Choline is an essential nutrient needed for optimal health.
Choline is a recently discovered nutrient.
Tt wasn't until 1998 that it was recognized as an essential nutrient by the institute of medicine.
While your body produces some choline, you need to get choline from your diet to avoid deficiency.
However, many people do not meet the recommended intake of this nutrient (1).
This article provides everything you need to know about choline, including what it is and why you need it.
ًWhat is choline?
Choline is an essential nutrient (2).
This means that it is necessary for normal bodily functions and human health. while your liver can produce small amounts, you have to get most of them through your diet.
Choline is an organic, water-soluble compound. it is neither a vitamin nor a mineral.
However, due to its similarity, it is often grouped with vitamin B compounds. In fact, this nutrient affects many important body functions.
It affects liver function, healthy brain development, muscle movement, nervous system, and metabolism.
Therefore, sufficient amounts are required to achieve optimal health (1).
Summary: Choline is an essential nutrient that must be included in your diet to maintain optimal health.
Provides a variety of functions for your body
Choline plays an important role in many processes in your body, including:
- cell structure: need to make fats that support the structural integrity of cell membranes (3).
- cellular messaging: it is involved in the production of compounds that act as cellular messengers.
- fat transport and metabolism: it is essential for making the substances needed to remove cholesterol from the liver. choline deficiencies may cause fat and cholesterol to accumulate in the liver (4, 5).
- DNA synthesis: Choline and other vitamins, such as B12 and folic acid, contribute to important processes in DNA synthesis.
- healthy nervous system: this nutrient is necessary for the manufacture of acetylcholine, an important neurotransmitter. it involves basic functions such as memory, muscle movement, and regulation of the heartbeat.
Summary: Choline is involved in many different processes, such as cell structure and information transmission, fat transport and metabolism, DNA synthesis, and nervous system maintenance.
How much do you need?
DUE TO THE LACK OF AVAILABLE EVIDENCE, THE REFERENCE DAILY INTAKE (RDI) FOR CHOLINE HAS NOT BEEN ESTABLISHED.
However, the Institute of Medicine sets a value for an adequate intake (AI). (6)
This value is sufficient for most healthy people to help them avoid the negative consequences of deficiency, such as liver damage.
however, the requirements vary by genetic makeup and sex (7, 8, 9).
In addition, determining choline intake is difficult because its presence in various foods is relatively unknown.
The following are the recommended AI values for choline by age group (10):
- 0-6 months: 125 mg daily
- 7-12 months: 150 mg daily
- 1-3 years: 200 mg daily
- 4-8 years: 250 mg daily
- 9-13 years: 375 mg daily
- 14-19 years: 400 mg per day for women and 550 mg per day for men
- adult females: 425 mg per day
- adult males: 550 mg per day
- lactating women: 550 mg per day
- pregnant women: 930 mg daily
it is important to note that choline requirements may depend on the individual. many people will do with less choline, while others will need more (2).
In a study of 26 men, 6 people developed symptoms of choline deficiency even while taking AI (9).
Summary: adequate intake of choline is 425 mg per day for women and 550 mg per day for men. however, requirements may vary from person to person.
Deficiency is unhealthy but rare
a choline deficiency can cause damage, especially to your liver.
A small study of 57 adults found that 77% of men, 80% of postmenopausal women, and 44% of premenopausal women experience liver and/or muscle damage after a choline-deficient diet. （11）
Another study noted that when postmenopausal women consumed a choline-deficient diet, 73 percent developed liver or muscle damage. （12）
However, once they start consuming enough choline, these symptoms go away.
Choline is especially important during pregnancy, as low intake may increase the risk of neural tube defects in unborn babies.
One study determined that higher dietary intake during conception was associated with a lower risk of neural tube defects. （13）
In addition, a low intake of choline may increase your risk of other pregnancy complications. these include preeclampsia, preterm birth, and low birth weight (2).
While most Americans don't consume enough in their diets, the actual lack of them is rare.
Summary: choline deficiency is associated with liver and/or muscle damage. low intake during pregnancy is associated with complications.
Some people are at risk of deficiency
Although choline deficiency is rare, the risk is increased in some people (14):
- endurance athletes: during prolonged endurance exercises, such as marathons, levels decline. it is unclear whether taking supplements improves performance (15, 16).
- high alcohol intake: alcohol increases the risk of choline need and deficiency, especially when intake is low (17, 18).
- postmenopausal women: estrogen contributes to the production of choline in the body. because estrogen levels tend to decline in postmenopausal women, the risk of their deficiency may be greater. （6, 19）。
- pregnant women: increased choline demand during pregnancy. this is most likely because unborn babies need choline to develop (20).
Summary: people at increased risk of choline deficiency include athletes, heavy drinkers, postmenopausal women, and pregnant women.
Main dietary source
Choline can be obtained from a variety of foods and supplements.
Food sources
Dietary sources are usually in the form of phosphatidylcholine from lecithin (a type of fat).
the most abundant dietary sources of choline include (21):
- beef liver: 1 tablet (2.4 ounces or 68 grams) contains 290 mg.
- chicken liver: 1 tablet (2.4 ounces or 68 grams) contains 222 mg.
- eggs: 1 large hard-boiled egg contains 113 mg.
- fresh cod: 3 oz (85 g) contains 248 mg.
- salmon: a 3.9-ounce (110 g) fillet contains 62.7 mg.
- cauliflower: 1/2 cup (118 ml) contains 24.2 mg.
- broccoli: 1/2 cup (118 ml) contains 31.3 mg.
- soybean oil: 1 tablespoon (15 ml) contains 47.3 mg.
Since one egg provides about 20-25% of the daily needs, two large eggs can provide almost half (22).
In addition, a 3-ounce (85 g) serving of bovine kidney or beef liver can meet most of the daily needs of women and men (23).
Additives and supplements
Soy lecithin is a widely used food additive that contains choline. therefore, it is likely that the extra choline is ingested through the diet through food additives.
Lecithin can also be purchased as a supplement. however, lecithin tends to contain only 10-20% phosphatidylcholine.
Phosphatidylcholine can also be taken as a pill or powder supplement, but choline only accounts for about 13% of the weight of phosphatidylcholine (24).
Other forms of supplementation include choline chloride, CDP-choline, α-GPC, and betaine.
If you are looking for supplements, CDP-choline and alpha-GPC tend to have higher levels of choline per unit weight. They are also easier to absorb than others.
Some sources claim that choline in nutritional supplements can reduce body fat, but there is little evidence to support these claims.
Summary: Rich food sources of choline include beef liver, eggs, fish, nuts, cauliflower, and broccoli. Choline can also be used as a supplement, of which CDP-choline and α-GPC appear to be the best types.
Effects on heart health
Higher choline intake was associated with a reduced risk of heart disease (25).
Folic acid and choline help convert the amino acid homocysteine to methionine.
Eherefore, a deficiency of any one nutrient leads to the accumulation of homocysteine in the blood.
Elevated homocysteine levels in the blood are associated with an increased risk of heart disease and stroke (26).
However, the evidence is mixed.
Although choline may lower homocysteine levels, the association between choline intake and heart disease risk is unclear. （27, 28, 29, 30, 31, 32）。
Summary: choline can help reduce the risk of heart disease by lowering homocysteine levels. however, the evidence is mixed.
Effects on the brain
choline is necessary for the production of acetylcholine, a neurotransmitter that plays an important role in regulating memory, mood, and intelligence. （33）
It is also needed for the process of synthesizing DNA, which is important for brain function and development (34).
Therefore, it is not surprising that choline intake is associated with improvements in brain function.
Memory and brain function
Large observational studies have linked choline intake and blood levels to improved brain function, including better memory and processing. （35, 36）
Daily supplementation of 1,000 mg improves short- and long-term verbal memory in adults with poor memory in children aged 50-85 years. （37）
In a 6-month study, phosphatidylcholine was given to patients with early Alzheimer's disease and moderately improved memory in a small subgroup. （38）
however, other studies on healthy people and people with dementia have found no effect on memory (39, 40, 41).
Brain development
Several animal studies have shown that taking choline supplements during pregnancy may improve fetal brain development. （20, 42, 43）
However, there are only a few studies on humans.
An observational study of 1,210 pregnant women found that choline intake was not associated with the psychological performance of children at age 3 (44).
However, the same study determined that higher intake in the second trimester was associated with better visual memory scores in the same children aged 7 years. (45）
In another study, 99 pregnant women took 750 mg of choline daily from the 18th week of pregnancy to the third trimester of pregnancy. they have no benefits for brain function or memory (46).
Mental health
There is some evidence that choline may play a role in the development and treatment of certain mental health disorders.
One large observational study linked lower blood levels to a higher risk of anxiety—but not to depression (47).
These levels are also used as indicators of certain mood disorders, and choline supplements are sometimes used to treat bipolar disorder (48).
One study found that choline therapy improved manic symptoms in individuals diagnosed with bipolar disorder. (49）
However, there is not much research on this at the moment.
Summary: choline can enhance memory function, improve brain development and treat anxiety and other mental disorders. however, the evidence is mixed.
Other health benefits
Choline is associated with the development and treatment of certain diseases.
for most of them, however, this relationship is unclear and research is ongoing (50).
Hepatopathy
although choline deficiency can lead to liver disease, it is unclear whether intake below the recommended level increases the risk of liver disease.
a study of more than 56,000 people found that normal-weight women with the highest intake had a 28% lower risk of liver disease compared to women with the lowest intake. (51）
the study showed that men or overweight women were not associated with liver disease (51).
another study of 664 patients with the non-alcoholic liver disease found that the lower the intake, the higher the severity of the disease. (52）。
Cancer
Some studies have shown that women who consume large amounts of choline have a lower risk of breast cancer (53, 54, 55).
A study of 1,508 women found that those who had a diet high in free choline were 24% less likely to develop breast cancer. (55）。
However, the evidence is mixed.
Other observational studies have found no association with cancer, but test-tube studies have shown that deficiency may increase the risk of liver cancer. (56, 57, 58）
conversely, higher intakes were also associated with an increased risk of prostate cancer in men and colon cancer in women. (59, 60）。
Neural tube defects
consuming more choline during pregnancy may reduce the risk of neural tube defects in infants.
one study noted a 51% lower risk of neural tube defects in women with high intake before and after conception compared to women with very low intake. (61）
another observational study found that pregnant women with the lowest intake were more than twice as likely to have a neurologically defective baby. (62）
however, other studies have observed no link between maternal intake and the risk of neural tube defects. (63, 64）
Summary: There is limited evidence that choline may reduce the risk of neural tube defects and liver disease in infants. that said, the effect of choline on cancer is unclear. more research is needed.
Too much can be harmful
Consuming too much choline can have unpleasant and potentially harmful side effects.
These include decreased blood pressure, sweating, fishy smell, diarrhea, nausea, and vomiting (65).
the maximum daily limit for adults is 3,500 mg per day. this is the maximum intake that is unlikely to cause harm.
it is unlikely that a person will only consume so much food. this level is almost impossible to reach without taking supplements in large doses.
Summary: excessive intake of choline has been linked to unpleasant and potentially harmful side effects. however, you are unlikely to consume this level only from food.
Conclusion:
Choline is an essential nutrient needed for optimal health.
It may play a key role in healthy brain function, heart health, liver function, and pregnancy.
While the actual lack is rare, many people in western countries are not meeting the recommended intake.
To increase your intake, consider eating more choline-rich foods such as salmon, eggs, broccoli, and cauliflower.