydrogenase. Furthermore, chocolate consumption was associated with an increase in vitamin E/cholesterol ratio, antioxidant power, mean daily exercise time, heart rate, time to fatigue, physical performance, and improvement in redox status.

Conclusion: Despite the limited number of studies in this area, small sample sizes, and the presence of limitations in each study, chocolate consumption has demonstrated the potential to enhance athletic performance and recovery in football players. However, further research is essential to fully understand the scope of these effects.

1. Hulteen R.M., Smith J., Morgan P., Barnett L., Hallal P., Colyvas K., Lubans D. Global participation in sport and leisure-time physical activities: A systematic review and meta-analysis. Prev. Med. 2017;95:14–25. https://doi.org/10.1016/j.ypmed.2016.11.027

2. Krustrup P., Aagaard P., Nybo L., Petersen J., Mohr M., Bangsbo J. Recreational football as a health promoting activity: a topical review. Scand. J. Med. Sci. Sports. 2010;20:1–13. https://doi.org/10.1111/j.1600-0838.2010.01108.x

3. Faude O., Rößler R., Junge A. Football injuries in children and adolescent players: are there clues for prevention? Sports Med. 2013;43:819–837. https://doi.org/10.1007/s40279-013-0061-x

4. Jeong T.-S., Reilly T., Morton J., Bae S.W., Drust B. Quantification of the physiological loading of one week of “pre-season” and one week of “in-season” training in professional soccer players. J. Sports Sci. 2011;29(11):1161–1166. https://doi.org/10.1080/02640414.2011.583671

5. Morgado M.C., Sousa M., Coelho A.B., Vale S., Costa J.A., Seabra A. Effects of “Football and Nutrition for Health” program on body composition, physical fitness, eating behaviours, nutritional knowledge, and psychological status among 7 to 10 years school children. Front. Pediatr. 2023.11:1251053. https://doi.org/10.3389/fped.2023.1251053

6. Baranauskas M., Kupčiūnaitė I., Stukas R. Dietary Intake of Protein and Essential Amino Acids for Sustainable Muscle Development in Elite Male Athletes. Nutrients. 2023;15(18):4003. https://doi.org/10.3390/nu15184003

7. Heaton L.E., Davis J.K., Rawson E.S., Nuccio R.P., Witard O.C., Stein K.W., et al., Selected in-season nutritional strategies to enhance recovery for team sport athletes: a practical overview. Sports Med. 2017;47:2201–2218. https://doi.org/10.1007/s40279-017-0759-2

8. Molaeikhaletabadi M., Bagheri R., Hemmatinafar M., Nemati J., Wong A., Nordvall M., et al. Short-Term Effects of Low-Fat Chocolate Milk on Delayed Onset Muscle Soreness and Performance in Players on a Women’s University Badminton Team. Int. J. Environ. Res. Public Health. 2022;19(6):3677. https://doi.org/10.3390/ijerph19063677

9. Born K.A., Dooley E.E., Cheshire P.A., McGill L.E., Cosgrove J.M., Ivy J.L., et al. Chocolate Milk versus carbohydrate supplements in adolescent athletes: a field based study. J. Int. Soc. Sports Nutr. 2019;16(1):6. https://doi.org/10.1186/s12970-019-0272-0

10. Wan H.Y., Stickford J.L., Dawkins E.J., Lindeman A.K., Stager J.M. Acute modulation in dietary behavior following glycogen depletion and postexercise supplementation in trained cyclists. Appl. Physiol. Nutr. Metab. 2018;43(12):1326–1333. https://doi.org/10.1139/apnm-2018-0152

11. Ángel García-Merino J., Moreno-Pérez D., de Lucas B., Montalvo-Lominchar M.G., Muñoz E., Sánchez L., et al. Chronic flavanol-rich cocoa powder supplementation reduces body fat mass in endurance athletes by modifying the follistatin/myostatin ratio and leptin levels. Food Funct. 2020;11(4):3441–3450. https://doi.org/10.1039/d0fo00246a

12. Nocella C., Cavarretta E., Fossati C., Pigozzi F., Quaranta F., Peruzzi M., et al. Dark Chocolate Intake Positively Modulates Gut Permeability in Elite Football Athletes: A Randomized Controlled Study. Nutrients, 2023;15(19):4203 https://doi.org/10.3390/nu15194203

13. Pieterse L., van Rensburg D.C.J., van Rensburg A.J., Grant C.C., Fletcher L. Comparison of low-fat chocolate flavoured milk to the standard practice of care as a recovery intervention in Ironman athletes: A randomised control trial. African Journal for Physical Activity and Health Sciences (AJPHES). 2022;28(3):203–217. https://doi.org/10.37597/ajphes.2022.28.3.2

14. Kocakulak N.A., Karakuş M., Akkurt S., Özdemir N., Koca F. The Effect of Dark Chocolate on Oxidative Stress Parameters After High-Intensity Kickboxing Training. Spor Bilimleri Araştırmaları Dergisi. 2023;8(3):473–485. https://doi.org/10.25307/jssr.1210569

15. McDermott M.M., Criqui M.H., Domanchuk K., Ferrucci L., Guralnik J.M., Kibbe M.R., et al. Cocoa to Improve Walking Performance in Older People With Peripheral Artery Disease: The COCOA-PAD Pilot Randomized Clinical Trial. Circ. Res. 2020;126(5):589–599. https://doi.org/10.1161/circresaha.119.315600

16. Banaei P., Tadibi V., Amiri E., Machado D.G. da S. Concomitant dual-site tDCS and dark chocolate improve cognitive and endurance performance following cognitive effort under hypoxia: a randomized controlled trial. Sci. Rep. 2023;13(1):16473. https://doi.org/10.1038/s41598-023-43568-y

17. Eskandari M., Hooshmand Moghadam B., Bagheri R., Ashtary-Larky D., Eskandari E., Nordvall M., et al. Effects of Interval Jump Rope Exercise Combined with Dark Chocolate Supplementation on Inflammatory Adipokine, Cytokine Concentrations, and Body Composition in Obese Adolescent Boys. Nutrients. 2020;12(10):3011. https://doi.org/10.3390/nu12103011

18. Fakhari M., Fakhari M., BamBaeichi E. The effects of pilates and flavanol-rich dark chocolate consumption on the total antioxidant capacity, glycemic control and BMI in diabetic females with neuropathy complications. J. Bodyw. Mov. Ther. 2021;26:294–299. https://doi.org/10.1016/j.jbmt.2020.11.020

19. Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gøtzsche P.C., Ioannidis J.P.A. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS medicine. 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

20. Page M., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71

21. Harriss D., MacSween A., Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int. J. Sports Med. 2019;40(13):813–817. https://doi.org/10.1055/a-1015-3123

22. National Heart, Lung, and Blood Institute. Quality Assessment of Controlled Intervention Studies [internet]. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. 2021.

23. Fraga C.G., Actis-Goretta L., Ottaviani J.I., Carrasquedo F., Lotito S.B., Lazarus S., et al. Regular consumption of a flavanolrich chocolate can improve oxidant stress in young soccer players. Clin. Dev. Immunol. 2005;12(1):11–17. https://doi.org/10.1080/10446670410001722159

24. Gilson S.F., Saunders M.J., Moran C.W., Moore R.W., Womack C.J., Todd M.K. Effects of chocolate milk consumption on markers of muscle recovery following soccer training: a randomized cross-over study. J. Int. Soc. Sports Nutr. 2010;7(1):19. https://doi.org/10.1186/1550-2783-7-19

25. Soleimani M., Amini A., Ahmadi A., Atashak S., Mehdivand A., Kawsari E., Shamsoddini A.R., Bazgir B. Effect of short-term supplementation of cocoa on platelet factors (Plt, MPV, PDW) of athlete male’s blood after an exhaustive aerobic exercise. Scientific Journal of Kurdistan University of Medical Sciences. 2013;18(4):18–27.

26. González-Garrido J.A., García-Sánchez J.R., Garrido-Llanos S., Olivares-Corichi I.M. An association of cocoa consumption with improved physical fitness and decreased muscle damage and oxidative stress in athletes. J. Sports Med. Phys. Fitness. 2017;57(4):441–447. https://doi.org/10.23736/s0022-4707.16.06032-1

27. Cavarretta E., Peruzzi M., Del Vescovo R., Di Pilla F., Gobbi G., Serdoz A., et al. Dark Chocolate Intake Positively Modulates Redox Status and Markers of Muscular Damage in Elite Football Athletes: A Randomized Controlled Study. Oxid. Med. Cell. Longev. 2018;2018:4061901. https://doi.org/10.1155/2018/4061901

28. de Carvalho F.G., Fisher M.G., Thornley T.T., Roemer K., Pritchett R., Freitas E.C. de, et al. Cocoa flavanol effects on markers of oxidative stress and recovery after muscle damage protocol in elite rugby players. Nutrition. 2019;62:47–51. https://doi.org/10.1016/j.nut.2018.10.035

29. da Silva C.D., de Oliveira D.R., Perrone Í.T., Fonseca C.H., Garcia E.S. Low-fat, lactose-free and leucine-enriched chocolate cow milk prototype: A preliminary study on sensorial acceptability and gastrointestinal complaints following exhaustive exercise. J. Int. Soc. Sports Nutr. 2021;18(1):14. https://doi.org/10.1186/s12970-020-00406-0

30. Spaccarotella K.J., Andzel W.D. The effects of low fat chocolate milk on postexercise recovery in collegiate athletes. J. Strength Cond. Res. 2011;25(12):3456–3460. https://doi.org/10.1519/jsc.0b013e3182163071

31. Ekstrand J., Hägglund M., Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am. J. Sports Med. 2011;39(6):1226–1232. https://doi.org/10.1177/0363546510395879

32. Nobari H., Kargarfard M., Minasian V., Cholewa J.M., Pérez-Gómez J. The effects of 14-week betaine supplementation on endocrine markers, body composition and anthropometrics in professional youth soccer players: A double blind, randomized, placebo-controlled trial. J. Int. Soc. Sports Nutr. 2021;18(1):20. https://doi.org/10.1186/s12970-021-00417-5

33. Andújar I., Recio M.C., Giner R.M., Ríos J.L. Cocoa polyphenols and their potential benefits for human health. Oxid. Med. Cell. Longev. 2012;2012:906252. https://doi.org/10.1155/2012/906252

34. González-Garrido J.A., García-Sánchez J.R., GarridoLlanos S., Olivares-Corichi I.M. An association of cocoa consumption with improved physical fitness and decreased muscle damage and oxidative stress in athletes. J. Sports Med. Phys. Fitness. 2015;57(4):441–447. https://doi.org/10.23736/s0022-4707.16.06032-1

35. Moir H.J., Maciejczyk M., Maciejczyk M., Aidar F.J., Arazi H. Editorial: Exercise-induced oxidative stress and the role of antioxidants in sport and exercise. Front. Sports Act. Living. 2023;5:1269826. https://doi.org/10.3389/fspor.2023.1269826

36. Banfi G., Morelli P. Relation between values of haemoglobin, erythrocytes and reticulocytes and body mass index in elite athletes of different sports disciplines. Int. J. Lab. Hematol. 2007;29(6):484–485. https://doi.org/10.1111/j.1751-553X.2007.00908.x

37. Díaz Martínez A.E., Alcaide Martín M.J., González-Gross M. Basal values of biochemical and hematological parameters in elite athletes. Int. J. Environ. Res. Public Health. 2022;19(5):3059. https://doi.org/10.3390/ijerph19053059

38. Ferguson-Stegall L., McCleave E.L., Ding Z., Doerner P.G., Wang B., Liao Y.H., et al. Postexercise carbohydrate– protein supplementation improves subsequent exercise performance and intracellular signaling for protein synthesis. J. Strength Cond. Res. 2011;25(5):1210–1224. https://doi.org/10.1519/jsc.0b013e318212db21

39. Hazell T.J., Islam H., Townsend L.K., Schmale M.S., Copeland J.L. Effects of exercise intensity on plasma concentrations of appetite-regulating hormones: Potential mechanisms. Appetite. 2016;98:80–88. https://doi.org/10.1016/j.appet.2015.12.016

40. Zhou Y., Tse C.-S. Sweet taste brings happiness, but happiness does not taste sweet: The unidirectionality of taste-emotion metaphoric association. Journal of Cognitive Psychology. 2022;34(3):339–361. https://doi.org/10.1080/20445911.2021.2020797

41. Jeukendrup A., Vet-Joop K., Sturk A., Stegen Jhjc., Senden J., Saris Whm., et al. Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acutephase reaction during and after a long-distance triathlon in highly trained men. Clin. Sci. 2000;98(1):47–55. https://doi.org/10.1042/cs19990258

42. Buchman A.L., Killip D., Ou C.N., Rognerud C.L., Pownall H., Dennis K., et al. Short-term vitamin E supplementation before marathon running: a placebo-controlled trial. Nutrition. 1999;15(4):278–283. https://doi.org/10.1016/s0899-9007(99)00005-2

43. Szymanski M.C., Gillum T.L., Gould L.M., Morin D.S., Kuennen M.R. Short-term dietary curcumin supplementation reduces gastrointestinal barrier damage and physiological strain responses during exertional heat stress. J. Appl. Physiol. 2018;124(2):330–340. https://doi.org/10.1152/japplphysiol.00515.2017

44. Rodríguez-Daza M.C., Pulido-Mateos E.C., Lupien-Meilleur J., Guyonnet D., Desjardins Y., Roy D. Polyphenol-mediated gut microbiota modulation: Toward prebiotics and further. Front. Nutr. 2021;8:689456. https://doi.org/10.3389/fnut.2021.689456

45. Nieman D.C., Gillitt N.D., Knab A.M., Shanely R.A., Pappan K.L., Jin F., et al., Influence of a polyphenol-enriched protein powder on exercise-induced inflammation and oxidative stress in athletes: a randomized trial using a metabolomics approach. Plos one. 2013;8(8):e72215. https://doi.org/10.1371/journal.pone.0072215

46. Xu Z., Sun X., Ding B., Zi M., Ma Y. Resveratrol attenuated high intensity exercise training-induced inflammation and ferroptosis via Nrf2/FTH1/GPX4 pathway in intestine of mice. Turk. J. Med. Sci. 2023;53(2):446–454. https://doi.org/10.55730/1300-0144.5604

47. Niwano Y., Kohzaki H., Shirato M., Shishido S., Nakamura K. Putative mechanisms underlying the beneficial effects of polyphenols in murine models of metabolic disorders in relation to gut microbiota. Curr. Issues Mol. Biol. 2022;44(3):1353–1375. https://doi.org/10.3390/cimb44030091