The Truth on Eggs, Choline & Prostate Cancer

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Many studies, not all, have associated egg consumption to aggressive prostate cancer.

That’s a doozy since eggs are a staple diet for most and a preferred source of protein for many.

Let’s take a look at the scientific data regarding egg consumption and prostate cancer.

In The Health Professionals Follow-Up Study (HPFS), a study observing over fifty thousand male health professionals since 1986 noticed that men who consumed ≥2.5 eggs per week had a 1.8-fold increased risk of developing lethal prostate cancer compared with men who consumed <0.5 eggs per week. However, this study found no association between consumption of eggs and risk of deadly prostate cancer after diagnosis.

On the other hand, results from 15 prospective cohort study involving 842,149 men from North America, Europe, Australia, and Asia, examined the association of incidence of prostate cancer and the intake of unprocessed and processed red meat, seafood, eggs, and poultry. No association among unprocessed red meat, processed red meat poultry and seafood and prostate cancer was made.

However, a connection was detected between eggs intake and fatal prostate cancers risk.

The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), another very large male study found an increased risk of recurrence for higher intakes of eggs (and poultry with skin) around the time of diagnosis.

Egg intake in CaPSURE was higher, with a mean of 7.9 servings per week compared to 3.2 servings per week in our population. Also, CaPSURE™, men who consumed the most eggs after prostate cancer diagnosis ( about 5.5 eggs per week) had a two-fold increased risk of prostate cancer recurrence compared with men who consumed the least eggs (<0.5 eggs per week)

A Swedish study also reported that men with the highest plasma levels of choline had a 46 % increased risk of prostate cancer compared with men with the lowest levels.

One study of studies (meta-analysis) suggested no association with risk of prostate cancer diagnosis or prostate cancer-specific mortality from consumption of eggs.

Breast cancer,  ovarian cancer and again prostate cancer were at higher rates amongst people who consumed eggs in this study.

Are Eggs from Hens raised in better conditions protective against cancer?

Almost all eggs in the United States are from hens living in a stressed environment under unsanitary cages surrounded by manure infested by flies, maggots, and rodents. Lastly, hens are often starved (a process called molting) to increase egg production.

Eggs raised in such unfavorable environments may play a role in the interaction of nutrient content in our bodies but I am not sure how protective or contributory they are in cancer formation.

Why are Eggs Connected to an Increase Risk of Prostate Cancer?

It seems like the connection between eggs, and prostate cancer is on an (important) nutrient called choline. The crux is that choline is essential for human life and mental performance and we would not do well without it.

And that’s what makes the association with nutrition and cancer confusing and frustrating.

Here’s another thing, choline is used as a tracer for a specific type of PET scan called Choline C-11 PET scan to find smaller prostate cancer cells in the body that can’t be found with other imaging technology.

What does this mean?

A tracer is a substance introduced into the body gobbled up by cancer cells so such cells can light up in images and location of cancer can be found.

Amongst integrative oncologists, it is often said that sugar is bad for cancer because glucose ( a simple sugar) is taken up by cancer cells in another type of PET scan called F-FDG PET.

If the argument with excess sugar consumption is true, then it must apply to choline as well. No?

What is Choline?

Choline is a nutrient in food with many important roles to support health including brain function similar to but not from the family of B-vitamins.

Choline and its metabolites are needed for three main physiological purposes:

  1. structural integrity and signaling roles for cell membranes,
  2. cholinergic neurotransmission (acetylcholine synthesis),
  3. a source for methyl groups via its metabolite, trimethylglycine (betaine), which participates in the S-adenosylmethionine (SAMe) synthesis pathways.

(Source)

If this is all sounds like gobbly gook to you, the bottom line is that choline does good things for your body. The recommended adequate intake (AI) of choline is 550 mg/day for men (425mg for women).

One study found that men with the highest choline intake (~500 mg/day) had a 70 % increased risk of incident lethal prostate cancer compared with men with the lowest intake (~300 mg/day)

The top 5 foods contributing to choline in the diets of the participants were whole eggs, beef, skim milk, reduced-fat milk, and poultry without skin.

What to Make out of the association with Eggs, choline and prostate cancer?

  • Don’t try to eliminate choline from your diet. You won’t be able to as this nutrient is found in a lot of foods and some of those foods are necessary for good health. Besides, many foods that are a five on the CaPLESS Food Rating System, like broccoli and cauliflower contain some choline.

 

  • The yolks in eggs carry the choline, not egg whites. One large egg has about 150mg of choline. Eat egg whites mostly, with maybe one egg yolk. I am not sure you have to give up eggs at all if you do not want to, just don’t eat them every day.

 

  • Eliminate or limit dairy consumption. Don’t do diets of exclusion, i.e., low-fat or 2% milk, for example. Fat is not your dietarily enemy. Plus taking out a macronutrient from food often mean adding other crap to it. In the case of choline, there seems to be more of it in low-fat and non-fat milk than whole milk.

 

  • Don’t take supplements that include phosphatidylcholine or stand-alone lecithin, often found in brain or memory boost supplements if you had prostate cancer or at high risk of it. Lecithin improves absorbability of fat-soluble nutrients like curcumin, and it is often blended for that purpose. The amounts of lecithin, when used for this purpose, is small.

 

 

And that’s the story between Eggs, choline and prostate cancer. Of course, I could have written a dissertation on this topic but wanted to provide you with brief, actionable information.

Thoughts?

 

Previous Three Blog posts:

Your Protection Against the Flu with Natural Medicine

What Dietary Supplements Can and Can’t-Do

Cauliflower Rice recipe – CaPLESS Eats

 

 

 

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by Dr. Geo

24 comments… add one
  • Dr. Ben Weitz 02/26/2018, 7:43 AM

    It sounds like if we are concerned about preventing prostate cancer, we might be better off with egg whites. We used to eat egg whites before we learned that saturated fat was not the boogie man we thought it was.

    Reply
    • Dr. Geo 02/26/2018, 9:27 AM

      It’s tricky because choline is so important for brain health and eating egg whites has little to do with the cholesterol in it and more to do with choline, at least for prostate cancer. The other thing is that egg yolk has other excellent nutrients including carotenoids. Yes, back to egg whites with maybe one yolk.

      Reply
  • Jim 02/26/2018, 12:17 PM

    Is it possible that the choline in animals is already a processed choline whereas the choline in plants is not processed and thus has a different bioavailability.

    Reply
    • Dr. Geo 02/26/2018, 1:00 PM

      Great question. And it may be theoretically possible that plant and animal choline is different metabolically. Plus the fact that plants have so much health benefits to offer beyond vitamins and minerals (like phytochemicals). The other component if a little is good, more is not always better. For now, the takeaway is to be cautious with foods high in choline but not too cautious where you don’t get enough for brain function.

      Reply
  • David 02/26/2018, 1:29 PM

    Just read your blog this morning and had a sickening feeling after I was done. EGGS ARE A CRUCIAL PART OF MY DIET! Being hypoglycemic, eating lots of protein is important for me, but I don’t digest animal protein very well, so don’t eat beef, chicken or pork. Eggs though are a large part of what I do eat, local, organic eggs that is. I have a smoothie every morning which includes two raw eggs, I have egg salad 1-2X a week and omelets for lunch on weekends.

    I don’t know how I would substitute eggs out of my diet, even cut down much. I do eat plenty of turkey, probably too much, and fish twice a week. I have food allergies to black beans, garbanzos and avoid pinto because I’m trying to eat low carb.

    I’m perplexed. Can I just breathe air and have good thoughts?

    Reply
    • Dr. Geo 02/26/2018, 2:32 PM

      Thanks for commenting here, David. There are two points I can share that will help you. One, if you do not have a strong family history of prostate cancer and never been diagnosed, then you should worry less about egg consumption. Two, choline is found in the yolk of an egg, thus I would eat no more than three yolks a week, or so. Eat the cage-free variety if possible… I will be writing about what such terms mean with regards to eggs soon. And don’t breathe too much air, as that too may be toxic (a little sarcasm). 🙂

      Reply
      • David 02/26/2018, 7:31 PM

        I do eat the cage-free variety that’s local and organic. Any suggestions on protein sources that are as easy digestible as eggs? If I’m cutting back to only 3 yolks per week, that’s at least 13 less yolks for me in an average week. (and that’s no yolk 🙂

        Reply
        • David 02/27/2018, 9:28 AM

          I think I figured it out — EAT MOR TOFU (m-o-o-o-o)

          Reply
  • Art 02/26/2018, 1:48 PM

    I’m wondering if there are any studies on Organic eggs around. I know they are quite different from conventional eggs as they cook much faster at the same heat level.

    Reply
    • Dr. Geo 02/26/2018, 2:33 PM

      From a choline perspective, it does not matter if the eggs are organic. Stay tuned as I will soon write on what those terms mean with regards to eggs.

      Reply
  • Seth 02/26/2018, 2:21 PM

    Dr. Geo, what does this sentence mean? “However, this study found no association between consumption of eggs and risk of deadly prostate cancer after diagnosis” (the first part of this paragraph said that there was a 1.8-fold increased risk of developing lethal prostate cancer, but this end of paragraph sentence seems to state the opposite)

    Reply
    • Dr. Geo 02/26/2018, 2:39 PM

      That means that they found an association between prostate cancer diagnosis but no association in advanced (or recurrence) of prostate cancer after those subjects were treated for the disease. Based on the overall studies on eggs and prostate cancer (and all cancers in general), I would eat egg yolks infrequently after a prostate cancer diagnosis – which will now be updated on the CaPLESS Food Rating System.

      Reply
  • Matthew Sweetwood 02/27/2018, 12:50 PM

    Ok, now I am confused. I hate this stuff. I eat 3-4 eggs a week – yolk and all. I really don’t want to stop that or even have my enjoyment of them ruined by studies which are correlation, not accusation proof. Ugh,

    Reply
    • Dr. Geo 02/28/2018, 8:45 AM

      I feel your pain. I am only the messenger… 🙂 Much of nutrition science is correlation based (observational studies) but I do pay attention when numerous such studies with a large population say the same thing.

      Reply
  • Concerned/Confused 03/01/2018, 12:40 AM

    Hi Dr. Geo,
    Eggs aside, what is the research saying about chicken?

    It was surprising to see poultry pointed at, but also the information seemed contradictory: Chicken with skin is bad. Or is it skinless chicken that’s risky? I couldn’t tell. I read the 2012 article and the 2011 article behind that one, and still couldn’t be sure what was being recommended. We’ve been regularly (1x/week) eating organic, kosher, antibiotic-free, no hormones added, boneless, skinless chicken breasts, thinking they were a safe “3.” Should all chicken now be avoided, or is some okay? And while we’re at it, what about organic grass-fed steak or chopped meat–okay as a periodic 3, or to be avoided?

    Asking from vantage point of post-radical prostatectomy.

    Thank you for guidance!

    Reply
    • Dr. Geo 03/05/2018, 11:22 AM

      I am working on an article on poultry / prostate cancer. My findings and experience so far dictate that poultry is OK to eat ( in one study reduction of prostate cancer), skin off best and baked better than fried. Any other cooking method other than fried seems acceptable. Fish is always your best bet.

      Reply
  • Ralph W Moss, PhD 03/03/2018, 4:10 PM

    Geo, a very provocative article. Thank you for raising these important issues. I am still trying to wrap my head around this Harvard paper. One thing that jumped out at me was that the authors themselves state that these findings only held for North America! There was no such effect in the rest of the world. So if excess choline is the cause, then wouldn’t this biochemical fact hold for the entire male population, and not just those of us in the U.S. and Canada.

    I also started to do some research to see if there was a correlation between egg consumption and prostate cancer mortality. It’s crude but could be provocative. Here is what I have found out:

    The top country in the world for per capita egg consumption is China. In 2008, the average Chinese person consumed the 333 eggs per year. In the same year, by comparison, average consumption in the U.S. was 248 eggs….i.e., 85 fewer eggs consumed per person per year. One might therefore expect a concomitant increase in fatal PC in Americans.

    But the annual mortality rate from prostate cancer in China was 2.5 per 100,000 men (in 2013), while the annual mortality rate from PC in the US in that same year was 19.9 per 100,000 men. In other words, American men on average eat far fewer eggs but have a PC mortality rate almost eight times greater than in China! And, as I said, there is no correlation between egg yolk or choline consumption outside the borders of the U.S. and Canada.

    http://www.thepoultrysite.com/articles/1575/good-news-on-global-egg-consumption/

    http://global-disease-burden.healthgrove.com/l/33965/Prostate-Cancer-in-America

    http://global-disease-burden.healthgrove.com/l/34017/Prostate-Cancer-in-China

    https://www.statista.com/statistics/183678/per-capita-consumption-of-eggs-in-the-us-since-2000/

    Reply
    • Dr. Geo 03/05/2018, 11:18 AM

      Yes, thank you, Dr. Moss. Like most observational studies, sometimes there are more questions than answers. For example, with your China citation, Asian countries, in general, have lower rates of prostate cancer but the incidence steadily increases when they move to a Western country. WHy is that? it could be quality of food but Chinese also smoke more and have more air pollution. Hard to tell… as one could correlate smoking and air pollution to prostate cancer as protective, which would not make sense. Lastly, the quality of eggs may make a difference. At this point, I like the idea of a rotation diet (changing macronutrient intake, along with intermittent fasting) which is now part of the CaPLESS Eat program.

      This study suggests that how hens are raised make a difference in the quality of their eggs: https://www.ncbi.nlm.nih.gov/pubmed/27811323

      Reply
  • Lisa Hines 03/21/2018, 12:54 AM

    Thank you for expanding upon this complex topic of choline and it’s possible role in advancing prostate cancer. Many MOs, urologists are just not well read on this issue to any degree. My husband was recently diagnosed last summer with prostate cancer just five weeks after turning 40. It is aggressive, as it often is in younger men, he had Gleason of 9 per his path report. So we have done quite a bit of reading up on what foods could possibly accelerate it the disease process. I had came across the Richmond studies and the also read on PET C11 choline scan. So we opted to eliminate eggs, meat for the most part and have tried to adopt a more plant based diet. Choline is good and necessary for cellular functions so we try to glean as much as possible via cruciferous veggies. You balanced out and put in perspective what we were reading the literature currently out on this topic which is helpful. We understand it (studies) are not necessarily iron clad at this point, but the smoke is there enough for us at least to reduce those foods at this time from his diet. With his young age, we are trying to be as strategic as possible. Thus far he has responded exceptionally well to the interventions (RP and ADT) but I do believe the diet also is playing a role too. We try our best to apply our knowledge with a grain of realism. Plus, he is by all appearances a healthy active soldier to look at him one would never guess he had aggressive PCa. I say that because his job is physically demanding which requires him to eat well. Hopefully, he will continue to be responsive to both the ADT and his dietary changes. Lord willing, they will act synergically to keep this PC managed for years and even decades to come. Thanks for the article, truly enjoyed the information and comments presented!

    Reply
    • Dr. Geo 03/21/2018, 8:11 PM

      Thank you for sharing your husband’s story. All the best to you both.

      Reply
  • Neil 04/06/2018, 4:38 PM

    I have had chronic fatigue for many years and a practitioner whose opinion I value recently suggested that I take a product that is primarily phosphoglycolipids to help rebuild cell membranes. I am 60 yrs old and my PSA over the last 3+ yrs has risen from 3 or 4 up to 7.83. (I do have BPH). My urologist is strongly recommending a biopsy, however I recently made an appt with a urologist who I am hoping will send me for an mri instead. (Hopefully he can convince the insurance co. to pay for it). Would you recommend that I avoid the phosphoglycolipids product for now? How about post-mri if nothing serious (only low-grade Ca or nothing) shows up?

    Reply
    • Dr. Geo 04/11/2018, 10:05 AM

      Hi Neil. Although I am a doctor, I don’t play one on the internet for obvious reasons. In general, I can say that I get all my high risk prostate cancer patients off choline related supplements. If nothing serious post MRI and no strong family history of prostate cancer then phosphoglycoplids should be fine.

      Reply
      • Neil 04/12/2018, 1:39 PM

        Thank you.

        Reply
  • Dave Riley 06/02/2018, 4:26 AM

    I ate 4 yesterday and 2 most says. Little if any dairy. Still here 11 years into prostate cancer treatment.

    Reply

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