Choline is essential for metabolism and membranes; however too much choline intake can be bad, and is linked to stroke, heart attacks, blood clots, as well as metabolic syndrome and cancer.
Researchers from Cleveland Clinic followed 4,000 people and showed that the consumption of eggs and fatty meats increased choline levels in the blood stream, much as taking a choline supplement did. This caused increases in a compound Trimethylamine or TMA. And this, when oxidized by a compound in the liver (FMO3), led to increases in a highly inflammatory compound called TMAO.
It is well established that TMAO is linked to metabolic syndrome, diabetes, heart disease, chronic kidney disease, atherosclerosis and heart attack and stroke.
Other foods causing TMA were shown by Harvard Medical School researchers to be steak, fatty processed meats like salami, pate, hams and bacon, chicken fat, milk, mass-market eggs and even choline in B complex supplements. Harvard researchers led by Erin L Richman linked these via TMA to aggressive and lethal prostate cancer (1).
TMA is generated by the gut bacteria when they metabolise choline, or lecithin (phosphatidylcholine), or L-carnitine. In fact, there is a strong link between the gut microbiome and TMAO regulation (2). In other studies there has been evidence that taking a daily probiotic reduced the above risks.
While some choline consumption is essential for healthy membranes in the body, too much consumption greatly increases levels of TMA.
Cleveland Clinic showed that this is linked to increased plaque and deposits of fat in the arteries, and higher risk of heart and stroke problems (4).
In 2014, there were also links from choline consumption and metabolite levels to Colorectal cancer found in the Women’s Health study (3).
You can check your levels of TMAO.
Other foods on the ‘bad’ list are butter and cream cheese, energy drinks and diet drinks. The researchers at Cleveland suggested you should consume more whole grains, lean meat, fish, nuts and seeds and vegetables and fruit. In particular in the Mediterranean diet, red wine and Extra virgin Olive oil are known to reduce TMAO levels.
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- Erin L. Richman et al. Choline intake and risk of lethal prostate cancer; Am J Clinical nutrition; 2012 Oct 96(4)
- Pauline Gatarek – EXCLI J, 2021, 20, 301-319; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975634/
- Sajin Bae et al, Plasma Choline metabolites and colorectal cancer; Cancer Res, 2014 Dec 15; https://pubmed.ncbi.nlm.nih.gov/25336191/#affiliation-2
- Cleveland Clinic, Choline TMAO, Heart attacks and Strokes