Nuts and nut butters are featured in many ‘healthy dessert’ recipes online and are often referred to as a health food. On the other hand, reports of nut allergies have increased greatly in the last 10 years, especially among children.
So are nuts really as healthy as they are made out to be and how many should you consume on a daily basis?
I conducted my own research, using only peer-reviewed science published in quality journals, and put together this article, which takes a detailed look at what nuts are composed of and the potential positive and negative health effects from consuming nuts.
What are nuts?
Let’s start with defining exactly what nuts are. Tree nuts are dry, hard fruits with one seed. The most common tree nuts include:
- Brazil nuts
- Pine nuts
Peanuts are actually legumes as they grow in the ground, but they have a similar nutrient profile to tree nuts.
Chestnuts are unlike other tree nuts as they are starchy and contain little fat.
What are nuts made up of?
Nuts are a very energy dense food as they contain a high amount of fat ranging from 46% in cashews and pistachios to 76% in macadamia nuts (1).
This fat is predominantly in the form of monounsaturated fatty acids (MUFAs). Hazelnuts, for example, contain 61% total fat content with approximately 90% of those fats being the MUFA oleic acid (2, 3).
Nuts also contain the omega-6 polyunsaturated fatty acid (PUFA) linoleic acid and the short chain omega-3 PUFA α-linolenic acid (ALA). Walnuts are in fact the whole food with the highest content of ALA of all edible plants (1).
As well as being a rich source of unsaturated fatty acids, nuts are a good source of protein, with a high content of the amino acid L-arginine.
Nuts are a rich source of a variety of vitamins and minerals, including tocopherols (a form of vitamin E), folate (a B vitamin), magnesium, zinc and calcium (4). Brazil nuts are an excellent source of the trace element selenium. Daily consumption of just one Brazil nut is sufficient to supply the recommended dietary intake of selenium (5).
Additionally, nuts are abundant in the antioxidant compounds polyphenols (6) and in the plant phytochemicals known as phytosterols (7). The majority of the antioxidants in all nuts are located in the skin, known as the pellicle (8). In walnuts, for example, more than 90% of the total antioxidants are lost when the skin is removed (9).
Raw nuts contain between 3 and 13% dietary fibre, with almonds and pistachios having the highest content (10).
Nuts are naturally low in carbohydrates.
Brief summary: Nuts are an energy dense food containing high amounts of monounsaturated and polyunsaturated fatty acids, protein, especially the amino acid L-arginine, a variety of vitamins and minerals, antioxidants and dietary fibre and are low in carbohydrates.
Nut consumption has been associated with cardiovascular health benefits
The first reports of the health outcomes of nuts were in the early 1990s when two important studies were published: the Adventist Health Study, which related frequent nut consumption with a lower risk of coronary heart disease (CHD) (11) and a randomized clinical trial showing that the intake of walnuts reduced serum cholesterol levels (12).
Since then many studies have been conducted on nut consumption and cardiovascular health.
Large studies conducted in the US investigating associations of dietary components with health outcomes reported a beneficial effect of nut consumption on fatal and non-fatal CHD (8, 13-15). The results from these studies suggest a strong association, not a direct causation, between nut consumption and reduced CHD rates.
Random clinical trials have shown that nut consumption has a cholesterol-lowering effect (16). The consumption of 67 grams of nuts per day (2 small servings) was associated with an average reduction in total cholesterol, a reduction in low-density lipoprotein-cholesterol (LDL-C) (the ‘bad’ form of cholesterol) and a reduction in the ratio of LDL to high-density lipoprotein (HDL).
The cholesterol-lowering effects of nuts were shown to be greater for subjects with higher LDL-C levels and for those subjects following a typical ‘Western’ diet rather than a Mediterranean diet. In other words, if you are not obese but have high LDL-C levels and are following a Western diet, consisting of predominantly refined cereals and sugars, refined vegetable oils, fatty meats, dairy products and salt (17), then you will benefit the most from substituting calories from saturated fats with nuts.
A recent review found that there is insufficient evidence to indicate that increased nut consumption will reduce the risk of cardiovascular disease (CVD) in healthy individuals (18).
The mechanisms explaining how nut consumption can improve blood lipid and lipoprotein profile and cardiovascular health are not clear.
In the 1990s it was thought that dietary saturated fatty acids were a main cause of cardiovascular disease (CVD) (19). Therefore, it was recommended that dietary saturated fatty acids be replaced with MUFAs and PUFAs, such as those found in nuts. However, it is now clear that excess carbohydrates, especially when combined with saturated fatty acids, are more detrimental to cardiovascular health (20-24). Therefore, it is hard to say whether the MUFAs and PUFAs in nuts are the cause of improved blood lipid/lipoprotein profiles or if the elimination of certain foods, such as refined carbohydrates and saturated fatty acids, are the cause.
The other beneficial compounds in nuts, such as the polyphenols, may also contribute to cardiovascular health (25-28).
Brief summary: Frequent nut consumption has been associated with reduced rates of coronary heart disease in large epidemiological studies. In individuals with elevated LDL-C levels who are eating a typical Western diet the substitution of saturated fats with nuts may improve blood lipid/lipoprotein profile and improve cardiovascular health.
Nut consumption is not associated with a reduced risk for type 2 diabetes
Several recent major studies have found no association between nut consumption and the risk of type 2 diabetes (29-31).
Will eating nuts cause weight gain?
Although nuts are high in fat and calories, multiple epidemiological studies have shown that frequent nut consumption (greater than 2 servings per week) is not associated with an increased body mass index (BMI) or risk of obesity (32-34).
In clinical studies where small servings of nuts were incorporated into the diet, subjects showed less weight gain than predicted due to the extra energy provided by the nuts (35-39).
These findings may be due to the high amounts of unsaturated fatty acids, dietary fiber and protein found in nuts making them a very satisfying food and preventing hunger, overeating and snacking on less nutritious foods (40).
Also, nuts must be chewed thoroughly before swallowing, and chewing activates mechanical, nutrient and sensory signaling systems that may alter appetite (41).
There is some evidence to suggest that MUFAs and PUFAs are oxidized in the body more rapidly than saturated fatty acids (42), which may also explain why nut consumption is not associated with weight gain.
The cell walls of nuts, which are composed of non-starch polysaccharides (dietary fibre) and enclose the fats, could also explain why nut consumption does not appear to cause weight gain. Additional fat has been found to be excreted in the feces of healthy subjects eating an almond-rich diet (43). Further research into this found that a large portion of the almond cell walls remained intact following chewing and digestion. This prevents the release of the fats from inside the almond cells meaning less fat is absorbed in the gastrointestinal tract (44).
Brief summary: For a number of possible reasons, including the satisfying effects of nuts, the chewing of nuts, the MUFAs and PUFAs in nuts and the cell walls of nuts, the incorporation of a small serving of raw nuts on a daily basis into a healthy diet not exceeding calorie requirements is unlikely to lead to weight gain.
The reports of peanut and tree nut allergy have greatly increased in children in the last 10 years (47). The reasons for this increase are not completely known. An increase in awareness and reporting by parents and an increase in nut consumption may be contributing factors (46).
A number of alternative theories attempting to explain the increase in nut allergies have also been proposed. A decline in the diversity of the gut microbiota (the bacteria found in the gastrointestinal tract) of the infant (48, 49) and/or of the mother during pregnancy, increases in maternal obesity rates (50) and changes in the timing of the introduction of solids to infants have all been suggested to contribute to the increase in nut allergies in recent years (51).
Nut allergy most commonly presents in the first five years of life. More than 90% of children with nut allergy will have a history of eczema, asthma, rhinitis (inflammation of the mucous membrane inside the nose) or another food allergy (52).
If a child is allergic to nuts, they will show a reaction upon their first ingestion of nuts. Typical signs and symptoms of an allergic reaction to nuts include erythema (redness of the skin, usually in patches), hives (pale red, raised itchy bumps on the skin), swelling of the lips, face and around the eyes, itching of the skin and throat, hoarse voice, coughing, sneezing, nausea and diarrhea. These symptoms will develop within minutes of exposure (53).
Peanut and tree nut allergy can be diagnosed by a combination of medical history, physical examination and diagnostic testing, such as the skin prick test (54).
The best timing for the introduction of ‘allergenic foods’ (nuts, eggs, cow’s milk and shellfish) to infants is an area that is currently under intense investigation and is still yet to be determined (55). Although the World Health Organization (WHO) recommends the introduction of solids to infants after the age of 6 months (56), experts in the field of allergy research recommend that infants should be introduced to solids around the age of 4 – 6 months and that ‘allergenic foods’ do not need to be avoided by infants when solids are introduced (57-59).
Avoiding nuts during pregnancy (if the pregnant woman is not allergic) does not appear to decrease the risk of nut allergy in children (55). In fact, pregnant women, who are not allergic to nuts, who consume nuts during the early stages of pregnancy may actually reduce the risk of nut allergy in their children (60).
There is no treatment for nut allergies. The only way to manage peanut and tree nut allergy is by avoiding these foods and being prepared to handle an accidental ingestion.
Research is being conducted into treatments for nut allergies. One treatment method that is currently under investigation is allergen-specific immunotherapy. This involves exposing the allergic individual to small amounts of the substance that they are allergic to, known as an allergen. Studies have shown some success with allergen-specific immunotherapy in people with peanut allergy (61, 62) and hazelnut allergy (63, 64), but further research is needed before this can be considered as a treatment option.
Brief summary: Peanut and tree nut allergies can cause serious life-threatening reactions and reports have increased among children in the last 10 years. Most children with a nut allergy will have a history of eczema, asthma or another food allergy. Avoiding nuts during the first 6 months of an infant’s life or during pregnancy does not seem to reduce the risk of nut allergy in children. There is currently no treatment for nut allergy, but this is an active area of research.
Nuts can be contaminated with harmful aflatoxins
Aflatoxins are toxic substances produced by the fungi Aspergillus flavus, Aspergillus parasiticus and Aspergillus nomius.
These toxins cause dangerous diseases in humans, such as liver cancer. Aflatoxins can also cause disease in animals.
Peanuts and tree nuts are one of the food crops that can be contaminated with aflatoxins.
Contamination with aflatoxins occurs mainly in tropical and subtropical regions of the world. Contamination can occur during harvesting, drying or storage of food crops. Poor agriculture and harvesting practices, as well as improper drying, handling, packaging, storage and transport of food crops can result in contamination with aflatoxins (65, 66).
Once the food has been processed, further contamination with aflatoxins is unlikely as long as the food items are stored correctly (67).
Developing countries located in tropical regions are at the greatest risk for exposure to foods contaminated with aflatoxins (66).
Pistachios are the main source of dietary aflatoxins (68). In 2010, the USA banned the import of all pistachios from Iran where contamination of these nuts is a major problem.
Most countries in the world, including the USA, the European Union and Canada, have strict regulations to control the presence of aflatoxins in food to protect human and animal health (69). However, there are reports of nuts and nut products contaminated with aflatoxins in Sudan (70, 71), Iran (72), Malaysia (73), Tunisia (74), Pakistan (75) Qatar (76) and South Korea (77).
More sensitive and rapid methods for the detection of aflatoxins in food products, including nuts, are currently being developed (78).
Brief summary: Peanuts and tree nuts can be contaminated with harmful aflatoxins, which are produced by fungi. Contamination of nuts with aflatoxins mainly occurs in subtropical and tropical developing countries that have poor agriculture and harvesting practices. Most countries in the world have strict regulations to control the presence of aflatoxins in food.
Nuts are naturally low in carbohydrates and contain a number of potentially beneficial compounds, including monounsaturated and polyunsaturated fatty acids, polyphenols, phytosterols, an array of vitamins and minerals and dietary fibre. Some of these compounds may explain the association between nut consumption and the reduced risk of cardiovascular disease, however, no direct causation has been clearly identified.
Reports of peanut and tree nut allergies have increased among children in the last 10 years. The exact reasons for this increase are unknown. The research suggests that avoiding nuts during the first 6 months of an infant’s life or during pregnancy does not reduce the risk of nut allergy in children.
Tree nuts and peanuts are one of the foods most commonly contaminated with harmful aflatoxins produced by fungi, which can cause dangerous disease such as liver cancer. Contamination of nuts with aflatoxins is most likely to occur in subtropical and tropical developing countries that have poor agriculture and harvesting practices.
Nuts can be included as a part of a healthy diet, especially low carbohydrate diets. Raw nuts as a snack are a far better option than many other convenient snack foods containing refined carbohydrates and trans fatty acids. Although studies have shown that nuts are not associated with increased body mass index (BMI) or risk of obesity, let’s not forget that nuts are very high in calories and should be limited to 1- 2 servings per day, particularly if you are trying to lose weight.
So now that you have had all your questions about nuts answered, here is a link to my recipe for a whole food Chicken cashew nut featuring, of course, cashews (but not too many).
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