Can Chocolate Help With Asthma? Hemorrhoids? Feminine Hygiene?

Today (December 16) is National Chocolate-Covered Anything Day.

Before getting into anything profound, let’s cover a little science. 

⇒Pop quiz (multiple choice)

Which of the following conditions could chocolate be effective for?

a) Asthma
b) Hemorrhoids
c) Feminine personal hygiene products
d) All of the above

Answer: A — and only barely. Chocolate has been touted as useful for all the above (and plenty of other things), but asthma is the only one with a remotely plausible mechanism. To see why, we need a quick detour into coffee chemistry—specifically caffeine and its close chemical cousins (Figure 1).

Screwy chemistry nomenclature time

One of the alkaloids found in chocolate is theobromine. How much bromine is in theobromine? None. The name comes from the cacao tree’s scientific name, Theobroma cacao, which is derived from Greek roots meaning “food of the gods.” Add the standard alkaloid suffix -ine, and you get theobromine—a name that sounds like it should contain bromine, but doesn't have any. One of many reasons why people hate chemistry.

Figure 1. Four methylxanthines associated with coffee/cocoa: caffeine and three isomeric dimethylxanthines (paraxanthine, theobromine, theophylline).

Coffee (and chocolate) chemicals

Caffeine is a methylxanthine, and your liver metabolizes it into three closely related dimethylxanthines: paraxanthine (the major one), plus smaller amounts of theobromine and theophylline. These three are positional isomers—same formula, different placement of methyl groups.

Two of these metabolites—paraxanthine and theobromine—can act as weak adenosine-receptor antagonists, which is one reason methylxanthines can theoretically promote airway relaxation/bronchodilation. The problem is potency: they’re generally too weak to matter clinically at the levels you’d get from normal foods (yes, including the much beloved Milky Way bar and the polyurethane foam-tasting icky Three Musketeers bar, which is inferior in every way).

⇒A key point: theobromine doesn’t have to be “made” from caffeine to show up in your body—chocolate already contains plenty of it. But either way—dietary theobromine or metabolically produced theobromine—the effect is modest at best, bordering on non-existent. So don’t kid yourself: if you’re a bit on the heavy side and asthmatic, Hershey’s Kisses will mostly make you heavier, not less asthmatic.

Real asthma drugs. Sort of

• Caffeine is a kind of “old school” bronchodilator: it can nudge lung function a bit, but it’s not a serious rescue drug.
• Theophylline actually was a widely used prescription asthma medication for decades, but it’s now largely obsolete because better (and safer) inhaled therapies exist.

Also worth noting: metabolism mostly runs “downhill.” Theobromine doesn’t get converted back into caffeine, and it isn’t converted into theophylline in any meaningful way—so you don’t get to “upgrade” chocolate into an asthma drug by wishful thinking (or digestion). So, the only way chocolate is really gonna help with your asthma is if you use it to bribe an Uber driver to take you to the hospital. 

What about hemorrhoids?

Chocolate has also been recommended for hemorrhoids, albeit in 1552. This is especially impressive, because the name of the document with this splendid recommendation is the Badianus Manuscript. Badianus?? I s### you not. It was a Mexican medical document claiming that cacao-based remedies could treat those bad boys, as well as angina, fatigue, dysentery, and gout. The Smithsonian Magazine's article also mentions that Montezuma used various "chocolate concoctions" before visiting his wives. Perhaps one of the various Mrs. Montezumas was responsible for the famous phrase. 

Feminine hygiene?

In what may or may not be a translation issue, Alibaba claims to sell chocolate tampons: 

Rich and velvety sweet, indulgent delicacy, Dubai chocolate tampons is born of cocoa beans and has traveled through many changes into a whole array of forms and flavors.

This left me speechless. As hard as I tried, I could not come up with even one snotty comment I wouldn’t catch hell for.

So I won't give it a plug. 

But maybe in the future. Future, as in, send me Krugerrands in the near future, and I'll reconsider. 

Summing things up...

• Chocolate is a damn fine food and terrible medicine.
• That includes dark chocolate, which is perpetually marketed as an elixir from the gods. If you want an antioxidant, breathe a bunch of hydrogen. Lighting a match afterward is optional, but not recommended.
• Three Musketeers bars suck. Milky Ways do not.
• You might want to avoid Alibaba for personal hygiene products.
• Send the Krugerrands

NOTE:

[1] By the late 1990s, theophylline had been replaced by inhalers containing corticosteroids, leukotriene inhibitors, and long-acting beta agonists