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A dozen years of clinical research explore benefitsof walnuts unique nutritional profile
California Walnuts
exceptional source of ala
plant based omega-3s
Unique among nuts, walnuts contain the highest amount
o alpha-linolenic acid (ALA), the plant-based omega-3
atty acid (see graph to the right), required by the human
body. As one o the best plant ood sources o omega-3s, a
one-ounce serving o walnuts provides 2.6 grams o ALA. A
growing body o science is beginning to uncover a variety o
benets that ALA/omega-3s may provide to our bodies. While
most nuts contain monounsaturated ats, only walnuts are
comprised primarily o polyunsaturated at (13 grams out o
18 grams total at). Dietary guidelines recommend that peo-
ple keep total at intake between 20 to 35 percent o calories,
with most ats coming rom sources o polyunsaturated and
monounsaturated atty acids.
antioxidant rankings
According to an evidence-based review, antioxidants help to
protect rom certain chronic diseases o aging, including cardio-
vascular, neurological and anticarcinogenic ailments due to their
ability to control ree radicals known to negatively infuence
healthy aging.1 Walnuts contain many antioxidants (13.126
mmol/100 grams). In a 2006 study, 1113 dierent oods were
tested and walnuts ranked second only to blackberries in terms
o antioxidant content (see graph on page 2).2
Another study examining the levels o antioxidants in various
oods, reported at least 10 dierent antioxidants present in
walnuts (802 mg GAE o total phenols per ounce). According
to the study, a handul o walnuts has signicantly more
phenols (an antioxidant) than a glass o apple juice (117 mg),
a milk chocolate bar (205 mg), or a glass o red wine (372 mg).3
1 Functional oods, herbs and nutraceuticals: towards biochemical mechanisms o healthy aging. Biogerontology. 2004;5 (5):275-89.2 Content o Redox-active Compounds (ie, antioxidants) in Foods Consumed in the United States. Am J Clin Nutr. 2006 Jul;84(1):95-135.3 Walnut Polyphenolics Inhibit J Nutr. 2001 Nov;131(11):2837-42.4
Melatonin in Walnuts: Infuence on Levels o Melatonin and Total Antioxidant Capacity o Blood. Nutrition. 2005 Sep;21(9):920-4.
Melatonin is an antioxidant that is naturally ound in walnuts.4
Research, led by melatonin expert Dr. Russel Reiter, published
in the September 2005 issue o Nutrition: The International
Journal of Applied and Basic Nutritional Sciences, reported
the calculate concentrations o melatonin in walnuts was
3.5 +/- 1.0ng/g.
Scientifc Summary
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protein, fiber, magnesium &
phospherous too
In addition to antioxidants and essential ALA/omega-3 atty
acids, an ounce o walnuts provides a convenient source o
protein (4 grams) and ber (2 grams). Most Americans dont
get enough dietary ber which promotes healthy bowel unc-
tion and helps you eel ull a key component in maintaining a
healthy weight. Walnuts are also a good source o magnesium
(44.79 mg/oz) and phosphorus (98.09 mg/oz) both impor-
tant minerals involved the bodys processes and necessary or
achieving optimal wellness.
smart for the heartEating a handul o walnuts every day is an easy way to
boost your daily nutrition. For more than a dozen years,
highly-respected scientists have shown diverse benets o
this whole ood through clinical research. Because o the
strength o evidence supporting cardiovascular health, the
U.S. Food and Drug Administration approved a qualied
health claim or walnuts in March 2004.6
A review o ve clinical trials, published in the Journal of Nutri-
tion, evaluated the intent and quality o scientic evidence or
a potential benecial health relationship between the intake o
walnuts and the reduction and prevention o coronary heartdisease.7 The review included controlled, peer-reviewed, hu-
man clinical walnut intervention trials, involving approximately
200 subjects representative o the 51% o the adult popula-
tion in the United States at risk o coronary heart disease. The
intervention trials in this review consistently demonstrated
walnut consumption as a key component in lowering blood
cholesterol concentrations in study participants, thus support-
ing walnuts as part o a heart-healthy diet.
A cross-over design study, published in the Journal of American
College of Cardiology, randomized 12 healthy adult subjects
and 12 with hypercholesterolemia to either a high-at meal to
which 25 grams o olive oil or 40 grams o walnuts were added.
Brachial artery unction was evaluated beore and ater the
test meals. Flow mediated dilation was better ater the walnut
meal in both groups. E-selection, an infammatory marker, was
lower ater the walnut meal.8
Penn State research published in the Journal of Nutrition
showed that eating walnuts reduced C-reactive Protein (CRP)
and harmul plaque adhesion molecules, two signicant mark-
ers o infammation in arteries. This human controlled eeding
study evaluated the eects o ALA/omega-3s on multiplecardiovascular disease risk actors. Those consuming a diet
high in polyunsaturated atty acids, especially ALA/omega-3s,
exhibited decreased lipid and lipoprotein levels and vascular
anti-infammatory eects.9
good for bone health
Bone health improved with alpha-linolenic acid (ALA) omega-3
consumption in a clinical research study published in the
January 2007 issue o Nutrition Journal.10 This rst controlled
human eeding study evaluated the eect o dietary ALA/ome-
ga-3s provided by walnuts and faxseed, on bone turnover, as
assessed by measurements o biomarkers. 23 participants ol-
lowed three dierent diets over a six week time rame or each:
1) Average American Diet, 2) Linoleic Diet and 3) ALA Diet.
Specic markers measuring bone metabolism and resorption
were measured during each diet. The researchers concluded
that the results indicate that plant sources o dietary omega-3
polyunsaturated atty acids may have a protective eect on
bone metabolism via a decrease in bone resorption in the
presence o consistent levels o bone ormation.
5
http://www.grinhealth.org/Research/ONQI.aspx
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high nutrition ranking
On the NuVal Nutritional Scoring System5 (a consumer nutri-
tion guide to be used by many grocery store chains) walnuts
received 82 points on a 100 point scale, an excellent score
among oods and nuts (see graph below). Scores are obtained
using the Overall Nutritional Quality Index (ONQI) an algo-
rithm designed to generate a single, summative score or the
overall nutritional quality o a ood based on the micronutri-
ent and macronutrient composition o the item. Thirty dierent
nutrient actors are considered into the equation including
vitamins, minerals, protein, carbohydrates, at and antioxidants.
Items are then stratied into a rank order o relative nutritious-
ness both universally (i.e., across all ood categories) and within
specic ood categories (e.g., breads, cereals, rozen desserts).
nutritious food for people
with diabetes
A study published in 2004 reported a positive eect o a
moderate-at diet, inclusive o walnuts, on blood lipid proles
in patients with type 2 diabetes. This parallel randomized
controlled trial included 58 men and women, ages 3575, di-
agnosed with type 2 diabetes at least one year prior. The study
compared three dietary advice groups each with 30 percent
energy as at: 1) low at, 2) modied low at, and 3) modied
low at, inclusive o 30g walnuts (equivalent to around 810nuts) per day. The walnut group achieved a 10% reduction in
LDL cholesterol and a greater increase in HDL (good) choles-
terol levels than the other two treatment groups. The research-
ers concluded that adding walnuts to the diet improved the
blood lipid levels o the patients with type 2 diabetes.11
In addition, Harvard researchers examined the association
between nut consumption and risk o type 2 diabetes in a large
prospective cohort study o 83,818 women rom the Nurses
Health Study aged 3459; with no history o diabetes, cardio-
vascular disease or cancer. Subjects completed a validated
dietary questionnaire at baseline in 1980 and were ollowed up
or 16 years. They ound that women who ate one-ounce por-
tions o nuts, such as walnuts, or peanut butter ve times or
more each week had a signicant lower risk o developing type 2
diabetes compared to the women who rarely or never ate
nuts. Based on these ndings, the researchers concluded that
higher nut and peanut butter consumption may have helped
lower the risk o type 2 diabetes in these women. However, to
avoid increasing caloric intake, regular nut consumption canbe recommended as a replacement or rened carbohydrate
products or red or processed meats.12
tasty tool for weight
management
It turns out the good at (2.6 grams ALA/omega-3s per ounce),
ber (2 grams per ounce) and protein (4 grams per ounce) in
walnuts aid in satiety, an important actor in successul weight
management. A 2001 Loma Linda University study ound that
regular walnut consumption does not lead to weight gain in
study participants. This small randomized crossover eedingtrial included 10 men with hypercholesterolemia. Participants
were given one o three diets to ollow over a six week period:
1) control, 2) Mediterranean-type cholesterol-lowering diet,
and 3) a diet o similar composition in which walnuts replaced
35 percent o energy rom unsaturated at. Ater six months
6 Supportive but not conclusive research shows that eating 1.5 ounces o walnuts per day, as part o a low saturated at and low choles terol diet, and not resulting in increased caloricintake may reduce the risk o coronary heart disease.
7 The Scientic Evidence or a Benecial Health Relationship Between Walnuts and Coronary Heart Disease. J Nutr. 2002 May;132(5):1062S-1101S.8 Acute Eects o High-Fat Meals Enriched with Walnuts or Olive Oil on Postprandial Endothelial Function. J Am Coll Cardiol. 2006 Oct 17;48(8) :1666-71.9 Dietary Alpha-Linolenic Acid Reduces Infammatory and Lipid Cardiovascular Risk Factors in Hypercholesterolemic Men and Women. J Nutr. 2004 Nov;134(11):2991-7.10An increase in dietary n-3 at ty acids decreases a marker o bone resorption in humans. Nutrition Journal. 2007 Jan;6:2.11Including Walnuts in a Low-Fat/Modied-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes. Diabetes Care. 2004 Dec;27(12):2777-83.12
Nut and Peanut Butter Consumption and Risk o Type 2 Diabetes. JAMA. 2002 Nov 27;288(20):2554-60.
NuVal Nutritional Scoring System
NuValRanking
0
50
40
30
20
10
60
70
80
90
100
82
Pumpkin
Seed
s(fre
shcooked)
Flaxs
eedOil
Walnu
ts(ra
w)
Almon
ds(ra
w,dried
,unblan
ched)
Almon
ds(d
ry-roa
sted
,uns
alted
)
Peca
ns,raw
(drie
d)
Pistachi
oNuts(
raw,
dried
)
Almon
ds(blan
ched)
Filbe
rts(blan
ched)
Filbe
rts(ro
aste
d,un
salte
d)
Sunflow
erSe
eds
Flaxs
eed
Pean
uts,
raw(d
ried)
Raisi
ns-unc
ooke
d
HoneyR
oasted
Pean
uts
Canola
Oil
Cash
ews
Canola
Oilb
ased
tubm
arga
rine
Maca
damia
Nuts,
raw(d
ried)
Unsw
eeten
edDried
Coconut
Pretz
els
Chocola
tePie
ces,Ch
ips,Mo
rsels
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the walnut eaters had not gained weight. The walnut diet
reduced serum total and LDL (bad) cholesterol by 4.2 percent
and 6.0 percent respectively. Overall, individuals in this study
who substituted walnuts or other calories did not gain weight
and showed improvements in cholesterol levels.13
In addition, a randomized, prospective trial, published in the
International Journal of Obesity, evaluated weight loss patterns
o 101 overweight men and women. During this 18-monthstudy, subjects consumed either a moderate-at Mediterranean
diet including nuts such as walnuts (35 percent o energy) or a
standard low-at diet (20 percent o energy). The participants
ollowing a Mediterranean-style moderate at weight loss diet,
including peanuts and tree nuts, such as walnuts, were able to
improve weight-loss and keep weight o or a longer period than
people ollowing the traditionally recommended low-at diet. The
researchers suggest that adding nuts may help provide satiety
which is a actor in successul dieting.14 The bottom line: tasty
oods like walnuts can be a great addition to many diets.
strength of themediterranean diet
Walnuts are a traditional component in the Mediterranean
diet and a key ingredient in the landmark PREDIMED study:
a multicenter, randomized, primary prevention trial o cardio-
vascular disease supported by the Spanish Health Ministry.
Findings published in the May 2008 edition o the European
Journal of Clinical Nutritionreported that the consumption o
typical Mediterranean oods was associated with lower levels
o infammatory markers linked to atherosclerosis, insulin
resistance and type 2 diabetes.15 The study measured various
infammatory markers (VCAM-1, ICAM-1, IL-6 and CRP) and
evaluated the diets o 772 men and women (5580 years o
age) at high cardiovascular risk. Individuals with the highest
consumption o olive oil and nuts, including walnuts, showed
the lowest levels o infammation.
Another sub study, reported in 2006 in the Annals of Internal
Medicine, compared the short-term eect o two Mediterranean
diets versus those o a low-at diet on intermediate markers
o cardiovascular disease.16 772 asymptomatic individuals at
high cardiovascular risk were assigned to a low-at diet or to
one o two Mediterranean diets: one supplemented with mixed
nuts, mainly walnuts (15 g walnuts, 7.5 g hazelnuts, and 7.5 g
almonds) and the other with virgin olive oil the main at
component o the Mediterranean diet. When compared to
the low-at diet, the Mediterranean diet (supplemented with
oil olive or nuts, primarily walnuts) reduced arterial pressure,
blood lipids, asting blood glucose, and infammation in study
participants. The researchers noted that this short-term study
provided more intense dietary education on the Mediterranean
diet than on a low-at regime.
A third study rom the PREDIMED trial, published in July 2007
in the Archives of Internal Medicine, examined the eect o the
Mediterranean diet on the oxidative damage on 372 subjects
at high cardiovascular risk. Over a 3-month period, individuals
ollowed either a low-at diet or one o two Mediterraneandiets: one supplemented with mixed nuts, mainly walnuts (15 g
walnuts, 7.5 g hazelnuts, and 7.5 g almonds) and the other
with virgin olive oil. Those ollowing the Mediterranean diet
experienced a decrease in oxidized low-density lipoprotein (a
marker indicating oxidative damage), as well as blood pres-
sure, triglycerides and an improvement in cholesterol levels.
The investigators believe that these results provide urther
evidence to recommend the traditional Mediterranean diet as
a useul tool against risk actors or coronary heart disease.17
Finally, PREDIMED study results appearing in the December
2008 edition o the Archives of Internal Medicineindicate that
the Mediterranean diet supplemented with nuts, primarily
walnuts, may help manage metabolic syndrome a collection
o risk actors associated with cardiovascular disease and
diabetes. More than 1,200 Spaniards, between 55 to 80 years
o age, ollowed one o the three ollowing diets or one year:
1) Mediterranean diet supplemented with three nuts, primarily
walnuts (15 g walnuts, 7.5 g hazelnuts, and 7.5 g almonds),
2) Mediterranean diet supplemented with olive oil or 3) a stan-
dard low at diet. The two groups on the Mediterranean diet
were advised to increase ruit, vegetable and sh consumption;
substitute white meat or bee or processed meat; prepare
homemade tomato sauce with garlic, onions and herbs; and
include red wine i the individual normally drinks alcohol. The
group consuming the Mediterranean diet with walnuts showed
the greatest decrease in the metabolic syndrome 13.7% as
opposed to those ollowing a Mediterranean diet supplemented
with olive oil (6.7% decrease) and the control group consuming
a standard low at diet (2% decrease).18
13Walnut-Enriched Diet Increases the Association o LDL rom Hypercholesterolemic Men with Human HepG2 cells J Lipid Res. 2001 Dec;42(12):2069-7614Int J Obes Relat Metab Disord. 2001 Oct;25(10):1503-11.15Components o the Mediterranean-type ood pattern and serum infammatory markers among patients at high risk or cardiovascular disease. Eur J Clin Nutr. 2008 May;62 (5):651-9.16Eects o a Mediterranean-style diet on cardiovascular risk actors. Ann Intern Med. 2006 Jul 4;145(1):1-11.17Eects o a Traditional Mediterranean Diet on Lipoprotein Oxidation. Arch Intern Med. 2007 Jun 11;167(11):1195-203.18
Eect o a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results o the PREDIMED randomized trial. Arch Intern Med. 2008 Dec 8;168(22):2449-58.
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appendix a: table illustrating studies referenced
Functional oods, herbs and nutraceuticals: towards biochemical mechanisms o healthy aging.
Published: June 2006
Journal: Biogerontology. 2004;5(5):275-89
Authors: Ferrari CK
Research Organization: University o Sao Paulo
Study Description: The purpose o this study was to review important evidence-based mechanisms o unctional
oods with special interest on prevention o chronic diseases o aging. The ocus is on cardiovas-
cular, neurological and anticarcinogenic properties o unctional oods, herbs and nutraceuticals.
Results: Aging is associated with mitochondrial dysunctions, which trigger membrane leakage, release
o reactive species rom oxygen and nitrogen and subsequent induction o peroxidative reactions
that result in biomolecules damaging and releasing o metals with amplication o ree radicals
discharge. Free radicals induce neuronal cell death increasing tissue loss, which could be
associated with memory detriment. These pathological events are involved in cardiovascular,
neurodegenerative and carcinogenic processes. Dietary bioactive compounds rom dierent
unctional oods, herbs and nutraceuticals (ginseng, ginkgo, nuts, grains, tomato, soy phytoes-
trogens, curcumin, melatonin, polyphenols, antioxidant vitamins, carnitine, carnosine, ubiqui-
none, etc.) can ameliorate or even prevent diseases. Protection rom chronic diseases o aging
involves antioxidant activities, mitochondrial stabilizing unctions, metal chelating activities,
inhibition o apoptosis o vital cells, and induction o cancer cell apoptosis.
REVIEW ARTICLE
LABO RATORY ANALYSIS
Content o redox-active compounds (i.e., antioxidants) in oods consumed in the United States.
Published: July 2006
Journal: Am J Clin Nutr. 2006 Jul;84(1):95-135
Authors: Halvorsen BL, Carlsen MH, Phillips KM, Bhn SK, Holte K, Jacobs DR Jr, Blomho R
Research Organization: University o Oslo, Oslo, Norway
Study Description: The objective o the study was to generate a ranked ood table with values or total content
o redox-active compounds. An assay that measures the total concentration o redox-active
compounds above a certain cuto reduction potential was used to analyze 1113 ood samples
obtained rom the US Department o Agriculture National Food and Nutrient Analysis Program.
Results: On the basis o typical serving sizes, blackberries, walnuts, strawberries, artichokes, cranberries,
brewed coee, raspberries, pecans, blueberries, ground cloves, grape juice, and unsweetened
baking chocolate were at the top o the ranked list. The researchers concluded that this ranked
antioxidant ood table provides a useul tool or investigations into the possible health benet o
dietary antioxidants.
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LABO RATORY ANALYSIS
CLINICAL STUDY
Walnut polyphenolics inhibit in vitro human plasma and LDL oxidation.
Published: August 2001
Journal: J. Nutr. 131:2837-42
Authors: Anderson K, Teuber S, Gobeille A, Cremin P, Waterhouse A, Steinberg F
Research Organization: University o Caliornia, Davis
Study Description: Polyphenol-rich extracts rom walnuts and other oods were studied.
Results: The study reported at least 10 dierent antioxidants present in walnuts (802 mg GAE o total phenols
per ounce). According to the study, a handul o walnuts has signicantly more phenolics (antioxidants)
than a glass o apple juice (117 mg), a milk chocolate bar (205 mg), or a glass o red wine (372 mg).
Melatonin in walnuts: infuence on levels o melatonin and total antioxidant capacity o blood.
Published: September 2005
Journal: Nutrition. 2005 Sep;21(9):920-4
Authors: Reiter RJ, Manchester LC, Tan D
Research Organization: The University o Texas Health Science Center at San Antonio
Study Description: Melatonin, an antioxidant, was extracted rom walnuts and quantied by high-perormance
liquid chromatography.
Results: The calculated concentrations o melatonin in walnuts was 3.5 +/- 1.0 ng/g.
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REVIEW ARTICLE
CLINICAL STUDY
The scientic evidence or a benecial health relationship between walnuts and coronary heart disease.
Published: May 2002
Journal: J Nutr. 2002 May;132(5):1062S-1101S
Authors: Feldman EB
Research Organization: Lie Sciences Research Oce, Inc.
Study Description: Because walnuts contain multiple health-benecial components, such as having a low lysine:
arginine ratio and high levels o arginine, olate, ber, tannins, and polyphenols, ve independent
experts evaluated the intent and quality o scientic evidence or a potential benecial health
relationship between the intake o walnuts and the reduction and prevention o coronary heart
disease. Five controlled, peer-reviewed, human clinical walnut intervention trials, involving ap-
proximately 200 subjects representative o the 51% o the adult population in the United States at
risk o coronary heart disease were reviewed. ering diet, and a diet o similar composition in which
walnuts replaced 35 percent o energy rom unsaturated at, were given or six weeks each to ten
men with polygenic hypercholesterolemia.
Results: The intervention trials consistently demonstrated walnuts as part o a heart-healthy diet, lower
blood cholesterol concentrations in study participants. None o these studies were o extended
duration that would be essential or evaluation o the sustainability o the observed outcomes.
These results were supported by several large prospective observational studies in humans, all
demonstrating a dose response-related inverse association o the relative risk o coronary heart
disease with the requent daily consumption o small amounts o nuts, including walnuts.
Acute Eects o High-Fat Meals Enriched With Walnuts or Olive Oil on Postprandial Endothelial Function.
Published: October 2006
Journal: J Am Coll Cardiol. 2006;48:1666-1671
Authors: Corts B, Nez I, Con M, Gilabert R, Prez-Heras A, Casals E, Deuloeu R, Ros E
Research Organization: University o Barcelona, Hospital Clinic
Study Description: Twelve healthy adult subjects and twelve subjects with hypercholesterolemia were randomized
in a cross-over design to consume high-at meals to which 25 grams o olive oil or 40 grams o
walnuts were added. Brachial artery unction was evaluated while subjects were asting and
4 hours ater test meals.
Results: Flow mediated dilation was improved ater the walnut meal in both groups. E-selection, an in-
fammatory marker, was lower ater the walnut meal. Researchers noted in their conclusion that,
adding walnuts to a high-at meal acutely improves FMD independently o changes in oxidation,
infammation or ADMA.
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CLINICAL STUDY
An increase in dietary n-3 atty acids decreases a marker o bone resorption in humans.
Published: January 2007
Journal: Nutrition Journal2007, 6:2
Authors: Griel A, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL
Research Organization: The Pennsylvania State University
Study Description: A randomized 3-period controlled eeding study in humans (n=23; ages 36-65y) evaluated
the eects o dietary n-3 PUFA, alpha-linolenic acid (ALA) on a marker o bone resorption.
Serum N-telopeptides (NTx) were signicantly lower ollowing a high ALA diet versus an average
American diet.
Results: Key ndings suggest alpha-linolenic acid (ALA), an essential omega-3 atty acid, is benecial tothe skeletal system by decreasing the breakdown o bone. This is the rst human study evaluating
the eect o plant-based sources o omega-3 atty acids (ALA) on bone health. The results suggest
higher consumption o ALA leads to a reduction in bone turnover, and a shit in the balance o
bone degradation/ormation toward ormation.
CLINICAL STUDY
Dietary Alpha-Linolenic Acid Reduces Infammatory and Lipid Cardiovascular Risk Factors in Hypercholesterolemic Men and Women.
Published: November 2004
Journal: J Nutr. 2004 Nov;134(11):2991-7
Authors: Zhao G, Etherton TD, Martin KR, West SG, Gillies PJ, Kris-Etherton PM
Research Organization: The Pennsylvania State University
Study Description: Subjects included 20 men (ages 36-60) and three women (ages 55-65) with moderate hyper-
cholesterolemia.
Randomized, controlled, 3-diet, 3-period, cross-over study design. The diets included two diets
low in saturated at and cholesterol, and high in PUFA varying in ALA (ALA diet) and linoleic acid
(LA Diet) compared with an average American diet (AAD). In the two high-PUFA diets, hal o
the total at was derived rom walnuts and walnut oil because they are rich sources o PUFA and,
particularly, ALA (100 g o walnuts provides 38g o LA and 9g o ALA; 100 g o walnut oil provides
53g o LA and 10g o ALA). The ALA diet included a teaspoon o faxseed oil.
Results: Compared to the average American diet, subjects on both the LA and the ALA diets had loweredtotal cholesterol o 11 percent, lowered LDL o 11-12 percent and decrease in triglycerides o 18
percent. Ater six weeks on the diet, CRP declined ater both the LA and ALA diets but more
dramatically on the ALA diet. The researchers concluded that within this study population, a diet
high in PUFA, especially ALA, provides cardioprotective eects by decreasing lipid and lipopro-
tein levels and by eliciting vascular anti-infammatory eects.
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PROSPECTIVE COHORT STUDY
CLINICAL STUDY
Including Walnuts in a Low-Fat/Modied-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes.
Published: December 2004
Journal: Diabetes Care. 2004;27(12):2777-2783
Authors: Tapsell LC, Gillen LJ, Patch CS, Batterham M, Owen A, Bare M, Kennedy M
Research Organization: National Centre o Excellence in Functional Foods, University o Wollongong, Australia
Study Description: Subjects included 58 men and women, ages 35-75, diagnosed with type 2 diabetes mellitus at
least one year and generally well. A parallel randomized controlled trial compared three dietary
advice groups, each with 30 percent energy as at: low at, modied low at and modied low
at inclusive o 30g walnuts (equivalent to around 810 nuts) per day.
Results: The walnut group achieved a signicantly greater increase in HDL cholesterol-to-total cholesterol
ratio and HDL than the other two treatment groups. A 10 percent reduction in LDL cholesterol
was also achieved in the walnut group. In conclusion, Structured whole o diet advice that
included 30g walnuts/day delivering substantial amounts o polyunsaturated atty acid improved
the lipid prole o patients with type 2 diabetes.
Nut and peanut butter consumption and risk o type 2 diabetes in women.
Published: November 2002
Journal: JAMA. 2002 Nov 27;288(20):2554-60
Authors: Jiang R, Manson JE, Stamper MJ, Liu S, Willett WC, Hu FB
Research Organization: Harvard School o Public Health
Study Description: Subjects included 83,818 women rom 11 states in the Nurses Health Study; aged 34-59; with no
history o diabetes, cardiovascular disease or cancer. This was a prospective cohort study. Subjects
completed a validated dietary questionnaire at baseline in 1980 and were ollowed up or 16 years.
Results: Based on this study population, the researchers believe the ndings suggest potential benets o
higher nut and peanut butter consumption in lowering risk o type 2 diabetes in women. To avoid
increasing caloric intake, regular nut consumption can be recommended as a replacement or
consumption o rened grain products or red or processed meats.
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CLINICAL STUDY
Walnut-enriched diet increases the association o LDL rom hypercholesterolemic men with human HepG2 cells.
Published: December 2001
Journal: J. Lipid Res., December 1, 2001; 42(12): 2069-2076.
Authors: Munoz S, Merlos M, Zambon D, Rodriguez C, Sabate J, Ros E, Laguna JC
Research Organization: Hospital Clinic o Barcelona/Loma Linda University
Study Description: Randomized, crossover eeding trial with three diets: control, Mediterranean-type cholesterol-low-
ering diet, and a diet o similar composition in which walnuts replaced 35 percent o energy rom
unsaturated at, were given or six weeks each to ten men with polygenic hypercholesterolemia
Results: Ater six months the subjects on the walnut diet had not gained weight. The walnut diet reduced
serum total and LDL (bad) cholesterol by 4.2 percent and 6.0 percent respectively.
0
CLINICAL STUDY
A randomized controlled trial o a moderate-at, low-energy diet compared with a low at, low-energy diet or weight loss in overweight adults.
Published: October 2001
Journal: Int J Obes Relat Metab Disord. 2001 Oct;25(10):1503-11
Authors: McManus K, Antinoro L, Sacks F
Research Organization: Brigham & Womens Hospital
Study Description: Subjects included 101 overweight men and women. Randomized, prospective 18-month trial in a ree-
living population: (1) Moderate-at diet (35 percent o energy); (2) low-at diet (20 percent o energy)
Results: Participants ollowing a Mediterranean-style moderate at weight loss diet, including peanuts
and tree nuts, such as walnuts, were able to improve weight loss and keep weight o or a longer
period than people ollowing the traditionally recommended low-at diet. The researchers suggestthat the diet success o the participants may have been attributed to the satiety o the tree nuts
(i.e. walnuts) a key actor in weight loss.
CROSS SECTIONA L ANALYSIS
Components o the Mediterranean-type ood pattern and serum infammatorymarkers among patients at high risk or cardiovascular disease.
Published: May 2008
Journal: Eur J Clin Nutr. 2008;62:651-9
Authors: Salas-Salvad J, Garcia-Arellano A, Estruch R, Marquez-Sandoval F, Corella D, Fiol M,
Gmez-Gracia E, Violes E, Ars F, Herrera C, Lahoz C, Lapetra J, Perona JS, Muoz-Aguado D,Martnez-Gonzlez MA, Ros E, or the PREDIMED Investigators
Research Organization: Hospital Clinic o Barcelona
Study Description: Diets o 772 men and women (55-80 years o age) at high cardiovascular risk were evaluated
using ood requency questionnaires. Infammation was measured using serum concentrations
o high-sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), intracellular adhesion molecule-1
(ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1).
Results: Subjects with the highest consumption o nuts and virgin olive oil showed the lowest concentrations o
VCAM-1, ICAM-1, IL-6 and CRP. The researchers concluded that, within the subjects o this study, the
consumption o typical Mediterranean oods (ruits, cereals, virgin olive oil and nuts) was associated with
lower serum concentrations o infammatory markers especially those related to endothelial unction.
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CLINICAL STUDY
CLINICAL STUDY
Eects o a Mediterranean-style diet on cardiovascular risk actors: a randomized trial.
Published: July 2006
Journal: Ann Intern Med. 2006 Jul 4;145(1):1-11
Authors: Estruch R, Martnez-Gonzlez MA, Corella D, Salas-Salvad J, Ruiz-Gutirrez V, Covas MI,Fiol M, Gmez-Gracia E, Lpez-Sabater MC, Vinyoles E, Ars F, Conde M, Lahoz C, Lapetra J,
Sez G, Ros E; or the --PREDIMED Study Investigators
Research Organization: Hospital Clinic o Barcelona
Study Description: Aliated with 10 teaching hospitals across Spain, the Prevencion con Dieta Mediterranea
(PREDIMED) is a large, parallel-group, multi-center, randomized, controlled our-year eeding trial
that aims to assess the eects o the Mediterranean diet on the primary prevention o cardiovas-
cular disease (www.predimed.org). The present study assesses the rst three months studying
772 participants, men and women, 55-80 years old, with one or more o the ollowing: type 2
diabetes, smoking, hypertension, or high cholesterol levels. In this study there are three inter-
ventions: Mediterranean diet with virgin olive oil, Mediterranean diet with mixed nuts (walnuts,
almonds, hazelnuts), or low-at diet.
Results: Researchers noted that the high risk participants in this study who improved their diet with olive
oil or nuts, such as walnuts, showed lower blood pressure, improved lipid proles, and decreased
insulin resistance compared with those allocated to the low-at diet. Compared with the low-at
diet, the average changes in the Mediterranean diet with olive oil group and the Mediterranean
diet with nuts group were -0.39 mmol/L and -0.30 mmol/L , respectively, or plasma glucose levels;
-5.9 mm Hg and -7.1 mm Hg, respectively, or systolic blood pressure; and -0.38 and - 0.26,
respectively, or the cholesterol-high-density lipoprotein cholesterol ratio.
Eect o a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial.
Published: June 2007
Journal: Arch Intern Med. 2007 Jun 11;167(11):1195-203
Authors: Fito M, Guxens M, Corella D, Sez G, Estruch R, de la Torre R, Frances F, Cabezas C,
Lopez-Sabater Mdel C, Marrugat J, Garcia-Arellano A, Ars F, Ruiz-Gutirrez V, Ros E,
Salas-Salvad J, Fiol M, Sola R, Covas MI; or the PREDIMED Study Investigators
Research Organization: Hospital Clinic o Barcelona
Study Description: PREDIMED is a long-term multi-center trial -supported by the Spanish Health Ministry- designed
to assess the eects o a Mediterranean-style diet on the primary prevention o cardiovascular
disease. In this study, a total o 372 men and women at high cardiovascular between 5580
years o age, were assigned to a low-at diet or one o two Mediterranean diets:
1) Mediterranean diet with virgin olive oil or
2) Mediterranean diet with mixed nuts (15 g walnuts, 7.5 g hazelnuts, and 7.5 g almonds).
Changes in oxidative stress markers in participants were evaluated at 3 months.
Results: Ater the 3-month interventions, LDL levels decreased in both o the Mediterranean groups,
(Mediterranean diet with olive oil: -10.6 U/L; Mediterranean diet with nuts: -7.3 U/L) without
changes in the low-at diet group. The decrease in the oxidative damage to LDL cholesterol seen
in the studys participants is one o the protective mechanisms by which the Mediterranean diet
exerts a protective eect on coronary heart disease development.
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