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. 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.

  2. 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!

  3. 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!

  4. 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.

  5. 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.


  6. 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.

  7. 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

  8. 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.

  9. 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!

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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?

  15. 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.

  16. 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.

  17. 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.

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