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Eggs, Choline, and Cancer

Choline may be the reason egg consumption is associated with prostate cancer progression and death.

October 14, 2013 |
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Supplementary Info

Sources Cited

E. L. Richman, S. A. Kenfield, M. J. Stampfer, E. L. Giovannucci, J. M. Chan. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: Incidence and survival. Cancer Prev Res (Phila) 2011 4(12):2110 - 2121.

E. L. Richman, M. J. Stampfer, A. Paciorek, J. M. Broering, P. R. Carroll, J. M. Chan. Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression. Am. J. Clin. Nutr. 2010 91(3):712 - 721.

M. Johansson, B. Van Guelpen, S. E. Vollset, J. Hultdin, A. Bergh, T. Key, O. Midttun, G. Hallmans, P. M. Ueland, P. Stattin. One-carbon metabolism and prostate cancer risk: Prospective investigation of seven circulating B vitamins and metabolites. Cancer Epidemiol. Biomarkers Prev. 2009 18(5):1538 - 1543.

C. Nanni, E. Zamagni, M. Cavo, D. Rubello, P. Tacchetti, C. Pettinato, M. Farsad, P. Castellucci, V. Ambrosini, G. C. Montini, A. Al-Nahhas, R. Franchi, S. Fanti. 11C-choline vs. 18F-FDG PET/CT in assessing bone involvement in patients with multiple myeloma. World J Surg Oncol 2007 5:68.

E. L. Richman, S. A. Kenfield, M. J. Stampfer, E. L. Giovannucci, S. H. Zeisel, W. C. Willett, J. M. Chan. Choline intake and risk of lethal prostate cancer: Incidence and survival. Am. J. Clin. Nutr. 2012 96(4):855 - 863.

E. Ackerstaff, B. R. Pflug, J. B. Nelson, Z. M. Bhujwalla. Detection of increased choline compounds with proton nuclear magnetic resonance spectroscopy subsequent to malignant transformation of human prostatic epithelial cells. Cancer Res. 2001 61(9):3599 - 3603.

Acknowledgements

Images thanks to MrX via Wikimedia Commons.

Transcript

Two million men in the U.S. are living with prostate cancer, but that's better than dying from prostate cancer. Catch it when it's localized and your 5-year survival is practically guaranteed, but once it really starts spreading your chances drop to 1 in 3. "Thus, identification of modifiable factors that affect the progression of prostate cancer is something that deserves study.” So Harvard researchers took more than a thousand men with early stage prostate cancer and followed them for a couple years to see if there was anything in their diet associated with a resurgence of the cancer, such as spread to the bone.

Compared to men who hardly ate any eggs, men who ate even less than a single egg a day had a significant 2-fold increased risk of prostate cancer progression. The only thing worse was poultry consumption. Up to 4 times the risk of progression among high-risk men. They think it might be the cooked meat carcinogens—the heterocyclic amines that for some reason build up more in chicken and turkey muscle than in other meats.

But what about the eggs? Why would less than once-a-day egg consumption double the risk of cancer progression? It may be the choline. A plausible breakfast mechanism that may explain the association between eggs and prostate cancer progression is high dietary choline. Egg consumption is a determinant of how much choline you have in your blood, and higher blood choline has been associated with a greater risk of getting prostate cancer in the first place. So the choline in eggs may both increase one's risk of getting it, then having it spread, and also having it kill you.

Choline intake and the risk of lethal prostate cancer. Choline consumption associated not just with getting cancer and spreading cancer, but also a significantly increased risk of dying from it. Those that ate the most had a 70% increased risk of lethal prostate cancer. Another recent study found that men who consumed 2 and a half or more eggs per week—that's just like one egg every three days--had an 81% increased risk of lethal prostate cancer. Now it could just be the cholesterol in eggs that's increasing fatal cancer risk, but it could also be that choline.

Maybe that's why meat, milk, and eggs have all been associated with advanced prostate cancer, because of the choline. In fact, choline is so concentrated in cancer cells that if you follow choline uptake you can track the spread of cancer through the body. But why may dietary choline increase the risk of lethal prostate cancer? Remember, dietary choline is converted in the gut to trimethylamine, and so the Harvard researchers speculated that the TMAO from the high dietary choline intake may increase inflammation. This may promote progression of prostate cancer to lethal disease.

In the New England Journal of Medicine, that same Cleveland Clinic research team that did the famous study on carnitine repeated the study, but this time instead of feeding people a steak, they fed people some hard-boiled eggs. Just as they suspected, a similar spike in that toxic TMAO, so it's not just red meat. And the link between TMAO levels in the blood and strokes, heart attack, and death was seen even in low-risk groups like those with low-risk cholesterol levels. Thus eating eggs may increase our risk regardless what our cholesterol is, because of the choline.

It's ironic that the choline content of eggs is something the egg industry actually boasts about. And the industry is aware of the cancer data. Through the Freedom of Information Act I was able to get my hands on an email from the executive director of the industry's Egg Nutrition Center to an American Egg Board executive talking about how choline may be a culprit in promoting cancer progression, "Certainly worth keeping in mind as we continue to promote choline as another good reason to consume eggs."

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.

To help out on the site please email volunteer@nutritionfacts.org.

Dr. Michael Greger

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).

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • 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.

    • http://www.eatandbeatcancer.com/ Harriet Sugar Miller

      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.

      • http://www.animalliberationaction.org/ Brandon Becker

        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.

        • http://www.animalliberationaction.org/ Brandon Becker

          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/