Pistachios: Cholesterol and Lipids

Table of Contents

1. The Lipid Panel in Plain Words
2. The Fat Profile of a Pistachio
3. Phytosterols: The Plant Sterols
4. The Dose-Response Feeding Study
5. LDL Particles, Apolipoproteins and HDL Function
6. Oxidized LDL and Serum Antioxidants
7. Trials in People With High Cholesterol
8. Trials in Metabolic Syndrome, Prediabetes and Weight Loss
9. What the Pistachio Meta-Analyses Pooled
10. Pistachios Against Almonds, Walnuts and Other Nuts
11. All Nuts Together: The Largest Pooled Analyses
12. The 2003 FDA Qualified Health Claim
13. What Is Not Known
14. Who the Research Raises Concerns For
15. Connections
16. Key Research Papers
17. Featured Videos

The Lipid Panel in Plain Words

Cholesterol and triglycerides are fats, and fats do not dissolve in blood. They travel inside particles called lipoproteins — a shell of protein and phospholipid around a core of fat. A standard lipid panel reports four numbers, and the pistachio trials report some extra ones:

• LDL cholesterol (LDL-C) — the cholesterol carried in low-density lipoprotein particles, the particles that can lodge in artery walls. It is the main target of cholesterol-lowering treatment.
• HDL cholesterol (HDL-C) — cholesterol in high-density lipoprotein, the particles that carry cholesterol back from tissues to the liver.
• Triglycerides (TG) — the storage form of fat, carried mostly in very-low-density lipoprotein. Levels rise with excess calories, refined carbohydrate and insulin resistance.
• Total cholesterol (TC), and the TC:HDL and LDL:HDL ratios, which compare the two kinds of particle.
• Apolipoprotein B (apoB) — the single protein on every LDL and VLDL particle, so it counts the number of potentially artery-clogging particles. Apolipoprotein A-I is the main protein of HDL. See ApoB.
• Small, dense LDL — a subclass of LDL particles that are smaller and more easily oxidized.
• Oxidized LDL — LDL whose fats have been damaged by oxidation, the form that immune cells in the artery wall take up as plaque begins (see Atherosclerosis).

Lipid results in the studies below are given in milligrams per decilitre (mg/dL), as used in the United States, or in millimoles per litre (mmol/L); 1 mmol/L of cholesterol is about 38.7 mg/dL and 1 mmol/L of triglyceride about 88.6 mg/dL.

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The Fat Profile of a Pistachio

The USDA FoodData Central record for raw pistachios (FDC 170184, “Nuts, pistachio nuts, raw”, SR Legacy) lists, per 100 grams and per one ounce (28 grams):

• Total fat: 45.3 g per 100 g; about 12.7 g per ounce.
• Monounsaturated fat: 23.3 g per 100 g (about 6.5 g per ounce), almost all of it oleic acid (22.7 g per 100 g), the main fat of olive oil.
• Polyunsaturated fat: 14.4 g per 100 g (about 4.0 g per ounce), nearly all linoleic acid, an omega-6 fat (14.1 g); the plant omega-3 alpha-linolenic acid is only 0.29 g.
• Saturated fat: 5.9 g per 100 g (about 1.7 g per ounce), mostly palmitic acid.
• Cholesterol: 0 mg. Trans fat: 0 g.
• Energy: 560 kcal per 100 g; fiber 10.6 g per 100 g.

For comparison, the same database lists almonds (FDC 170567) at 49.9 g fat with 31.6 g monounsaturated, and English walnuts (FDC 170187) at 65.2 g fat with 47.2 g polyunsaturated, including 9.1 g of alpha-linolenic acid. Pistachios sit between the two: lower in total fat and calories than either, with a fat that is about half monounsaturated and about a third polyunsaturated.

Why the type of fat matters for LDL comes from decades of feeding studies. A 1995 meta-analysis by Gardner and Kraemer pooled 14 studies that swapped oils of different types while keeping total fat, saturated fat, fiber and cholesterol the same. Replacing saturated fat with either monounsaturated or polyunsaturated fat lowered total and LDL cholesterol by a similar amount — roughly 0.65 mmol/L (about 25 mg/dL) relative to the high-saturated-fat diets — and the two kinds of unsaturated fat did not differ from each other on LDL or HDL. Those studies tested oils, not nuts, and they describe a swap: the effect comes from what the unsaturated fat replaces.

Reviews of pistachio composition by Dreher (2012) and by Bulló and colleagues (2015) add that, among nuts, pistachios carry the highest levels of potassium, gamma-tocopherol (a form of vitamin E), vitamin K, phytosterols and the xanthophyll carotenoids lutein and zeaxanthin — the last two being behind the nut's green colour. Dreher's review counted five randomised cardiovascular trials at the time showing heart-healthy blood lipid changes with pistachios.

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Phytosterols: The Plant Sterols

Phytosterols are the plant counterpart of cholesterol — molecules with nearly the same shape, made in plant cell membranes. In the gut they compete with cholesterol for a place in the tiny fat droplets (micelles) from which cholesterol is absorbed, so more cholesterol leaves in the stool. Isolated plant sterols are added to some fortified foods for that reason.

The USDA record for raw pistachios lists 214 mg of phytosterols per 100 grams — about 60 mg per ounce — of which 198 mg is beta-sitosterol, 10 mg campesterol and 5 mg stigmasterol. The same database lists beta-sitosterol at 130 mg per 100 g for almonds and 87 mg for English walnuts. The reviews cited above describe pistachios as having the highest phytosterol content of the common nuts.

Whether the amount in a serving or two of pistachios is enough by itself to change cholesterol absorption has not been measured directly in the trials behind this page. What one trial did show is that the sterols get into the blood: in the controlled-feeding study described in the next section, plasma beta-sitosterol rose significantly (P < 0.0001) when pistachios were included, and the researchers used that rise to confirm that participants had actually eaten the nuts (Holligan and colleagues, 2014).

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The Dose-Response Feeding Study

The most tightly controlled pistachio lipid trial was run at Pennsylvania State University and published by Gebauer, West, Kay, Alaupovic, Bagshaw and Kris-Etherton in the American Journal of Clinical Nutrition in 2008. In a controlled-feeding study all food is provided, so the only planned difference between diets is the test food. Its design:

• Who: 28 adults with LDL cholesterol of at least 2.86 mmol/L (about 110 mg/dL).
• Design: randomised crossover — every participant ate all three diets, for 4 weeks each, after 2 weeks on a typical Western diet.
• Diets (equal in calories, saturated fat held at 8% of energy): a lower-fat control diet with no pistachios (25% fat); one serving a day, 10% of energy from pistachios (30% fat); two servings a day, 20% of energy from pistachios (34% fat). The companion paper by Kay and colleagues gives the serving sizes as 32–63 g a day and 63–126 g a day, adjusted to each person's energy needs.

Reported results (from the paper's abstract):

• The two-serving diet lowered, compared with the control diet, total cholesterol by 8%, LDL cholesterol by 11.6%, non-HDL cholesterol by 11%, apolipoprotein B by 4% and the apoB/apoA-I ratio by 4%.
• The ratios fell step by step with dose: TC:HDL by 1% with one serving and 8% with two; LDL:HDL by 3% and 11%; non-HDL:HDL by 2% and 10%.
• An index of the enzyme stearoyl-CoA desaturase, which helps the body make its own fats, fell by 1% on the two-serving diet; the authors suggested this as one possible mechanism.

The study is notable because the control diet was itself a cholesterol-lowering, lower-fat diet of the kind long advised for heart health: the pistachio diets had more total fat and still produced lower LDL. A result that grows with the dose is also harder to attribute to chance than a single comparison. Its limits are that it was small, short (4 weeks per diet) and run under feeding conditions that differ from everyday eating.

The same 28 participants supplied the blood samples for two follow-up papers — on particle subclasses and HDL function (Holligan 2014) and on oxidized LDL (Kay 2010) — described next. A separate paper from the same trial reported blood pressure; it is covered on Blood Pressure and Blood Vessels.

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LDL Particles, Apolipoproteins and HDL Function

Holligan, West, Gebauer, Kay and Kris-Etherton (British Journal of Nutrition, 2014) re-examined blood from the controlled-feeding study using laboratory (“ex vivo”) tests that go beyond the standard panel:

• Small, dense LDL fell on the two-serving diet compared with the one-serving diet (P = 0.03) and compared with the control diet (P = 0.001). The drop in small dense LDL tracked the drop in triglycerides (r = 0.42, P = 0.025).
• The triglyceride-to-HDL ratio fell on the two-serving diet compared with the control diet (P = 0.036).
• HDL subclasses: the larger, more functional alpha-1 and alpha-2 HDL particles rose with pistachios, but the changes did not reach statistical significance (P = 0.073 and P = 0.056).
• HDL function: cholesterol efflux capacity — how well a person's serum pulls cholesterol out of cells, a laboratory test of HDL's clean-up role — improved on two servings compared with one only in participants whose baseline C-reactive protein (an inflammation marker) was low. It was not a general result.

Combined with the apoB drop of 4% in the original paper, these results suggest pistachios changed not only the amount of cholesterol in LDL but also the number and kind of particles carrying it. The evidence is from one small trial, and particle measurements were secondary outcomes.

On apoB more broadly, the largest pooled analysis of nut trials (Nishi and colleagues, 2025; see below) found nuts in general lowered apoB by 0.04 g/L, and the 2023 analysis by Houston and colleagues rated the certainty of the apoB reduction from nuts as “moderate”. Neither abstract gives a pistachio-only apoB figure.

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Oxidized LDL and Serum Antioxidants

LDL becomes most harmful to the artery wall after its fats are oxidized. Pistachios are rich, relative to other nuts, in lutein, beta-carotene and gamma-tocopherol, all fat-soluble antioxidants that travel in lipoproteins. Kay, Gebauer, West and Kris-Etherton (Journal of Nutrition, 2010) measured these in the same 28 adults:

• On both pistachio diets, plasma lutein (P < 0.0001), alpha-carotene and beta-carotene (P < 0.01) were higher than after the baseline Western diet; lutein was also higher than after the control diet, and gamma-tocopherol was higher than control after the two-serving diet.
• Serum oxidized LDL was lower after both the one- and two-serving diets than after the control diet (P < 0.05).
• The fall in oxidized LDL went with the fall in LDL cholesterol (r = 0.42). After allowing for the LDL change, rises in lutein and gamma-tocopherol on the two-serving diet were only modestly and not significantly associated with lower oxidized LDL (P = 0.06 and P = 0.08). The authors' reading was that most of the drop came from cholesterol lowering, with a possible added contribution from the nut's antioxidants.

Other trials measured related markers. In the 24-week Indian metabolic syndrome trial (Gulati 2014, below), thiobarbituric acid reactive substances (TBARS), a blood marker of fat oxidation, fell significantly with pistachios (P < 0.01). The meta-analysis by Ghanavati and colleagues (2020) pooled malondialdehyde (MDA), another fat-oxidation product, and found a reduction of 0.36 units (95% CI −0.49 to −0.23) with no heterogeneity (I² = 0%). In a 4-month weight-loss trial, plasma alpha-carotene, beta-carotene and lutein rose in the group given 42 g of pistachios a day (Rock 2020). In 49 people with prediabetes, a diet with 57 g of pistachios a day for 4 months reduced a marker of oxidative damage to DNA compared with a control diet (Canudas 2019) — a different target from LDL, but evidence of an antioxidant effect in the body.

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Trials in People With High Cholesterol

Edwards and colleagues, 1999 (Los Angeles). The first pistachio lipid trial: 10 patients with moderate high cholesterol, randomised crossover, three weeks with 20% of daily calories from pistachios in place of other fat calories. Total cholesterol fell (P < 0.04), the TC:HDL ratio fell (P < 0.01) and the LDL:HDL ratio fell (P < 0.02). LDL and triglycerides fell but not significantly, and HDL rose with only a borderline result (P < 0.09). Body weight and blood pressure stayed the same. With ten people, the study could detect only large changes.

Gebauer and colleagues, 2008 (controlled feeding). 28 adults with raised LDL; LDL fell 11.6% on two servings a day (details above).

Kasliwal and colleagues, 2015 (Gurgaon, India). 60 adults with mild dyslipidaemia (abnormal blood lipids) were randomised to lifestyle advice alone or lifestyle advice plus 80 g of in-shell pistachios a day (about 40 g, or 1.5 ounces, shelled) for 3 months. The trial was open label — participants knew their group. In the pistachio group LDL cholesterol fell from 137.2 to 127.6 mg/dL (P = 0.02), HDL rose from 35.7 to 37.8 mg/dL (P = 0.04) and the TC:HDL ratio fell from 5.8 to 5.3 (P = 0.001); the lifestyle-only group showed no change in any biochemical measure. These are before-and-after changes within the pistachio group. The same trial also measured artery stiffness, covered on the blood vessels page.

Lippi and colleagues' 2016 systematic review gathered 9 intervention studies (4 randomised crossover, 3 randomised controlled, and prospective studies) in which pistachios replaced part of the usual calorie intake. Total and LDL cholesterol decreased in 6 of 9 studies, with HDL rising. The TC:HDL ratio fell in all 7 studies that reported it and the LDL:HDL ratio in all 6. Triglycerides fell significantly in only 2 of 8. No study found an unfavourable change in the lipid profile. The authors noted the effect depended on pistachios not increasing the usual daily calorie intake.

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Trials in Metabolic Syndrome, Prediabetes and Weight Loss

Metabolic syndrome (Gulati and colleagues, 2014). 60 Asian Indian adults with metabolic syndrome — a cluster of large waist, raised blood pressure, blood sugar and triglycerides, and low HDL (see Metabolic Syndrome) — were randomised after a 3-week run-in to a standard diet-and-exercise programme with or without unsalted pistachios providing 20% of energy, for 24 weeks. Compared with the control group, the pistachio group improved total cholesterol (P < 0.02) and LDL cholesterol (P < 0.006), along with waist circumference, fasting glucose, C-reactive protein, TNF-alpha, free fatty acids, TBARS and adiponectin.

Weight loss with a pistachio snack (Li and colleagues, 2010). 59 adults with obesity followed a 12-week calorie-reduced diet (500 kcal a day below resting metabolic rate) with an afternoon snack of either 53 g (240 kcal) of salted pistachios or 56 g (220 kcal) of salted pretzels. Triglycerides were lower in the pistachio group at 6 weeks (88.0 vs 144.6 mg/dL, P = 0.01) and 12 weeks (88.1 vs 132.2 mg/dL, P = 0.02). There was no difference in total cholesterol, HDL or LDL between groups. The comparison food was a refined-carbohydrate snack, which tends to raise triglycerides, so part of the gap may reflect the pretzels.

Behavioural weight loss (Rock and colleagues, 2020). 100 adults with overweight or obesity, 4 months, 42 g of pistachios a day versus a weight-loss programme alone. Weight loss was similar (about 5% in both groups); the abstract reports blood-pressure and carotenoid changes in the pistachio group but no lipid result, so this trial adds nothing either way on cholesterol.

Prediabetes and type 2 diabetes. The prediabetes crossover trial (57 g a day for 4 months) is described on Blood Sugar and Diabetes; the abstracts available for this page report its glucose, insulin, microRNA and DNA-oxidation results, not its lipid results. No pistachio trial in people with type 2 diabetes that reports lipid outcomes is among the studies reviewed for this page, so no statement is made here about lipids in diabetes specifically.

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What the Pistachio Meta-Analyses Pooled

A meta-analysis combines the results of several trials into one estimate. “WMD” (weighted mean difference) is the average change against control in the original units; the 95% confidence interval (CI) gives the range the true value probably lies in, and a range that crosses zero means no clear effect. I² measures heterogeneity — how much the trials disagree with each other; above about 75% is usually read as high.

• Hadi and colleagues, 2023 (12 RCTs): LDL −3.82 mg/dL (95% CI −5.49 to −2.16); triglycerides −11.19 mg/dL (−14.21 to −8.17); total cholesterol −7.48 mg/dL (−12.62 to −2.34); HDL +2.45 mg/dL (−2.44 to 7.33), meaning no change.
• Ghanavati and colleagues, 2020 (11 RCTs, 506 people): the abstract reports ratios rather than LDL alone — TC:HDL −0.46 (−0.76 to −0.15; I² 95%) and LDL:HDL −0.24 (−0.38 to −0.11; I² 96%); malondialdehyde −0.36 (I² 0%).
• Baghery and colleagues, 2022 (17 RCTs, 940 people; metabolic syndrome components only, no LDL): triglycerides −16.76 mg/dL (−16.89 to −16.64); HDL +1.43 mg/dL (1.39 to 1.47); no change in waist circumference or body mass index.
• Gunathilake and colleagues, 2022 (all nuts, with a pistachio subgroup): for pistachios only total cholesterol is reported, as a standardised mean difference of −2.89 (−4.80 to −0.98; I² 97.4%).

Reading the table:

• LDL. The one pistachio meta-analysis that pooled LDL alone (Hadi 2023) found a reduction of about 3.8 mg/dL — real but small, and much smaller than the 11.6% in the tightly controlled feeding study, which is typical when trials of different quality, doses and populations are pooled.
• Triglycerides. Two analyses found a reduction, of about 11 and 17 mg/dL. This contrasts with Lippi's count, in which only 2 of 8 studies found a significant triglyceride drop on their own — pooling can reveal a small effect that single small trials miss.
• HDL. Mixed: no change in Hadi 2023; a 1.4 mg/dL rise in Baghery 2022.
• Heterogeneity. Where the abstracts report it, the trials disagreed strongly on lipid outcomes (I² 95–97%). The Baghery 2022 confidence intervals are very narrow for a pool of 17 small trials (a range of about 0.25 mg/dL for triglycerides). A letter to the journal questioned how that analysis calculated its effect sizes; in their 2024 reply the authors defended the method, reanalysed the data using an assumed correlation of 0.5 between conditions, said the high heterogeneity for most outcomes probably reflected differences in participants' health status, and kept their conclusion.
• The general nut analysis by Gunathilake and colleagues found no overall effect of nuts on the lipid profile, but a significant reduction in total cholesterol for the pistachio subgroup. Its result is expressed as a standardised mean difference (SMD), a unit-free measure that cannot be converted directly into mg/dL, and the I² of 97.4% shows the pooled trials varied widely.

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Pistachios Against Almonds, Walnuts and Other Nuts

Few trials test two nuts head to head, so a network meta-analysis links trials through their shared comparisons (each nut against a control diet, or against another nut) to rank the nuts indirectly. Liu and colleagues (American Journal of Clinical Nutrition, 2020) did this for walnuts, pistachios, hazelnuts, cashews and almonds, using 34 trials with 1,677 participants.

• The pistachio-enriched diet ranked first for lowering triglycerides, LDL cholesterol and total cholesterol. Rankings use SUCRA, the percentage chance-weighted position from worst (0%) to best (100%): pistachios scored 85% for triglycerides, 87% for LDL and 96% for total cholesterol.
• Walnuts ranked second for triglycerides and total cholesterol; almonds ranked second for LDL.
• Pistachio- and walnut-enriched diets lowered triglycerides, LDL and total cholesterol more than control diets. Pistachios also beat hazelnuts for triglycerides and total cholesterol.
• The authors rated the quality of evidence as low, and said the analysis was limited by the small number and generally poor reporting of the trials.

A ranking is not proof that one nut is better than another in a head-to-head trial; it reflects the trials that happen to exist for each nut, their populations and their doses. A 2024 review of nut bioactive compounds by Olas concluded, from laboratory (in vitro) and animal (in vivo) studies, that almonds, walnuts and pistachios are the best nut sources of ingredients with cardioprotective properties. The almond and walnut evidence is set out on Almonds: Heart Health and LDL and Walnuts: Heart Health and PREDIMED.

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All Nuts Together: The Largest Pooled Analyses

Because pistachio trials are few, the larger body of evidence on nuts in general frames them:

• Nishi and colleagues, 2025 pooled 113 trials with 8,060 adults at a median dose of 45.5 g of nuts a day. Nuts lowered total cholesterol by 0.14 mmol/L (about 5.4 mg/dL), LDL by 0.12 mmol/L (about 4.6 mg/dL), triglycerides by 0.05 mmol/L (about 4.4 mg/dL), the TC:HDL ratio by 0.11, the LDL:HDL ratio by 0.19 and apoB by 0.04 g/L. There was no significant effect on HDL. Certainty was rated high for apolipoprotein A and generally moderate to low for the other outcomes. The paper's disclosure statement lists support to one author from several nut-industry organisations, which the authors state had no role in the study.
• Houston and colleagues, 2023 reviewed 139 studies of tree nuts and peanuts (129 in the meta-analysis). LDL, total cholesterol, triglycerides, the TC:HDL and LDL:HDL ratios, and apoB all decreased. The certainty of evidence was moderate for the ratios and apoB, low for triglycerides and very low for LDL and total cholesterol, because the trials were inconsistent and publication bias was likely.
• Gunathilake and colleagues, 2022: no overall effect of nuts on lipids, with differences by nut type (pistachio and cashew subgroups described above).

Lipids are a stand-in for heart disease, not heart disease itself. For hard outcomes the evidence on nuts is observational: a 2017 meta-analysis of 18 prospective cohort studies (Chen and colleagues) found that people eating the most nuts had a 25% lower risk of cardiovascular death (relative risk 0.75) and 27% lower risk of coronary heart disease death than those eating the least, with the risk levelling off at about 3 servings a week. Studies of this kind show association, not cause, and they did not separate pistachios from other nuts.

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The 2003 FDA Qualified Health Claim

On July 14, 2003, the US Food and Drug Administration answered a petition from a tree-nut trade foundation with a letter of enforcement discretion for a qualified health claim — a claim allowed on labels when the supporting evidence falls short of the “significant scientific agreement” standard for a full health claim. The wording FDA allowed is:

“Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts [, such as name of specific nut,] as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.”

The letter names pistachio nuts among the nuts eligible to carry the claim, together with almonds, hazelnuts, pecans, some pine nuts and walnuts; some nuts were excluded because their saturated fat content exceeded the disqualifying level. FDA later issued separate qualified claims for walnuts (2004) and macadamia nuts (2017). Sources: FDA: Qualified Health Claims — Letters of Enforcement Discretion; FDA letter on nuts and coronary heart disease, July 14, 2003 (FDA archive).

The claim's own wording — “suggests but does not prove” — reflects FDA's judgment that the evidence was supportive but not conclusive. The 1.5 ounces (about 42 g) it names is close to the 40–42 g a day used in several of the pistachio trials above.

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What Is Not Known

• Hard outcomes. No trial has tested whether eating pistachios reduces heart attacks, strokes or cardiovascular deaths. All pistachio trials measured blood markers over weeks to months. The outcome trial most often cited for nuts, PREDIMED, tested a Mediterranean diet supplemented with mixed nuts, not pistachios on their own (see the walnut PREDIMED page).
• Size and consistency of the LDL effect. Estimates range from about 4 mg/dL in pooled trials to about 12% in a controlled feeding study, and the pooled trials disagree strongly with each other.
• Which component does the work. No trial separated the effects of the unsaturated fat, the phytosterols, the fiber or the antioxidants. The trials tested the whole nut, usually in place of other foods.
• Long-term effect and dose. Only one study compared two doses directly, for 4 weeks per dose.
• People with diabetes, on statins, or with inherited high cholesterol. No lipid trial in these groups is among the studies reviewed for this page (see Familial Hypercholesterolemia).
• Funding and independence. Several pistachio trials and reviews have ties to nut-industry funders; for example, a 2021 review of pistachio composition and health effects (Mandalari and colleagues) discloses that three authors are consultants to a pistachio growers' organisation, which the authors state had no role in the manuscript. Independent replication of the lipid trials is limited.

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Who the Research Raises Concerns For

• People with tree nut allergy. Pistachio allergy is closely linked to cashew allergy and can cause severe reactions; this is covered on Protein and Fiber.
• Calories. The lipid benefits in these trials came when pistachios replaced other foods or fats, often within calorie-controlled diets. Lippi's review states that the favourable effects depended on pistachios not raising the usual calorie intake. At 560 kcal per 100 g, adding them on top of an unchanged diet is a different situation from the one tested.
• Salt. Raw pistachios contain almost no sodium; salted pistachios carry what was added in processing. The Li 2010 trial used salted pistachios; the Gulati 2014 trial used unsalted ones.
• People on cholesterol-lowering treatment. Decisions about lipid-lowering medicines belong with a clinician.

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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
• Blood Pressure and Blood Vessels
• Blood Sugar and Diabetes
• Weight and Mindful Eating
• Gut Microbiome
• Eye Health: Lutein and Zeaxanthin
• Almonds: Heart Health and LDL
• Walnuts: Heart Health and PREDIMED
• Peanuts: Heart Health and Mortality
• Macadamias: Heart Health and Monounsaturated Fats
• Pecans: Cholesterol and Lipids
• Lipid Panel — the blood test
• ApoB — the particle-count test
• Cholesterol Management
• Atherosclerosis — where oxidized LDL matters
• Familial Hypercholesterolemia
• Metabolic Syndrome
• Cholesterol and Lipoproteins — interactive animation
• Avocado: Monounsaturated Fats
• Olive Oil — the other major oleic-acid food

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Key Research Papers

1. Edwards K, Kwaw I, Matud J, et al. Effect of pistachio nuts on serum lipid levels in patients with moderate hypercholesterolemia. Journal of the American College of Nutrition. 1999;18(3):229-32. PubMed PMID: 10376778
2. Holligan SD, West SG, Gebauer SK, et al. A moderate-fat diet containing pistachios improves emerging markers of cardiometabolic syndrome in healthy adults with elevated LDL levels. The British Journal of Nutrition. 2014;112(5):744-52. PubMed PMID: 25008473
3. 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
4. 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
5. 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
6. Rock CL, Zunshine E, Nguyen HT, et al. Effects of Pistachio Consumption in a Behavioral Weight Loss Intervention on Weight Change, Cardiometabolic Factors, and Dietary Intake. Nutrients. 2020;12(7). PubMed PMID: 32698457
7. 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
8. Hadi A, Asbaghi O, Kazemi M, et al. Consumption of pistachio nuts positively affects lipid profiles: A systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. 2023;63(21):5358-5371. PubMed PMID: 34933637
9. 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
10. 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
11. 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
12. Lippi G, Cervellin G, Mattiuzzi C. More pistachio nuts for improving the blood lipid profile. Systematic review of epidemiological evidence. Acta Bio-Medica. 2016;87(1):5-12. PubMed PMID: 27163889
13. Liu K, Hui S, Wang B, et al. Comparative effects of different types of tree nut consumption on blood lipids: a network meta-analysis of clinical trials. The American Journal of Clinical Nutrition. 2020;111(1):219-227. PubMed PMID: 31773150
14. Gunathilake M, Van NTH, Kim J. Effects of nut consumption on blood lipid profile: A meta-analysis of randomized controlled trials. Nutrition, Metabolism, and Cardiovascular Diseases. 2022;32(3):537-549. PubMed PMID: 35144856
15. Nishi SK, Paz-Graniel I, Ni J, et al. Effect of nut consumption on blood lipids: An updated systematic review and meta-analysis of randomized controlled trials. Nutrition, Metabolism, and Cardiovascular Diseases. 2025;35(5):103771. PubMed PMID: 39638677
16. Houston L, Probst YC, Chandra Singh M, et al. Tree Nut and Peanut Consumption and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition. 2023;14(5):1029-1049. PubMed PMID: 37149262
17. Chen GC, Zhang R, Martínez-González MA, et al. Nut consumption in relation to all-cause and cause-specific mortality: a meta-analysis 18 prospective studies. Food & Function. 2017;8(11):3893-3905. PubMed PMID: 28875220
18. Gardner CD, Kraemer HC. Monounsaturated versus polyunsaturated dietary fat and serum lipids. A meta-analysis. Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15(11):1917-27. PubMed PMID: 7583572
19. Dreher ML. Pistachio nuts: composition and potential health benefits. Nutrition Reviews. 2012;70(4):234-40. PubMed PMID: 22458696
20. 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
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PubMed Topic Searches

1. PubMed: the pistachio dose-response feeding study (Gebauer, 2008)
2. PubMed: pistachios, serum antioxidants and oxidized LDL (Kay, 2010)
3. PubMed: pistachio lipid meta-analyses
4. PubMed: pistachios and LDL cholesterol in randomised trials
5. PubMed: nuts and apolipoprotein B
6. PubMed: nut phytosterols and cholesterol absorption

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