I just read an article about the value of eating 56g of walnuts per day in people with diabetes; eating the nuts for 8 weeks resulted in improved endothelial function, and no weight gain. Granted, it's a small study of only 24 people, but it's interesting. I especially like Dr. Katz' Lord of the Rings description of blood vessels as 'the one ring to rule them all', meaning that the health of blood vessels is an excellent way to measure overall health. You can read the article here: http://www.medscape.com/viewarticle/717343. It requires free registration to Medscape.

Patients often ask me which type of nut is 'best'. My usual reply is that we have research on some specific nuts, such as almonds and pistacchios (and now walnuts) but my gut feeling is that eating a mixture of nuts is also going to give them benefit. Of course I also talk about portion sizes of nuts, and the small size always amazes them.

Do you recommend one specific type of nut over others? Thanks for sharing your ideas!

To the best of my knowledge  FDA approved almonds, hazelnuts, peanuts, pecans, pignola pine nuts, pistachios, and walnuts as heart-healthy nuts.  But the agency left out Brazil nuts, macadamias, cashews, and pinyon pine nuts because they contain 3 to 5 grams of saturated fat per ounce. The nuts that were approved contain only 1 or 2 grams.
I find myself discussing the cholesterol lowering power of sunflower seeds and walnuts( both unsalted) with my patients more, however, do mention that almonds and pistachios are OK as well. Thanks. Isabella, RN/CDE

I recommend a variety of nuts, just like a variety of fruits or vegetables. Here are some quicky notes I have on nuts.

In epidemiological studies, both peanuts and tree nuts in general have been associated with less diabetes and CVD. The arginine content may contribute to the heart-healthy effects. In a report at FNCE last October said that people who eat tree nuts compared to non-nut eaters weigh less, have smaller waists, have lower levels of C-reactive protein and higher HDLs. Additionally, the nut eaters consume more fiber, vitamin E, calcium, magnesium and potassium, and they have lower intakes of sodium.

Walnuts: respectable source of the omega-3 fatty acid ALA (2.5 grams per ounce), and a small study demonstrated improved LDL-cholesterol.

Almonds: study demonstrated improved LDL, 33% DV for vitamin E in one ounce

Pistachios: only 3 calories per nut, shells provide a visual cue to decrease portion and shells prolong the eating event, another LDL improvement, contains 342 micrograms, lutein + zeaxabthin, also contains bets-carotene and 25% DV for B6 in one ounce.

Brazil nuts: just 2 per day provide daily supply of selenium. Use caution because Brazil nuts also contain variable amounts of barium and radium.

Pecans: study showed improved HDL and LD cholesterol, lowered triglycerides, contains gamma-tochopherol.

All of the lipid studies were small and I didn’t study any of them to see their statistical power or any more than basic study design. My guess is that nuts in general are good for us.

Thanks Isabella. I looked up the FDA health claim, and this is what it says:

Types of nuts eligible for this claim are restricted to almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts, and walnuts. Types of nuts on which the health claim may be based is restricted to those nuts that were specifically included in the health claim petition, but that do not exceed 4 g saturated fat per 50 g of nuts.

The University of Nebraska Cooperative Extension has an excellent piece on nuts here:  http://lancaster.unl.edu/food/ftmar04.htm  They have a table that lists the nutritional value of a wide variety of nuts that I'm going to print off and make availble for my clients.

I love this discussion format - it gets me thinking, and I benefit from the knowledge of all of you!

Lynn -

Thanks for your nice clarification about what it is that the FDA allows to be said about nuts in the FDA approved health-claim. I think it's really important that we as HCP understand the processes within FDA for approval of things like health-claims, nutrition claims, food additives, etc.

Reality is that the process of getting a health claim approved thru FDA has been in existence only since 1998. It was instituted as a path to allow companies/organizations to be able to discuss health related benefits of their products in advertising, on products, etc. And several years ago FDA instituted another category of health claims called Qualified Health Claims. These, at least in my view, are relatively weak statements, but allowed by FDA none the less.

It should be understood by HCPs that companies and organization have/do petition the FDA for approval of specific health claims with significant clinical research/substantiation. They are then either approved/disapproved by FDA. If approved FDA provides exactly the wording that companies are allowed to use for the specific health claim.

For example, here’s the health claim statement approved for nuts taken directly from a document on FDA’s website: http://www.fda.gov/Food/LabelingNutrition/LabelClaims/QualifiedHealthClaims/ucm073992.htm#nuts: “Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts [such as name of specific nut] as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease. [See nutrition information for fat content.]” Notes: The bracketed phrase naming a specific nut is optional. The bracketed fat content disclosure statement is applicable to a claim made for whole or chopped nuts, but not a claim made for nut-containing products.

FDA also specifies exactly which categories and types of nuts can use this health claim:

Eligible Foods

• (1) Whole or chopped nuts listed below that are raw, blanched, roasted, salted, and/or lightly coated and/or flavored; any fat or carbohydrate added in the coating or flavoring must meet the § 101.9(f)(1) definition of an insignificant amount.
• (2) Nut-containing products other than whole or chopped nuts that contain at least 11 g of one or more of the nuts listed below per RACC.
• (3) Types of nuts eligible for this claim are restricted to almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts, and walnuts. Types of nuts on which the health claim may be based is restricted to those nuts that were specifically included in the health claim petition, but that do not exceed 4 g saturated fat per 50 g of nuts.

There are currently about 15 FDA approved health claims. I believe there are far fewer FDA Qualified Health Claims.

Great content all! Thanks!

Hope Warshaw,

Nutrition Section Editor, www.PRESENTdiabetes.com

Thanks for the additional information and clarification, Hope. I have to admit that while I was reading through the information on the FDA website, it sure sounded to me like the food companies themselves were the ones pushing for the qualified health claim - and that's exactly what you explained.

If the qualified health claim process is started by food manufacturers, who starts the process for the other form of health claims?

Nuts Though it was previously assumed that nuts are not good as they are high in their fat content but now it has been proven that nuts contain only healthier fats. This healthier fats help to lower the insulin resistance. The fat content of the nuts help to lower down blood sugar by keeping the person away from binge eating. Few examples of healthier nuts are Cashew, Brazil Nuts, Pecans, Macadamia Nuts, Almonds, Walnuts, Peanuts,There are some who have allergies towards some nuts; so it is advisable to stay away from those kinds. However those diabetics who do not have this problem must, take the nuts as regular part of their diets.