Choline

What is choline?

Choline is an essential nutrient that plays a role in the synthesis of phospholipid membranes and is a source of methyl groups that are needed for many steps in metabolism. It’s also the precursor to the neurotransmitter acetylcholine. Choline has particular relevance for brain development, liver health, and skeletal muscle function. Choline is mostly found in animal foods such as eggs, milk, fish, chicken, and beef, but some plant foods also contain choline.

What foods are rich in choline?

Choline is found naturally in foods in different forms, including the fat-soluble phospholipids phosphatidylcholine and sphingomyelin and the water-soluble compounds phosphocholine, glycerophosphocholine, and free choline. About half of the dietary choline consumed in the United States is in the form of phosphatidylcholine. The main dietary sources of choline are animal-based foods such as meat, poultry, fish, dairy, and eggs, as well as some cruciferous vegetables, beans, nuts, seeds, and whole grains. The top sources of choline are beef liver (3 ounces contains 356 mg of choline), eggs (one large egg contains 147 mg of choline), beef (3 ounces contains 117 mg of choline) and soybeans (one half of a cup contains 107 mg of choline).

Does our body make choline?

Choline is produced endogenously in the liver (as phosphatidylcholine), but the amount we make isn’t sufficient to meet our body’s needs. Therefore, it’s essential to obtain choline from the diet and/or supplements. According to some estimates, adults in the United States only consume between 278 and 402 mg of choline per day, which falls below the adequate intake (AI) for choline. Despite having lower-than-recommended dietary intakes of choline, most adults don’t appear to be choline-deficient, possibly due to the contribution from endogenous choline production.

What are choline’s main benefits?

Choline supplementation during pregnancy or early childhood has favorable effects on children’s brain function and neurodevelopment, including memory, attention, and visual-spatial learning. Choline supplementation among children with fetal alcohol spectrum disorder improves memory, nonverbal intelligence, visual-spatial skills, ADHD symptoms, executive function, and white matter microstructure. These effects occur primarily when choline is supplemented before the age of 5. Higher choline intakes have been associated with a lower risk for cardiovascular events and stroke, cognitive impairment, post-stroke depression, cardiovascular disease, and dementia. A higher intake of choline is also associated with lower levels of cardiometabolic risk factors. Interestingly, a low choline intake may impair gains in strength and lean mass in response to exercise training and reduce cognitive function.

Who is most at risk for a choline deficiency?

Choline deficiency can lead to muscle damage, liver damage, and nonalcoholic fatty liver disease. However, clinically evident choline deficiency is very rare, likely due to the contribution of the body’s endogenous choline production. Choline intakes tend to be below the adequate intake for children and adults, who average an intake of 256 mg per day and 278–402 mg per day, respectively.

What are choline’s main drawbacks?

High/excessive intakes of choline can result in some side effects, including a fishy body odor, vomiting, excessive sweating and salivation, low blood pressure (hypotension), and liver toxicity. In addition, choline consumption has been shown to increase the production of trimethylamine N-oxide (TMAO), which is associated with an increased risk of cardiovascular disease. However, some studies indicate that the amount of choline consumed in 3 eggs per day does not elevate plasma TMAO levels. Some studies have associated higher choline intakes with increased atrial fibrillation and type 2 diabetes.