Cacao and Safety - Cacao Contraindications


Cacao (Theobroma cacao) is an evergreen tree whose fully fermented fruit seeds, known as “cacao beans,” are the main ingredient in Cacao Nibs, Cacao Paste, Cacao Butter, and Chocolate. Cacao contains many bioactive compounds and essential minerals that work together to support immune function, cardiovascular health, enhance cognitive function, elevate mood, and improve mental health, oxidative stress, metabolic syndrome, inflammatory conditions, fatigue, skin health, bone health and overall nutritional health. 

It is important to respect the more subtle but still very profound power of this plant medicine - she is not for everyone, but she is for most people! Whilst the health benefits of cacao are vast and scientific studies have shown cacao can assist with many symptoms and conditions naturally, there are a few precautions regarding its compatibility with some health disorders or medications, that should be explored before consuming cacao. Let’s take a look together…

  • Antidepressants 
    15-20g dose for anyone taking antidepressants and 5HTP consult health care professional if there are any concerns. Those on MAIO antidepressants should not consume cacao
  • Pregnancy & Breastfeeding 
    Cacao is generally considered safe in pregnancy and during breastfeeding when taken in moderation. We recommend a serving size of 15-20g for those pregnant or breastfeeding. 
  • GERD 
    It is best to begin consuming cacao in a smaller quantity (10-20g) to assess sensitivity. 
  • IBS 
    It is best to begin consuming cacao in a smaller quantity (10-20g) to assess sensitivity. 
  • Bleeding Disorders 
    Consult with a doctor prior to consumption if you have a bleeding disorder or are consuming any related medication. 
  • Children
    It is best for children to begin consuming cacao in a smaller quantity to assess sensitivity (15-20g). 
  • Heart Conditions 
    Consult with a doctor before using cacao and also begin with a lower dose (15-20g). 
  • High Blood Pressure 
    Consult with a doctor before using cacao and also begin with a lower dose (15-20g). 
  • Low Blood Pressure 
    Consult with a doctor before using cacao and also begin with a lower dose (15-20g). 
  • Sensitivities (e.g caffeine or stimulant sensitivities)
    It is best to begin consuming cacao in a smaller quantity (15-20g) to assess sensitivity. 
  • Medication use 
    It is best to consult with a doctor about all drugs and supplements you are using or considering, prior to the consumption of cacao


Cacao contains tryptophan, tryptamine and MAO (mono-amine oxidase) inhibitors that may cause a synergistic intensification when combined with antidepressants or 5-Hydroxytryptophan (5-HTP). As these components can increase or influence serotonin production caution should be taken when using cacao on some antidepressants. There is minimal research on this currently and for most it is unlikely to cause a problem but as a precaution we promote starting on lower doses of cacao (15-20g) for anyone taking antidepressants and consulting your health care professional if you have any concerns.

Cacao should however be avoided entirely when using the MAOI class of antidepressants due to the levels of tyramine in cacao. MAOI prevents the breakdown of tyramine, which causes levels to spike. As tyramine plays a role in blood pressure regulation, it can cause blood pressure to rapidly rise to dangerous levels. This is known as the ‘cheese effect’ as cheeses contain high levels of tyramine (higher than those in cacao). Fortunately MAOI based antidepressants are first generation antidepressants and are less common these days. People taking them are on a restricted diet that includes limiting or avoiding chocolate, so they should know if they can consume or not. If unsure about your antidepressants please consult your doctor first before consuming cacao.

Heart conditions

Cacao contains moderate-high levels of the methylxanthine theobromine and low levels of caffeine. The theobromine in cacao can increase heart rate and act as a vasodilator (opens blood vessels), lowering blood pressure. The stimulating effects of cacao as with all stimulants needs to be considered for those with heart conditions. As you would with coffee, we advise anyone with a heart condition to consult their doctor before using cacao and also to begin with lower doses (15-20g).

Conversely, flavanols - the primary health component found in cacao have been linked to multiple heart health benefits due to their potent antioxidant activity. Consumed in moderation cacao can be very beneficial for those with metabolic syndrome and heart disease.

Pregnancy & breastfeeding

Cacao is generally considered safe in pregnancy and during breastfeeding when taken in moderation. We recommend a serving size of 15-20g for those pregnant or breastfeeding. Although cacao contains much less caffeine than coffee (10x less), caffeine can cross the placenta producing fetal blood concentrations similar to the mother's levels. Some evidence suggests that high doses of caffeine during pregnancy might be associated with premature delivery, low birth weight, and miscarriage. Some experts advise keeping caffeine consumption below 200 mg per day during pregnancy, therefore it is suggested to monitor intake.

Caffeine is also a concern during breast-feeding. Breast milk concentrations of caffeine are thought to be approximately half the level of caffeine in the mother's blood. Caffeine excess may cause the nursing infant to become irritable and have too frequent bowel movements.

In traditional Mayan communities, cacao is often given to mothers as a health tonic as it is full of replenishing nutrients. cacao can affect different people in different ways so if you have any concerns about using cacao while pregnant or breast-feeding we advise you to discuss it with your medical practitioner prior to consumption.

Blood pressure

As a vasodilator and smooth muscle relaxant, cacao can improve blood flow and oxygenation. Although cacao has the potential to acutely increase blood pressure it does not appear to result in long term increases in resting blood pressure. In fact, the flavonoid activity of cacao has been shown over time to lower resting blood pressure. If you are on blood pressure medication or have high blood pressure we advise you to begin on (15-20g) of cacao and consult with your doctor before starting cacao.

Caffeine sensitivity

Although theobromine is a mild stimulant, for some it can be quite awakening or make some people feel a bit anxious. The activity of theobromine is more peripheral and not so specific to the central nervous system, providing less stimulation and more warming and awakening. Cacao contains far less caffeine than coffee - about a tenth of the amount. Some people often find they actually sleep really well and dream vividly after cacao, due to the other active constituents such as magnesium, tryptamine and tryptophan. For those with caffeine sensitivity, it is recommended to avoid drinking cacao in the evening, and start with a lower dose (15-20g) to find what dosage works best for you and what your sensitivity threshold is.


Some individuals are allergic or sensitive to theobromine - it can trigger headaches or migraines in some people. It is best to begin consuming cacao in a smaller quantity (10-20g) if you are hypersensitive or have found that chocolate in the past has triggered a migraine.


High consumption of cacao stimulates the brain and there is some scientific research to suggest a possible connection between caffeine, cacao consumption and increased seizures for people with. Scientific evidence is still inconclusive; therefore it is best to take caution if you have a history of epilepsy and check with your doctor prior to consumption.


Children are completely fine to consume cacao, however it is recommended to lower the dose to ½-⅔, depending on the age and nature of the child, so 15-20g of ceremonial paste. Drinks and treats made with cacao are a wonderful, nutrient packed alternative to confectionary chocolate that won’t cause a sugar high.

Bleeding disorders

Cacao may slow blood clotting in some rare cases. Consuming a lot of cacao might increase the risk of bleeding and bruising in people with bleeding disorders. Platelets are clot-forming cells responsible for the prevention of bleeding. Cacao polyphenols have an antiplatelet effect, suppressing platelet activation and aggregation by decreasing levels of thromboxane A2. We recommend consulting with a doctor prior to consumption if you have a bleeding disorder or are consuming any related medication.

Gastroesophageal Reflux Disease (GERD)

Cacao seems to hinder the effectiveness of the valve in the esophagus that keeps the contents of the stomach from coming back into the food tube or the airway. Ingesting cacao can cause a surge of serotonin. The serotonin causes the lower esophageal sphincter to relax. The relaxation means the 'door' between the esophagus and stomach is opened and acid is allowed to flow back up to the esophagus. This could make the symptoms of GERD worse. Small doses are advised to assess sensitivity. 


Cacao increases blood flow and may increase pressure in the eye. Cacao should be used cautiously in people with glaucoma.

Irritable bowel syndrome (IBS)

The stimulating effects of cacao, especially when taken in large amounts, can worsen diarrhea and might worsen symptoms of IBS. On the other hand, cacao metabolites can modulate the composition of the gut microbiota exerting prebiotic mechanisms. Prebiotics are non-digestible fibres from plant foods that promote the growth of beneficial microorganisms (probiotics) in the intestines. Cacao metabolites have shown to enhance the growth of beneficial gut bacteria, such as Lactobacillus and Bifidobacterium, while reducing the number of pathogenic ones, such as Clostridium perfringens. Probiotics can enhance gut health, increase anti-inflammatory activity, and possibly alleviate IBS symptoms like abdominal pain, bloating, and bowel movement irregularity. More research is necessary to fully understand the interplay of cocoa polyphenols and the gut bacteria. It is recommended to start with a smaller dose if you have IBS. 

Diuretic activity

Cacao has a diuretic effect because it can stimulate the renal epithelium. Theobromine is a natural diuretic found in cacao that increases the flow of urine and removes excess fluids from the body. People who are suffering from oedema accumulation (excessive liquid in some parts of the body), high blood pressure, and cardiovascular disease can benefit from this natural diuretic. However with this in mind, it is important to increase water consumption with cacao as it can be dehydrating. We recommend drinking water before and after cacao use.

Drug and Supplement Interactions

Although cacao is considered a safe superfood, if you are taking any medication it is best to consult with your doctor, and let them know about all drugs and supplements you are using or considering.

Is Cacao a hallucinogen?

Cacao has bioactive properties, but is not considered a hallucinogen. The main bioactive components are theobromine, phenethylamine, anandamide, tryptophan; the precursor to serotonin and tryptamine; precursor to DMT. Theobromine vasodilates the blood vessels and increases blood flow, creating a feeling of warmth and expansion. Phenethylamine (PEA) provides a link between classic psychedelics and cacao. PEA is the backbone to many of the happy chemicals in the brain, like dopamine and norepinephrine, and is also the backbone to psychedelic compounds like MDMA and mescaline. Anandamide, the “bliss molecule”, is a neurotransmitter that binds to the same brain receptors as THC, mimicking the psychoactive effects of cannabis. Tryptamine enhances DMT production and activity in the brain, enhancing dreams and imagination.

Unlike Ayahuasca and San Pedro, cacao does not take you on a trip. Instead it creates the conditions for you to open up and experience more depth, intimacy, connection and presence. Cacao is a gentle guide that opens doors rather than pushing you through it.

Cacao has been traditionally combined with different types of psychedelic plants to enhance their experience – examples include the Aztec tradition of combining cacao and psilocybin. The Aztecs called the sacred mushrooms teonanacátl (flesh of the gods). Cacao's official name is theobroma cacao (food of the gods). It is considered a powerful combination that increases the effect where the mushroom opens the mind and cacao opens the heart.

So, Is Cacao dangerous?

Cacao is an ancient healer and teacher. Her energy and physical compounds guide and support us in our healing – taking us into the heart space and a place of awakening and embodied connection. As a spiritual aid and superfood it is packed with antioxidants, vitamins, nutrients and minerals with a traditional history of use dating back over 5000 years.

In general no, Cacao is not dangerous to humans. However, consuming cacao in excess could have some negative side effects for some people. High doses can produce headaches, sweats, nausea, or even heart palpitations for a small percentage of people. Theobromine poisoning has been reported to cause heart failure, seizures, acute kidney damage, and dehydration. It is much more dangerous to small animals who have a very tough time processing theobromine and thus are more susceptible to theobromine overdose.

It is important to monitor intake and check in with your doctor if you are on medication or have a serious health condition, prior to consuming cacao. For those taking 20-60g of ceremonial cacao daily, they are unlikely to experience any negative health issues.

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Botanical Medicine by Dr. Marciano & Dr. Vizniak


The information on this document is intended for educational purposes 

only. Every attempt has been made to ensure information is accurate and up-to-date. No claims are made with respect to the treatment of any physically diseased condition and no attempt is made to dissuade individuals from seeking medical treatment for any condition. In addition, the products advertised are not intended to treat, cure, mitigate, diagnose or prevent any illness or disease. 

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