Pistachios - the healthiest of them all?

There is something hypnotic about sitting with a bowl of pistachios, cracking each one open and poppin' them in your mouth. For all their trouble though, are they worth it? I don’t want to pick favourites, I think all nuts are delicious and have a special place in my heart (pantry??). Pistachios however, may well be on the top shelf for me, and maybe for you as well. 

Pistachios are undoubtedly a top healthy choice for everyone. Pistachios have been studied extensively, and are a healthy functional food for pregnant women and their babies, as well as men and women regardless of individual health status. Basically everyone can benefit from eating pistachios. Let’s see how below.

Pistachios (Pistacia vera) are a member of the Anacardiaceae family and are related to cashews, mangoes and cherries. Cultivation of pistachios dates back further than 6500 BC. Pistachios are native to parts of Central and West Asia, Middle Eastern countries and are distributed throughout the Mediterranean.

Pistachio trees can live up to 300 years and give way to a green and purple coated nut within a clam-shaped shell. When the pistachio fruit ripens, the shell changes from green to a warm yellow colour and splits open. This is called dehiscence and can be heard with a ‘pop’.

So unshelled pistachios that remain closed are in fact unripe, and in all honesty, are not worth the labour involved to eat them!

2 small bowls of shelled pistachio nuts

Pistachio nutritional profile

  • High in unsaturated fats - brain and cell membrane function
  • High in linolenic acid - anti inflammatory
  • High in fibre - helps with cholesterol and digestive function
  • High in magnesium, copper and vitamin B1
  • Very high in vitamin B6 - important for progesterone, neurotransmitters and energy
  • Powerful antioxidants from polyphenols -  lutein, alpha and beta carotene and tocopherol
  • Pistachios contain arginine - precursor to nitric oxide, which relaxes blood vessels

I must say it’s rare to find any intervention, let alone a food, that yields such a robust set of research which covers multiple age groups, populations and areas of health.

The cool thing about assessing foods such as pistachios, is that they are generally regarded as safe with minimal or no side effects. We can also see in real time their beneficial health outcomes.

Pistachios health benefits

  • Aids in weight management
  • Improves diabetes symptoms
  • Supports microbiome diversity
  • Cholesterol & vascular health
  • Improves sexual function

There are many studies showing pistachios to be very protective for cardiovascular and metabolic health. According to the research, diabetes, heart disease, high cholesterol, systemic inflammation and vascular conditions are all health concerns in which pistachios may be beneficial.

A bag of healthy pistachios from The Nut Market

Maternal Health & Gestational Diabetes

In 2019, a study known as the St. Carlos Gestational Diabetes Mellitus Prevention Study was conducted. It included just under 700 pregnant women, half of whom were instructed to eat a Mediterranean diet to assess outcomes on gestational diabetes. These women were also advised to have 30g pistachios per day, which is roughly a handful, along with extra virgin olive oil. These women also walked for around 30 minutes per day. The other half were advised to restrict or avoid dietary fat, including from nuts, seeds and olive oil and stick to a standard diet of their choosing.  Women in the pistachio and olive oil group gained less weight than the control group. There was also a significant reduction in gestational diabetes in the pistachio group. This study also revealed beneficial outcomes to the newborns of these women, including high rates of healthy birth weight, lower incidence of perineal trauma and lower rates of emergency caesareans. These factors may well be resulting from Mediterranean diet more so than pistachios, however it speaks of how important dietary interventions can be for pregnant women and their babies.

Pistachios protect pancreatic cells

49 pre-diabetic participants consumed a pistachio-supplemented diet. DNA oxidative damage to pancreatic cells was reduced and telomere length was retained in the pistachio group. This means pistachios have a protective effect on pancreatic beta cells that produce insulin and may improve their expression, thereby improving diabetic outcomes.

Nutrient profile and weight management

A 2020 study published in the journal Appetite, assessed the impacts of pistachios on women’s body weight, composition, satiety and nutrient intake. This 12 week study saw 60 premenopausal women eating 44 g of pistachios daily or a control diet. The women reported feeling a sense of fullness (satiety) following pistachio consumption. Monounsaturated and polyunsaturated fats were increased in blood samples from the pistachio group. Body composition and weight were unchanged at the end of the study. This means that although pistachios are high in energy, the women eating them did not gain weight or have any changes in body fat distribution. This led the authors to conclude that pistachios are effective in maintaining healthy weight and nutrient profiles and should be included as part of a healthy balanced diet.

Meta-analysis on cholesterol

Taking a birds-eye-view of the data, a recent meta analysis examined 34 clinical trials with 1677 participants in total. The authors compared the health effects of walnuts, pistachios, hazelnuts, almonds and cashews. Specifically, the impact on cholesterol profiles and cardiovascular health was assessed. Pistachio-supplemented diets rated the highest for improving triglycerides and LDL cholesterol, which can be inflammatory in high levels. This is a fairly significant finding, as all nuts are healthy, yet when going head to head, pistachios are a clear winner.

Metabolic syndrome

A 24-week randomized controlled trial included 60 men with metabolic syndrome. In this study, half these men consumed pistachios for just 3 weeks and several cardiometabolic markers were measured. Weight, abdominal adipose tissue, fasting blood glucose, fasting insulin and glycosylated hemoglobin among other parameters all showed vast improvements. The results showed that conditions such as diabetes, fatty liver disease and hypertension could all benefit from pistachio-enriched dietary intervention.

Glucose metabolism

A Spanish study with 54 participants consumed either 57g of pistachios per day as part of a usual diet or a control diet with no pistachios for 4 months. Pistachio-rich diets improve cellular glucose uptake, decrease insulin resistance and lower inflammatory markers such as fibrinogen and oxidized LDL particles. This means pistachios could be useful in treating prediabetes and any related metabolic condition like heart disease.

A display of pistachio nuts

Diabetes Management

Pistachios are naturally high in fat and complex carbohydrates. This makes them a favourable option for diabetics to manage blood glucose levels. A 2008 study involving 108 participants with type 2 diabetes consumed either a full dose of nuts including pistachios, a half-dose or none over 3 months. Nut intake, with the inclusion of pistachios as a replacement for carbohydrates improved glycaemic control and cholesterol profiles in individuals with type 2 diabetes.

Weight loss

A randomized controlled study with 100 generally healthy yet overweight participants were assigned to either a control or pistachio-supplemented diet over 4 months. At the end of the study, the participants who had eaten 42g of pistachios per day lost weight, had lower BMIs and lower blood pressure compared to the control group.


Pistachios, like all nuts, are a natural source of prebiotic foods, which benefit intestinal bacteria. These substrates in nuts help maintain microbial diversity and promote overall digestive and immune health. The effect of pistachio consumption on microbiome composition was analysed in a randomised trial by Ukhanova et al. (2014). The results showed pistachio consumption had a potent effect on increasing beneficial gut microbe numbers.

Sexual function

17 male patients with diagnosed erectile dysfunction (ED) for more than 12 months were included in a study conducted by Aldemir et al. (2011). After consuming 100g of pistachios per day for 3 weeks, the men with ED in this study reported improvements in erectile function along with improved cholesterol levels. The participants also reported no side effects. The authors noted that arginine in pistachios could be responsible for maintaining arterial blood flow throughout the body and therefore help improve ED symptoms.

Storage and cooking

Unshelled pistachios are likely to have a longer shelf-life, unlike their shelled counterparts. Pistachios are so delicious in my view, that the effort required to crack the half-split shell is worth it for the reward. Pistachios are excellent on their own or are also found in many Middle Eastern savoury and sweet dishes.


Pistachio Kulfi

Kulfi is a traditional Indian dessert using different spices and fruits. Not unlike a crème caramel, this pistachio kulfi is rich and velvety and super simple to make. Enjoy.


  • 2L milk
  • 3/4 cup caster sugar
  • 1/2 cup blanched pistachios, finely ground
  • 8 cardamom pods
  • Organic dried rose petals or chopped pistachios to serve
  • 8 kulfi moulds or ramekins


  1. Place milk in a large saucepan over medium high heat and bring to the boil
  2. After 3 minutes, reduce heat to low and simmer for 1 hour, or until milk is reduced by half.
  3. Add sugar, pistachios and cardamom pods and cook for 10 minutes until slightly thickened.
  4. Remove and transfer to a large bowl and allow it to cool to room temperature. Remove cardamom pods.
  5. Fill moulds or ramekins with mixture leaving about 1cm from the top. Cover and freeze for around 4 hours.
  6. To release frozen kulfi from moulds, run a warm palette knife along the inside of each mould.
  7. Turn out kulfi onto a plate and scatter over rose petals or pistachios to serve

Article References

Aldemir, M., Okulu, E., Neşelioğlu, S., Erel, O., & Kayıgil, O. (2011). Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. International journal of impotence research, 23(1), 32–38. https://doi.org/10.1038/ijir.2010.33


Assaf-Balut, C., García de la Torre, N., Durán, A., Fuentes, M., Bordiú, E., Del Valle, L., Familiar, C., Ortolá, A., Jiménez, I., Herraiz, M. A., Izquierdo, N., Perez, N., Torrejon, M. J., Ortega, M. I., Illana, F. J., Runkle, I., de Miguel, M. P., Montañez, C., Barabash, A., Cuesta, M., … Calle-Pascual, A. L. (2017). A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study. PloS one, 12(10), e0185873. https://doi.org/10.1371/journal.pone.0185873


Assaf-Balut, C., García de la Torre, N., Duran, A., Fuentes, M., Bordiú, E., Del Valle, L., Familiar, C., Valerio, J., Jiménez, I., Herraiz, M. A., Izquierdo, N., Torrejon, M. J., Cuadrado, M. Á., Ortega, I., Illana, F. J., Runkle, I., de Miguel, P., Moraga, I., Montañez, C., Barabash, A., … Calle-Pascual, A. L. (2019). A Mediterranean Diet with an Enhanced Consumption of Extra Virgin Olive Oil and Pistachios Improves Pregnancy Outcomes in Women Without Gestational Diabetes Mellitus: A Sub-Analysis of the St. Carlos Gestational Diabetes Mellitus Prevention Study. Annals of nutrition & metabolism, 74(1), 69–79. https://doi.org/10.1159/000495793


Canudas, S., Hernández-Alonso, P., Galié, S., Muralidharan, J., Morell-Azanza, L., Zalba, G., García-Gavilán, J., Martí, A., Salas-Salvadó, J., & Bulló, M. (2019). Pistachio consumption modulates DNA oxidation and genes related to telomere maintenance: a crossover randomized clinical trial. The American journal of clinical nutrition, 109(6), 1738–1745. https://doi.org/10.1093/ajcn/nqz048


Del Gobbo, L. C., Falk, M. C., Feldman, R., Lewis, K., & Mozaffarian, D. (2015). Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. The American journal of clinical nutrition, 102(6), 1347–1356. https://doi.org/10.3945/ajcn.115.110965


Edwards, K., Kwaw, I., Matud, J., & Kurtz, I. (1999). Effect of pistachio nuts on serum lipid levels in patients with moderate hypercholesterolemia. Journal of the American College of Nutrition, 18(3), 229–232. https://doi.org/10.1080/07315724.1999.10718856


Fantino, M., Bichard, C., Mistretta, F., & Bellisle, F. (2020). Daily consumption of pistachios over 12 weeks improves dietary profile without increasing body weight in healthy women: A randomized controlled intervention. Appetite, 144, 104483. https://doi.org/10.1016/j.appet.2019.104483


Fogacci, F., Cicero, A., Derosa, G., Rizzo, M., Veronesi, M., & Borghi, C. (2019). Effect of pistachio on brachial artery diameter and flow-mediated dilatation: A systematic review and meta-analysis of randomized, controlled-feeding clinical studies. Critical reviews in food science and nutrition, 59(2), 328–335. https://doi.org/10.1080/10408398.2017.1368007


Gebauer, S. K., West, S. G., Kay, C. D., Alaupovic, P., Bagshaw, D., & Kris-Etherton, P. M. (2008). Effects of pistachios on cardiovascular disease risk factors and potential mechanisms of action: a dose-response study. The American journal of clinical nutrition, 88(3), 651–659. https://doi.org/10.1093/ajcn/88.3.651


Gulati, S., Misra, A., Pandey, R. M., Bhatt, S. P., & Saluja, S. (2014). 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 (Burbank, Los Angeles County, Calif.), 30(2), 192–197. https://doi.org/10.1016/j.nut.2013.08.005


Hernández-Alonso, P., Salas-Salvadó, J., Baldrich-Mora, M., Juanola-Falgarona, M., & Bulló, M. (2014). Beneficial effect of pistachio consumption on glucose metabolism, insulin resistance, inflammation, and related metabolic risk markers: a randomized clinical trial. Diabetes care, 37(11), 3098–3105. https://doi.org/10.2337/dc14-1431


Jenkins, D., Kendall, C., Lamarche, B., Banach, M. S., Srichaikul, K., Vidgen, E., Mitchell, S., Parker, T., Nishi, S., Bashyam, B., de Souza, R. J., Ireland, C., Pichika, S. C., Beyene, J., Sievenpiper, J. L., & Josse, R. G. (2018). Nuts as a replacement for carbohydrates in the diabetic diet: a reanalysis of a randomised controlled trial. Diabetologia, 61(8), 1734–1747. https://doi.org/10.1007/s00125-018-4628-9


Kasliwal, R. R., Bansal, M., Mehrotra, R., Yeptho, K. P., & Trehan, N. (2015). Effect of pistachio nut consumption on endothelial function and arterial stiffness. Nutrition (Burbank, Los Angeles County, Calif.), 31(5), 678–685. https://doi.org/10.1016/j.nut.2014.10.019


Kocyigit, A., Koylu, A. A., & Keles, H. (2006). Effects of pistachio nuts consumption on plasma lipid profile and oxidative status in healthy volunteers. Nutrition, metabolism, and cardiovascular diseases : NMCD, 16(3), 202–209. https://doi.org/10.1016/j.numecd.2005.08.004


Liu, K., Hui, S., Wang, B., Kaliannan, K., Guo, X., & Liang, L. (2020). 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, 111(1), 219–227. https://doi.org/10.1093/ajcn/nqz280


Melero, V., García de la Torre, N., Assaf-Balut, C., Jiménez, I., Del Valle, L., Durán, A., Bordiú, E., Valerio, J. J., Herraiz, M. A., Izquierdo, N., Torrejón, M. J., Runkle, I., Barabash, A., Rubio, M. A., & Calle-Pascual, A. L. (2020). Effect of a Mediterranean Diet-Based Nutritional Intervention on the Risk of Developing Gestational Diabetes Mellitus and Other Maternal-Fetal Adverse Events in Hispanic Women Residents in Spain. Nutrients, 12(11), 3505. https://doi.org/10.3390/nu12113505


Rock, C. L., Zunshine, E., Nguyen, H. T., Perez, A. O., Zoumas, C., Pakiz, B., & White, M. M. (2020). Effects of Pistachio Consumption in a Behavioral Weight Loss Intervention on Weight Change, Cardiometabolic Factors, and Dietary Intake. Nutrients, 12(7), 2155. https://doi.org/10.3390/nu12072155


Sheridan, M. J., Cooper, J. N., Erario, M., & Cheifetz, C. E. (2007). Pistachio nut consumption and serum lipid levels. Journal of the American College of Nutrition, 26(2), 141–148. https://doi.org/10.1080/07315724.2007.10719595


Sabaté, J., Oda, K., & Ros, E. (2010). Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Archives of internal medicine, 170(9), 821–827. https://doi.org/10.1001/archinternmed.2010.79


Sari, I., Baltaci, Y., Bagci, C., Davutoglu, V., Erel, O., Celik, H., Ozer, O., Aksoy, N., & Aksoy, M. (2010). Effect of pistachio diet on lipid parameters, endothelial function, inflammation, and oxidative status: a prospective study. Nutrition (Burbank, Los Angeles County, Calif.), 26(4), 399–404. https://doi.org/10.1016/j.nut.2009.05.023


Sauder, K. A., McCrea, C. E., Ulbrecht, J. S., Kris-Etherton, P. M., & West, S. G. (2014). Pistachio nut consumption modifies systemic hemodynamics, increases heart rate variability, and reduces ambulatory blood pressure in well-controlled type 2 diabetes: a randomized trial. Journal of the American Heart Association, 3(4), e000873. https://doi.org/10.1161/JAHA.114.000873


Ukhanova, M., Wang, X., Baer, D. J., Novotny, J. A., Fredborg, M., & Mai, V. (2014). Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. The British journal of nutrition, 111(12), 2146–2152. https://doi.org/10.1017/S0007114514000385


West, S. G., Gebauer, S. K., Kay, C. D., Bagshaw, D. M., Savastano, D. M., Diefenbach, C., & Kris-Etherton, P. M. (2012). Diets containing pistachios reduce systolic blood pressure and peripheral vascular responses to stress in adults with dyslipidemia. Hypertension (Dallas, Tex. : 1979), 60(1), 58–63. https://doi.org/10.1161/HYPERTENSIONAHA.111.182147


Xia, K., Yang, T., An, L. Y., Lin, Y. Y., Qi, Y. X., Chen, X. Z., & Sun, D. L. (2020). The relationship between pistachio (Pistacia vera L) intake and adiposity: A systematic review and meta-analysis of randomized controlled trials. Medicine, 99(34), e21136. https://doi.org/10.1097/MD.0000000000021136