Nutritional Pearls: Does Eating Nuts Affect All-Cause Mortality?

Adam, a 36-year-old overweight man, has been struggling with his weight for many years. He is particularly concerned about his difficulty with giving up salty, crunchy snacks like chips and crackers, which he eats regularly.  He asks if there is anything you can suggest that may help him to improve his health, without giving up salty snacks altogether.

How do you advise your patient?

What is the correct answer?
(Answer and discussion on next page

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients. Resources include special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen. He is an associate clinical professor of medicine and executive director of The Goldring Center for Culinary Medicine at Tulane University in New Orleans. Dr Harlan is the 2014 co-chair and keynote speaker at the Cardiometabolic Risk Summit in Las Vegas, October 10-12. 

Answer: Salted nuts contain no more, and often less sodium than other, highly processed snack foods.

I have been saying to patients for years that I would prefer that they eat nuts over other salty/savory snacks such as chips and crackers. While salted nuts are salty, they generally contain no more sodium (and often less) than highly processed snack foods.

There is also good evidence that nuts help reduce the risk of type 2 diabetes, and, more broadly, they've also been associated with a reduced risk of death from cardiovascular disease.

Could Eating Nuts Lower Mortality Risk?
Can Olive Oil and Nuts Reverse Metabolic Syndrome?

The Research

Scientists from multiple institutions in Massachusetts, from Harvard to the VA in Boston, used data collected through The Physician's Health Study, a large-scale, long-term trial of the effects of aspirin and beta-carotene on the risk of cancers or cardiovascular disease in over 20,000 male physicians. The study includes detailed dietary, health, and lifestyle questionnaires gathered on a yearly basis for nearly 10 years.

The researchers analyzed the peanut and tree nut intake of the physicians in the study and compared the intake of those who died from any cause with those who did not. As part of their analysis, the scientists took into account such variables as body mass index, physical activity levels, smoking status, fruit and vegetable intake, estimated amounts of saturated fat in the diet, and whether the participants had high blood pressure or diabetes.

The Results

They found that those participants who ate 5 or more 1-ounce servings of nuts per week were 26% less likely to die from any cause, including cardiovascular disease, cancer, or stroke. That's huge! Even more interesting is that those who reported eating between 1 and 4 servings per week reduced their risk of death by about 15%.

What’s the “Take Home”?

Once again, this is an observational study, so this data does not necessarily prove that nuts are the reason people were less likely to die from any cause. That said, the researchers were careful to take into account many variables that are likely to have an effect on one's health and risk of death from various causes. Add this study to the pile of existing research saying "eat nuts!"


1. Hshieh TT, Petrone AB Gaziano JM, Djousse L. Am J Clin Nutr. 2015;101:407-12.

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