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


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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. Funny thing. I love liverwurst but hate liver. I’m guessing liverwurst isn’t a good substitute 🙂

    • 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…

  2. 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?

  3. 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.

  4. 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!

  5. 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.

  6. 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 !

  7. 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.


  8. 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?

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

  10. 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!

  11. 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.

  12. 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.

  13. 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.

  14. 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!!!

  15. 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.

  16. 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.

  17. 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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