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Chapter
The Beneficial Role of Nuts and
Seeds in a Plant-Based Diet
Michael S. Donaldson
Abstract
In the last several years research has been accumulating that demonstrates that
nuts and seeds are beneficial for all people. While some plant-based diet programs
have embraced the inclusion of nuts and seeds, other programs have eschewed nuts
and seeds, remaining firmly committed to a starch-based dietary pattern. This chapter
assembles the scientific evidence regarding the benefits of nuts and seeds into three
issues: (1) The nutrient density of nuts and seeds compared to grains and legumes of
the same caloric content, (2) The improvement of health outcomes and extra benefits
when nuts and seeds are included in plant-based diets, (3) The safety of nuts and
seeds when a person is dealing with cancer. As a result of examining these issues with
the known scientific evidence it will become apparent that one to two ounces of nuts
and seeds daily is a very beneficial part of a plant-based diet.
Keywords: nuts, seeds, cardiovascular disease, cancer, plant based diet
1. Introduction
The scientific evidence for the benefits of a plant-based diet is enumerated in the
various chapters of this book. Much of the evidence comes from programs and clinical
trials that avoided any added fats or fatty foods, even from plant sources. So a title
containing “nuts”and “benefits”in the same sentence may seem like an oxymoron, a
contradiction in terms at the least. The inclusion of fatty foods like nuts and seeds has
been and continues to be a controversial topic within the plant-based research com-
munity. While newer publications from the last several years relate to benefits of nuts
and seeds, the older plant-based diet literature largely found positive results without
the inclusion of nuts or seeds. Dr. Dean Ornish and Dr. Caldwell Esselstyn established
the benefits of a low-fat plant-based diet for reversing heart disease. Dr. Ornish was
one of the first doctors to prove that a plant-based diet could reverse heart disease,
using the best testing methods available to provide the evidence to sway beliefs [1].
Dr. Esselstyn also reversed heart disease using this very low-fat diet, having about a
99% success rate [2]. Both Dr. Ornish and Dr. Esselstyn were able to get their great
clinical success purposefully avoiding nuts and seeds and any added fats in the diet.
Their success has been continued by others as well [3].
On the other hand, the position paper of the American Dietetic Association states
“A well-planned vegetarian diet containing vegetables, fruits, whole grains, legumes,
1
nuts, and seeds can provide adequate nutrition.”[4]. The use of enhanced intake of
beans, greens, seeds, nuts, whole grains, and other colorful plant products is
recommended for athletes by Fuhrman and Ferreri [5]. In examining protein intakes
on plant-based diets Mariotti and Gardner warn, “An insufficient protein intake from
vegetarian diets may occur if the diet does not include protein-rich foods such as
legumes (the most traditional source) and nuts and seeds, or any protein analogs of
animal foods”[6].
In view of the lingering scientific controversy of the inclusion of nuts and seeds
into a healthy plant-based diet this chapter is written so that the information is clearly
available in one place for people to understand how nuts and seeds can be beneficial.
There are 3 main issues to be addressed in this article. They are:
1.The nutrient density of nuts and seeds compared to grains and legumes.
2.The improvement of health outcomes and extra benefits when nuts and seeds are
included in vegetarian or vegan diets.
3.The safety of nuts and seeds when a person is dealing with cancer.
As a result of examining these issues, it will become apparent that 1 to 2 ounces of
nuts and seeds on a daily basis is a very beneficial part of a healthy plant-based diet.
2. Nutrient density of nuts versus grains and legumes
The first issue is to examine the nutrient density of nuts and seeds compared to
grains and legumes. To examine this issue, four common nuts and five common seeds
were compared with five grains and six types of beans and lentils. A 200-calorie
serving of each food was compared for nutrients, as this is just slightly more than a 1
ounce serving of nuts or seeds. Nutrient amounts were taken from USDA standard
reference nutrient tables incorporated into the software program NutriBase (Version
11.71, Phoenix, AZ).
As shown in Table 1, equal caloric amounts of nuts, cooked grains and cooked
beans vary in serving sizes, measured in grams. About 1 ounce of seeds or nuts yields
200 calories, while it takes about one cup of cooked grains or about ¾ cup of cooked
beans to get the same amount of calories. The main difference is the amount of water
that is not in nuts and seeds and the fact that fats pack more calories into a smaller
space than carbohydrates and proteins.
2.1 Macronutrient content in nuts versus grains and legumes
Nuts and seeds and grains have about 6.5 grams of protein per 200-calorie serving,
while cooked dry beans have about double this amount, at 13 grams of protein per
200-calorie serving. So for protein, beans are a better source of protein than nuts and
seeds. Beans average 35% of the calories as protein, ranging from 26 percent (pink
beans and chickpeas) to 40 percent (lentils). Nuts and seeds are about 14% protein,
ranging from about 5 percent (pecans) to 20 percent (pumpkin seed kernels). Grains
are similar to nuts in protein content ranging from 10 percent (brown rice) to 16
percent (quinoa).
2
Plant-Based Diet
Carbohydrate content is again a big difference between nuts and seeds and grains/
beans. The carbohydrate content of nuts and seeds is very low, especially considering
their fiber content. Nuts and seeds averaged about 3 grams of net carbohydrate per
200-calorie serving. Only pistachios were above 5 grams. Grains averaged about 34
grams of net carbs, while beans averaged 24 grams. About 72% of the calories in grains
come from carbohydrates; 60% of calories in beans are from carbohydrates.
Fiber is another category where the beans are about double the amount in nuts and
seeds and grains, with about 12 grams of fiber per serving of beans compared to about
4 grams for grains and 5 grams for nuts and seeds. Flax seeds and chia seeds are much
higher in fiber than other seeds or nuts. The average fiber content without these two
seeds is 3.1 grams per serving.
Ingredient Grams Protein
(g)
%Cal,
Protein
Carbs
(g)
Fiber
(g)
Net Carb
(g)
%Cal,
Carb
Fat
(g)
%Cal,
Fat
Almond, Raw 35.0 7.3 14.8 7.5 4.3 3.1 6.4 17.3 78.8
Walnut, Raw 30.6 4.7 9.0 4.2 2.1 2.2 4.2 20.0 86.8
Pecan, Raw 29.0 2.7 5.2 4.0 2.8 1.2 2.4 20.9 92.3
Pistachio, Rstd 35.3 7.4 14.8 10.4 3.5 6.9 13.8 15.8 71.4
Sunflower Seed 34.3 7.1 14.0 6.9 3.0 3.9 7.7 17.7 78.3
Sesame Seed 34.9 6.2 12.6 8.2 4.1 4.1 8.3 17.3 79.2
Flax Seed 37.5 6.9 15.9 10.8 10.2 0.6 1.4 15.8 82.7
Chia Seed 41.2 6.8 17.7 17.4 14.2 3.2 8.3 12.7 74.0
Pumpkin Seed 35.8 10.8 20.8 3.8 2.2 1.7 3.2 17.6 76.0
Nuts & Seeds,
Average
34.8 6.7 13.9 8.1 5.1 3.0 6.2 17.2 79.9
Quinoa, ckd 166.7 7.3 16.2 35.5 4.7 30.8 68.0 3.2 15.9
Wild Rice, ckd 198 7.9 16.4 42.3 3.6 38.7 80.4 0.7 3.2
Brown Rice, ckd 180.2 4.7 10.0 41.4 3.2 38.1 82.1 1.6 7.9
WW Bread 72.0 6.0 12.7 37.0 4.3 32.7 68.8 3.9 18.4
Oatmeal, wtr 281.7 7.2 15.6 33.8 4.8 29.0 63.3 4.3 21.0
Grains, Average 179.7 6.6 14.2 38.0 4.1 33.9 72.5 2.7 13.3
Pinto Bean, bld 139.9 12.6 32.5 36.7 12.6 24.1 62.2 0.9 5.3
Black Bean, bld 151.5 13.4 35.3 35.9 13.2 22.7 59.8 0.8 4.8
Chickpea, cnd 227.3 11.2 26.7 30.7 10.0 20.7 49.4 4.4 23.9
GN Bean, bld 169.5 14.1 35.6 35.8 11.9 23.9 60.1 0.8 4.3
Navy Bean, bld 142.9 11.8 32.7 37.2 15.0 22.2 61.8 0.9 5.5
Pink Bean, bld 134.2 12.2 27.6 37.5 7.1 30.3 69.0 0.7 3.4
Lentil, bld 172.4 15.6 40.8 34.7 13.6 21.1 55.3 0.7 3.9
Beans, Average 162.5 13.0 33.0 35.5 11.9 23.6 59.7 1.3 7.3
Food group with the highest amount of a nutrient shown in red. Rstd = roasted; Bld = boiled; Ckd = cooked; WW = whole
wheat; wtr = prepared with water; cnd = canned; GN Bean = Great Northern Bean.
Table 1.
Proximate nutrient comparison of 200 calories servings of nuts, grains and dry beans.
3
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
Nuts and seeds are rich in fat, with about 80 percent of the calories coming from
fats. Pecans and walnuts are particularly high in fat, with 87 and 92 percent of their
calories, respectively, coming from fat. Beans on average have about 4.5 percent of the
calories as fat, except for chickpeas which are at about 24 percent. Grains are also
naturally low in fat.
So, nuts and seeds are a modest source of protein, very low in carbohydrates and a
rich source of fats. Grains are a modest source of protein, low in fat and have a large
amount of starch in them. Dry beans and lentils are an excellent source of protein,
very low in fat, and a very good source of fiber as well.
One of the benefits of nuts and seeds here is the lack of glycemic response from
their consumption. A recent randomized trial compared glucose and insulin levels
after consuming a 253-calorie serving of mixed nuts or unsalted pretzels after an
overnight fast. In the pretzel group glucose and insulin levels 60 minutes after eating
were elevated, while in the mixed nuts group neither glucose nor insulin levels were
significantly different from baseline levels [7]. In addition to nuts, flax seeds and
chia seeds are very rich in dietary fiber. When 15 volunteers took, in random order, a
50-gram glucose challenge by itself or along with 25 g chia seeds or 31.5 g flax seeds
the blood glucose response during 2 hours was blunted significantly by 39 and 28% by
chia seeds and flax seeds, respectively [8]. These seeds, especially chia seeds, were
able to turn glucose into a slow-release carbohydrate with their high-viscosity fiber.
A comparison of the classes of fats in nuts and seeds is given in Figure 1 for a
200-calorie serving of four kinds of nuts and five kinds of seeds. As seen in Figure 1,
there is very little saturated fat in nuts and seeds. Almonds, pecans, and pistachio nuts
are high in monounsaturated fatty acids (MUFAs) with over 50 percent of their fat as
MUFA. Only walnuts, flax seeds, and chia seeds have significant amounts of omega 3
polyunsaturated fatty acids (PUFAs) as alpha linolenic acid (ALA), a short-chain
omega 3 fatty acid. Walnuts, sunflower, sesame, and pumpkin seeds have a large
amount of the omega 6 fatty acid linoleic acid (LA). In their unprocessed, raw form
both LA and ALA are very valuable fats and are essential nutrients, not found in grains
and legumes in appreciable amounts. This is another benefit of nuts and seeds. So,
these raw nuts and seeds are a good source of LA and ALA, which can be damaged
by roasting, especially for long times over the temperature of 300°F (150°C) [9].
Though only trace amounts are transformed into the long-chain omega 3 fatty acid
DHA [10], there are many health benefits from ALA and EPA generated from ALA
[11]. Overall, the fatty acid profiles of nuts and seeds are very favorable to cardiovas-
cular health as MUFAs and especially PUFAs tend to lower cholesterol and the inci-
dence of cardiovascular disease compared to saturated fats [12]. And whatever is
protective of the heart is likely to be beneficial for the brain, bones, joints, and
muscles of the body.
2.2 Vitamin content
A comparison of the vitamin content of 200-calorie servings of common nuts and
seeds, grains and dry beans is given in Table 2. The Recommended Daily Intake (RDI)
is given for each nutrient, as it is much easier to compare percentages rather than
actual amounts. The nutrient amount for a particular food is in bold case for amounts
greater than 20 percent of the RDI. As you can see, these foods are not a rich source of
several of these vitamins, such as vitamin A, vitamin C, and vitamin K. These vitamins
are found in higher amounts in fruits and vegetables. The vitamins which contents are
high in nuts and seeds are mentioned in the text below.
4
Plant-Based Diet
Ingredient Vit-A μg
RAE
B1
mg
B2
mg
B3
mg
B5
mg
B6
mg
Chol
mg
Folate μg
DFE
Vit C
mg
Vit E
mg
K1 μg
RDI, absolute
amounts
900 1.2 1.3 16 5 1.7 550 400 90 15 120
Almond, Raw 0% 6% 30% 8% 3% 3% 3% 4% 0% 59% 0%
Walnut, Raw 0% 8% 4% 2% 3% 9% 2% 7% 0% 1% 1%
Pecan, Raw 0.1% 16% 3% 2% 5% 4% 2% 2% 0% 3% 1%
Pistachio, Rstd 0.5% 21% 6% 3% 4% 24% 5% 5% 1% 6% 4%
Sunflower Seed 0.1% 43% 9% 18% 8% 27% 3% 19% 1% 80% 0%
Sesame Seed 0% 23% 7% 10% 0% 16% 2% 8% 0% 1% 0%
Flax Seed 0% 52% 5% 7% 7% 11% 5% 8% 0% 1% 1%
Chia Seed 0% 22% 5% 23% 1% 1%
Pumpkin Seed 0% 8% 4% 11% 5% 3% 4% 5% 1% 5% 2%
Figure 1.
A breakdown of the distribution of saturated, monounsaturated and polyunsaturated fats in nuts and seeds.
SFA = saturated fat, MUFA = monounsaturated fat, Omega 3 = alpha linolenic acid, Omega 6 = linoleic acid.
5
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
A serving of sunflower seeds provides over 40 percent of the RDI for thiamin
(vitamin B1). A 200-calorie serving of flax seeds provides over 50 percent of the RDI.
Most seeds are generally an excellent source of thiamin, with pumpkin seeds being the
exception. Grains on average provide 15 percent of the RDI. Beans are also an excel-
lent source of vitamin B1, providing between 20 and 30 percent of the RDI for
thiamin, similar to the average for seeds.
A serving of almonds provides over 30 percent of the RDI for riboflavin (vitamin
B2). But most nuts and seeds are not this rich a source of riboflavin, averaging about 5
percent of the RDI. Grains and beans are not much better, with less than 10 percent of
the RDI per serving.
Sunflowers are a notable source of niacin (vitamin B3), with 18 percent of the RDI
per serving. But chia seeds are even better at 23 percent. Rice and whole wheat bread
are good sources with 16–18 percent of the RDI of niacin per serving. Beans are not a
rich source of niacin with only lentils providing more than 10 percent of the RDI.
Pistachio nuts and sunflower seeds are excellent sources of vitamin B6, with sesame
and flax seeds also being good sources. Grains are good sources, except for oatmeal.
Beans are also good sources, with chickpeas delivering over 60% of the RDI per serving.
Almonds and sunflower seeds are very rich sources of vitamin E. Most other nuts
and seeds, grains and beans provide little vitamin E, but these two foods are two of the
richest food sources of vitamin E. In a South Korean trial using 56 g/day of almonds
Ingredient Vit-A μg
RAE
B1
mg
B2
mg
B3
mg
B5
mg
B6
mg
Chol
mg
Folate μg
DFE
Vit C
mg
Vit E
mg
K1 μg
Nuts & Seeds,
Average
0.1% 22% 8% 9% 5% 12% 3% 7% 0% 17% 1%
Quinoa, ckd 0% 15% 14% 4% 12% 7% 18% 0% 7% 0%
Wild Rice, ckd 0% 8% 13% 16% 6% 16% 4% 13% 0% 3% 1%
Brown Rice, ckd 0% 14% 4% 17% 10% 15% 3% 2% 0% 0% 1%
WW Bread 0% 18% 12% 18% 7% 8% 3% 14% 0% 4% 6%
Oatmeal, wtr 0% 18% 3% 4% 18% 1% 4% 4% 0% 2% 1%
Grains,
Average
0% 15% 9% 12% 10% 10% 4% 10% 0% 3% 2%
Pinto Bean, bld 0% 23% 7% 3% 6% 19% 60% 1% 9% 4%
Black Bean, bld 0% 31% 7% 5% 7% 6% 56% 0% 0% 0%
Chickpea, cnd 0.2% 6% 2% 2% 14% 63% 10% 14% 0% 3% 4%
GN Bean, bld 0% 23% 8% 7% 9% 12% 43% 2%
Navy Bean, bld 0% 28% 7% 6% 8% 12% 12% 50% 0% 1%
Pink Bean, bld 0% 28% 6% 5% 8% 14% 9% 56% 0% 9% 4%
Lentil, bld 0.1% 24% 10% 11% 22% 18% 10% 78% 3% 1% 2%
Beans, Average 0% 23% 7% 6% 10% 21% 10% 51% 1% 4% 3%
Excellent sources of nutrients (≥20% of RDI) are shown in bold case. Blank cells indicate missing data. Rstd = roasted;
Bld = boiled; Ckd = cooked; WW = whole wheat; wtr = prepared with water; cnd = canned; GN Bean = Great Northern
Bean.
Table 2.
Vitamin comparison of nuts, grains and dry beans, as a percent of the recommended dietary intake (RDI).
6
Plant-Based Diet
or a control cookie in a 4-week cross-over pattern, volunteers doubled their intake
of vitamin E, which resulted in an 8.5% increase in plasma α-tocopherol levels
while simultaneously reducing total cholesterol 5.5% and non-HDL cholesterol
by 6.4% [13].
From this analysis of vitamins, we can deduce a few points. First, different foods
have different strengths as sources of nutrients, so it is helpful to encourage people to
eat a variety of plant foods to take advantage of different nutrient profiles to even out
overall intake. Second, when averaging the percent of the RDI for each vitamin,
sunflower seeds are, on average, the best source of micronutrients (19%) of all of
these foods listed in Table 3. Almonds are also a good source of vitamins with an
Ingredient Calc
(mg)
Mag
(mg)
Phos
(mg)
Pot
(mg)
Cop
(mg)
Iron
(mg)
Mng
(mg)
Sel
(μg)
Zn
(mg)
RDI, absolute
amounts
1300 420 1250 4700 0.9 18 2.3 55 11
Almond, Raw 7% 22% 13% 5% 40% 7% 33% 3% 10%
Walnut, Raw 2% 12% 8% 3% 54% 5% 45% 3% 9%
Pecan, Raw 2% 8% 6% 3% 39% 4% 57% 2% 12%
Pistachio, Rstd 3% 9% 13% 8% 51% 8% 19% 6% 8%
Sunflower Seed 2% 27% 18% 5% 69% 10% 29% 33% 16%
Sesame Seed 26% 29% 18% 3% 69% 28% 37% 22% 25%
Flax Seed 7% 35% 19% 6% 51% 12% 40% 17% 15%
Chia Seed 20% 33% 28% 4% 42% 18% 49% 41% 17%
Pumpkin Seed 1% 33% 35% 6% 53% 18% 71% 6% 25%
Nuts & Seeds,
Average
8% 25% 18% 5% 62% 12% 42% 15% 15%
Quinoa, ckd 2% 25% 20% 6% 36% 14% 46% 8% 17%
Wild Rice, ckd 0% 15% 13% 4% 27% 7% 24% 3% 24%
Brown Rice, ckd 1% 18% 12% 2% 20% 4% 71% 32% 10%
WW Bread 2% 14% 11% 5% 20% 12% 59% 50% 10%
Oatmeal, wtr 2% 18% 17% 4% 23% 14% 71% 28% 26%
Grains, Average 2% 18% 15% 4% 25% 10% 54% 24% 17%
Pinto Bean, bld 5% 17% 16% 13% 34% 16% 27% 16% 12%
Black Bean, bld 3% 25% 17% 11% 36% 18% 29% 3% 15%
Chickpea, cnd 6% 15% 15% 7% 39% 16% 81% 8% 14%
GN Bean, bld 9% 20% 22% 14% 47% 20% 81% 13% 14%
Navy Bean, bld 8% 18% 16% 12% 33% 19% 33% 8% 13%
Pink Bean, bld 5% 21% 18% 15% 40% 17% 33% 3% 12%
Lentil, bld 3% 15% 25% 14% 48% 32% 37% 9% 20%
Beans, Average 6% 19% 18% 12% 40% 20% 40% 9% 14%
Table 3.
Mineral Comparison of Nuts, Grains and Dry Beans, as a Percent of the Recommended Dietary Intake (RDI).
Excellent sources of nutrients (≥20% of RDI) are shown in bold case.
7
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
average of 11% RDI. Beans average is 12% RDI, with lentils coming in highest at 16%.
This vitamin analysis shows that sunflower seeds, almonds, and lentils are great foods
for at least weekly consumption, if not more frequently.
2.3 Mineral content
As can be seen from Table 3, nuts and seeds, whole grains and dry beans all
provide a much higher amount of the essential minerals than of the vitamins. The RDI
amount in milligrams or micrograms (for selenium) are given in the first row of the
table.
Sesame seeds and chia seeds are both excellent sources of calcium, providing 26
and 20 percent of the RDI, respectively. Almonds and flax seeds are also decent
sources, with about 95 mg of calcium per serving. Great Northern beans and navy
beans are also decent sources of calcium, around 100 mg per serving, but the other
beans are not so high. Calcium has long been a nutrient of concern for people follow-
ing plant-based diets, so the inclusion of nuts and seeds rich in calcium will boost
intakes of calcium compared to eating isocaloric amounts of grains.
Magnesium is a shortfall nutrient for the US population. About 50 percent of all
American consume less than the Estimated Average Requirement (EAR) for magne-
sium [14]. Among the elderly it is worse, with 75% of men age 71+ and 63% of women
age 71+ under the EAR for magnesium. Adolescents do not fare well, either, with 78
and 89 percent of males and females, respectively, 14–18 years of age consuming less
than the EAR. Magnesium is very important for cardiovascular health, bone health,
prevention of diabetes, cognitive function [15], and prevention of eclampsia during
pregnancy [16].
Consuming more nuts and seeds can improve intake of magnesium. On average
nuts and seeds are better sources of magnesium than grains or beans, though there is
some variation. A 200-calorie serving of seeds averages 35% of the RDI for magne-
sium, making them a superfood for magnesium. Almonds are the only nut that is an
excellent source (≥20% of RDI) of magnesium. Grains are good sources, with quinoa
excelling at 25% of RDI for magnesium. Some beans are excellent sources of magne-
sium (black beans, Great Northern beans, pink beans) and the average for beans
comes out to 18% of RDI for magnesium. Generally, grains and beans have only half of
the amount of magnesium found in seeds, so substituting a serving of seeds for a
serving of whole grains will improve a persons’magnesium status.
Though high intake of potassium is a strength of plant-based diets and contributes
to normal blood pressure [17], strong bones [18], and cardiovascular and overall
survival [19], nuts and seeds and grains are low sources of potassium, while beans are
generally good sources. Potassium is found in abundance in fruit and vegetables, so
this is where most of the requirements are met. Beans win this mineral by a two-fold
margin.
Copper is easily obtained in a plant-based diet. It is easy to get half of the RDI for
copper with a 200-calorie serving of nuts or seeds. Sesame seeds provide 1.4 mg of
copper, almost 160% of the RDI. Beans are also an excellent source of copper, but not
as good as nuts and seeds.
Plant-based diets need good sources of iron. Women of reproductive age following
plant-based diets especially need iron to replace iron lost in their monthly reproduc-
tive cycle to prevent anemia. While some whole grains are good sources of iron, seeds
are an even better source of iron, and sesame seeds are an excellent source. Nuts and
rice are not rich in iron. Beans are a good source, with lentils and Great Northern
8
Plant-Based Diet
beans being excellent sources. Beans, on average, are a better source of iron than even
the seeds.
Selenium is important as an antioxidant mineral, contributing to the synthesis of
the intracellular antioxidant glutathione and selenoproteins. Good selenium status has
been found to improve a body’s defenses against viral diseases such as HIV and
COVID [20]. Brazil nuts are well known for their selenium content, a listing of over
580 μg per 200 calories (30.5 grams, about 6 nuts). Other nuts are generally low in
selenium along with beans, but most seeds are an excellent source of selenium. Pinto
beans and Great Northern beans are good sources of selenium.
Zinc is an essential mineral with many roles in the body. Zinc plays a role in
immune defense, showing effectiveness against respiratory viruses [21]. Higher die-
tary intake of zinc from non-red meat sources was associated with lower risk of
progression of coronary artery calcification scores [22]. Nuts and seeds are generally
good sources of zinc, with sesame seeds and pumpkin seeds being excellent sources.
Wild rice and oatmeal, but not whole wheat, are also excellent sources of zinc from
the grain category. Dry beans are good sources, with lentils being an excellent source
of zinc.
In conclusion, when averaging the RDIs for all minerals, nuts have 15%, seeds have
28%, grains 19% and beans 20% of the RDIs. So, nuts are not as mineral dense as
seeds, but seeds are a really good way of increasing essential mineral intake. Overall
mineral intake is important, as indicated in a study of the Iowa Women’s Health
Study. Quintiles of mineral intake were used to create an overall mineral score, with
positive scores for calcium, magnesium, manganese, zinc, selenium, potassium and
iodine, and negative scores for iron, copper, phosphorus and sodium. Higher ranks of
the mineral score were associated with lower risk of colorectal cancer in these 55- to
69-year-old women, up to 25% decreased risk comparing highest to lowest rank of
mineral score [23]. So, increasing mineral intake by substituting a serving of grains
out for a serving of seeds will likely reduce risk of disease.
2.4 Summary of nutrient comparison
To summarize this section nuts and seeds are the category of food that is the best
way to get an extra 200 calories. When comparing just nuts and seeds versus grains
one can see that nuts and seeds are more nutrient dense and deliver more nutrients per
200 calories. The average percentage of RDI for vitamins and minerals are 14.4
percent for nuts and seeds and 12.3 percent for grains (see Table 4). However, if we
remove walnuts, pecans and pistachio nuts from the equation and just look at almonds
Food Group Average % of RDI Nutrient Density
Grains 12.3% 1.0
All nuts and seeds 14.4% +17%
Beans 15.6% +27%
Almonds and seeds 17.6% +43%
Seeds 18.5% +50%
Lentils 19.1% +55%
Table 4.
Summary of comparison of nutrient density of food groups.
9
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
and the seeds, the average RDI is now 17.6 percent. This is 43 percent more nutrition
than what you get from grains, on average. So, seeds and almonds are more nutrient
dense than grains.
When comparing nuts and seeds versus beans it can be seen that almonds and
seeds have a slightly higher average RDI compared to the beans (17.6 versus 15.6
percent). So, even though they are lower in protein (about 7.5 versus 13 g of protein
per serving) almonds and seeds are still overall more nutritionally dense than the
average dry bean. For some nutrients beans, especially lentils, are actually more
nutrient dense, so it would be wise to still be include beans in the diet as well, but not
in the place of a serving of nuts and/or seeds.
So, it can be concluded that nuts, particularly almonds, and seeds are nutritionally
more dense than grains, about 43 percent more. Seeds are also about 19 percent more
nutritionally dense than dry beans in general. Should almonds and seeds replace grains
in this 200-calorie serving? From a nutrient standpoint the answer is a clear yes.
3. Health outcomes of eating nuts and seeds
As mentioned in the introduction, Drs. Esselstyn and Ornish obtained excellent
results in reversing heart disease without the inclusion of nuts and seeds. However,
since the publication of their results there have been many investigations in the area of
nuts and seeds. There have been short-term studies on the effects of various nuts on
cholesterol and blood lipids. There have been short-term studies on satiety and weight
loss and/or weight gain. There have been prospective cohort studies that have
reported observations of groups of people over long periods of time. And there have
been some randomized controlled clinical trials using nuts and seeds as well. Now we
have more evidence about the benefits of nuts and seeds.
The issue to be examined here is whether health outcomes are better or worse
when nuts and seeds are included in vegetarian or vegan diets.
This issue will be examined from four lines of evidence: (1) short-term studies on
weight gain and obesity, (2) short-term studies on blood lipids, (3) health outcomes in
population studies, and (4) vegetarian population studies in particular.
3.1 Short-term body weight studies
Since nuts are energy-dense foods, it is important to know if they caused weight
gain, or if they were associated with obesity. In a review and meta-analysis of 33
controlled clinical trials, it was found there was no difference in body weight, body
mass index (BMI) or waist circumference between the nut or control diet groups [24].
Population studies have also found that nut consumption did not affect body weight.
People who regularly ate nuts actually tended to not gain weight or become obese over
time [25, 26]. It appears that people compensate for eating nuts by eating less of other
foods. Nuts’fat and protein content tend to make them a satisfying, filling food,
whether eaten as snacks or with meals [27].
3.2 Short-term blood lipid studies
Since population studies have indicated that nuts reduced risk of cardiovascular
disease, short-term studies have been conducted to attempt to deduce the mechanism
for this health outcome. Many controlled clinical trials have examined different nuts
10
Plant-Based Diet
and blood lipid levels, but there are few reports including inflammatory markers and
endothelial function. A review and meta-analysis of 61 blood lipid studies found that
for a 1-ounce (28 gram) serving of nuts per day, there was a decrease in total choles-
terol (4.7 mg/dL), low-density lipoprotein (LDL) cholesterol (4.8 mg/dL), ApoB
lipoprotein (3.7 mg/dL) and triglycerides (2.2 mg/dL) [28]. The results were better
for 2 ounces a day than for just 1 daily ounce. This significant, but small decrease in
cholesterol levels is probably not the only reason that nuts are beneficial, but these
results do point in the right direction. A recent review of 26 walnut controlled inter-
ventions found similar results, with no negative effects on body weight or blood
pressure [29]. Almonds have been examined separately as well, with 27 almond-
control datasets yielding very similar results [30]. So, the amount of nuts rather than
the type of nut contributes to the lipid-lowering effect.
Studies have also examined the effect of nuts on blood pressure. No consistent
significant results have been obtained [31]. Nor have there been significant reductions
in markers of inflammation. Serum C-reactive protein has been measured in multiple
studies with little change due to eating nuts [32].
However, there has been a consistent improvement in endothelial cell function,
measured by flow-mediated dilation (FMD). Endothelial cells allow more blood flow
through the release of nitric oxide. Flow-mediated dilation is a strong predictor of
future cardiovascular disease [33]. A review of 10 trials found that nut consumption
significantly improved FMD, but walnuts were the only nut that had a significant
effect [34].
In summary, short-term studies have found significant effects on cholesterol
levels, and walnuts for endothelial function, but no significant effects for blood
pressure or inflammation. Nuts also contain phytosterols and other antioxidants that
may be beneficial. Whatever the mechanism, long-term studies of populations of
people have clearly demonstrated an advantage of eating nuts and seeds.
3.3 Long-term studies of populations
A recent review of reviews and meta-analyses on nuts and cardiovascular disease
was published. There have been so many studies and meta-analyses of studies, which
synthesize the information from individual studies into a coherent conclusive state-
ment, that they could actually do an overview of all of the reviews and meta-analyses
that have been done on population studies of eating nuts. There are 234 references to
reviews, meta-analyses and large individual study reports in this article by Kim et al.
[35]. Here is what these authors found about nuts and cardiometabolic disease. Con-
sumption of nuts was associated with a 19–20 percent decrease in all-cause mortality.
Coronary heart disease (CHD) incidence was reduced by 20–34 percent and CHD
death was reduced by 27–30 percent. Cardiovascular disease (CVD) incidence
(includes strokes as well as heart disease) was reduced by 19 percent and CVD death
was reduced by 25 percent. Stroke incidence was reduced by 10–11 percent and stroke
death was reduced by 18 percent.
In addition to this review, Aune et al. [36] have found a 15 percent reduction in
total cancer death and a 39 percent decrease in diabetes deaths, and a 75 percent
decrease in infectious disease deaths. For specific cancers, Wu et al. [37] reviewed 36
observational studies with a total of over 30,000 people. They found significant
associations between eating nuts and a 15 percent overall reduction in cancer. Specific
cancers with reductions were colorectal cancer (24% reduction), endometrial cancer
(42% reduction), and pancreatic cancer (32% reduction). A recent meta-analysis by
11
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
Naghshi et al. [38], which included 43 articles on cancer risk and 9 articles on cancer
mortality, found a 14% reduction in cancer risk associated with total nut intake, and a
13% reduction in overall cancer mortality from eating nuts, in close agreement with
the work of Aune et al. [36]. A 5 g/d increase in nut intake was found to be associated
with a 3, 6 and 25% lower risk of overall, pancreatic and colon cancer, respectively.
It is possible that the people eating nuts are just healthier overall because of other
dietary choices and lifestyle habits. Even though population studies control for other
dietary and lifestyle factors, there is a small question still. Direct evidence against the
healthy nut eater hypothesis comes from a population study from Iran. In the 50,000-
person Golestan Cohort nut eating was not associated with other healthy lifestyle
habits. People who ate more nuts were also more likely to smoke, drink alcohol, be
obese, less likely to exercise, but also were younger, of higher social economic status
and had more education. In this cohort the nuts were still protective, leading to less
coronary heart disease death and cancer death, especially among women. All-cause
mortality was 29 percent less among people consuming three or more servings of nuts
per week [39]. So, it appears that the benefits of nuts can be attributed to the nuts
consumption and not to other lifestyle behaviors.
3.4 Long-term studies of vegetarian populations
The benefits of nuts have been seen among vegetarians and vegans who have
healthy lifestyles as well. In a publication from the Adventist Health Study 2, there
was a factor analysis looking at the sources of protein and risk of death [40]. For
animal protein, there was a 61 percent increased risk of cardiovascular death, but
for the nut protein factor there was a 40 percent decrease in risk of cardiovascular
death. There were no significant associations with the factors for protein from
grains, processed foods, or legumes, fruits, and vegetables. Among younger
adults, aged 25–44 the meat protein factor risk was associated with 2-fold higher
risk of cardiovascular death and the nut factor was associated with 3-fold lower
risk. Nuts seemed to be protective and meat protein specifically seemed to increase
risk of death. The protective effect of nuts was seen across different levels of plant-
based dietary patterns in this population, suggesting that focusing on more specific
plant protein-based diets may improve the ability of dietary recommendations to
prevent CVD.
In the first Adventist Health Study this protective effect of nuts was first reported.
When people who ate nuts at least 4 times per week were compared to those who ate
nuts less than 1 time per week there was a 48 percent decrease in fatal CHD events and
a 55 percent decrease in definite non-fatal heart attacks in the nut-eating group [41].
This protective effect was seen regardless of sex, age, smoking status, hypertensive
status, vegetarian or nonvegetarian, exercise level, or whether or not people ate white
bread. Nuts were protective despite all these other factors.
3.5 Summary of health benefits of nuts and seeds
The health benefits of nuts and seeds are summarized in Table 5. The evidence is
robust. The benefits of nuts have been seen in at least 20 different cohorts, including
populations at least from the USA, Europe, Iran, and China over a period of more than
26 years. The benefits from one or two ounces of nuts per day are substantial —20%
reduction in all-cause mortality, 30% reduction in death by heart disease, 18% reduc-
tion in stroke death, 39% reduction in type 2 diabetes death and a 13–15% reduction in
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Plant-Based Diet
cancer death. Optimal results will be realized by optimizing all aspects of dietary and
lifestyle choices, but the inclusion of a serving of nuts per day appears to be a wise
choice.
Description of
Study
Amount of
Nuts
Study
Length
Health Outcomes Ref.
n = 1888, 33 clinical
trials
Varied Varied No significant difference in body weight,
BMI, waist circumference
Flores-
Mateo [24]
n = 51,188 women,
Nurses’Health
Study II
≥2 X /wk. vs.
rare
8 years Slightly less weight gain over time, non-
significant lower risk of obesity
Bes-
Rastrollo
[25]
n = 373,293, EPIC-
PANACEA
12.4 g/d
median vs.
none
5 years ↓5% becoming overweight or obese Freisling
2018 [26]
Meta-analysis of 61
controlled clinical
studies, n = 2852
1 serving =
28 g/d
Median dose
56 g/d
3to
26 weeks
Nut intake (per serving/d) lowered total
cholesterol 4.7 mg/dL, LDL cholesterol
4.8 mg/dL, ApoB -3.7 mg/dL, and
triglycerides 2.2 mg/dL.
Stronger effects were observed for ≥60 g
nuts/d.
Del Gobbo
[28]
Review of 10 trials,
n = 374
37 to 128 g/d 8 to
24 weeks
nut consumption significantly improved
flow mediated dilation
Xiao [34]
Review of meta-
analyses of
prospective studies
Varied Varied ↓19–20% overall mortality
↓20–34% CHD incidence
↓27–30% CHD mortality
↓19% all CVD incidence
↓25% all CVD mortality
↓10–11% stroke incidence
↓18% stroke mortality
Kim [35]
Meta-analysis of
prospective studies
Results per
28 g/d
Varied ↓15% total cancer mortality
↓39% diabetes mortality
↓52% respiratory disease mortality
↓75% infectious disease mortality
Aune [36]
Meta-analysis, 36
studies, n = 30,708
Prospective and
case–control studies
Varied Varied ↓15% total cancer mortality
↓24% colorectal, ↓42% endometrial,
↓32 pancreatic
Wu [37]
Review and meta-
analysis, n = 819,851
Highest vs.
lowest intake
compared
Varied ↓14% cancer risk
↓13% cancer mortality
Naghshi
[38]
Golestan Cohort
Study, Iran,
n = 50,045
3 serving/
wk. vs.
none
7 years ↓29% all-cause mortality, nut
consumption not associated with healthy
lifestyle
Eslamparast
[39]
Adventist Health
Study, n = 31,208
4x/wk. vs. <
1x/wk
6 years ↓48% CHD mortality, ↓55% definite
non-fatal CHD events
Fraser [41]
Adventist Health
Study 2, n = 81,337
Median
9.9 years
↓40% risk of CVD death; 3-fold lower for
age 25–44
Tharrey
[40]
CVD = cardiovascular disease, CHD = coronary heart disease.
Table 5.
Summary of health benefits of nuts and seeds.
13
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
4. The safety of nuts and seeds when dealing with cancer
There is one remaining issue to address here. The evidence above indicates that
nuts help prevent some cancers, but what is the role of nuts and seeds after diagnosis,
or during treatment or remission of cancer?
A more fundamental issue is whether dietary fats cause growth of tumors.
It is well accepted that sugar feeds cancer directly. The PET scan is done on this
principle. A sugar molecule with a radiolabeled tracer on it, typically
18
F-
fluorodeoxyglucose, is injected into a person. Whatever part of the body is metabo-
lizing sugar the fastest is the biggest tumor. Tumors metabolize sugar at an accelerated
rate compared to the rest of the body.
Protein may also be a factor in tumor growth. Tumor cells can grow on the amino
acid glutamine nearly as well as with glucose as an energy source, especially under low
oxygen conditions [42–44]. The TCA cycle that produces energy can run on either
glucose or glutamine especially in cancer cells.
Protein can also indirectly feed cancer through hormonal effects. High protein,
especially animal protein, raises insulin levels and especially raises IGF-1 levels. IGF-1
is a growth hormone that promotes the growth of all cells. Sufficient levels of IGF-1
prevent frailty but excessive levels have been associated in several studies with higher
risk of cancer incidence and death [45].
So, sugar and animal protein both contribute to tumor growth. Does dietary fat
also cause tumor growth? It is well known that abdominal fat is a risk factor for
cancer. Fat cells in your body produce inflammatory substances. Being overweight or
obese is a risk factor for cancer. It has already been established that nuts and seeds do
not contribute to obesity in populations that habitually consume them daily.
It turns out that the source of dietary fat makes a difference. It always has, even in
the Seven Countries Study on fat and international rates of heart disease deaths [46].
When the analysis is separated into plant fats and animal fats the animal fats appear to
be associated with disease, but not plant fats. More recent studies have also found this
effect.
In recent analysis of data from two large cohorts of the USA population, the
Nurses’Health Study and the Health Professionals Follow-Up Study, the source of
MUFAs was separated into plant and animal source. Guasch-Ferré et al. found the
MUFAs from plants were associated with lower total mortality and the MUFAs from
animals were associated with higher total mortality [47]. Just the opposite effects were
seen, depending on the source of the fats. This would indicate that MUFAs from nuts
are not in the same category as MUFAs from animal products.
Another recent article also highlighted the difference between MUFAs from plants
or animals. The results of analyzing 16 years of follow-up of the NIH-AARP Diet and
Health Study with about 520,000 people were that cardiovascular mortality was
positively associated with saturated fats, trans fats, arachidonic acid (from animal
foods), and animal-sourced MUFAs and was inversely associated with marine omega-
3 PUFAs, linoleic acid (omega 6 oil from plants), and plant-sourced MUFAs [48].
So, plant fats are different from animal sourced fats for health outcomes. When
looking at the question of whether fat accelerates tumor growth, the source of the fat
has to be considered.
A direct answer to our question of the safety of nuts for cancer patients is also
available. In a prospective study of colon cancer patients who were enrolled in a
randomized adjuvant chemotherapy trial, those that ate two or more servings of tree
nuts per week during the 6.5 years of follow-up had a 46 percent improvement in
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Plant-Based Diet
disease-free survival rate and a 53 percent improvement in overall survival [49]. This
analysis controlled for other known or suspected risk factors for cancer recurrence, so
it appears that the effect is from the nuts themselves. So in this group of cancer
patients the ones who ate nuts lived longer without disease and lived longer overall.
Hallelujah Acres and others have advocated the use of flax seeds for cancer
patients. The lignans in the fiber of the flax seeds are metabolized into enterodiol and
enterolactone, which are well known for reducing cancer risk [50]. Ground flax seeds
are considered by many to be a superfood, but while flax seeds are unique, they are a
high fat food that has much in common with other nuts and seeds. Sesame seeds also
are a precursor source of enterodiol and enterolactone [51]. Other nuts and seeds have
phytochemicals in them that appear to be protective to those who eat them as well.
So, the scientific evidence says that nuts and seeds are not only safe, but beneficial
in every stage of life, including while battling with cancer. Populations who eat nuts
have lower rates of cancer, MUFAs from plants are protective from disease, as
opposed to MUFAs from animal sources, there is no clear mechanism for dietary plant
fats to accelerate the growth of tumor cells, and a recent clinical trial has shown that
intake of nuts by colon cancer patients undergoing chemotherapy had better disease-
free survival and overall survival.
5. Conclusion
Let us quickly review the answers to our original queries.
1.Nuts, particularly almonds, and seeds are nutritionally denser than grains, about
43 percent more. Seeds are also about 19 percent more nutritionally dense than
dry beans in general.
2.The benefits from one or two ounces of nuts per day are substantial—20%
reduction in all-cause mortality, 30% reduction in death by heart disease, 18%
reduction in stroke death, 39% reduction in type 2 diabetes death and a 13–15%
reduction in cancer death.
3.Nuts are safe to eat when dealing with cancer. Populations who eat nuts have
lower rates of cancer and a recent clinical trial has shown that intake of nuts by
colon cancer patients undergoing chemotherapy had better disease-free survival
and overall survival.
4.The health benefits of nuts and seeds are clear. Nuts and seeds can be easily
integrated into any diet. Plant-based diets are improved with nuts and seeds and
omnivorous diets, or even low-carbohydrate diets can be improved by including
nuts and seeds. The evidence is sufficient and conclusive. Nuts and seeds are
beneficial foods.
Acknowledgements
A special thanks to Olin Idol for constructive conversations and suggestions for
improving this manuscript.
15
The Beneficial Role of Nuts and Seeds in a Plant-Based Diet
DOI: http://dx.doi.org/10.5772/intechopen.110677
Conflict of interest
The author declares no conflict of interest.
Author details
Michael S. Donaldson
Hallelujah Acres, Zillah, USA
*Address all correspondence to: mdonaldson@myhdiet.com
© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
16
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