If you’re over the age of 40, then you’re at risk for peripheral arterial disease, or PAD.

PAD involves a narrowing of the arteries that carry blood to the legs. The most noticeable symptom is leg pain while walking which gets better with rest.

While there’s no cure for PAD, doctors may prescribe aspirin or other blood thinning medications to increase blood circulation. However, if arteries become blocked, surgery is often recommended. That’s why I’m excited to share how scientists found a natural remedy in an unlikely place that’s providing relief to many patients.

When researchers at Northwestern University Feinberg School of Medicine began looking into safer, natural options, they turned their attention to drinking cocoa. If this seems out of left field, keep reading…

Clinical Studies Show Cocoa Improves Blood Flow

Cocoa is rich in a number of bioactive flavonoids, including epicatechin. Previous research has shown this particular plant chemical has positive vascular effects, expanding constricted blood vessels and improving blood flow.

In 2014, researchers published the first scientific evidence that cocoa could benefit patients with PAD. In this study, researchers followed twenty patients, with an average age of 69, who were put on a treadmill to test how far and for how long they could walk without pain.

Half the volunteers were then given 40 grams of dark chocolate with a cocoa content greater than 85 percent– almost pure dark chocolate — while the rest ate the same amount of milk chocolate containing less than 35 percent cocoa.

The Cocoa Group Walked 11 Percent Farther

Two hours later they were tested again on the treadmill. The milk chocolate patients showed no improvement, but people in the dark chocolate group were able to walk 11 percent farther, on average, and for a 15 percent longer duration.

For the more recent Feinberg study, researchers randomly assigned 44 patients aged 60 to drink three mugs of cocoa a day (quite a choco-blowout, in my opinion) or the same amount of a placebo drink. The cocoa was natural, unprocessed, and contained a daily total of 75mg of epicatechin.

These patients also had MRI scans of their legs to measure blood flow, and some of the volunteers agreed to a biopsy of the calf muscle to test energy production.

Better Blood Flow and Muscle Health

At the end of six months, the placebo group deteriorated, suffering a decline of 26.5 yards in the distance they could walk, but the cocoa drinkers were able to walk 46.5 yards more. These are impressive results for a treatment as simple, safe and tasty as hot cocoa.

Compared to placebo, the cocoa drinkers also experienced a 20 percent improvement in blood flow to the calves, and a 14 percent increase in the density of capillaries — the tiny blood vessels that deliver oxygen to the tissues.

In addition, the cocoa group saw a 98 percent improvement in mitochondrial activity, a marker of energy production at the cellular level.

“Significant” Results

Lead author Dr. Mary McDermott explained, “The degree of improvement from chocolate was significant and meaningful. The epicatechins help dilate blood vessels, which enables more oxygen to travel to the tissues.”

Dr. McDermott published the study in the journal Circulation Research in February.

In a commentary on the study in the same journal, Dr. Naomi Hamburg, chair of the American Heart Association’s Peripheral Vascular Disease Council, wrote, “Taken together, the pilot study by McDermott and colleagues provides compelling preliminary evidence to support a potential benefit of epicatechin-rich cocoa on walking ability along with protection from worsening of calf muscle perfusion [blood flow to the tissues], skeletal muscle injury, and mitochondrial dysfunction.

“Someday, we may be able to prescribe eating more chocolate to our patients with PAD.”

My advice, with results like these, is why wait? Especially if you’re already experiencing leg pain, and know you have circulation problems or that you’re at risk for them. I’m all for safe, affordable, natural treatments like this that do no harm and can do a lot of good.

But remember, not any old hot cocoa will do. You can make your own using dark chocolate or other chocolate that’s high in cacao, the epicatechin rich compound from which cocoa is derived.

My recipe, which is delicious if I say so myself: 12 ounces of whole milk, 1.5 tbs of 100 percent cocoa powder, sugar to taste (as little as possible, I use one tsp), and four drops of vanilla extract. Warm up slowly at low or medium heat, stirring frequently, until the ingredients are dissolved and the mixture is hot. You don’t want to scald the milk.

Don’t mistake “hot chocolate” powders for 100 percent dark chocolate cocoa powder.


  1. https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.119.315600?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
  2. https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.316614
  3. https://news.northwestern.edu/stories/2020/02/hot-cocoa-aids-walking-in-peripheral-artery-disease/