Pistachios: Blood Sugar and Diabetes

Table of Contents

1. Three Different Blood-Sugar Measurements
2. What a Handful Brings to a Meal
3. Why the Post-Meal Rise Is Smaller
4. Single-Meal Trials: Alone and With Bread, Rice and Pasta
5. Metabolic Syndrome Trials
6. The Prediabetes Crossover Trial
7. Type 2 Diabetes
8. Trials in Other Groups, Including Null Results
9. The Meta-Analyses: Pooled Numbers
10. Animal Work
11. What Is Not Known
12. Who the Research Raises Concerns For
13. Connections
14. Key Research Papers
15. Featured Videos

Three Different Blood-Sugar Measurements

Studies on food and blood sugar do not all measure the same thing, and mixing them up is the most common way findings get overstated. The pistachio studies used four main measurements:

• Post-meal (postprandial) glucose. Blood sugar measured repeatedly for about two hours after a test meal. The result is often expressed as the area under the curve, or as a percentage of the response to a reference food such as white bread — the same approach used to calculate a glycemic index. It shows how one meal behaves, not how a person's metabolism changes over months.
• Fasting glucose. Blood sugar after an overnight fast. It reflects, mainly, how much sugar the liver releases overnight and how well insulin restrains it. A fasting glucose that is raised but still below the diabetes range is one form of prediabetes.
• Fasting insulin and HOMA-IR. Fasting insulin shows how hard the pancreas is working to hold fasting glucose where it is. HOMA-IR (homeostasis model assessment of insulin resistance) is a score calculated from fasting glucose and fasting insulin together; a higher score means more insulin resistance.
• HbA1c. Hemoglobin A1c is the share of red-blood-cell hemoglobin that has picked up a sugar molecule (see the glycation animation). Because red cells live about three months, it reflects average blood sugar over that period. It is the main marker used to diagnose and track type 2 diabetes.

A food can lower the post-meal rise without changing HbA1c, and it can nudge fasting glucose without changing fasting insulin. Each study below is labelled with the measurement it actually reported.

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What a Handful Brings to a Meal

The USDA FoodData Central entry for raw pistachio kernels (FDC 170184) lists, per 100 grams, 560 kcal, 20.2 g protein, 45.3 g fat and 27.2 g carbohydrate, of which 10.6 g is fiber. Converted to a one-ounce (28.35 g) portion, roughly 49 kernels:

Two points matter for blood sugar. First, an ounce of pistachios carries only about 4.7 grams of carbohydrate that is not fiber, most of it sucrose, and almost no starch — so there is very little in the nut itself to raise blood glucose. Second, the same ounce brings protein, fat and fiber, which change how the rest of a meal is digested. Reviews of pistachio composition describe the nut as relatively low in fat and energy among nuts and high in protein, fiber, potassium, magnesium and xanthophyll carotenoids (Dreher, 2012; Bulló and colleagues, 2015). The full composition table is on the pistachio nutrient profile, and the protein and fiber are discussed in detail on Protein and Fiber.

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Why the Post-Meal Rise Is Smaller

After a meal of white bread, starch is broken down to glucose quickly in the small intestine and absorbed, and blood sugar peaks within 30 to 60 minutes. Adding a food rich in fat, protein and fiber changes that sequence in several ways that nutrition researchers describe:

• Slower stomach emptying. Fat and protein slow the rate at which the stomach releases its contents into the intestine, so the starch arrives in smaller portions over a longer time. The peak comes later and lower.
• Fiber and intact cell walls. Fiber thickens the intestinal contents and slows contact between digestive enzymes and starch. In whole nuts, some fat and protein stay locked inside plant cell walls that chewing does not break, which further slows their release.
• Gut hormones. Fat and protein reaching the intestine trigger hormones such as glucagon-like peptide-1 (GLP-1), which slows stomach emptying, signals fullness and helps the pancreas release insulin in proportion to the glucose that arrives. One of the pistachio trials below measured a rise in GLP-1 after a pistachio meal.
• Less carbohydrate per bite. When pistachios replace part of a starchy food, rather than being added on top, the meal simply contains less carbohydrate. Several of the longer trials swapped pistachios for other foods so that calories stayed the same, which means part of any effect may come from what was removed, not only from what was added.

These mechanisms explain a smaller post-meal rise. Whether a smaller rise repeated meal after meal translates into lower fasting glucose, lower HbA1c or fewer cases of diabetes is a separate question, and it is what the longer trials tried to answer.

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Single-Meal Trials: Alone and With Bread, Rice and Pasta

Kendall, Josse, Esfahani and Jenkins, 2011 (European Journal of Clinical Nutrition). Measurement: post-meal glucose over two hours, expressed as a relative glycemic response compared with white bread (white bread = 100 percent). Ten healthy volunteers (3 men and 7 women, average age 48, average BMI 28) took part in two experiments.

• Pistachios alone. Eaten on their own, 28, 56 and 84 grams of pistachios produced responses of 5.7, 3.8 and 9.3 percent of the white-bread response — close to no rise at all.
• Pistachios added to white bread (50 grams of available carbohydrate). The effect depended on the dose: 28 grams lowered the response to 89.1 percent, which was not statistically significant (P = 0.100); 56 grams lowered it to 67.3 percent (P = 0.009); and 84 grams lowered it to 51.5 percent (P < 0.001).
• 56 grams added to other starchy foods. Parboiled rice fell from 72.5 to 58.7 percent (P = 0.031) and pasta from 94.8 to 56.4 percent (P = 0.025). For mashed potatoes the response fell from 109.0 to 87.4 percent, which only approached significance (P = 0.063).

Two details are easy to miss. The amount usually described as one serving, about 28 grams, did not significantly blunt the bread response in this study; the significant effects started at about two servings. And the study was very small, with ten people, so the exact percentages carry wide uncertainty. The authors concluded that pistachios have minimal effect on blood sugar when eaten alone and reduce the response when eaten with a carbohydrate meal.

Kendall and colleagues, 2014 (European Journal of Clinical Nutrition). Measurement: post-meal glucose and insulin, plus gut hormones. This randomized crossover study in 20 adults with metabolic syndrome is described in the next section, because it is the single-meal study done in people with an existing metabolic problem.

The Dreher review (2012) summarised this early work as suggesting that adding pistachios to high-glycemic meals may lower the overall post-meal response — a cautious phrasing that still fits the evidence.

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Metabolic Syndrome Trials

Metabolic syndrome is a cluster of risk factors — a large waist, raised triglycerides, low HDL cholesterol, raised blood pressure and raised fasting glucose — that together raise the risk of type 2 diabetes and heart disease.

The single-meal study (Kendall and colleagues, 2014). Measurement: post-meal glucose, post-meal insulin, gut hormones and blood-vessel function. Twenty people with metabolic syndrome ate five test meals in random order over 5 to 10 weeks. Three meals contained 50 grams of available carbohydrate (white bread alone; white bread with butter and cheese; white bread with pistachios) and two contained 12 grams (white bread alone; pistachios alone).

• Within each carbohydrate level, glucose was highest after the white-bread-only meals, and the rise was significantly smaller when either butter and cheese or pistachios were eaten with the bread (P < 0.05).
• Post-meal insulin was highest after the butter-and-cheese meal and did not differ between the white-bread-only and pistachio meals. In other words, the pistachio meal produced less glucose without needing more insulin; the authors described this as possibly “insulin-sparing”.
• Hormones that stimulate insulin release, including glucagon-like peptide, were higher after the butter-and-cheese and pistachio meals than after white bread alone.

The comparison with butter and cheese is useful: it shows that much of the glucose-blunting effect comes from adding fat and protein to bread, not from something unique to pistachios. The difference was in the insulin response.

The 24-week trial in Asian Indians (Gulati and colleagues, 2014, Nutrition). Measurements: fasting glucose, fasting insulin, HbA1c, waist, abdominal fat by MRI, lipids and inflammatory markers. Sixty adults with metabolic syndrome in New Delhi completed a three-week diet-and-exercise run-in and were then randomized either to continue the standard diet and exercise plan or to the same plan with unsalted pistachios supplying 20 percent of daily energy, for 24 weeks. Compared with the control group, the pistachio group had significant improvements in waist circumference (P < 0.02), fasting blood glucose (P < 0.04), total cholesterol, LDL cholesterol, the inflammation markers hs-CRP and TNF-α, free fatty acids, an oxidative-stress marker (TBARS) and adiponectin (P < 0.001). Fasting insulin and HbA1c (glycosylated hemoglobin) were measured but were not among the significant improvements the abstract lists, so this trial supports a fasting-glucose effect, not an HbA1c effect.

The pooled analysis of metabolic syndrome components by Baghery and colleagues is covered in the meta-analysis section.

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The Prediabetes Crossover Trial

The longest and most detailed pistachio trial in prediabetes was run by the Human Nutrition Unit at Rovira i Virgili University in Reus, Spain, by Hernández-Alonso, Salas-Salvadó, Bulló and colleagues. It was a randomized crossover trial: every participant ate both diets, one after the other in random order, so each person served as their own comparison.

• Diets. A pistachio-supplemented diet including 57 grams of pistachios a day (about two ounces), with roughly 50 percent of calories from carbohydrate and 33 to 35 percent from fat; and a control diet with about 55 percent from carbohydrate and 30 percent from fat. The two diets had the same calories.
• Duration. Four months on each diet, separated by a two-week washout.

The main glucose results. Measurements: fasting glucose, fasting insulin, HOMA-IR, inflammatory and other risk markers. The main report, published in Diabetes Care in 2014 with 54 participants, found that fasting glucose, fasting insulin and HOMA-IR all decreased significantly after the pistachio diet compared with the control diet, along with fibrinogen, oxidized LDL and platelet factor 4, while GLP-1 rose. (Hernández-Alonso 2014, PMID 25125505).

Three further analyses from the same trial are in this page's citation list:

• Circulating microRNAs (Hernández-Alonso and colleagues, 2017, European Journal of Nutrition). In 49 participants, after the pistachio period, two small regulatory RNA molecules in the blood that have been linked to glucose and insulin metabolism, miR-192 and miR-375, were significantly lower than after the control period. Their changes correlated with changes in plasma glucose, insulin and HOMA-IR. A third, miR-21, rose without reaching significance (P = 0.092). This is a mechanism study: it shows a molecular pattern that moves with insulin sensitivity, not a separate clinical benefit.
• Urine metabolites (Hernández-Alonso and colleagues, 2017, The Journal of Nutritional Biochemistry). In 39 participants, three urinary compounds produced by gut bacteria (hippurate, p-cresol sulfate and dimethylamine) were lower after the pistachio diet, and within the pistachio period trimethylamine N-oxide (TMAO) fell (P = 0.034). The authors note these metabolites have been associated with insulin resistance and type 2 diabetes; the study did not show that the change itself improved blood sugar. More on this is on Gut Microbiome.
• DNA damage and telomere genes (Canudas and colleagues, 2019, The American Journal of Clinical Nutrition). In 49 participants, the pistachio diet reduced a marker of oxidative damage to DNA (8-hydroxydeoxyguanosine) compared with the control diet (mean −3.5 percent, P = 0.009) and increased the activity of two telomere-related genes, TERT and WRAP53. Changes in TERT activity were inversely related to changes in fasting plasma glucose and HOMA-IR.

What this trial does and does not show: it found lower fasting glucose, fasting insulin and insulin resistance over four months in people with prediabetes. It did not follow people long enough to see whether fewer of them progressed to type 2 diabetes, and its abstracts do not report an HbA1c result.

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Type 2 Diabetes

Fewer pistachio trials have been done in people who already have type 2 diabetes, and the individual trials are not in this page's verified citation list. They are represented here through the meta-analyses that pooled them:

• Nowrouzi-Sohrabi and colleagues (2020) pooled six randomized trials in people with type 2 diabetes, prediabetes or metabolic syndrome. They found a significant improvement in fasting glucose and HOMA-IR but no significant change in HbA1c or fasting insulin (numbers below).
• Hadi and colleagues (2023), pooling eight trials, noted that few of the available studies included people with diabetes and that sample sizes were small, and called for well-designed trials aimed at diabetic populations.

Because HbA1c is the main marker used to manage type 2 diabetes, the lack of a clear HbA1c effect in the pistachio-specific pooled data is the most important limitation for this group. One broader meta-analysis did find a small HbA1c reduction (Ghanavati and colleagues, 2020, below), so the question is not settled either way.

A related, broader body of evidence concerns dietary fiber in diabetes. Reynolds, Akerman and Mann (2020, PLoS Medicine) reviewed 42 trials with 1,789 adults with prediabetes, type 1 or type 2 diabetes, and two cohorts of 8,300 adults with diabetes. Higher-fiber diets lowered HbA1c (mean difference −2.00 mmol/mol, from 33 trials), fasting plasma glucose (−0.56 mmol/L, from 34 trials), insulin and HOMA-IR compared with lower-fiber diets, though all trial analyses showed high heterogeneity. In the cohorts, a fiber intake of 35 grams a day, compared with the average 19 grams, was associated with 14 fewer deaths per 1,000 participants over the study period. That review is about fiber in general, not pistachios; an ounce of pistachios supplies about 3 grams of it.

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Trials in Other Groups, Including Null Results

Several pistachio and mixed-nut trials in people without diabetes measured glucose or insulin as secondary outcomes. Their results are mixed, and the null results are part of the picture.

• Weight-loss program, obese adults (Li and colleagues, 2010, Journal of the American College of Nutrition). Measurements: fasting glucose and insulin among others. Over 12 weeks on a calorie-reduced diet, 31 people received an afternoon snack of 53 grams of salted pistachios (240 kcal) and 28 received 56 grams of salted pretzels (220 kcal). Triglycerides were significantly lower in the pistachio group, but there were no significant differences in glucose or insulin between the groups.
• Mild dyslipidemia, India (Kasliwal and colleagues, 2015, Nutrition). Measurement: fasting blood sugar, as a secondary outcome. Sixty adults were randomized to lifestyle changes alone or lifestyle changes plus 40 grams of shelled pistachios a day for three months. Within the pistachio group, fasting blood sugar went from 88.8 to 86.6 mg/dL (P = 0.05) — a small change in people whose fasting glucose was already normal. The main findings of this trial were on cholesterol and arterial stiffness.
• Mixed nuts and brain insulin sensitivity (Nijssen and colleagues, 2024, The American Journal of Clinical Nutrition). Measurement: insulin sensitivity by oral glucose tolerance test, plus brain blood-flow responses to insulin sprayed into the nose. In 28 older adults with overweight or obesity, 60 grams a day of mixed nuts (15 grams each of walnuts, pistachios, cashews and hazelnuts) for 16 weeks, compared with no nuts, improved the brain's response to insulin in several regions and lowered liver fat, LDL cholesterol and systolic blood pressure. Peripheral insulin sensitivity — the body's ordinary insulin response measured by the glucose tolerance test — did not change. Only a quarter of the nuts were pistachios.

These trials suggest that a glucose effect is easier to detect in people whose blood sugar is already raised (prediabetes, metabolic syndrome) than in people with normal glucose, and that it is not guaranteed even then.

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The Meta-Analyses: Pooled Numbers

Four meta-analyses in this page's citation list pooled randomized pistachio trials and reported blood-sugar outcomes. They overlap heavily — the same small set of trials appears in most of them — so they are not four independent confirmations.

Ghanavati and colleagues, 2020 (Complementary Therapies in Medicine). Eleven randomized trials with 506 participants, on cardiometabolic risk factors in general. Pistachio consumption reduced fasting blood sugar (weighted mean difference −3.73; 95% confidence interval −6.99 to −0.46), HbA1c (−0.14; −0.26 to −0.02) and insulin (−2.43; −4.85 to −0.001), as well as cholesterol ratios, systolic blood pressure and an oxidative-stress marker. The heterogeneity figure (I²) for fasting blood sugar was 99 percent, meaning the individual trials disagreed with each other far more than chance would explain; the pooled number is an average across very different results. The upper limit of the insulin interval sits almost exactly at zero, which makes that finding borderline.

Nowrouzi-Sohrabi and colleagues, 2020 (Diabetes & Metabolic Syndrome). Six randomized trials in people with type 2 diabetes, prediabetes or metabolic syndrome. Pistachios significantly reduced fasting blood glucose (reported as OR = 1.7, 95% CI 1.2 to 2.4, P = 0.002, I² = 0%) and HOMA-IR (OR = 1.5, 95% CI 1.0 to 2.4, P = 0.043, I² = 0%). There was no significant improvement in HbA1c (OR = 1.4, 95% CI 0.9 to 2.1, P = 0.089) or fasting plasma insulin (OR = 1.3, 95% CI 0.9 to 1.9, P = 0.133). The authors expressed these continuous measurements as odds ratios, an unusual choice, so the figures show direction and significance but not a size in mg/dL. Their conclusion: pistachios “might” reduce fasting glucose and HOMA-IR, while HbA1c and fasting insulin “might not significantly improve”.

Baghery, Mohammadifard and Khanamani Falahati-Pour, 2022 (Nutrition Reviews). Seventeen randomized trials with 940 adults, looking at the components of metabolic syndrome. Pistachio supplementation significantly reduced fasting blood glucose (mean difference −3.62 mg/dL; 95% CI −6.45 to −0.8), systolic blood pressure (−2.89 mmHg), and triglycerides (−16.76 mg/dL), and raised HDL cholesterol (+1.43 mg/dL). Waist circumference, diastolic blood pressure and body mass index did not change considerably. A letter to the editor later challenged the way effect sizes were calculated, including taking more than one effect size from a single study; in their 2024 reply, the authors defended the approach, acknowledged a high rate of heterogeneity for most outcomes (which they attributed to differences in participants' health status), and reported reanalysing the data with an assumed correlation coefficient of 0.5. The authors list their affiliation as a pistachio safety research center in Rafsanjan, Iran.

Hadi, Asbaghi and colleagues, 2023 (The British Journal of Nutrition). Eight randomized trials in people at high cardiovascular risk, with pistachios exchanged for other foods at equal calories. Pistachios lowered fasting blood sugar (weighted mean difference −5.32 mg/dL; 95% CI −7.80 to −2.64) and fasting insulin (−1.86 µIU/mL; −3.13 to −0.59). HOMA-IR did not change (−0.66; −1.89 to 0.58; P = 0.30). The authors noted the limited number of studies with diabetic participants and the small sample sizes.

Reading the four together. The one finding all four agree on is a small reduction in fasting glucose, of roughly 3.6 to 5.3 mg/dL where a size is given. Fasting insulin and HOMA-IR were significant in some analyses and not in others — Nowrouzi-Sohrabi found HOMA-IR significant and insulin not, Hadi found the reverse. HbA1c was significant in one analysis (Ghanavati, −0.14 points) and not significant in another (Nowrouzi-Sohrabi). With so few trials, many of them small and short, this kind of inconsistency is expected.

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Animal Work

One study in the citation pack was done in rats, not people. Prapa and colleagues (2024, Nutrients) gave rats with chemically induced diabetes (a model of type 1 diabetes, made with the drug streptozotocin) pistachios carrying a lactic-acid bacterium, Pediococcus acidilactici, either free or attached to the nut, for four weeks. The bacteria-on-pistachio diets shifted the rats' gut bacteria and lowered an inflammatory marker. This tested a probiotic delivered on pistachios, in rats, and does not show what plain pistachios do for blood sugar in people.

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What Is Not Known

• Whether pistachios prevent diabetes. No trial in this page's citation list has counted new cases of type 2 diabetes. The prediabetes trial measured fasting glucose, insulin and HOMA-IR over four months per diet; it did not report how many people moved into or out of the diabetes range over years.
• Whether pistachios lower HbA1c. The pooled evidence is split: one meta-analysis found a reduction of 0.14 percentage points, another found no significant change.
• How much of the effect is substitution. In many trials pistachios replaced other foods, often carbohydrate, at equal calories. A diet with less refined starch may lower fasting glucose whatever replaces it; the butter-and-cheese meal in the 2014 Kendall study blunted the glucose rise too.
• The dose for a single meal. In the 2011 single-meal study, 28 grams added to bread did not make a significant difference; 56 and 84 grams did. Most longer trials used 40 to 57 grams a day or 20 percent of energy.
• Gestational diabetes and type 1 diabetes. No human pistachio trial in pregnancy or in type 1 diabetes is in this page's citation list. The only type 1 diabetes work in the pack is the rat study above.
• Long-term and independent replication. The trials are small (10 to 60 people in the individual studies above, up to 54 in the prediabetes crossover), mostly a few weeks to six months long, and concentrated in a few research groups. At least one trial in this series, the Carughi satiety pilot, declares pistachio-industry funding and consultancy. That does not make a result wrong, but independent, longer trials would carry more weight.
• Roasted, salted and flavoured pistachios. The study foods were mostly plain or unsalted pistachios; the 2010 weight-loss trial used salted ones. Sweetened or candy-coated versions were not tested and would add sugar.

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Who the Research Raises Concerns For

• People with a tree-nut allergy. Pistachio allergy is closely linked to cashew allergy, because the two are botanical relatives. The NUT CRACKER study (Elizur and colleagues, 2022, Allergy) treated cashew-pistachio allergy together, and the British Society for Allergy and Clinical Immunology guideline (Stiefel and colleagues, 2017) covers the diagnosis and management of peanut and tree-nut allergy.
• People on glucose-lowering medicines. The trials above reported small changes in fasting glucose; none of them was designed to study interactions with diabetes medicines. Decisions about diabetes treatment belong with a clinician.
• People watching calories or sodium. Two ounces of pistachios, the amount in the prediabetes trial, supplies over 300 kcal. Several trials found no weight gain when pistachios replaced other foods (see Weight and Mindful Eating), but the trials were controlled. Salted pistachios add sodium, which matters for people with high blood pressure.
• Mould toxins. Like peanuts, pistachios can carry aflatoxins, toxins from moulds that grow on stored nuts; the topic is covered on the peanut page on aflatoxin and safe sourcing.

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Connections

• Nuts — the nuts landing page
• Pistachios — the main topic page
• Pistachios — Benefits Deep Dive — the hub for this series
• Pistachios: Nutrient Profile — the full composition table
• Protein and Fiber
• Weight and Mindful Eating
• Gut Microbiome
• Cholesterol and Lipids
• Blood Pressure and Blood Vessels
• Eye Health: Lutein and Zeaxanthin
• Almonds: Blood Sugar and Diabetes
• Walnuts: Blood Sugar and Diabetes
• Type 2 Diabetes
• Prediabetes
• Insulin Resistance
• Metabolic Syndrome
• HOMA-IR — the insulin-resistance score
• Hemoglobin A1C
• Fasting Insulin
• hs-CRP — the inflammation marker in the metabolic syndrome trial
• Blood Sugar — diet and blood sugar
• Dietary Fiber
• Magnesium
• Beans: Blood Sugar and Diabetes

Key Research Papers

1. Kendall CW, Josse AR, Esfahani A, et al. The impact of pistachio intake alone or in combination with high-carbohydrate foods on post-prandial glycemia. European Journal of Clinical Nutrition. 2011;65(6):696-702. PubMed PMID: 21364607
2. Kendall CW, West SG, Augustin LS, et al. Acute effects of pistachio consumption on glucose and insulin, satiety hormones and endothelial function in the metabolic syndrome. European Journal of Clinical Nutrition. 2014;68(3):370-5. PubMed PMID: 24424074
3. Gulati S, Misra A, Pandey RM, et al. Effects of pistachio nuts on body composition, metabolic, inflammatory and oxidative stress parameters in Asian Indians with metabolic syndrome: a 24-wk, randomized control trial. Nutrition. 2014;30(2):192-7. PubMed PMID: 24377454
4. Hernández-Alonso P, Giardina S, Salas-Salvadó J, et al. Chronic pistachio intake modulates circulating microRNAs related to glucose metabolism and insulin resistance in prediabetic subjects. European Journal of Nutrition. 2017;56(6):2181-2191. PubMed PMID: 27383196
5. Hernández-Alonso P, Cañueto D, Giardina S, et al. Effect of pistachio consumption on the modulation of urinary gut microbiota-related metabolites in prediabetic subjects. The Journal of Nutritional Biochemistry. 2017;45:48-53. PubMed PMID: 28432876
6. Canudas S, Hernández-Alonso P, Galié S, et al. Pistachio consumption modulates DNA oxidation and genes related to telomere maintenance: a crossover randomized clinical trial. The American Journal of Clinical Nutrition. 2019;109(6):1738-1745. PubMed PMID: 31051499
7. Li Z, Song R, Nguyen C, et al. Pistachio nuts reduce triglycerides and body weight by comparison to refined carbohydrate snack in obese subjects on a 12-week weight loss program. Journal of the American College of Nutrition. 2010;29(3):198-203. PubMed PMID: 20833992
8. Kasliwal RR, Bansal M, Mehrotra R, et al. Effect of pistachio nut consumption on endothelial function and arterial stiffness. Nutrition. 2015;31(5):678-85. PubMed PMID: 25837212
9. Nijssen KM, Mensink RP, Plat J, et al. Mixed nut consumption improves brain insulin sensitivity: a randomized, single-blinded, controlled, crossover trial in older adults with overweight or obesity. The American Journal of Clinical Nutrition. 2024;119(2):314-323. PubMed PMID: 38128733
10. Ghanavati M, Rahmani J, Clark CCT, et al. Pistachios and cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled clinical trials. Complementary Therapies in Medicine. 2020;52:102513. PubMed PMID: 32951758
11. Nowrouzi-Sohrabi P, Hassanipour S, Sisakht M, et al. The effectiveness of pistachio on glycemic control and insulin sensitivity in patients with type 2 diabetes, prediabetes and metabolic syndrome: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome. 2020;14(5):1589-1595. PubMed PMID: 32947760
12. Baghery F, Mohammadifard N, Khanamani Falahati-Pour S. The effect of pistachio supplementation on metabolic syndrome and its components in adults: a systematic review and meta-analysis of randomized controlled trials. Nutrition Reviews. 2022;80(10):2051-2063. PubMed PMID: 35689651
13. Baghery F, Mohammadifard N, Khanamani Falahati-Pour S. Reply to Letter to the editor regarding "The effect of pistachio supplementation on metabolic syndrome and its components in adults: a systematic review and meta-analysis of randomized controlled trials". Nutrition Reviews. 2024;82(5):711-713. PubMed PMID: 37550254
14. Hadi A, Asbaghi O, Kazemi M, et al. Effects of pistachios on glycaemic control: a systematic review and meta-analysis of randomised controlled trials. The British Journal of Nutrition. 2023;129(10):1693-1702. PubMed PMID: 35795961
15. Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Medicine. 2020;17(3):e1003053. PubMed PMID: 32142510
16. Dreher ML. Pistachio nuts: composition and potential health benefits. Nutrition Reviews. 2012;70(4):234-40. PubMed PMID: 22458696
17. Bulló M, Juanola-Falgarona M, Hernández-Alonso P, et al. Nutrition attributes and health effects of pistachio nuts. The British Journal of Nutrition. 2015;113 Suppl 2:S79-93. PubMed PMID: 26148925
18. Prapa I, Yanni AE, Kompoura V, et al. Functional Modulation of Gut Microbiota and Blood Parameters in Diabetic Rats Following Dietary Intervention with Free or Immobilized Pediococcus acidilactici SK Cells on Pistachio Nuts. Nutrients. 2024;16(23). PubMed PMID: 39683613
19. Carughi A, Bellisle F, Dougkas A, et al. A Randomized Controlled Pilot Study to Assess Effects of a Daily Pistachio (Pistacia Vera) Afternoon Snack on Next-Meal Energy Intake, Satiety, and Anthropometry in French Women. Nutrients. 2019;11(4). PubMed PMID: 30986958
20. Elizur A, Appel MY, Nachshon L, et al. Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study). Allergy. 2022;77(6):1863-1872. PubMed PMID: 35000223
21. Stiefel G, Anagnostou K, Boyle RJ, et al. BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Clinical and Experimental Allergy. 2017;47(6):719-739. PubMed PMID: 28836701
22. Hernández-Alonso P, Salas-Salvadó J, Baldrich-Mora M, et al. Beneficial effect of pistachio consumption on glucose metabolism, insulin resistance, inflammation, and related metabolic risk markers: a randomized clinical trial. Diabetes Care. 2014;37(11):3098-105. PubMed PMID: 25125505

PubMed Topic Searches

1. PubMed: the pistachio prediabetes crossover trial (Reus, Spain)
2. PubMed: pistachios and post-meal blood sugar
3. PubMed: pistachios in type 2 diabetes, randomized trials
4. PubMed: pistachios and HbA1c
5. PubMed: pistachios and metabolic syndrome
6. PubMed: pistachios and gestational diabetes
7. PubMed: nut consumption and new cases of type 2 diabetes

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