Chocolates Truffles. Have One. Just One. Ok, Two.

Email from Jennifer, about a problem almost too good to be true.

My question concerns gourmet chocolates, like truffles and other filled chocolates. I have always loved those, and do try to steer clear of cream-filled chocolates, but sometimes I'm too tempted, and have one or two. I don't seem to have a problem digesting them, even though just about everything else with dairy (muffins, ice cream, milk, etc.) causes problems. I've joked that I've somehow been lucky to get a chocolate exception to LI. Is there something to that (more than a joke)? Is there something about cream-filled chocolates that would cause less of a reaction than other dairy items?

What a wonderful question to get to answer the very same week that the headline "Chocoholics may have an edge in heart health" appeared in the Washington Post.

I normally have the dismal job of reminding people that most headlines they see in newspapers about the latest miraculous report about foods or medicines are literally not worth the paper they're printed on. The studies are too small, or too short, or too conflicted to rely on. This study rises to a much higher standard. It's what's known as a meta-study, one that analyzes the medical literature and tries to form a conclusion based on all the best and largest studies. This one looked at 114,009 adults from seven studies, with different methodologies. Here come the science.

Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. Adriana Buitrago-Lopez et al. BMJ 2011; 343:d4488 doi: 10.1136/bmj.d4488 (Published 29 August 2011)

Abstract

Objective
To evaluate the association of chocolate consumption with the risk of developing cardiometabolic disorders.

Design
Systematic review and meta-analysis of randomised controlled trials and observational studies.

Data sources
Medline, Embase, Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, reference lists of relevant studies to October 2010, and email contact with authors.

Study selection
Randomised trials and cohort, case-control, and cross sectional studies carried out in human adults, in which the association between chocolate consumption and the risk of outcomes related to cardiometabolic disorders were reported.

Data extraction
Data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The primary outcome was cardiometabolic disorders, including cardiovascular disease (coronary heart disease and stroke), diabetes, and metabolic syndrome. A meta-analysis assessed the risk of developing cardiometabolic disorders by comparing the highest and lowest level of chocolate consumption.

Results
From 4576 references seven studies met the inclusion criteria (including 114 009 participants). None of the studies was a randomised trial, six were cohort studies, and one a cross sectional study. Large variation was observed between these seven studies for measurement of chocolate consumption, methods, and outcomes evaluated. Five of the seven studies reported a beneficial association between higher levels of chocolate consumption and the risk of cardiometabolic disorders. The highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease (relative risk 0.63 (95% confidence interval 0.44 to 0.90)) and a 29% reduction in stroke compared with the lowest levels.

Conclusions
Based on observational evidence, levels of chocolate consumption seem to be associated with a substantial reduction in the risk of cardiometabolic disorders. Further experimental studies are required to confirm a potentially beneficial effect of chocolate consumption.

Or as the Washington Post boiled it down:

People who ate the most chocolate — dark or light and in such forms as bars, drinks, desserts, snacks and nutritional supplements — were 37 percent less likely to have developed cardiovascular disease and 29 percent less likely to have had a stroke than were those who ate the least amount of chocolate.

More chocolate for everyone!

Yes, that includes you, readers who are lactose intolerant. There are two parts to this answer, and both of them are good news.

Personally, I'm a dark chocolate fanatic. That doesn't mean that the higher the cocoa content the better. Truthfully, those 85% cocoa super-intense bars go over the edge into bitterness. I'll stick with 70-72% cocoa for the best experience. Adding fruit doesn't hurt, either for flavor or health. I found a supplier of dark chocolate-coated black currents, an intense rush that satisfies even when I have just one or two raisin-sized pieces. I substitute that for dessert, part of an overall purge of excess sugar from my diet. I've gone down a pants size in the past few months, losing about one pound a week, a good recommended amount.

And all that dark chocolate? It's milk free. So the lactose content is zero.

That's not what Jennifer asked about, though. Chocolate truffles may be dark chocolate or milk chocolate. Either way, they're likely to have some sort of cream-filled interiors that kiss each taste bud and send them flying. And cream means milk. Which means lactose.

The secret? A truffle is tiny. All that intense flavor is packed into a tiny volume, a neutron star for calories. I checked a number of brands and found that truffles seem to run from 10 to 20 grams, much less than an ounce, which is 28.375 grams. An ounce of pure milk contains less than a gram and a half of lactose. Truffles are half that size and are mostly not milk. Therefore the fraction of a gram of lactose in any given truffle is probably too small to matter.

As long as you don't gobble down (or it is gobble up) the whole carton of truffles at a sitting, the vast majority of us with lactose intolerance don't have to worry about symptoms. Think of it as the indulgence it's supposed to be, and have one, just as some better restaurants offer at the end of a meal. Just remember that a truffle is an indulgence and stop at one. I'll allow two. I mean, we're talking truffles here.

If you want to up your chocolate content to get some of that heart-healthy goodness, though, I'd recommend sticking to a good dark chocolate with less fat and fewer calories. In place of dessert, not in addition to it. Then you can go shopping for new jeans. Three pair, including tax, $36 at the VF outlet store. Talk about indulgence.