Choline

What is choline?

Choline is essential for:

Are you choline deficient?

Symptoms of choline deficiency

Food sources of choline

Choline supplementation

Choline overdose, contraindications

References

What is choline?

Choline is a vitamin-like essential water-soluble micronutrient. It is not a vitamin, but is closely related to the vitamin B group, especially vitamin B12. Choline acts as a methyl donor (see DSMO) and is involved in many physiological processes including normal metabolism, transport of lipids, methylation reactions and neurotransmitter synthesis. (4)

Choline is essential for:

• Brain function. Citicoline has also been studied as a potential treatment to limit neurological damage in patients experiencing stroke or traumatic brain injury. (1)
• Cell membrane structure and function.
• Eye and retina health. Evidence suggests that treatment with citicoline (a choline derivative) may be used to improve retinal function in some patients with glaucoma. (13)
• Heart health by limiting and controlling homocysteine.
• Hormonal balance.
• Inflammation control.
• Liver health. Choline combined with ketogenic fasting is a preventative and cure for a fatty liver. See supplementation below. (2, 3, 5)
• Muscle function.
• Nerve function. Choline is converted to acetylcholine, a neurotransmitter.

Are you choline deficient?

The risk of choline deficiency is low for those on a traditional diet of real, wild or free range food. However, vegetarians and vegans are at significant risk of deficiency, as are those on a modern processed food diet.

Choline is essential for so many bodily processes that it is difficult to diagnose choline deficiency just by examining the symptoms, because so many other nutrient deficiencies can also cause similar symptoms.

A blood test is available to measure choline, but it does not accurately reflect tissue concentrations around the body.

Other blood tests that show low levels of betaine, phosphatidylcholine and very low-density lipoprotein (VLDL) can also be a sign of choline deficiency.

A number of health conditions prevent the absorption of choline from food, even when eating a choline-rich diet. These include:

• Gastric by-pass surgery.
• Liver problems like cirrhosis.
• Pharmaceuticals. Some pharmaceutical drugs such as anticonvulsants and statins can cause choline deficiency.
• Kidney transplant.

Symptoms of choline deficiency

• Fatty liver. Choline is essential for liver health, protecting against hepatitis and cirrhosis. Choline deficiency causes abnormal deposition of fat in the liver resulting in a condition called non-alcoholic fatty liver disease. (2, 3, 5)
• Muscle damage. Choline deficiency can lead to muscle dysfunction. This can be confirmed with a test that measures muscle enzyme levels. (6)
• Poor brain function. Brain fog, depression, memory loss, Alzheimer's disease, dementia, Huntington's chorea, Tourette syndrome, seizures, schizophrenia and other brain disorders. (1)
• Fatigue and tiredness. Athletes use choline to enhance bodybuilding and delay fatigue during endurance sports.
• Pregnancy and breastfeeding risks. Choline is essential for neural tube formation, brain development and the overall development of a foetus. Choline is a cornerstone of prenatal care because inadequate choline intake during pregnancy is associated with neural tube defects and cognitive deficits in the infant and health complications in the mother.
• Cancer elevated risk.
• Hypertension (high blood pressure).
• Cholesterol ratios deteriorate.
• Asthma.

Food sources of choline

The liver produces a little choline, but not enough for the full needs of the body.

A healthy gut biome also has microbes that produce choline, but again not enough for needs.

1. Liver is the richest source of choline. Beef liver contains about 420 mg per 100 grams.
2. Egg yolk. A large egg contains about 145 mg.
3. Other animal sources of choline include beef, chicken, salmon and other meats, fish and seafood. Beef for example, contains about 135 mg of choline per 100 grams.
4. Dark leafy green vegetables. A cup of cooked spinach contains up to 60 mg of choline. Other cooked green vegetables such as Swiss chard and collard greens contain lesser amounts of choline.
5. Chic peas, split peas, navy beans. 1 cup before cooking contains 180-200 mg.
6. Cruciferous vegetables like broccoli contain a little choline but not enough if on a vegan or vegetarian diet. Almonds also contain a very small amount of choline.

Choline supplementation

There are several choices available for different types of choline supplements, some which will be more readily absorbed and used by the body, while others may have different effects. Your body converts choline into the molecule acetylcholine that is responsible for many of choline's health benefits. Different types of choline supplements also differ in their ability to cross the blood-brain barrier once ingested.

Try to purchase a choline supplement that is made from whole food sources and is of high quality. Alternatively, the best synthesised supplement may be CDP choline, also called citicoline or Alpha GPC choline.

The following daily choline supplement levels should be sufficient for producing optimal benefits without causing any harm: (7, 12)

Infants and babies:      125-150 mg
Children 1-8 years:      150-250 mg
Teens 8-13 years:       250-375 mg
Women above 14:       425-500 mg
Pregnant women:        450 mg
Breastfeeding women: 550 mg
Men above 14:              550 mg

For fatty liver in an adult. 3000 mg per day, combined with ketogenic fasting. This combination should result in up to 50% reduction in fatty liver in two weeks.

Choline overdose, contraindications

Choline is not known to interact with any medications, but please tell your doctor, pharmacist or other health care providers about any dietary supplements, prescription and over-the-counter medicines that you take.

Excessive choline supplementation can cause a fishy body odour, nausea or vomiting, heavy sweating and salivation, low blood pressure and liver damage. Some research also suggests that very high amounts of choline may increase the risk of heart disease.

Studies have shown that high levels of choline are associated with increased risk of prostate cancer, (8, 9, 11) and to a lesser extent some other cancers. (10) This is in addition to an association of prostate cancer with high egg consumption.

The daily upper limits for choline include intakes from both food and supplementation should not exceed the following upper limits: (7, 12)

Birth to 12 months       Not established
Children 1-3 years       1,000 mg
Children 9-13 years      2,000 mg
Teens 14-18 years       3,000 mg
Adults                          3,500 mg

Your comments about any of your experiences - positive or negative - with your use of choline are welcome at Grow Youthful. I am always curious about your use of and experience with natural remedies, and your feedback is very welcome.

References

1. Sanders LM, Zeisel SH. Choline: Dietary Requirements and Role in Brain Development. Nutr Today. 2007;42(4):181-186. doi: 10.1097/01.NT.0000286155.55343.fa. PMID: 18716669; PMCID: PMC2518394.

2. Sherriff JL, O'Sullivan TA, Properzi C, Oddo JL, Adams LA. Choline, Its Potential Role in Nonalcoholic Fatty Liver Disease, and the Case for Human and Bacterial Genes. Adv Nutr. 2016 Jan 15;7(1):5-13. doi: 10.3945/an.114.007955. PMID: 26773011; PMCID: PMC4717871.

3. Octavia Pickett-Blakely, Kimberly Young, Rotonya M Carr. Micronutrients in Non-alcoholic Fatty Liver Disease Pathogenesis. CMGH, Vol 6, Issue 4, 451-462, 22 August 2018.

4. Mahamid M, Mahroum N, Bragazzi NL, Shalaata K, Yavne Y, Adawi M, Amital H, Watad A. Folate and B12 Levels Correlate with Histological Severity in NASH Patients. Nutrients. 2018 Apr 2;10(4):440. doi: 10.3390/nu10040440. PMID: 29614799; PMCID: PMC5946225.

5. Hariri M, Zohdi S. Effect of Vitamin D on Non-Alcoholic Fatty Liver Disease: A Systematic Review of Randomized Controlled Clinical Trials. Int J Prev Med. 2019 Jan 15;10:14. doi: 10.4103/ijpvm.IJPVM_499_17. PMID: 30774848; PMCID: PMC6360993.

6. da Costa KA, Niculescu MD, Craciunescu CN, Fischer LM, Zeisel SH. Choline deficiency increases lymphocyte apoptosis and DNA damage in humans. Am J Clin Nutr. 2006 Jul;84(1):88-94. doi: 10.1093/ajcn/84.1.88. PMID: 16825685; PMCID: PMC2430662.

7. National Institutes of Health, Office of Dietary Supplements, Consumer Fact Sheet for Choline. ods.od.nih.gov. Retrieved 16 June 2024.

8. Richman EL, Kenfield SA, Stampfer MJ, Giovannucci EL, Zeisel SH, Willett WC, et al. Choline intake and risk of lethal prostate cancer: incidence and survival. Am J Clin Nutr. 2012;96:855-863.

9. Johansson M, Van Guelpen B, Vollset SE, Hultdin J, Bergh A, Key T, et al. One-carbon metabolism and prostate cancer risk: prospective investigation of seven circulating B vitamins and metabolites. Cancer Epidemiol Biomark Prev. 2009;18:1538-1543.

10. Li W, Li C, Liu T, et al. The association of serum choline concentrations with the risk of cancers: a community-based nested case-control study. Sci Rep 13, 22144 (2023).

11. Chad A Reichard, Bryan D Naelitz, Zeneng Wang, Xun Jia, Jianbo Li, Meir J Stampfer, Eric A Klein, Stanley L Hazen, Nima Sharifi. Gut Microbiome-Dependent Metabolic Pathways and Risk of Lethal Prostate Cancer: Prospective Analysis of a PLCO Cancer Screening Trial Cohort. Cancer Epidemiol Biomarkers Prev 1 January 2022; 31 (1): 192-199.

12. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Institute of Medicine, Washington, DC: National Academy Press; 1998.

13. Prinz J, Prokosch V, Liu H, Walter P, Fuest M, Migliorini F. Efficacy of citicoline as a supplement in glaucoma patients: A systematic review. PLoS One. 2023 Sep 28;18(9):e0291836. doi: 10.1371/journal.pone.0291836. PMID: 37768938; PMCID: PMC10538785.