Cacao Beyond Chocolate: My Drink, My Massaman Curry and the COSMOS Study
HealthyRetired — The Healthy Aging Project
Category: Food | Status: Draft | 7 October 2026
When people hear “cacao,” they often think of a chocolate bar. In my kitchen, it has a wider role. I use a 100% solid cacao block from Kad Kokoa in Thailand to prepare my cacao drink, and I also add it to my Massaman curry.
For a curry serving two people, I add one piece weighing about 15 grams—approximately 7.5 grams per person. This is my cooking habit, not a medicinal dose. It shows that cacao can belong in savoury cooking as well as in a cup or a dessert.
Before discussing possible health benefits, it helps to understand what we are buying. Cacao beans, cocoa powder, chocolate and cocoa extracts are related products, but they are not interchangeable.
Cacao, cocoa and chocolate: what is the difference?
These products begin with the seeds of the cacao tree, Theobroma cacao. Processing turns the beans into different ingredients. The names “cacao” and “cocoa” are used inconsistently in shops, so the label and manufacturing information matter more than either word alone. [1]
| Product | What it contains | Typical kitchen use |
|---|---|---|
| Cacao nibs | Pieces of cacao beans, containing solids and cocoa butter | A crunchy addition to food |
| Cacao mass or paste | Ground beans, retaining solids and cocoa butter | Drinks, cooking and chocolate making |
| Natural cocoa powder | Cocoa solids after much of the cocoa butter has been removed; not alkalised | Drinks, sauces and baking |
| Dutch-processed cocoa powder | Cocoa powder treated with alkali | Drinks and baking with a different flavour and colour |
| Chocolate | Cocoa ingredients, often combined with sugar and sometimes milk; unsweetened 100% versions also exist | Eating and cooking |
| Standardised cocoa extract | An extract formulated to deliver a specified amount of compounds such as flavanols | Supplements and research |
A solid block labelled 100% cacao usually contains cacao mass, sometimes with additional cocoa butter. Check the ingredient list: if it contains only cacao ingredients, there is no added sugar. The retained cocoa butter makes it richer and more energy-dense than a comparable amount of reduced-fat powder.
For someone avoiding added sugar, an unsweetened block or plain cocoa powder offers control over the finished dish. But “100%” describes the cocoa ingredient percentage; it does not tell us how many flavanols the product contains.
Dutch processing: a substantial loss of flavanols
Dutch processing, also called alkalisation, treats cocoa with alkali to reduce its acidity and change its flavour and colour. It is a useful manufacturing technique, but it can substantially reduce cocoa flavanols. [2,3]
Flavanols are plant compounds, including epicatechin, that have attracted interest in cardiovascular research. Laboratory studies comparing cocoa powders found lower concentrations after alkalisation. The extent varies with the process and product. [2,3]
It would be inaccurate to say that Dutch processing removes “all the nutrition.” Cocoa still contains other components. The more precise point is that alkalisation can greatly reduce the flavanols studied for potential vascular benefits.
If flavanols are your reason for choosing cocoa, look for “natural,” “non-alkalised” or “not Dutch-processed,” and ask the manufacturer when the label is unclear. Dark colour, bitterness and a high cacao percentage do not reliably tell us the flavanol dose. Laboratory measurement is needed for a meaningful comparison. [4]
What does NutritionFacts.org say?
Dr Michael Greger's NutritionFacts.org discusses cocoa's flavanols and distinguishes cocoa powder from products with added sugar. This is a useful reminder to examine the whole food: the nutrition of a sweetened chocolate drink depends on much more than its cacao ingredient. [5]
Plain cocoa powder can be a practical choice when you want cacao flavour with less cocoa butter. A solid cacao block offers a different texture and richness. Both have culinary uses; a premium label is not essential for enjoying cacao without added sugar.
What the COSMOS study actually tested
The COcoa Supplement and Multivitamin Outcomes Study, known as COSMOS, was a large randomised, double-blind, placebo-controlled trial involving 21,442 older US adults. It tested a daily cocoa extract providing 500 mg of cocoa flavanols, including 80 mg of epicatechin, with a median treatment and follow-up period of 3.6 years. [6]
Its main cardiovascular outcome was a combination of events such as heart attack, stroke and cardiovascular death. The cocoa extract did not significantly reduce that primary outcome. Researchers did find a 27% relative reduction in cardiovascular deaths, a secondary outcome. That is encouraging, but requires confirmation and does not mean 27% fewer deaths from all causes. [6]
The trial received support from Mars Edge, which also supplied the cocoa extract, alongside other funding. This should be disclosed when discussing the research. Funding does not by itself invalidate a study, but readers should see the main result alongside the more favourable secondary finding. [6]
COSMOS tested a standardised extract. It did not test my Kad Kokoa block, a cup of ceremonial cacao or ordinary chocolate. Without product-specific measurements, we cannot calculate an equivalent serving or promise the same effects.
Why flavanols interest circulation researchers
Cocoa flavanols have been studied in relation to nitric-oxide-mediated blood-vessel function. Nitric oxide helps vessels relax. Some controlled cocoa studies have found improvements in vascular function, although changes in vessel measurements do not automatically establish fewer heart attacks or longer life. [7]
For example, a trial in people with hypertension found improved insulin-mediated vessel dilation without improved blood pressure or insulin resistance. This illustrates why “supports circulation” needs careful explanation rather than becoming a blanket treatment claim. [7]
My Kad Kokoa block: a Thai example
I use a 100% solid block from Kad Kokoa, a Thai bean-to-bar producer. The company's official site describes its use of Thai cacao and lists several different products, including chocolate bars and drinking chocolate. [8]
Readers can find the producer at kadkokoa.co. Check the individual product rather than assuming that everything from one brand is unsweetened or processed in the same way.
My block's alkalisation status and flavanol concentration have not been verified for this article. I can describe what I use and enjoy, while keeping that separate from laboratory evidence.
A cacao drink and a savoury curry
For a drink, finely chop or grate a little solid cacao and stir it into warm water or unsweetened plant milk until dispersed. Adjust the amount to suit the flavour you enjoy. A drink made from cacao mass retains cocoa butter, so it will differ from one made with powder.
In my Massaman curry, I use about 15 grams for two people. To try the same idea, chop the cacao and stir it into the hot curry until melted and incorporated. Taste the sauce before adding more. Cacao contributes its own flavour, so the amount that suits one curry may not suit another.
This is a cooking suggestion, not evidence that curry delivers the dose used in COSMOS. Nor do we know the exact flavanol content remaining in my finished dish.
Choosing cacao with clear expectations
Check three things: ingredients, processing and purpose. For an unsweetened drink, a short ingredient list is useful. For retaining flavanols, non-alkalised processing is relevant. For comparison with a clinical study, measured flavanol content matters. [2,4]
“Ceremonial,” “raw” and “bean-to-bar” do not by themselves establish a clinical benefit. Enjoy a product for its taste and origin, but keep research claims tied to what researchers actually tested.
Cacao earns its place in my kitchen because I enjoy using it. A drink and a little cacao in a two-person curry are simple examples of that enjoyment. The health research is interesting; it does not need to turn an ingredient into a miracle.
Sources and evidence notes
- Katz and colleagues: Clinical benefit and preservation of flavanols in dark chocolate manufacturing. Background on cocoa composition and processing.
- Miller and colleagues: Impact of alkalisation on the antioxidant and flavanol content of commercial cocoa powders. Laboratory product analysis, not a clinical trial; cocoa-industry affiliation is disclosed in the paper.
- Andrés-Lacueva and colleagues: Flavanol and flavonol contents of cocoa powder products—manufacturing effects. Chemical analysis of processing effects.
- Cocoa flavanols: measurement, bioavailability and bioactivity. Why flavanol measurements matter.
- NutritionFacts.org: Cocoa. Dr Michael Greger's discussion and linked research.
- COSMOS: Cocoa flavanol supplementation and cardiovascular events. Primary trial report, outcomes and funding disclosures.
- Cocoa consumption, vessel dilation and blood pressure in essential hypertension. Controlled trial showing the distinction between vascular measures and other outcomes.
- Kad Kokoa: Thai cacao origins and official product catalogue. Manufacturer information; not independent evidence of flavanol content or health effects.
General food and research information, not an individual treatment recommendation. Personal cooking examples are identified as such.