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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)

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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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135 Comments

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  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.)

  6. 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.

  7. 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.

  8. 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)

    http://people.csail.mit.edu/seneff/why_statins_dont_really_work.html

      • 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.

  9. 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.

  10. 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?

  11. 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.

  12. 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.

  13. 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.

    JW

  14. 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.

  15. 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. 🙁

  16. 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!!!

    • I’d skip the wheat flour, though. If you must use flour, try rice flour instead.

    • 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.

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