Scientific Name(s): Prunus dulcis (P. Mill) D.A. Webb
Common Name(s): Almond milk, Almond oil, Amygdale amara, Amygdalin, Bitermandel, Bitter almond, Ku wei bian tao, Laetrile, Oil of almonds, Sweet almond, Vitamin B17, Volatile almond oil
Medically reviewed by Drugs.com. Last updated on Nov 22, 2022.
Almonds are used as a dietary source of protein, unsaturated fats, minerals, micronutrients, phytochemicals, alpha-tocopheral, and fiber, as well as in confectioneries. The efficacy of almonds in altering the lipid profile is weakly supported by the literature; larger, more robust clinical trials of longer duration are required. The almond derivative laetrile/amygdalin has been used as an alternative cancer treatment, but there is no clinical evidence to support this use. Laetrile is banned by the US Food and Drug Administration (FDA) and in Europe for use in cancer therapy. Preliminary data support use of topical almond oil cream for striae gravidum.
Trials of almond dietary supplementation in adults have used 25 to 168 g of almonds per day. The American Heart Association (AHA) recommends the daily intake of nuts (28.35 to 56.7 g) as part of a healthy diet. There is no widely accepted standard for laetrile/amygdalin dosing due to the potential for toxicity and no evidence for efficacy.
Allergy to almonds or its products.
Consumption of bitter almond or laetrile is not recommended in pregnant or breast-feeding women because of insufficient data and a theoretical risk of birth defects. Consumption of sweet almond has generally recognized as safe (GRAS) status when used as food. Avoid dosages above those found in food because safety is unproven.
None well documented.
Adverse reactions similar to those of cyanide poisoning have been reported.
Cyanide poisoning and death have resulted from laetrile and bitter almond consumption.
The almond, apricot, cherry, peach, and plum are members of the Rosaceae (rose) family. The almond is distinct because its seed is edible, while the outer pulp is hard, inedible, and juiceless. The genus Prunus (plum), to which the almond tree belongs, is synonymous with Amygdalus in the US Department of Agriculture's PLANTS database, but the literature remains confusing and often categorizes the sweet and bitter almond in different genera. Synonyms are Amygdalus communis L., Amygdalus dulcis P. Mill, Prunus amygdalus Batsch, Prunus communis (L.) Arcang., and Prunus dulcis (Mill.) D.A. Webb var. amara (DC.) Buchheim.USDA 2012
The plant, a moderate-sized tree, was probably introduced to the United States from Eastern Europe or western Asia. The United States, especially California, is the world's major producer of almonds.Sathe 2002 Many varieties of the plant differ in flower color and form, as well as in the size of the fruit or shell. Plants with entirely pink flowers produce sweet almonds; those with flowers that are almost white at the tip of the petals and are red/pink at the base produce bitter almonds. When fully ripe, the green outer covering of the fruit dries and splits and the almond shell (endocarp) drops out. The almond seed is rounded at one end and pointed at the other, with a yellow, fibrous outer covering.USDA 2012
References to the almond are found in Greek mythology, the Bible, and in Shakespeare's writings. In the Middle Ages, almonds already were commercially important.Almonds 2012
Amygdalin was isolated by French chemists in 1830, and reports of its use as an anticancer agent date back to 1845 in Russia. In the United States, records show laetrile was used as a cancer treatment in the 1920s and was patented in the 1950s as a supposedly nontoxic form of amygdalin.NCI 2012
The FDA has banned the sale of laetrile as a medicinal product; however, it remains available and its use is promoted in Mexico where it often is produced.NCI 2012 Sweet almond is historically described as Mistura Amygdalae, Pulvis Amygdalae Compositus, and Almond Oil in the British Herbal Pharmacopoeia.
Almond nuts have a unique fatty acid profile, largely composed of unsaturated fats, some saturated fats, and no cholesterol. In addition to the protein and carbohydrate content, almonds contain large amounts of alpha-tocopherol and arginine, as well as magnesium, potassium, and sodium. Almonds are rich in phytosterols, including beta-sitosterol, stigmasterol, and campesterol.Berryman 2011 The skin of the almond nut accounts for 4% of the total nut weight and is rich in polyphenols, including hydroxybenzoic acids and aldehydes, flavonol and flavanone aglycones, and glycosides.Bartolomé 2010 Other chemical compounds in the almond include betulinic, oleanic, and ursolic acids. Other acids (corosolic and maslinic) have been identified as aldehydes. Antioxidant flavonoids quercetin, isorhamnetin, quercitrin, kaempferol, and morin have been isolated. Prunasin, a cyanogenic compound, is found only in the vegetative parts of the almond plant.Amico 2006, Frison 2002, Dicenta 2002, Sang 2002, Takeoka 2003, Wijeratne 2006
Amygdalin exists in the seeds of apricots, cherries, and plums.Shragg 1982 Amygdalin is hydrolyzed to yield glucose, benzaldehyde, and hydrocyanic acid. The production of cyanide defines cyanogenic glycosides. Enzymatic release of cyanide can occur in the presence of beta-glucuronidase, an enzyme found in the seeds and in the human intestine.Shragg 1982 When the cyanide component is removed, the resulting oil is referred to as "bitter almond oil" and consists mostly of benzaldehyde. This oil is toxic when consumed in large amounts.
The term "laetrile" is often used interchangeably with amygdalin, but they are not the same chemical entity. The word was coined from laevorotatory and mandelonitrile and is used to describe a semisynthetic derivative of amygdalin. Most laetrile from Mexico is made from crushed apricot seeds and is a mixture of amygdalin and neoamygdalin, which are mandelonitrile gentiobiosides. Other laetrile products of varying composition are commercially available.Milazzo 2006
Uses and Pharmacology
The widespread consumption of nuts as part of a healthy diet makes data from animal studies largely irrelevant.
Most studies find no increase in body weight associated with increased consumption of almonds(Fraser 2002, Hollis 2007, Zaveri 2009) and epidemiological studies suggest an inverse association may exist between frequency of nut consumption and body mass index.(Cassady 2009)
Despite promising in vitro experiments, the use of amygdalin as a cancer treatment has not been validated by any clinical trials. The National Cancer Institute sponsored phase 1 and 2 clinical trials in the 1980s but found no evidence to support the use of laetrile in the treatment of cancer.(NCI 2012) Because a Cochrane review found no clinical trials that met adequate methodological quality, a meta-analysis could not be conducted.(Milazzo 2006) A further review evaluated all published clinical trial data and found no basis for the health claims of laetrile use in cancer.(Milazzo 2007) Laetrile has been banned in the United States and Europe for use in cancer therapy; however, interest continues and products are sold via the Internet.(Meijer 2001, Milazzo 2006, Milazzo 2007)
The widespread consumption of nuts as part of a healthy diet makes data from animal studies largely irrelevant.
Limited studies have been conducted in healthy volunteers and patients with type 2 diabetes with equivocal results. Effects on glycemic index, fasting insulin and glucose, insulin resistance, and 24-hour urinary C-peptide output are unclear.(Cohen 2011, Jenkins 2008, Josse 2007, Li 2011, Lovejoy 2002)
The American Diabetes Association updated guidelines on the standards of medical care in diabetes (2021) recommends an individualized medical nutrition therapy program as needed to achieve treatment goals for all people with type 1 or 2 diabetes, prediabetes, and gestational diabetes (level A). Additionally, they recommend that a variety of eating patterns can be considered to prevent diabetes in patients with prediabetes (level B) and that the overall quality of food consumed should have an emphasis on whole grains, legumes, nuts, fruits, and vegetables with minimal processed foods, which is associated with a lower risk of type 2 diabetes. However, in patients with type 2 diabetes, they note that carbohydrate sources high in protein, such as nuts, should not be used to treat or prevent hypoglycemia due to the potential concurrent rise in endogenous insulin.(ADA 2021a, ADA 2021b)
Topical application of almond oil cream (2 g every 12 hours) to the abdomen of nulliparous women from week 16 to delivery significantly reduced the extension of striae gravidum compared to controls in a double-blind, clinical trial (N=149). Extension across all abdominal zones was 8% for aloe vera cream, 9.5% for sweet almond oil cream, 18.5% for the base cream, and 65.5% for no treatment controls. Similarly, the average diameter and number of striae were significantly reduced with the almond oil, aloe vera, and base creams compared to no treatment controls (P<0.001 for all), with the 2 active treatment groups also significantly reducing erythema and itching of striae (P<0.001).(Hajhashemi 2018)
The widespread consumption of nuts as part of a healthy diet and the availability of clinical data make data from animal studies largely irrelevant.
Based on observations of epidemiological data and findings from intervention studies, the AHA recommends the daily intake of nuts (28.35 to 56.7 g) as part of a healthy diet. The FDA allows a qualified claim that eating 42.52 g/day of most nuts as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.(Berryman 2011, FDA 2003, Torabian 2009)
Specific trials evaluating the efficacy of almonds in reducing cardiovascular risk factors, including reducing hyperlipidemia, are generally lacking and limited methodologically by lack of randomization, small numbers of participants, absence of controls, short washout periods, or short duration.(Berryman 2011, Phung 2009) A review of available trial data and a meta-analysis of 5 clinical trials found a decrease in total cholesterol with daily consumption of almonds. Trials included in the meta-analysis used a range of 25 to 168 g of almonds per day.(Berryman 2011, Phung 2009)
Almonds, rich in phytosterols, fiber, and alpha-tocopherol, may act via various mechanisms to reduce cholesterol absorption and increase elimination, as well as via interaction at the cellular level with enzymes such as HMG-CoA reductase.(Berryman 2011) Increased fiber intake, decreased oxidative stress, decreased lipid peroxidation, and increased serum tocopherol may offer explanation for the observed cardiovascular benefits of almond consumption. Changes in the lipid profile have been demonstrated in some but not all clinical studies.(Berryman 2011, Damasceno 2011, Fraser 2002, Hyson 2002, Jalali-Khanabadi 2010, Jambazian 2005, Jenkins 2002, Jenkins 2008, Kalgaonkar 2011, Li 2007, Li 2011, Spiller 2003, Torabian 2009, Zaveri 2009) The reductions in total cholesterol observed in clinical trials due to almond consumption are modest in comparison with the relatively larger benefit observed in cohort studies for risk reduction of cardiovascular disease; other mechanisms may be responsible for the effect.(Jenkins 2008)
Compared to no intervention, consumption of almond oil (20 mL/day) for 30 days led to significant improvements in some but not all lipid parameters compared to controls in hyperlipidemic patients in a randomized open-label trial (N=85). Total cholesterol, low-density lipoprotein, and high-density lipoprotein improved by −16 mg/dL (P=0.009), −10 mg/dL (P<0.001), and +6 mg/dL (P<0.001) with almond oil compared to controls, respectively. Treatment was well tolerated.(Zibaeenezhad 2019)
The Academy of Nutrition and Dietetics updated position paper on vegetarian diets (2016) states that adequate nutrition can be provided by a well-planned vegetarian diet that includes nuts. Therapeutic vegetarian diets are useful in maintaining a healthy weight and BMI and are associated with a reduction in cardiovascular disease risk and type 2 diabetes. Almonds provide a moderate amount of calcium, although bioavailability is fairly low (20%), and nuts provide a source of protein and zinc.(Melina 2016)
A study evaluated the effect of dietary almonds on markers of inflammation, finding decreases in C-reactive protein but no effect on interleukin or fibrinogen. No dose response was found.(Rajaram 2010)
Assessment of data from 6,705 participants without baseline atrial fibrillation in the PREDIMED trial revealed a significant relevant reduction in risk of atrial fibrillation (38%) with the Mediterranean diet supplemented with extravirgin olive oil (50 g/day or more) but not with the Mediterranean diet supplemented with nuts (almonds, hazelnuts, walnuts).(Martinez-Gonzalez 2014)
Almond oil has been used with phenol to treat rectal prolapse in infants(Sasaki 2004) and either alone or as a carrier of other essential oils in massage therapy.
Trials of almond dietary supplementation in adults have used 25 to 168 g of almonds per day.Berryman 2011, Phung 2009
The AHA recommends the daily intake of nuts (28.35 to 56.7 g) as part of a healthy diet.Torabian 2009
Almonds are considered a good source of tocopherol to meet the recommended daily allowance for vitamin E, now increased to 15 mg/day.Jambazian 2005
Topical sweet almond oil cream (1:1) 2 g every 12 hours rubbed gently onto abdominal area for prevention and reduction of striae gravidum.Hajhashemi 2018
There is no widely accepted standard for laetrile/amygdalin dosing due to the potential for toxicity and no evidence for efficacy.Milazzo 2006, Milazzo 2007, NCI 2012
Pregnancy / Lactation
Consumption of bitter almond or laetrile is not recommended in pregnant or breast-feeding women because of insufficient data and a theoretical risk of birth defects.
Cyanide has not been reported as a direct cause of birth defects in humans. Birth defects, harmful effects on the reproductive system, and skeletal abnormalities have been reported in mice fed water containing sodium cyanide and in hamsters given oral laetrile.ATSDR 2012
Children born to mothers exposed to cyanide and thiocyanate during pregnancy have exhibited thyroid disease.ATSDR 2012
None well documented.
Allergies to nuts are common, affecting an estimated 0.5% of the US population.Roux 2001, Sathe 2002 Adverse reactions similar to those of cyanide poisoning have been reported.NCI 2012 The protein component is primarily composed of amadin, which confers the antigenicity of the nut in IgE-mediated allergy.Sathe 2002
Almond-based diets are possibly deficient in selenium, riboflavin, and pantothenic and folic acids.Jaceldo-Siegl 2004 Published case reports have shown that infants fed almond milk exhibited hypoalbuminemia and consequent peripheral edema, as well as deficiencies in calcium and iron.Doron 2001
Cyanide poisoning and death have resulted from laetrile and bitter almond consumption.Shragg 1982 A minimum lethal dose of cyanide is estimated at 50 mg (or 0.5 mg/kg body weight).Shragg 1982 Oral amygdalin/laetrile is considered 40 times more toxic than the intravenous form because of its conversion to hydrogen cyanide by enzymes in the intestine.NCI 2012, Shragg 1982 Symptoms of cyanide poisoning (eg, coma, cyanosis, dizziness, headache, hypotension, nausea, neuropathy, ptosis, vomiting) may be potentiated by eating foods containing beta-glucosidase (eg, bean sprouts, carrots, celery, peaches) or by taking high doses of vitamin C.NCI 2012
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