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Good health begins with a good eggy breakfast
A good brain begins with a good breakfast
On 6 January 2010, the UK's Daily Mirror newspaper published a report highlighting the importance of a good, cooked breakfast for a mother-to-be.[1] Headlined 'Brainy kids for mums who eat full English breakfast' it said A traditional slap-up full English breakfast could help mums-to-be boost their unborn child's intelligence.'
The benefits apparently lie in the levels of choline in such foods. Choline was officially recognized as an essential nutrient by the Institute of Medicine as recently as 1998.[2]
Researchers believe the nutrient choline — found in eggs and meat products including liver, bacon and sausages — helps memory functions develop.
Dr Steven Zeisel, who led the study at the University of North Carolina,[3] said:
"Choline can change the switches that control brain development in the foetus."Understanding more about how diet modifies genes could be important for assuring optimal development."
Dr Gerald Weissmann, editor of the US Experimental Biology journal in which the research is published, added:
We may never be able to call bacon a health food with a straight face, but [research in this field] is making us rethink things we consider healthful and unhealthful.
"This is yet another example showing that good pre-natal nutrition is vitally important throughout a child's entire lifetime."
Foetal brain development
During pregnancy, large amounts of choline are delivered to the foetus across the placenta. Choline concentration in the amniotic fluid is 10-fold higher than that present in maternal blood.[4] When a woman becomes pregnant, levels of choline in her blood increase by up to 50% in the last month of pregnancy.[5] Choline is 6- to7-times higher in the foetus and newborn than it is in adults.[6]
But this transfer of choline from mother to foetus depletes the mother's choline supply.[7] Lactation places even higher demands on the mother's supplies of choline.[8] Although the mother's body can synthesise choline to some extent, this huge demand cannot be met in this way. It is essential, therefore, that a diet high in choline is eaten at this time.
But there is much more to this story. It may also help with other conditions later in life.
Neural tube defects
Pregnancy and lactation are times when demand for choline is especially high and the supply of choline is critical. Low levels are believed to contribute to the increasing incidence of neural tube defects.[9, 10] Dividing women into four groups based on their choline intakes, Shaw et al.[10] found that women with the lowest dietary choline intake had four times the risk of giving birth to a child with a neural tube defect, compared with women in the highest quarter of intake. Higher intakes around the time of conception also reduced the risks of all neural tube defects as well as spina bifida and anencephaly separately.
The recommended Adequate Intake (AI) for pregnant women is 450 mg per day; it is even higher at 550 mg per day for breast-feeding women. These amounts are rarely met by the modern 'healthy' diet with its bias towards foods of plant origin as foods with the highest levels of choline are not only all from animals, but also are highest in the variety meats and offal that are rarely stocked by supermarkets (see table below).
Coronary heart disease (CHD)
The dietary recommendations that we should reduce our intakes of saturated fats and meat were aimed at reducing a rising number of coronary deaths in the first half of the 20th century, which had been blamed on cholesterol. However, over the last decade or so, it has been realised that cholesterol is less important than other markers: two of these are a protein called homocysteine,[11] and the inflammation marker, C-reactive protein (CRP).[12] Both of these are higher with inadequate intakes of choline.
Other chronic degenerative diseases
In addition to CHD, high levels of homocysteine have been associated with greater risk for several chronic diseases and conditions including cancer,[13] cognitive decline and Alzheimer's disease,[14] and osteoporotic bone fractures.[15]
How can we get enough choline?
Apart from pregnant and lactating women mentioned above, the Adequate Intakes at present are 425 mg per day for women and 550 mg per day for men.
The good news is that choline is found in a wide variety of foods; the bad news is that the best sources are those regarded as 'unhealthy'! The U.S Department of Agriculture recently released an updated version of its first database of choline content in foods, including more than 630 foods.[16] As you will see in the table below, the most concentrated sources of dietary choline are egg yolks and liver. The muscle meats that most people eat are considerably lower in choline, 'Egg beaters', made with egg whites, aren't worth eating, and, with the exceptions of wheat germ and soya, the choline content of all plants is woefully inadequate.
As far as infants are concerned, human milk is rich in choline compounds. Soy-derived infant formulas have lower total choline concentrations than do human milk and cow's milk-derived formulas. [17]
Conclusion
More evidence that we should eat a natural, meat-based diet; and not waste the parts we now tend to throw away — the liver, heart, kidneys, fat, etc.
And, importantly, we really need the question more forcefully the current unhealthy 'healthy' dietary guidelines which continue to spew out from the British Dietetic Association, Food Standards Agency and similar US agencies.
| Food | Choline mg/100g |
| Animal products | |
| Egg, yolk, raw, fresh | 680.0 |
| Egg, whole, cooked, fried | 270.0 |
| Egg, whole, raw, fresh | 250.0 |
| Egg, whole, cooked, hard boiled | 230.0 |
| Egg, white, raw, fresh | 1.1 |
| Chicken, liver, all classes, cooked, pan-fried | 330.0 |
| Chicken, liver, all classes, cooked, simmered | 290.0 |
| Chicken, liver, all classes, raw | 190.0 |
| Turkey, heart, all classes, cooked, simmered | 170.0 |
| Turkey, heart, all classes, raw | 130.0 |
| Turkey, liver, all classes, cooked, simmered | 220.0 |
| Turkey, liver, all classes, raw | 220.0 |
| Pork, cured, ham roasted | 110.0 |
| Pork, cured, ham pan-broil | 140.0 |
| Pork, cured, ham, roasted | 110.0 |
| Beef, variety meats and by-products, liver, cooked, braised | 430.0 |
| Beef, variety meats and by-products, liver, cooked, pan-fried | 420.0 |
| Beef, variety meats and by-products, liver, raw | 330.0 |
| Beef, chuck, grilled | 110.0 |
| Veal, variety meats and by-products, liver, braised | 400.0 |
| Veal, variety meats and by-products, liver, pan-fried | 410.0 |
| Veal, variety meats and by-products, liver, raw | 310.0 |
| Fish | |
| Fish, salmon, red (sockeye), smoked (Alaska Native) | 220.0 |
| Fish, steelhead trout, dried, flesh (Shoshone Bannock) | 260.0 |
| Fish, whitefish, eggs (Alaska Native) | 250.0 |
| Plant foods | |
| Soy flour, defatted | 190.0 |
| Next highest | |
| Edamame, frozen | 56.0 |
| Best fruit | |
| Orange juice, frozen concentrate, unsweetened, undiluted | 20.0 |
| Best nut | |
| Nuts, almonds | 52.0 |
| Best cereal (including breads) | |
| Cereals ready-to-eat, wheat germ, toasted, plain | 180.0 |
| Infant formula, dry powder | 130.0 |
| Fast foods containing above 100mg | |
| Biscuit with egg, cheese and bacon | 130.0 |
Notes on table
I had intended to include only foods that contain over 200mg per 100 grams. However, these lists do contain foods with lower levels so that you can see the difference between different parts of an animal, or different ways of cooking.
Eggs
Note that practically all the choline in eggs in the yolk. Eating 'egg beaters', or discarding the yolks and eating only the whites is a disgraceful waste of valuable food. In Poland, they eat the yolks and use the whites for house building! I think that's a waste too, but at least they are eating the most nutritious part.
Cooking
It's noticeable that cooking tends to increase the amount of choline compared to raw, and that frying is the best method of cooking.
Liver vs muscle
The meat with the highest choline levels is liver. The USDA doesn't list other variety meats or offal so I was not able to compare kidneys, heart, tripe and others. However, I suspect these too may well be higher in choline than the lean muscle meat that forms almost exclusively most people's intake
Plant foods
There is only one plant food that contains over 100 mg/100g and that is soy. Among other plants, edamame is the only one over 50. Concentrated orange juice is the only fruit-based food that reaches 20. Nuts do better but, again, are a poor source of choline. Among cereal grains, breakfast cereals and cereal-based breads, only wheat germ breaks 100.
Infant formula
Infant formula doesn't look too bad until you realise that the figure of 130 is for the dry powder only. Mixed and fed to the child, 100g would be an enormous amount. Human milk is a much better source.
Fast food
No fast food breaks 100 except for the one listed which contains both egg and bacon.
References
1. http://www.mirror.co.uk/news/top-stories/2010/01/06/be-a-fry-baby-115875-21945750/
2. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B012, Pantothenic Acid, Biotin, and Choline. Washington, D.C.: National Academy of Sciences; 1998. pp. 390-422.
3. Steven H. Zeisel SH, da Costa K-A. Choline: An Essential Nutrient for Public Health. Nutr Rev. 2009; 67(11): 615-623. doi: 10.1111/j.1753-4887.2009.00246.x.
4. Zeisel S. Perinatal choline influences brain structure and function. Nutr Rev. 2006; 64:197-203.
5. Ozarda I, Uncu G, Ulus I. Free and phospholipid-bound choline concentrations in serum during pregnancy, after deliver and in newborns. Arch Physiol Biochem. 2002;110:393-399.
6. Zeisel S. Developmental changes in rat blood choline concentration. Biochem J. 1981;198:565-570.
7. Zeisel S. Choline: Critical role during fetal development and dietary requirements in adults. Annu Rev Nutr. 2006;26:229-250.
8. Steegers-Theunissen R, Boers G, Trijbels F, et al. Maternal hyperhomocysteinemia: a risk factor for neural-tube defects? Metabolism. 1994;4:1475-1480.
9. Shaw G, Carmichael S, Yang W, Selvin S, Schaffer D. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol. 2004;160:102-109.
10. Rees W, Wilson F, Maloney C. Sulfur amino acid metabolism in pregnancy: the impact of methionine in the maternal diet. J Nutr. 2006;136:1701S-1705S
11. The Homocysteine Studies Collaboration, 2002. Homocysteine and risk of ischemic heart disease and stroke. J Am Med Assoc 2002;288:2015-2022.
12. Detopoulou P, Panaglotakos B, Antonopoulou S, Pittsavos C, Stefanadis C. Dietary choline and betaine intakes in relation to concentrations of inflammatory markers in health adults: the ATTICA study. Am J Clin Nutr. 2008;87:424-430.
13. Wu L, Wu J. Hyperhomocysteinemia is a risk factor for cancer and a new potential tumor marker. Clin Chim Acta. 2002;322:21-28.
14. Seshadri S, Beiser A, Selhub J, Jacques P, Rosenberg I, D'Agostino R, Wilson P, Wolf P. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med. 2002;346:476-483.
15. van Meurs J, Dhonukshe-Rutten, Pluijm S, van der Klift M, et al. Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med. 2004;350:2033-2041.
16. USDA Database for the Choline Content of Common Foods; Release Two, January 2008.
17. Holmes-McNary M, Cheng WL, Mar MH, Fussel S, Zeisel S. Choline and choline esters in human and rat milk and in infant formulas. Am J Clin Nutr. 1996;64:572—576.
Last updated 7 January 2010
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