The results of the “Fourth Nut” poll are in and the winner is a nut first cultivated in Bronze Age Central Asia,
Almost 60% of readers who took the time to vote selected the pistachio nut.
Coming in a distant second was the macadamia nut. One reader prized it because it only contained saturated fat and monounsaturated fats. Another bemoaned their candy-like quality which makes over-consumption an issue.
A couple of readers were strong proponents of Brazil nuts. This prompted me to enter a selenium rabbit hole from which I have yet to emerge. If I can escape with my selenoproteins intact I’ll let you know.
Pistachios are a fine choice from a health standpoint and seem to be embraced by all nutritional cults, with the exception of the very nutty Caldwell “NO OIL” Esselstyn’s acolytes.
The Pistachio Principle PR Institute
I’m in the process of sorting through the nutritional studies on pistachios, and the hardest part is determining which data are sponsored by the pistachio industry.
For example, poorly researched online articles about pistachios will typically state that “research suggests” that “pistachios could help to reduce hypertension and promote development of beneficial gut microbes. They’re even gaining credibility as a tool for weight loss”
The first reference is an open access review article which clearly just wants to extoll any and all positive pistachio data and was paid for by the American Pistachio Growers. The second article comes directly from “The Pistachio Health Institute,” a PR voice for the pistachio industry.
To Shell or Not to Shell
My major dilemma was deciding if the pistachios should be shelled or left in-shell. (This has led me down the pistachio production rabbit hole).
I was concerned that the outsides of the pistachio shells could be contaminated in some way and the idea of mixing them in with unshelled nuts seemed a little strange.
If you Google images of mixed nuts pistachio you only see mixtures with unshelled pistachios.
Why, then, are most pistachios sold and consumed in-shell?
Between 70 and 90 percent of pistachios develop a natural split in their shells during the growing process, After those pistachios are shaken off the trees by harvesting machines, they can be salted and roasted while still inside the shells as that natural crack allows heat and salt access to the nut, eliminating a step in the industrial process and saving processors some money.
The pistachio PR machine would also have us believe that eating pistachios in-shell can lead to weight loss:
Why choose any other nut?
This pistachios principle is based on 2 studies in the journal Appetite (seems to be a legitimate journal) by JE Painter of the department of “Family and Consumer Sciences” Eastern Illinois University in Charleston, Illinois.
I’m awaiting a full copy of the paper, but the abstract notes that students offered in-shell pistachios consumed only 125 calories, whereas those offered shelled pistachios consumed 211 calories yet “fullness and satisfaction” were similar.
My skeptical sensors were exploding when I read about this study. I doubt that it will ever be reproduced.
If we look at cost, an unofficial analysis revealed:
The pre-shelled pistachios were priced at $5.99 for 6.3 oz of nuts.
The 8 oz bag of pistachios were priced at $4.49. After shelling he was left with 4.3 oz of nuts.
Un-shelled pistachios = $1.04 per oz.
Shelled pistachios = $0.95 per oz.
If you go the lazy route, you save $.09 per oz!
Most likely, the fourth nut will be a shelled pistachio unless readers convince me otherwise or the blather from the pistachio PR machine annoys me too much.
The eternal fiance’e has just weighed in and tells me that women who care about their well-groomed nails will not consume in-shell pistachio nuts for fear of damaging their manicures.
That, my friends, is the nail in the coffin for shelled pistachios as the fourth nut.
The skeptical cardiologist has given out the entire first batch of Dr. P’s Heart Nuts to his patients.
This precisely constructed mixture of hazelnuts, almonds and walnuts designed to maximize heart healthiness has been warmly received and hopefully enthusiastically consumed.
To some extent I feel like I may be preaching to the choir as many of the Heart Nuts recipients told me they were already avid nut fans and consumers.
However, I plan to press on with my mission to increase the amount of nut snacking in the world.
To this end, I have reorganized my blog and created a page devoted to Nuts and Drupes. You can find it here and I’ll reproduce it below.
Furthermore, I have decided to add a fourth nut to the mixture. At this time, I am intensely researching pistachio nuts and macadamia nuts to be the honored nut.
Please feel free to suggest other candidates to be the Fourth Nut (along with appropriate justification) in the comments below and vote in the poll.
From The Nuts Page
Nuts, despite containing a lot of fat, are a fantastic heart-healthy snack.
I’ve started handing out my special Dr. P’s Heart Nuts to patients along with the following:
You have received a packet of cardiovascular disease-busting Dr. P’s Heart Nuts!
One packet 15 grams of almonds, 15 grams of hazelnuts and 30 grams of walnuts.
There is very good scientific evidence that consuming 1/2 packet of these per day will reduce your risk of dying from heart attacks, strokes, and cancer.
The exact components are based on the landmark randomized trial of the Mediterranean diet, enhanced by either extra-virgin olive oil or nuts (PREDIMED, in which participants in the two Mediterranean-diet groups received either extra-virgin olive oil (approximately 1 liter per week) or 30g of mixed nuts per day
In other observational studies it has been found that for every 28 grams/ day increase in nut intake, risk was reduced by:
29% for coronary heart disease 7% for stroke
21% for cardiovascular disease 15% for cancer
22% for all-cause mortality
Surprisingly, death from diseases, other than heart disease or cancer, were also significantly reduced:
52% for respiratory disease
35% for neurodenerative disease
75% for infectious disease
74% for kidney disease
So when you are considering snacking, snack on nuts not processed food! Dr. Pearson
Posts About Nuts
Posts relevant to nuts and prevention of heart disease on my blog are
After finding out the first two facts about almonds I ended up getting raw, organic almonds from Spain. Unfortunately, about 1 in 10 of these were extremely bitter. It turns out these bitter almonds have significant amounts of cyanide. So I wrote “Beware The Bitter Almond.”
I switched my raw, organic almond source to Nuts.com and with their almonds I very rarely encounter the bitter almond.
The other nuts in the mixture are raw and organic and obtained from Nuts.com.
The skeptical cardiologist has finally prepared Dr. P’s Heart Nuts for distribution. The major stumbling block in preparing them was finding almonds which were raw (see here), but not gassed with proplyene oxide (see here), and which did not contain potentially toxic levels of cyanide (see here).
During this search I learned a lot about almonds and cyanide toxicity, and ended up using raw organic almonds from nuts.com, which come from Spain.
I’ll be giving out these packets (containing 15 grams of almonds, 15 grams of hazelnuts and 30 grams of walnuts) to my patients because there is really good scientific evidence that consuming 1/2 packet of these per day will reduce their risk of dying from heart attacks, strokes, and cancer.
The exact components are based on the landmark randomized trial of the Mediterranean diet, enhanced by either extra-virgin olive oil or nuts (PREDIMED, in which participants in the two Mediterranean-diet groups received either extra-virgin olive oil (approximately 1 liter per week) or 30g of mixed nuts per day (15g of walnuts, 7.5g of hazelnuts, and 7.5g of almonds) at no cost, and those in the control group received small nonfood gifts).
After 5 years, those on the Mediterranean diet had about a 30% lower rate of heart attack, stroke or cardiovascular death than the control group.
It’s fantastic to have a randomized trial (the strongest form of scientific evidence) supporting nuts, as it buttresses consistent (weaker, but easier to obtain), observational data.
I applied for a trademark for my Heart Nuts, not because I plan to market them, but because I thought it would be interesting to possess a trademark of some kind.
The response from a lawyer at the federal trademark and patent office is hilariously full of mind-numbing and needlessly complicated legalese.
Heres one example:
Applicant must disclaim the wording “NUTS” because it merely describes an ingredient of applicant’s goods, and thus is an unregistrable component of the mark. See 15 U.S.C. §§1052(e)(1), 1056(a); DuoProSS Meditech Corp. v. Inviro Med. Devices, Ltd., 695 F.3d 1247, 1251, 103 USPQ2d 1753, 1755 (Fed. Cir. 2012) (quoting In re Oppedahl & Larson LLP, 373 F.3d 1171, 1173, 71 USPQ2d 1370, 1371 (Fed. Cir. 2004)); TMEP §§1213, 1213.03(a).
The attached evidence from The American Heritage Dictionary of the English Language shows this wording means “[a]n indehiscent fruit having a single seed enclosed in a hard shell, such as an acorn or hazelnut”, or “[a]ny of various other usually edible seeds enclosed in a hard covering such as a seed coat or the stone of a drupe, as in a pine nut, peanut, almond, or walnut.” Therefore, the wording merely describes applicant’s goods, in that they consist exclusively of nuts identified as hazelnuts, almonds, and walnuts.
An applicant may not claim exclusive rights to terms that others may need to use to describe their goods and/or services in the marketplace. See Dena Corp. v. Belvedere Int’l, Inc., 950 F.2d 1555, 1560, 21 USPQ2d 1047, 1051 (Fed. Cir. 1991); In re Aug. Storck KG, 218 USPQ 823, 825 (TTAB 1983). A disclaimer of unregistrable matter does not affect the appearance of the mark; that is, a disclaimer does not physically remove the disclaimed matter from the mark. See Schwarzkopf v. John H. Breck, Inc., 340 F.2d 978, 978, 144 USPQ 433, 433 (C.C.P.A. 1965); TMEP §1213.
If applicant does not provide the required disclaimer, the USPTO may refuse to register the entire mark. SeeIn re Stereotaxis Inc., 429 F.3d 1039, 1040-41, 77 USPQ2d 1087, 1088-89 (Fed. Cir. 2005); TMEP §1213.01(b).
Applicant should submit a disclaimer in the following standardized format:
No claim is made to the exclusive right to use “NUTS” apart from the mark as shown."
I’ve gotten dozens of emails from trademark attorneys offering to help me respond to the denial of my trademark request. Is this a conspiracy amongst lawyers to gin up business?
Nuts Reduce Mortality From Lots of Different Diseases
The most recent examination of observational data performed a meta-analysis of 20 prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016.
It found that for every 28 grams/day increase in nut intake, risk was reduced by:
29% for coronary heart disease
7% for stroke (not significant)
21% for cardiovascular disease
15% for cancer
22% for all-cause mortality
Surprisingly, death from diseases, other than heart disease or cancer, were also significantly reduced:
52% for respiratory disease
35% for neurodenerative disease
75% for infectious disease
74% for kidney disease
The authors concluded:
If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013.
If everybody consumed Dr. P’s Heart Nuts, we could save 4.4 million lives!
If you’re curious about why nuts are so healthy, check out this recent meta-analysis, a discussion of possible mechanisms of the health benefits of nuts complete with references:
Nuts are good sources of unsaturated fatty acids, protein, fiber, vitamin E, potassium, magnesium, and phytochemicals. Intervention studies have shown that nut consumption reduces total cholesterol, low-density lipoprotein cholesterol, and the ratio of low- to high-density lipoprotein cholesterol, and ratio of total to high-density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels in a dose–response manner [4, 65]. In addition, studies have shown reduced endothelial dysfunction , lipid peroxidation , and insulin resistance [6, 66] with a higher intake of nuts. Oxidative damage and insulin resistance are important pathogenic drivers of cancer [67, 68] and a number of specific causes of death . Nuts and seeds and particularly walnuts, pecans, and sunflower seeds have a high antioxidant content , and could prevent cancer by reducing oxidative DNA damage , cell proliferation [71, 72], inflammation [73, 74], and circulating insulin-like growth factor 1 concentrations  and by inducing apoptosis , suppressing angiogenesis , and altering the gut microbiota . Although nuts are high in total fat, they have been associated with lower weight gain [78, 79, 80] and lower risk of overweight and obesity  in observational studies and some randomized controlled trials .
It’s World Nutella day according to Ferrero, the Italian confectonery company and manufacturer of the globally beloved hazelnut-based spread.
“With Nutella we spread positive energy to families to bring more happiness to the world” we are informed. On this day, apparently, the world should be spreading Nutella on as many food products as possible, ramping up positive energy levels to unprecedented levels.
Here are some of the other products Ferrero sells:
Three of them are clearly recognized by consumers as candy.
Should Nutella be in the same category as tic-tacs?
Perhaps in anticipation of World Nutella Day, a graphic has been appearing on Twitter:
detailing the ingredients of Nutella. The English version of this was posted on Reddit on a subreddit that I can’t mention on my family-friendly blog. It is a translation of a graphic that was published in German originally.
I’m not sure where the original data for the graphic came from but it seems to be a reasonable illustration of how much of Nutella is made up of palm oil and sugar. A 2 tbsp serving of Nutella (37 grams) contains 12 grams of fat, 21 grams of sugar and 2 grams of protein. Only about 12% of Nutella comes from actual hazelnuts.
I don’t have any concerns from a cardiovascular risk standpoint with the fat content of either the palm oil or the hazelnuts in Nutella.
But the 5 teaspoons of sugar per serving
are just still another source of empty
sugar calories adding to the daily dietary glut of sugar consumers face when consuming highly processed foods.
Nutella definitely is a highly processed, highly sugared product that shouldn’t be a regular part of a healthy Mediterranean diet. Most of the ingredients have gone through complex sourcing and factory processing although their marketing material strains to emphasize the freshness and naturalness of these ingredients.
One ingredient not depicted on the now viral graphic of Nutella is vanillin. From Nutella’s ingredient graphic one might think the vanillin is being extracted from (per wikipedia)
In reality, however, the Nutella people, ” use synthetic vanillin, an aroma identical to the one naturally present in the vanilla pod.”
Is the Palm OIl In Nutella Carcinogenic?
Some question the healthiness of the palm oil in nutella, either due to its high saturated fat content or its carcinogenic potential. A european food safety authority paper in May, 2016 declared certain toxins found in palm oil in particular to be “genotoxic and carcinogenic”
EFSA assessed the risks for public health of the substances: glycidyl fatty acid esters (GE), 3-monochloropropanediol (3-MCPD), and 2-monochloropropanediol (2-MCPD) and their fatty acid esters. The substances form during food processing, in particular, when refining vegetable oils at high temperatures (approx. 200°C)
The highest levels of GE, as well as 3-MCPD and 2-MCPD (including esters) were found in palm oils and palm fats, followed by other oils and fats. For consumers aged three and above, margarines and ‘pastries and cakes’ were the main sources of exposure to all substances.
As a result, According to Reuters, In Italy, some products containing palm oil have been removed from grocer’s shelves and one pastry company has eliminated palm oil from it products, labeling them as “palm oil free.”
High temperatures are used to remove palm oil’s natural red color and neutralize its smell, but Ferrero says it uses an industrial process that combines a temperature of just below 200C and extremely low pressure to minimize contaminants.
Nutella has fought back, defending its use of palm oil, with television and print advertisements.
Healthier Alternatives To Nutella
Conner Middleman, nutritionist , cooking instructor and author of Zest For Life, has shared with me her recipe for Nutritella, a healthier version of Nutella you can make at home. She points out in her intro to the recipe:
Nutella was invented in the 1940s in the Piedmont region of northern Italy, where hazelnuts grow plentifully. Alas, modern, store-bought Nutella contains a mere 13% hazelnut and only a hint of cocoa; the rest is made up of sugar, palm oil and artificial vanilla flavoring. My home-made version of Nutella, on the other hand, contains very little sweetener (in the form of raw honey), 3 tablespoons of flavonoid-rich dark cocoa, and about 90% hazelnuts, which boast a particularly high concentration of antioxidants and healthy fats (mostly monounsaturated). This is not to say that you should eat this spread by the tablespoonful; its high fat content means it’s high in calories and it should be enjoyed in sensible amounts (1-2 tbsp/day). The good news is that a high-fat food such as this one keeps you sated for longer, and because it is made from whole, real foods, it’s not only rich in calories, but also in nutrients!
Here’s the recipe:
1 cup/125g toasted hazelnuts (Trader Joe’s roasted Oregon hazelnuts work great here; alternatively buy plain, raw hazelnuts and roast them yourself as described below)
½ oz/2 tbsp/15g unsweetened cocoa
3 tbsp hazelnut oil (La Tourangelle is my favorite brand – available in the oils section of good supermarkets or online)
If you are roasting the hazelnuts from scratch, preheat oven to 350F. Place nuts on a dry, clean baking sheet and roast for 8 minutes (set timer). Remove and tip hot nuts onto a clean kitchen towel (pictured here).
As they cool, the skins will loosen, crack and flake off. Gather up the towel by its corners and scoop together into a tight bundle. Hold the bundle with one hand and knead the nuts with the other through the cloth to rub the skins off them. Place bundle back on a flat surface and open; lift out the nuts and lightly shake off the skins. (Leave some skin on the nuts – it’s where most of the antioxidants reside.)
If using pre-roasted nuts, start here.
Place the hazelnuts in an electric blender with the cocoa, oil, honey/maple syrup and vanilla extract. Process on “high” for about 30-40 seconds until all the ingredients come together in a coarse paste.
With the motor running, add milk or water (whichever using), a tablespoon at a time, and keep processing until the mixture reaches the desired consistency.
Transfer to a clean glass jar and refrigerate. Keeps for at least 2 weeks.
You can check out Conner’s excellent website, Modern Mediterranean, replete with more recipes and information on the cancer-fighting benefits of the Mediterranean diet, here. and her You-tube channel here.
Of course, the skeptical cardiologist Heart Nuts project advocates just eating unadulterated hazelnuts along with other healthy drupes, nuts and legumes for snacking and soon we will be distributing these to you using our trademark-pending walnut-auscultating squirrel, Sparky.
The skeptical cardiologist nut project (aka the nutty cardiologist project) now has a logo. Say hello to the world’s only walnut-auscultating promoter of nut consumption. Soon you will see his smiling face on the packets of nuts I’ll be handing out to help defeat cardiovascular disease.
Special thanks to my wonderful Washington University computer-science major and bass guitar wiz daughter, Gwyneth, for creating the squirrel doctor during her winter break.
I promised 10 bags of nuts and “oodles of glory” to the reader whose name I selected but I can’t identify who proposed Heart Nuts. Let me know who you are and I’ll get the nuts to you.
Now I need a name for the squirrel.
See here for my post on KIND bars versus Simply Nuts and here for my review of nuts, drupes and legumes and reduced mortality.
N.B. Nuts are recognized as promoting reduced cholesterol, oxidative stress, and insulin resistance thereby reducing the risk of cardiovascular disease.
I’ve focused on their cardiovascular benefits (perhaps mediated by dietary fiber, magnesium, polyunsaturated fats, vitamin E, and antioxidants) but recent studies suggest other health benefits that could contribute to improved longevity.
Nuts contain bioactive compounds both known (ellagic acid, anacardic acid, genistein, resveratrol, and inositol phosphates) and unknown which may reduce the risk of cancer or other chronic diseases.
A recent meta-analysis found that consuming one serving of nuts per day was associated with a 15% lower risk of any cancer and a 22% lower risk of dying from any cause.
The skeptical cardiologist likes to see his afib patients stay in the normal rhythm (normal sinus rhythm) after they are cardioverted. On Halloween here in the office at Cardiac Specialists of St. Lukes three of our assistants helped drive home the message with a creative ensemble costume:
Speaking of Halloween, rather than handing out candy next Halloween, I’ll be handing out sacks of stroke-bustin’ nuts.
I’m sure the neighborhood kids will love the alternative to all that high fructose corn syrup!
In my previous post highlighting the marketing hype, silliness, and duplicity surrounding Kind bars, I revealed that the skeptical cardiologist would soon begin issuing bags of special stroke-busting nuts to his patients.
I solicited a catchy name for the sacks.
One reader suggested:
“The Snack” or “Snack?” No one will forget that name.. In the center of a small heart shape on the front of the package will be shown the type of nuts (either written or better as a picture.. )
How about “Pearson’s Health Nuts?” It could refer to both the nuts and the eaters.
“Nuts About Nuts!”
The logo is a kindly cardiologist, in a lab coat, peering over the top of his glasses, with a stethoscope draped around his shoulders.
Call it Pearson’s delight!!! I always keep a bag of nuts mixed with raisins, m&ms, almonds and cashews. Have done this for last 3 years. But some times I over eat them. But better than junk food..hope this is ok
(Raisins and M & Ms are right out! Too much sugar)
I’ve created a poll that I would appreciate your voting on. I can guarantee this will be less controversial than the Presidential election.
Raw Almonds: Straight From Fumigation
While exploring where to obtain the best walnuts, almonds, and hazelnuts for these “yet to be named” snacks, I discovered that the vast majority of almonds consumed in the US have been pasteurized by fumigation with an organic chemical called propylene oxide (PPO).
Because of two salmonella outbreaks involving almonds from California, the FDA mandated in 2007 that all California almonds had to be pasteurized either by a steam process or by PPO. Since the PPO process is cheaper, the vast majority of non-organic almonds have been sprayed with PPO. Both PPO sprayed and steamed almonds are marketed as “raw.”
Although I’m not fanatical about choosing organic (with the exception of dairy) I really don’t like the idea of eating things that have been sprayed with PPO. PPO is primarily used to make polyurethane plastics. The CDC says:
“propylene oxide is a direct-acting carcinogen”
Several online sources state that PPO has been banned in “Canada, Mexico, and the European Union” including this Almond fact sheet from cornucopia.org
but it’s more accurate to say that these countries have not approved PPO fumigation.
Consequently, I’m getting my almonds from nutsinbulk.com. They are selling almonds from Spain, grown organically, and they promise there will be no PPO consumed.
Once my nuts arrive and I get them in appropriate sacks with appropriate labels, I’ll start handing them out to my patients.
If anyone has advice on creating such labels and sacks feel free to comment below.
P.S. Here’s what the CDC says about PPO
Studies in animals have demonstrated that propylene oxide is a direct-acting carcinogen. B6C3F1 mice exposed by inhalation to propylene oxide developed hemangiomas and hemangiosarcomas of the nasal mucosa. F344/N rats exposed to propylene oxide in air developed papillary adenomas of the nasal epithelium. Degeneration of the olfactory epithelium and hyperplasia of the respiratory epithelium were induced in the nasal cavities of Wistar rats exposed to propylene oxide by inhalation. Squamous cell carcinomas of the forestomach developed in rats administered propylene oxide by gavage. Although epidemiologic data are not available from workers exposed to propylene oxide, the findings of cancer and other tumors in both rats and mice treated with propylene oxide meet the criteria established in the Occupational Safety and Health Administration Cancer Policy [Title 29 of the Code of Federal Regulations, Section 1990.112] for regarding propylene oxide as a potential occupational carcinogen. The National Institute for Occupational Safety and Health therefore recommends that occupational exposures to propylene oxide be reduced to the lowest feasible concentration.
The eternal fiancee’ of the skeptical cardiologist (EFOSC) deserves serious kudos for (among myriad other things) challenging his conventional ideas about heart-healthy food and serving as his dietary muse.
However, the EFOSC seems to have a weakness for what I would consider a highly processed, sugared up, over-priced piece of marketing hype—Kind Bars.
I asked the EFOSC recently why she was so enamored of Kind Bars and she told me “I like that they are convenient, you can find them anywhere, they are not expensive and they taste good and they are low in sugar and they are 100 times better than all the other snack bars on the market that are expensive and have tons of sugar and chemicals and disgusting things in them:
She also points out that for frequent business travelers, the bars are more convenient (and often cheaper) than buying a bag of nuts in an airport kiosk.
She is not alone.
The Booming “Healthy and Natural” Snack Bar Business
The “healthy” snack bar business has been booming lately.
“Bar makers are opening the floodgates on nuts, dried meats, cricket flour and other nutrient and protein-rich ingredients to compete for consumers and command top dollar. Many of these ingredients cost more than those found in a traditional cookie—and as sources of protein, ounce for ounce, some of them cost more than a steak.There are 1,012 nutrition bars on the market now, compared with just 226 a decade ago, according to a tally by Valient Market Research in Philadelphia.”
Consumers, attracted by convenience and a desire for “healthy and natural” food are paying more for snacks like Kind bars which have high profit margins.
“The average bar costs about two dollars, up from just one dollar 10 years ago, a sign of how much more consumers are willing to pay, or “diminishing price sensitivity,” as Valient founder Scott Upham calls it. “The cost of ingredients makes up only 25% of the price, and profit margins for bars tend to hover as high as 40% to 50%, compared with only 20% to 30% for most other packaged foods, says Mr. Upham.”
Stores love them because “they are individually wrapped and have a long shelf life, yet they are popular and turn over fast.”
Are Kind Bars And Their Ilk Healthy?
Interestingly, about a year ago, the FDA issued a “warning letter” to Kind asking the company to remove the term “healthy” from its product labels.
Violation 1a. of that letter fingers Kind Fruit & Nut Almond & Apricot for having 3.5 grams of saturated fat per 40 grams of food (the so-called Reference Amount customarily consumed or RACC) which is more than the 1 gram of saturated fat per RACC allowed if is one is going to describe one’s food as healthy.
This is clearly a ridiculous and out-dated requirement: saturated fats are a diverse category of nutrients, some of which are likely very healthy (see my posts on dairy fat or coconut oil). According to these criteria, foods that are clearly very healthy such as avocados, salmon and nuts, cannot be labeled as healthy.
Kind fought back and challenged the FDA and the FDA backed down.
“The FDA said in a statement to The Wall Street Journal that in light of evolving nutrition research and other forthcoming food-labeling rules, “we believe now is an opportune time to re-evaluate regulations concerning nutrient content claims, generally, including the term ‘healthy.’”
However, I don’t think Kind bars are necessarily a healthy good food choice. I think people buy them because they have been slickly marketed as “healthy” and “natural.”
As Marion Nestle points out, when it comes to food labels, “healthy” and “natural” are marketing terms. Their purpose is to sell food products.
The ingredients in the almond and apricot Kind bar are: Almonds, coconut, honey, non GMO glucose, apricots, apple juice, crisp rice, vegetable glycerine, chicory root fiber, soy lecithin, citrus pectin, natural apricot flavor.
Nutrition: 180 calories, 10 g fat (3.5 g saturated fat), 25 mg sodium, 23 g carbs, 3 g fiber, 13 g sugar, 3 g protein
Basically, the healthy part of this Kind Bar is almonds and coconut, which you could purchase for a hell of a lot less than what you are paying for this processed junk.
Also, please note that it doesn’t contain any actual apricots, merely “apricot flavor.”
Also, note that the third ingredient is honey and the fourth is non GMO glucose. What on earth is non GMO glucose? Do we really care whether the added sugar you are pumping into your crappy bars is GMO or non GMO?
Some Kind bars are clearly no healthier than a typical Payday candy bar:
“the packaging of the dark chocolate cherry cashew bar advertises the word “Antioxidants.” In other words, the bar isn’t promoted as being low in sugar, so it’s a fair choice to compare with a PayDay. The Kind bar has 9 grams of fat—1 gram less than PayDay’s bar. The sugar count, at 14 grams, is 2 grams less than PayDay. So far, so good. But this particular Kind product has a total carbohydrate count 1 gram higher than PayDay, and 1 fewer grams of protein. The bar has 2.5 grams of dietary fiber, a fraction more than PayDay.”
The Kind PR machine responds thusly:
“It is not at all a fair comparison to equate KIND’s Dark Chocolate Cherry Cashew bar to a Pay Day,” a company spokesman said. “This completely ignores the nutrient-rich ingredients that are in a KIND bar, not to mention the exponentially lower level of sodium.”
You can buy 24 Payday bars at Sam’s Club for $14, about 61 cents a bar.
To be fair to the EFOSC, she usually only eats Kind bars that have about 5 grams of sugar.
Preventing Stroke and Heart Attack with 30g of “Mixed Nuts” Daily
The PREDIMED trial, in particular, showed a remarkable benefit in reducing heart attacks and strokes when patients ate a Mediterranean diet supplemented with 30g mixed nuts per day (15g walnuts, 7.5g almonds and 7.5g hazelnuts). Walnuts and almonds are actually drupes, but hazelnuts are true nuts.
The Mediterranean diet, including nuts, reduced the risk of cardiovascular diseases (myocardial infarction, stroke or cardiovascular death) by 30% and specifically reduced the risk of stroke by 49% when compared to a reference diet consisting of advice on a low-fat diet (American Heart Association guidelines). The Mediterranean diet enriched with extra-virgin olive oil also reduced the risk of cardiovascular diseases by 30%.
You can buy 454 grams of walnuts or hazelnuts for $14 , and 454 grams of almonds for $10. Thus, for 46 cents for the walnuts, 23 cents for the hazelnuts and 16 cents for the almonds (total 85 cents) you can recreate the snack that the Spaniards ate in PREDIMED.
This compares to Kind bars which retail anywhere from $1.99 to $3.50.
“WALNUTS. Walnuts differ from other nuts in that they are very rich in omega 6 and omega 3 type unsaturated fats. Moreover, the antioxidants they contain are among the most powerful in the plant world. It should be mentioned that, like omega 3 in fish, nut fats possess important beneficial properties for general health and the heart in particular.
ALMONDS. Almonds form part of many traditional desserts and sweets of Arabic origin, such as nougat. Currently, Spain is the second largest producer and consumer of almonds in the world, after the United States. As with hazelnuts and olive oil, almonds are rich in oleic acid. They differ from other nuts in that they contain more fibre, vitamin E, calcium and magnesium.
HAZELNUTS. Hazelnuts, another widely consumed nut in Spain, are very rich in oleic acid. Furthermore, they are nuts that provide a large amount of folic acid, a vitamin very important for regulating the metabolism, a lack of which can lead to thrombosis and an acceleration of degenerative processes such as arteriosclerosis and senile dementia.”
Unfortunately, I can eat neither hazelnuts nor walnuts (tree nut allergy), but I’ve decided to create for my patients little baggies filled with 30 grams of the magical PREDIMED nut mixture. I’ll give these out during office visits as I explain the glories of the Mediterranean diet (I’ll try to forbear elaborating to them the difference between drupes and nuts).
I need a catchy name for these bags-“Pearson’s PREDIMED bags” or “Stroke-busting nuts?”
If any reader or patient has a suggestion, please add it to the comments.
If I choose your suggestion, I’ll provide you with 10 bags of nuts and oodles of glory!
Hopefully, once I start creating the nut bags, the EFOSC will begin to eschew the faux healthiness of Kind bars and embrace the natural and unmarketed goodness of drupes and nuts.
A drupe is a type of fruit in which an outer fleshy part surrounds a shell (what we sometimes call a pit) with a seed inside. Some examples of drupes are peaches, plums, and cherries—but walnuts, almonds, and pecans are also drupes. They’re just drupes in which we eat the seed inside the pit instead of the fruit!
“Every 3 months a supply of 1,350-g walnuts (®California Walnut Commission, Sacramento, Cal), 675-g almonds (®Borges SA, Reus, Spain), and 675 g hazelnuts (®La Morella Nuts, Reus, Spain) is provided to each participant assigned to the MeDiet+Nuts group.”
I hold in my left hand an EpiPen, self-described as a “0.3 mg epinephrine auto-injector.” The EpiPen is a marvel of modern manufacturing. Take it out of its solid, clear, plastic enclosure and you will notice instructions on how to use it in simple text and cartoons.
Basically, pull up the blue plastic piece at the top and you have activated it: now grasp the body and swing it down to your thigh , pushing the orange tip until it clicks, indicating the needle has emerged and injected life-saving epinephrine into the large muscle in your leg.
Epinephrine injections are the treatment of choice for severe allergic reactions. I have kept EpiPens around me since my first episode of anaphylaxis after eating pecans as a child (see my post on nuts, legumes, drupes and mortality here) and can attest to how easy this is to use in treatment of an acute case of anaphylaxis.
About 12 years ago, when I lived in Louisville, Kentucky I was receiving allergy shots for chronic allergic rhinitis and conjunctivitis. One day I worked out after my shot and I suddenly began itching all over. Hives appeared on my chest and my face began swelling. I found it hard to breathe.
I was experiencing anaphylaxis, a severe, rapid and sometimes fatal allergic reaction that can occur after insect bites or stings, certain food consumption (I’ve had it to pecans, cashews, and walnuts), and medications.
Fortunately, I had in my possession two EpiPens and even more fortunate they were non-expired EpiPens. I quickly dressed, grabbed the EpiPens and had my then wife drive me to the closest ER.
After a few minutes I realized I was getting worse and opened up the first Epipen and jammed the needle into my thigh. I continued to get worse-my breathing became severely labored-and I grabbed the second EpiPen and repeated the thigh stabbing. Alas, the situation did not immediately improve and I made a command decision to stop at a fire station we were passing. There I was bundled into an ambulance, given IV steroids and oxygen and ultimately ended up in an ER.
Epinephrine directly stimulates alpha and beta-receptors of the sympathetic nervous system and after the injections I felt like I had consumed 10 cups of coffee. My heart was racing, my blood pressure sky high and I was shaking uncontrollably. This is not a drug you want to take unless you desperately need it. In my case and thousands of others with anaphylaxis it is life-saving.
Consequently, I carry one with me at all times and as knowledge of food anaphylaxis and its treatment has spread in the last decade, Epipen sales and profits have exploded.
EpiPen Success: Marketing and Lobbying
Last September, Bloomberg published a story on the brilliant marketing of Mylan that turned EpiPen into a billion-dollar product. The Bloomberg article noted that the CEO of Mylan, Heather Bresch (who is the daughter of Democratic Senator Joe Manchin of West Virginia) “turned to Washington for help”:
In 2010 new federal guidelines said patients who had severe allergic reactions should be prescribed two epinephrine doses, and soon after Mylan stopped selling single pens in favor of twin-packs. At the time, 35 percent of prescriptions were for single EpiPens. The U.S. Food and Drug Administration had changed label rules to allow the devices to be marketed to anyone at risk, rather than only those who’d already had an anaphylaxis reaction. “Those were both big events that we’ve started to capitalize on,” Bresch said in October 2011.
In 2013, the year following the widely publicized death of a 7-year-old girl at a school in Virginia after an allergic reaction to peanuts, Congress passed legislation encouraging states to have epinephrine devices on hand in schools. Now 47 states require or encourage schools to stock the devices.
Recent Furor Over High EpiPen Prices
In the last few days, the rising cost of EpiPens has become front page news. Although the active ingredient, epinephrine, is generic and cheap, and the basic delivery system has been around for decades, Mylan, the company that purchased the rights to EpiPen in 2007 has increased its price from 57$ per injector to 600$ for 2 injectors.
Lack of generic competition to the EpiPen is the primary reason that the price could be raised so much and also explains in many circumstances why drug costs are high in the US.
The US has long spent more on prescription medication than other countries. In 2013 per capita US spending on rx drugs was $858 compared to $400 for 19 industrialized anations.
Examples of markedly higher prices in the US are the statin drug crestor (216$/month for 10 mg in US versus $46 in France) and the asthma inhaler Advair ($216 US versus $20 in France.)
A recent article in JAMA analyzed the sources of the high prices in the US and concluded it is due to the fact that “unlike nearly every other advanced nation, the US health care system allows manufacturers to set their own price for a given product. In contrast, in countries with national health insurance systems, a delegated body negotiates drug prices or rejects coverage of products if the price demanded by the manufacture is excessive in light of the benefit provided.”
The ability of drug companies in the US to maintain high prices, the article points out, is due to 2 market forces: protection from competition and negotiating power.
Interestingly, last year , Mylan moved its corporate address overseas to lower its U.S. taxes in a transaction known as an inversion and is now incorporated in the Netherlands,
Bresch, the Mylan CEO is quoted as saying “We do subsidize the rest of the world… and as a country we’ve made a conscious decision to do that,” Bresch said. “And I think the world’s a better place for it.”
Perhaps it would be better if the US, instead of having Congress rush into action and investigations when certain drug costs become worthy of news articles and public shaming, had a system in place like most other industrialized nations, that monitored and regulated drug costs.
Under such a system, life-saving medications like the EpiPen would not arbitrarily quadruple in price.