The fourth part of our Debunking Fad Diet Series and up this time I am addressing some of the incorrect claims that surround the vegan WFPB (Whole Food Plant Based) ideology when it comes to nuts and cardiovascular disease.
Proponents of extreme ultra-low fat WFPB vegan diets generally tend to claim that nuts should be militantly avoided for patients with existing heart disease or even for healthy individuals.
However, this is rooted in outdated low fat diet dogma rather than being based on the current science.
The WFPB (Whole Food Plantbased) Vegan movement likes to pride itself on being the “evidence-based” faction of veganism, despite their constant demonization and incorrect claims towards numerous proven heart-healthy foods such as nuts, olive oil and fish being nothing more than complete pseudo-science at this point.
Any plant-based diet proponent that cannot interpret that the massive body of literature consistently concludes that the likes of nuts, olive oil and omega-3 rish oily fish are heart-healthy foods which possess potentially life-saving therapeutic benefits is stuck clinging onto out dated diet dogma.
There are all manners of incorrect claims from the WFPB proponents when it comes to nuts and cardiovascular health. So many that its hard to list and address them all in the one article.
Many WFPB proponents even out rightly claim that nuts CAUSE cardiovascular disease, despite having absolutely no research to support this opinion and the massive body of literature over 25+ years consistently finding the opposite to be true i.e higher nut intake is consistently inversely associated with CVD risk reduction and heart health benefits.
Other popular myths surrounding nuts is that they worsen endothelial function, despite the likes of walnuts having been shown in studies to actually improve endothelial function.
In this article I am going to share some of the latest scientific research on nut consumption and cardiovascular health, disease risk, mortality, attenuation of CVD risk factors and much more.
1. Nuts Are A Heart-Healthy Plant Food-Group
Firstly we must start the article by addressing the basic fact that tree-nuts have consistently been shown to be a heart-healthy food-group from the research.
I also must highlight and emphasize just what amazing sources of nutrition tree-nuts are such as walnuts, almonds, cashews, brazil nuts for example.
There is good reason why virtually every single study out there consistently finds higher/regular consumption of tree-nuts and even peanuts to offer significant cardiovascular health benefits.
Nuts are literally packed with multiple cardio protective nutrients and phyto-chemicals, which have been shown to support heart-health via numerous different mechanisms.
Nuts (tree nuts and peanuts) are nutrient dense foods with complex matrices rich in unsaturated fatty and other bioactive compounds: high-quality vegetable protein, fiber, minerals, tocopherols, phytosterols, and phenolic compounds. 
Nut components, such as unsaturated fatty acids, l-arginine, beneficial minerals, phenolic compounds and phytosterols, appear to be of paramount importance for their health effects. 
2. Nuts Reduce Cardiovascular Disease Risk!
The second part of debunk is addressing the main claim from the WFPB diet proponents, which is that nuts need to be avoided for people with existing cardiovascular disease, due to being “unhealthy” or nuts potential ability to worsen these conditions.
These opinions are of course once again not actually based on scientific evidence.
The massive body of literature on nuts consistently finds higher intake to be associated with reductions in cardiovascular disease risk, amongst other heart-health related benefits.
We conducted a review of the literature with respect to observational studies and randomized trials completed in the past ≈25 years that examined nut intake and CVD endpoints. We included findings from major cohort studies, a large intervention trial, and numerous smaller nut trials.
Collectively, data from observational and intervention studies indicate strong and significant association between nut intake and decreased risk of fatal and non-fatal coronary heart disease, myocardial infarction, and sudden death; and somewhat weak association with stroke. 
Another study published in 2020 evaluated the association of within‐individual changes in consumption of total and specific types of nuts and the subsequent risk of incident cardiovascular disease (CVD) in US men and women.
The study concluded:
Increasing total consumption of nuts and intake of individual types of nuts (eg, walnuts, other tree nuts, and peanuts) was associated with a subsequent lower risk of CVD. These data support the role of nut intake in the primary prevention of CVD. 
3. Nuts Heart-Health Mechanisms (Improving lipid and apolipoprotein profile, lowering oxidative stress/inflammation and more….)
Research has found that tree-nuts potentially have multiple different mechanisms responsible for their cardiovascular health benefits.
The primary mechanism by which nuts protect against CVD is through the improvement of lipid and apolipoprotein profile.
Increasing evidence also indicates that nut consumption may confer protection against CVD via lowering of oxidative stress, inflammation, and improvement in endothelial function. 
Other speculated mechanisms include a prebiotic effect and reducing hypertension.
4. Nuts & Endothelial Function
Another common incorrect claim from the WFPB vegan diet proponents is the mistaken belief that nuts somehow worsen endothelial function both in healthy and/or patients with existing coronary heart disease.
When actually Walnuts specifically have been shown to improve endothelial function in studies.
Much of this incorrect belief is based on a few sporadic acute post-prandial high fat meal studies that have nothing to do with nuts in most cases.
A systematic review and meta-analysis of randomized controlled trials published 2018 assessed the effect of nuts on vascular endothelial function.
The systematic review and meta-analysis concluded:
Nut consumption significantly improved endothelial function. However, the beneficial effect was limited to walnuts. 
Another systematic review and meta-analysis published in 2018 on the effect of walnuts on vascular endothelial function concluded:
The available evidence from RCTs suggests there may be a clinically relevant effect of walnut consumption on EF. 
As we can see from the current literature nuts have a neutral to beneficial effect on vascular endothelial function, part of where they are thought to potentially derive some of their CVD related benefits.
4. Replace Nuts With More Grains…(Isocaloric Saturated Fat Replacement)
Having debated with numerous WFPB ultra low-fat vegan diet proponents the discussion always comes down to isocaloric replacements, dietary substitutions and essentially what food is superior for reducing cardiovascular disease risk.
There is an engrained belief in the WFPB movement that carbohydrates and whole grains are superior to the likes of MUFA and PUFA’s from vegetable fat sources, which of course doesn’t appear true according to the literature.
In most cases from what I’ve seen PUFA and MUFA out perform whole grains for CHD risk reduction.
As such the WFPB proponents generally recommend to replace what calories would be used on nuts and replacing with typically more whole grains and in some cases just carbohydrates in general, which is out dated advice for heart health as far as I can see from the literature.
In cohort studies modeling specific replacement nutrients, there is consistent evidence that polyunsaturated fatty acids are the most beneficial replacement nutrient for CVD risk reduction as compared to either saturated fat or total carbohydrate. 
This blind notion in the WFPB vegan community that increasing carbohydrate intake and reducing the total fat content of the diet <10% of total calories being superior for supporting cardiovascular health is largely rooted in out dated low fat diet pseudo-science.
We know the quality and types of fats in the diet are now considered to be far more important, than simply reducing the total fat content to potentially unhealthy levels.
When you reduce the total fat content of your diet to <5-10% of total calories and purposely start restricting intake of the very plant-foods that contain generous quantities of omega-3 fatty acids(ALA) such as walnuts, various plant-oils etc, then it can become a huge challenge to obtain adequate essential fatty acid intake.
This unhealthy belief that removing healthy plant-foods such as nuts which have consistently been shown that higher intake is associated with numerous cardiovascular benefits and isocalorically replacing these foods with more whole-grains or carbohydrates might actually be detrimental to heart health as shown below.
In the pooling project, isocalorically replacing saturated fat intake with either total carbohydrate or total MUFA did not result in reduced risk of coronary events; in fact, consuming total carbohydrate in place of saturated fat was associated with significantly higher risk (hazard ratio: 1.07; 95% CI: 1.01, 1.14) 
This belief once again is purely based on the notion that because Caldwell Esselstyn’s studies didn’t contain nuts, it means they are somehow potentially harmful for cardiovascular health or that them simply not being part of the diet used in his study proves in some way superior benefits can be had without their inclusion in the diet.
There is absolutely no reason why nuts can’t and shouldn’t play an important role in any heart-healthy predominantly plant-based diet pattern. Except for those with a known nut allergy of course.
In fact I am of the opinion all the three foods in this article from nuts, olive oil and omega-3 rich oily fish rightly deserve their place in any optimized diet pattern for cardiovascular health.
I believe the WFPB vegan community are actually promoting counter productive advice for these individuals with heart disease by claiming these foods are either unhealthy or should be avoided for existing CVD patients, when in fact they have been shown to actually support heart-health, reduce CVD risk and mortality with higher regular consumption.
The information in this article has not been evaluated by the FDA and should not be used to diagnose, cure or treat any disease, implied or otherwise.
Always consult with a qualified healthcare professional before making any significant dietary or lifestyle changes including supplements and herbs.