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Professors Mary B. Engler, RN, and Marguerite M. Engler, RN, in their lab at the University of California at San Francisco.

The day her study on the cardiovascular benefits of dark chocolate was published in the Journal of the American College of Nutrition, Mary B. Engler, RN, PhD, MS, a professor at the University of California, San Francisco School of Nursing, got a call from the university press office, asking if she could do an interview for the CBS Evening News.

The television crew hung black drapes in her office to block the glare and asked if she had a model of a heart to use as a prop while they filmed. They shined a red light on the heart. They had her look at a university press person while she talked on a speakerphone to the program director, who called from New York. They instructed her not to look at the phone or camera. The setup and taping took three hours.

“They only showed 10 seconds,” Engler says, laughing. It was her induction into a place few nurse researchers ever bask — the national media spotlight.

Mary Engler and her identical twin sister, Marguerite M. Engler, RN, PhD, MS, FAHA, have been researching the relationship between nutrition and heart health since the early 1980s. Marguerite is also a professor at the UCSF School of Nursing and a coauthor of the chocolate study.

The Englers’ previous research has included studies on the cardiovascular benefits of omega-3 fatty acids found in fish oils, and early nutritional interventions for children and adolescents who are at increased risk for coronary artery disease.

Sudden popularity

But the work that the media and a sweets-loving public have taken straight to heart is the Englers’ study showing a connection between dark chocolate rich in flavonoids — antioxidant plant compounds — and improved blood flow. The study, released last June, has resulted in media stories around the world and national television coverage.

Fish oils, the Englers say, never generated such a response.

They have received e-mails, phone calls, and requests for interviews for TV, radio, newspapers, journals, magazines, and websites. The chocolate study has been picked up by national and international medical and health science publications and has received more press coverage than any other research done by the school of nursing this year, according to the university press office and Kathleen Dracup, RN, DNSc, dean of the school of nursing.

“I was overwhelmed,” says Mary. “It was nonstop.” She and Marguerite are sitting in a conference room down the hall from their offices in the school of nursing. They seem amazed at the response the chocolate study is still receiving.

People continue to call with chocolate questions. What is the best dark chocolate? Can I eat chocolate every day? A company in Brazil was interested in making chocolate with a higher cocoa content because of its possible health benefits. A food magazine editor asked if a chocolate dessert would be a healthy end to a holiday meal. Cardiovascular colleagues in Italy have expressed interest in future research collaborations.

Mary and Marguerite suspect the chocolate study received so much attention because so much of nutrition news tells people something is bad for them. “It was nice for people to get some good news,” Mary says.

“A lot of people wrote, ‘Thank you for doing this study, it’s so important,’” says Marguerite.

Twin paths

The Englers are striking women, tall and blonde with soft, high voices and elegant, expressive hands. They often finish each other’s thoughts and sometimes each other’s sentences. They laugh a lot and exchange bemused glances when they talk about how colleagues and students have sometimes mistaken one of them for the other. Even Dracup says she initially had trouble telling them apart.

The closeness between them has served them well in the demanding field of research, Dracup says. Research partners must rely on each other to meet deadlines, do the work properly and carefully, and follow through on a project. “You have to create a relationship built on trust,” Dracup says. “I think they both brought that to their professional relationship.”

“Who could you trust more than your sister?” asks Mary. “And I know Marguerite’s exceptional background and training.”

The Englers’ career paths are almost as identical as they are. They went to nursing school together in Virginia and received advanced degrees in biology and physiology from American University and Georgetown University in Washington, D.C. They both did doctoral research training at the National Institutes of Health in Bethesda, Md., and worked on critical care and cardiovascular surgery units there. They came to UCSF in 1988 to teach physiology and help establish a cardiovascular graduate nursing program at the School of Nursing.

At UCSF they have separated a bit, following new interests, Dracup says. Mary has become interested in genetics and is the director of the nursing school’s new genetics program, and Marguerite has focused on clinical trials, she says. But their offices are next-door and they share a house. “They’re still very knowledgeable about each other’s research,” Dracup says.

While caring for patients before and after open-heart surgery on the cardiovascular unit at the NIH, the Englers talked to them about their diets and lifestyle habits. “After seeing how invasive heart surgery was, we thought, ‘There has to be a better way,’” Mary says. Prevention of heart disease through diet and exercise seemed like a logical answer. This led to their interest in nutrition and specifically the effects of omega-3 fatty acids on vascular health.

They spent more than 10 years doing laboratory research. Among other important discoveries, they found that the major omega-3 fatty acid, docosahexaenoic acid (DHA), could cause significant dilation in certain arteries. They designed a study in the late 1980s that involved giving omega-3 fatty acids supplements to patients after heart surgery to see if it would improve vascular function, but they could not interest cardiologists in the project.

Power of flavonoids

Things are different now, the Englers say. The medical community has a better perception of the importance of nutrition in health and disease. Mary believes consumers are driving the interest. “People are interested in being in charge of their own health and eating right,” she says.