Decades of Research Spotlight Almonds’ Heart Health Benefits

Heart disease remains the number one cause of death worldwide, and unfortunately, continues to rise year over year¹. According to the World Health Organization (WHO), as many as 80% of heart attacks and strokes are preventable, and the majority of cardiovascular disease (CVD) risk factors can be prevented or controlled with a healthy diet and other lifestyle modifications².

Diet is important for the management of CVD risk. The Almond Board of California has supported more than two decades of research on the role of almonds in helping to maintain a healthy heart and healthy cholesterol levels. According to the WHO, a healthy diet helps to protect against noncommunicable diseases, such as heart disease³. The WHO defines a healthy diet as one that includes nuts, in addition to fruits, vegetables, legumes, and whole grains⁴.

Nutrition research has long been a cornerstone of the Almond Board of California and we continue to be committed to learning how almonds can help address public health concerns and promote healthy lifestyles.

A Heartfelt Journey

In 1995, the Almond Board of California’s nutrition research efforts began with a focus on heart health. Today, we continue to fund additional innovative research to further our understanding and more importantly, provide people the sound evidence as they make dietary choices to support heart health and overall wellness.

Why Almonds?

A 2016 systematic review and meta-analysis examined the breadth of research on almonds and blood lipid levels. The analysis of 18 published randomized controlled trials with a total of 837 participants showed significant favorable effects of eating almonds on total cholesterol, harmful low-density lipoprotein (LDL-cholesterol) and triglycerides, with no change in beneficial high-density lipoprotein (HDL)-cholesterol levels⁵. Additional analyses that were undertaken by the study authors found that the effects of almonds on total cholesterol and LDL-cholesterol were most pronounced in studies in which the almond dose was 45g or greater, or where study participants had elevated total and LDL-cholesterol levels at the start of the study. The evidence indicates that consuming almonds should be encouraged as part of a healthy diet to help in the management of blood lipid levels. It is well-established that elevated lipid levels are associated with increased risk of heart disease.

New Research Frontiers

Research supporting the role of almonds in heart health initially began in 1992, with the first study demonstrating that almonds (100g of almonds per day for 9 weeks) as part of a low saturated fat, low cholesterol, high-fiber diet improved cholesterol levels⁶. It was this landmark study that helped set the stage for the Almond Board’s nutrition research program and provided compelling evidence to continue looking at the cardiovascular effects of almonds. Years of research in this area would eventually showcase that despite (and possibly because of) their fat content, almonds could play a role in supporting a healthy heart.  Today, the Almond Board of California continues expanding into innovative heart health research areas, most recently looking at vascular health and the cardiac system’s resilience to mental stress (reviewed below).

A recent study⁷ from researchers at King’s College London looked at a British population and investigated several heart health risk factors as part of a multifactorial investigation. This study, called the Almonds Trial Targeting Dietary Intervention with Snacks (ATTIS), was a six-week randomized control, parallel-arm trial of 107 participants (with above average CVD risk) who consumed either almonds or a calorie-matched control snack providing 20% of each participant’s estimated daily energy needs. Compared to the control group, those in the almond group saw improved (increased) endothelial function (mean difference 4.1% units compared to the control snack)⁸, assessed by measuring flow-mediated dilation (FMD), a key indicator of vascular health. This was a novel finding for almond nutrition research because improved FMD means that arteries can dilate more easily in response to increased blood flow, which is a strong indicator of cardiovascular health, and poor endothelial function is seen as a strong predictor of the initiation and progression of atherosclerosis. Further, plasma LDL-cholesterol levels decreased in the almond group relative to the control group (mean difference -0.25 mmol/L). There were no differences between the two groups in liver fat and several other measures (triglycerides, HDL cholesterol, glucose, insulin).

We all encounter stress in our day-to-day lives and, unfortunately, mental stress is among the psychosocial factors thought to contribute to CVD risk. Heart rate variability (HRV), a measure of the fluctuation in time intervals between consecutive heartbeats, is an important indicator of the cardiovascular system’s response to stress and it is thought that lifestyle factors, including physical activity and diet, might impact HRV. Higher HRV represents greater adaptability of the heart in response to environmental and psychological challenges, while low HRV is linked to CVD and sudden cardiac death.

To better understand the effects of almonds on HRV, researchers measured HRV in participants undergoing a laboratory mental stress challenge and saw improvements in some measures of HRV in participants who had been consuming almonds versus calorie-matched snack over a six-week period.  In this secondary study, of ATTIS⁹, researchers from King’s College London measured participants’ real-time HRV at rest (lying down for five-minute periods) and during an acute mental stress test. During the acute mental stress test, participants randomized to the almond group showed better heart rate regulation compared to the control group, indicated by statistically significant differences in high frequency power, which specifically evaluates beat-to-beat intervals (a measure of HRV). The study findings demonstrate that eating almonds in place of typical snacks may diminish the drop in HRV that occurs during mental stress, thereby improving cardiac function. These results suggest that consuming almonds has the potential to increase cardiovascular resilience to mental stress by improving regulation of heart rate.

Timeline - A Look at Our Heart Healthy History

• 1992: The first study, by Spiller et al.,¹⁰ was published evaluating the impact of almonds on heart health. This research sought to determine almonds’ impact on LDL-cholesterol.
• 1990’s: Consumers commonly believed that eating foods with high fat content caused weight gain. To help clarify the role of healthful fats in the diet, ABC began funding research to look at the health effects of consuming “good” – unsaturated – fats via almonds. Research on the health effects of almonds, along with avocados and olive oil, helped to change public perception about substituting saturated fats for unsaturated fats, like monounsaturated fats, and clarify that different kinds of fat have different health effects.
• 1998: The first Almond Board of California funded study was published: “Nuts and plasma lipids: An almond diet lowers LDL-cholesterol while preserving HDL-cholesterol”¹¹
• 2002: ABC began funding Portfolio Diet studies. This research provided a better understanding of how almonds help manage cholesterol levels. The Portfolio Eating Plan – a groundbreaking dietary approach that seeks to maximize the potential for lowering cholesterol – came out of this research. The Portfolio Eating Plan recommended consuming 30g per day of nuts, like almonds, in addition to other heart-healthy foods.
• 2003: It’s official!  FDA approves first qualified heart health claim for tree nuts. The International Tree Nut Council filed a petition to the U.S. Food and Drug Administration (FDA) to acknowledge the role nuts can play in reducing the risk of heart disease.
• Scientific evidence suggests, but does not prove, that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.

Great progress has been made over the past couple of decades, but it doesn’t stop there - the Almond Board of California currently has more research underway to help better understand the role almonds play in this critical health area.

Powerful Nutrient Package

Why does the consumption of almonds have favorable impacts on blood lipid levels? Almonds not only have a low glycemic index, but their powerful nutrient package makes every 30-gram serving (a handful), an easy way to snack smarter, especially when it comes to heart health*:

• 6 grams of plant protein
• 4 grams of dietary fiber
• 14 grams of unsaturated fats (with only 1 gram of saturated fat), and
• Important vitamins and minerals like vitamin E (7.7mg / 60% NRV), magnesium (81mg / 22% NRV), and potassium (220mg / 11% NRV)

*The WHO recommends that the majority of your fat intake be unsaturated—and good news because one serving of almonds (30g) has 14g of unsaturated fat (healthy fat) and only 1g of saturated fat.

Recipe Inspiration

Dietary changes are often the first and one of the most effective steps to reduce the risk of cardiovascular disease, and the body of research suggests that snacking on almonds can help maintain a healthy heart and healthy cholesterol levels. Incorporating almonds into your diet can be simple with these easy recipes: