California Walnuts

Scientific Summary

A dozen years of clinical research explore benefits

of walnuts’ unique nutritional profile

exceptional source of ala

plant based omega-3s
Unique among nuts, walnuts contain the highest amount
of alpha-linolenic acid (ALA), the plant-based omega-3
fatty acid (see graph to the right), required by the human
body. As one of the best plant food sources of omega-3s, a
one-ounce serving of walnuts provides 2.6 grams of ALA. A
growing body of science is beginning to uncover a variety of
benefits that ALA/omega-3s may provide to our bodies. While
most nuts contain monounsaturated fats, only walnuts are
comprised primarily of polyunsaturated fat (13 grams out of
18 grams total fat). Dietary guidelines recommend that peo-
ple keep total fat intake between 20 to 35 percent of calories,
with most fats coming from sources of polyunsaturated and
monounsaturated fatty acids.

antioxidant rankings
According to an evidence-based review, antioxidants help to
protect from certain chronic diseases of aging, including cardio-
vascular, neurological and anticarcinogenic ailments due to their
ability to control free radicals — known to negatively influence
healthy aging.1 Walnuts contain many antioxidants (13.126
mmol/100 grams). In a 2006 study, 1113 different foods were
tested and walnuts ranked second only to blackberries in terms
of antioxidant content (see graph on page 2).2

Another study examining the levels of antioxidants in various
foods, reported at least 10 different antioxidants present in
walnuts (802 mg GAE of total phenols per ounce). According
to the study, a handful of walnuts has significantly more
phenols (an antioxidant) than a glass of apple juice (117 mg),
a milk chocolate bar (205 mg), or a glass of red wine (372 mg).3
Melatonin is an antioxidant that is naturally found in walnuts.4
Research, led by melatonin expert Dr. Russel Reiter, published
in the September 2005 issue of Nutrition: The International
Journal of Applied and Basic Nutritional Sciences, reported
the calculate concentrations of melatonin in walnuts was
3.5 +/- 1.0ng/g.

1
Functional foods, herbs and nutraceuticals: towards biochemical mechanisms of healthy aging. Biogerontology. 2004;5(5):275-89.
2
Content of 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: Influence on Levels of Melatonin and Total Antioxidant Capacity of Blood. Nutrition. 2005 Sep;21(9):920-4.

 protein, fiber, magnesium & A cross-over design study, published in the Journal of American
phospherous too College of Cardiology, randomized 12 healthy adult subjects
and 12 with hypercholesterolemia to either a high-fat meal to
In addition to antioxidants and essential ALA/omega-3 fatty
which 25 grams of olive oil or 40 grams of walnuts were added.
acids, an ounce of walnuts provides a convenient source of
Brachial artery function was evaluated before and after the
protein (4 grams) and fiber (2 grams). Most Americans don’t
test meals. Flow mediated dilation was better after the walnut
get enough dietary fiber — which promotes healthy bowel func-
meal in both groups. E-selection, an inflammatory marker, was
tion and helps you feel full — a key component in maintaining a
lower after the walnut meal.8
healthy weight. Walnuts are also a good source of magnesium
(44.79 mg/oz) and phosphorus (98.09 mg/oz) — both impor- Penn State research published in the Journal of Nutrition
tant minerals involved the body’s processes and necessary for showed that eating walnuts reduced C-reactive Protein (CRP)
achieving optimal wellness. and harmful plaque adhesion molecules, two significant mark-
ers of inflammation in arteries. This human controlled feeding
smart for the heart study evaluated the effects of ALA/omega-3s on multiple
cardiovascular disease risk factors. Those consuming a diet
Eating a handful of walnuts every day is an easy way to
high in polyunsaturated fatty acids, especially ALA/omega-3s,
boost your daily nutrition. For more than a dozen years,
exhibited decreased lipid and lipoprotein levels and vascular
highly-respected scientists have shown diverse benefits of
anti-inflammatory effects.9
this whole food through clinical research. Because of the
strength of evidence supporting cardiovascular health, the
U.S. Food and Drug Administration approved a qualified good for bone health
health claim for walnuts in March 2004.6 Bone health improved with alpha-linolenic acid (ALA) omega-3
consumption in a clinical research study published in the
A review of five clinical trials, published in the Journal of Nutri-
January 2007 issue of Nutrition Journal.10 This first controlled
tion, evaluated the intent and quality of scientific evidence for
human feeding study evaluated the effect of dietary ALA/ome-
a potential beneficial health relationship between the intake of
ga-3s provided by walnuts and flaxseed, on bone turnover, as
walnuts and the reduction and prevention of coronary heart
assessed by measurements of biomarkers. 23 participants fol-
disease.7 The review included controlled, peer-reviewed, hu-
lowed three different diets over a six week time frame for each:
man clinical walnut intervention trials, involving approximately
1) Average American Diet, 2) Linoleic Diet and 3) ALA Diet.
200 subjects representative of the 51% of the adult popula-
Specific markers measuring bone metabolism and resorption
tion in the United States at risk of coronary heart disease. The
were measured during each diet. The researchers concluded
intervention trials in this review consistently demonstrated
that the “results indicate that plant sources of dietary omega-3
walnut consumption as a key component in lowering blood
polyunsaturated fatty acids may have a protective effect on
cholesterol concentrations in study participants, thus support-
bone metabolism via a decrease in bone resorption in the
ing walnuts as part of a heart-healthy diet.
presence of consistent levels of bone formation.”

http://www.griffinhealth.org/Research/ONQI.aspx
5


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high nutrition ranking
On the NuVal™ Nutritional Scoring System (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 foods 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 for the
“overall nutritional quality” of a food based on the micronutri-
ent and macronutrient composition of the item. Thirty different
nutrient factors are considered into the equation including
vitamins, minerals, protein, carbohydrates, fat and antioxidants.
Items are then stratified into a rank order of relative nutritious-
ness both universally (i.e., across all food categories) and within
specific food categories (e.g., breads, cereals, frozen desserts).
nutritious food for people
with diabetes
A study published in 2004 reported a positive effect of a
moderate-fat diet, inclusive of walnuts, on blood lipid profiles
in patients with type 2 diabetes. This parallel randomized
controlled trial included 58 men and women, ages 35–75, di-
agnosed with type 2 diabetes at least one year prior. The study
compared three dietary advice groups each with 30 percent
energy as fat: 1) low fat, 2) modified low fat, and 3) modified
low fat, inclusive of 30g walnuts (equivalent to around 8–10
nuts) 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 of the patients with type 2 diabetes.11
In addition, Harvard researchers examined the association
5 between nut consumption and risk of type 2 diabetes in a large
prospective cohort study of 83,818 women from the Nurses’
Health Study aged 34–59; with no history of diabetes, cardio-
vascular disease or cancer. Subjects completed a validated
dietary questionnaire at baseline in 1980 and were followed up
for 16 years. They found that women who ate one-ounce por-
tions of nuts, such as walnuts, or peanut butter five times or
more each week had a significant lower risk of developing type 2
diabetes compared to the women who rarely or never ate
nuts. Based on these findings, the researchers concluded that
higher nut and peanut butter consumption may have helped
lower the risk of type 2 diabetes in these women. However, to
avoid increasing caloric intake, regular nut consumption can
be recommended as a replacement for refined carbohydrate
products or red or processed meats.12
tasty tool for weight
management
It turns out the good fat (2.6 grams ALA/omega-3s per ounce),
fiber (2 grams per ounce) and protein (4 grams per ounce) in
walnuts aid in satiety, an important factor in successful weight
management. A 2001 Loma Linda University study found that
regular walnut consumption does not lead to weight gain in
study participants. This small randomized crossover feeding
trial included 10 men with hypercholesterolemia. Participants
were given one of three diets to follow over a six week period:
1) control, 2) Mediterranean-type cholesterol-lowering diet,
and 3) a diet of similar composition in which walnuts replaced
35 percent of energy from unsaturated fat. After six months

6
“Supportive but not conclusive research shows that eating 1.5 ounces of walnuts per day, as part of a low saturated fat and low cholesterol diet, and not resulting in increased caloric
intake may reduce the risk of coronary heart disease.”
7
The Scientific Evidence for a Beneficial Health Relationship Between Walnuts and Coronary Heart Disease. J Nutr. 2002 May;132(5):1062S-1101S.
8
Acute Effects of 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 Inflammatory and Lipid Cardiovascular Risk Factors in Hypercholesterolemic Men and Women. J Nutr. 2004 Nov;134(11):2991-7.
An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutrition Journal. 2007 Jan;6:2.
10

Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes. Diabetes Care. 2004 Dec;27(12):2777-83.
11

Nut and Peanut Butter Consumption and Risk of Type 2 Diabetes. JAMA. 2002 Nov 27;288(20):2554-60.
12


 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 for 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
of 101 overweight men and women. During this 18-month
study, subjects consumed either a moderate-fat Mediterranean
diet including nuts such as walnuts (35 percent of energy) or a
standard low-fat diet (20 percent of energy). The participants
following a Mediterranean-style moderate fat weight loss diet,
including peanuts and tree nuts, such as walnuts, were able to
improve weight-loss and keep weight off for a longer period than
people following the traditionally recommended low-fat diet. The
researchers suggest that adding nuts may help provide satiety
which is a factor in successful dieting.14 The bottom line: tasty
foods like walnuts can be a great addition to many diets.
strength of the
mediterranean 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 of cardio-
vascular disease — supported by the Spanish Health Ministry.
Findings published in the May 2008 edition of the European
Journal of Clinical Nutrition reported that the consumption of
typical Mediterranean foods was associated with lower levels
of inflammatory markers — linked to atherosclerosis, insulin
resistance and type 2 diabetes.15 The study measured various
inflammatory markers (VCAM-1, ICAM-1, IL-6 and CRP) and
evaluated the diets of 772 men and women (55–80 years of
age) at high cardiovascular risk. Individuals with the highest
consumption of olive oil and nuts, including walnuts, showed
the lowest levels of inflammation.
13
Walnut-Enriched Diet Increases the Association of LDL from Hypercholesterolemic Men with Human HepG2 cells J Lipid Res. 2001 Dec;42(12):2069-76
14
Int J Obes Relat Metab Disord. 2001 Oct;25(10):1503-11.
15
Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. Eur J Clin Nutr. 2008 May;62(5):651-9.
16
Effects of a Mediterranean-style diet on cardiovascular risk factors. Ann Intern Med. 2006 Jul 4;145(1):1-11.
17
Effects of a Traditional Mediterranean Diet on Lipoprotein Oxidation. Arch Intern Med. 2007 Jun 11;167(11):1195-203.
18
Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008 Dec 8;168(22):2449-58.

Another sub study, reported in 2006 in the Annals of Internal
Medicine, compared the short-term effect of two Mediterranean
diets versus those of a low-fat diet on intermediate markers
of cardiovascular disease.16 772 asymptomatic individuals at
high cardiovascular risk were assigned to a low-fat diet or to
one of 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 fat
component of the Mediterranean diet. When compared to
the low-fat diet, the Mediterranean diet (supplemented with
oil olive or nuts, primarily walnuts) reduced arterial pressure,
blood lipids, fasting blood glucose, and inflammation in study
participants. The researchers noted that this short-term study
provided more intense dietary education on the Mediterranean
diet than on a low-fat regime.
A third study from the PREDIMED trial, published in July 2007
in the Archives of Internal Medicine, examined the effect of the
Mediterranean diet on the oxidative damage on 372 subjects
at high cardiovascular risk. Over a 3-month period, individuals
followed either a low-fat diet or one of 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. Those following 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 further
evidence to recommend the traditional Mediterranean diet as
a useful tool against risk factors for coronary heart disease.”17
Finally, PREDIMED study results appearing in the December
2008 edition of the Archives of Internal Medicine indicate that
the Mediterranean diet supplemented with nuts, primarily
walnuts, may help manage metabolic syndrome — a collection
of risk factors associated with cardiovascular disease and
diabetes. More than 1,200 Spaniards, between 55 to 80 years
of age, followed one of the three following diets for 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 fat diet. The two groups on the Mediterranean diet
were advised to increase fruit, vegetable and fish consumption;
substitute white meat for beef or processed meat; prepare
homemade tomato sauce with garlic, onions and herbs; and
include red wine if 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 following a Mediterranean diet supplemented
with olive oil (6.7% decrease) and the control group consuming
a standard low fat diet (2% decrease).18
appendix a: table illustrating studies referenced
REVIEW ARTICLE

Functional foods, herbs and nutraceuticals: towards biochemical mechanisms of healthy aging.
Published: June 2006
Journal: Biogerontology. 2004;5(5):275-89
Authors: Ferrari CK
Research Organization: University of Sao Paulo
Study Description: The purpose of this study was to review important evidence-based mechanisms of functional
foods with special interest on prevention of chronic diseases of aging. The focus is on cardiovas-
cular, neurological and anticarcinogenic properties of functional foods, herbs and nutraceuticals.
Results: Aging is associated with mitochondrial dysfunctions, which trigger membrane leakage, release
of reactive species from oxygen and nitrogen and subsequent induction of peroxidative reactions
that result in biomolecules’ damaging and releasing of metals with amplification of free 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 from different
functional foods, 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 from chronic diseases of aging
involves antioxidant activities, mitochondrial stabilizing functions, metal chelating activities,
inhibition of apoptosis of vital cells, and induction of cancer cell apoptosis.

L A B O R AT O R Y A N A LY S I S

Content of redox-active compounds (i.e., antioxidants) in foods 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, Bøhn SK, Holte K, Jacobs DR Jr, Blomhoff R
Research Organization: University of Oslo, Oslo, Norway
Study Description: The objective of the study was to generate a ranked food table with values for total content
of redox-active compounds. An assay that measures the total concentration of redox-active
compounds above a certain cutoff reduction potential was used to analyze 1113 food samples
obtained from the US Department of Agriculture National Food and Nutrient Analysis Program.
Results: On the basis of typical serving sizes, blackberries, walnuts, strawberries, artichokes, cranberries,
brewed coffee, raspberries, pecans, blueberries, ground cloves, grape juice, and unsweetened
baking chocolate were at the top of the ranked list. The researchers concluded that this ranked
antioxidant food table provides a useful tool for investigations into the possible health benefit of
dietary antioxidants.


 L A B O R AT O R Y A N A LY S I S

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 of California, Davis
Study Description: Polyphenol-rich extracts from walnuts and other foods were studied.
Results: The study reported at least 10 different antioxidants present in walnuts (802 mg GAE of total phenols
per ounce). According to the study, a handful of walnuts has significantly more phenolics (antioxidants)
than a glass of apple juice (117 mg), a milk chocolate bar (205 mg), or a glass of red wine (372 mg).

CLINICAL STUDY

Melatonin in walnuts: influence on levels of melatonin and total antioxidant capacity of blood.
Published: September 2005
Journal: Nutrition. 2005 Sep;21(9):920-4
Authors: Reiter RJ, Manchester LC, Tan D
Research Organization: The University of Texas Health Science Center at San Antonio
Study Description: Melatonin, an antioxidant, was extracted from walnuts and quantified by high-performance
liquid chromatography.
Results: The calculated concentrations of melatonin in walnuts was 3.5 +/- 1.0 ng/g.


 REVIEW ARTICLE

The scientific evidence for a beneficial 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: Life Sciences Research Office, Inc.
Study Description: Because walnuts contain multiple health-beneficial components, such as having a low lysine:
arginine ratio and high levels of arginine, folate, fiber, tannins, and polyphenols, five independent
experts evaluated the intent and quality of scientific evidence for a potential beneficial health
relationship between the intake of walnuts and the reduction and prevention of coronary heart
disease. Five controlled, peer-reviewed, human clinical walnut intervention trials, involving ap-
proximately 200 subjects representative of the 51% of the adult population in the United States at
risk of coronary heart disease were reviewed. ering diet, and a diet of similar composition in which
walnuts replaced 35 percent of energy from unsaturated fat, were given for six weeks each to ten
men with polygenic hypercholesterolemia.
Results: The intervention trials consistently demonstrated walnuts as part of a heart-healthy diet, lower
blood cholesterol concentrations in study participants. None of these studies were of extended
duration that would be essential for evaluation of the sustainability of the observed outcomes.
These results were supported by several large prospective observational studies in humans, all
demonstrating a dose response-related inverse association of the relative risk of coronary heart
disease with the frequent daily consumption of small amounts of nuts, including walnuts.

CLINICAL STUDY

Acute Effects of 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: Cortés B, Núñez I, Cofán M, Gilabert R, Pérez-Heras A, Casals E, Deulofeu R, Ros E
Research Organization: University of Barcelona, Hospital Clinic
Study Description: Twelve healthy adult subjects and twelve subjects with hypercholesterolemia were randomized
in a cross-over design to consume high-fat meals to which 25 grams of olive oil or 40 grams of
walnuts were added. Brachial artery function was evaluated while subjects were fasting and
4 hours after test meals.
Results: Flow mediated dilation was improved after the walnut meal in both groups. E-selection, an in-
flammatory marker, was lower after the walnut meal. Researchers noted in their conclusion that,
“adding walnuts to a high-fat meal acutely improves FMD independently of changes in oxidation,
inflammation or ADMA.”


 CLINICAL STUDY

Dietary Alpha-Linolenic Acid Reduces Inflammatory 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 fat 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, half of
the total fat was derived from walnuts and walnut oil because they are rich sources of PUFA and,
particularly, ALA (100 g of walnuts provides 38g of LA and 9g of ALA; 100 g of walnut oil provides
53g of LA and 10g of ALA). The ALA diet included a teaspoon of flaxseed oil.
Results: Compared to the average American diet, subjects on both the LA and the ALA diets had lowered
total cholesterol of 11 percent, lowered LDL of 11-12 percent and decrease in triglycerides of 18
percent. After six weeks on the diet, CRP declined after 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 effects by decreasing lipid and lipopro-
tein levels and by eliciting vascular anti-inflammatory effects.

CLINICAL STUDY

An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans.
Published: January 2007
Journal: Nutrition Journal 2007, 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 feeding study in humans (n=23; ages 36-65y) evaluated
the effects of dietary n-3 PUFA, alpha-linolenic acid (ALA) on a marker of bone resorption.
Serum N-telopeptides (NTx) were significantly lower following a high ALA diet versus an average
American diet.
Results: Key findings suggest alpha-linolenic acid (ALA), an essential omega-3 fatty acid, is beneficial to
the skeletal system by decreasing the breakdown of bone. This is the first human study evaluating
the effect of plant-based sources of omega-3 fatty acids (ALA) on bone health. The results suggest
higher consumption of ALA leads to a reduction in bone turnover, and a shift in the balance of
bone degradation/formation toward formation.


 CLINICAL STUDY

Including Walnuts in a Low-Fat/Modified-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 of Excellence in Functional Foods, University of 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 fat: low fat, modified low fat and modified low
fat inclusive of 30g walnuts (equivalent to around 8–10 nuts) per day.
Results: The walnut group achieved a significantly 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 of diet’ advice that
included 30g walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved
the lipid profile of patients with type 2 diabetes.”

PROSPECTIVE COHORT STUDY

Nut and peanut butter consumption and risk of type 2 diabetes in women.
Published: November 2002
Journal: JAMA. 2002 Nov 27;288(20):2554-60
Authors: Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB
Research Organization: Harvard School of Public Health
Study Description: Subjects included 83,818 women from 11 states in the Nurses’ Health Study; aged 34-59; with no
history of diabetes, cardiovascular disease or cancer. This was a prospective cohort study. Subjects
completed a validated dietary questionnaire at baseline in 1980 and were followed up for 16 years.
Results: Based on this study population, the researchers believe the “findings suggest potential benefits of
higher nut and peanut butter consumption in lowering risk of type 2 diabetes in women. To avoid
increasing caloric intake, regular nut consumption can be recommended as a replacement for
consumption of refined grain products or red or processed meats.”


 CLINICAL STUDY

Walnut-enriched diet increases the association of LDL from 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 of Barcelona/Loma Linda University
Study Description: Randomized, crossover feeding trial with three diets: control, Mediterranean-type cholesterol-low-
ering diet, and a diet of similar composition in which walnuts replaced 35 percent of energy from
unsaturated fat, were given for six weeks each to ten men with polygenic hypercholesterolemia
Results: After 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.

CLINICAL STUDY

A randomized controlled trial of a moderate-fat, low-energy diet compared with a low fat, low-energy diet for 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 & Women’s Hospital
Study Description: Subjects included 101 overweight men and women. Randomized, prospective 18-month trial in a free-
living population: (1) Moderate-fat diet (35 percent of energy); (2) low-fat diet (20 percent of energy)
Results: Participants following a Mediterranean-style moderate fat weight loss diet, including peanuts
and tree nuts, such as walnuts, were able to improve weight loss and keep weight off for a longer
period than people following the traditionally recommended low-fat diet. The researchers suggest
that the diet success of the participants may have been attributed to the satiety of the tree nuts
(i.e. walnuts) — a key factor in weight loss.

C R O S S S E C T I O N A L A N A LY S I S

Components of the Mediterranean-type food pattern and serum inflammatorymarkers among patients at high risk for cardiovascular disease.
Published: May 2008
Journal: Eur J Clin Nutr. 2008;62:651-9
Authors: Salas-Salvadó J, Garcia-Arellano A, Estruch R, Marquez-Sandoval F, Corella D, Fiol M,
Gómez-Gracia E, Viñoles E, Arós F, Herrera C, Lahoz C, Lapetra J, Perona JS, Muñoz-Aguado D,
Martínez-González MA, Ros E, for the PREDIMED Investigators
Research Organization: Hospital Clinic of Barcelona
Study Description: Diets of 772 men and women (55-80 years of age) at high cardiovascular risk were evaluated
using food frequency questionnaires. Inflammation was measured using serum concentrations
of 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 of nuts and virgin olive oil showed the lowest concentrations of
VCAM-1, ICAM-1, IL-6 and CRP. The researchers concluded that, within the subjects of this study, the
consumption of typical Mediterranean foods (fruits, cereals, virgin olive oil and nuts) was associated with
lower serum concentrations of inflammatory markers especially those related to endothelial function.
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Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial.

Published: July 2006
Journal: Ann Intern Med. 2006 Jul 4;145(1):1-11
Authors: Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI,
Fiol M, Gómez-Gracia E, López-Sabater MC, Vinyoles E, Arós F, Conde M, Lahoz C, Lapetra J,
Sáez G, Ros E; for the --PREDIMED Study Investigators
Research Organization: Hospital Clinic of Barcelona
Study Description: Affiliated with 10 teaching hospitals across Spain, the Prevencion con Dieta Mediterranea
(PREDIMED) is a large, parallel-group, multi-center, randomized, controlled four-year feeding trial
that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovas-
cular disease (www.predimed.org). The present study assesses the first three months studying
772 participants, men and women, 55-80 years old, with one or more of the following: 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-fat 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 profiles, and decreased
insulin resistance compared with those allocated to the low-fat diet. Compared with the low-fat
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, for plasma glucose levels;
-5.9 mm Hg and -7.1 mm Hg, respectively, for systolic blood pressure; and -0.38 and - 0.26,
respectively, for the cholesterol-high-density lipoprotein cholesterol ratio.

CLINICAL STUDY

Effect of 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, Sáez G, Estruch R, de la Torre R, Frances F, Cabezas C,
Lopez-Sabater Mdel C, Marrugat J, Garcia-Arellano A, Arós F, Ruiz-Gutiérrez V, Ros E,
Salas-Salvadó J, Fiol M, Sola R, Covas MI; for the PREDIMED Study Investigators
Research Organization: Hospital Clinic of Barcelona
Study Description: PREDIMED is a long-term multi-center trial -supported by the Spanish Health Ministry- designed
to assess the effects of a Mediterranean-style diet on the primary prevention of cardiovascular
disease. In this study, a total of 372 men and women at high cardiovascular between 55–80
years of age, were assigned to a low-fat diet or one of 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: After the 3-month interventions, LDL levels decreased in both of 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-fat diet group. The decrease in the oxidative damage to LDL cholesterol seen
in the study’s participants is one of the protective mechanisms by which the Mediterranean diet
exerts a protective effect on coronary heart disease development.
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 CLINICAL STUDY

Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED
randomized trial.
Published: December 2008
Journal: Arch Intern Med. 2008 Dec 8;168(22):2449-58
Authors: Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R, Corella
D, Fiol M, Gómez-Gracia E, Arós F, Flores G, Lapetra J, Lamuela-Raventós R, Ruiz-Gutiérrez V,
Bulló M, Basora J, Covas MI; PREDIMED Study Investigators
Research Organization: Hospital Clinic of Barcelona
Study Description: This study compared the 1-year effect of two variations of the Mediterranean versus a typical
low-fat diet on metabolic syndrome status. A total of 1224 participants were recruited from the
PREDIMED study who were between 55 and 80 years of age and at high risk for cardiovascular
disease. Participants followed one of the three following diets for 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 standard low fat diet.
The two groups on the Mediterranean diet were advised to increase fruit, vegetable and fish con-
sumption; substitute white meat for beef or processed meat; prepare homemade tomato sauce
with garlic, onions and herbs; and include red wine if the individually normally drinks alcohol.
Results: The group consuming the Mediterranean diet with walnuts showed the greatest decrease in the
metabolic syndrome — 13.7% as opposed to those following a Mediterranean diet supplemented
with olive oil (6.7% decrease) and the control group consuming a standard low fat diet (2%
decrease). The researchers concluded that a traditional Mediterranean diet enriched with nuts
including walnuts could be a useful tool in the management of metabolic syndrome.

The California walnut industry is made up of over 4,000 growers

and 58 handlers. The growers and handlers are represented by
two entities, the California Walnut Board (CWB) and the California
Walnut Commission (CWC).

california walnut commission

The California Walnut Commission, established in 1987, is funded
California Walnut Commission
by mandatory assessments of the growers. The Commission is an
agency of the State of California that works in concurrence with 101 Parkshore Drive, Suite 250
the Secretary of the California Department of Food and Agriculture Folsom, CA 95630
Telephone: (916) 932-7070
(CDFA). The CWC is mainly involved in health research and export
Fax: (916) 932-7071
market development activities. www.walnuts.org | Email: info@walnuts.org

non-discrimination statement
The California Walnut Board (CWB) and California Walnut Commission (CWC) prohibit discrimination in all programs and activities on the basis of race, color, national
origin, age, disability, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part
of an individual’s income is derived from any public assistance programs.
Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact the CWB / CWC
offices at (916) 922-5888.
To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272
(voice) or (202) 720-6382 (TDD). WMB/CWC is an equal opportunity employer and provider.

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