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Nuts and seeds on a plant based diet: what the doctors say
Nuts, seeds and avocado on a plant based diet: what Esselstyn, McDougall, Campbell, Barnard and other doctors say, where they differ, with sources.
Updated . For education only, not medical advice.
Our view
Nuts, seeds and avocados are whole plant foods, yet most of their calories come from fat: McDougall put them at 80 to 90% fat in 2016, and Rogers in 2025 counted 89% of the calories in walnuts, 78% in almonds and 74% in cashews12. The doctors on this site do not argue over whether these foods beat meat or oil; they argue over how much of them is wise134.
On this question we give most weight to the low-fat clinicians who have no stake in selling nuts and have watched patients for decades567. Esselstyn wants none for people with established heart disease, McDougall drops them for the fastest weight loss, Novick keeps them minimal, Nelson eats few and warns against the hype, and Rogers does not eat them at all56782. Esselstyn and Nelson both point out that nut industry groups paid for much of the favorable research, and Novick adds that nut calories still count even when trials show little weight gain91011.
The one use nearly all of them accept is a spoonful of ground flax or chia: Esselstyn allows it even for heart patients, and Barnard, Novick and the Ornish program fit it into their low-fat plans12131415.
Where they agree
All of them rank these foods above animal fat and oil: McDougall said in 2016 that nuts and avocados are not unhealthy, Barnard in 2022 put avocado fat ahead of animal fat, and Campbell defends whole-nut fat because it comes sealed in with vitamin E and other antioxidants1316.
They also agree that nuts are dense and easy to overeat1718. Barnard noted in 2024 that shelled, salted nuts go down quickly, Esselstyn said he rarely sees a patient stop at one nut, and Goldhamer said in 2017 that some people cannot stop once they start171819. By Lisle’s 2026 count, sprouted grain toast spread with almond butter comes to roughly 2,400 calories a pound, over twice what steak carries20.
Even those who allow nuts keep the portion small: about an ounce a day at Goldhamer’s TrueNorth center, at most an ounce for lean, healthy people in Barnard’s 2024 advice, and an ounce used as a condiment for Rip Esselstyn212223. For weight loss, McDougall, Barnard, Novick, Lisle and Rip Esselstyn all name nuts as one of the first foods to cut or hold down63242523.
Where they differ
The disagreement is one of degree: whether people with heart disease should eat any nuts, whether nuts add weight, how far to trust the research, and where avocado and seeds fit542627.
Heart disease
Esselstyn’s 2014 paper listed nuts and avocado among the foods his heart program avoided, and in a 2018 webinar he said nuts are acceptable to him for people free of diagnosed heart disease, but not once the diagnosis is made, because he has never seen a trial in which nuts reversed advanced heart disease285. His FAQ sets the line in numbers: with no heart disease, and with drug-free cholesterol no higher than 150 total and 80 for LDL, some nuts and avocado are acceptable29. Nelson said in 2018 that the one group who should probably avoid or cut back on nuts is people with heart disease8. On the other side, Campbell said in 2019 that he disagrees with his friend Esselstyn here, and David Jenkins makes a set daily amount of nuts one pillar of his cholesterol-lowering portfolio diet, citing the nut arm of the PREDIMED trial43031. The Ornish program sits between them, with nuts allowed only in small amounts in its 2022 guidelines32.
Do nuts add weight?
Trials often find that adding nuts causes less weight gain than their calories predict, and in 2008 Novick reviewed why: people eat less of other foods, making up on average for roughly 75% of what the nuts supply, energy use rises slightly, and part of the fat leaves the body unabsorbed26. His conclusion was that the calories still count, and he pointed out that the population studies used to promote nuts mostly tracked people eating roughly an ounce on two to five days of the week11. A 2026 video on Nelson’s VegSource channel added that 14 of the 18 cholesterol trials offered as proof that nuts do not fatten were built to hold calories and weight steady, so they could not test that claim33. From experience, Chef AJ said in 2017 that a daily ounce or so of nuts had held her 50 pounds above her later weight, and McDougall’s August 2007 newsletter expected fat-rich whole foods such as nuts and avocados to add weight3435.
How far to trust nut research
Esselstyn said in 2018 that many of the nut studies in peer-reviewed journals were funded by nut companies, which in his view casts doubt on them9. Nelson argued in 2019 that much nut research is commercial, naming the California almond commission and an international tree nut association among the groups paying for it3610. Novick argued in a 2012 talk that, in people with diabetes, controlled nut trials produced small, mixed effects that appeared only where nuts took the place of refined grains or processed foods37. Campbell, by contrast, said in 2020 that no published study he knew of argued against a moderate intake of nuts38.
Avocado
Rogers is the strictest: in a 2025 video he said avocados are so high in fat that they should never be eaten27. The Ornish program’s 2022 guidelines add no avocados, and Kahleova said in 2022 and 2024 that the low-fat vegan diets in the Physicians Committee trials asked people to go easy on avocados and nuts394041. Barnard said in 2022 that avocado fat is better than animal fat but still carries 9 calories per gram3. Rip Esselstyn uses a quarter to a half avocado on a salad or sandwich, not whole ones42.
Seeds
Seeds get gentler treatment than nuts1219. Esselstyn’s FAQ finds a daily tablespoon or two of ground chia or flax suitable for everyone, heart patients included, Barnard said in 2022 that a tablespoon or so of chia or flax poses no problem, and Novick allows one tablespoon of ground flax a day for omega-3121314. The Ornish program counts 5 teaspoons of ground flax as one low-fat serving, holding 3 grams of fat or less15. Goldhamer said in 2017 that people who cannot stop eating nuts may still manage seeds, while Rogers in 2025 questioned sunflower seeds, pointing to a blogger whose lab tests reported a lot of lead in them1943.
Views over time
Some positions have moved with the years444546. Campbell said in 2019 that research since Esselstyn’s early heart work had convinced him nuts are fine as a whole food44. The Ornish program allowed nuts in small amounts in its 2022 guidelines, and a later article on its site, archived in 2026, presents limited portions of certain nuts and seeds as a new allowance in the reversal program3245. Chef AJ, who blamed nuts for most of 50 extra pounds, added leaner options to the 2022 anniversary edition of Unprocessed, such as oats standing in for walnuts in the crust of desserts4746. Rip Esselstyn has held one moderate line from his 2009 Engine 2 recipes, which used hummus and avocado, to his 2022 advice4823.
What each expert says
JMJohn McDougall
McDougall said in a 2016 webinar that nuts, seeds, avocados and coconuts do no harm as foods, yet they pack more energy than anything else and work against staying trim1. When the goal is the quickest weight loss, he said in 2022, they have to go, calling them delicacies and remembering that, as a boy, a five-pound sack of nuts lasted his family of six a whole week of cracking6.
Esselstyn keeps nuts and avocado away from heart patients, a rule in his 2014 paper that he defended in 2018 on the grounds that nuts carry saturated fat and are hard to stop eating284918. His FAQ makes exceptions for chestnuts, which are very low in fat, and for ground flax or chia2912.
Campbell told McDougall in 2019 that he parts with Esselstyn on nuts, since nature wraps their fat in antioxidants416. In 2020 he presented his diet advice as something to aim at, not a strict rule, and said he knew of no evidence against some nuts38.
Barnard said in 2022 that when weight loss stalls, nuts or oils are often the cause3. In 2024 he advised anyone carrying extra body fat or showing insulin resistance to keep nuts to a minimum, and lean, healthy people to use about an ounce a day as a flavoring22.
The Ornish program keeps fat low by adding no avocados and fitting nuts into servings of 3 grams of fat or less, which works out to about 5 almonds or one walnut3915. Its site describes limited nuts and seeds as a newer allowance in the reversal program45.
TrueNorth allows about an ounce of nuts and seeds a day, the amount Goldhamer gave in 2017 and again in 20225021. In 2025 he called nuts, seeds and avocado concentrated foods, best kept to small portions51.
Rogers does not eat nuts and in 2025 called them overrated, pointing to how much of their energy comes from fat227. He tells people to skip avocados entirely27.
Novick has advised keeping nuts, seeds and avocados minimal since at least 1998, and in 2012 said to avoid or strictly limit them once weight loss stops724. His omega-3 allowance is half an ounce of walnuts or a tablespoon of ground flax a day14.
Nelson said in 2018 that anyone may eat nuts if they ignore the hype, and that he seldom eats them himself because he would eat too many852. In 2019 he called much of the nut research commercial36.
Unlike his father, Rip Esselstyn lets everyone have a little: roughly one ounce daily, used like a condiment, and two at the very most23. A 2018 talk of his treats nuts and seeds as an add-on to the four main food groups53.
Chef AJ blames nuts for most of the 50 pounds she once carried, a point she made in 2017 and again in 20223447. In a 2021 talk she said she was not asking people to avoid whole food fats, only to keep them apart from starch54.
In 2026 Jenkins described his portfolio diet as a menu that includes a daily amount of nuts, where eating half of it brings about half the effect30. He added that the nut-enriched diet in PREDIMED also lowered cardiac events31.
Kahleova said in 2022 that people in a trial were free to choose fruit and vegetables yet told to watch avocados and nuts, and to choose packaged foods with 3 grams of fat or less per serving40. In 2024 she repeated that their low-fat vegan diet keeps oil, nuts and avocados minimal41.
Lisle said in 2024 that he would drop nuts and seeds altogether if he wanted to lose weight25. He sees smooth nut butter spread on bread as a food with no match in nature, unlike richer whole foods such as corn tortillas5556.
We treat nuts, seeds and avocado as rich extras rather than staples, as the low-fat doctors here do175. A spoonful of ground flax or chia is the use most of them accept1213. Whether any nuts suit someone with heart disease or a weight goal is where they disagree, so that is a question for your own doctor. This page is education, not medical advice.
Each small number links to its reference below: the video at the exact second, or the page where it was said.