By Dr. Mercola
Nearly two decades ago, scientists unveiled the potential of a nutrient that had been all but forgotten: choline, first discovered in 1862.1 In 1998, the Institute of Medicine revealed that choline is actually essential for optimal health, meaning it can’t be produced by your body but must come from an outside source.
Although a small amount of choline is produced by your liver, the rest must come through what you eat. Unfortunately, an estimated 90 percent of the U.S. population is deficient in choline.2 According to Netherlands-based health information authority WellWise.org:
“Choline is used in the synthesis of specialized fat molecules in our bodies, called phospholipids. The most common of these is phosphatidylcholine, also known as lecithin, which is a critical component of human cell membranes.”3
Choline: What It Is and What It Does for You
Choline is sometimes grouped with vitamin B complex (B1, B2, B3, B5, B6, B7, B9 and B12) because their functions, such as how your liver, brain, muscles, nervous system and overall metabolism work, also help maintain optimal health and stave off disease.
For instance, studies show higher choline intake to be linked to a decreased heart disease risk,4 as well as a 24 percent decreased breast cancer risk among 1,508 women studied.5 This nutrient performs in several different ways throughout your body, including:
- Cell messaging, by producing cell-messaging compounds6
- Cell structure, making fats to support your cell membrane composition
- Fat transport and metabolism, as choline is needed to carry cholesterol from your liver, and a choline deficiency could result in excess fat and cholesterol buildup7
- DNA synthesis, aiding in the process along with other vitamins, such as folate and vitamin B12
- Nervous system health, because choline is necessary for making acetylcholine, a neurotransmitter involved in healthy muscle, heart and memory performance.
Why Eating Only Half Your Eggs Is Cutting Out Half Your Benefits
In the ‘70s, many doctors told their patients not to eat eggs, or at least egg yolks, because of all the cholesterol and saturated fat, but in reality, those things are good for you! A single hard-boiled egg contains 113 milligrams of choline, or nearly 25 percent of your daily requirement.8 In fact, according to the Fatty Liver Diet Guide:
“Eggs rank very high on the list of foods that are high in either lecithin, which converts to choline, or in choline itself. Note that this is the egg yolks only, not egg whites, which only have traces of this micronutrient.
Choline is essential in the production of phosphatidylcholine, a fat molecule called a phospholipid. But wait! Isn’t all fat bad? No — especially if it is essential to overall health and in particular, liver health.
Simply put — if you don’t have enough choline, your liver can’t move out fat. It instead begins to collect within your liver, creating fatty liver.”9
Several more excellent choline sources are organic, grass-fed beef liver (2.4 grams contains 290 milligrams) and wild-caught Alaskan salmon10 with egg yolks being one of the best sources in the American diet.11
Other healthy sources include other organic, grass-fed meats and wild-caught, non-polluted fish, vegetables such as cauliflower (one-half cup contains 24.2 milligrams), and healthy fats and oils.
Krill: Another Source of Choline
A 2011 study out of Norway found 69 choline-containing phospholipids in krill oil, most of which contained omega-3 fatty acids. Natural Product Insider reported:
“Using high performance liquid chromatography (HPLC)-electrospray tandem mass spectrometry, the researchers mapped the phospholipids, including the phosphatidylcholine and lyso-phosphatidylcholine classes, in krill oil extracted from Euphausia superba (krill).
They also quantified the prevalent phosphatidylcholine class [and] compared the results with prior analysis. A total of 69 choline-containing phospholipids were detected, including 60 phosphatidylcholine substances”12
- Help optimize cholesterol
- Protect against liver disease including hepatitis
- Help alcoholics prevent cirrhosis
- Reduce digestive tract inflammation
- Lessen symptoms of ulcerative colitis and irritable bowel syndrome (IBS)
What Happens If You Don’t Get Enough Choline?
A Dietary Reference Intake (DRI) value hasn’t yet been established for choline, but the Institute of Medicine set an “adequate daily intake” value of 425 milligrams per day for women, 550 milligrams per day for men13 and 250 milligrams for children14 to help prevent a deficiency and potential organ and muscle damage.
Supplementation is an option if you’re concerned about getting enough choline in your diet. Choline requirements, however, depend on factors such as gender, age, genetic makeup and diet.
It even varies across racial and ethnic groups.15 Some people taking a certain amount might be fine, but others taking the same amount may be deficient.
Another study showed that, deprived of dietary choline, 77 percent of men and 80 percent of postmenopausal women suffered either fatty liver or muscle damage, even when taking the currently recommended adequate Intake (indicating that amount is insufficient),16 but when getting enough choline, the symptoms disappeared.
A study on the severity of 664 people with non-alcoholic liver disease showed that decreased choline intake significantly increased their symptoms, including fibrosis, the thickening and scarring of connective tissue.17
Choline Deficiency Risk Higher for Certain People
Another review indicated that higher periconceptional choline intake was associated with reduced neural tube defect risk.18 Choline deficiency in pregnant moms may also raise the risk of problems such as premature birth, low birth weight and preeclampsia. Other at-risk individuals for choline deficiency include:
- Athletes: During endurance exercise, such as a marathon, choline levels deplete. Choline supplementation before severe physical stress had varying advantageous effects in studies.19,20 Choline supplementation may quickly reduce body mass without side effects.21
- High alcohol consumers: Excess alcohol consumption can both increase your need for more choline and your risk of deficiency.22
- Postmenopausal women: Lower estrogen concentrations in postmenopausal women increased their risk of organ dysfunction in response to a low-choline diet, so their requirements are higher than those of premenopausal women.23
- Vegetarians: Choline supplementation may also be important for this demographic, as they have an elevated risk for deficiency.24
Research Shows Choline to Be ‘Groundbreaking’ Nutrient
Choline requirements rise exponentially for pregnant women. A study in the FASEB Journal reported that pregnant women who took 930 milligrams in their third trimester experienced a 33 percent decreased concentration of cortisol, the stress hormone, which could later in life protect the child from metal health issues, high blood pressure and type 2 diabetes. According to the Annual Review of Nutrition:
“Choline is critical during fetal development, when it influences stem cell proliferation and apoptosis, thereby altering brain and spinal cord structure and function and influencing risk for neural tube defects and lifelong memory function.”25
Science Daily reported:
“Choline … when given as a dietary supplement in the last two trimesters of pregnancy and in early infancy, is showing a lower rate of physiological schizophrenic risk factors in infants 33 days old.
The study breaks new ground both in its potentially therapeutic findings and in its strategy to target markers of schizophrenia long before the illness itself actually appears.
Choline is also being studied for potential benefits in liver disease, including chronic hepatitis and cirrhosis, depression, memory loss, Alzheimer's disease and dementia, and certain types of seizures.”26
In one study of 1,210 pregnant women taking choline, higher second-trimester intake showed the children had better visual memory scores at age 7.27 Another study on the topic reported that during pregnancy and lactation, choline reserves are depleted at the very time it’s crucial for normal brain development. Mothers who ingest it may impart lifelong memory enhancement to their child due to changes in the development of the hippocampus (memory center) of the brain.28
Additionally, an animal study revealed that prenatal choline supplementation improved learning capabilities of babies born with Down syndrome and protected them from developing Alzheimer’s later in life.29
Memory, Mood and Intelligence: Choline’s Brain Benefits
Choline is required for DNA synthesis and is crucial for optimal brain development and function,30 as well as for improved memory and processing; however, the evidence is mixed. A Forbes article noted:
“It’s not just the prenatal brain that’s stimulated and strengthened by phosphatidylcholine (PC). Neuroscientists have been studying the potential of choline to prevent cognitive decline and the onset of Alzheimer’s and dementia and even to regrow brain cells as we age … phosphatidylcholine was found to stimulate the growth of new brain cells and neural connections, a process known as neurogenesis and once thought impossible after a certain age.”31
The neurotransmitter acetylcholine is important in regulating memory, mood and intelligence, and choline is required to produce it. According to one review, “Loss of cholinergic neurons is associated with impaired cognitive function, particularly memory loss and Alzheimer disease.”32
One researcher said that while choline may not prevent Alzheimer’s, eating a balanced diet may make all the difference in the way your brain ages. Case in point: when around 1,400 adults aged 36 to 83 underwent questionnaires, memory tests and MRI brain scans between 1991 and 2001, scientists concluded that those taking the most choline performed better.33
Senior researcher Rhoda Au, Ph.D., of Boston University School of Medicine, said such results indicate that people with lower choline intakes may be on a downward "pathway" cognitively than those with higher intakes. As the Framingham Offspring cohort noted:
“Higher concurrent choline intake was related to better cognitive performance, whereas higher remote choline intake was associated with little to no white-matter hypertensity.”34
Studies also indicated that choline concentrations in blood was associated with relieving anxiety, but not depression;35 and in at least one study (although few are available), individuals with rapid-cycling bipolar disorder treated with choline had either a “substantial reduction in manic symptoms” or all mood symptoms were reduced.36
Too much choline has been linked to a few unpleasant or harmful side effects, such as sweating, nausea, vomiting, “fishy” body odor and lowered blood pressure. This is why it’s best to get choline from food sources as much as possible, as it’s very unlikely that you’ll get too much choline via dietary sources.