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Historically chocolate has been reported to exert several effects on human sexuality, mainly acting as an effective aphrodisiac, increasing sexual desire, and improving sexual pleasure.
The aim of our study was to assess whether there is an association between daily chocolate intake and sexual function in a convenience sample of Northern Italian women.
A convenience sample of 163 women (mean +/- SD age: 35.3 +/- 9.2 years; body mass index [BMI]: 22.5 +/- 3.5 kg/m2), recruited through advertising, completed an anonymous semistructured interview on recreational habits and questionnaires to assess sexual function (Female Sexual Function Index [FSFI]), sexual distress (Female Sexual Distress Scale), and depression (Beck Depression Inventory and Center for Epidemiological Survey Depression Scale).
Complete data were available for 153/163 (93.8%) women. Participants who reported daily chocolate intake (Group 1: 120 women) were significantly younger than those (Group 2: 33 women) who did not report to eat chocolate (33.9 +/- 0.8 years vs. 40.4 +/- 1.6 years, respectively) (P = 0.0003), despite a similar BMI. Participants in Group 1 had significantly higher total (P = 0.002) and desire domain (P = 0.01) FSFI scores than participants in Group 2. No differences between the two groups were observed concerning sexual arousal and satisfaction, sexual distress and depression. Our data also confirm that aging has a high statistically significant impact on women's sexual function.
It is alluring to hypothesize that chocolate can have either a psychological or a biological positive impact on women's sexuality. In our sample women reporting chocolate consumption have higher FSFI scores than women who do not eat chocolate. However, when data are adjusted for age FSFI scores are similar, regardless of chocolate consumption.
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... Female sexuality is regulated by several anatomical, neurobiological, and psychological mechanisms and their interaction characterises the state of women's sexual response . Several studies suggested that some foods could also have an intriguing impact on female sexual quality of life [2,3]. recently, Mondaini et al.  found that regular moderate intake of red wine is associated with higher FSFI scores for sexual desire, lubrication and overall sexual function as compared to teetotaller status. ...
... recently, Mondaini et al.  found that regular moderate intake of red wine is associated with higher FSFI scores for sexual desire, lubrication and overall sexual function as compared to teetotaller status. Moreover, Salonia et al.  showed that those women who reported eating ≥1 chocolate cubes daily have higher FSFI scores for both sexual desire and overall sexual function than women who did not report eating chocolate. The authors hypothesised that the reason for the impact of these foods on female sexuality may be the fact that foods containing polyphenols and antioxidant can stimulate peripheral vasodilation via activation of the nitric oxide system [2,3]. ...
... Moreover, Salonia et al.  showed that those women who reported eating ≥1 chocolate cubes daily have higher FSFI scores for both sexual desire and overall sexual function than women who did not report eating chocolate. The authors hypothesised that the reason for the impact of these foods on female sexuality may be the fact that foods containing polyphenols and antioxidant can stimulate peripheral vasodilation via activation of the nitric oxide system [2,3]. During sexual arousal, in fact, the central reduction of sympathetic tone and the release of two vasodilator neurotransmitters (vasoactive intestinal peptide--VIP; nitric oxide--nO), create an increase in the blood flow to the external genitalia and vagina and promote relaxation of the smooth muscle of the cavernous sinuses in the clitoris . ...
Even if some evidence exists of a positive correlation between regular intake of phytoestrogens, polyphenols, antioxidants and women's sexual health, there is not a study addressing the potential correlation between daily apple consumption and women's sexual function. We aim to assess whether there is a tie between daily apple intake and sexual function in a sample of healthy young sexually active Italian women, not complaining of any sexual disorders.
Seven hundred and thirty-one women (mean age 31.9, range 18-43) were enrolled in this cross-sectional study (from September 2011 to April 2012). All participants completed anonymously the Female Sexual Function Index (FSFI) and were asked to report on their amount of daily apple consumption and their eating habits. On the basis of apple consumption all women were split into two groups: Group A--regular daily apple consumption, Group B--no regular apple consumption (<1 apple/day). The main outcome measure was the FSFI questionnaire result.
Three hundred and forty-three women reported a regular daily apple intake and were classified in Group A, while 388 were included in Group B. Group A had a significantly higher total (p = 0.001; Cohen's d = 3.39) and lubrication domain (p = 0.001; Cohen's d = 3.02) FSFI scores than participants in Group B. Multivariate analysis demonstrated that daily apple intake must be considered as an independent parameter (p = 0.002) in predicting a better score at questionnaire examination.
This study suggests a potential relationship between regular daily apple consumption and better sexuality in our young women population.
... Balboa-Castillo et al.  analysed a cohort of 4599 individuals (average age: 54.1 years, 50.8% women), with no evidence of correlation between QoL and a greater or lower consumption of 10 g/day of chocolate, although these authors did not include an analysis based on age and sex. In women, the consumption of chocolate could have a significant positive impact on sexual function, especially on sexual desire . A greater consumption of chocolate has been associated with a higher score in the Centre for Epidemiologic Studies Depression Scale (CES-D) , in which 16 or more points often represent a positive screening result, although no cause-effect relationship has been established between showing more signs of depression and a greater consumption of chocolate . ...
... To sum up, despite the worsening of QoL that takes place during menopause and the indications about the possible positive effect that the consumption of chocolate can have on such deterioration, there are very few studies that approached this topic, obtaining divergent and poorly clarifying results [10,11,13]. Beyond the evaluation of pharmacological and/or nutritional therapies during menopause, it is fundamental to determine the real impact of these on QoL . ...
... This was a condition of the design that could partly justify the absence of additional beneficial results on the dimensions of the Cervantes scale, especially on sexuality. In previous studies, the consumption of chocolate had a significant impact on sexual desire in women , although after adjusting for age, Nutrients 2020, 12, 2754 9 of 12 such association disappeared. However, it is necessary to further investigate the impact of the intake of chocolate on specific aspects of QoL. ...
Menopause has a negative impact on quality of life (QoL). The aim of the present study was to analyse the effect on QoL of adding 10 g per day of chocolate with a high concentration of cocoa (99%) to the habitual diet, for 6 months, in a sample of postmenopausal women. Postmenopausal women (n = 140) aged 50-64 years were randomised to either an addition of 10 g per day of cocoa-rich chocolate to their usual diet or no supplement addition. All variables were measured at baseline and after six months of intervention. QoL was evaluated using the 3-level version of EuroQol-5D (EuroQoL-5D-3L), the EuroQol Visual Analogue Scale (EQ-VAS) and the Cervantes scale. Analysis of covariance (ANCOVA) analyses adjusted for the main determinants of QoL considered in this study showed no changes in the global score of QoL evaluated with the EuroQoL-5D-3L. The intervention group showed an increase of 6.0 points (95% confidence interval (CI): 0.4, 11.7) in the EQ-VAS compared to the control group (p = 0.036). No significant changes were observed between groups in the global score of QoL nor in the dimensions and subdimensions measured with the Cervantes scale. The additional daily contribution of 10 g of cocoa-rich chocolate in postmenopausal women could have a slight impact on their perception toward their health state, although without modifying the health-related QoL or the dimensions that compose it.
... Chocolate exerts several effects on human sexuality, mainly acting as an aphrodisiac . Cocoa powder and chocolate contain three unsaturated N-acylethanolamines, which, acting as cannabinoid mimics, could activate cannabinoid receptors or increase anandamide concentrations [103,104]. ...
... Chocolate exerts several effects on human sexuality, mainly acting as an aphrodisiac . Cocoa powder and chocolate contain three unsaturated N-acylethanolamines, which, acting as cannabinoid mimics, could activate cannabinoid receptors or increase anandamide concentrations [103,104]. The latter, in conjunction with other components of chocolate (such as caffeine and theobromine), produces a transient feeling of well-being. ...
... The latter, in conjunction with other components of chocolate (such as caffeine and theobromine), produces a transient feeling of well-being. Anandamide enhances sexual performance in male rats [103,105]. Moreover, serotonin has been found in several regions of the female genital tract in humans and other animals, where it acts on vasoconstriction and vasodilatation. ...
Chocolate is well known for its fine flavor, and its history began in ancient times, when the Maya considered chocolate (a cocoa drink prepared with hot water) the “Food of the Gods”. The food industry produces many different types of chocolate: in recent years, dark chocolate, in particular, has gained great popularity. Interest in chocolate has grown, owing to its physiological and potential health effects, such as regulation of blood pressure, insulin levels, vascular functions, oxidation processes, prebiotic effects, glucose homeostasis, and lipid metabolism. However, further translational and epidemiologic studies are needed to confirm available results and to evaluate other possible effects related to the consumption of cocoa and chocolate, verifying in humans the effects hitherto demonstrated only in vitro, and suggesting how best to consume (in terms of dose, mode, and time) chocolate in the daily diet.
... 62 The unsaturated N-acylethanolamines in chocolate, which may activate cannabinoid receptors or increase endocannabinoid levels, are associated with increased sensitivity and euphoria. 60,63 In addition, the taste and fatty nature of chocolate is reported to stimulate the hypothalamus, thereby resulting in pleasurable sensations and increasing brain serotonin (5-hydroxytrytrytamine) levels. 60 There are approximately 52 Epimedium species of herbaceous flowering plants, also known as rowdy lamb herb, bishop's hat or horny goat weed, 64 that have been used to treat ED for over 2 000 years. ...
... 60,63 In addition, the taste and fatty nature of chocolate is reported to stimulate the hypothalamus, thereby resulting in pleasurable sensations and increasing brain serotonin (5-hydroxytrytrytamine) levels. 60 There are approximately 52 Epimedium species of herbaceous flowering plants, also known as rowdy lamb herb, bishop's hat or horny goat weed, 64 that have been used to treat ED for over 2 000 years. 65 Icariin, the active ingredient, 66 increases levels of nitric oxide and PDE5 activity. ...
Traditionally, the term "impotence" has been used to signify a male's inability to attain and maintain an erection. Impotence, in most circumstances, is more precisely referred to as erectile dysfunction (ED). An estimated 10-20 million men suffer from the condition. However, this number is expected to increase dramatically, with an estimated figure of 322 million by 2025. Even though the prevalence of ED increases with age, it must be stressed that ageing itself is not a cause of ED as it is associated with metabolic syndrome, cardiovascular disease, diabetes mellitus and other noncommunicable diseases, such as obesity. Many patients self-medicate by resorting to local herbs and over-the-counter (OTC) preparations to manage ED. Because of the increasing number of men seeking treatment for ED, there is a need to assess the safety and biological plausibility of some of the readily available preparations (as well as food and drink) that reportedly enhance sexual desire or performance. For the purpose of this review, the aphrodisiacal qualities of freely available foods and natural OTC products will be reviewed and evaluated. These include oysters, alcoholic beverages, chocolate, chilli, Epimedium extract (horny goat weed), Panax ginseng, Ginkgo biloba, Tribulis terrestris, Eriosema kraussianum and Spanish fly (cantharides).
... In our survey 42.0 percent believe that the effect of chocolate on their sexual behaviour is  a research which reveals women with 1 chocolate cube a day had greater FSFI values for sexual desire as well as for sexual function as women who have not reported consuming chocolate. ...
... Cai et al.  suggest a potential relationship between regular daily apple consumption and better sexuality in young women population. In the study of Salonia et al.  women reporting chocolate consumption have higher FSFI scores than women who do not eat chocolate. However, when data were adjusted for age, FSFI scores were similar, regardless of chocolate consumption. ...
... Chocolate has often been cited as an aphrodisiac, hence the reason for gifting boxes filled with fine delicacies to loved ones. Despite inconclusive evidence concerning the effects on mood , in most countries, offering chocolate as a gift has become a well-established tradition among lovers. In this regard, the importance and motivations behind Valentine's Day gifts has been investigated many times in the literature : several hypotheses have been made, including contradicting themes such as obligation, altruism, and self-interest [30,31]. ...
Sentiment analysis (SA) is a technique aimed at extracting opinions and sentiments through the analysis of text, often used in healthcare research to understand patients’ needs and interests. Data from social networks, such as Twitter, can provide useful insights on sexual behavior. We aimed to assess the perception of Valentine’s Day by performing SA on tweets we collected between 28 January and 13 February 2019. Analysis was done using ad hoc software. A total of 883,615 unique tweets containing the word “valentine” in their text were collected. Geo-localization was available for 48,918 tweets; most the tweets came from the US (36,889, 75.41%), the UK (2605, 5.33%) and Canada (1661, 3.4%). The number of tweets increased approaching February 14. “Love” was the most recurring word, appearing in 111,981 tweets, followed by “gift” (55,136), “special” (34,518) and “happy” (33,913). Overall, 7318 tweets mentioned “sex”: among these tweets, the most recurring words were “sexy” (2317 tweets), “love” (1394) and “gift” (679); words pertaining to intimacy and sexual activity, such as “lingerie”, “porn”, and “date” were less common. In conclusion, tweets about Valentine’s Day mostly focus on the emotions, or on the material aspect of the celebration, and the sexual aspect of Valentine’s Day is rarely mentioned.
... Out of the 152 complete responses available for analysis, the results show that the total FSFI score as well as the desire domain within the FSFI were significantly higher in women who consume chocolate; however, when adjusted for age and body mass index, no significance is evident. There was no difference between each group in the remaining questionnaires evaluated (Salonia et al., 2006). While the idea for the study is interesting, convenience sampling has a high risk of bias and is unreliable to draw sound conclusions from. ...
Female Sexual Dysfunction is a complex condition with biopsychosocial origins. With limited FDA approved treatment options, plants traditionally used as aphrodisiacs may be a therapeutic option.
To distinguish the plants commonly used in female aphrodisiac products (AP) on the market, and to evaluate their ethnobotanical and clinical evidence as a basis for their inclusion.
This study is a narrative review of 42 plants commonly found in AP on the market. Most species listed have anecdotal use as aphrodisiacs throughout history; therefore, a systematic search was done for clinical evidence. The primary outcome assessed is the clinical efficacy of plants in the treatment of libido desire disorders.
Little evidence from the literature to substantiate claims of plants currently on the market as AP for female libido.
Studies of plants used as ingredients for AP are severely lacking. There is no plant currently used in any AP with a strong enough clinical finding to be recommended for libido/desire disorders. Further research should aim to develop and validate in vitro models corresponding to the neurobiological underpinnings evident in FSD as markers for further studying in vivo efficacy in animal models before moving on to humans.
... Gambir, in a similar fashion to cocoa and chocolate, has been reported to exert an effect on human sexuality, acting as an effective aphrodisiac, increasing sexual desire and improving sexual pleasure (Salonia et al., 2006). Cocoa products, apart from phenylethylamide (PEA), which has been reported stimulate the hypothalamus inducing pleasure sensations (Maxwell, 1996), also include (+)-catechin, (+)-epicatechin and procyanidins (Todorovic et al., 2015), which are present in gambir too. ...
A dangerous aphrodisiac, commonly known as ‘Jamaican stone’, banned by the U.S. Food and Drug Administration, has been studied by vibrational spectroscopy in order to solve the controversy on its composition. The results of the ATR-FTIR analysis revealed the presence of the α-pyrone ring, which is characteristic of bufadienolides from toad venom and bulbs of squill (Drimia maritima (L.) Stearn). This conclusion was reached after a comparative study with the spectra for phytochemicals derived from gambir and cat’s claw, two Uncaria species also preconized as aphrodisiacs and deemed as possible constituents of the ‘stone’. Owing to their physiologic similarities to digoxin, bufadienolides have been shown to produce a toxic profile similar to that of digoxin, although the lack one of the side chains found on digoxin should allow the use of hemodialysis to treat ‘Jamaican stone’ overdose.
The search for a remedy or a prescription that can enhance sexual function and/or treat male erectile dysfunction has been an obsession throughout known history. Whether it was an Eastern civilization or a Western one, religious or atheist, man's aspiration for a better or best "manhood" has been a history-time goal.
This review will discuss the current research done on the most popular natural aphrodisiacs and examine the weight of evidence to support or discourage the use of any of these substances to enhance sexual desire and/or function.
Review of the current evidence on the use of natural substances as aphrodisiacs.
Efficacy of natural aphrodisiacs in enhancing sexual function in men and women.
There is little evidence from literature to recommend the usage of natural aphrodisiacs for the enhancement of sexual desire and/or performance. Data on yohimbine's efficacy does not support the wide use of the drug, which has only mild effects in the treatment of psychogenic ED. Although there's a positive trend towards recommending ginseng as an effective aphrodisiac, however, more in depth studies involving large number of subjects and its mechanism of action are needed before definite conclusions could be reached. Data on the use of natural aphrodisiacs in women is limited.
The current body of objective evidence does not support the use of any natural aphrodisiac as an effective treatment for male or female sexual dysfunctions. Potent men and men with ED will continue the search for natural aphrodisiacs despite the current disappointing data on their effectiveness. Care should be taken regarding the fraud addition of sildenafil analogues to natural aphrodisiacs.
This book provides an overview of the science and technology of chocolate manufacture from cocoa production, through the manufacturing processes, to the sensory, nutrition and health aspects of chocolate consumption. It covers cocoa cultivation and production with special attention paid to cocoa bean composition, genotypic variations in the bean, post-harvest pre-treatments, fermentation and drying processes, and the biochemical basis of these operations. The scientific principles behind industrial chocolate manufacture are outlined with detailed explanations of the various stages of chocolate manufacturing processes including mixing, refining, conching and tempering. Other topics covered include the chemistry of flavour formation and development during cocoa processing and chocolate manufacture; volatile flavour compounds and their characteristics and identification; sensory descriptions and character; and flavour release and perception in chocolate. The nutritional and health benefits of cocoa and chocolate consumption are also addressed. There is a focus throughout on those factors that influence the flavour and quality characteristics of the finished chocolate and that provide scope for process optimization and improvement. The book is designed to be a desk reference for all those engaged in the business of making and using chocolate worldwide; confectionery and chocolate scientists in industry and academia; students and practising food scientists and technologists; food engineers; nutritionists and other health professionals; and libraries of institutions where food science is studied and researched.
The use of aphrodisiacs dates back thousands of years in Chinese, Indian, Egyptian, Roman, and Greek cultures. Although the scientific basis of these substances was not understood, aphrodisiacs were valued for their ability to enhance the sexual experience. Their use allowed for human procreation and the ability to obtain a sexually fulfilling relationship. Aphrodisiacs used historically include ambrein, Bufo toad, Spanish fly, yohimbine, Tribulus terrestris, horny goat weed, muira puama, MACA root, Panax ginseng, nutmeg, saffron, and cacao. Previous studies on these substances have shown potential aphrodisiac properties using animal models and in human clinical trials. Aphrodisiacs were shown to relax corpus cavernosum smooth muscle tissue in animals, improve erection quality in humans and animals, or increase sexual behavior and satisfaction in humans and animals. Although most studies showed positive effects of aphrodisiacs on sexual enhancement, more studies are needed to understand their mechanism of action. The need for clinical trials using larger populations is also evident to prove the effectiveness of aphrodisiacs for human use. This paper will review recent scientific studies conducted on these commonly used aphrodisiacs, and determine whether the results support or refute their use for human sexual enhancement.
Sexuality and sexual performance have always captured the interest of men and their therapists. For centuries (even millennia), phytotherapy was the only effective therapeutic “recourse”; the other forms of treatment being most often hazardous or void of any foundation and sometimes even toxic. The 20th century saw the explosion of “scientific” medicine based on evidence and therapies with synthetic medications, excluding at the outset, traditional medications, notably phytotherapy and other alternative therapies. Nevertheless, the end of the 20th century saw a certain return to basics with alternative medicines having a place alongside traditional medicine, including in sexology and this in spite of the marketing of phosphodiesterase type 5 inhibitors, the first oral synthesized drugs that were actually effective in dealing with erection difficulties. Today, dietetics and quality of life are credited with overcoming stress, pollution, bland and industrial food and the search for performance with time relentlessly running out. This file, certainly incomplete, attempts to paint a picture of the principal plants and foods able to benefit sexual function. The authors also analyze the impact of vascular risk factors on sexuality and ask the question of the importance of prevention and of treatment of these risk factors in the “restoration” of sexual function. The authors will be glad to gather comments and suggestions from readers.
Throughout the ages, humans have searched for new ways of enhancing sexuality and sexual performance. We review some of the
more popular products, such as herbs, botanicals, combination products, and topical formulations that have been heralded as
sexual enhancers or have mythological roots suggesting they can be used for the treatment of sexual dysfunction. Lastly, we
discuss sexual touch (Tantra), aroma, nutrition, and exercise as modalities that have been used to improve or enhance sexual
All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption.
Cocoa and chocolate have been acclaimed for several years for their possible medicinal and heart benefits. It is only recently, however, that some of these claims have been more clearly identified and studied. Recent epidemiological and clinical studies, for example, have shown that dietary supplementation With flavonoid-rich cocoa and chocolate may exert a protective effect on low-density lipoprotein (LDL) oxidation, which has been associated with a reduced risk of developing atherosclerosis. Some of the identified benefits of flavonoid-rich cocoa and chocolate include antioxidant properties, reduced blood pressure via the induction of nitric-oxide (NO)-dependent vasodilation in men, improved endothelial function, increased insulin sensitivity, decreased platelet activation and function, as well as modulated immune function and inflammation. Furthermore, chocolate has been reported to release phenylethylamine and serotonin into the human system, producing some aphrodisiac and mood-lifting effects. Since these claims could have implications for the consumption levels of cocoa and chocolate products on the global market, understanding the critical factors involved and their potential benefits are currently thought to be of great importance to consumers.
IntroductionThe Food and Drug Administration defines an aphrodisiac drug product as “any product that bears labeling claims that it will arouse or increase sexual desire, or that it will improve sexual performance.” Presently, there are no approved medications for the treatment of lowered desire for women, and many opt for “natural” products.AimThe aim of this article was to review the most popular and currently used aphrodisiac products marketed in the United States. The safety and efficacy of animal- and plant-based aphrodisiacs, vitamins and minerals, and popular over-the-counter combination supplements have been reviewed.Methods
An English PubMed literature search was performed using the key words “sexuality,” “sex,” “aphrodisiac,” and “sexual enhancer.” Approximately 50 articles were reviewed by the authors. The authors used relevant case series, case-controlled, and randomized clinical trial data.Main Outcome MeasuresProducts were evaluated based on the quality of research, and their known efficacy and safety considerations. Products with low risk and potential benefit for sexual response based on prior research studies were highlighted.ResultsResearch has demonstrated that the risks of yohimbine, Spanish fly, mad honey, and Bufo toad may outweigh any benefit, and these products should be avoided. Other products, such as Maca, Tribulus, Ginkgo, and ginseng, have limited but emerging data. Randomized clinical trial data are often lacking, but future research should be performed to further elucidate the efficacy and safety of these products.Conclusion
Future randomized clinical trials are warranted before health care practitioners can recommend most aphrodisiac products. There remain some medical concerns with drug interactions, purity, reliability, and safety. West E and Krychman M. Natural aphrodisiacs—A review of selected sexual enhancers. Sex Med Rev **;**:**–**.
Sexuality and sexual performance have always captured the interest of men and therapists all over the world. For centuries (even millennia), phytotherapy was the only effective therapeutic "recourse"; the other forms of treatment being most often hazardous or void of any foundation and sometimes even toxic. The 20 th century saw the explosion of "scientific" medicine based on evidence and therapies with synthetical medications, excluding at the outset, traditional medications, notably phytotherapy and other alternative therapies. Nevertheless, the end of the 20 th century saw a certain "return to the sources" with the alternative therapies regaining a place alongside the classic medicine, including in sexology and this, in spite of the marketing of the phosphodiesterase type 5 inhibitors, the first oral synthesized drugs that are actually effective to treat erectile dysfunction. • Several placebo-controlled studies demonstrated the efficacy of ginseng to improve libido and erection • Ginger and ginkgo biloba proved as effective as a placebo • The truffle (Tuber melanosporum) known for centuries as having aphrodisiac properties contains a substance close to testosterone : the 5-α-androst-16-en-3α-ol steroïd • Cacao contains several "psycho-active" substances: theobromin, phenylethylamin... Chocolate: a brain stimulator? • (Red) wine, at low dosages, has positive effects on sexual interest and ejaculation. Furthermore the cardioprotective properties of red wine (the so-called French Paradox) have been confirmed • Today the impact of the vascular risk factors on sexual function is well known. Prevention of erectile dysfunction is recommended by adopting a adapted diet and life style.
Over the course of the reproductive life span, it is common for women to experience one or more of the most common gynecologic conditions, including sexual dysfunction, polycystic ovary syndrome, fibroids, endometriosis, and infertility. Although current management guidelines often turn to the established pharmaceutical approaches for each of these diagnoses, the scientific literature also supports an evidence-based approach rooted in the paradigm of food as medicine. Achieving healthy dietary patterns is a core goal of lifestyle medicine, and a plant-forward approach akin to the Mediterranean diet holds great promise for improving many chronic gynecologic diseases. Furthermore, creating an optimal preconception environment from a nutritional standpoint may facilitate epigenetic signaling, thus improving the health of future generations. This state-of-the-art review explores the literature connecting diet with sexual and reproductive health in premenopausal women.
Many cultures throughout history have passed down knowledge rumored to enhance sexual performance of both men and women including sexual techniques, foods, and nutritional supplements. Sexual techniques can take the form of stimulating certain aspects of the female anatomy and sexual positions such as stimulation of the Grafenberg “G” spot. Other techniques focus on the psychological aspects of sex including synchronization of orgasms and ejaculation prolongation. Cultures around the world have imbued foods as aphrodisiacs, in addition to herbs, plants, and other dietary supplements, collectively known as nutraceuticals. Among the more common ones are pomegranates, antioxidant rich foods, omega-3, basil, cardamom, garlic, watermelon, oysters, l-arginine, caffeine, and dehydroepiandrosterone (DHEA). Herbs such as Chlorophytum borivilianum of the Indian subcontinent to Lepidium meyenii of the South American Andes have long been reported to have aphrodisiac qualities. Many of these products are rich in components that promote cardiovascular health, produce anti-inflammatory activity, cause vasodilatation and increase androgen levels—all important factors in sexual performance. This chapter reviews the various sexual enhancement techniques, foods, and nutraceuticals and the evidence to support their use.
Media and popular literature link chocolate and sex-interest in women, but there is little research examining their association. This cross-sectional analysis sought to address this gap by assessing the relation of chocolate-consumption frequency to self-rated interest in sex. Seven-hundred twenty-three (723) Southern California men and women, age >20, completed surveys providing chocolate-consumption frequency (Choc0, x/week) and interest in sex (rated 0-10). Regression (robust standard errors) examined the relationship of chocolate-consumption frequency (Choc0, x/week) to sex-interest, adjusted for potential confounders. Tests for gender and age interactions guided gender- and age-stratified analyses. The mean sex-interest was 7.0±3.0 overall; 5.7±3.1 in women and 7.4±2.8 in men. The reported chocolate frequency was 2.0±2.5x/week overall; 2.5±2.8x/week in women and 1.8±2.4x/week in men. Those who ate chocolate more frequently reported lower interest in sex. Significance was sustained with an adjustment: per-time-per-week chocolate was eaten, β=-0.11(SE=0.050), p=0.02. The gender interaction was significant (p=0.03). The gender-stratified analysis showed the effect was driven by the much stronger relation in women: full model, per time-per-week chocolate consumed, β=-0.26(SE=0.08), p=0.002. Chocolate-consumption frequency was the strongest assessed predictor of sex-interest in women. A relationship was not observed in men, though a trend was present in younger men. Women who ate chocolate more frequently reported less interest in sex, a finding not explained by assessed potential confounders. Popular portrayals in which chocolate is represented as substituting for sex and "satisfying" the need for sex in women represent one possible explanation for these findings.
Urologists have led the basic science and clinical research of organic-based issues in male sexual dysfunction. Concerning scientific, evidence-based, biologic-focused information, the field of sexual dysfunction in women is relatively new compared with sexual dysfunction in men. Basic science, epidemiology, physiology, pathophysiology, diagnosis, and treatment data on women's sexual health issues are now more regularly published than ever before, with the urologic community once again leading the way. This article reviews some pioneering, resourceful, creative, and novel contributions that urologists have made to enhance the understanding of sexual dysfunction in women. As is obvious in infertility treatment, sexual medicine health care requires biologic and psychologic attention to both members of the couple. The goal of all sexual medicine health care providers is to provide the best health care delivery to women and men with sexual health concerns.
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
A recent major theory was that a meal high in carbohydrate increased the rate that tryptophan enters the brain, leading to an increase in the level of the neurotransmitter serotonin that modulates mood. Although such a mechanism may be important under laboratory conditions it is unlikely to be of significance following the eating of any typical meal. As little as 2-4% of the calories of a meal as protein will prevent an increased availability of tryptophan. Arguably the food with the greatest impact on mood is chocolate. Those who crave chocolate tend to do so when they feel emotionally low. There have been a series of suggestions that chocolate's mood elevating properties reflect 'drug-like' constituents including anandamines, caffeine, phenylethylamine and magnesium. However, the levels of these substances are so low as to preclude such influences. As all palatable foods stimulate endorphin release in the brain this is the most likely mechanism to account for the elevation of mood. A deficiency of many vitamins is associated with psychological symptoms. In some elderly patients folate deficiency is associated with depression. In four double-blind studies an improvement in thiamine status was associated with improved mood. Iron deficiency anaemia is common, particularly in women, and is associated with apathy, depression and rapid fatigue when exercising.
Arachidonylethanolamide, an arachidonic acid derivative in porcine brain, was identified in a screen for endogenous ligands
for the cannabinoid receptor. The structure of this compound, which has been named "anandamide," was determined by mass spectrometry
and nuclear magnetic resonance spectroscopy and was confirmed by synthesis. Anandamide inhibited the specific binding of a
radiolabeled cannabinoid probe to synaptosomal membranes in a manner typical of competitive ligands and produced a concentration-dependent
inhibition of the electrically evoked twitch response to the mouse vas deferens, a characteristic effect of psychotropic cannabinoids.
These properties suggest that anandamide may function as a natural ligand for the cannabinoid receptor.
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.
To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.
Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.
A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey.
Risk of experiencing sexual dysfunction as well as negative concomitant outcomes.
Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.
The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
The medicinal use of cacao, or chocolate, both as a primary remedy and as a vehicle to deliver other medicines, originated in the New World and diffused to Europe in the mid 1500s. These practices originated among the Olmec, Maya and Mexica (Aztec). The word cacao is derived from Olmec and the subsequent Mayan languages (kakaw); the chocolate-related term cacahuatl is Nahuatl (Aztec language), derived from Olmec/Mayan etymology. Early colonial era documents included instructions for the medicinal use of cacao. The Badianus Codex (1552) noted the use of cacao flowers to treat fatigue, whereas the Florentine Codex (1590) offered a prescription of cacao beans, maize and the herb tlacoxochitl (Calliandra anomala) to alleviate fever and panting of breath and to treat the faint of heart. Subsequent 16th to early 20th century manuscripts produced in Europe and New Spain revealed >100 medicinal uses for cacao/chocolate. Three consistent roles can be identified: 1) to treat emaciated patients to gain weight; 2) to stimulate nervous systems of apathetic, exhausted or feeble patients; and 3) to improve digestion and elimination where cacao/chocolate countered the effects of stagnant or weak stomachs, stimulated kidneys and improved bowel function. Additional medical complaints treated with chocolate/cacao have included anemia, poor appetite, mental fatigue, poor breast milk production, consumption/tuberculosis, fever, gout, kidney stones, reduced longevity and poor sexual appetite/low virility. Chocolate paste was a medium used to administer drugs and to counter the taste of bitter pharmacological additives. In addition to cacao beans, preparations of cacao bark, oil (cacao butter), leaves and flowers have been used to treat burns, bowel dysfunction, cuts and skin irritations.
Dopamine (DA) is responsive to hormonal manipulations and has been implicated in the regulation of female rat sexual behavior. In the present studies, extracellular DA levels were assessed in the medial preoptic area (MPOA) of ovariectomized female rats in response to exogenous ovarian hormones and during sexual activity. In female rats primed with a low dose of estradiol benzoate (2 microg), but not with a higher dose (20 microg), a 500-microg progesterone injection increased extracellular DA and facilitated copulatory behavior. Extracellular DA levels in the MPOA were further augmented during sexual interactions with a male rat in a nonpacing copulatory chamber by either perineal or vaginal stimulation. However, in a pacing chamber, DA efflux did not increase, although the metabolites rose significantly during copulation. Together, these findings suggest that extracellular DA in the MPOA responds to the hormonal state of the female rat and may contribute to her expression of sexual behavior.
A review of the literature indicates that serotonin is active in several peripheral mechanisms that are likely to affect female sexual functioning. Serotonin has been found in several regions of the female genital tract in both animals and humans. In the central nervous system (CNS), serotonin acts primarily as a neurotransmitter, but in the periphery, serotonin acts primarily as a vasoconstrictor and vasodilator. Since, in the periphery, the principal component of sexual arousal is vasocongestion of the genital tissue, it is likely that serotonin participates in producing normal sexual arousal. In addition, serotonin administration produces contraction of the smooth muscles of the genito-urinary system and is found in nerves innervating the sexual organs. Taken together, this evidence suggests that peripheral serotonergic activity may be involved in the normal sexual response cycle. In addition, exogenous substances that alter serotonin activity, such as selective serotonin uptake inhibitors (SSRIs) and the atypical antipsychotics, can produce sexual dysfunction. It is possible that sexual side effects seen with these drugs may result, at least in part, from their action on peripheral mechanisms.
We performed successive H(2)(15)O-PET scans on volunteers as they ate chocolate to beyond satiety. Thus, the sensory stimulus and act (eating) were held constant while the reward value of the chocolate and motivation of the subject to eat were manipulated by feeding. Non-specific effects of satiety (such as feelings of fullness and autonomic changes) were also present and probably contributed to the modulation of brain activity. After eating each piece of chocolate, subjects gave ratings of how pleasant/unpleasant the chocolate was and of how much they did or did not want another piece of chocolate. Regional cerebral blood flow was then regressed against subjects' ratings. Different groups of structures were recruited selectively depending on whether subjects were eating chocolate when they were highly motivated to eat and rated the chocolate as very pleasant [subcallosal region, caudomedial orbitofrontal cortex (OFC), insula/operculum, striatum and midbrain] or whether they ate chocolate despite being satiated (parahippocampal gyrus, caudolateral OFC and prefrontal regions). As predicted, modulation was observed in cortical chemosensory areas, including the insula and caudomedial and caudolateral OFC, suggesting that the reward value of food is represented here. Of particular interest, the medial and lateral caudal OFC showed opposite patterns of activity. This pattern of activity indicates that there may be a functional segregation of the neural representation of reward and punishment within this region. The only brain region that was active during both positive and negative compared with neutral conditions was the posterior cingulate cortex. Therefore, these results support the hypothesis that there are two separate motivational systems: one orchestrating approach and another avoidance behaviours.
The Maya archaeological site at Colha in northern Belize, Central America, has yielded several spouted ceramic vessels that contain residues from the preparation of food and beverages. Here we analyse dry residue samples by using high-performance liquid chromatography coupled to atmospheric-pressure chemical-ionization mass spectrometry, and show that chocolate (Theobroma cacao) was consumed by the Preclassic Maya as early as 600 bc, pushing back the earliest chemical evidence of cacao use by some 1,000 years. Our application of this new and highly sensitive analytical technique could be extended to the identification of other ancient foods and beverages.
There is some speculation that dietary flavonoids from chocolate, in particular (-)epicatechin, may promote cardiovascular health as a result of direct antioxidant effects or through antithrombotic mechanisms. Here we show that consumption of plain, dark chocolate (Fig. 1) results in an increase in both the total antioxidant capacity and the (-)epicatechin content of blood plasma, but that these effects are markedly reduced when the chocolate is consumed with milk or if milk is incorporated as milk chocolate. Our findings indicate that milk may interfere with the absorption of antioxidants from chocolate in vivo and may therefore negate the potential health benefits that can be derived from eating moderate amounts of dark chocolate.
Dark chocolate derived from the plant (Theobroma cacao) is a rich source of flavonoids. Cardioprotective effects including antioxidant properties, inhibition of platelet activity, and activation of endothelial nitric oxide synthase have been ascribed to the cocoa flavonoids.
To investigate the effects of flavonoid-rich dark chocolate on endothelial function, measures of oxidative stress, blood lipids, and blood pressure in healthy adult subjects.
The study was a randomized, double-blind, placebo-controlled design conducted over a 2 week period in 21 healthy adult subjects. Subjects were randomly assigned to daily intake of high-flavonoid (213 mg procyanidins, 46 mg epicatechin) or low-flavonoid dark chocolate bars (46 g, 1.6 oz).
High-flavonoid chocolate consumption improved endothelium-dependent flow-mediated dilation (FMD) of the brachial artery (mean change = 1.3 +/- 0.7%) as compared to low-flavonoid chocolate consumption (mean change = -0.96 +/- 0.5%) (p = 0.024). No significant differences were noted in the resistance to LDL oxidation, total antioxidant capacity, 8-isoprostanes, blood pressure, lipid parameters, body weight or body mass index (BMI) between the two groups. Plasma epicatechin concentrations were markedly increased at 2 weeks in the high-flavonoid group (204.4 +/- 18.5 nmol/L, p < or = 0.001) but not in the low-flavonoid group (17.5 +/- 9 nmol/L, p = 0.99).
Flavonoid-rich dark chocolate improves endothelial function and is associated with an increase in plasma epicatechin concentrations in healthy adults. No changes in oxidative stress measures, lipid profiles, blood pressure, body weight or BMI were seen.
The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.
Cocoa products are sources of flavan-3-ols, which have attracted interest regarding cardiovascular health. This review provides a survey of our research on the effects of cocoa polyphenols on leukotriene and nitric oxide (NO) metabolism and on myeloperoxidase-induced modification of LDL. Because intake of flavonoid-rich chocolate by human subjects was reported to decrease the plasma concentrations of proinflammatory cysteinyl leukotrienes, we assessed whether cocoa polyphenols inhibited human 5-lipoxygenase, the key enzyme of leukotriene synthesis. (-)-Epicatechin and other cocoa flavan-3-ols proved to be inhibitory at the enzyme level. This action may confer antileukotriene action in vivo. In a double-blind crossover study, 20 individuals at risk for cardiovascular diseases received cocoa beverages with high or low contents of flavan-3-ols. NO-dependent, flow-mediated dilation of the brachial artery and concentrations of nitroso compounds in plasma were measured, and it was shown that ingestion of the high-flavanol coca drink but not the low-flavanol cocoa drink significantly increased plasma concentrations of nitroso compounds and flow-mediated dilation of the brachial artery. Therefore, ingested flavonoids may reverse endothelial dysfunction through enhancement of NO bioactivity. Oxidative modification of LDL appears to be crucial for atherogenesis, and one of the mediators is the proinflammatory proatherogenic enzyme myeloperoxidase. Micromolar concentrations of (-)-epicatechin or other flavonoids were found to suppress lipid peroxidation in LDL induced by myeloperoxidase in the presence of physiologically relevant concentrations of nitrite, an NO metabolite. Adverse effects of NO metabolites, such as nitrite and peroxynitrite, were thus attenuated.
Responses to three different presentations of a highly liked food (chocolate) were measured in two groups of female subjects. One group of subjects identified themselves as overeaters of chocolate (overeaters), while the other group of subjects were of a similar age and body mass index, but ate this food in moderation (controls). The three conditions of presentation were (a) a fixed amount of milk chocolate; (b) ad lib access to milk chocolate; and (c) a self-selected amount of the individual's most preferred form of chocolate. The main findings were that variables associated with the excitation of appetite (hunger, desire to eat, prospective consumption) were higher in overeaters and variables associated with the inhibition of appetite (fullness, changes in pleasantness and pleasure of eating) were lower in overeaters relative to controls. It is suggested that investigations of individuals who eat certain foods to excess can inform our understanding of normative and aberrant eating behaviour.
Experiments were performed to find biochemical evidence of an activation of endogenous opiate peptides in the brain by incentive reward. A method used to estimate specific in vivo opiate binding in rats using the labelled opiate agonist, 3H-etorphine, indicated a considerable reduction in opiate binding exclusively in the hypothalamus of non-deprived animals given a highly palatable food to eat for 20 min. Radioimmunoassay of the hypothalamus of rats under similar conditions found a pronounced drop in the concentration of beta-endorphin, but not in dynorphin, in the hypothalamus, indicating a release and breakdown of beta-endorphin. Therefore, the reduction in opiate binding in the hypothalamus may at least be partially explained by an occupation of opiate receptors by beta-endorphin, causing a reduced availability of receptors to etorphine. A possible role of hypothalamic beta-endorphin in the facilitation of reward pathways in the brain is discussed.
Although certain commonalities exist between eating and drug use (mood effects, external cue-control of appetites, reinforcement, etc.), it is argued that the vast majority of cases of (self-reported) food craving and food “addiction” should not be viewed as addictive behavior. An explanation is proposed that instead gives a prominent role to the psychological processes of ambivalence and attribution, operating together with normal mechanisms of appetite control, the hedonic effects of certain foods, and socially and culturally determined perceptions of appropriate intakes and uses of those foods. Ambivalence (e.g., “nice but naughty”) about foods such as chocolate arises from the attitude that it is highly palatable but should be eaten with restraint. Attempts to restrict intake, however, cause the desire for chocolate to become more salient, an experience that is then labelled as a craving. This, together with a need to provide a reason for why resisting eating chocolate is difficult and sometimes fails, can, in turn, lead the individual to an explanation in terms of addiction (e.g., “chocoholism”). Moreishness (“causing a desire for more”) occurs during, rather than preceding, an eating episode, and is experienced when the eater attempts to limit consumption before appetite for the food has been sated.
At least three categories of atypical depression have been described. The hysteroid dysphoria is characterized by repeated episodes of depressed mood in response to feeling rejected, and a craving for sweets and chocolate. Two other issues are characterized by a cyclical occurrence of changes of mood and appetite, i.e., the late luteal phase dysphoric disorder (DSM-III-R, appendix), or “the premenstrual syndrome” (PMS), and the major depression with seasonal pattern (DSM-III-R), or seasonal affective disorder (SAD). The reactive mood changes are frequently accompanied by features as hypersomnia, lethargy and increased appetite, particularly with a preference for carbohydrates.
Central serotonin pathways participate in the regulation of mood and behavioural impulsivity, and modulate eating patterns qualitatively and quantitatively. Depressives with PMS og SAD benefit, in general, from treatments with serotonin potentiating drugs, suggesting that brain serotonin plays a role in the pathophysiology. Ingestion of carbohydrates increases the plasma ratio of tryptophan to other large neutral amino acids in man and animal, and the serotonin synthesis in the rat brain. Based on these findings it has been suggested that the excessive carbohydrate intake by patients with PMS and SAD reflects a selfmedication that temporarily relieves the vegetative symptoms via an increased central serotonergic activity.
A questionnaire was administered to over 1000 male and female college undergraduates to collect self-reports regarding food cravings (defined as an intense desire to eat a specific food). Ninety-seven per cent of woman and 68 per cent of men reported experiencing food cravings. Chocolate was the most frequently reported food craved, especially among women. The majority of subjects reported that they indulged their food cravings at least half the time. Females tended to respond with more negative affect to indulging their cravings than men. Only 32 per cent of women perceived that their cravings were linked to menstrual cycles. There was no tendency for an increase in food cravings with dietary restraint. The data provided a detailed description of perceptions regarding food cravings among college-age adults, but also underscored some of the limitations of self-report measures of food craving. In spite of these limitations, however, the results challenge several assumptions regarding food craving and highlight some promising avenues for future investigation.
Although several self-rating scales for depression have been proposed in the past two decades, very few have been validated on non-English-speaking populations. The present study was carried out in northern Italy in order to examine the validity of the CES-D self-rating scale for depression in another language and culture. The scale was used with 40 depressives and 40 normals who were matched. The Hamilton Rating Scale for Depression (HRSD) was used as an additional test of concurrent validity. The results show that the CES-D is a valid measure in that it sensitively discriminates between depressed patients and normals and presents satisfactory correlations with the observer rating scale (HRSD) in both groups. The scale in its Italian translation is likely to be helpful in the assessment of depression of Italian immigrants in North America and Australia, especially in those whose English is poor.
To test the hypothesis that some foods are eaten to alter mood, the relationship between mood and intake of chocolate was investigated in 40 women. Twenty self-identified chocolate 'addicts' and 20 controls rated hunger, mood, intensity of craving and amount of chocolate eaten in a diary for seven consecutive days. The 'addicts' reported a significantly greater number of eating episodes and consumed a larger amount of chocolate than controls. 'Addicts' also rated depression, guilt and craving higher and feeling content and relaxed as lower before eating than controls. However, eating chocolate resulted in increased feelings of guilt in the 'addicts' and no significant changes in feeling depressed or relaxed. On indices of disordered eating and depression, 'addicts' scored significantly higher than controls; however, eating chocolate did not improve mood. Although chocolate is a food which provides pleasure, for those who consider intake of this food to be excessive, any pleasure experienced is short lived and accompanied by feelings of guilt.
Score on a scale of attitude towards the consumption of five high-fat foods and their low-fat alternatives was correlated with the energy percentage of fat in the diet across 419 subjects. Attitudes towards low-fat alternatives were more positive than towards high-fat foods. Mean energy percentage of fat in the diet was 38.8% (SD 7.1). The attitude scale explained 25% of the variance in percentage energy as fat. Test-retest reliability of the attitude scale (n = 25) was 0.92 (95% confidence limits 0.82 and 0.97). The reproducibility of energy percentage fat in the diet (n = 33) was 0.64 (95% confidence limits 0.38 and 0.81). Differences in attitude score were found between men and women, subjects following a dietary treatment and those who did not, and subjects with a fat intake according to the Dutch dietary guidelines and those who had not (p < 0.001). Fat intake (expressed as percentage of energy intake) differed between age groups (p < 0.05), and between subjects following a special diet and those who did not (p < 0.001). No difference in attitude score or energy percentage of fat was found for education level, occupation level, body mass index or household size. It is concluded that attitudes towards high-fat foods and their low-fat alternatives are useful in understanding fat intake.
The purpose of this baseline survey was to obtain comparable data on perceived influences on food choice from EU member countries as the starting point for EU healthy eating promotion campaigns and programmes.
A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire.
The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union.
14331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state.
The five most important factors influencing consumers food choice were 'quality or freshness' (74%), 'price' (43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'family preferences' (29%). Subjects in different categories (age, sex, education and employment status) selected different factors as having major influence on their food choice. Demographic factors seemed to have greater effects on perceived influences than culture (country): 'quality/freshness', 'price', 'trying to eat healthy', 'family preferences' seemed to be most important in women, 'taste' and 'habit' in males. Females and older and more educated subjects were more likely than other subjects to select 'trying to eat healthy' as having a major influence. 'Price' seemed most important in unemployed and retired subjects.
We investigated brain circuitry mediating cocaine-induced euphoria and craving using functional MRI (fMRI). During double-blind cocaine (0.6 mg/kg) and saline infusions in cocaine-dependent subjects, the entire brain was imaged for 5 min before and 13 min after infusion while subjects rated scales for rush, high, low, and craving. Cocaine induced focal signal increases in nucleus accumbens/subcallosal cortex (NAc/SCC), caudate, putamen, basal forebrain, thalamus, insula, hippocampus, parahippocampal gyrus, cingulate, lateral prefrontal and temporal cortices, parietal cortex, striate/extrastriate cortices, ventral tegmentum, and pons and produced signal decreases in amygdala, temporal pole, and medial frontal cortex. Saline produced few positive or negative activations, which were localized to lateral prefrontal cortex and temporo-occipital cortex. Subjects who underwent repeat studies showed good replication of the regional fMRI activation pattern following cocaine and saline infusions, with activations on saline retest that might reflect expectancy. Brain regions that exhibited early and short duration signal maxima showed a higher correlation with rush ratings. These included the ventral tegmentum, pons, basal forebrain, caudate, cingulate, and most regions of lateral prefrontal cortex. In contrast, regions that demonstrated early but sustained signal maxima were more correlated with craving than with rush ratings; such regions included the NAc/SCC, right parahippocampal gyrus, and some regions of lateral prefrontal cortex. Sustained negative signal change was noted in the amygdala, which correlated with craving ratings. Our data demonstrate the ability of fMRI to map dynamic patterns of brain activation following cocaine infusion in cocaine-dependent subjects and provide evidence of dynamically changing brain networks associated with cocaine-induced euphoria and cocaine-induced craving.
The present studies sought to examine the effect of olfactory stimulation on human Central Nervous System activity. In the first experiment (n = 21), EEG response to the 'synthetic' odours of chocolate, spearmint, almond, strawberry, vegetable, garlic and onion, and cumin or no odour was recorded from 19 electrodes (F3, F4, F7, F8, Fz, T3, T4, T5, T6, P3, P4, Pz, O1, O2, C3, C4, Cz) in all EEG frequencies (delta, theta, alpha, beta1 and beta2). Exposure to the odour of chocolate was associated with significant reductions in theta activity when compared with the odours of almond and cumin, with a trend towards significance when compared with no-odour control. Exposure to the odour of spearmint was associated with a significant reduction in EEG theta when compared with the no-odour control. No significant effects were observed in other frequencies. In a second experiment (n = 15), EEG response to the odours of real foods (chocolate, baked beans, rotting pork) and two controls (no odour and hot water) was recorded as in Experiment 1. The odour of chocolate was associated with significantly less theta activity than was any other stimulus. It is hypothesised that the alterations in theta reflect shifts in attention or cognitive load during olfactory perception, with a reduction in theta indicating a reduced level of attention.
Health and Taste Attitudes Questionnaires were developed to assess consumers' orientations toward the health and hedonic characteristics of foods. Items were generated in a qualitative study. The original 37 items on health and 44 on taste were rated from "strongly disagree" to "strongly agree" by a representative sample of 1005 Finnish adults (18-81 years). The number of items was reduced using factor and item analysis, resulting in 20 health- and 18 taste-related statements. Three health-related and three taste-related factors were extracted. The health-related factors were labelled as "General health interest", "Light product interest", and "Natural product interest". The taste-related factors were named "Craving for sweet foods", "Using food as a reward", and "Pleasure". Cronbach's alphas of the multi-item scales, based on the statements loading highly on each factor, ranged from 0.67 to 0.89. Age and gender affected the responses. Females were more interested in the health and taste aspects of foods than were males. Younger respondents were less concerned with health but more interested in taste than were older respondents. A preliminary test of predictive validity was conducted by analysing subjects' responses to foods with weak and strong connotations of health and taste, and currently the questionnaires are being validated with further behavioural tests.
Although addictive behavior is generally associated with drug and alcohol abuse or compulsive sexual activity, chocolate may evoke similar psychopharmacologic and behavioral reactions in susceptible persons. A review of the literature on chocolate cravings indicates that the hedonic appeal of chocolate (fat, sugar, texture, and aroma) is likely to be a predominant factor in such cravings. Other characteristics of chocolate, however, may be equally as important contributors to the phenomena of chocolate cravings. Chocolate may be used by some as a form of self-medication for dietary deficiencies (eg, magnesium) or to balance low levels of neurotransmitters involved in the regulation of mood, food intake, and compulsive behaviors (eg, serotonin and dopamine). Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menses, which suggests a hormonal link and confirms the assumed gender-specific nature of chocolate cravings. Chocolate contains several biologically active constituents (methylxanthines, biogenic amines, and cannabinoid-like fatty acids), all of which potentially cause abnormal behaviors and psychological sensations that parallel those of other addictive substances. Most likely, a combination of chocolate's sensory characteristics, nutrient composition, and psychoactive ingredients, compounded with monthly hormonal fluctuations and mood swings among women, will ultimately form the model of chocolate cravings. Dietetics professionals must be aware that chocolate cravings are real. The psychopharmacologic and chemosensory effects of chocolate must be considered when formulating recommendations for overall healthful eating and for treatment of nutritionally related health issues.
Although certain commonalities exist between eating and drug use (mood effects, external cue-control of appetites, reinforcement, etc. ), it is argued that the vast majority of cases of (self-reported) food craving and food "addiction" should not be viewed as addictive behavior. An explanation is proposed that instead gives a prominent role to the psychological processes of ambivalence and attribution, operating together with normal mechanisms of appetite control, the hedonic effects of certain foods, and socially and culturally determined perceptions of appropriate intakes and uses of those foods. Ambivalence (e.g., "nice but naughty") about foods such as chocolate arises from the attitude that it is highly palatable but should be eaten with restraint. Attempts to restrict intake, however, cause the desire for chocolate to become more salient, an experience that is then labelled as a craving. This, together with a need to provide a reason for why resisting eating chocolate is difficult and sometimes fails, can, in turn, lead the individual to an explanation in terms of addiction (e.g., "chocoholism"). Moreishness ("causing a desire for more") occurs during, rather than preceding, an eating episode, and is experienced when the eater attempts to limit consumption before appetite for the food has been sated.
The aim of this work was to search for eating disorders, DSM III-R Axis I mental disorders, personality disorders, and addictive behavior, in self-labeled "chocolate addicts". Subjects were recruited through advertisements placed in a university and a hospital. Fifteen subjects were included, 3 men and 12 women aged between 18 and 49. Most of them were not overweight, although 7 thought they had a weight problem. They consumed an average of 50 g per day of pure cacao and, for 13 subjects, this consumption was lasting since childhood or adolescence. The psychological effects of chocolate, as indicated by the subjects, consisted in feelings of increased energy or increased concentration ability, and in an anxiolytic effect during stress. Seven subjects described minor withdrawal symptoms. None of the subjects reached the thresholds for eating disorders on the EAT and BULIT scales. The structured interview (MINI) identified an important ratio of subjects with a history of major depressive episode (13/15), and one woman was currently experiencing a major depressive episode. Four people suffered, or had suffered from anxiety disorders. Although only one subject satisfied all criteria for a personality disorder on the DIP-Q, seven displayed some pathological personality features. The self-labeled "chocoholics" do not seem to suffer from eating disorders, but may represent a population of psychologically vulnerable and depression--or anxiety--prone people. They seem to use chocolate as a light psychotropic drug able to relieve some of their distress. The amount of cacao consumed, although very chronically, remains moderate, and they rarely display other addictive behaviors.
The Health and Taste Attitude Scales (HTAS) developed by Roininen, Lähteenmäki and Tuorila in 1999 measure the importance of health and taste aspects of foods in the food choice process. These multi-item scales consist of sets of statements, ranging from "strongly disagree" to "strongly agree", which further divide into three Health (General health interest, Light product interest and Natural product interest) and three Taste (Craving for sweet foods, Using food as a reward and Pleasure) sub-scales. Finnish (N=467), Dutch (N=477), and British (N=361) respondents completed a questionnaire which contained four components: the HTAS, a separate "paper and pencil task" of choosing a food for a snack; pleasantness, healthiness and frequency of consumption of eight foods; and the Restraint Eating Scale of the Dutch Eating Behaviour Questionnaire (DEBQ). The latter three components were included in order to validate various aspects of the HTAS. The factor structure of HTAS was found to be equal in all three countries. However, there were some minor differences in factor loadings among countries, e.g. the Natural product interest and Pleasure sub-scale items had lower factor loadings in the UK than in Finland and The Netherlands. Finnish respondents had the most positive attitude towards light products. Dutch and British respondents scored higher on all Taste sub-scales than their Finnish counterparts. Respondents' health-related attitudes were good predictors of their "healthy food choices" in the snack task and self-reported consumption. Two of the Taste sub-scales (Craving for sweet foods and Using food as a reward) predicted well respondents' self-reported consumption of, for example, full-fat chocolate bars. All the Health and two of the Taste sub-scales proved to be useful tools for characterizing consumer attitudes within and between countries.
Frequent and repeated exposure to foods produces stimulus satiation or monotony. To explore further the nature of stimulus satiation, two experiments were conducted. Experiment 1 investigated the influence of initial pleasantness and frequency of intake on monotony. Tests showed that bread and butter was eaten more frequently but was liked less than chocolate. Therefore, normal-weight, healthy males were randomly assigned to either a chocolate condition (CC, N=13) or bread and butter condition (BC, N=16). All subjects received fixed amounts of the assigned food (67g/1473kJ of chocolate or 95g/1355kJ of bread and butter) every day for 22 days. On days 1, 8, 15 and 22 subjects consumed this food ad libitum. Pleasantness of taste and desire to eat chocolate declined significantly over time but no such changes were observed for bread and butter. Experiment 2 examined intake, pleasantness and desire to eat chocolate in 53 subjects over a 15 day period, with 3 conditions: control (CS: N=15), fixed (FS: N=20) and variable (VS: N=18). CS received no chocolate except on test days (days 1, 8 and 15), FS received 67g/1473kJ of chocolate daily and VS received increasing amounts of chocolate from 57g/1251kJ on day 1 to 86g/1888kJ by day 12. Pleasantness and desire to eat chocolate declined over time with this being more pronounced for F and V subjects. However, ad libitum intake increased over time. Both experiments demonstrated significant changes in pleasantness and desire to eat chocolate, but no commensurate decline in intake. Thus, although stimulus satiation occurred for subjective ratings of pleasantness and desire to eat chocolate, intake remained unaffected. This apparent dissociation between pleasantness and intake may reflect different processes underlying liking and wanting.
Vaginal sexual arousal is a vasocongestive and neuromuscular event controlled by facilitatory parasympathetic and inhibitory sympathetic inputs. Autonomic preganglionic parasympathetic and inhibitory sympathetic fibers to the vagina and clitoris originate in the spinal cord in the sacral parasympathetic nucleus at the sacral level and in the dorsal gray commissure and the intermediolateral cell column at the thoracolumbar level, respectively. Parasympathetic fibers are conveyed by the pelvic nerve, and sympathetic fibers are conveyed by the hypogastric nerve and the paravertebral sympathetic chain. The activity of these spinal nuclei is controlled by descending projections from the brain and sensory afferens (conveyed in the pudendal, hypogastric, pelvic, and vagus nerves) from the genitalia. A key but unresolved issue concerns the neurotransmitters involved in the control of genital sexual arousal. At the peripheral level, acetylcholine plays a minor role in the regulation of vaginal blood flow, however, recent data suggests that it may be involved in the control of vaginal smooth muscle contractions. Vasoactive intestinal peptide and nitric oxide may be responsible for the increase in vaginal blood flow during sexual arousal, whereas noradrenaline is likely inhibitory. Within the central nervous system, serotoninergic projections from the brain to the spinal cord likely inhibit the induction of genital arousal by peripheral informations (spinal reflex). Although some neurotransmitters regulating the display of sexual behavior have been identified (for example, dopamine), their involvement in the control of genital sexual arousal has not been invested. Anatomical and electrophysiological data point to a contribution of the paraventricular nucleus of he hypothalamus and the median preoptic area, respectively, as key elements in the control of genital arousal. The recent development of models allowing the assessment of vaginal sexual arousal in anesthetized female rats should assist in deciphering the neurochemical pathways controlling vaginal sexual arousal and the development of suitable pharmacological treatment for female sexual dysfunctions.
Recent consensus-based characterizations of female sexual dysfunction have emphasized personal distress as an essential component of their definition. To assist researchers and clinicians, we developed a new scale, the Female Sexual Distress Scale, to measure sexually related personal distress in women. In this article, we describe the initial stages in the development and validation of this instrument. Three studies involving a total of approximately 500 women were performed to evaluate the reliability and validity of the scale in different samples of sexually functional and dysfunctional women. Results indicated a unidimensional factor structure in both the original 20-item version and in a "polished" 12-item version. We observed a high degree of internal consistency and test-retest reliability in both versions across all three studies. Additionally, the scale showed a high degree of discriminative ability to distinguish between sexually dysfunctional and functional women in each of the studies. One study also showed a strong sensitivity to treatment response. Finally, we observed moderate positive correlations with other conceptually related nonsexual measures of distress, supporting the construct validity of the scale. Overall, these findings provide solid support for the FSDS as a valid and reliable measure for assessing sexually related personal distress in women.
Human telomere maintenance is essential for the protection of chromosome ends, and changes in telomere length have been implicated in ageing and cancer. Human telomere length is regulated by the TTAGGG-repeat-binding protein TRF1 and its interacting partners tankyrase 1, TIN2 and PINX1 (refs 5-9). As the TRF1 complex binds to the duplex DNA of the telomere, it is unclear how it can affect telomerase, which acts on the single-stranded 3' telomeric overhang. Here we show that the TRF1 complex interacts with a single-stranded telomeric DNA-binding protein--protection of telomeres 1 (POT1)--and that human POT1 controls telomerase-mediated telomere elongation. The presence of POT1 on telomeres was diminished when the amount of single-stranded DNA was reduced. Furthermore, POT1 binding was regulated by the TRF1 complex in response to telomere length. A mutant form of POT1 lacking the DNA-binding domain abrogated TRF1-mediated control of telomere length, and induced rapid and extensive telomere elongation. We propose that the interaction between the TRF1 complex and POT1 affects the loading of POT1 on the single-stranded telomeric DNA, thus transmitting information about telomere length to the telomere terminus, where telomerase is regulated.
Consumption of flavonoid-rich beverages, including tea and red wine, has been associated with a reduction in coronary events, but the physiological mechanism remains obscure. Cocoa can contain extraordinary concentrations of flavanols, a flavonoid subclass shown to activate nitric oxide synthase in vitro.
To test the hypothesis that flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in humans.
The study prospectively assessed the effects of Flavanol-rich cocoa, using both time and beverage controls. Participants were blinded to intervention; the endpoint was objective and blinded.
Pulse wave amplitude was measured on the finger in 27 healthy people with a volume-sensitive validated calibrated plethysmograph, before and after 5 days of consumption of Flavanol-rich cocoa [821 mg of flavanols/day, quantitated as (-)-epicatechin, (+)-catechin, and related procyanidin oligomers]. The specific nitric oxide synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) was infused intravenously on day 1, before cocoa, and on day 5, after an acute ingestion of cocoa.
Four days of flavanol-rich cocoa induced consistent and striking peripheral vasodilation (P = 0.009). On day 5, pulse wave amplitude exhibited a large additional acute response to cocoa (P = 0.01). L-NAME completely reversed this vasodilation (P = 0.004). In addition, intake of flavanol-rich cocoa augmented the vasodilator response to ischemia. Flavanol-poor cocoa induced much smaller responses (P = 0.005), and none was induced in the time-control study. Flavanol-rich cocoa also amplified the systemic pressor effects of L-NAME (P = 0.005).
In healthy humans, flavanol-rich cocoa induced vasodilation via activation of the nitric oxide system, providing a plausible mechanism for the protection that flavanol-rich foods induce against coronary events.
Sexual dysfunction (SD) in women is a multifactorial condition with anatomical, physiological, medical, psychological and social components. Well-designed, random-sample, community-based epidemiological investigations of women with SD are limited. Current data reveal that up to 76% of women have some type of SD [1,2]. Population census data from the USA suggest that approximate to 10 million American women aged 50-74 years self-report complaints of diminished vaginal lubrication, pain and discomfort during intercourse, decreased arousal, and difficulty achieving orgasm. Laumann et al.  found that SD is more prevalent in women (43%) than in men (31%), and is associated with various psycho-demographic characteristics, e. g. age, education, and poor physical and emotional health. More importantly, women's SD (WSD) is associated with negative experiences in sexual relationships. Recently, Brock et al.  reported the results of an international survey aimed at assessing both the prevalence and predictors of SD among mature men and women. Among a population of 4507 subjects, decreased sexual interest was reported by 34% of women and 18% of men; moreover, 19% of women and 11% of men reported that they did not consider sex pleasurable. Of the women interviewed, 23% reported inadequate lubrication, with a significant increase in this complaint in women aged 50-69 years .
Oleamide is a lipid with diverse properties, including cannabinoid-like activity. For example, it induces the classic triad of effects attributable to these molecules: decrease in core temperature, hypolocomotion, and reduction in pain perception. However, as it binds to the cannabinoid receptors (CB1) only at high concentrations, it is not considered an actual endocannabinoid. In this study, we tested the effect of oleamide on food intake and sexual behavior and compared it to the effect induced by anandamide. Results indicate that oleamide and anandamide increased food intake during the 3h post-injection. In addition, anandamide but not oleamide induced changes in sexual performance. This study further supports the role of endocannabinoids in food ingestion and male sexual behavior and gives additional support to the notion that, although oleamide might not be an endocannabinoid, it shares some effects with them.
Animal studies suggest that induction of depression-like states may alter preference for sweet tastants. A major goal of the present study was to search for correlations between depressive symptoms measured by the Beck Depression Inventory (BDI) and taste responses to sweet and bitter substances. Thirty-three nonclinical volunteers rated intensity and pleasantness of chocolate and vanilla milk as well as of sucrose- and quinine-soaked filter paper disks. Reactivity to citric acid (sour) and sodium chloride (salty) was also tested with the paper disk methodology. Taste detection thresholds were assessed by means of electrogustometry. A weak inverse relationship was found between the BDI scores (range: 3-33) and rated intensity of paper disks soaked in 60% sucrose. No correlations were found between depressive symptoms and intensity, pleasantness or identification of the other samples. Similarly, there was no relationship between the BDI scores and responses to chocolate and vanilla milk. BDI scores were not associated with electrogustometric thresholds. These data suggest that depressive symptoms may not influence taste reactivity in nonclinical population.
To assess prevalence and risk factors for erectile dysfunction (ED) by using the International Index of Erectile Function- 5 (IIEF-5) in men undergoing a health investigation.
Men aged 20-80 years participating in a health-screening project in the area of Vienna completed the IIEF-5 for evaluation of ED. In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors, medical history and a blood analysis.
A total of 2869 men were analysed. According to the IIEF-5 score, 32.2% reported on any degree of ED (IIEF-5 score <22), 23.7% had mild ED (IIEF-5 score 17-21), 5.0% mild to moderate ED (IIEF-5 score 12-16), 2.2% moderate ED (IIEF-5 score 8-11) and 1.3% severe ED (IIEF-5 score 5-7). The proportion of men with ED remained stable from 20 to 50 years (26-29%) and increased thereafter to 37.5% (51-60 years) and to 71.2% in those 71-80 years of age. Severe ED (IIEF-5 score 5-7) increased from 0.4% (20-30 years) to 0.5% (41-50 years), 1.3% (51-60 years) and to 9.6% in those aged 71-80 years. Risk factors for ED were age, diabetes (OR: 3.0; 95%CI: 1.53-5.87), hyperlipidemia (OR: 2.29; 95%CI: 1.42-3.7), lower urinary tract symptoms (OR: 2.2; 95%CI: 1.76-2.76), hypertension (OR: 2.05; 95%CI: 1.61-2.6), psychological stress (OR: 1.68; 95%CI: 1.43-1.98) and low physical activity (OR: 1.35; 95%CI: 1.15-1.6) (all, p < 0.05).
Overall, 32.2% of men in our study had ED according to the IIEF-5. Apart from age, most important risk factors for ED were diabetes, hyperlipidemia, lower urinary tract symptoms, hypertension and psychological stress.
Scientific interest in the impact of aging on women's sexual function and dysfunction has increased in the half century since Kinsey described age-related changes in women's sexual activities. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area.
To review community-based studies investigating changes in women's sexual function and sexual dysfunction with age, taking into account confounders to aging and methodological limitations.
Electronic databases were searched for published studies investigating changes in sexual function and dysfunction with age. A critical review was carried out.
Age-related changes in sexual function and dysfunction.
There are inconsistencies in the way sexual function and sexual dysfunction are measured. Validated scales are infrequently used. Low response rates, limited age ranges, and restrictive inclusion criteria limit the generalizability of many studies. Confounders are often either not measured or not analyzed. Longitudinal studies are rare, making it difficult to separate the effects of birth cohort and aging. The evidence indicates that a woman's sexual function declines with age. This decline begins in a woman's late 20s to late 30s. Specifically, desire, frequency of orgasm, and frequency of sexual intercourse decrease with age. However, it is not clear whether arousal decreases or remains relatively constant. In longitudinal studies, decline in women's sexual function has also been detected, but patterns of stability and improved sexual function have also been observed for short periods of time. The prevalence of most sexual difficulties or dysfunctions changes little with age, with the exception of sexual pain, which may decrease.
Age-related changes in sexually related personal distress may help explain why the prevalence of sexual dysfunctions remains constant with age while sexual function declines. More research is needed to demonstrate this.
Food cravings in a college population
Brain mechanisms of palatability
Depressive symptoms and taste reactivity in humans
Flavanol‐rich cocoa induces nitric‐oxide‐dependent vasodilation in healthy humans