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Evidence Analysis Questions:
 What is the relationship between consuming almonds and cholesterol levels in patients with hyperlipidemia?
Based on the results of five small studies, as an component of a low saturated fat diet, 2.5 to 3.5oz (70 to 100g) of almonds per day (isocalorically replaced) resulted in a reduction of approximately 4% to 11% in total cholesterol and 7% to 12% in LDL-cholesterol.
Two of the five studies showed a 1.7% to 3.5% increase in HDL-cholesterol level with a consumption of approximately 2.5oz (70g) of almonds. One study showed a dose-dependent reduction in total cholesterol (6% vs. 3.4% reduction in total cholesterol and 9.4% vs. 4.4% change in LDL-cholesterol levels) following consumption of 2.5oz (70g) and 1.3oz (37g) almonds respectively.
Further research is needed to verify these findings.
Grade II
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
No evidence exists to describe the relationship between consuming almonds and the risk of CHD.
Grade V
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
More research is needed on the effect of almonds, and other dietary factors on novel risk factors of CVD. In addition, the effect of novel risk factors on CVD morbidity and mortality needs further investigation.
One small study (final N=27) with a high attrition rate (37%) found almonds when isocalorically incorporated in the diet, decreased two markers of oxidative stress, serum malondialdehyde and urinary isoprostane output.
Grade III
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
It is difficult to isolate the independent effect of almonds on serum lipid levels. Three small studies conducted in men and women on an experimental diet showed preliminary evidence that a diet high almond content (isocalorically replaced with 2.3 to 3 oz. or 66 to 84g) lowers total serum cholesterol 4 to 13% and LDL-cholesterol levels 6 to 15%. One neutral quality study found a therapeutic lifestyle change (TLC) diet incorporating isocaloric amounts of almonds and chocolate, had no effect on serum cholesterol levels.
Additional research is needed to a demonstrate the independent effect of almonds in people consuming a self-selected diet.
Grade III
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
No evidence exists to describe the relationship between a portfolio diet containing almonds and the risk of CHD.
Grade V
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
Seven studies assessed the effect of a portfolio diet incorporating almonds isocalorically on blood lipid levels in hyperlipidemic adults. Six studies assessed the efficacy of a portfolio diet provided by a metabolic kitchen for a four-week period and found it reduced LDL-cholesterol by approximately 30%. A self-selected portfolio diet followed for one-year produced a 12.8±2% LDL-cholesterol reduction. All studies were conducted by the same research laboratory and patients participated in multiple trials. The direct impact of almonds is not discernable.
Grade II
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
Although the direct impact of almonds is not discernable, almonds as an isocaloric component of a portfolio diet (low in saturated fat, incorporating viscous fiber, soybean protein and plant sterols) appears to reduce some novel risk factors or markers of CVD. Two studies reported four-week compliance to a portfolio diet containing almonds significantly reduced the level of small LDL cholesterol particles; one study reported decrease in cholesterol content in the small LDL particle. Another study using this same vegan diet for one-year reported a slight, but statistically significant reduction in hemoglobin and hematocrit, an increase in platelet volume and an approximately 10% change in neutrophils and neutrophil-lymphocyte ratio. A portfolio diet containing almonds was found to be equally as effective as a first generation statin medication in reducing C-reactive protein (CRP) levels.
Grade III
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
No evidence exists to describe the relationship between a portfolio diet containing almonds and cholesterol levels in patients with normal cholesterol.
Grade V
Overall strength of the available supporting evidence: Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable
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