What Explains the Egg-Cancer Connection

The reason egg consumption is associated with elevated cancer risk may be the TMAO, considered the “smoking gun” of microbiome-disease interactions.

“We are walking communities comprised not only of a Homo sapiens host, but also of trillions of symbiotic commensal microorganisms within the gut and on every other surface of our bodies.” There are more bacterial cells in our gut than there are human cells in our entire body. In fact, only about 10 percent of the DNA in our body is human. The rest is in our microbiome, the microbes with whom we share with the “walking community” we call our body. What do they do?

Our gut bacteria microbiota “serve as a filter for our largest environmental exposure—what we eat”—and, “technically speaking, food is a foreign object that we take into our bodies” by the pound every day. The “microbial community within each of us significantly influences how we experience a meal…Hence, our metabolism and absorption of food occurs through” this filter of bacteria.

However, as you can see at 1:22 in my video How Our Gut Bacteria Can Use Eggs to Accelerate Cancer, if we eat a lot of meat, including poultry and fish, milk, cheese, and eggs, we can foster the growth of bacteria that convert the choline and carnitine in those foods into trimethylamine (TMA), which can be oxidized into TMAO and wreak havoc on our arteries, increasing our risk of heart attack, stroke, and death.

We’ve known about this “troublesome” transformation from choline into trimethylamine for more than 40 years, but that was way before we learned about the heart disease connection. Why were researchers concerned back then? Because these methylamines might form nitrosamines, which have “marked carcinogenic activity”—cancer-causing activity. So where is choline found in our diet? Mostly from meat, eggs, dairy, and refined grains. The link between meat and cancer probably wouldn’t surprise anyone. In fact, just due to the industrial pollutants, like PCBs, children probably shouldn’t eat more than about five servings a month of meats like beef, pork, or chicken combined. But, what about cancer and eggs?

Studies going back to the 1970s hinted at a correlation between eggs and colon cancer, as you can see at 2:45 in my video. That was based just on so-called ecological data, though, showing that countries eating more eggs tended to have higher cancer rates, but that could be due to a million factors. It needed to be put to the test.

This testing started in the 80s, and, by the 1990s, 15 studies had been published, of which 10 suggested “a direct association” between egg consumption and colorectal cancer, “whereas five found no association.” By 2014, dozens more studies had been published, confirming that eggs may indeed be playing a role in the development of colon cancer, though no relationship was discovered between egg consumption and the development of precancerous polyps, which “suggested that egg consumption might be involved in the promotional” stage of cancer growth—accelerating cancer growth—rather than initiating the cancer in the first place.

This brings us to 2015. Perhaps it’s the TMAO made from the choline in meat and eggs that’s promoting cancer growth. Indeed, in the Women’s Health Initiative study, women with the highest TMAO levels in their blood had approximately three times greater risk of rectal cancer, suggesting that TMAO levels “may serve as a potential predictor of increased colorectal cancer risk.”

As you can see at 4:17 in my video, though there may be more evidence for elevated breast cancer risk with egg consumption than prostate cancer risk, the only other study to date on TMAO and cancer looked at prostate cancer and did indeed find a higher risk.

“Diet has long been considered a primary factor in health; however, with the microbiome revolution of the past decade, we have begun to understand how diet can” affect the back and forth between us and the rest of us inside, and the whole TMAO story is “a smoking gun” in gut bacteria-disease interactions.

Since choline and carnitine are the primary sources of TMAO production, the logical intervention strategy might be to reduce meat, dairy, and egg consumption. And, if we eat plant-based for long enough, we can actually change our gut microbial communities such that we may not be able to make TMAO even if we try.

“The theory of ‘you are what you eat’ finally is supported by scientific evidence.” We may not have to eat healthy for long, though. Soon, Big Pharma hopes, “we may yet ‘drug the microbiome’…as a way of promoting cardiovascular health.”

What did the egg industry do in response to this information? Distort the scientific record. See my video Egg Industry Response to Choline and TMAO.


This is not the first time the egg industry has been caught in the act. See, for example:

For background on TMAO see my original coverage in Carnitine, Choline, Cancer, and Cholesterol: The TMAO Connection and then find out How to Reduce Your TMAO Levels. Also, see: Flashback Friday: How to Reduce Your TMAO Levels.

This is all part of the microbiome revolution in medicine, the underappreciated role our gut flora play in our health. For more, see: 

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Should Plant-Based Women Supplement with DHA During Pregnancy?

A systematic review of randomized controlled trials of DHA supplementation of pregnant and breastfeeding women failed to find any clear and consistent short- or long-term benefit for psychomotor, mental, visual, or physical development. Perhaps DHA supplementation during pregnancy has no effect because the body wisely protects the growth of the baby’s brain by drawing off of maternal stores of DHA, upregulating maternal DHA synthesis, and preferentially shuttling it to the fetus. But what if moms don’t start out with large maternal stores? In other words, maybe DHA failed to help women who were already getting enough, but perhaps women with very low intakes would benefit from DHA supplementation. My video Should Vegan Women Supplement with DHA During Pregnancy? explores the evidence available to date.

It’s interesting to note that, by 1978, researchers already were suggesting a plant-based diet as the diet of choice in the treatment of our number-one killer, heart disease, but babies breastfed by vegan moms had significantly less DHA in their bloodstreams, presumably because the moms had significantly less DHA in their breast milk.

The question is whether these differences are of any consequence. The growth and development of vegan and vegetarian born children are normal as long as they’re getting their B12, and “[t]here is no evidence that neural or intellectual functions are impaired.” In fact, the two studies we have on kids in vegetarian communities showed they had higher IQs, though that may be because their parents tended to be better educated. However, even though the kids seemed fine, that doesn’t rule out the possibility that there may be some “subtle differences…in visual or neural functioning.”

It would be interesting to compare the function of babies getting vegan breast milk levels versus general population levels. In one of the studies I profile in my video, it shows that vegans hit a level of 14, vegetarians 30, and omnivores 37. Another study compared 0 to 32, 64, and 96, and, though 32 worked better than 0, more than 32 didn’t add anything. This could explain why the general population at 37 doesn’t benefit from additional DHA supplementation. But what about down at 14? Most studies at that level show no advantage over 0, though one study found a benefit supplementing at as low as 5, but that doesn’t help us.

Just because babies breastfed by vegan moms have significantly lower DHA levels in the blood, that doesn’t necessarily mean they have lower levels in their brain, which is where it counts. What we need is a randomized, controlled trial in non-fish-eaters of DHA supplementation. Until then, it’s going to remain uncertain. So, what should pregnant and breastfeeding women who avoid fish do in the meanwhile? Low intake of DHA doesn’t “necessarily equate with fetal DHA inadequacy,” but new data suggest that some infants may not be getting enough and could benefit from their moms supplementing. Given this, I recommend pregnant and breastfeeding women on plant-based diets to follow the consensus guidelines to get about 200mg of preformed DHA from an uncontaminated source, like algae oil, which is probably the best combination for all women given the state of our world to minimize exposure to toxic pollutants such as dioxins, PCBs, and mercury. 


To gain a better understanding of why algae oil is better than purified fish oil, I encourage you to watch my video Should Pregnant and Breastfeeding Women Take DHA.

I’ve discussed concerns about pollutants in seafood during pregnancy in a number of my videos:

Finally, for more on taking long-chain omega-3s to protect your heart, see: 

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Should Pregnant and Breastfeeding Women Take DHA Supplements?

One of the reasons breastfed infants may have better cognitive and visual development is because human milk contains long-chain, polyunsaturated fatty acids like the omega-3 DHA, while most available infant formulas do not, based on data I discuss in my video Should Pregnant and Breastfeeding Women Take DHA?. Infants given control formula without DHA didn’t do as well as those given DHA-fortified formula, and neither group did as well as the breastfed infants, who serve as the “gold standard.” This was enough to convince formula manufacturers to start adding DHA to their infant formula starting back in 2002.

The question then became how much to add? Easy, right? Just add the amount that is naturally found in breast milk. However, the DHA level in breast milk is extremely variable depending on what the mom is eating. There are a number of healthy populations who don’t eat any seafood, for example, and they have much lower levels in their milk yet seem fine. So this makes it difficult to determine the optimal amount to add to formula or, for that matter, what to recommend for pregnant and breastfeeding women. “Consensus guidelines recommend that women should aim to consume an average of 200 mg” of DHA daily during pregnancy. “Simply encouraging pregnant women to eat more fish is not so simple, because most fish are to some extent contaminated” with toxic pollutants, such as mercury. (See my video Mercury vs. Omega-3s for Brain Development for more on this.) For most fish, such as tuna, the brain damage caused by the mercury would exceed the benefit from the DHA.

Additionally, some pollutants, like PCBs, can get stuck in our bodies for decades, so it’s not enough to just eat clean during pregnancy.

What about purified fish oil? The methods supplement manufacturers use, like distillation, leave considerable amounts of PCBs and other pollutants in the products, so much so that when taken as directed, salmon, herring, and tuna oils would exceed the tolerable daily intake of toxicity.

Thankfully, one can get the benefits without the risks by getting DHA from algae instead, which is where the fish eventually get it from themselves. So, pregnant and breastfeeding moms can cut out the middle-fish and get DHA directly from the source—at the bottom of the food chain where we don’t have to worry about toxic pollutants.

Until recently, we thought everyone should take these long-chain omega-3s for their heart. However, the balance of evidence is now such that doctors “should not recommend fish oil intake or fish consumption solely for the primary or secondary prevention of CHD,” coronary heart disease. But what about for expectant and breastfeeding mothers? What does the latest science show? Putting all the studies together, it turns out adding DHA to formula does not appear to help infant cognition after all, similar to other recent compilations of evidence that show “no significant benefit.” In fact, at least four meta-analyses, or systematic reviews, have reached a similar conclusion. These were based mostly on the standard series of measurements known as the Bayley Scales for Infant Development. If other tests were used, would there be different results? So far, no. Giving women DHA supplements during pregnancy did not appear to help with other outcomes, like attention span or working memory, either.

Although there may be no significant benefit to infant cognition, what about other things like vision? Six trials have been done to date supplementing pregnant women. Four showed no effect, and the two trials that showed benefit had some problems. So, while we really don’t know at this point, if all the studies so far show either nothing or benefit, why not just take them to err on the side of caution?

There may not be any demonstrable “clear and consistent” benefits, but there are new studies on this coming out all the time. If it’s harmless, maybe women should just take it to be on the safe side? The problem is that it may not be harmless in large doses. In a study in which women were given a whopping 800mg of DHA a day during pregnancy, infant “girls exposed to higher-dose DHA in utero [in the womb] had lower language scores and were more likely to have delayed language development than girls from the control group.”

So, the “absence of clear positive effects and the possible presence of negative effects in the children raise the question whether DHA supplementation is justifiable…” But it was a really large dose, suggesting that there may be “an optimum DHA level below and above which DHA might be detrimental to the developing brain.”


So, maybe too much is detrimental, but what about too little? I discuss that in Should Vegan Women Supplement with DHA During Pregnancy.

Other videos on the concerns about the pollutants in the aquatic food chain include:

For more on fish oil, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: