Doctor's Note

More on nuts and heart disease in my videos Nuts and Bolts of Cholesterol Lowering and How Do Nuts Prevent Sudden Cardiac Death?

More on nuts and cancer in Tree Nuts or Peanuts for Breast Cancer Prevention?

Nuts and inflammatory disease: Fighting Inflammation in a Nut Shell.

More than you ever wanted to know about nuts and weight here: Nuts and Obesity: The Weight of Evidence.

What if your physician tells you to not eat nuts because you have diverticulosis? Share this video with them: Diverticulosis & Nuts.

Those 100 pistachios a day may have one side-effect, though: Pistachio Nuts for Erectile Dysfunction.

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  • jack

    People who eat a plant-based whole foods diet are already protected from the diseases presented here. Same goes for decreased mortality. So can nut consumption do even more for a person who’s already eating healthy or will nuts give them no greater edge? I’m aware of a study that showed improved health for people on a Mediterranean diet who substituted nuts for olive oil, but is there a study out there that compares people on a healthy vegan no added oils, plant-based whole foods with and without nuts?

    • Catherine J Frompovich

      Fats are most important for brain health, as the brain even manufactures some cholesterol. It’s important not to have a fat-free, or even very restricted low-fat, diets. Studies have shown that calcium in milk is not as bioavailable in fat-free milk as it is in whole milk! The myth that fat is bad has to be displaced in medicine and healthcare. BAD fats, e.g., trans fats-margarine-hydrogenated, chemically-extruded polyunsaturated fats which usually are rancid and produce carcinogenic factors when cooked with or eaten, and highly-marbleized animal fats, especially when charbroiled (PAHs), are the culprits.
      Years ago MDs and RDs denounced avocados as ‘bad’ fats; same with nuts. I remember those days as I fought against such nutritional ignorance. Today those foods are promoted as healthy heart foods, and rightfully so.
      That’s why organic seeds, nuts, and fat sources like olives and avocados should be important staples in any plant based diet.

      • Rims Bose

        I agree with this fact and we should no more motivate absolute fat free diet for anyone and encourage to have a diet with SFA and PUFA in 1:1 ratio as well as PUFA and MUFA in the same ratio

      • b00mer

        I don’t consume oils or copious amounts of nuts or avocados. I do eat chia and flax regularly, and when I make hummus I use tahini. You would probably consider my diet “very restricted”. However with that my fat consumption is about 12-18% of my total calories. I don’t see how this could be considered unhealthily low. I’m not concerned with lowering it, but I wouldn’t want it to be any higher certainly.

        When I hear the words “fat free diet” I cringe a little, and always think back to a post by Jeff Novick, where he lists all the fat percentages of certain foods: kale 12%, romaine lettuce 14%, oatmeal 16%, strawberries 9%, etc. There’s no such thing as a “fat free diet”.

        • Joe Caner

          I’ve done an 80-10-10 macro nutrient diet before. I lasted for about eight months on it, and the excess pounds just fell off. You can do it, but it means no added oils and a tablespoon of flax with everything else being greens, grains, vegetables, fruits and mushrooms. At the end of the day you might have some fat budget left over to have a few walnuts or almonds. It was difficult at first, but it will really up regulate your sensitivity to added oils, and down regulate your desire for them. When you go out to eat, everything will taste like its swimming in oil.

          • b00mer

            Hi Joe, I don’t disagree that an 80-10-10 diet is healthy, I just don’t happen to follow it myself. I do omit oils from my diet and don’t eat very many nuts at all; and yet my fat % is higher than 10%. Because my diet is whole foods-based, varied, and made nearly entirely of what you mentioned, greens, grains, vegetables, fruits (though also lots of legumes), I don’t feel the need to “chase” any particular numbers. I go with nutrient density and variety and let the %’s fall where they may.

        • Ben

          I am doing exactly the same, flax, chia, and hummus made with tahini on occasion. Avocado on occasion but only 1/4th, I have 4 members in my family so each of us gets 1/4th. I have experimented with adding nuts to my diet, based on videos like this one, which of course raises my fat intake to well over 20%. All I get is extra fat around my mid-section. I am 46, though, so maybe that’s why, maybe if I was in my 20s or 30s I would not get the fat gain. I like to maintain a lean waistline so I see no reason to add the nuts to my diet. I’ve heard Dr. Fuhrman say that a diet 30% in fat can still be a healthy diet, as can a diet 15% in fat or 20% in fat, however, he says a diet 10% in fat is not a healthy diet. I guess that’s one of the areas where he breaks from Dr. McDougal, because McDougal believes a diet 10% in fat can be healthy. I have no idea who is right. Personally I like to err on the side of caution, and since I do well at the 15% range, give or take a few percentage points, I will stick with it..

      • Lisa

        Animal fats of all kinds – like those found in milk – are harmful.

    • Joe Caner

      I would love to see a study which compares the whole foods plant based vegan population who do and do not consume nuts and/or avocados. Sadly, it is a pretty sparse demographic with a reputation for an above average prognosis. I don’t know who do such a study unless they were the control group in a study comparing them to omnivores.

    • Quiana

      Omnivorous Adventists who at nuts outlived Vegan Adventists who avoided them.

    • Yes, this is also my question Jack. I love Dr. Greger’s site, but I have never understood his pro-nut position, since most plant-based doc that I follow suggest a strong caution with nuts due to their incredibly high caloric density. Like you, I wonder about whether nuts would be beneficial or not to me in that I am currently eating low fat, plant-based due to cardiac concerns and am following the Esselstyn diet. I am concerned that introducing nuts would be going backward. I would like to see a nut trial done on two groups of whole food plant-based eaters.

      • Lt. Nimitz

        Same here. I am a Esselstyn diet follower but because I did a test and my arteries are clean I use just few walnuts (4-5) and couple of Brazilian nuts every day. I do use Flaxseeds a lot though. I wonder why these nuts would be beneficial to the heart when Esselstyn saw regression of arteries diseases only when someone would steer clear from any foods containing high fat content otherwise not regression was shown. Makes me wonder. Always confusions. Because with my extremely low intake of nuts and seeds, not oils and not fatty vegetables my blood test is perfect, my Pulse Wave Analisys test show to have a arteries of a 22 years old (I am 40) I think will stick to what I have been doing.

  • Marie S

    Why do many plant-based whole foods doctors such as McDougall, Esselystein, and Ornish recommend that we stay away from nuts?

    • Because nuts are high in fat and cause weight gain if over consumed just like every other food – why are nuts magical of all things? Most studies controlled the weights of the patients so they didn’t gain weight. Very misleading.

      • Lt. Nimitz

        Not one of them talks about weight gain, they speak about Heart Disease and Diabetes prevention instead. So if they believe high fat content of any kind will increase chances to incur one of these diseases why promoting nuts?

    • brec

      Esselstyn and Ornish advise coronary artery disease (atherosclerosis) patients. They recommend that those patients eschew (which means, of course, “not chew”!) nuts because of their fat content; they believe that fat of any kind should be very limited for CAD patients.

      • They both need to update their recommendations in light of recent research.

    • Q

      Yes, this is the question I have. I am trying to reverse heart disease and am a runner so I do eat nuts not a lot but a small amount to help with my training… but if the nuts are so good why are they not good to use in reversing heart disease as you have pointed out in the M E and O works on reversal……????? BTW the WFPBD is a wonderful journey and lifestyle plan…. I feel like a million bucks!!

      • I prefer to go the nutty route. However, some of Esselstyn’s patients experience angina when they eat nuts/avocado/olives, even when whole.

        • DL

          Nuts, like other high fat foods, can be a trigger for acid reflux– which can be mistaken for angina or other heart pain. My partner, without known CAD, is very sensitive to reflux, and has difficulty with nuts. (Ironically, he would actually like to gain weight.) Might it be that some of Esseslstyn’s patients who report angina when they eat nuts/avocado/olives could be experiencing reflux, rather than renewed angina? The question might be difficult to answer. Perhaps distinguishing between chest pain that occurs shortly after occasional nut ingestion and chest pain after an extended period of nut eating might be suggestive.

      • dermot reilly

        to reverse heart disease nuts are not on ornishes or esselstyns list of foods, it is difficult to get the total fat down to 10% of dietary intake if nuts or avocados are consumed, or dairy, it is the 10% reduction that reverses heart disease, reading ross hornes experience with pritikin, he figured that after 2 years on a 10% low fat,low sugar, the arteries begin to unload the plaque, read ross hornes book “you can do better than pritikin.”also what reverses an illness may also prevent it.

        • I’m about to post the text below to my Tumblr. Your post inspired it:

          Is it really the 10% fat content of the Ornish/Esselstyn diet which causes the regression of arterial plaques? Or is it, instead, the type of fat eaten that makes the difference rather than the fat percentage?


          Is it actually the reduction of LDL and inflammation of a whole foods, plant-based diet that reverses the disease process?

          Revelatory research done by the Cleveland Clinic with high dose statins (80mg) and intravenous ultrasound (IVUS) gives us the answer:

          Coronary plaques were verified with IVUS to shrink when LDL was lowered to 60 mg/dl or below. In addition, the anti-inflammatory properties of the statins contributed even further to the reversal process. Even more plaque improvements were made with blood pressure reduction and blood sugar control in diabetics.

          Of course, they could have tested a WFPB diet, too, but what can one expect from a medical profession which has so little faith in supporting lifestyle change as the answer for most patients in a pill-popping culture and an obesegenic environment? These drug trials and IVUS technology at least confirm that actual atheroma regression is FACT, not fiction. Nor is it mere vegetarian/vegan propaganda. And that’s VERY exciting!!

          So how does a whole foods, plant-based diet reverse coronary vascular disease AND reduce cardiac mortality?

          (1) Dramatic reduction of LDL.
          (2) The anti-inflammatory and anti-thrombotic properties of copious and synchronous phytochemical compounds such as salicylic acid and others in their natural state, plus the absence of inflammatory endotoxins from animal foods.
          (3) The blood flow enhancement of nitric oxide generated by leafy green vegetables (a process which is augmented, btw, by sun exposure).
          (4) Lowered blood pressure lessens the constant physical trauma to arteries.
          (5) Natural blood sugar control and increase in insulin sensitivity.
          (6) Weight reduction further contributes biochemically to the decrease of endogenous saturated fat, LDL, blood pressure, insulin resistance, and inflammation.

          So this begs the question about the percentage of fat in the WFPB diet. Obviously, the less total fat in the diet, the less LDL-raising saturated fat there will be in the body. However, it seems that the inclusion of whole food polyunsaturated and monounsaturated fat sources like nuts, seeds, and avocados may help lower LDL and inflammatory CRP’s even further [possibly speeding up atherosclerotic regression], as mentioned in this video by Dr. Joel Fuhrman:

          Drs. McDougall, Mills, and Esselstyn also weigh in on the subject.

          Dr. Fuhrman expounds further in this video clip:

          Of course, it’s Drs. Ornish and Esselstyn who have the clinical studies behind them, but my personal lipid panel seems to favor Dr. Fuhrman’s and Dr. Greger’s approach…

          Your mileage may vary.


          IVUS is fascinating technology. Unlike thallium stress tests or angiograms which are two-dimensional and really show just blood-flow, intravenous ultrasound is 3D and images the actual plaque itself! IVUS reveals the amazing reason a person can have a heart attack days or weeks after plaques have NOT been detected by current diagnostic imaging in common use:

          Plaques begin by growing outward first before they ever encroach on blood flow inside the artery! Unstable plaques can kill without a single visible stenosis. Can you say Sudden Cardiac Death?

          Check out the Cleveland Clinic videos on this subject:

          Intravascular Ultrasound Insight into the Pathophysiology of Coronary Disease

          Factors Driving Progression and Regression of Coronary Plaques

          New Targets for Anti-Atherosclerotic Therapy

          Caveat: The HDL-raising drug mentioned in the 3rd video was pulled by the manufacturer due to increased mortality.

          GO PLANTS INSTEAD!!!

          • JacquieRN

            Thank you MacSmiley for sharing your insights, so interesting indeed.

          • dermot reilly

            hi macsmiley great post very interesting, just like to add one thing, according to essestyn and ornish, also I believe, the ldl in low fat vegans can be not very low, esselstyn says “because the total fat is so low ( below 150 is the magic number) the hdl does not need to be so high to control the ldl. they also used to notice less white blood cell activity, this was a concern until it was realized? it is animal products that have a greater need for more infection control with all the added toxins, I do not have the link to this, any of esselstyns talks should reveal it, especially his talks with dr hans Diehl…

          • I’ve heard that HDL doesn’t have to be high with low LDL. But doctors in practice don’t seem to be comforted by this. It surely doesn’t hurt to raise HDL with exercise and healthy weight loss, lowering triglycerides, since there is a relation to TG and HDL, especially with metabolic syndrome.

            As for white blood cell activity, I couldn’t be sure on that. Since CVD is an inflammatory process, I assume less LDL in one’s artery walls would equate to a reduced need for WBCs.

            Anyone else with expertise who can comment on this?

      • Lawrence

        Q, As I understand, Dr. Esselstyn asserts that all oils damage the endothelial cells that line our vasculature and produce nitric oxide, a powerful vasodilator that increases blood flow and lowers blood pressure. Below are links to some interesting reading on endothelial function and nut consumption, from which you may draw your own conclusions about eating nuts. Happy you are feeling great on WFPB diet. Don’t look back, keep it up!

        • Q

          Thanks, this really helps a lot….. Love the info and the WFPBD….

          • Lawrence

            No problem. In case you haven’t seen this, here’s Dr. and Mrs. Esselstyn at their best imho:


            When Dr. Ess talks about ‘strengthening the cap on your plaque,’ I’m pretty sure he’s referring to ‘laminar shear strength’ discussed in this article:


            BTW, in trying to provide an intelligent answer to your question, I have learned a great deal myself. Thanks!

          • val

            I love this man, Dr. Esselstyn…erudite and passionate about his message! awesome! thank you!

      • I was looking at Dr. Esselstyn’s cholesterol data for his original patients, and I had to wonder if their LDL numbers would have been even lower, and thus their atherosclerotic regression even more extensive had they been consuming an ounce of nuts every day.

    • Some of Esselstyn’s cardiac patients experience angina when they eat nuts/avocado/olives, even when whole.

      Sorry I posted this below under the wrong comment.

    • Carl

      My doc told me to avoid nuts also, but it was not about fat–rather rancidity. I have to say I can’t dispute this, unless you get the nuts fresh from their shell.

  • Most nut studies (sponsored by nut industry) controlled people’s weight during the study. So if they started gaining weight, they cut back on their calories. And then we say nuts don’t cause weight gain. See how that works? As scientists do we think calories ie energy from nuts disappears magically in the body?

    • yardplanter

      Will, you are correct re the disappearing calories act. However, ( and it may have been shown in the study ) if the same caloric content was supplied as oil in place of nuts, the weight gain would probably have been noticed. Hence, the ‘magic’ of nuts and their little fibrous bodies.

      • yardplanter

        We need to be a little skeptical here. the nut eaters also consumed more fruit and vegetables

        baseline , Med +OO, Med+nuts

        Nuts, g/day 0, 4.9 ± 2.3 , 25.7 ± 14.4
        Veg, g/day 317 ± 144, 329 ± 145, 355 ± 149
        Fruit, g/day 344 ± 200, 354 ± 195, 407 ± 204

        all p<0.001

        On the other hand total caloric intake was highest for Med +nuts

        Total energy intake, g/day 2,060 ± 529, 2,222 ± 514, 2,416 ± 537

        no info on weight gain but I did email the authors.

    • Martin Miller Poynter

      I believe it was Dr. Fuhrman who said that not all of the nut/seed is digested by the body, and thus not all of the calories are absorbed. What is undigested is eliminated in the stool.

    • Ted Crystal

      You are correct about the RD’s in those studies adjusting calories to offset nut consumption. Nuts, because they are so calorie dense, tend to addictive. For tens of millions of years primates had to struggle to get enough calories to survive. This food scarcity left us with a hardwired instinct to get as many calories as we could whenever available. Overeating nuts adds way to much fat to the diet. Most of that fat is N6 and as that N6/N3 ratio tips further pro-inflammatory cytokines ensue. They are OK if you can limit yourself to 1 or 2 ounces daily. If you can’t, skip them. Seeds like flax and chia would be a far better choice being very high in ALA.

      • Ben

        I agree. I skip nuts altogether and only consume flax, chia and pumpkin seeds. Pumpkin will not screw up your N6/N3 balance, they are 4-1 N6 to N3. And as a weightlifting male I benefit from the high zinc levels in pumpkin seeds. Also pumpkin seeds are 21% protein, the highest of all seeds/nuts.

        • b00mer

          Hi Ben, by my calculations, the omega 6:3 ratio in pumpkin seeds is about about 175:1. Did you calculate the 4:1 ratio yourself or read it somewhere?

          Walnuts do have a ratio of 4:1 if you happen to enjoy those.

          • Joe Caner

            I checked two sources for the omega 6:3 ratios for pumpkin seeds and I got 114:1 and 168:1, but I think it’s pretty safe to say that you are not going to improve your ratios with them regardless of whatever the actual numbers are.

            Where pumpkin seeds really shine is their magnesium content because it a common mineral deficiency and its arginine content because it may boost your bodies ability to burn fat.

            There are favorable ratio of omega 3’s in green leafy vegetables, but if you really want to boost your omega 3 ratios, I don’t believe flaxseeds can be beat, and one tablespoon a day will cover you.

          • Ben

            Yep, you are right, thanks for the correction. I am eating them very sparingly, though, so they still don’t disrupt my omega 3/6 balance and my total fat % is still at around 15%. Thanks again for the correction.

        • Ben

          The reason, IMO, that the people did not gain weight on the nuts or lost weight on the nuts, is because the nut consumption improved the quality of their diet. These are just mainstream folks in these studies, consuming a SAD. I know from personal experience, adding handfuls of nuts to my diet will only put extra fat around my waistline.

          • We all react differently to foods, of course. The operative word here may be handfuls (plural) versus carefully measured amounts.

            One of my most used kitchen tools is my OXO food scale which helps me not only manage my caloric intake but, just as importantly, my finances by controlling my serving sizes.

            My initial weight loss came from a financially lean period whereby I ended up measuring serving sizes to get the designated number of servings off the Nutrition Facts panel from my boxes of shredded wheat and whole wheat pasta! :-D

    • Not all the studies were isocaloric. Two years ago, Dr Greger did an extensive review of a truckload of studies. It’s well worth watching.

    • You haven’t watched ALL of Dr. Greger’s videos on nut studies, have you? Otherwise, you would not have made that comment.

      At least watch this one:

      You can do your own homework for his related series of videos afterwards.

      • Yeah this has been debunked by Jeff Nelson of Vegsource. Nuts have fat, 9 calories per gram it’s just science and energy balance.

        • Nope. Read that when first written. Not convinced. See PREDIMED.

    • Sorry for double posting that link. When first posted, the comment shows directly underneath yours. But later on, when you come back to the page, the comment drops to the bottom of all the replies. Disqus has no delete button.

  • Martin Miller Poynter

    Can we assume the same benefits from seed consumption?

    • Ben

      Even better benefits from seed consumption. Dr. Fuhrman has long advocated seeds over nuts as the ideal choice. Furhman says we should consume G-Bombs every day. G (greens) B (beans) O (onions) M (mushrooms) B (berries) S (seeds).

      • Timar

        Yeah, sure, if Dr. Fuhrman (or any other vegan low-fat diet guru) says so – who needs any studies…

        • Ben

          Fuhrman says so for two reasons. #1 seeds are more nutrient dense then nuts. #2 easier to maintain ideal ratio of omega 6/3. Anyone who knows anything about Dr. Fuhrman knows he does a good job of evaluating the latest science.

          • Timar

            I would say Dr. Fuhrman does a great job in making pointless generalizations which are obviously not based on latest science but on… whatever.

        • b00mer

          I don’t really consider Fuhrman a “low-fat” guy. He’s as gaga for nuts and seeds as McDougall is for potatoes. He is against oil, but I think that’s more an issue of the low nutrient density than the fat content. And even then, he says it’s fine to eat it (or any other of the non-recommended foods) as long as it amounts to less than 10% of your calories.

        • Dr. Fuhrman — Value of High Fat Food

          Plant-based, yes, but animal foods on his “nutritarian” program are allowed in limited amounts.

  • Plantstrongdoc M.D.

    Best part: Your body really thrives on a mainly plantbased diet – and a bonus: You live longer! What many people misunderstand: WFPD is NOT about missing something, but gaining something – energy and well-being.

  • DGH

    Nuts appear to be very healthy. We have a randomized trial to prove it: PREDIMED. It shows especially benefit for non-fatal stroke.

  • jack

    Although this study doesn’t directly address vegans, it shows that nus are certainly better than most of the junk that folks usually eat, and my be helpful for people whose cardiovascular heath is somewhat compromised.

    • mike at the river

      Is it the omega 3 in nuts or some other ingredients the provide the benefits? Dr Esselstyn avoids nuts for cardiac patients, other may have some. Ditto for McDougall, Barnard, Novick (1 oz/day). Most limit fats to 10% of calories on their low fat, Whole Food, plant-based diet (low salt, oil, sugar). Walnuts would be the healthiest nut due to their 4:1 omega 6: omega 3 ratio, but flaxseed even better (1:4), plus other benefits. Studies done on healthy Whole Food, low fat, plant-based vegans seems lacking, so hard to compare different populations….Mike

      • b00mer

        Another blog Dr. Greger did specifically pointed to magnesium as a key nutrient in cardiac health.

      • Darryl

        Its probably not the omega-3:omega-6 ratio of nuts, because with the possible exception of walnuts (1:4), the ALA:LA ratio of nuts is mostly poor. Peanuts are equally effective in mortality reduction, and their ALA:LA ratio is a terrible 1:500.

        Its more plausible that nuts are functioning as a magnesium and vitamin E supplement, as deficiencies of these two nutrients are widespread, and nuts are fairly good sources. However if this is their primary mechanism wheat germ may offer similar benefits with fewer calories.

  • Raz

    you did not emphasize that the nuts should be fresh and natural! not Roasted.

  • Jay M

    IMO, while adding nuts to the average diet seems to have benefits, adding them to a low-fat, low-protein 80/10/10-style vegan diet may be detrimental. In comparison to fruits and veggies, nuts have higher protein thus should raise IGF and nuts contain more PUFAs which are prone to oxidation.

    • Low-Fat or Whole Food?
      Which type of plant-based diet has been shown to maximize cholesterol reduction?

      • Jay M

        I try to follow a diet that is generally both, low-fat & whole food based, mostly raw, some cooked: papayas, bananas, apple, veggies and tubers. Bean, infrequently.

      • Jay M

        For me personally, a fruit & veggie diet reduces cholesterol level the most. The addition of beans increases it slightly. Olive oil raises it more. Meat & dairy, the most.

  • Wow, that’s a shame about that first group. I wonder if they were able to gain back the lost life-span once they restarted eating nuts. Hopefully!

  • b00mer

    I think there is much less of a true debate surrounding nut consumption than there appears to be in the WFPB diet world. Esselstyn, McDougall, Furhman, Greger, and Barnard all maintain that 1 oz of nuts or seeds daily is fine.

    There are variations on a theme: Furhman essentially requires 1 oz daily, Greger appears to condone a slightly higher amount (“1-2 handfuls”), McDougall has doubts about whether people can practically limit themselves to only 1 oz at a time, and Esselstyn forbids them to the segment of the population actively trying to reverse CVD.

    So for anyone who doesn’t have active heart disease, eating 1 oz nuts or seeds daily is condoned pretty much across the board.

    • Thea

      b00mer: Just to add to your excellent post – Even Jeff Novick who did the “From Oil to Nuts” DVD, going into great detail about the problems with nuts (calories and too many omega 6’s) says right there in that video that 1-2 ounces of nuts in the context of a healthy whole plant food based diet is fine.

      I feel that sometimes discussions nuts are really distractions from the main diet issues that face us.

      • Tone and attitude is everything in a message. I believe all the current research in favor of the health benefits of nuts and seeds should make each and every one of these doctors encourage nuts and seeds in their preferred doses, not just allow them or discourage them with exceptions, and that includes Dr. Esselstyn’s cardiac patients. They are missing out on some extremely cardiac-beneficial nutrients.

        Roasted or raw (and peanuts should be roasted), recommending nuts in their natural state while discouraging oily, salted nuts is not such a hard thing to do. Drs. Fuhrman and Greger do it all the time.

        • Thea

          MacSmiley: I need to give your post some more thought in order to form a personal opinion, but I wanted to thank you for your post as it is certainly a legitimate thought. Thanks.

    • Dr. Fuhrman recommends nuts and seeds even to those with active cardiovascular disease. However, he discourages snacking or eating out of the bag.

      I take umbrage at Drs. McDougall and Dr. Esselstyn’s openly-admitted lack of faith in the self-control of their patients. It takes away “the locus of control”, as Dr. Esselstyn likes to say, away from the patient. If he can get the NO OILS message through to people, he can communicate ONLY ONE OUNCE OF NUTS just as well.

      It’s very easy to measure out an ounce or a quarter cup of nuts. Avocado is more challenging to measure, but not impossible.

    • Ben

      But Fuhrman is really unique because he says a diet 40% in fat can still be a healthy diet. I am not sure any of the other doctors would agree with him on that. But he might be right, who knows. I think you would have to really increase your veggie consumption to make a 40% fat diet work, though, and most would probably not want to consume that many veggies day in, day out. That’s a lot of chewing, of course, you could use the blender to help out with that.

  • Laloofah

    I think the title of this should read, “Nuts May Help Postpone Death.” Because if they actually prevent it, then this is your most awesome video ever!! :-)

  • Alessio

    I think this McDougall’s article is very interesting:

    • The date on that article is 2009. I hope Dr. McDougall has updated his viewpoint by now in light of more recent studies.

    • Thea

      Alessio: Great article. Thanks for sharing.

      My thoughts: I don’t think it necessarily contradicts Dr. Greger’s viewpoint. Dr. Greger might recommend more nuts and seeds than Dr. McDougall, but neither of them would recommend a diet based primarily on nuts and seeds. And Dr. McDougall does talk about the nutritional benefits of nuts/seeds. McDougall is just concerned with the fat content and people eating too much. That’s my take-away anyway.

      Thanks again for the article. I liked it.

      • Ben

        I once did a diet based on nuts, seeds and oil. It was a raw foods diet. I would make these labor intensive meals. I experienced rapid weight loss, too much actually, and I started experiencing brain fog. I was probably consuming about 80% fat. My only carbs were from the limited fruit. I wonder if I was in that ketosis state? Well, everyone said I looked terrible, emaciated. That was many years ago, though. You live and you learn. Now I don’t trust diet philosophies. Give me the science.

  • BlackTaxi2d

    dr mcdougall suggests not eating nuts because of their fat and protein content. can you comment on this any how it is different from this video you made? thanks

  • Tong Ren Healer

    Interestng phrase,

    Nuts May Help Prevent Death
    Can death ever actually be prevented? I know what you mean though. Thanks for the awesome videos and information.

  • Isaac

    Arg. I’m so confused. Nuts have high levels of AGEs (glycotoxins), which you’ve talked about as bad, but now nuts are supposedly good! Haha. Do I embrace my heavy peanut/almond/cashew/walnut snacking or not?

    • Don’t worry. Be happy. Eat an ounce a day, plus a tablespoon or two of ground flaxseeds. Explore different kinds (but keep Brazil nuts down to 1-2/day so as not to OD on selenium). Your heart and other parts will thank you. ;-)

  • Joe Caner

    I’m confused as well. Esselstyn and Ornish have successfully used a low fat vegan diet to reverse coronary arterial disease (CAD) in which they eliminated oils and restricted nut and seed consumption. Eliminating or at least severely restricting oil consumption is probably a very good thing. It’s difficult not to take these results lightly because most of us have been eating the SAD diet so most of us have arterial plaques, and would benefit from disease reversal that that the Ornish/Esselstyn diet have delivered. That being said, nut and seed consumption is not necessarily problematic.

    What concerns me is an article published in by Jeff Nelson, who advocate the afore mentioned diet, reviews 22 studies that were funded by the nut industry and concludes that nut consumption does cause weight gain.

    The article is “Nuts & Weight Gain: It’s Worse Than We Thought”

    I like nuts and seeds as part of my whole plants vegan diet, and eat them daily, but I do keep a close eye on my total calorie intake, fat intake and composition and percentage of calories consumed. Ideally, I would like to stop calorie counting, but my weight is stable, and I have not great desire to eat outside the parameters that I have set for myself because I find my diet to be satisfying. Actually, with the inclusion of nuts, seeds and avocados, I find my diet to be down right decadent…

  • gr4fr32r

    I wish all the freaks here would shut the fuck up. if you don’t do high output physical activity, nobody gives a shit what your gimp ass has to say about your shitty eating regime.

  • Ben

    Thanks for the info. Also pumpkin seeds are great at providing zinc. But with most of us consuming a lot of beans maybe zinc is not a concern. But with male athletes sometimes low zinc can be an issue.

  • Jean

    Can you clarify the health benefits of eating nuts? I watched your video that mentioned that Kaiser Permanente is promoting a plant based diet ( AWSOME) In their brochure that outlines the plant based diet, it said that ” people with heart disease may want to avoid or limit nuts, seeds, and other fats and oils”. Is this just their version on the diet?, which is great, but are nuts ok for people trying to reverse CAD.

  • Really

    Seems like Dr. Greger is pro nuts for our diet. The arguments he makes for nuts can be made for fatty meat. He is evolving to the dark side.

  • question about mycotoxins

    During my university studies the mycotoxin content of nuts have been stressed and therefore it was advised against nut consumption. Longterm intake of even low doses of mycotoxins can have detrimental effects on health.
    My question to Dr. Greger would be: How can the putative positive effects of nut consumption be reconciled with the knowledge that nuts are likely to be contamined with mycotoxins (even if they cannot be always seen with the naked eye).

  • tulika chari

    So what is the best way to eat nuts?
    Should they be soaked and then eaten?
    Should they be dry roasted and eaten?
    Or should they be soaked and then dehydrated in the oven for 24 hours or until dry and then eaten?

    • Joseph Gonzales R.D.

      Raw! You can soak if you want, many people do. I just eat them raw seems to do the trick. Lightly roasted is fine, too.

  • mike

    “Nuts May Help Prevent Death”
    That’s a pretty bold claim. Nuts might help me live longer, but I seriously doubt they’ll help me to live forever.

  • Noe Marcial

    so how much is tu much?

  • Ed Lincoln

    Do we need updated information on nuts for cardiac patients ?

  • Rick Hearn

    I was watching one of Dr. Gregers videos where the first 20 minutes cited studies showing vegetarians and vegans were not living longer than meat eaters. Turns out it was the high omega 6 to omega 3 ratio from using processed oils. So my question is, why are nuts different since most are very high in omega 6 fatty acids. Doesn’t this have the same effect on the ratio. Is it even the ratio at all or what food source causes the imbalance. I was hoping for clarification before adding nuts to my diet

    • David Sprouse MS PA-C NF Mod

      Hi Rick,
      There’s a lot more to whole nuts than their constituent oils. For instance, nuts are high in fiber, antioxidants, lignans and are a good source of the amino acid arginine, which is a precursor to nitric oxide (which in turn is a vasodilator critical to maintaining healthy blood flow to the heart, skeletal muscles and other organs). This is almost certainly why nuts show such dramatic health benefits that aren’t seen with vegetable oil alone.

      • Rick Hearn

        Thank you for your response, I understand all the other benefits of nuts but Dr. Gregers specific point in his video was that vegans and vegetarians with high omega6 to omega 3 ratios were showing similar mortality rates to those who ate animal products. So considering the high level of omega6 in nuts are you saying these other properties of nuts somehow mitigate those effects or change the absorption in the body of omega6 from nuts

        • Thea

          Rick Hearn: I can’t speak to your particular theory (though I do believe that is at least partially correct.) But I have a thought for you: The issue about omega 3 to 6 ratios is more about overall daily consumption of the essential fats as opposed to how much is in a single bit of food. Dr. Greger does recommend nuts and seeds in his Daily Dozen, but only 1/4 cup whole or 2 tablespoons (1/8 cup) nut butter. I haven’t done the math (nor used cronometer), but I’m guessing that In the context of a whole plant food diet that consists only of Dr. Greger’s Daily Dozen (including the flaxseeds!), the over all omega 3 to 6 ratio in the diet that day would be pretty good. After all, greens and other veggies have a very good 3 to 6 ratio. Also, the ratio could be especially good depending on the nut or seed chosen. What do you think?

          • Rick Hearn

            What I think is that I don’t know, that is why I was hoping Dr. Greger could clarify this since it was his original video statements that raised a red flag for me. I researched the ratios the other day and walnuts are the only nut with a decent 6 to 3 ratio of 4:1. The others are in the thousands to 1. You should watch the video if you haven’t. It was quite the eye opener for me. It’s on you tube, called 40 year old vegan dies of heart disease. Also look up the amount of omega 6 in nuts like almonds, cashews, pecans, brazils. It’s high.

          • Thea

            Rick: I’ve watched the video a couple of times. I agree that it is a good talk. I just think it doesn’t matter what the ratio of a nut is if you are having say (to exaggerate to make a point), one almond that day and the rest of your intake for the day is heavily weighted toward omega 3s. Your ratio overall for that day would be just fine. That’s just my understanding. I hope you get the answer/clarity you are looking for. This is a question that many people share.

          • Rick Hearn

            The thing is Dr. Greger is not recommending 1 almond a day but more like a small handful/or a few ounces. This ends up being a lot of omega 6. However I think I just found the answer over on Mark’s daily apple. Apparently the vitamin E and polyphenols in the nuts prevent oxidation of the linoleic acid (omega 6) and that prevents the problems that come from getting to much omega 6 from processed oils which oxidize easily.

          • Hendrik

            I thought the problems with having too much omega-6 fatty acids are:-
            1) omega-6 causes inflammation in the arteries
            2) omega-6 blocks the conversion of the omega-3 fatty acid ALA to EPA and DHA.
            If one takes EPA/DHA supplements, then the second problem is not a problem,
            but the first problem, inflammation, still remains.

          • Thea

            Hendrik: Omega-6 is an essential fat. This means that humans must get omega 6 from our diet or we will not be healthy. It’s not good to have too much omega 6, but it is important to remember that omega 6 is an essential part of every human’s diet. There was a poster not too long ago who was worried that she was not getting *enough* omega 6 following the Daily Dozen except excluding the nuts. I think you can probably get enough omega 6 without the nuts, but an ounce of nuts make it a lot easier to meet our likely omega 6 requirements.
            I know you are responding to Rick Hearn, and I assume he will respond back. I’m not attempting to come between your talk. I just thought I would give you something to think about.

          • Hendrik

            Thanks for the comment Thea;- I take your point that omega-6 fatty acids play an important role in our metabolism (so dosage becomes the question). My comment above was for the context where the ratio of omega-6 to omega-3 is too high, which it seems can happen if you have too many nuts of the wrong kind. It’s very easy to eat more than an ounce of nuts.

          • Thea

            Hendrik: Oh I agree with that. Very easy!

          • Rick Hearn

            I found the answer on another website. Apparently the vitamin E and polyphenols and some other compounds in nuts keep the linoleic acid ( omega6) from oxidizing which is what causes the problems with processed oils since they oxidize easily especially when heated,

        • David Sprouse MS PA-C NF Mod

          Hi Rick,
          Do you have a link to the video to which you are referring? I’d have to see it before addressing your questions in more detail.

          • Rick Hearn

            Need to watch the first 25 minutes or so to get the gist of what His point is about the omega 6 to 3 ratio

          • David Sprouse MS PA-C

            Well first of all, this video is 13 years old — look at all that hair!!! :) . From everything I’ve seen and read by Dr. Greger since then, including his new book How Not To Die, he is very much “pro-nut” based on the gobs of research data that have been published in recent years showing that they dramatically decrease risk of an early death. *IF* we maintain adequate omega-3 (preferably from combination of omega-3-rich sources such as walnut, flax and preformed DHA/EPA from algae oil) and do our best to avoid extracted oils in general (whole food, whole food, whole food), I don’t see any reason to obsess about the n-6 to n-3 ratio when it comes to nuts.

  • Miroslav Kovar

    Are there any studies on the effects of antinutrients in raw nuts and seeds? Do any of you have personal experience?

  • Miroslav Kovar

    If, for some reason, I had to eliminate all nuts and seeds from my diet, what foods would represent alternative and sufficient sources of the vitamins and minerals in them?

  • RooT62

    I’m a vegan and I usually eat some nuts everyday – almond, walnuts and pistachios – probably about 1oz in total. I also have a handful of pumpkin seeds daily. I’ve recently read a report saying that this means I could have a too high intake of phytic acid which will inhibit absorption of certain minerals ,ie calcium and zinc – the very reasons I’m eating them. Should I soak them before I eat them (yuk!), does roasting help? Confused!

    • Thea

      RooT62: Good news! Phytic acid is nothing to worry about. It’s probably even good for you. Check out the videos here on NutritionFacts on “Phytates”:

      • RooT62

        Thanks Thea. I tried to find related posts before but didn’t realise (doh) that phytic acid and phytates were the same thing. Feel much happier now I’ve read more about them!

  • Viktor

    I can’t manage to find too many studies on the health effects of different kinds of seeds (ex. pumpkin, sesame and sunflower. There’s plenty on flax and chia) and wonder if they should be regarded like nuts (or nutbutters like tahini) or if they have any other health benefits.

  • Jeffrey

    Doc, I find it interesting that the participants who continued eating nuts had the significant survival advantage – compared to switching and eating EVOO. Perhaps the oil continued to do damage to the endothelial cells in the arteries, shredding them, and ultimately, aggravating and inflaming them, and thus jarring plaque – causing more heart attacks – and perhaps death. It would be most helpful to hear whether those folks had died of heart attacks.

  • Lt. Nimitz

    This 16 years Raw Vegan developed artery disease and a stroke and it was attributed by Dr. Esselstyn to his high consumption of nuts and nuts butters. Doctor Greger will be great please if you could get int touch with Dr. Esselstyn and clear up this confusion. Would be great for all the world Vegan Community.

    Here is the video in question: