Background <p>Ghanaian alcoholic bitters are widely consumed for their perceived health benefits. However, the liver and kidneys are susceptible to damage as a result of alcohol intake. There is however, limited research on the effects of Ghanaian herbal alcoholic bitters on the liver and kidney, and whether cocoa supplementation offers any protection.</p> Aim <p>To assess the effects of Ghanaian alcoholic bitters on the liver and kidneys of rats and to determine the protective role of natural cocoa powder.</p> Materials and methods <p>Twenty-four Sprague Dawley rats were randomly assigned to four groups: Control, Alcoholic Bitters, Natural Cocoa Powder, and Alcoholic Bitters + Natural Cocoa Powder. The intervention lasted 63&#xa0;days, after which liver and kidney tissues were harvested and processed for histological analysis. Slides were examined using light microscopy, and histopathological changes were scored using a modified staging and grading system.</p> Results <p>The Natural Cocoa Powder showed the most severe hepatic steatosis while the Alcoholic Bitters exhibited marked hepatocyte ballooning, confluent necrosis, Mallory-Denk bodies, and inflammatory cell infiltration. Co-administration of cocoa powder with bitters mitigates the liver changes to some extent. In kidney tissues, moderate interstitial and glomerular hemorrhages were observed, suggesting acute kidney injury.</p> Conclusion <p>Natural cocoa powder demonstrated a partial protective effect against alcoholic bitters-induced liver injury. Prolonged exposure to alcoholic bitters, with or without cocoa, led to adverse kidney changes, and cocoa co-administration did not significantly mitigate these effects. Further research is needed to clarify the mechanisms behind cocoa-induced liver and kidney alterations and to validate these findings.</p>