The New York Times reported that "Chocolate truffles were virtually unknown in the United States when, in 1973, Alice Medrich started making and selling them from her home in Berkeley." Because Medrich's truffles have soft centers, when coated they have a characteristic larger, "lumpy" shape compared to French truffles, and have come to be known as California truffles.

Her books include "Pure Dessert," "Chocolate Holidays: Unforgettable Desserts for Every Season," "Bittersweet: Recipes and Tales from a Life in Chocolate," "A Year in Chocolate: Four Seasons of Unforgettable Desserts," "Alice Medrich's Cookies and Brownies," "Sinfully Delicious Low-Fat Desserts," "Chocolate and the Art of Low-Fat Desserts," "Cocolat: Extraordinary Chocolate Desserts," and "A Chocolate Lover's Alphabet."

"Cocolat" and "Chocolate and the Art of Low-Fat Desserts" have both won James Beard awards for Cookbook of the Year.

Medrich founded the Cocolat chain of chocolate stores in 1976. By 1990, Cocolat had expanded to seven stores in the San Francisco Bay area. However, the company got into financial difficulty after an arson fire destroyed its Berkeley headquarters in 1991, causing damages estimated at $2 million, and the embezzlement of $500,000 by an employee. The latter forced Medrich to sell her interest in the company. It went out of business several years later, among not only financial difficulties but allegations that the new owners had harassed employees who were not Scientologists.

Alice Medrich is divorced from Elliott Medrich.