A major focus of dyslipidemia treatment and prevention of cardiovascular disease (CVD) is the reduction of low-density lipoprotein cholesterol (LDL-c), which is not without good reason. LDL-c has been extensively researched and implicated as a causal factor in the buildup of arterial plaque. Observational data clearly shows that high LDL-c is a risk factor for CVD, but this research also shows that low high-density lipoprotein cholesterol (HDL-c) is a risk factor.

Classically, HDL-c is responsible for reverse cholesterol transport, meaning it gathers the cholesterol that could become plaque and brings it back to the liver. Although this role made HDL-c appear to directly counter that of LDL-c, it is now known that HDL-c has many non-classical functions as well, such as anti-inflammatory, antioxidant, and anticoagulant activities. However, it may be that HDL-c is only protective in non-healthy populations, as genetic mechanisms that raise plasma HDL-c do not seem to lower risk of heart attacks, but high HDL-c has been shown protective in statin-treated individuals even when LDL-c was below 70 mg/dL.

For individuals at risk of CVD, there are many current and promising drug therapies for raising HDL-c, as well as more holistic approaches such as engaging in regular exercise, not smoking, and consuming more unsaturated fats. It does now appear that we can add “eating almonds” to this list.

Published ahead of print in the Journal of Nutrition, Jamshed et al from Aga Khan University, Pakistan recruited 113 coronary artery disease patients to consume Pakistani almonds (PA), American almonds (AA), or not change their diet for 12-weeks. The almonds were provided to the participants in pre-weighed packets (10 g), and the participants were instructed to soak 1 package of almonds overnight and eat them on an empty stomach before breakfast after removing their skin. This was done every day for the 12-week intervention.

Although the almond groups never differed between one-another, at both 6 and 12 weeks they had significantly greater HDL-c and significantly less LDL-c, total cholesterol (TC), triglycerides (TG), and very-low-density lipoprotein (VLDL) than the control group. During this intervention period, drug regimens did not differ between groups and remained constant over rime and there were no changes in physical activity or habitual diet per self-report questionnaires.

The changes in blood lipids are unbelievable, and I would not believe that a 20% increase in HDL-c with a concurrent 40% reduction in LDL-c is possible from the daily consumption of a mere 10 grams of almonds. These results become all the more impressive considering that each participant was on lipid-lowering medications, suggesting eating almonds may be a highly effective adjunct to drug therapies.

Oddly, a fairly recent meta-analysis of five randomized controlled trials found that almond consumption of 25-168 grams per day does not have a significant effect on HDL-c. However, all included studies were of short duration (4 weeks) and used whole almonds as a snack or almond powder added to other foods. Additionally, the study participants did not have low HDL-c at baseline and two trials were in otherwise healthy adults. By contrast, the current study had coronary artery disease patients with HDL-c in the low 30s mg/dL consume almonds for 6-12 weeks in a very unique way based upon South Asian tradition. These individuals were also on lipid-lowering medications and a synergistic effect with the almonds cannot be ruled out.

There are many small changes to diet and lifestyle that can be made to reduce CVD risk, and consuming almonds may be one of them. Because we cannot conclude if the current study results came about from the way the almonds were prepared or some aspect of the study participants or some combination of these factors, it is difficult to generalize these findings to other individuals. That said, given the magnitude of improvement observed with almond consumption, it may be prudent to consume 10 grams of soaked and skinless almonds before breakfast when the goal is a healthier blood lipid profile. What is there to lose?