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David1941

The Health Benefits of Nuts (incl. kidney stone concerns)

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The Health Benefits of Nuts

©2016, David Leonard. Educational Program Coordinator (retired), Nutrition Connections Program, Univ of NH Cooperative Extension

NOTE: Kidney stone concerns about nuts are covered in my response to Pete & Pat's comment (see the next 2 posts below).

Impressive research reveals that regular nut intake (about 1.5 to 2 oz. on most days) is linked with lower risk of death, heart disease, type-2 diabetes, gallstones, and cancer. Of course, people with a nut allergy should avoid them.

Some handy nut conversions. One ounce of nuts equals:

  • Peanuts: Just under ¼ cup peanuts or about 28 kernels (166 calories)
  • Almonds: 22 whole or just under 1/4 cup (163 cals.)
  • Walnuts: 14 halves (185 cals.). ¼ cup chopped = 1.25 oz. (231 cals.). 1/3 cup chopped = 1.75 oz. (325 cals.)
  • Pistachios: 49 shelled whole kernels or about 1/4 cup (162 cals.)
  • Cashews: Just under ¼ cup of halves & wholes (163 cals.)

Nuts aren’t fattening! In fact, studies reveal that moderate amounts don't boost weight. Despite their high calorie content (160-185 per oz.), a combined analysis of 33 clinical trials found that 1 to 2 oz. a day didn’t increase weight, even when added to the diet without replacing other foods (AJCN 2013; 97(6):1346-55).

In another study, adding an extra 500 calories a day of peanuts (about 3 oz. or 3/4 cup) to the diet of 15 adults for 8 weeks resulted in 2.2 lbs. of weight gain versus an expected gain of 7.9 lbs. (AJCN 2009:89:1913-19).

So why aren't nuts (in moderation) linked to weight gain? They're unusually satisfying per calorie due to their protein, fiber, and healthy monounsaturated & polyunsaturated fats which the body "burns" more completely than saturated fat. Plus, a significant portion of the fat calories in nuts (but not nut butters) isn’t absorbed but excreted in the stool, since we don’t chew them very thoroughly.

The best way to add nuts to your diet is to substitute them for an equal calorie amount of other foods you may be overdoing like red meat, processed meat, refined grains (white rice, white bread, white pasta), sweets, and regular soda.

What Makes Nuts So Healthy?

1. Their fat is largely healthy (low in saturated fat, no trans fat). Walnuts are also a good source of an omega-3 fat called ALA (alpha-linolenic acid), although it’s weaker than the types (EPA, DHA) found in oily fish like salmon, sardines, herring, rainbow trout, arctic char, and anchovies.

2. They’re rich in disease-fighting antioxidants including vitamin E (especially almonds, walnuts, pistachios and pecans)

3. They're high in magnesium which helps reduce the risk of type 2 diabetes.

Which nuts have the most research-backed benefits? Walnuts, almonds, pistachios, and peanuts (even if they're honey roasted). Choose unsalted or lightly-salted nuts.

Reduced death risk: A study of 76,000 women (Nurses’ Health Study,1980-2010) and 43,000 men (Health Professionals Follow-up Study, 1986-2010) found that nut intake (including peanuts) was associated with a reduced all-cause death risk compared to no intake (based on a 1-oz. serving size): 7% (less than once a week), 11% (once a week), 13% (2 to 4 times weekly), 15% (5 to 6 times), 20% (7 or more times). Similar links were found between nut intake and lower death risk from cancer, heart disease, and respiratory disease. Nut type wasn't a factor. (NEJM 2013; 396:2001-11).

Heart disease: A combined analysis of 4 large-scale studies (Adventist, Nurses Health, Iowa Women’s, and Physicians Health) found that people eating nuts at least 4 times a week had a 37% reduced risk of heart disease compared to those seldom or never eating nuts. Each weekly serving of nuts (1 oz.) was linked with an 8.3% average risk reduction (Brit. J of Nutr, 11/06).

The 17-year Physician Health nut study of 21,000 male doctors found a 47% reduced risk of sudden cardiac death (fatal heart arrhythmia) for those eating nuts 2 or more times a week, compared to those seldom eating nuts (Arch Intern Med, 6/24/02).

Diabetes prevention: Combined results of 3 studies (646,000 men & women followed for 14-28 years) found that substituting an ounce of nuts for a daily serving of red meat cut type-2 diabetes risk by 21% (Am J Clin Nutr, e-pub 8/10/11).

Cancer prevention: Combined results from 36 studies ranging from 4.6 to 30 years duration (30,000 total participants) found that those eating the most nuts had a 15% lower risk of cancer in general compared to those eating the least. The strongest protection was for colo-rectal, endometrial, and pancreatic cancers, but only a few of the studies measured this (Nutr Reviews 2015; 73(7):409-25)

A study of 826 patients with stage III colo-rectal cancer found that those eating tree nuts at least twice weekly had a 46% reduced recurrence risk & a 53% lower death risk.  Peanuts or peanut butter weren't significantly linked.  Changes in colon-cancer related genes accounted for at least part of the benefit.  (Presented at the 2017 annual ASCO conference; results preliminary till published).

Reduced gallstone risk: A 20-year study of 81,000 female nurses found that eating 5 or more ounces of peanuts per week reduced gallstone surgery risk by 25% (Am J Clin Nutr. 2004 Jul; 80(1):76-81). A 12-year study of 44,000 male physicians found a 30% lower gallstone incidence in those eating at least 5 oz. of nuts per week compared to infrequent nut eaters (Am J Epidemiol, 11/15/04).

Are nuts safe for people with diverticulosis or diverticulitis? For decades, many doctors told patients with these conditions to avoid nuts, popcorn, corn, small seeds like those in strawberries and blueberries, fearing they might damage the intestinal lining or lodge in the pouches and promote inflammation.

But, a study following 47,000 men for 18 years found no significant link between these foods and either diverticulosis or diverticulitis. In fact:

  • Those eating nuts at least twice a week had a 20% lower incidence of diverticulitis
  • Those eating popcorn at least twice a week had a 28% lower incidence of diverticulitis
  • Corn was not associated with increased risk.
  • Those eating strawberries or blueberries at least twice a week had a 13% lower incidence of diverticulitis and a 14% lower risk of diverticular bleeding. (JAMA, 8/27/08; Vol. 300, No. 8:907-913)

These days, most doctors and gastroenterologists don't follow the old cautions, but you should heed your own doctor's advice, especially during a diverticulitis "flare-up".

Don't nuts increase kidney stone risk due to their oxalate content? Please see my response to Pete and Pat's concerns (2nd and 3rd posts in this thread).

 

Walnut storage tip: Once shelled, their omega-3 fat can become rancid if stored too long at warm temps. Store them in the fridge in an airtight container if you won’t use them soon. Fresh walnuts have a nutty smell & sweet taste. A paint thinner smell indicates spoilage.

My Other Posts in this Health Issues Forum:

IMPORTANT DISCLAIMERS

1. The info presented in this post should not replace professional medical or dietary advice, diagnosis or treatment.

2. Always consult your registered dietitian or physician before making any significant dietary or exercise changes.

3. Don't ignore professional medical advice due to the info presented here.

Edited by David1941

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We like almost all nuts, but do avoid eating a lot of peanuts now. DH had kidney stones and they are high on the list for contributing to stones.

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Hi Pete and Pat,

I'm glad your brought up kidney stones, and I assume you’re referring to the oxalate content of peanuts and other nuts. Until recently, the oxalate found in many plant foods was considered a key risk factor for people with a history of calcium oxalate kidney stones (the most common type).

 

Plant foods vary widely in their oxalate content, but nuts are considered a high-oxalate food (peanuts have 27 mg per oz., walnuts 31 mg per oz., and almonds have 121 mg per oz. Cooked spinach has 755 mg oxalate in ½ cup). For a partial table, go to www.denvernephrology.com/wp-content/uploads/2012/12/Oxalate2008.pdf.

 

Low-oxalate diets are usually defined as having less than 50 mg of oxalate per day (a few sources say less than 80 mg).

 

But recent research indicates that dietary oxalate may be less risky than supposed and that one's overall diet is more important than its oxalate content alone. One reason is that other nutrients can substantially offset oxalate risk, such as calcium-rich foods, the potassium citrate in fruits & veggies, phytates (see below) and the omega-3 fat (EPA, DHA) in oily fish like salmon, sardines, and arctic char. Also, a sizeable portion of the oxalate that ends up in the urine to potentially form stones is actually made by the body itself as part of normal metabolism.

 

The following journal article concludes that dietary oxalate is a modest risk factor (J Am Soc Nephrol. 2007 Jul; 18(7):2198-20 free full text at http://www.ncbi.nlm.nih.gov/pubmed/17538185 ).

 

The highly-regarded low-sodium DASH diet (Dietary Approaches to Stop Hypertension; www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm) is high in whole grains, fruits, veggies, beans, nuts, and low-fat dairy and is proven to lower blood pressure and reduce risk of heart disease and stroke. Despite it's relatively high oxalate content, it’s also linked with lower kidney stone risk. Below are 2 revealing studies:

 

1. A 2009 study of 45,821 men & 94,108 older women followed for 18 years plus 101,837 younger women followed for 14 years found that those whose diets most closely resembled the DASH diet had a 45% lower risk of kidney stones for the men, 42% lower for the older women, and 40% lower for the younger women (even though those with the highest DASH score had the highest oxalate intake).

 

The authors believe the key DASH diet factors the reduce stone risk are calcium, potassium citrate (from fruits/veggies), phytates in whole grains, beans and nuts, and magnesium (J. Am. Soc Nephrol. 2009 Oct;20(10):2253-59; Full text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754098/ )

 

2. An 8-week study that randomized 41 oxalate stone formers to a low-sodium DASH diet or low-oxalate diet found that DASH lowered lab markers for stone risk by 35% vs. 14% for the low-oxalate group.

 

The authors note that when high-oxalate foods are eaten together with calcium-rich foods (DASH is high in calcium), the calcium and oxalate bind in the stomach and are eliminated in the stool rather than entering the blood stream to eventually form kidney stones in the urinary tract (Amer. J. of Kidney Diseases, March 2014; see also https://www.kidney.org/news/newsroom/nr/BP-Reducing-Diet-May-Diminish-Stone-Risk ).

 

In short, rather than missing out on the many health benefits of nuts over fear of kidney stones, it might be more prudent to include nuts in an overall healthy (and stone-reducing) diet like DASH and to reduce any of the other kidney stone risk factors below that might apply:

  • Obesity
  • High sodium intake
  • High non-dairy animal protein intake (meat, poultry, fish) (applies to uric acid stones only)
  • Insufficient fluid intake
  • Overdoing calcium supplements: But adequate calcium from food lowers risk as mentioned above. .
  • Soda containing phosphoric acid
  • Excessive vitamin C: Over 1000-1500 IU daily

But your physician or specialist should have the final say, since he (she) knows your personal health factors best.

 

Thanks again for bringing this subject up!

David

 

IMPORTANT DISCLAIMERS

1. The info presented in this post should not replace professional medical or dietary advice, diagnosis or treatment.

2. Always consult your registered dietitian or physician before making any significant dietary or exercise changes.

3. Don't ignore professional medical advice due to the info presented here.

Edited by David1941

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Lemon juice mixed with water once a day is supposed to help with kidney stones.

 

Thanks for the reminder about the health benefits of nuts David.

Edited by Jimalberta

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I noticed I have gained some weight lately eating Pecan's.

Could that be because they are in the Butter Pecan Ice Cream I eat at least 3-4 times a week?

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Lemon juice mixed with water once a day is supposed to help with kidney stones.

 

 

Hi Jimalberta,

 

Thank you for bringing up lemon and water (or lemonade) to prevent kidney stones.

 

It’s true that the citrate in some types of fruit and other foods lowers the risk of calcium oxalate kidney stones (comprising about 65-75% of all stones) and calcium phosphate stones by forming soluble compounds with urinary calcium to prevent crystallization; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777061/ ). Potassium citrate is especially beneficial and found in many fruits (but not cranberries, prunes, plums or lemonade whose citrate is mainly citric acid), veggies, fish, milk, and yogurt. Citrate can also be given by prescription but it's important to follow your doctor's instructions .

 

Orange juice ( http://cjasn.asnjournals.org/content/1/6/1269.full.pdf+html ) and melon juice (http://www.ncbi.nlm.nih.gov/pubmed/22500592 ) appear more effective at raising citrate levels than often recommended lemon juice (commonly 2 Tablespoons Real Lemon to 3/4 cup; 2 servings daily), even though all have about the same citrate content. The citrate in orange & melon juices is in the more beneficial potassium citrate form, but lemon juice's citrate is largely citric acid whose hydrogen ions appear to diminish citrate’s beneficial effects. One downside of o.j. and melon juice is the added calories, so it would be better to use an Rx for potassium citrate.

CAUTION: If you take potassium-sparing drugs like ACE inhibitors or ARB's for blood pressure, check with your doctor before substituting orange juice or melon juice in place of lemon juice, especially if you have reduced kidney function. Orange & melon juices are much higher in potassium than lemonade and could possibly raise levels too high. The same with high-strength prescription potassium citrate which can also adversely react with other meds (check with your doctor).

Edited by David1941

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