Thursday, 21 November 2013

Clinic Speak: Eating nuts reduces mortality

Have you eaten nuts today? Risks and benefits of dietary interventions. #MSBlog #MSResearch #ClinicSpeak

"As part of my mission to promote an holistic approach to MS I would like to highlight the advantage of lifestyle issues in particular diet. I adopted eating nuts on a regular basis about 18 months ago after reading an editorial on their health benefits; I was convinced. The following paper in this week's New England Journal of Medicine takes this further and shows the impact on nuts on all-cause survival or death. There are no reasons, to the best of my knowledge, why these benefits wouldn't extend to MSers. Nuts probably work via targeting vascular risks factors and we now know that MSers tolerate cerebrovascular disease poorly. MSers with comorbidities (other diseases, for example hypertension, diabetes, etc.) do worse than MSers with no comorbidties. Smokers do worse than non-smokers. Exercise improves outcomes, etc."

"There is a twist to the above. I eat nuts 5-6 times per week with the aim of eating 30g per day. I like mixed nuts, because of the variety. I have just been discharged from hospital with renal colic from kidney stones; a very painful and traumatic experience. The urologist asked me if I eat nuts, as nut eating is a risk factor for kidney stones. Nuts are rich in oxalates and are linked to the development of calcium oxalate stones."

"I bet you will ask what about my 5,000U per day vitamin D3 supplement? Excess vitamin D may increase calcium excretion in the urine and help precipitate kidney stones. Correct, but I didn't tell him about that habit."

"I don't agree or disagree with the evidence, but before changing my behaviour I need more evidence. The reason for my position on this is that I had my first attack of renal colic 6 years ago when I was not eating nuts on a daily basis, nor was I on vitamin D supplements. I am therefore not going to change these practices until I know if my stones are calcium oxalate stones or I have increased calcium in my urine. I will have answers to these two questions within the next few weeks."

"Why tell you my story? There is a moral to it. There are risks and benefits to any intervention in MS including dietary interventions. There has been a lot of recent discussions about the benefits and risks of disease-modifying therapies (DMTs). Another discussion that needs to happen is around the risks and benefits of not treating MS with DMTs, or of treating MS with moderately or highly effective treatments. What do you think?"

Bao et al. Association of Nut Consumption with Total and Cause-Specific Mortality. N Engl J Med 2013; 369:2001-2011.

BACKGROUND: Increased nut consumption has been associated with a reduced risk of major chronic diseases, including cardiovascular disease and type 2 diabetes mellitus. However, the association between nut consumption and mortality remains unclear.

METHODS: We examined the association between nut consumption and subsequent total and cause-specific mortality among 76,464 women in the Nurses' Health Study (1980–2010) and 42,498 men in the Health Professionals Follow-up Study (1986–2010). Participants with a history of cancer, heart disease, or stroke were excluded. Nut consumption was assessed at baseline and updated every 2 to 4 years.

RESULTS: During 3,038,853 person-years of follow-up, 16,200 women and 11,229 men died. Nut consumption was inversely associated with total mortality among both women and men, after adjustment for other known or suspected risk factors. The pooled multivariate hazard ratios for death among participants who ate nuts, as compared with those who did not, were 0.93 (95% confidence interval [CI], 0.90 to 0.96) for the consumption of nuts less than once per week, 0.89 (95% CI, 0.86 to 0.93) for once per week, 0.87 (95% CI, 0.83 to 0.90) for two to four times per week, 0.85 (95% CI, 0.79 to 0.91) for five or six times per week, and 0.80 (95% CI, 0.73 to 0.86) for seven or more times per week (P<0.001 for trend). Significant inverse associations were also observed between nut consumption and deaths due to cancer, heart disease, and respiratory disease.

CONCLUSIONS: In two large, independent cohorts of nurses and other health professionals, the frequency of nut consumption was inversely associated with total and cause-specific mortality, independently of other predictors of death. (Funded by the National Institutes of Health and the International Tree Nut Council Nutrition Research and Education Foundation.)


  1. Increased 25(OH) in the blood reduces the parathyroid hormone and 1,25(OH) levels in the blood reducing calcium excretion, except when you reach toxic levels. 10,000iu a day or less has never caused a reported case of toxicity.

  2. So now we know why ProfG has been so quite :-)

  3. Learn how to spell MD :)

  4. "I have just been discharged from hospital with renal colic from kidney stones; a very painful and traumatic experience."
    Get well soon!!!

  5. Wishing him a smooth recovery and no future episodes of renal colic.

  6. I concur. There are squirrel studies that find some animals never get old:-) I'll file this under "smoking=BAD, exercise=GOOD, nuts=GOOD"

    1. Who knew there was an International Tree Nut Council Nutrition Research and Education Foundation (ITNCNREF) whew.......that's a mouthful of nuts:-).


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