Coming up on this episode of The Doctor’s Farmacy.
Dr. Mark Hyman:
Having a few eggs every day is no problem. The whole thing about cholesterol and eggs was debunked. And the US dietary guidelines even, which is a very often conservative group, has said that it’s not a nutrientive concern.
Hey everybody, it’s Dr. Mark Hyman. Welcome to Doctor’s Farmacy, a place for conversations that matter. Today I’m bringing you a health bite, little bites of health information that can help you make small steps to improve your health over time. Now, I know you’ve probably been paying attention to the headlines around nutrition like I have, and it’s super confusing when it comes to so many different things. One day fat is bad, then it’s good, one day meat is bad, then it’s good, and eggs are right up there with everything else. Eggs were bad because they had cholesterol, then they were good. Maybe now they’re bad again because they increase something called, maybe do increase something called, TMAO. We’ll talk about that. That’s what this podcast is about, how to get your head around confusing research and how to make sense of it all. And I’m going to kind of give you a little bit of a tip on how to think about it all.
Basically, in 2017, there was a study that reported that dietary choline increased the risk of stroke, heart attacks, heart disease, and it did so by increasing a metabolite from gut bacteria called TMAO. TMAO is, I’ll spare you the big complicated medical name, but essentially the suggestion was that when you increase choline, which is a really important nutrient, it’s important for brain function, for heart health, for so many different things, that it actually increases TMAO.
But the devil is in the details of this study, and it’s a big difference saying that dietary choline, which is found in eggs and supplementary choline, which is in supplements are the same thing. They’re not. There’s also more complicated features, which is what’s going on with your gut bacteria, which I think is a real take home here, and I’m going to kind of give a lead in on that in a minute.
But basically there was a study that showed, which was super small by the way, 18 people, that gave healthy middle-aged adult, 450 milligrams of choline supplements every day for two months. Now what they did was they found, when they measured the TMAO in the blood, which is a blood test you can now get, that it increased almost tenfold and that markers of blood clots and platelet stickiness, which causes blood clots, also increased.
So based on this study of supplemental choline, they somehow drew the conclusion that dietary choline, meaning what you get from your diet, like eggs or sardines for example, are going to harm you. Now, is that true? Well, the catch is that dietary choline and supplemental choline may not be the same thing and that they didn’t really contextualize this whole thing.
Now, there was another study that was in 2021, follow-up study at Cleveland Clinic, and the title was Dietary Choline Supplements, but Not Eggs, Raised Fasting TMAO Levels in People with Normal Kidney Function: a Randomized Controlled Trial. This is a really important follow-up study. And they basically prescribed choline supplements or eggs to people who are healthy and found that choline supplements, but not eggs, were associated with increased TMAO and blood clotting. The participants in the egg group ate four eggs a day, which nobody does, for four weeks with no markers of blood clotting or increased risk of TMAO.
So having a few eggs every day is no problem. And also for cholesterol, by the way, the whole thing about cholesterol and eggs was debunked. And we know from, for example now, the US dietary guidelines even, which is a very often conservative group, has said that it’s not a nutrient concern in our diet. That if you eat eggs with, let’s say, 200 milligrams of cholesterol, it’s not going to raise your blood cholesterol and it’s not going to impact your risk of heart attacks. Why? Because you have five liters of blood. Let’s say you have 200 milligrams per deciliter of blood, that’s 2000 milligrams per liter, that’s five liters, so that’s 10,000 milligrams of cholesterol and you throw a couple hundred milligrams in there, it doesn’t really do much, right? That’s kind of another whole conversation. I’ve written a lot about that.
Let’s talk about choline, because choline is really important. It’s part of your brain cells, it’s part of every cell membrane. Phosphorylcholine is a part of your fatty acid profile, it makes up your cell membranes, it’s important for communication, it’s important for detoxification, for liver function, it’s super important. Dietary choline really is not associated with any increases in risks.
Now, what is going on with supplemental choline? How does that work? The problem is that dietary choline is super helpful, but when you take something in a pharmacologic dose or a super high dose, you can kind of screw things up in terms of your biochemistry, so you have to be paying attention to that. But also, let’s talk about TMAO a little bit more.
TMAO essentially is a compound that is produced from gut metabolites. Now we know that it’s produced when you eat meat or when you have supplemental choline or even if you eat fish. Now, we know from all the studies on fish consumption that fish is healthy, that it’s associated with lower risk of heart attack, lower risk of stroke, it has more omega-3 fats. There’s a lot of benefits to it. And yet fish also dramatically increases TMAO, which contradicts the sort of overall science around this.
But the truth is that that eating foods is part of the story, but it’s what’s going on in your gut microbiome that is the other big part of the story. The microbiome is such an important part of our overall health, and if you have a bad microbiome, you’re going to produce more toxic metabolites. The key is not necessarily not eating things like fish or meat or eggs, which can increase TMAO, but actually changing your microbiome to a healthier microbiome so you don’t produce as much TMAO. That can be done through the typical ways we do this through eating a high fiber diet, through probiotic and prebiotic foods, through polyphenols, all the things we talked about.
Basically, TMAO is more reflective of gut health and gut bacteria than what you’re doing. For example, if you have a high fat, high sugar meal that’s typically eaten in America, processed fat, it increases TMAO. And really you want to get rid of all that crap in your diet, you want to have a healthy microbiome, and you want to understand that choline and phosphorylcholine are essential parts of our biochemistry and our health and our brain function and our liver detoxification. And if you don’t have it, it can potentially be a problem.
It’s a really complicated thing. There’s a lot written about this. I’ve written a little bit about this as well. I think we kind of have to not get all bunged up on this, and I think we should be aware that it’s really important that dietary choline, which is in eggs and liver and meat, fish, as I mentioned, is basically converted into TMAO in the liver because of bad bacteria. So we need to get rid of the bad bacteria in our gut. We need to eat a healthy diet. Basically, I’m not so worried about it. I don’t think choline rich foods will increase your risk of any issue around heart disease.
You can measure TMAO in your blood if you want, but I think the story around TMAO is a little more complicated. I hope you’ve kind of come away with understanding that basically fix your gut bacteria, don’t worry about dietary choline, you need it, and eat sardines and eat eggs is the basic bottom line.
Hopefully this has been a helpful health bite, literally, and hope you’ve enjoyed it. If you loved this little health bite, share with your friends and family on social media, I’m sure they’d love to hear more about this. Leave a comment, what have you learned about your own health and your risk factors? Have you checked your TMAO? What’s worked? What’s not worked? Let’s hear about it, we’d love to know. We’ll see you next time on the Doctor’s Farmacy.
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