The reason egg consumption is associated with elevated cancer risk may be the TMAO, considered the “smoking gun” of microbiome-disease interactions.
Flashback Friday: How Our Gut Bacteria Can Use Eggs to Accelerate Cancer
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
“We are walking communities comprised not only of a Homo sapiens host, but also of trillions of symbiotic commensal microorganisms within the gut, and on every other surface of our bodies.” There are more bacterial cells in our gut than there are human cells in our entire body. In fact, only about 10% of the DNA in our body is human. The rest is in our microbiome—the microbes that we share with this walking community we call our body. What do they do?
Our “[g]ut microbiota [our gut bacteria microbiome] serve as a filter for our largest environmental exposure—what we eat. Technically speaking, food is a foreign object that we take into our bodies [by the pound] every day.” “And, the microbial community within each of us significantly influences how we experience [those meals].” “Hence, our metabolism and absorption of food occurs through [this] filter of bacteria.”
But, if we eat a lot of meat, poultry, fish, milk, cheese, eggs, we can foster the growth of bacteria that convert the choline and carnitine in these foods into TMA—trimethylamine, which can be oxidized into TMAO, and wreak havoc on our arteries, increasing our risk of heart attack, stroke, and death.
We’ve known about this troublesome transformation from choline into trimethylamine for over 40 years. But, that was way before we learned about the heart disease connection. Why were they concerned back then? Because these methylamines might form “nitrosamines [which] have marked carcinogenic activity”—cancer-causing activity.
So, where is choline found in our diet? Mostly from meat, eggs, dairy, and refined grains. The link between meat and cancer probably wouldn’t surprise anyone. In fact, just due to the industrial pollutants alone (like PCBs), children probably shouldn’t eat more than like five servings a month of meats like beef, pork, or chicken, combined. But, what about cancer and eggs?
Studies going back to the 70s hinted at a correlation between eggs and colon cancer. But, that was just based on so-called ecological data, showing that countries that ate more eggs tended to have higher cancer rates. But, that could be due to a million things, right? It needed to be put to the test.
This started in the 80s, and by the 1990s, 15 studies had been published: ten suggesting “a direct association” between egg consumption and colorectal cancer, and five showing “no association.” By 2014, there were dozens more studies published, confirming that eggs may indeed be playing a role in the development of colon cancer—though no relationship was discovered between egg consumption and the development of precancerous polyps, which suggests that “egg[s] might be involved [more] in the promotional [stage of cancer growth—accelerating cancer growth, rather than] initiating [the cancer in the first place].”
Which brings us to 2015. Maybe it’s the TMAO, made from the choline in meat and eggs, that’s promoting cancer growth. And, indeed, in the Women’s Health Initiative study, women with the highest TMAO levels in their blood “had…approximately [three] times greater risk of rectal cancer”—suggesting “TMAO [levels] may serve as a potential predictor of increased colorectal cancer risk.”
Though there may be more evidence for elevated breast cancer risk with egg consumption than prostate cancer risk, the only other study to date on TMAO and cancer looked at prostate cancer, and did, indeed, find a higher risk.
“Diet has long been considered a primary factor in health. However, with the microbiome revolution of the past decade, we have begun to understand how diet can” affect the back-and-forth between us-and-the-rest-of-us inside. And, the whole TMAO story is like “a smoking gun in [gut bacteria]-disease interactions.”
Since “choline…and carnitine are [the] primary sources of…TMAO production, the “logical intervention strategy” might be to reduce meat, dairy, and egg consumption. And, if we eat plant-based for long enough, we can actually change our “gut microbial communities,” such that they may not be able to make TMAO, even if we try. “The theory of “you are what you eat” [is] finally…supported by scientific evidence.”
We may not have to eat healthy for long, though. Soon, we may yet be able to “‘drug the microbiome’” as a way of “promoting cardiovascular health.”
Please consider volunteering to help out on the site.
- Tig H, Moschen AR. Food, immunity, and the microbiome. Gastroenterology. 2015 May;148(6):1107-19.
- Vinjé S, Stroes E, Nieuwdorp M, Hazen SL. The gut microbiome as novel cardio-metabolic target: the time has come! Eur Heart J. 2014 Apr;35(14):883-7.
- Xu R, Wang Q, Li L. A genome-wide systems analysis reveals strong link between colorectal cancer and trimethylamine N-oxide (TMAO), a gut microbial metabolite of dietary meat and fat. BMC Genomics. 2015;16 Suppl 7:S4.
- Miller CA, Corbin KD, da Costa KA, Zhang S, Zhao X, Galanko JA, Blevins T, Bennett BJ, O'Connor A, Zeisel SH. Effect of egg ingestion on trimethylamine-N-oxide production in humans: a randomized, controlled, dose-response study. Am J Clin Nutr. 2014 Sep;100(3):778-86.
- Falony G, Vieira-Silva S, Raes J. Microbiology Meets Big Data: The Case of Gut Microbiota–Derived Trimethylamine. Annu Rev Microbiol. 2015;69:305-21.
- Goldsmith JR, Sartor RB. The role of diet on intestinal microbiota metabolism: downstream impacts on host immune function and health, and therapeutic implications. J Gastroenterol. 2014 May;49(5):785-98.
- Bae S, Ulrich CM, Neuhouser ML, Malysheva O, Bailey LB, Xiao L, Brown EC, Cushing-Haugen KL, Zheng Y, Cheng TY, Miller JW, Green R, Lane DS, Beresford SA, Caudill MA. Plasma choline metabolites and colorectal cancer risk in the Women's Health Initiative Observational Study. Cancer Res. 2014 Dec 15;74(24):7442-52.
- Tang WH, Hazen SL. The contributory role of gut microbiota in cardiovascular disease. J Clin Invest. 2014 Oct;124(10):4204-11.
- Mondul AM, Moore SC, Weinstein SJ, Karoly ED, Sampson JN, Albanes D. Metabolomic analysis of prostate cancer risk in a prospective cohort: The alpha-tocolpherol, beta-carotene cancer prevention (ATBC) study. Int J Cancer. 2015 Nov 1;137(9):2124-32.
- Zeisel SH, Wishnok JS, Blusztajn JK. Formation of methylamines from ingested choline and lecithin. J Pharmacol Exp Ther. 1983 May;225(2):320-4.
- Yonemori KM, Lim U, Koga KR, Wilkens LR, Au D, Boushey CJ, Le Marchand L, Kolonel LN, Murphy SP. Dietary Choline and Betaine Intakes Vary in an Adult Multiethnic Population. J Nutr. 2013 Jun;143(6):894-9.
- Steinmetz KA, Potter JD. Egg consumption and cancer of the colon and rectum. Eur J Cancer Prev. 1994 May;3(3):237-45.
- Hernández ÁR, Boada LD, Almeida-González M, Mendoza Z, Ruiz-Suárez N, Valeron PF, Camacho M, Zumbado M, Henríquez-Hernández LA, Luzardo OP. An estimation of the carcinogenic risk associated with the intake of multiple relevant carcinogens found in meat and charcuterie products. Sci Total Environ. 2015 May 1;514:33-41.
- Matthew JA, Johnson IT. Egg consumption and risk-markers for colorectal neoplasia. Eur J Cancer Prev. 1995 Oct;4(5):425-8.
- Zhang J, Zhao Z, Berkel HJ. Egg Consumption and Mortality From Colon and Rectal Cancers: An Ecological Study. Nutr Cancer. 2003;46(2):158-65.
- Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15;15(4):617-31.
- Tse G, Eslick GD. Egg consumption and risk of GI neoplasms: dose-response meta-analysis and systematic review. Eur J Nutr. 2014 Oct;53(7):1581-90.
- Miller AB, Howe GR, Jain M, Craib KJ, Harrison L. Food items and food groups as risk factors in a case-control study of diet and colo-rectal cancer. Int J Cancer. 1983 Aug 15;32(2):155-61.
- Keum N, Lee DH, Marchand N, Oh H, Liu H, Aune D, Greenwood DC, Giovannucci EL. Egg intake and cancers of the breast, ovary and prostate: a dose-response meta-analysis of prospective observational studies. Br J Nutr. 2015 Oct 14;114(7):1099-107.
Image credit: Praveen via pixabay. Image has been modified.
Video credit: Tyler McReynolds, Teetotalin LLC
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
“We are walking communities comprised not only of a Homo sapiens host, but also of trillions of symbiotic commensal microorganisms within the gut, and on every other surface of our bodies.” There are more bacterial cells in our gut than there are human cells in our entire body. In fact, only about 10% of the DNA in our body is human. The rest is in our microbiome—the microbes that we share with this walking community we call our body. What do they do?
Our “[g]ut microbiota [our gut bacteria microbiome] serve as a filter for our largest environmental exposure—what we eat. Technically speaking, food is a foreign object that we take into our bodies [by the pound] every day.” “And, the microbial community within each of us significantly influences how we experience [those meals].” “Hence, our metabolism and absorption of food occurs through [this] filter of bacteria.”
But, if we eat a lot of meat, poultry, fish, milk, cheese, eggs, we can foster the growth of bacteria that convert the choline and carnitine in these foods into TMA—trimethylamine, which can be oxidized into TMAO, and wreak havoc on our arteries, increasing our risk of heart attack, stroke, and death.
We’ve known about this troublesome transformation from choline into trimethylamine for over 40 years. But, that was way before we learned about the heart disease connection. Why were they concerned back then? Because these methylamines might form “nitrosamines [which] have marked carcinogenic activity”—cancer-causing activity.
So, where is choline found in our diet? Mostly from meat, eggs, dairy, and refined grains. The link between meat and cancer probably wouldn’t surprise anyone. In fact, just due to the industrial pollutants alone (like PCBs), children probably shouldn’t eat more than like five servings a month of meats like beef, pork, or chicken, combined. But, what about cancer and eggs?
Studies going back to the 70s hinted at a correlation between eggs and colon cancer. But, that was just based on so-called ecological data, showing that countries that ate more eggs tended to have higher cancer rates. But, that could be due to a million things, right? It needed to be put to the test.
This started in the 80s, and by the 1990s, 15 studies had been published: ten suggesting “a direct association” between egg consumption and colorectal cancer, and five showing “no association.” By 2014, there were dozens more studies published, confirming that eggs may indeed be playing a role in the development of colon cancer—though no relationship was discovered between egg consumption and the development of precancerous polyps, which suggests that “egg[s] might be involved [more] in the promotional [stage of cancer growth—accelerating cancer growth, rather than] initiating [the cancer in the first place].”
Which brings us to 2015. Maybe it’s the TMAO, made from the choline in meat and eggs, that’s promoting cancer growth. And, indeed, in the Women’s Health Initiative study, women with the highest TMAO levels in their blood “had…approximately [three] times greater risk of rectal cancer”—suggesting “TMAO [levels] may serve as a potential predictor of increased colorectal cancer risk.”
Though there may be more evidence for elevated breast cancer risk with egg consumption than prostate cancer risk, the only other study to date on TMAO and cancer looked at prostate cancer, and did, indeed, find a higher risk.
“Diet has long been considered a primary factor in health. However, with the microbiome revolution of the past decade, we have begun to understand how diet can” affect the back-and-forth between us-and-the-rest-of-us inside. And, the whole TMAO story is like “a smoking gun in [gut bacteria]-disease interactions.”
Since “choline…and carnitine are [the] primary sources of…TMAO production, the “logical intervention strategy” might be to reduce meat, dairy, and egg consumption. And, if we eat plant-based for long enough, we can actually change our “gut microbial communities,” such that they may not be able to make TMAO, even if we try. “The theory of “you are what you eat” [is] finally…supported by scientific evidence.”
We may not have to eat healthy for long, though. Soon, we may yet be able to “‘drug the microbiome’” as a way of “promoting cardiovascular health.”
Please consider volunteering to help out on the site.
- Tig H, Moschen AR. Food, immunity, and the microbiome. Gastroenterology. 2015 May;148(6):1107-19.
- Vinjé S, Stroes E, Nieuwdorp M, Hazen SL. The gut microbiome as novel cardio-metabolic target: the time has come! Eur Heart J. 2014 Apr;35(14):883-7.
- Xu R, Wang Q, Li L. A genome-wide systems analysis reveals strong link between colorectal cancer and trimethylamine N-oxide (TMAO), a gut microbial metabolite of dietary meat and fat. BMC Genomics. 2015;16 Suppl 7:S4.
- Miller CA, Corbin KD, da Costa KA, Zhang S, Zhao X, Galanko JA, Blevins T, Bennett BJ, O'Connor A, Zeisel SH. Effect of egg ingestion on trimethylamine-N-oxide production in humans: a randomized, controlled, dose-response study. Am J Clin Nutr. 2014 Sep;100(3):778-86.
- Falony G, Vieira-Silva S, Raes J. Microbiology Meets Big Data: The Case of Gut Microbiota–Derived Trimethylamine. Annu Rev Microbiol. 2015;69:305-21.
- Goldsmith JR, Sartor RB. The role of diet on intestinal microbiota metabolism: downstream impacts on host immune function and health, and therapeutic implications. J Gastroenterol. 2014 May;49(5):785-98.
- Bae S, Ulrich CM, Neuhouser ML, Malysheva O, Bailey LB, Xiao L, Brown EC, Cushing-Haugen KL, Zheng Y, Cheng TY, Miller JW, Green R, Lane DS, Beresford SA, Caudill MA. Plasma choline metabolites and colorectal cancer risk in the Women's Health Initiative Observational Study. Cancer Res. 2014 Dec 15;74(24):7442-52.
- Tang WH, Hazen SL. The contributory role of gut microbiota in cardiovascular disease. J Clin Invest. 2014 Oct;124(10):4204-11.
- Mondul AM, Moore SC, Weinstein SJ, Karoly ED, Sampson JN, Albanes D. Metabolomic analysis of prostate cancer risk in a prospective cohort: The alpha-tocolpherol, beta-carotene cancer prevention (ATBC) study. Int J Cancer. 2015 Nov 1;137(9):2124-32.
- Zeisel SH, Wishnok JS, Blusztajn JK. Formation of methylamines from ingested choline and lecithin. J Pharmacol Exp Ther. 1983 May;225(2):320-4.
- Yonemori KM, Lim U, Koga KR, Wilkens LR, Au D, Boushey CJ, Le Marchand L, Kolonel LN, Murphy SP. Dietary Choline and Betaine Intakes Vary in an Adult Multiethnic Population. J Nutr. 2013 Jun;143(6):894-9.
- Steinmetz KA, Potter JD. Egg consumption and cancer of the colon and rectum. Eur J Cancer Prev. 1994 May;3(3):237-45.
- Hernández ÁR, Boada LD, Almeida-González M, Mendoza Z, Ruiz-Suárez N, Valeron PF, Camacho M, Zumbado M, Henríquez-Hernández LA, Luzardo OP. An estimation of the carcinogenic risk associated with the intake of multiple relevant carcinogens found in meat and charcuterie products. Sci Total Environ. 2015 May 1;514:33-41.
- Matthew JA, Johnson IT. Egg consumption and risk-markers for colorectal neoplasia. Eur J Cancer Prev. 1995 Oct;4(5):425-8.
- Zhang J, Zhao Z, Berkel HJ. Egg Consumption and Mortality From Colon and Rectal Cancers: An Ecological Study. Nutr Cancer. 2003;46(2):158-65.
- Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15;15(4):617-31.
- Tse G, Eslick GD. Egg consumption and risk of GI neoplasms: dose-response meta-analysis and systematic review. Eur J Nutr. 2014 Oct;53(7):1581-90.
- Miller AB, Howe GR, Jain M, Craib KJ, Harrison L. Food items and food groups as risk factors in a case-control study of diet and colo-rectal cancer. Int J Cancer. 1983 Aug 15;32(2):155-61.
- Keum N, Lee DH, Marchand N, Oh H, Liu H, Aune D, Greenwood DC, Giovannucci EL. Egg intake and cancers of the breast, ovary and prostate: a dose-response meta-analysis of prospective observational studies. Br J Nutr. 2015 Oct 14;114(7):1099-107.
Image credit: Praveen via pixabay. Image has been modified.
Video credit: Tyler McReynolds, Teetotalin LLC
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Flashback Friday: How Our Gut Bacteria Can Use Eggs to Accelerate Cancer
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
What did the egg industry do in response to this information? Distort the scientific record. See Egg Industry Response to Choline and TMAO.
This isn’t the first time the egg industry has been caught in the act. See, for example:
- Who Says Eggs Aren’t Healthy or Safe?
- Does Cholesterol Size Matter?
- How the Egg Board Designs Misleading Studies
- Debunking Egg Industry Myths
- Eggs and Cholesterol: Patently False and Misleading Claims
- Eggs and Breast Cancer
For background on TMAO, see my original coverage in Carnitine, Choline, Cancer, and Cholesterol: The TMAO Connection and then find out How to Reduce Your TMAO Levels.
For all new videos on TMAO, visit the topic page.
This is all part of the microbiome revolution in medicine, the underappreciated role our gut flora play in our health. For more, see:
- Stool pH and Colon Cancer
- Bowel Wars: Hydrogen Sulfide vs. Butyrate
- Putrefying Protein and “Toxifying” Enzymes
- Microbiome: The Inside Story
- Prebiotics: Tending Our Inner Garden
- What’s Your Gut Microbiome Enterotype?
- How to Change Your Enterotype
- Paleopoo: What We Can Learn from Fossilized Feces
- Gut Dysbiosis: Starving Our Microbial Self
- Is Obesity Infectious?
- How to Develop a Healthy Gut Ecosystem
- How to Become a Fecal Transplant Super Donor
- The Role of the Gut Microbiome in Autism
- Microbiome: We Are What They Eat
- Gut Microbiome: Strike It Rich with Whole Grains
- Effect of Sucralose (Splenda) on the Microbiome
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