Doctor's Note

If you’re a long-time follower and some of this sounds familiar, it’s because I had to fast-track some of this choline information to offer background for my Dr. Oz Show appearance. A longer video that covers this can be found in Carnitine, Choline, Cancer and Cholesterol: The TMAO Connection. In my last video, Eggs and Choline: Something Fishy, I talked about what trimethylamine might do to one’s body odor.

With regard to the prevention of prostate cancer progression, chicken and eggs may be the worst foods to eat, but what might be the best? See my recent video Prostate Cancer Survival: The A/V Ratio.

More on the heterocyclic amines in chicken and eggs in:

To prevent prostate cancer in the first place, see videos such as:

What about reversing cancer progression? See Dr. Ornish’s work Cancer Reversal Through Diet?, followed up by the Pritikin Foundation: Ex Vivo Cancer Proliferation Bioassay. Flax may help as well (Flaxseed vs. Prostate Cancer).

For more context, check out my associated blog post: Why the Egg-Cancer Link?

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  • Brian Humphrey

    Great job exampling (the graph really helped) how increase intake of Choline can lead to a spike in TMA levels in throughout the body! Also love the email at the end. Priceless!!
    Thanks again Dr. Greger!

  • Don P

    Is there Choline in egg whites? Does the consumption of egg whites promote the same results?

    • Roberta Peck

      See my comment above, the choline is primarily in the yolk.

    • Is it the methionine in egg whites that might be problematic?

  • SFR53inAZ

    Choline has been touted as good for your memory – and is only in the yolk?
    Is this true and what else can do the job of choline for your memory?
    Thanks

    • Roberta Peck

      There is choline in many plant based sources,only in much lower amounts.

    • Thea

      SFR53inAZ: I highly recommend the book, “Power Foods For the Brain” by Neal D. Barnard, MD. I think that book will answer your questions about the best way to protect your memory. Good luck.

  • Roberta Peck

    Dr.Barry Sears states that the only way to eat eggs is to throw the yolk away since it contains so much aracodonic acid. After I looked up the choline in whites vs yokes, I found that the choline is primarily found in the yolk.

    • Toxins

      Regardless of this fact, egg whites have the potential to raise IGF-1 and should be generally avoided.
      http://nutritionfacts.org/index.php?s=igf-1

    • blackbart

      A scientific advisory from the American Heart Association has favorably evaluated the health impact of dietary omega-6 fats, including arachidonic acid.[21] The group does not recommend limiting this essential fatty acid. In fact, the paper recommends individuals follow a diet that consists of at least 5–10% of calories coming from omega-6 fats, including arachidonic acid. Dietary ‘ARA is not a risk factor for heart disease, and may play a role in maintaining optimal metabolism and reduced heart disease risk. It is, therefore, recommended to maintain sufficient intake levels of both omega-3 and omega-6 essential fatty acids for optimal health.’

      http://en.wikipedia.org/wiki/Arachidonic_acid

  • HemoDynamic, M.D.

    LMAO about TMAO!
    Did you get a Whiff of that?
    (Gotta have some fun these days :)

  • Toxins

    Please view the last video for some reference. Choline is easily attained and most people get too much already.
    http://nutritionfacts.org/video/eggs-and-choline-something-fishy/

  • eva101

    what about choline from soybeans. how much is harmful?

  • otto9n9otto

    Should we also shun radishes (which help prevent prostate cancer) and peas due to the choline content?

    http://nutritiondata.self.com/foods-000144000000000000000-18.html

  • Melissa

    I have a similar question: do high choline plant foods contribute a problem here?

  • Tara D

    Dr Gregor- is it still safe to continue taking my plant derived choline supplement?

    • Toxins

      Based on the evidence, I see no reason to consume supplemental choline, as people get it n far more then adequate amounts through diet alone.

      • I’ve vegan and input my daily food consumption into peacounter.com and found that I can meet or exceed the DRIs on all vitamins/minerals except choline. I don’t see any way I can get to the recommended 550 mg per day for men without a supplement.

        • I just saw this comment from Jack Norris, the creater of peacounter.com, who says on his blog:
          “The USDA database doesn’t include the choline amounts for most foods
          (and so neither does PeaCounter). That is a problem with the whole
          choline issue. But for items that show no choline, I extrapolate from
          other sources. Hopefully the USDA will include them in the future.”

          Therefore, I can’t rely on peacounter.com to determine how much choline I’m getting.

  • Fer M

    1 stalk of broccoli has the same amount of Choline as 1 egg according to nutritiondata.self. Is eating broccoli 2.5 times per week then also not recommended?

  • Tushar Mehta

    hello Michael

    I was reading this article and could not figure out if choline from animal products was found to be a worse offender than choline from veg products. it seems like there is a lt of choline intake from veg products too. I could not quite figure it out so defer to the bigger brain (you!).

    thanks!

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441112/

  • JD TalBeasy

    Background: I’m 25 years old and in good athletic shape. I weight train 3-4 days a week, while doing cardio at least 6 times a week(2 sprint sessions 4 walking sessions to help increase lipolysis).
    I eat at least 7-12 servings of vegetables a day. Is it still that detrimental to my health to eat 3 whole eggs 5-6 days a week even though I eat them either with 2 pieces of Whole grain bread or 3 servings of vegetables?

    • Toxins

      Being fit, and of good weight is one aspect of good health, but it does not necessarily protect you from chronic disease. Please see Dr. Gregers summary of eggs and view the attached links. There are many ill health attributes with eggs.
      http://nutritionfacts.org/topics/eggs/

  • DanT1945

    I’m wondering, does the choline increase the results from a PSA test. My PSA is always high. Runs about 8. We have done the biopsy thing and there is no issues that can be found. I’m wondering if I eat eggs before the test would it raise the result?? Just thinking out loud.

  • Jen

    Does eating foods containing eggs, like pasta or some breads like banana nut, still have the same effect?

  • blackbart

    Huh….then why does WebMD say only good things about Choline?

    http://www.webmd.com/vitamins-supplements/ingredientmono-436-CHOLINE.aspx?activeIngredientId=436&activeIngredientName=CHOLINE

    And Wikipedia calls it an ‘essential nutrient’?

    ‘Choline must be consumed through the diet for the body to remain healthy.[6] It is used in the synthesis of the constructional components in the body’s cell membranes. Despite the perceived benefits of choline, dietary recommendations have discouraged people from eating certain high-choline foods, such as eggs and fatty meats. The 2005 National Health and Nutrition Examination Survey stated that only 2% of postmenopausal women consume the recommended intake for choline.[7]’

    http://en.wikipedia.org/wiki/Choline

  • Derek Edmunds

    It is sad to see so many believe this propaganda. You often see many nutritionists come at the cholesterol in eggs(which eggs actually contain good cholesterol that can help move out the bad) but now you’re coming at the best thing about eggs? You keep saying you “think” or “it could also” but there is absolutely no supported research directly against choline. HOWEVER, if you believe this crap maybe you should also avoid salmon, shrimp, beef, chicken, cauliflower and many other healthy foods rich in choline. Do some research people and don’t let this guy think for you..

    • Thea

      Derek Edmunds: Yes, the strong recommendation is for people to avoid salmon, shrimp, beef, and chicken if they want the best chances at being healthy. For more information about meat:

      http://nutritionfacts.org/topics/meat/

      • approveds

        Salmon is the best food you can have, and the Queen, and Prince Philip practically live on it. As did the Queen Mother. It is also the main reason they are still working, in their 90’s, when most of their subjects, if they are still alive, are in nursing homes.

        The Queen can tell you every nutrient, vitamin, mineral etc in any food, and what it can do for you. They only use alternative therapy, (apart from operations). The reason salmon is so good for you, is that the pink colour is caused by the food they feed on, as with shrimps, , which is a microalgae called ‘astaxanthin’.

        • Thea

          approveds: This is a site that covers the science of nutrition. Stories about “the Queen” and her offspring, while amusing in a way, are not compelling arguments.

          From a scientific perspective, we know that salmon is very bad for you, just like all fish. Salmon has been specifically studied quite a bit, though, so you will see that particular fish mentioned on this site. You can get an overview of the science concerning fish by looking at this page: http://nutritionfacts.org/topics/fish. If you click through the links and find yourself on a NutritionFacts video page, you can click the ‘sources cited’ button to the right of each video to dive into the actual science if you are interested.

          That topic page on fish is really just the beginning of what we know about the nutritional harms of fish and salmon. To learn more, I invite you to explore the rest of this site. For example, you might look up the problems with animal protein as it relates to cancer.

          One more thought for you: It tickled my funny bone that you mention a microalgae in salmon as being the reason why you think that salmon is healthy. In other words, you think that plants (algae) that get inside the fish is the primary benefit for eating the fish. Funniness aside, consider that food is a package deal. When you eat salmon, you not only get the pink plant benefit, but you also get all the (huge) negatives that come with eating salmon: animal protein, contaminants, saturated fat, cholesterol, and probably others that are not coming to mind right now. We know from many different types of scientific studies that those bad things from salmon override any good things. So, why not get the good things directly (plants) and skip the bad things that comes with the fish package.

          Good luck.

          • approveds

            Are you a vegan, is this site a ‘Vegan Site’, if so it would explain your answers, which have very little to do with science? I understand the Vegan argument, and it has many merits, but it is not real science.

  • Brian R Gard

    Giving up eggs was easy, feel a lot better, I do not know what is wrong with people Whole Plant Foods is the only way to go….

    • approveds

      I have eaten at least four eggs per day since I was ten, sometimes 12 eggs per day. My cholesterol is low, and I am slim.

      • Thea

        approvedds: A lot of people who eat he way you do claim their cholesterol is low, but when they report the actual numbers for total cholesterol and LDL, in fact, the numbers are high. Do you know your actual numbers?

        Anyway, I hope you are the exception and are able to eat so much unhealthy things and still do OK. Just like there are some people who smoke and still do fine. You may have hit the gene lottery.

        • approveds

          You are wrong again, eggs are one of the best foods you can have. They contain lecithin, which breaks down cholesterol. as you know your total cholesterol contains good, and bad cholesterol. I am not an exception, I know more about diet than most people, and it is nothing to do with genes.

          • Thea

            approveds: From your replies, it appears that you have a lot more you could learn about diet if you want to know what the science has to say about it. I invite you to actually look at the information on this site, including topics that cover cholesterol and eggs.

            Hey, did you know that people who have a total cholesterol under 150 *and* an LCD under 70 are virtually heart-attack proof? There really is a safe level of cholesterol cholesterol to have. You can learn more about this topic on this site.

            Good luck.

          • approveds

            Most science now is moving towards the view that high cholesterol levels have nothing to do with health, heart or cancer.

  • link
  • crosswind

    Thanks for posting about TMAO. It’s linked to FMO3 gene mutation. a genetic disorder. 23andme does not test for this gene yet, but they said maybe they will in the future. It’s pretty obvious if we have this mutation, when we eat high choline & carnitine foods. I wonder if heavy metals lke mercury toxicity can trigger this gene. i never noticed an issue until about age 40, when i was diagnosed with MTHFR, CBS, COMT, MAO, double DAO & others. Either Addressing methylation or the overload of metals must have triggered. So, I’m eating low choline now & take charcoal for mold biotoxins & other serious detoxing.

  • plumr

    I have prostate cancer, and my main staple of my diet is eggs. have put on 30 lbs [which I needed]. my psa went from 90 to 1.3 in 6 months

    • Joseph Gonzales R.D.

      Glad to see the PSA fall and you were able to gain weight!

  • Will

    I am a huge fan of your website and am interested in breast cancer, so I looked at another study about choline and saw that greater consumption deceased breast cancer. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430758/#!po=50.0000

  • approveds

    All this information about eggs on this site is complete nonsense. Eggs do not increase you cholesterol, of increase risk of cancers.

    • Prof Dr S Bakhtiar Choudhary,

      Dear friends, My grand father, and his brothers all lived 100 years, ate daily a whole egg; I suppose just choline is not going to cause cancer or Progression. There are many etiological backgrounds for this. Contrary to this, Yolk is a very rich source of many vitamins and minerals; Eating an egg a day is no problem, mind it choline heat labile and gets denatured soon when you cook. So do not have eat raw egg. dont eat eggs at a time.. enjoy

      • approveds

        Brilliant, eggs are the best food in the World, followed by salmon, and watercress.

  • approveds

    If you want to be healthy, and still be working in your 90’s, then I suggest looking at the diet of the Queen and Prince Philip. They are a living experiment in nutrition. Most of the so called ‘experts’, will not even live into their 90’s let alone be working.

  • Sam

    Not everyone is the same genetically, here is an interesting article that backs up a claim that people with folate mutations require

    additional choline…

    “Overall, our findings indicate that loss-of-function variants in folate-metabolizing
    enzymes strain cellular PC production, possibly via impaired folate-dependent phosphatidylethanolamine-N-methyltransferase (PEMT)-PC synthesis, and suggest that women with these risk genotypes may benefit from choline intakes
    exceeding current recommendations.”

    “Genetic impairments in folate enzymes increase dependence on dietary choline for phosphatidylcholine production at the expense of betaine synthesis.”

    http://www.fasebj.org/content/early/2016/06/28/fj.201500138RR.abstract?maxtoshow=&hits=1&RESULTFORMAT=&title=Folate&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct

  • Sam

    One more note, Asians eat a lot of tuna, which is meat and is reach in choline.

    • Thea

      Sam: You wrote that Asians eat a lot of tuna. You did not cite a source for this information, nor quantify what “a lot” means. I have something for you think about:
      .
      The healthiest Asian population is the traditional Okinawans. They are known for having a large number of 100+ year olds, who are doing very well health-wise. The following post from Rami shows the break down of the traditional Okinawan diet: http://nutritionfacts.org/video/paleolithic-lessons/#comment-845250941

      In that post, you can see that only 1 percent of their calories came from fish. If you add up all sources of animal products, you still end up with less than 4% of calories. I would not define that amount as “a lot”.

      It’s interesting to note that 69% of their calories came from sweet potatoes and if you want to look at macronutrients, 85% of their calories were from carbohydrates. Interesting stuff!

      • Sam

        It is interesting, Thea, sweet potatoes… Thank you, I’ll look this over. Do you show any studies why Okinawan men have high testosterone levels?

        I came across a post, here: http://nutritionfacts.org/2013/02/12/less-cancer-in-vegan-men-despite-more-testosterone/

        so a guy asks an interesting question, that as he turned vegan his T levels dropped.

        • Thea

          Sam: I would have just referred you to the link you already found. (Good for you for finding that page.)

          The questions to ask would be: Is the guy accurate/correct? Were reliable tests done? And: What exactly was his diet? Because “vegan” does not tell us much. I’m not asking to analyze his diet. I’m just saying that if this guy you mention wants to figure out the issue, those are the areas he might look into.

      • Sam

        Thea, here is the reference you were asking about:
        http://www.huffingtonpost.com/dan-buettner/okinawa-blue-zone_b_7012042.html

        “Before 1940 Okinawans also consumed fish at least three times per week together withseven servings of vegetables and maybe one or two servings of grain perday. They also ate two servings of flavonoid-rich soy, usually in the form of tofu. They didn’t eat much fruit; they enjoyed a few eggs a
        week. Dairy and meat represented only about 3 percent of their calories.
        On special occasions, usually during the Lunar New Year, people
        butchered the family pig and feasted on pork.

        The meat in their diet gave me pause. When I first struck off on my Blue Zones research in 2000, I was absolutely convinced that I’d find that a vegan diet yielded the greatest health and life expectancy. So when I
        discovered that older Okinawans not only ate pork but loved it, I
        thought their example must be an outlier — that they were living long despite pork. Pork is high in saturated fat, which, when consumed in excess, often leads to heart disease. But again, we learn a few lessons.
        Okinawans stewed the pork for days, cooking out and skimming off the
        fat. What they ate, in the end, was the high-protein collagen.”

        • Thea

          Sam: Thanks for the reference. If you look analyze the article, you can see even with his own numbers, the Okinawans were eating minuscule amounts of animal products. Then he throws in statements that appear to contradicts the data he displays, but those statements are not backed up by data/studies.

          For example, “fish 3 times a week”. I wonder where that comes from. If true, it would have had to have been *tiny* amounts of fish. Even one ounce of fish seems to exceed the amounts a traditional Okinawan ate in a day if you go a by a study done in 1919. And fish would not be the only protein source. There would have been a lot of protein from all the other foods. So, the amount of protein the person could have gotten from fish would be extremely small.

          Study done in 1919? Check out the 1:40 mark in this video: http://plantpositive.squarespace.com/blog/2012/3/25/tpns-32-ancient-and-out-of-fashion.html Then, if you want to understand the numbers I’m discussing, bring up say 1 ounce of a fish (cod or salmon) on the Nutrition Self website to see how much protein and fat the animal product has in grams: http://nutritiondata.self.com/

          So, we have a study done in 1919 and a study done in 1949 showing that animal products were a very small part of the traditional Okinawan diet. Where the author of your article went with that information is baffling to me.

      • Sam

        “The second demonstrated that high intakesof milk and fats and oils had favourable effects on ten-year survivorship in 422 urban residents aged sixty-nine to seventy-one. The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the ten years. In the third study, nutrient intakes were compared between a sample from Okinawa Prefecture where life expectancies at birth and sixty-five were the longest in Japan, and a sample from Akita Prefecture where the life expectancies were much shorter. It found that the proportion of energy from proteins and fats were significantly higher in the former than in the latter. ”

        Shibata H., Nagai H., Haga H., Yasumura S., Suzuki T., Suyama Y. Nutrition for the Japanese elderly. Nutr & Health.

        “Okinawans eat about 100 grams of meat per day-compared to 70
        in Japan and just over 20 in China-and at least an equal amount of fish,
        for a total of about 200 grams per day, compared to 280 grams per
        personper day of meat and fish in America. ”

        Deborah Franklyn, “Take a Lesson from the People of Okinawa,” Health, September 1996, pp 57-63

        http://stan-heretic.blogspot.com/2009/10/beware-of-okinawa-diet-scam.html

        • Thea

          Sam: This has to be a study of modern people since as we have discussed, the traditional Okinawa diet, the one responsible for the exceptional health of their elders has very little meat. However, we know that modern people’s diets have changed dramatically. I don’t have the time to review that study to analyze it, but maybe someone else will do that for you.

  • comealivehealth

    I would like to know if eggs with yolks still runny and meats that are not well done but rather medium rare show up differently. Same with the blood type diet approach. It seems to me to chemistry of foods change when they are cooked versus not….and that the reason chicken and eggs show up as so damaging may be because we must cook them hard in order to avoid bacterial problems. I am looking at Hair Analysis material that says eggs (runny yolks) and meat are important to bring body biochemistry back to balance. Please comment. I so appreciate your excellent videos and research and explanations.