Why You Should Eat More (Not Less) Cholesterol | Chris Kresser

Why You Should Eat More (Not Less) Cholesterol

by Chris Kresser

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For decades now, the general American population has been neurotically avoiding cholesterol-rich foods for fear of developing heart disease, thanks to the promulgation of the unfortunate Diet-Heart hypothesis. (1)

Those of us that follow a paleo diet are well aware by now that dietary cholesterol does not significantly affect cholesterol levels in the blood or risk for heart disease, and that there is no reason to avoid whole foods with naturally high levels of cholesterol.

However, beyond just ‘not avoiding’ high cholesterol foods, there is a significant reason for us to make a special effort to include many high cholesterol foods in our diet.

The reason? The much under-appreciated B-vitamin called choline, found primarily in cholesterol-rich foods.

If you haven’t heard of choline, or don’t know much about this vital nutrient, you’re not alone. Choline has only been ‘officially’ recognized as an essential nutrient since 1998, when the Food and Nutrition Board of the Institute of Medicine established an Adequate Intake (AI) level of 425 mg per day for women and 550 mg per day for men. (2) Even though it has been deemed a nutrient vital for human health, only 10% of Americans are meeting the conservative AI levels established by the IOM.

If you eat a strict paleo diet, you may be closer to meeting your choline needs than the average American, but only if you are regularly including choline rich foods in your diet. The best whole food sources of dietary choline are egg yolks and liver, which are often avoided by many Americans due to unfounded fear of dietary fat and cholesterol.

However, these high cholesterol foods are at the top the choline-rich foods list, followed (albeit distantly) by beef, cod, brussels sprouts, and broccoli. (3)

Why is choline such an important nutrient to consider in one’s diet?

Choline has a variety of functions in the body, including the synthesis of the neurotransmitter acetylcholine, cell-membrane signaling, lipid transport, and methylgroup metabolism. (4) In addition, it is an essential component of the many phospholipids that make up cell membranes, regulates several metabolic pathways, and aids detoxification in the body. During pregnancy, low choline intake is significantly associated with a higher risk of neural tube defects in the newborn.

Choline deficiency over time can have serious implications for our health. Symptoms of choline deficiency include fatigue, insomnia, poor kidney function, memory problems, and nerve-muscle imbalances.

Extreme dietary deficiency of choline can result in liver dysfunction, cardiovascular disease, impaired growth, abnormalities in bone formation, lack of red blood cell formation, infertility, kidney failure, anemia, and high blood pressure. Incredibly, choline deficiency is the only nutrient deficiency shown to induce the development of spontaneous carcinoma. (5)

Chris Masterjohn has written extensively about choline deficiency and its relationship to fatty liver disease which affects as many as 100 million Americans and is often attributed to excess alcohol and sugar consumption by conventional practitioners. After a review of the literature, Masterjohn concludes that choline deficiency plays a role in virtually every type of diet-induced fatty liver model, and that adequate dietary choline is essential for proper liver function. He also suggests that high consumption of dietary fat, including saturated fats, increases the amount of choline required to prevent the accumulation of fat in the liver. (6)

This means that if you’re eating a higher fat diet, it is even more crucial that you include a variety of choline rich foods in your diet.

Another important factor to consider is that while humans are able to produce some level of endogenous choline, some people have a common gene variation that further increases the amount of choline they must consume to satisfy their body’s requirements. (7) These particular people are more susceptible to choline deficiency, and must be especially vigilant about including choline rich food in their diets.

As choline is so important, you may be wondering what the best food sources are in order to improve your intake. There are many natural, whole foods that are excellent sources of bioavailable choline, with the best sources being beef liver, poultry liver, and whole eggs. (8) These foods are not only high in choline, but are also very high in many different vitamins and minerals such as as vitamin A, arachidonic acid, DHA, and the B vitamins. (9)

We already know liver is an amazing superfood. Liver from pastured animals is a great source of trace elements such as copper, zinc and chromium, plus highly bioavailable folate and iron. (10)

Liver is also the most potent source of dietary choline that we know of.

For example, a three ounce serving of pan-fried beef liver has over 400 mg of choline in it, compared to less than 80 mg in the same amount of cooked ground beef. (11)

While you don’t need to consume beef liver on a daily basis to reap the benefits of this superfood, it should be clear that including pastured liver and other organ meats as part of a nutritionally complete diet is one of the best ways to improve your health and prevent the many types of chronic disease caused by nutrient deficiencies.

If you’re not used to including lots of liver and whole eggs in your regular meal plan, give a few of the following recipes a try. It’s never too late to start incorporating more choline into your diet!

To read more about heart disease and cholesterol, check out the special report page.

Liver recipes: get your choline!

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  1. My 11 year old son has been diagnosed with fatty liver disease. ..going insane trying to find things that are good for this issue as well as things that he will eat and enjoy??? HELP PLEASE!

  2. Very dangerous and foolish review, I would strongly suggest if you have a family history of heart disease then ignore the review, it is irresponsible and to the unwitting very dangerous, I have a terrible family history of heart disease and am the oldest living male of my fathers side, all died young with heart disease and the more animal their diet the shorter they lived, I live a very very low cholesterol diet and even meditate every day and I am under 60yrs, cholesterol will kill you stone dead!

    • Yeah, and three out of four of my grandparents died of strokes and they all breathed air, I KNOW, air must be the cause of strokes! I’ve taken up getting my oxygen by IV and am much healthier and happier.

  3. I lost my fiancé tragically and unecessarily at a young age, and I fell into a deep depressive grief. Daily liver and daily bone broth brought me out of it. There was something deep and significant and powerful about the liver which my brain needed to heal. Surely, some of it was the cholesterol.

  4. I’ve read a few articles about the importance of eating liver but haven’t seen anything about what a good average amount is the best to shoot for. Just a roundabout number of ounces would be great. I bought the dessicated grass fed liver capsules and have been taking the 6 capsule recommended serving 7 days a week, but if 6 capsules are approx. 1oz each, that’s 7 ounces per week and that seems like a lot. I’m in between doctors (my old one went to concierge medicine and I haven’t been able to find a new one that I like) so I don’t have anyone to ask. I tend to be a little low on iron – 10ish. My last test I was 12. I can’t donate blood due to a recent tattoo so I don’t get a number as often as I used to. But I’ve been turned away a number of times due to low iron numbers.

    I would appreciate any help!

  5. have you done any research on high levels of choline for pregnancy women? I’ve read some things suggesting that taking/consuming as much as 3500 mg a day is extremely beneficial to baby’s brain health, memory function, etc.

    for example,

    i’ve also read somewhere that you just shouldnt consume more than 4500 mg/day. do you have an opinion on high levels of consumption and/or its benefits to baby? thanks!

  6. How important is it to eat grass fed/ organic livers? I have read that the toxins are more concentrated in animal fat than the organs. Am I better off eating conventional factory farmed liver than eating none at all? I am having trouble finding anything organic or pastured in my area.

  7. Chris, I’m looking for rresearch about choline levels in people with paeudocholinesterase deficiency. I’m homozygous and wonder if health issues may be related.

    • Hi Teri,

      I have dug into learning about cholinesterase-related issues since figuring out I seem to have problems with nightshade (tomatoes, potatoes, peppers, eggplant, etc.), including interacting with various folks dealing with pseudocholinesterase deficiency either themselves or within their families. I don’t remember running across anything in the literature or discussions about choline levels.

      I have seen a fair bit about atypical reactions to medications, pesticides, etc. related to pseudocholinesterase deficiency, particularly anesthetic agents such as succinylcholine, and medications for Alzheimer’s, glaucoma, and myasthenia gravis which act via cholinesterase inhibition. I’m personally curious if pseudocholinesterase deficiency might make people more likely to be susceptible to having problems with nightshade, but that’s only an unfounded suspicion at this point.

      Do you know which of the BCHE genetic polymorphisms you have? There are some good pointers from the SNPedia for resources about a couple of them, such as Rs1799807 or “Atypical” BChE.

      I’ve also been in contact with a couple of others dealing with and interested in understanding more about pseudocholinesterase deficiency who might be interested to get to know others in a similar situation. One who contacted me through the comments here http://humansystemdebugging.blogspot.be/2009/06/comments-from-google-site.html, and one through 23andme, and one who is active on the 23andme forums. If you have an account there you can contact me as Anne Wright and I can see if she’s interested to say hi.

      • Just saw this posting. I too have a pseudocholinesterase deficiency. I’m wondering if there is a connection between enzyme and the digestion (or non-digestion) of gluten. Have been trying to find anything on this.


  8. My new favorite way of eating liver is to cut chicken livers up coarsely and throw them into a pan of roasting whole chicken during the last half hour (at 350 degrees). They don’t look so pretty when they come out and they’re a bit hard when pressed, but the texture is just fine. When eaten alone, the taste is kind of strong, but when eaten with bland chicken meat, the combined taste is perfection.

    ‘Sausage Cake’ or pudding really, is a dish traditional here in Sweden, made with liver and rice or barley and spices and raisins. I found this recipe in English http://www.throughtheovendoor.com/viewtopic.php?f=17&t=3285
    It doesn’t call for liver, only 500 gr of meat. But it’s easy to substitute some of the meat for liver. I’d say about 350 gr of liver and 150 gr meat. You don’t need meat at all, but I think it mellows the taste a little.

  9. There are many doctors including me and my collegues (e.g. cardiologist profesor Bada from Comenius University in Bratislava, Slovakia) who not only admit, but strongly disagree with official recommendations for prevention and treatment of cardiovascular diseases. For many years they presented evidences both in media and professional scientific foras that these recommendations are no longer scientifically or morally defensible.

    Moreover, there are many other famous physicians in the world , e.g. nephrologist Dr. Uffe Ravnskov, who for many years wrote about cholesterol myths. Uffe Ravnskov’s 2000 book The Cholesterol Myths was a blockbuster among skeptics of mainstream health and nutrition dogma. In his boook Dr. Ravnskov takes aim at one of the biggest medical myths of our time–that saturated fat and cholesterol cause heart disease–and slays the Goliath with page after page of brilliant analysis. Anyone who has been told to go on a lowfat diet or take cholesterol-lowering drugs should read this book first. . . and then give it to his or her doctor!

    You can see more comments on this subject by me (nickname – kolibakoliba) in : http://articles.mercola.com/sites/articles/archive/2012/06/30/excessive-fructose-causes-obesity-and-cancer.aspx?e_cid=20120630_DNL_artNew_1

  10. Can a person with high cholesterol levels like total cholesterol 280, LDL= 202 & Hdl = 36.
    eat eggs ?

    My doctor says that i should not even touch eggs,

    will eating an egg daily further increase my bad cholesterol

    • Eggs contribute somewhat however it its the saturated fats (butter, coconut oil) that trigger the production of cholesterol by your liver. I have had similar cholesterol values after 1 year on paleo but have hone down to normal after reducing sat fats. Take restricting eggs as the last option

      • hi,

        Yes I incorporated 2 eggs in my diet on daily basis, plus cut down on breads and refined sugar, started daily walk of 300 mins & 1 capsule of Guggulu daily.

        Got my lipid test last week :

        Here are the result:

        Total : 238
        LDL : 170
        HDL : 40
        Triglycerides : 139

    • my doctor told me to not eat more than three eggs per week because of my high cholesterol. i stopped buying eggs from the supermarket and started buying from a local farmer,that had free range chickens.at my next check up three months later,my doctor made the comment that cutting back on eggs really helped.he was surprised when i told him i was eating more eggs.three every day along with bacon,but these were free range and not filled with pharmaceuticals to keep them alive.

  11. I’ve been interested in healthy living for a long time. And in the eighties I bought a book by Adelle Davis ( I think it was “Let’s eat rigth and keep fit”) In it she advocated grinding organ meats like liver and heart into hamburger meat. Sounded good to me but I never could find a butcher to do that for me and didn’t want to do it myself – so gave up on it.
    Many years later I read that Adelle Davis died of a rare disease “multipe myeloma” at age 70.
    Coincidence? Maybe not – who knows. It was only one of the things she recommended and practiced.

    • Most likely a coincidence, yes.

      Nobody yet knows any of the causes of myeloma. It’s a cancer that begins in the plasma cells and then usually collects in the bone marrow and solid parts of the bone.

      Considering modern science is showing that meat has protective benefits for certain cancers (especially CRC – colorectal cancer – see Dr. Tim Key’s studies in 2009 and 2010 in the American Journal of Clinical Nutrition) that we don’t yet understand, and the amount of nutrients essential for human health contained within meat, it’s quite unlikely eating healthy meats and organ meats would cause any issue.

      That being said, there is a strong statistical correlation between consumption of meat and cancer. However, almost all research that has been conducted includes PROCESSED meats (which obviously aren’t paleo and whether you’re paleo or not, all research indicates they just aren’t healthy) and many other confounding variables. And remember, correlation doesn’t equal causation.

      Based on the current research, the things I personally avoid are: Processed meats, cooking meats over a high temperature (no charring – it’s best to cook low-and-slow), heavy intake of meats (just because meat has nutrients doesn’t meat a 16oz porterhouse is better than a 4 or 6oz serving… and studies show heavy intake correlates with increased health issues.)

      It’s also best to ensure that you get enough vegetables and healthy oils as well – many people are under the misunderstanding that paleo and low-carb diets advocate meat over vegetables, which just isn’t true, or healthy. I personally eat around 8 cups of non-starchy vegetables daily (I eat more vegetables than one of my vegetarian co-workers, in fact), and most healthy paleo dieters I know also eat a very healthy amount of vegetables, nuts, oils, etc.

    • My dad had multiple myeloma. It is not a rare disease, actually. Multiple myeloma is a process where a monoclonal antibody is produced in vast numbers. It has profound impact on bone due to increases osteoclast activity. Ultimately though, it causes death due to renal failure as a result of dying cells which put a toxic load on the kidneys. Search bence-jones to learn more. I do not think that this sort of malignancy of blood components has anything to do with a diet high in organ meats. It appears that it is telomere damage and a resulting transcription error that causes a vast number of these diseases where the gene that triggers apoptosis is missing. It’s way more complicated than that, but I think you are fine eating liver. Adele Davis was a pioneer and I learned a lot from her many years ago. Like avoiding aluminum cookware.

    • Oh, my! These kinds of statements are very hurtful, and unstudied. Anyone can die at 70, even if healthy. There are SO many stressors and reasons. It’s just unfair to try to find the reason a health promoter died ‘young’. I have been studying health intensely for over 40 years(since my early 20’s). Guess what, I have recently developed foot drop. Not sure why yet, but my overall health has been great all these forty years. NOT ONE TRIP TO THE DOCTOR, for ANYTHING. And I don’t do mammograms, etc., so I mean, no trips! And I eat tons of cholesterol in the form of grass fed animal products, tons of sea salt and tons of healthy other fats, as in coconut oil. Not only am I not obese, I don’t have high cholesterol, or high blood pressure. So, if I have ‘over consumed’ all the “bad” foods that vegans abhor for 40 years , tell me why I haven’t been sick?? You’d think it would have caught up with me a bit sooner?

      This foot drop could be a revisiting of any number of the problems I had in my youth. Forceps birth…doc told my mom I might have seizures, which I did at age 6, then was on phenobarbital till my mom had had enough of watching the drug’s side effects, and converted over to healthy foods/supplements/weaning off the drug, but not before the constant constipation caused by the drug led to a burst appendix, which started a whole new cascade of problems…years of antibiotics, to name one, with their nice side effects. Then, in Switzerland, where I lived, we were given a live TB vaccine, which merged with my other problems and I had ‘bronchitis’, or so we thought, every year. Not until i went to work in a cafeteria, did I find out that i had a positive response to the TB test, and lo and behold, scarring was on my lungs.

      I’m saying all this to say, things beyond a person’s control can come back when they start aging, and particularly, if they have spent years ministering to people and losing sleep in the process. A better question would be to say, what was the quality of her life? There are people who live into their 80’s, but are sick constantly. There are those who live till 70, but are never ill. I think I know which I would choose!

  12. Nice work Chris, time to get the liver out of the freezer.
    When would you introduce liver to the little ones? Our 6 month old girl Flo is loving her meat, bones and veges (she prefers the bones and meat !) but a little hesistant about adding in liver. I know the Weston-Price recommends though, and it seems like a good food for babies.

    • My entire family eats liver and has NO IDEA, lol. (I hope they don’t read this blog…)

      I buy my beef from a local butcher store that sources pasture-raised/grass-fed organic beef from a great local ranch – and when I get ground-beef for burgers, my zucchini-lasagna or whatever, I have them grind some liver in with it.

      It allows us to get that extra nutrition only liver can provide, and my family has no idea, especially when flavored with healthy herbs, spice etc.

      What’s hilarious is I heard my 15 year old tell his buddy the other day that he hates liver. Yet he it’s it several times a month. =)

      Someday I’ll fess up and tell them, LOL.

  13. Chris, this makes a lot of sense.

    But do you recommend seeking out pastured/cage-free/organic eggs?
    In my travels outside the country, eggs elsewhere are really delicious, and much better than we get here.
    I intuitively think this says they are more nutritious, but I’m not sure there is hard evidence to prove that.
    Any thoughts?

      • I totally agree with this too… And a big “Thank You” for putting an egg front-and-centre on the page. They’re an amazing super-food, as far as I’m concerned.

        I spent 5 years of my childhood on a farm and we raised our own chickens and had fresh eggs every day. When we moved to the city we had eggs much less frequently.

        As someone who entered the health sciences field, and works as a medical professional, I was taught in school that dietary cholesterol and saturated fats were to be avoided. It took me until 20 years after graduating and 2 years of my own research to be convinced of the truth. That is the sad state of the medical profession, and most medical professionals are still where I was 2 years ago – believing what they were taught, regardless of the lack of evidence or the amount of conflicting studies.

        My own labs improved TREMENDOUSLY when I added eggs back into my diet. I now eat 3 eggs a day, every day. (Yes, from free-range chickens.) My cholesterol profile and triglycerides at 46 years old are better than when I was 24. I have just as much energy, too.

        My own doctor (I don’t know about other countries, but in Canada most provinces have ethical standards that prevent us from treating ourselves or those with whom we have a relationship) needed convincing, regardless of the improvement in labs, so I needed to bring my research in to her.

        Here’s the deal folks – traditional medical schools STILL train students on the lipid hypothesis. Students graduating today still believe the myths about cholesterol, saturated fats, etc., because it’s what they’re taught.

        If you wonder WHY they’re still taught that – please understand medical schools are a very political environment. Not only that, but they rely heavily on donations – donations from pharmaceutical companies, etc. This is the same situation with organizations like the American/Canadian Heart Associations, the American/Canadian Diabetes Associations and more.

        It will take people educating themselves and in some cases educating their medical professionals – or at least encouraging the medical professionals to educate themselves (not an easy thing to do…) – long before changes start to happen. And there will always be pressure to resist that change.

        It’s quite likely that had I not developed Type II diabetes I’d still be believing everything I was taught about the lipid hypothesis and would simply write-off conflicting ideas as bad science. It’s a sad but true statement.

      • Well, I put in my 2 cents on eggs and liver back on Jan. 8th, but must say I appreciate Glen’s contributions and suggestions that our doctors often need to be educated due to their poor training in nutrition for the most part.
        I also, like Glen, had to develop Type II diabetes to start doing my own research. Now I am way ahead, health-wise, compared to if I had not had the diabetes!
        Glen is far more optimistic than I could be, were I to consider how likely I might change the thinking of the typical allopathic practitioner, considering the influence on their education by the drug industry, and the continued influence after the schooling. Big job! Still, don’t give up hope.

  14. You can make a raw liver smoothie/blended soup that’s so palatable you’d be hard pressed to know that liver’s even in it. I don’t have an exact recipe but basically it’s throw a piece in a blender with liquid and then go from there…it’s a kitchen cupboard approach, whatever you have around that will help to disguise the taste. I’ll even go one step further and say that you can get it so that it actually tastes good…granted it’s not because of the liver but rather all the other ingredients.

    Some things that I’ve used:

    bone broth, tomato, greens, seaweed, lemon juice, salmon roe, miso, sauerkraut, beef heart, garlic, onion, turmeric, ginger, and SPICES…lots and lots of them.

  15. It is as if somewhere half-way through last century, somebody decided that this sort of basic physiology and biochemistry was too complex for the general public to understand. Then, since they didn’t need to communicate it to their patients, the doctors decided not to study up on this beyond medical school. Thanks for not giving up on the lay public Chris, and respecting the natural truth that is born in every one of us.

  16. Hi Chris,
    My dad is diabetic(for the past 10 years) and I am slowly getting him to go the paleo way. His LDLs are elevated and the recent stress echo came out positive. Should I be concerned about including egg yolks in his diet?

  17. I follow a primal diet and it has been a year in Sept. At my last check up my Doctor took me off my cholesterol medicine and my blood pressure was good….. I eat eggs and bacon almost every day.

    • It doesn’t filter them, it breaks them down. Liver’s an organ like any other, and if it just held on to all those toxins it’d die.

  18. I can’t do eggs and no one else in my family will eat liver when I fix it (waste!) so I just ordered some of the pills from Dr. Rons. How do I know how many and how frequently to take them?

    • Hi Kris,
      From what I understand, 6 capsules of Dr. Ron’s is equal 1 ounce of liver, so 4-6 per day would give you between 5-7 ounces of liver per week, or a generous serving. Remember they can raise your iron levels, so make sure you don’t have high ferritin (over 100-150). Lowering iron levels is best accomplished by donating blood, but avoiding fortified grain products is very important as well.

  19. Another option to get some liver into your diet is liver powder (or tablets, but I prefer powder). I blend a TB with coconut milk, some fresh leafy greens (usually spinach or parsley), some berries and a bit of stevia to sweeten. It’s really not bad. It’s a convenient way for me to get liver on a weekly basis. I use NOW brand, from Argentinean cows, which are raised on pasture. I also eat liverwurst.

  20. Excuse me for sounding like Hannibal Lecter. To get the most nutritional benefits, liver should be eaten as rare as possible, ideally raw. Optimum would be to consume still warm, from a freshly killed animal.
    I can manage lightly fried in a good dollop of pastured butter and still pink inside with chilies, pepper, garlic, onions, tomatoes and turmeric served on basmati rice. (slurping and salivating noisily with a glass of Chianti!)

    • That’s true of any food really. I’m having a hard time figuring out what nutritional benefit I’m getting even from organic veggies if they’ve been shipped from halfway around the world, parked in warehouses, etc. Yes, I’ll get minerals. I’m not sure what else.

      Big argument for buying local. My goal is to make that transition soon. I’m not the primary decision maker when it comes to food purchases in this household and that makes it difficult.

  21. I love liver, I love eggs, but am stumped as to how to get all my choline from foods when advised to eat liver only once or twice a week and since I have RA am currently eliminating eggs to see if they are a problem. And what about over-eating a food (like eggs) which can cause a sensitivity to them? I do a four day rotation diet, as much as possible. I’m really questioning how the RDA’s are established when it seems that to get a sufficient amount of them, one has to eat a veritable mountain of food. And this is from a woman who loves to eat! Take folate, for example. Sometimes it seems that I can barely reach the top of my plate piled with veggies that are supposed to be highest in folate and still cannot make the goal. This does not make sense.

  22. Dear Dr. Kresser:

    Do you give the same advice for people with Familial Hypercholesterolemia with levels between 320 – 500 since birth? I am blood tested every 3-6 mos and can tell you with certainty that certain (not all) saturated fats do indeed cause my levels to climb. Through strict diet and exercise, my levels can be brought down to 240. I eat a healthy diet of tons of fruits and veggies, nothing processed, low sugar, etc.

    • FH requires special consideration – but, neither liver nor egg yolks (the sources of choline mentioned here) are particularly high in saturated fat.

  23. I guess I’m one of the few who loves liver – any kind. But like someone said I like it best panfried till still pink inside – served with sauteed onion. I grew up with liver, kidneys, brain available fresh from a market that butchered every Tuesday (in Germany). You can’t image how good it tasted – fresh like that. Many years later (living in the US) I nostalgically purchased a package of kidneys from a supermarket, brought it home and cooked it as my mother did when I was a child. The smell and taste of ammonia was so repugnant I had to throw it out!!!!

    I haven’t eaten liver much these days because I don’t think the supermarket variety is healthy and I can’t find grassfed/pastured liver in my area. I guess it’s available online somewhere, but probably for more money (esp. shipping charges) than I care to put down. I did find a local source of free-range eggs and eat a lot of those.

    • US Wellness Meats sells grassfed meat that they ship for a $7 flat fee but there is a $75 minimum order amount. In particular they sell minimally processed organ sausages, such as liverworst, that are excellent and reasonably priced. They are literally just beef, organ(s), and spices. They also sell grassfed organ meat (and lots of other meats and seafood and goodies). I find their meat to be very expensive and we are fortunate to have access to grassfed meat locally, so we just purchase a side of beef for our freezer about twice per year. But we regularly make orders from US Wellness Meast for sausage, chicken feet, and pemmican. The pemmican is expensive, but makes a great breakfast on those late mornings. I don’t prefer the taste but have found I can choke it down if I store it in the freezer because the fat has better texture. Ask any Jewish restaurant owner how to make good bone broth and they will always say that chicken feet are the key. They also sell the brand of canned seafood Chris has recommended on here before. Last, but not least, they deliver FAST. We generally receive our order within just a couple of days via FedEx overnight. The food is frozen solid when it arrives and well-packaged in a cooler.

  24. Liver has a strong taste, and isn’t liked by many for this reason, but offal was once all the less well off could afford in the way of meat and they also included the lights. Also, I believe predators in the wild usually go for the liver first after a kill, especially wolves and wild dogs. Observing how wild animals live, is a simple way of seeing how our forefathers would have eaten and behaved before ‘farming’. With the exception of younger animals, they take less exercise than a ‘couch-potato’ and they run only when fleeing or when pursuing prey. Running uses energy, which they needed to conserve. Today I suppose we need to use the surplus energy we take in, and I feel better for a walk. At 72 I think that’s all I need, but where liver is concerned, I find it hard to eat. So, I am seeking ways to introduce it into my diet, in a more palatable fashion. I am not to keen on pate, since I learned how they produce ‘duck’ pate. Maybe I will find ways of producing my own!

    • I once heard a story about a zookeeper in the States who was distressed that his lions were not breeding. Couldn’t figure out why, decided to go to Africa and watch wild lions hunt to see what parts of the animals they ate. Witnessed a kill, shooed the lions away after they’d eaten some, looked at the animal carcass and the lions had gone in from the prey’s left side, right on into the abdomen and they’d gone after the liver. Well then. Zookeeper goes back to the States, starts feeding his lions more organ meat and especially liver and presto, he gets cubs.

      I was thrilled to discover that Publix store brand canned cat food usually has liver in it, unusual for canned cat food. Some of it’s even gluten-free but for those who have access, read the labels because that’s not true for all the flavors. (If you can’t afford to feed raw or don’t have the time.)

  25. Re: egg allergies and allergies in general

    I recently discovered NAET, an allergy elimination technique created by an Indian acupuncturist. I was very skeptical but desperate to be able to eat eggs and dairy without getting migraines. I’m happy to report that it’s worked!!!!! I’ve also met other families in my practitioner’s office – all of whom have reported excellent results. Apparently, it’s important to go to someone who practices correctly.

  26. Hi Chris, Can you advise alternative ways to get choline from food other than liver. I have been diagnosed with asymptomatic Hemachromatosis, and cannot eat liver, because it is so rich in iron. Thanks.

  27. Other benefits of cholesterol

    Stephanie Seneff claims that cholesterol benefits longevity:

    “Low values of all three measures of cholesterol were associated with a poorer prognosis for frailty, mental decline and early death. A reduced ability to synthesize cholesterol showed the strongest correlation with poor outcome.” (paragraph 9)

    and secondly, that cholesterol sulfate is necessary for heart health:

    “My research has uncovered compelling evidence that the nutrient that is most crucially needed to protect the heart from atherosclerosis is cholesterol sulfate. The extensive literature review my colleagues and I have conducted to produce these two papers shows compellingly that the fatty deposits that build-up in the artery walls leading to the heart exist mainly for the purpose of extracting cholesterol from glycated small dense LDL particles and synthesizing cholesterol sulfate from it, providing the cholesterol sulfate directly to the heart muscle.” (para 10)


      • Do you think the 2009 study showing eggs increased diabetes risk may be due to glyphosate in those mostly non-organic (assumption) eggs?

        Samsel and Senef state (Jan 2013) that glyphosate “enhances the damaging effects of other food borne chemical residues and environmental toxins” resulting in an insidious slowly manifesting inflammation that damages cellular systems throughout the body. They claim that “interference with CYP enzymes acts synergistic with disruption of the biosynthesis of aromatic amino acids by gut bacteria, as well as impairment in serum sulfate transport. ”

        I wish there was a cheap glyphosate test.

  28. I would assume beef liver from a grass fed cow would be better for you than a grain fed cow. But what about the choline level? I get grass fed cow from a neighbor, never thought to ask him to keep the liver for me. Any other organ meat that would be a health benefit?

    • I’ve heard heart is VERY good and I’m pretty sure tongue and kidney too. dont know waht their choline levels are though.

  29. I have been eating liver regularly for 8 months at least once a week along with sardines but my uric acid levels have soared to 9.8 and I am being recommended to cut back on these two foods. What do you recommend?

  30. I love pate but, I don’t serve it on crackers, melba toast etc. to avoid carbs. Any suggestion out there how to serve it? 🙂

    • You could use it as a veggie dip. I’ve seen recipes for grain-free crackers but either they’re crumbly or they’re made with almond flour, usually, which is fine in moderation but can be heavy on phytates depending on how it was treated.

  31. Great article! I am a dietitian, former vegan, recently turned Paleo. I ate liver for breakfast and lunch today! I actually have an auotimmune liver disease so I was hoping it would somehow help my liver to eat liver. Good to know I am on the right path. Thanks!

      • Dr. Kresser:

        I wrote in earlier to ask if you have the same advice about not worrying about cholesterol for patients with familial hypercholesterolemia. I didn’t see my question published, so I’m trying again.

    • When I was pregnant in the late 60’s my doctor order me to eat liver at least once a week. I to did not like it either but for my baby I did it twice a week. Cooked it and made a “mustard sandwich” with it. I also fed all three children the baby food liver while they were eating baby food. All healthy beautiful babies that have given me beautiful grandchildren.

    • Please do it. My daughter was born with vesicoureteral reflux on both sides, worse on the right, and the kidney was also smaller on that side–one-third to one-half the size of the left kidney. The doctor told me it was probably hereditary. Years later I learned that vitamin A is essential in the development of the ureteral bud, which governs how the ureters develop as well as the eventual kidney size. I’m furious that no one warned me and that they are actually *leaving out* vitamin A from prenatal vitamins now. Sometimes I see beta carotene on offer; just as often they don’t bother with any carotenoids or retinoids at all.

      I had a prenatal, but I had very little meat in my prenatal diet thanks to poverty, and the eggs and milk they give you through WIC don’t cut it. My daughter’s eyes appear to be fine (she’s had a kids’ vision test so far and passed it), but eyes develop much sooner than kidneys. I think I must have still had vitamin A reserves when I got pregnant with her.

      The Mayo Clinic is saying urinary tract defects are the most common class of birth defects in the United States. Meanwhile doctors are telling pregnant women to avoid all preformed vitamin A.

      Getting enough A will help your reproductive system recover, too. I first found out I was short on A when my menses returned after a couple years lactating. That was scary. Medics in developing countries use vitamin A to treat women with really heavy and painful periods. A Facebook friend of mine recently cured hers the same way after hearing my story. I wonder how many women have gotten hysterectomies who had only needed to improve their nutritional status and it just makes me stabby-angry.

      • Great advice Dana. Vitamin A is critical for the health of mucous membranes, which includes your nasal cavity, eyelids, windpipe and lungs, nose, mouth, urethra and genital organs. And preformed A is preferable to beta carotene in that it is most easily used by the body. Both diabetics and infants often have difficulty metabolizing beta carotene and may get little benefit from ingesting beta carotene.

        I know, because I am type II diabetic and eating carrots does apparently nothing for me in terms of preventing a sore throat. But once I get a sore throat (a presumed staph infection), I can usually cure it in a few hours with topical doses of gel-caps of vitamin A. The vitamin is absorbed directly into the throat as I swallow the broken vitamin capsules, and gets the mucous flowing again in a few hours, sloughing off the bacterial colony into the stomach where the acids make short work of it. All an infection usually is when it occurs in mucous membrane is just a lack of mucous flow. Without the flow, you have an ideal environment for culturing bacteria. I didn’t know doctors counseled against use of preformed vitamin A, but, to keep the business going, I’m not surprised that they do that.

        People often warn of the hazards of taking too much preformed vitamin A. The first symptom of vitamin A “poisoning” is achy joints, usually elbows and knees. I’ve had that once. When one takes vitamin A in capsules to fix a problem like an infection, several capsules will probably be fine, but over time, you want to limit the intake to a more reasonable amount, like 10,000 IU / day.

  32. Thanks for the encouragement folks. No I won’t give up.

    I don’t like liver unfortunately. I never did, but I eat eggs until they come out of my ears. (I am getting some battery hens on rescue, so I know how the eggs are produced!)
    I am not completely familiar with the paleo diet, but I try to eat only what was available to us before some fool decided to start making bread, other processed rubbish. (Ok I confess, I do like a slice of bread to help down my breakfast kippers twice a week!) I just eat meat of all sorts, greens and salads, cheese, and as I said, eggs and some fruit; berries mostly. For snacks I choose nuts, and pork scratchings that I make myself. I am still losing weight, and trying to do it slowly so my skin doesn’t wrinkle up afterwards! One thing I do miss is a bacon and tomato sandwich, on granary bread! (Guilty as charged).
    Thanks folks.


  33. Do we know if the choline in eggs is mostly concentrated in the yolk or the white? I can tolerate yolks but not the whites. Meanwhile, I buy all the liver I can get at the farmer’s market since its availability seems to vary wildly.

  34. I have been supplementing with a pill form of dessicated grass-fed beef liver. While I was pregnant last year, my iron levels stayed consistently in a healthy range, whereas in the past I had been borderline anemic. I’ll be curious to see if Chris Kresser or others can comment on supplementing in a pill form…

    • I personally think the dessicated liver is a great alternative, brought my ferritin up into a healthy range. Try to get a brand that comes from pastured New Zealand cattle. Pate is also great – but a whole lot more expensive unless you make your own. Frozen bits of liver can be swallowed like pills as well, but the volume would have to be greater. I would shoot for 1 ounce of liver per day in that form, or about 6 of the dessicated liver caps. Nutricology makes a good type, and so does Dr. Ron’s.

    • I’ve used it. I wasn’t in a position to test my ferritin levels but I *felt* better. If it was placebo effect, it lasted til the jar was gone. I keep meaning to buy more and I keep flaking. 🙁

  35. I read a recipe where you soak the liver for 2 hours in milk, then bread it with whole wheat flour. The milk is supposed to take away some of that liver flavor. So I’ve been doing that before pan frying it. It’s not bad. I’ve never had liver before this, so I can’t testify how well it does the job?? I’m more wondering if it takes out any of the important B vitamins I’m trying to get. I hope not!!!

    • My Nana always soaked liver in milk before cooking. I went to an organ meat cooking class a few years back and I remember it being mentioned then too.
      Soaking in lemon juice is great.
      I love liver and bacon, the liver has to be thinly sliced and I prefer it cooked in butter.
      The best advice on liver and in fact all organ meats can be found in Sally Fallon’s fantastic book Nourishing Traditions. It has great recipes and suggestions on how to introduce and if necessary disguise organ meats in your meals.

    • Hannah… well, I guess it’s a good a time as any to start. I have chicken liver in my freezer, so I will try this recipe. I so hope I can stand the taste…

  36. We are fighting a losing battle.
    The ‘You are what you eat’ brigade have far too great an audience opportunity.
    Now a kids’ programme is planned on TV (All about talking vegetables) and is being promoted as a healthy-eating ‘brain-wash’. What chance do young people stand of having a proper fat and protein rich diet when they are being ‘got at’ from an early age by the vegetarians and the low fat gurus? From a personal standpoint, I have given up trying to convince friends and relatives. I am tired of being laughed at for suggesting they should avoid so-called healthy-eating and consume more fat and protein. Hopeless.

    • I’ve found myself in the same boat, John. I don’t give up though. Instead of pounding my head against the wall solo, I chose the battleground, and make sure I have one or two like-minded people around before I start to talk to someone less educated on health. If several people agree, a hard-headed person is much more likely to listen, thinking they must have missed something recently that came out in the “news”. Whatever it takes, keep trying, but don’t stress if the time isn’t right.

    • John, don’t give up. I am still the first person to talk to my children about proper nutrition. The paleo/primal movement is just gaining momentum. I will talk to those who are receptive, I write on my blog, and I post links on Facebook all the time. Over the past year I “converted” 12 people to the paleo lifestyle. 🙂 It’s not as hopeless as you may think.

    • I flat-out tell my daughter that when people are vegetarian that is just because they believe something different than we do, and that meat and fat are good for her and she should eat them.

      Don’t waffle about this. This is not a time to be tolerant–and I’m a big one for diversity, but diversity is for other people. I cannot make myself black, I can’t make myself male and I don’t have to pretend that vegetarianism is OK in this household. It can be OK in vegetarian households instead. That is just fine with me.

      Your kids look to you to tell them what your values are. If you mess this up, you may never win them back later. And sure they’ll rebel–that’s the whole individuation thing when they are teenagers. It’s annoying. You will want to pull your hair out. But it’s a PHASE. Be consistent and firm anyway–count on them trying to rebel, but just keep repeating the same message: “This is what we do in this family.” They can do something different when they’re paying their own rent.

      If you were starving them it’d be different. It’s not omnivores always in the news with their babies starving to death even though they eat meals regularly, right?

  37. Lots of comments on how to ingest enough liver, or why it isn’t at the top of people’s favorite foods!

    Chris did mention eggs as the second most high-packed source of Choline! From what I’ve read, a large egg has 112 mg. of choline.

    Eggs are almost as great a source of choline as liver, and for me, it’s a lot easier to get organic, free-range eggs than to get organic, grass-fed liver.
    So 3 eggs and you are nearly there to meeting your requirement. That’s how many eggs I eat a day anyway. Instead of adding another egg “just to be sure” you can be fairly certain you’re getting enough choline if you are eating a paleo diet with some meat and lots of veggies:
    A serving of Cauliflower has 62 mg.
    A serving of navy beans has 48 mg.
    A serving of beef has 81 mg.
    See the link provided for serving size and the particulars. It all adds up. Without the liver you can still easily get your choline. Just don’t eat any empty calories, and if you skip the eggs too, you might want to eat several servings of meat or fish.

  38. Liver is my absolute favorite. I get it from the farmers market when I email them in advance to bring that and a little beef or lamb heart. When I have liver the world is a brighter place and I’m much nicer to people and energized. I have it with coconut oil and a yam and greens and I’m good to go for hours. I slice it thin and toss it in a covered saute pan with a little water and put it in the oven. The water keeps it from sticking it does not dry out. Fresh liver has very little smell and the texture is like truffles when cooked properly.

    For the heart I trim it clean of fat and other stuff. I slice very thin and marinate it with Coconut aminos(soy sauce alternative) and ginger juice. I put it in the fridge for a few hours/overnight. I also put it in the oven in a covered pan.

    I love organ meats, I never knew I was that kind of person. I’m so glad I know. Thanks Chris!

  39. We had goat liver for dinner last night. My husband had no problem eating it. It was a challenge for me. I think I only ate about a half a cup. My 11 year old ate some (two or three small chunks) but made horrible faces (in a humorous way) the whole time.

    I used this tasty recipe: http://www.vahrehvah.com/Liver+Masala:5985 (autoplaying video) and served it with a spicy spinach/kale and coconut-cashew rice.

  40. We use mainly chicken liver. First soaked in lemon juice – helps the taste – and then fried to medium in a pan with added madeira wine, cream, salt, pepper etc. This gets served with frued onions. Delicious !

  41. For those who don’t like liver, try pastured lamb liver (milder than beef) soaked for at least a few hours in milk. This removes some of the strong taste, and don’t over cook. AND cook it in bacon fat, serve it with the bacon and lots of sauteed onions alongside and on top. I also place a small chunk of butter in the pan after the liver is out and slightly brown it, squeeze in a little lemon juice, toss in some chopped parsley and pour it over all.

    • This sounds absolutely fabulous! I’ve “enjoyed” liver twice in my life. Both times it was ok. I was able to take it down but its been well over a year since I have had a taste. It’s so cheap but so different. I’ll experiment for sure again soon. Doing something like this may be the trick!

    • that sounds delicious – I just have to find a pastured lamb. (sometimes the 4-H kids sell theirs after fair season is over) I don’t love liver, but I learned to eat it when my mom burned the onions and the house smelled like a steak shop instead of liver ;o) So I have to eat it with over cooked onions. One time an home care aid made it with onions and gravy, but I didn’t see how she made her gravy; hers was very good. The soaking and the bacon fat sound like it will improve the taste even more.


  42. I made liver once… couldn’t stand it.. cut it up and put it in a “lasanga” style dish (no noodles) and it still didn’t mask the taste. It was lamb liver if I remember right. I still have some in my freezer. I tried Liver pate’ once.. it was better than my above mess but still not a favorite. I think I’ll just continue my very egg heavy diet. I have not totally given up on liver yet, but it might be a while before I’m brave enough to try it again. I will have to see if I can find some beef liver. Any word on chicken liver?

  43. Raw liver is undetectable, blended in a smoothie. Otherwise, I hide organ meat puréed in hamburgers, meatballs and soup.

  44. An easy way to incorporate more liver is to puree it, and freeze it in ice cube trays. Then simply pop a cube into the next soup or stew you are making. Add additional cubes as you get more used to the flavor.

    Liver is a powerhouse of nutrients!

  45. The main thing about liver is NOT to overcook it. Beef liver actually tastes
    a bit better (IMHO) than calf liver. Be sure it is not sliced too thick.

    When cooking liver, my experience is that if you cook it past pink in the middle,
    it will be tough and taste bad. Medium rare at most.

    I always pay fry the liver. I first saute dollar sliced onions in Red Palm oil, then add
    the liver to the center (cleared of onions) of the pan when the onions are nearly done.

    The Red Palm oil adds immensely to the flavor and the liver, and when cooked to medium
    rare and eaten with the onions, the liver/onions are delicious. Cook no further than
    medium, or you have ruined the meat. This is one of the few dishes where you might
    actually want to sop up any remaining oil/fat with a piece of (horrors!) bread.

    • Palm oil….that’s interesting. My husband comes from a culture where palm oil is used often in stews and such. He also grew up eating liver. i’ll have to ask him if he’s eaten the two together.

    • I second your advice. I use ghee for cooking the onions and liver, but otherwise do the same as Robert does. Browned on the outside and still pink the the middle is much nicer in both flavor and texture than when I’ve tried cooking it for longer.

      The other thing I’d emphasize is the importance of getting pastured liver, preferably from farmers you can trust to treat their animals well, rather than liver from factory farmed animals. From what I can tell, the liver is one of the main places that accumulate toxic substances when an animal is exposed to a higher toxic load than it can successfully deal with. So, it makes sense to me to try to ensure that the liver came from an animal that wasn’t exposed to a high toxic load during its life. Happily I got to know a couple farmer’s from the local farmer’s market well enough to trust them to put in the extra effort to do this right and I buy my liver from them. I hope others can find good sources like that too!

      • If liver just held on to toxins then it’d die too–it’s an organ like anything else. It’s possible to have toxins in the liver that are half-processed at the moment of the animal’s death and there are a few persistent chemicals that are tough to break down, but those are going to be pretty much *anywhere* in an animal’s body where there’s fat, and they tend to not be dependent on the diet. PDBE’s for instance (flame retardants)–they are pretty much in the atmosphere for better or for worse.

        The benefit you get from this stuff is far more than the risk you suffer from eating it. If someone can’t afford grass-fed then just get the prettiest CAFO livers you can–if it looks anemic, don’t eat it.

        One exception: I wouldn’t eat CAFO chicken livers on a bet. They tend to contain arsenic. Stick with beef.

    • And I would emphasize that getting organic egg is a lot easier than getting organic liver. So many objections here to liver, how to cook it, how to choke it down, how to avoid toxins. Everyone knows how to eat eggs and most enjoy eggs, and most are not allergic. Just use eggs. If a couple of servings of liver per week (per Kris) is sufficient, then 3 eggs 3 times a week should be sufficient. They just aren’t that much shy of providing the amount of choline that liver provides, ounce per ounce. And with eggs, we’re just talking about the way to know you are getting enough choline. Most other healthy foods provide some choline, and some foods provide quite a bit — enough to equal a third meal of liver per week at least!

      • Yes, but liver has a lot more in it than choline, including micronutrients that are difficult to obtain in significant amounts elsewhere.

        • It’s an awesome source of folate, and eating liver a couple times a week means you pretty much don’t ever need B12 supplements, like, *ever.*

        • I totally agree about the wonders of liver Chris! The article is about cholesterol and choline and how to get it. I was responding to those who had a problem with liver as a source choline, trying to help them get their choline if they didn’t like liver, or had no viable source of organic liver or had family members who refused to smell liver.

          However, an article on the benefits of liver would certainly be appreciated. Then we could go into it more completely and cover all those benefits. I’m in favor of that. Liver is fantastic.

  46. My only solution so far is to hide about 4-5 ounces of pre-cooked liver, finely diced, into a crock pot of my weekly bone broth stew. The spices and other meat “almost” completely cover the liver flavor and texture. I rely on eggs to cover the rest of my needs for choline.

  47. I love liver, my wife can’t stand even the thought of it. So I’ve been getting liverwurst and braunschweiger from a couple online sources, and she doesn’t have to smell it.

  48. Does fermented cod liver oil contain choline (green pastures brand)? I will try again with the beef/chicken liver, but I HATE the taste! And I’m allergic to eggs. Just wondering if CLO has a decent amount. Thanks!!!

  49. If the AI for women is 425 mg a day – what would a typical day look like that would satisfy this requirement? I mean, 3 oz of liver gives 400 mg but then you say you don’t have to eat it every day. What do you have to eat and in what quantities to make this 425 mg per day?

      • Kim, you can buy choline as a supplement but why would you want the synthetic, isolated version when you can get choline from real food in synergy with other nutrients. Desiccated liver is available in supplements, or, you can make your own liver “pills” by chopping organic liver into small pieces and freezing. I’m actually going to do this myself if my plan to mix ground liver into ground beef doesn’t work and it’s still too gamy. By the way, the DIY liver pills idea is not mine, it’s Sarah Pope’s (www.healthyhomeeconomist.com)

      • Desiccated grass-fed liver is available in capsules from Swanson’s and is very inexpensive. Mind you, they don’t share the choline content on the label and I don’t know the equivalence between the dried liver powder and fresh liver. But I’ve taken the capsules before, and I don’t like liver–you can catch sort of a whiff of it in the jar but it didn’t bother me at all.

        I’ve heard bad things about choline supplementation per se. Apparently supplement manufacturers don’t use the right form–same story as with B12 and folate, I’m sorry to say.

  50. Chris,
    How long does choline stay active in the body? I eat 2 pastured eggs a day and at least 6 ounces of pastured lamb’s liver once a week. (followed Chris Masterjohn’s advice for more than 3 years.)

    Should I eat liver twice a week instead, at say 4 ounces at a time? I’ve no problem with this, as it’s so cheap and nutritious.
    I have read that too much liver can be detrimental.

    • Oddly, everyone panics about the vitamin A content in liver, but up to a certain point you can balance out vitamin A and not worry about toxicity if you also have sufficient D.

      The *real* problem with liver is the copper content. If it weren’t so high in copper and if I liked it I’d eat it several days a week. But copper’s only supposed to be a trace mineral in your body, and it’s easy to go toxic.

  51. I have been struggling putting liver back into my diet (as my mom used to cook liver when I was a kid and it tasted nasty!), but I think I’ll give a few of these recipes a try. If I can hide it in something else, that’ll hopefully do the trick.
    Thanks for an excellent post. I’m sharing on Facebook. (Have been going back and forth with a vegan friend posting sites that support our point of view.)

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