Is drinking cocoa good for you?

We all love drinking a warm cup of cocoa, but is it good for you?


Cocoa contains chemicals called polyphenols, which are antioxidants also found in fruits and vegetables.  Polyphenols improve blood flow, lower blood pressure, and improve blood cholesterol and glucose levels.


Cocoa is abundant in flavanols, which are also antioxidants and  have an anti-inflammatory effect on our cells.


A recent study by the American Heart Association in patients with peripheral arterial disease found that patients who drank cocoa daily had improved blood flow to their legs with improved muscle function.  The patients who drank cocoa were able to walk further in a 6-minute walking test compared to patients who did not drink cocoa.


Cocoa also increases blood flow to the brain, improving brain function and reducing risk of neurodegenerative disease.


Another study found that patients who drank cocoa regularly had a small but significant reduction in their blood pressure.


Cocoa also reduces “bad” LDL cholesterol.  Cocoa consumption is linked to lower risk of heart disease, stroke, and death.



Can you make the diagnosis?

Nancy is working at her computer when she begins to notice it is hard to use her left hand.   Thinking it was because she was resting her elbow on the desk for too long, she tries to change the position, and continues working.

Her coworker approaches and asks Nancy a question.  When Nancy answers, her coworker notices that Nancy’s speech is slurred, and one side of her face appears to be drooping.

What is Nancy’s diagnosis?

  1.  Meningitis
  2.  Carpal tunnel syndrome
  3.  Migraine
  4.  Stroke



If you guessed 4.  Stroke, you are correct.

A stroke, or Cerebrovascular Accident (CVA), is caused when the circulation to a part of the brain is decreased.  Strokes can cause symptoms such as weakness, slurred speech, facial droop, and difficulty walking.

A stroke is a true emergency and Nancy’s coworker should call 911.  A pneumonic to remember about the warning signs of stroke is FAST (facial droop, arm weakness, speech difficulty, time to call 911).

Risk factors for stroke include high blood pressure, irregular heart rate such as atrial fibrillation, tobacco smoking, high cholesterol, and diabetes.

Treatment can include very strong blood thinners such as tPA (tissue plasminogen activator) but the patient must present within 3 hours of onset of their symptoms to receive these medications.

Meningitis can cause fever and confusion, but would not typically cause weakness worse on one side than the other.  Carpal tunnel syndrome causes pain and tingling in the hand.  The pain is often worse at night.  Carpal tunnel would not be expected to cause speech changes or facial droop.  A migraine can cause neurologic symptoms but is usually associated with a severe headache and vomiting.

Left facial droop:


How does salt affect blood pressure?

Our bodies have to have salt to live.  The currently dietary guidelines recommend about 2300 mg a day for most people.
Does eating salt (sodium) cause high blood pressure?
A worldwide medical study was performed in 1988 about salt.  It involved people from all around the world and tested over 10,000 people.  It measured their blood pressure,  their sodium intake, monitored their urine samples, and looked at their height, weight, and alcohol intake.   The researchers could find no significant link between salt and hypertension!
There are, however some people who are more sensitive to salt than others.  About 8 percent of the population appears to be more sensitive to salt. When a patient has high blood pressure, they can find out if they are salt-sensitive by decreasing the sodium in their diet to see if their blood pressure improves.
However, at this time there is no evidence that salt affects the  blood pressure for the other 92% of the population.

Can you make the diagnosis?

Greg sees that his neighbors are trying to move a new dresser into their apartment, and he offers to help them.  Together, they hoist the dresser up the stairway and get it set up.

That night, Greg wakes up with severe back pain.  When he tries to get up to go to the bathroom, he notices the pain is shooting down his left leg.

What does Greg have?

  1.  He has torn a muscle in his back.
  2.  A ruptured disc.
  3.  A urinary tract infection
  4.  A kidney stone


If you guessed 2.  A ruptured disc, you are correct!

A disc is a rubbery cushion that is between the spinal vertebra:


The disc is like a jelly donut.  The outer portion of the disc is thick and tougher.  The inside portion is soft material like jelly.

When a person has a back injury, such as from lifting a heavy object or twisting the back while lifting, the outer portion of the disc can rupture, and the “jelly” can be forced out of the disc.  That is a ruptured disc.  Then the ruptured disc and “jelly” can irritate the nerves coming out of the spine.

Sometimes a rupture disc can heal by itself over time.  But if a ruptured disc is accompanied by severe pain, pain down an arm or leg, is accompanied by weakness or numbness or loss of urinary or bowel control, then surgical intervention may be required.

A sprained or torn muscle in the back is a possibility.  There are many muscles in the back that can be injured, and these will typically heal with time.  A urinary tract infection is a possibility and can cause back pain over the kidney, but would usually be associated with a fever and burning with urination.  Kidney stones can cause severe back pain, but would be unlikely to radiate down the leg.

Can the placebo effect actually help patients?

Placebos are substances that have no actual medical benefit.  In scientific studies, patients will receive a placebo instead of the real medication to see if the actual study medicine works.  But can there be a health benefit to placebos?  Can our mind overcome health issues by believing we are being treated?

A very interesting study occurred in patients with Parkinson’s Disease.  Parkinson’s disease causes tremors and difficulty walking, because the brain cells have decreased levels of Dopamine.   In the study, a new medication was given to half the patients, and the other patients got a “placebo”, or sugar tablet.  The group that was taking the placebo actually showed significant improvement.  And their MRI scans showed improvement in brain activity!

How could this possibly happen?  The scientists believe that the placebo actually caused dopamine to be released in the brain.  We know that dopamine is part of the “reward center’ of the brain, and is released when a patient feels happy and rewarded.  So the placebo actually increased the dopamine level, because the patients felt hopeful and positive about their condition being treated.

Another study was done on chronic pain patients, and found that 30-50% will respond to placebos.   A similar study by University of Colorado, Boulder researchers found that placebo saline (salt water) injections reduced chronic lower-back pain.   In these studies, patients were told they were getting a placebo, but they still had improvement in their pain!



Are benzos the new opioids?

Benzodiazepines such as Xanax, Valium, and Ativan, are now being prescribed at 27 out of every 100 doctor visits, based on a survey from the National Center for Healthcare Statistics.   In addition, at about one third of those visits, opioids (narcotics) were also prescribed.

The rate of prescribing benzodiazepines was higher for women, and higher with increased age.

Benzodiazepines, also called benzos,  are used for a variety of ailments, including anxiety, other mental disorders, insomnia, seizures, and musculoskeletal issues.

While bendodiazepines are generally safe for short-term use, they are addictive, and patients can become physically dependent on them.

Side effects of benzodiazepines include over-sedation, respiratory system depression, dizziness and falls.

Long-term use of benzos has been linked with risk of dementia and suicide.  If a patient has been on long-term benzodiazepines, stopping them suddenly can be fatal.  The elderly are at higher risk for adverse effects.



Can you make the diagnosis?

Helen is getting ready to leave for her Bridge group when she starts having lower left abdominal pain.  She takes some Tylenol and heads out anyway, as it does not seem that bad.

During the day she notices her appetite is off, and she feels slightly nauseated.  She is able to drink tea and have some toast but doesn’t want anything else to eat.

That night, she wakes up with worse pain.  She checks her temperature and it is 99.9 F.

What does Helen have?

  1.  Diverticulitis
  2.  Appendicitis
  3.  Cholecystitis
  4.  Urinary tract infection


If you guessed 1.  Diverticulitis, you are right!

Diverticulitis is caused when little pouches form on our intestine over time, called diverticula  Food or poop can get stuck in the pouches, causing infection.  Symptoms include abdominal pain, nausea, and fever.  Blood in the stool can occur.

Risk factors for diverticulitis include family history, obesity, smoking, and low fiber diet.  Diverticula become more common with age.

Diverticulitis can be prevented by regular exercise as it promotes normal bowel function, eating more fiber, and drinking plenty of fluids which helps eliminate waste.

Diagnosis of diverticulitis is made typically by a CT scan, but can be found on colonoscopy as well.  Treatment is with antibiotics.  If the diverticula perforate or cause an abscess, then surgery may be necessary.

Appendicitis would typically be on the right lower side of the abdomen; cholecystitis would be on the right upper side.  Urinary tract infection would usually cause burning and increased frequency of urination.

Diverticula on wall of intestine: