Doctor's Note

I previously did a more in-depth dive into the choline issue in Carnitine, Choline, Cancer and Cholesterol: The TMAO Connection. More on eggs and cholesterol in Egg Cholesterol in the Diet and Avoiding Cholesterol Is a No Brainer.

More Freedom of Information Act juiciness in Eggs and Cholesterol: Patently False and Misleading Claims, Eggs vs. Cigarettes in Atherosclerosis, and my latest live presentation More Than an Apple a Day: Combating Common Diseases.

What else might make you smell fishy? See Bacterial Vaginosis and Diet.

For more context, check out my associated blog post: How Eggs Can Impact Body Odor.

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  • elsie blanche

    Thanks. What about consuming large amounts of choline exclusively from plant-based sources? Should this be of concern, and are there any studies that have looked at this?

    • Brandon Klinedinst

      This is more of a theoretical answer, and I can’t provide citations cause I’m not aware of any yet.

      However, based on what we currently know, the kinds of bacteria that proliferate from the consumption of animal products metabolize choline into unfavorable compounds, like those discussed in the video. The kinds of bacteria that flourish from the consumption of plant products don’t produce these same metabolites from choline.

      For instance, in one study they gave large steaks to omnivores and vegans (who agreed to do it for the research). The omnivores produced the harmful metabolites from the choline, the vegans did not. So the most likely answer to your question is that we should first and foremost be concerned about our gut flora populations, and less concerned about actual choline intake.

      • Guest

        Which are the specific gut bacteria that promote the harmful metabolites? Are they present in probiotic supplements and can be found listed on the labels? Seems this is something people who take probiotic supplements ought to know.

    • Darryl

      The studies in question are:

      2011: Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease
      2013: Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk

      In the first, supplementing ordinary mice chow with 0.5 or 1.0% pure choline (6-12 times the chow amount) was enough to roughly double atherosclerotic lesions.

      • Paleo Huntress

        Important? Not really.

        Choline and TMAO: Eggs Still Don’t Cause Heart Disease

        “Dr. Hazen’s team did show a temporary increase in total TMAO after eating eggs. However, as Dr. Chris Masterjohn pointed out to me in an email dialog, the researchers’ own data show that there’s no way that the “choline challenge” could have contributed to this increase in total TMAO. If it had, we would expect to see an initial increase in labeled TMAO followed by an increase in labeled TMAO. This would indicate that the labeled choline supplement (that participants ate with the eggs) had been metabolized by the gut bacteria and then converted into TMAO in the liver.

        But that’s not what happened. Figure 1C and Figure 1D” from the study. Figure 1C shows an increase in total serum TMAO at one hour after the choline challenge. But by hour four, total TMAO is back to baseline and by hour 8 it’s even below baseline (i.e. the participants had lower TMAO at 8 hours than they did before they ate the eggs/choline).

        What’s more, the researchers didn’t mention that other commonly eaten foods have a much more significant impact on TMAO than eggs. A 1999 study tested the effects of 46 different foods on the urinary excretion of TMAO in 6 human volunteers. Eggs had no effect on TMAO excretion compared to a light control breakfast, yet 19 out of 21 types of seafood tested did. In fact, halibut generated over 53 times as much TMAO as eggs! This is not surprising, because although all species of seafood contain lower amounts of choline than eggs, they do contain trimethylamine and TMAO. Dr. Hazen’s team was aware of this study, because they referenced it briefly in the discussion section of the NEJM paper. They acknowledged that “TMAO has been identified in fish” and “the ingestion of fish raises urinary TMAO levels.” But remarkably, they did not explain how much greater fish’s impact on TMAO was when compared to eggs.

        Finally, this paper did not prove that eating choline-rich foods (or any other foods) increases TMAO levels over time. In fact, the researchers themselves seem to suggest this is unlikely in the discussion section of the paper. They said: “the high correlation between urine and plasma levels of TMAO argues for effective urinary clearance of TMAO.” In other words, even if eating food does increase total TMAO levels, most people are able to quickly and efficiently clear that TMAO from their blood by excreting it in the urine. This makes it doubtful that dietary factors alone explain chronic elevations in TMAO”.

        “some research suggests that consuming large amounts of whole grain increasePrevotella bacteria in the gut, which were associated with the highest levels of TMAO in Dr. Hazen’s previous study on TMAO. If this is the case, consuming large amounts of fiber from whole grains may actually increase the risk of heart disease.”

        I don’t think this is the paper to hang your hat on, Darryl.

      • Paleo Huntress

        And regarding the first study of the two?

        Does Dietary Choline Contribute to Heart Disease?

        This is a study using MICE:

        [T]he authors showed that blood levels of choline, its metabolic byproduct betaine, and TMAO all correlated with the incidence and severity of cardiovascular disease in humans, although this was not prospective data showing that the occurrence of these compounds in the blood early in life predicted the development of heart disease later in life.”

        “They also showed that feeding mice phosphatidylcholine did in fact produce TMAO, but only in the presence of gut bacteria. Further, feeding mice five-fold or ten-fold higher concentrations of choline chloride than they would ordinarily receive, or simply feeding them TMAO itself, increased atherosclerotic lesion size, and atherosclerotic lesion size correlated with blood levels of TMAO.”

        Sounds pretty damning, right?

        There’s just one major problem with this hypothesis. Studies in humans have shown that neither phosphatidylcholine nor choline-rich foods produce detectable increases in trimethylamine.


        Here’s a figure from a 1983 study by Ziesel and colleagues showing urinary excretion of trimethylamine after supplementation with different types of choline in humans. The third bar in each panel represents the excretion of trimethylamine in the urine. Choline chloride and choline stearate led to the production of large amounts of trimethylamine, but lecithin (phosphatidylcholine), the main form of choline found in food, led to only a small increase.

        It turned out, however, that their lecithin was contaminated with some trimethylamine. If they “cleaned” it to remove the contamination, shown in the fourth panel, the lecithin did not increase urinary excretion of trimethylamine at all.”

        A 1999 study by other authors came to similar conclusions. They looked at the urinary excretion of both trimethylamine and its detoxification product TMAO in humans. They found that 60 percent of free choline and 30 percent of carnitine, another potential precursor, was excreted in the urine as one of these two products, but that neither betaine nor phosphatidylcholine converted to either product at all.

      • Paleo Huntress

        Here’s another- published just a few months ago: Is L-Carnitine the Link between Red Meat and Heart Disease? J Nutr Food Sci 3:e119

        “A meta-analysis of L-carnitine and cardiovascular disease (CVD) found analogous results [8]. Compared with placebo or control, increased dietary L-carnitine is associated with a 27% reduction in all-cause mortality, a 65% reduction in ventricular arrhythmias, and a 40% reduction in angina symptoms in patients experiencing acute myocardial infarction. Thus, based on the totality of the clinical evidence, as much as 4 grams L-carnitine per day administered up to 12 months not only improved cardiac function, but also increased life expectancy. It is, therefore, difficult to understand how others have linked dietary L-carnitine to worsening CVD outcomes.”

        According to the USDA Database for the Choline Content of Common Foods and the USDA National Nutrient Database for Standard Reference, high choline-containing foods include (per 100 g): beef liver (430 mg), eggs (250 mg), spinach (24.8 mg), cooked broccoli (40.1 mg), Brussels sprouts (40.6 mg), and tomato paste (38.5 mg). No clinical evidence exists linking the TMA/TMAO generated by ordinary diets to health risks. In one trial, TMA/TMAO levels in the urine were insignificantly small after consumption of 45 different foods from a varied diet including meat, fruit, vegetables, cereal and dairy products.

        The rapid clearance of these compounds under normal circumstances suggests that dietary intake of L-carnitine containing food is not sufficient to produce toxic levels of TMA/TMAO. Also, it is likely that the association between CVD and elevated blood concentrations of L-carnitine and related compounds such as choline are indicative of dysfunction(s) elsewhere and not causal.

        More sophisticated analytical techniques can now measure previously unquantifiable levels of blood TMA confirming that fish, and not red meat, is the primary dietary source for TMA/TMAO. More importantly, no study has shown a benefit of consuming beef over fish for cardiovascular health. The increased risk of CVD from elevated TMA/TMAO levels was deduced primarily from animal data. The TMA thesis may not hold up even in an atherogenic-prone mouse model selected to demonstrate various aspects of the same argument.

        [F]requent antibiotic use may lead to alteration in the normal microbiome resulting in chronically high outputs of TMAO.

        Neither dietary L-carnitine found in red meat nor choline and phosphatidylcholine found in liver, eggs and broccoli under normal circumstances contribute to a significant elevation of blood TMAO.

        • Darryl

          You can copypasta Weston Price articles at me all you like, but my response was purely on the subject of whether free choline had been studied to independently effect atherosclerosis. Pretty much every food (including plant foods) that contains phosphatidylcholine also includes some free choline. I’m on record elsewhere on this site expressing reservations about the Hazen studies.

          • Paleo Huntress

            I think you missed the point, and I certainly understand that you’re not a fan of the WAPF, I’m not either. (This piece you responded to is directly from the published article though, not from WAPF)

            You really can’t discount the argument when the data is right there backing it up. The point isn’t that veggies also contain choline but rather that it doesn’t matter. Dietary sources didn’t produce chronically elevated levels of TMAO and in fact, the levels actually dropped for a while (a rebound maybe?) after foods with higher levels were consumed.

          • yardplanter

            re the J food Nut Sci article,Anyone catch the point that L-Carnitine showed benefit in AMI when it was depleted ? The authors state there is no known benefit in prevention

  • M85

    Hmm… I wonder if there are any other “conjured up epidemics” 2:08 based on non existent nutritional deficiencies?

  • Naturozen

    I also wonder about dangers of veggie sources of choline i.e. spinach that has 9x the amount of choline than in 1 egg. If excessive choline intake produce health havoc producing TMA, will it matter whether it’s animal or plant source?

    • am95

      I’m not sure where you are getting those numbers from but a quick look at nutritiondata.self shows that you would have to eat nearly a 1.5 pounds of spinach to equal the choline found in a single medium egg.

      • Naturozen

        thanx for ur reply…the first minute of the vdo talks about lutein (NOT choline) rich in spinach. since the main topic of the vdo is choline in eggs, i assumed that the initial info that dr. g talks about is choline.

      • Guest


  • Scott

    So what is a person trying to adhere to a plant-based diet supposed to do for a natural source of B12? Since B12 is primarily found in meats and cereals.

    • Brandon Klinedinst


    • am95

      There’s nothing wrong just taking a supplement for B12.

    • Toxins

      Dr. Greger recommends supplementation

    • Thea

      Scott: am95 and Toxins have given you some great responses. I’ll also suggest that you look into nutritional yeast if you are very concerned about a “natural” source. I don’t know if nutritional yeast would count as natural to you or not, but it has a different feel than just taking a pill. Plus it is yummy. (But you would have to figure out how to work enough nutritional yeast into your regular diet each day.)

      Personally, I think Dr. Greger’s recommendation on b12 supplementation makes so much sense, I can’t imagine everyone (regardless of diet) not doing it. Check out those videos that Toxins pointed you to. Good luck.

      • Marissa

        Yep, nutritional yeast! YUM!

    • Mike Quinoa

      Apparently as we get older it’s harder for us to cleave the B12 from a protein source, so fortified foods and B12 supplements are the best way to go anyway.

      “Many older adults, who do not have enough hydrochloric acid in their stomach to absorb the vitamin B12 naturally present in food. People over 50 should get most of their vitamin B12 from fortified foods or dietary supplements because, in most cases, their bodies can absorb vitamin B12 from these sources.”

      • Toxins

        Even the youth need to supplement b12, especially when on a plant based diet. Elderly people over the age of 65 may need 1000 mcg of vitamin B12 a day.

    • Han

      How do you think those dead animals got it in the first place? For example vitamin D is created if you’re out in the sun. 99% of the animals in the industry don’t even know what the sun looks like. Same story for b12, those poor animals never ate life plants and got some b12 from the soil.

      They got supplemented! Just google for “lifestock supplementation.

      Yet another bad argument for eating meat.

  • militarydoc

    I have been on a plant based journey the past year and a half thanks to people like Dr. Greger. As a cardiologist, I would like to inform my colleagues about the benefits of a plant based diet. I have already had great success with my patients. Are there any “hot off the press” journal articles Dr. Greger might recommend to be discussed at an upcoming journal club meeting that would be relevant to my military cardiologist colleagues who are either unconvinced or uninformed about the benefits of a plant based diet?

    Any input from the nutrition guru would be appreciated! Our health care providers must be informed if we are to make a difference in peoples’ lives!

    • peter

      As a patient, I wish I could find a cardiologist who was genuinely interested in working with me to incorporate diet and exercise as part of my treatment program and to possibly allow me to reduce or eliminate some of the drugs I am taking. I have a good cardiologist but he is not enthusiastic about the diet I am on – not discouraging, but neither dose he seem to care much even though, among other things, I drove my LDL to under 70 on diet alone ( I stopped the statin for a few weeks to prove that diet alone would work). I also found it discouraging that the association of cardiologists in Florida could not tell me which of their many members had an interest in lifestyle effects such as diet and exercise.

  • peter

    I am a 59 yo male who thought was eating fairly healthy these last few decades. Since my late 20s I ate little pork or beef, some fowl, but a lot of fish and nuts. At a minimum a small can of tuna every day, then switched to salmon. I cut back on salmon a couple of years ago and relied more on a variety of nuts. My BMI was 25 to 27 range. A year ago I had a stress induced cardiac event (very similar to a heart attack). During evaluation cardiologist found 3 coronary arteries partially blocked, one at 90%, the others at 20 to 30. My carotids are also at about 20% blockage.
    This is only anecdotal of course as I cannot proof a conection, but I am very interested in this gut microbiome/TAMO connection to heart disease. It seems possible it is what happened to me.
    I have been on a plant only diet this last year and have seem my lipids drop dramatically and am hopeful that the heart damage and the atherosclerosis will not get worse and maybe improve a bit over time.

  • Gary S

    Doctor Al Sears MD, states eggs are the perfect food, he eats them every day, and he says they are the Gold Standard by which he rates all other protein, and that all of the amino acids are there in the ratios you need in one place, is Al Sears a total idiot or what.

    • Toxins

      Getting enough protein is something we should not concern ourselves with unless we do not get enough calories, which would mean malnourishment. This would apply mainly to those living in third world countries that do not have good access to food. There are for more issues with eggs then just the high choline content.

      The said doctor clearly has not examined the evidence!

    • Plantstrongdoc M.D.

      The concept of eggs as the perfect food or protein source is totally outdated. Eggs are the perfect source of cholesterol and thats it.

    • b00mer

      Hi Gary,

      Also, you can watch these for a different perspective on whether animal proteins really are “higher quality”:

    • The essential amino acid profile of eggs is virtually identical to broccoli and asparagus. It is more concentrated in eggs due to the lack of fiber. Given adequate calories of a varied diet it is not possible to be “protein deficient”. In fact consuming high amounts of protein especially animal has been shown to be harmful. Dr. McDougall wrote two excellent articles on protein with references.

      • Paleo Huntress

        How does an egg equal “too much protein”? Is there any reason one can’t eat eggs without eating too much protein? Two large eggs equals 12 grams of protein but a cup of steel cut oatmeal contains 10. If you add a few nuts you’re right there with the eggs.

        • Brandon Klinedinst

          The eggs are high in the amino acid methionine, which has undesirable consequences compared to plant foods. Plant foods have better ratios of arginine, BCAAs, and other desirable amino acid profiles lacking in animals products, necessarily eggs.

          • Paleo Huntress

            So, to conclude… the answer is no, there is no reason why one can’t eat eggs without eating too much protein. Thank you.

          • Brandon Klinedinst

            Because your body will not absorb excessive amounts of protein indefinitely, the more undesirable amino acids in one’s diet, the more permanent displacement of desirable amino acids.

          • Brandon Klinedinst

            Compounded by the fact that more methionine means more cellular proliferation, which leads to cancer progression and tumor growth. Eggs are very high in methionine.

          • Paleo Huntress

            And yet, people who eat eggs don’t have more cancer. Hmmm… Citation, please.

          • Brandon Klinedinst

            It’s a phenomenon termed “methionine dependence”. You can google the phrase and find much information on it.


            The take-home point here is that an optimal diet, assuming optimal is maximizing health and longevity, is a diet that is lower, rather than higher, in methionine. This necessarily requires a reduction or avoidance of animal products.

          • Paleo Huntress

            That argument would be far more convincing if vegetarians had lower overall rates of cancer, but they don’t. They simply have different kinds of cancer– with plant proteins having a higher correlation to cancers overall than animal proteins.

            Do you know what else cancer cells have an absolute dependence on?


            ALL cancer growth will be inhibited by a diet that favors fatty acid metabolism over glucose metabolism. If you’re concerned about cancer, you should be looking into a hypo-caloric ketogenic diet.

          • Han

            Citation, please…

          • Phaedra

            In much the same way that plant-based proponents argue that a good combination of different plant foods will provide a complete amino acid profile, the same can be said for animal food. When glycine is added to the diet (good sources would be poultry skin, gelatin and stock/broths made with skin and cartilage– the parts that people used to routinely eat), methionine becomes a non-issue. Turns out it isn’t about too much methionine, but rather too little glycine. A point of context, whole grains and wheat germ, etc.. are also quite high in methionine. An ounce of egg white contains 191mg, but an ounce of wheat gluten contains almost twice that at 375mg– and an ounce of wheat germ contains 165mg. You can see how other cereals stack up here.

            Dietary glycine supplementation mimics lifespan extension by dietary methionine restriction | FASEB J. April 2011 25

  • Darryl

    While there are a number of studies demonstrating adverse health consequences from choline-free diets, quantitative measures of our requirements are sparse. The Intititute of Medicine’s current adequate intake for choline (550 mg for men, 425 mg for women) was set using just two studies. In one study on rather sick patients fed intravenously, 100-170 mg choline (as PC) was adequate to maintain plasma choline levels. In the other study, on healthy men found 500 mg/d dietary choline was found adequate, and 13 mg/d inadequate, in preventing increases of liver alanine aminotransferase. 38-fold is a wide range, the IoM chose the high-end + a margin, and who can fault them given how little was known.

    Choline is used in the body for synthesis of phosphatidylcholine in cell membranes, the neurotransmitter acetylcholine, and via betaine, cycling homocysteine back to methionine. I suspect betaine (rich in beets, spinach, and wheat) spares some of the choline requirement, but again, evidence is spare.

  • Bethery

    What about CLA (conjugated linoleic acid)? My mother-in-law has read the only source of CLA is animal products, therefore I should eat meat and dairy. Is there a plant source of CLA? How important is it?

    • Toxins

      There is no dietary need to consume CLA, as our body converts ALA and omega 6 to CLA in adequate amounts.

      • Bethery

        Thanks. I will stock up on mushrooms.

    • Brandon Klinedinst

      CLA is found in mushrooms of many types :)

      • Brandon Klinedinst

        Including common mushrooms like crimini.

        • Bethery

          Thank you. Now I have something to counter with.

          • Paleo Huntress

            The CLA in mushrooms is found in very low concentrations. One would need to eat approximately 1/2 pound per day to reap the benefits.

          • Brandon Klinedinst

            You don’t want to consume too much trans-fat. Just barely above none-at-all is best. You get the perfect amount of trans-fat per day from a vegan diet. You’ll average about 100mg per 2000 calories.

          • Paleo Huntress

            CLA is the trams-fat exception. More is better.

          • Brandon Klinedinst

            There is an optimal amount desired. Humans consuming a diet high in plant foods have two benefits in regards to CLA, which humans consuming omnivorous diets don’t have. First off, vegan digestive tracts have higher bifidobacteria populations. Secondly, plant-based diets generally have large amounts of ALA intake. The bifidobacteria bioconvert large amounts of the ALA to CLA.

            This conversion in compromised in individuals with digestive pathologies, like those associated with intake of animal products, and in those lacking adequate bifidobacteria populations, like those consuming large amounts of animal products.

            The result here is that most omnivores and probably some vegetarians are ‘deficient’ in CLA.

          • Paleo Huntress

            Wow! That’s quite the claim to make without backing data. Citation please.

          • Brandon Klinedinst
          • Han

            Citation, please….

  • Ceri

    Am I right in interpreting the post above as choline is important in reducing homocysteine in the body?

    • Darryl

      Homocysteine can be remethylated back into methionine either through the folate cycle (which requires folate, B6 and B12), or via BHMT (which requires betaine). Betaine occurs in foods , especially beets, spinach, wheat; and can also be produced from dietary choline. Deficiencies of any of the cofactors in parentheses can result in elevated homocysteine.

  • Guest

    Dynamite video! Very clear and convincing.

  • Anne

    Wow..that’s scarey…thanks so much for all of your info….

  • Should vegans avoid soy lecithin in bread making/bakery products? It has a reasonably high amount of choline… or is it not enough to be significant? Someone once advised me to add lecithin to kids food as they need more for brain development – surely this is unnecessary on a wholefood plant-based diet?

    • Enola Knezevic

      Perhaps choline is under-represented in USDA database, but, on the vegan diet, I rarely get more than, say, 30% RDA. I used to take 14 mg of soya lecithin a day, but switched to a choline supplement because of the fat content. (I must admit I often forget to take the supplement).

      So, I, too. would like to know what choline intake I should strive to.

  • Linda

    Hello, I have a Colonoscopy Bag at this time due to Colon Surgery. “Eggs” really make my bag stink! Especially after two days in a row. Garlic does too but, that is a much better smell. LL

    • Paleo Huntress

      Eggs are rich in beneficial sulfur compounds, so that makes sense. Leave some steamed broccoli sitting around for a few days and see how ripe that gets. ;-)

  • Rick Phillips

    Is there the same problem mentioned in the video with choline if one only eats egg whites? What about egg whites in general, if eaten occasionally?

  • Aponi

    I question everything because there is so much misinformation everywhere, especially when things like money, prestige and notoriety are the key motivating factors for putting out the information. I agree with much of what I saw on a video I watched last night put out by Dr. Greger. However, I am skeptical about some of the information as well. After watching the video, I subscribed to this site to do some more investigating. This was the second video I watched, and I am now even more skeptical. I know that the egg industry is motivated by money, so information they put out is something I completely ignore. I have had vast improvements in my health since changing to a primarily plant-based diet. I do wonder, however, about the wisdom of relying on any “supplement.” Nature provides everything we need, and it always has – long before companies began making supplements to sell. I can honestly say I don’t know much about choline. That is one of the reasons I chose to watch this video. However, the anti-egg and cholesterol hype makes me question the bias behind any information found here as well. I am not certain whether eggs are healthy or unhealthy overall. My guess would be that eggs produced naturally and consumed in moderation are probably beneficial to health. As with everything else, dosage (keeping balanced proportions) is likely the most important factor. Even too much water, something of which we can consume large amounts and is absolutely necessary for our survival, is deadly when taken in excess proportions that throw our chemistry out of balance. Eggs are a natural source of B12 (although B12 is produced by bacteria and only stored in animal source foods and cooking, from what I understand, may reduce it’s bioavailability. I am currently looking into fermentation as another possible source). From what I gather, if a person is otherwise healthy and has a good balance of gut flora, even the choline in eggs is probably not likely to cause any major problems if taken in moderation. Cholesterol, on the other hand, is absolutely necessary to our survival as well. It has been known for a long time that there is no connection between cholesterol in food and cholesterol in blood. The connection that was promoted was based on faulty science motivated by money, prestige and notoriety. By far the bigger culprit to many of our current health epidemics is a plant-based sugar called fructose. Of course, it would be ridiculous to encourage everyone to avoid eating plants because of this, even those containing fructose. Instead, moderation and proportion, are key to good health, at least in my humble opinion.

    • Brandon Klinedinst

      I personally appreciate your skepticism. A few things I would take into consideration are that, for starters, the bioavailability of b12 in eggs is very poor, such that to meet one’s daily needs, he or she would be far exceeding any “balanced proportions”. And asides from the b12 content, I’m not aware of anything interesting about nutrition in eggs (certainly not the protein, since it’s too high in methionine).

      Also, while fructose is harmful when processed and used by itself, in the context of a whole plant food, added to a diet with plenty other variety, it’s perfectly fine and healthful.

      • Aponi

        Thank you for your feedback. I would like to point out, however, that I was not arguing in favor of eggs (or against them either). I think that much of the worry over B12 intake is overblown actually. I also agree that fructose, when taken in conjunction with its whole food source is probably not overly problematic. Our addiction to sweets in general, however, is much more of a concern. I, personally, have a great deal of digestive problems related to consuming most animal products. Therefore, I support the idea of eating a primarily plant-based diet. But I would have no qualms about eating anything that my body needed for optimal health.

        The purpose of my previous post was to point out the fact that some of the things represented in the video and on this site are citing faulty science. When I see this kind of thing from any informational source, it is a red flag for me because this knowledge has been out there for a long time. I simply cannot believe that people claiming to be experts are still demonizing cholesterol found in foods. Usually when I see that, I simply cross off that information source as being not credible because it is perpetuating a falsehood. It makes me question whether there is some hidden agenda here.

        • Paleo Huntress

          I think there are so many proponents of WFPB diets who simply don’t understand how much damage they do to their message by lying or misrepresenting evidence. Once you’ve been labeled a liar, people just stop listening to you. Dr. Greger may “scour the research”, but he only shares what he believes supports his message. And that is unfortunate.

    • It is confusing. It is important to be skeptical and to look at the literature. Our bodies produce cholesterol naturally. In my clinical experience there is a direct relation to cholesterol in the diet and the blood cholesterol. Fructose has a much smaller effect but can be significant if fructose is consumed in large enough amounts. Fructose is metabolized by the liver to uric acid, inflammatory aldehydes, triglycerides and some glycogen. I await the pharmacokinetic studies which help sort this out but until then it seems to me the science supports a whole food plant based diet with adequate B12 intake. I advise my patients to avoid eggs for a variety of reasons. For an exposure on the complexities involved I would recommend Dr. Campbell’s recent book, Whole.

  • My head is going to explode when it comes to EGGS! here is what i just found on another person’s page about EGGS: Eggs are so incredibly nutritious that they’re often called “nature’s multivitamin.”

    The nutrients in them are enough to turn a single cell into an entire baby chicken.

    However, eggs have been demonized in the past because they contain a large amount of cholesterol, which was believed to increase the risk of heart disease.

    But the truth is that despite being high in cholesterol, eggs don’t really raise the bad cholesterol in the blood. In fact, eggs primarily raise the “good” cholesterol (1, 2, 3, 4).

    Despite all the warnings about eggs in the past few decades, studies show that they are NOT associated with heart disease (5, 6, 7).

    If anything, eggs are pretty much a perfect food for humans. They’re loaded with protein, healthy fats, vitamins, minerals and unique antioxidants that protect the eyes (8, 9).

    They are also an excellent source of Choline, a nutrient that is very important for the health of the brain and about 90% of people aren’t getting enough of (10, 11).

    Despite being a “high fat” food, eating eggs for breakfast is proven to cause significant weight loss compared to a breakfast of bagels (12, 13).

    Bottom Line: Eggs are among the most nutritious foods on the planet and do not raise your risk of heart disease. Eggs for breakfast can help you lose weight.

    Read more:

    WHAT IS THE TRUTH???!!! I have listened to every video you have posted on EGGS and trying to reprogram my thinking- but everywhere i turn they are saying GOOD things about EGGS…so confused.

  • Toxins

    The key with articles that random authors post is to examine whether the claim they made is true. This would require looking through their references and checking the validity of their conclusions based on the referenced studies. Any author can say anything really if they misconstrue the data. Also, because a study concludes so and so, it does not mean this is a solid fact. You actually have to read how they conducted the study and if what they studied was significant. For example, a study Dr. Greger shared showed that fruit and vegetable consumption was not associated with lower mortality, but the amount of fruits and veggies consumed for the “high intake” group was still below 5 servings. We cannot then conclude that this study was significant, because 5 servings of fruits and veggies is still sub par.

    • Debbie Pepper Howard

      Thanks for the response. i get it about random authors but this is the information that is served up over and over again. i wish we could put the Doctors/Authors up for debate on issues like EGGS and have them battle it out and finally for once and for all have the TRUTH. Who is telling the truth? it just seems like every year something becomes bad for you…but oh wait… next year or so it’s not…ugh. I really feel like the minority here when it comes to the EGG debate- especially when the majority of “opinion” is that EGGS are the most amazing food out there. I keep re-posting Dr. Greger’s videos on my Fb page and I get the fight of a lifetime. .. not that it will stop me….but I guess I just want to be 100% sure. It’s not easy training an old brain to rethink everything it was once taught.

      • Toxins

        Its not just about the opinions, but whether they have the evidence to back their claims.

        As i posted above, its important to “examine whether the claim they made is true. This would require looking through their references and checking the validity of their conclusions based on the referenced studies. Any author can say anything really if they misconstrue the data. Also, because a study concludes so and so, it does not mean this is a solid fact. You actually have to read how they conducted the study and if what they studied was significant.”

        Here is a good summary of eggs.

        Eggs are considered good sources of lutein and omega 3 as well as an excellent source of protein. For these reasons, they are considered health foods. Looking at these claims in detail, chickens have lutein due to the fact that they have a varietized feed, these nutrients are not inherent of eggs. Based on the nutrient data found on the USDA database, 10 grams of spinach has approximately 12 times more lutein then 10 grams of an egg. We cannot really consider eggs an appropriate source of this nutrient.

        Regarding Omega 3, current levels of omega 3 in eggs are highly inadequate and one must consume around 30 eggs to reach an acceptable level of omega 3 for the day. A male needs around 1.6 grams of omega 3 per day, a female needs around 1.1 grams a day. A large egg contains about .037 grams of omega 3. Omega 3 in the ALA form processes to EPA which is also processed to DHA. These fats are anti-inflammatory. Omega 6 processes down to arachadonic acid which is highly inflammatory. According to the National Cancer Institute, eggs are the number 2 top contributor of arachidonic acid in the American Diet.

        Based on this as well as the low omega 3 content of eggs, the benefits received from omega 3 are masked by the high quantity of preformed Arachidonic Acid. High intake of arachadonic acid is linked to autoimmune diseases such as rheumatoid arthritis, ulcerative colitis, as well as a clear link with cancer development.

        Eggs have been associated with heart failure as noted here. “After 13.3 years of follow-up in this cohort of approximately 14,000 white and African-American men and women, greater intake of eggs and of high-fat dairy foods were both associated with greater risk of incident HF, whereas greater intake of whole-grain foods was associated with lower risk of incident HF. These associations were independent of demographic characteristics, lifestyle factors, prevalent CVD, diabetes, hypertension, and other food groups.”

        As well as an association type 2 diabetes with egg consumption of 1 egg a day. “Overall, the observed increased risk of type 2 diabetes with daily consumption of eggs in the current study raises the possibility of undesirable health effects with high rates of egg consumption and may help explain previously reported increased risk of CHD that was restricted to individuals with type 2 diabetes in the Health Professional Follow-up Study”

        In the Canadian Journal of Cardiology, David Spence (director of the stroke prevention/atherosclerosis research center and one of the worlds leading stroke experts), David Jenkins (the inventor of the glycemic index) and Jean Davignon (director of atherosclerosis research group) posted a review on eggs claiming that the egg industry has been downplaying the health risks of eggs through misleading advertisements. As soon as you eat one egg, you expose your body to several hours worth of oxidative stress, inflammation of ones arteries, endothelieum impairment (what keeps you blood running smoothly) and increases the susceptibility of LDL cholesterol to oxidize (beginning stages of heart disease). The authors go into great detail regarding dietary cholesterol and it is a very fascinating read indeed. The author’s final words “In our opinion, stopping egg consumption after a myocardial infarction or stroke would be like quitting smoking after lung cancer is diagnosed: a necessary act, but late.”

        The egg industry has claimed that cholesterol from eggs is not important and does not raise cholesterol levels. The fundamental flaw in the study the egg industry has used to make this claim is that they measured fasting lipid levels at night and not levels through out the day after egg consumption. “Diet is not all about fasting lipids; it is mainly about the three-quarters of the day that we are in the nonfasting state. Fasting lipids can be thought of as a baseline; they show what the endothelium was exposed to for the last few hours of the night.”

        A single egg yolk contains approximately 215 to 275 mg of cholesterol. A safe upper limit can be capped at 200 mg if one is looking to prevent heart disease as recommended by the CDC as one of their nutritional recommendations as seen on page 92. One egg far exceeds this daily upper limit.

        The balance of science is clearly against even moderate egg consumption as this food is a packaged deal. We do not get the nutrients found in eggs without getting the cholesterol and saturated fat. This similarity can be seen with chicken in terms of cholesterol and arachidonic acid

        as well as even the leanest beef containing an undesirable quantity of saturated fat as well as cholesterol

        “Tolerable upper intake levels (ULs) set by the Institute of Medicine (IOM) are important, in part because they are used for estimating the percentage of the population at potential risk of adverse effects from excessive nutrient intake. The IOM did not set ULs for trans fat, saturated fat, and cholesterol because any intake level above 0% of energy increased LDL cholesterol concentration and these three food components are unavoidable in ordinary diets.”

        In terms of saturated fat, the link below displays the top food sources of cholesterol raising fat.

        • Debbie Pepper Howard

          wow! thank you SO much for all of this information. i appreciate you taking the time to spell all this out for me. seriously, thanks. I am copying this and will be sharing this with friends!

        • Paleo Huntress

          Good to see that your copypasta skill is still alive and well.

          Unfortunately, plant sources of lutein are particularly difficult to assimilate. In this study, the folks eating the spinach (12,000 mcg/100 gram serving– that’s 3 CUPS, and 12 TIMES as much lutein by measure) DIDN’T improve their serum lutein levels as much as those eating the eggs- in fact, only 1/3 as much.

          So, even though the spinach contains 12 times the amount of lutein as the eggs, eating the spinach only increased serum lutein 1/3 as much as the eggs.

          This was even after COOKING the spinach with some oil, which researchers found significantly improved lutein availability above raw and cooked without oil.

          In the interest of transparence, the eggs had higher lutein levels than standard eggs, but nowhere NEAR the levels of the spinach.

          J. Nutr. August 1, 2004 vol. 134no. 8 1887-1893

          • Toxins

            And your point? I don’t know of a lutein deficiency among vegans. Consuming a single food for one nutrient is a poor approach to diet. Food is a package deal, one cannot consume the eggs without the marked levels of arichidonic acid and dietary cholesterol.

          • Paleo Huntress

            Aw now don’t be sore– clearly you think it’s important or you wouldn’t write about. And yet you DID write,

            “Based on the nutrient data found on the USDA database, 10 grams of spinach has approximately 12 times more lutein then 10 grams of an egg. We cannot really consider eggs an appropriate source of this nutrient.”

            And my point is that eggs raise lutein levels MORE than spinach, even though spinach “contains” significantly more lutein. So contrary to your claim (and the claims of so many PB advocates that gush on about what a plant foods contains instead of what really matters, what is bioavailable) we really CAN consider eggs a good source of lutein.

          • Brandon Klinedinst

            Lutein and zeaxanthin, which are both xanthophylls, are absorbed best when consumed with fat. So add some avocado, olives, or nuts and seeds in with your dark leafy greens.

          • Paleo Huntress

            That will definitely help a little.

      • Paleo Huntress

        Rather than posting opinion articles, why not track down his references yourself (he usually includes them) and post those links instead?

        • Dan

          Stanley Hazen’s research group at the Cleveland Clinic has shown that egg-induced TMAO elevations are strongly linked to the development of subsequent cardiovascular events over follow-up. That is a prima facie case for abandoning eggs in the diet. Not only that but taking choline, L-carnitine, steak or eggs puts TMAO to extremely high levels, and TMAO appears to induce atherosclerosis in both humans and mice. Vegans have a lesser elevation but it is still strikingly high. This is aside from the very high cholesterol content of eggs. Also one can build an ethical case for not eating eggs, even free-range.

          • Paleo Huntress

            That sounds interesting, Dan. Would you share the citation please?

          • Dan

            Look in PubMed by author – Stan Hazen at the Cleveland Clinic. His papers have been in Nature Medicine and the New England Journal of Medicine.

          • Paleo Huntress

            “I know I’m right, I just do, now go prove it for me.”

            Uh huh.

          • Paleo Huntress

            As an aside, anyone can build an ethical case for not eating row crops too, even organic and local.

  • Aponi

    You are so right! There is so much information and misinformation out there that it is enough to keep your head spinning for the rest of your life. I love to do research, and I use the information I gain to do my own experiments. One thing I have learned is that we all may have some general or broad nutritional needs, but each person is also unique. Just as no two fingerprints or snowflakes are identical, every individual has a unique chemistry that is determined by both genetics and environment. Therefore, I only use the information I find as guidelines and experiment to see what works best for me. I have learned to become very attuned to what my body tells me. Even if every bit of bias was removed from science (which it is not), then the best it can offer is theories based on the specifics of it’s study (those involved and which factors were controlled). Human beings do not live in a controlled laboratory setting. We are always having to adapt to conditions in our environment. Therefore, our nutritional needs can vary significantly from one individual to the next and even one point in time to the next. For example, if I was starving, not only would I be thrilled to have an egg, I may look at other types of food for survival that I would not otherwise even consider and my body would likely be happy for it! Since this is not my case (at least at this time), I can be more choosy about what I eat. Again, I listen to my body about what it needs. From time to time, I seem to crave eggs. I am not sure what I am lacking when that happens, but my body recognizes that eggs have provided whatever it is in the past and creates this craving within me. When I eat an egg or two the craving disappears and even the thought of eating an egg sounds repulsive. I think it is useful to gather information so you can learn more about what kinds of things to try for yourself. The key is to learn to listen to your body first before worrying so much about what various sources say. Use information to get ideas for trying new things to see what works best for you. Using this method, maybe one day I will find what it is about eggs that my body wants and be able to consume that instead of eggs. Until then, eggs it is! =)

    • Debbie Pepper Howard

      I totally agree with what you are saying.

      For me, I had stopped eating eggs years ago because I would immediately get nauseated- then I tried fresh farm eggs and I didn’t feel ill. Today I look at them differently with all of this information that is not good- and I just can’t bring myself to eat them. I used to LOVE scrambled eggs every morning, now i have a smoothie…I just can’t take the chance. My Mother, father, and most of my family has died form one cancer or another- and YOUNG. I just don’t want to take a chance on eggs killing me first!

      I feel like I have gone back to college and my major is now FOOD! I really do want to know as much as possible, obviously or we wouldn’t be on this site, but sometimes it’s overwhelming.

      • Paleo Huntress

        Every person is unique in how they respond to different foods, but FWIW, after 2 years of consuming NO animal foods, I returned to eating them, especially eggs. My serum cholesterol dropped almost 150 points and the ratio corrected itself. Turns out that for me, it was starch and grain that was elevating my endogenous production. So you need to figure out what enflames your body chronically and avoid those things.

        • Toxins

          Clearly your original vegan diet was lacking in nutritional quality.

          • Paleo Huntress

            Precisely. A WFPB diet was lacking in nutritional quality. It’s good that you’re able to acknowledge that WFPB is.

          • Paleo Huntress

            You are seriously abusing your moderator privileges. It’s getting rather comical now. Maybe I just need to send a personal message to Dr. Greger and point out how bad your behavior is making NF look.

        • Dan

          Total fasting cholesterol is a rather poor marker of future cardiovascular events – it would be interesting to see what your postprandial levels are doing.

          • Paleo Huntress

            Cholesterol in general is a poor marker of future cardiovascular events. What’s far better is inflammatory markers.

          • Dan

            Actually, Ridker has demonstrated numerous times that LDL cholesterol and hsCRP share about the same, fairly poor predictive value for cardiovascular events. I take no reassurance from having either a low LDL cholesterol or a low hsCRP. I take much reassurance from the quality of my diet and its absence of animal protein, low levels of choline and L-carnitine (which are demonstrated adverse cardiovascular risk factors, at least in humans), absence of cholesterol, low saturated fat and virtually no trans fat, no highly oxidative heme iron, and low phosphate load, little or no PAH’s and HCA’s.

            I simply do not see any benefit in terms of eating meat, eggs, dairy or fish – and much potential for harm, even if only from contaminants (and I don’t believe it’s only from contaminants). Eat as much grass-fed, organic, antibiotic and growth hormone-free red meat as you want – it’s still a leading risk factor for colorectal cancer (one of the top 3 cancers in men and women). Eat as much wild salmon as you want, it still produces unhealthy levels of TMAO and likely contains at least some bioaccumulative mercury.

            And if you’ve ever seen how a cow or a fish is killed, you’ll also likely never want to consume them again (but that maybe just me). The fact that a whole foods plant-based diet is healthy dovetails nicely with its impact on the environment, sustainability, animal welfare, global warming, even income disparities in poor nations (farm factory workers are amongst the poorest paid in our society).

            As far as I know, none of the above is a lie, and all of it is based on peer-reviewed science.

          • Paleo Huntress

            Well thank you for the sermon, but let’s stick to facts you can cite rather than your opinion.

  • Billy B

    The “Eggs(food)” article on Wikipedia is misleading in many regards of their nutritional value. If you know of anybody looking to support your egg research, perhaps a good testing ground for debate on these issues would be in the Eggs (food) article.

  • Kate McConaughy

    The trimethylamine produced from eating an excess of cruciferous vegitables such as broccoli and cauliflower can also cause the fishy odered bacteria to rear up. Is this a cause for consern for vegans?

    • Brandon Klinedinst

      I was unable to locate any information about TMA or TMAO in brassica vegetables. In the studies discussed on TMAO, researchers observed that vegans eating a steak (for the sake of science) were unable to produce the deadly compounds in their guts due to such discrepancies in intestinal bacteria species.

      • Paleo Huntress

        They had to KILL all of their gut flora first to accomplish this though. Vegans’s guts (mostly) all contain this same flora because most ate animal food at one time. So the only way any vegan could manage this is to take a powerful antibiotic and kill off all of their existing flora– and this is never a wise thing to do.

      • Kate McConaughy

        Google trimethylamine broccoli. There are quite a few references to brassica and choline reactions.

  • uv

    I recently read a vegan nutrition site, and the author mentions choline as something vegans are at risk of getting too little of.

    I then did a Google search on choline and found an article ( saying women need 425mg per day and men 550mg per day.

    The same article made it seem that getting enough choline as a vegan is possible, but only if consciously eating the right foods in the right amounts, and even then it would be a bit of a challenge. It made me consider taking a choline supplement. Then I saw this video and now I’m confused.

    Do you think that the current daily recommended intakes of choline are too high (due to the link with cancer)? Or is it true that most vegans probably aren’t getting enough choline and need to put in the effort to get enough?

    • Brandon Klinedinst

      Please no choline supplement. Just eat a balanced diet of berries, legumes, dark leafy greens, whole grains & starches, and nuts & seeds, with ample amounts of all the others fruits and veggies.

  • Oliver Hugh Perry

    Jack Norris, RD article on Choline…

  • Dr. Michael L. Smith

    Choline may be necessary in those with certain genetic SNPs which can negatively impact the SAMe methylation conversions and your rather superficial use of “cholesterol” as problematic in itself implies that the cholesterol is the problem whenin most cases it is [it’s] oxidation that is more of a problem.

  • daniel

    so i should not worry that i do not get enough choline? cause i am not. i never go beyond 350 mg since i cannot eat so much spinach or whatever.

    • Brandon Klinedinst

      Choline is very important. I had low choline as a vegan for about 2 years, and after that found out I had severely elevated homocysteine as a result (the cause was not b12 deficiency because this was tested and I was fine).

      Now my vegan diet is about 50% fruit, as these are the only plant foods high enough in choline and that digest quickly enough. If you try getting your choline from beans and greens you won’t be able to, because you will get too full too quickly. Only with fruit can you eat and digest enough to get what you need.

      Also many nations have their RDI for choline set to 450mg, while the US says 550mg. The 550mg is probably an overstatement.

  • Josh

    Can anyone help shed some light on choline and pregnancy. A popular book says eating eggs provides the choline a growing baby needs. I’ve watched the videos and read How Not to Die and would rather avoid eggs. Can anyone offer up how much choline is recommended and other plant sources?


  • Here’s another egg-industry-funded study for you, finding that an egg a day reduces the risk of stroke (but doesn’t improve the chances of reducing heart disease). I wonder how many unethical scientists it takes to produce the large volume of fraudulent studies.