Published on 11 Mar 2024

The Nutrient You Should Know About

Ensuring pregnant and breastfeeding mothers have enough choline is crucial. However, it’s equally important to recognise that the need for choline goes beyond just maternal well-being. Children and adults, regardless of age, can benefit from adequate choline intake for overall good health.

Choline provides a range of benefits, contributing to improved cognitive function, cardiovascular health, metabolism, mental well-being, and also reproductive health for women with PCOS. While the body produces some choline, it’s crucial to obtain it from the diet to prevent deficiencies. Additionally, some people face a higher risk of choline deficiency, which, though rare, can lead to organ dysfunction. Therefore, maintaining adequate choline levels is essential for achieving optimal health.

This article covers everything about choline, explaining what it is and why it’s beneficial for you.

What is Choline?

Choline is a water-soluble nutrient closely associated with folate and other vitamins within the B vitamin complex family. Similar to B vitamins, choline plays a crucial role in maintaining energy levels, active metabolism, and brain function. However, it does not fall into the category of a vitamin or a mineral. Instead, it is simply an essential micronutrient.

Typically, choline exists in the form of phosphatidylcholine, a compound integral to the structural makeup of fats. Therefore, foods naturally containing certain fats are good sources of choline.

Summary

Choline, a crucial water-soluble nutrient closely linked to B vitamins, maintains energy, metabolism, and brain function. Present in fats as phosphatidylcholine, it’s essential for various bodily functions, emphasising the importance of choline-rich foods in the diet.

Benefits of Choline

Choline offers significant benefits as the body utilises it in various ways, such as:

Good for Heart Health

A higher intake of choline reduces the risk of heart disease. Choline, along with folate, helps convert the amino acid homocysteine to methionine. Thus, a deficiency in either nutrient can lead to homocysteine accumulation in the blood, increasing the risk of heart disease and strokes.

Supports Pregnancy

During pregnancy, the baby’s cells divide rapidly, and choline is essential for supporting the baby’s brain development, including learning, memory, and attention. Choline, much like folate or folic acid, helps prevent neural tube defects. 

Pregnant women who consumed more than 498 mg/day of choline have a lower risk of their babies developing neural tube defects compared to those with lower choline levels, regardless of their folic acid intake.

Choline also lowers the risk of preeclampsia, which may be higher in women with PCOS. Babies born to mothers with sufficient choline levels also have lower levels of the stress hormone cortisol.

Improves Brain Function

The body requires choline to produce acetylcholine, a neurotransmitter crucial for regulating memory, mood, and intelligence. Choline is also necessary for the DNA synthesis process, which is vital for brain function and development.

Adults aged 50–85 with poor memory experienced improved short- and long-term verbal memory when taking a daily supplement of 1,000 mg. Furthermore, giving phosphatidylcholine to people with early Alzheimer’s disease led to a modest improvement in memory.

Manage Fatty Liver Disease

Choline is crucial for maintaining healthy liver function, and studies indicate a connection between choline deficiency and fatty liver disease. While there’s no evidence supporting choline’s ability to reverse fatty liver disease, it may play a role in preventing the condition. 

Among women with a moderate body mass index (BMI) between 18.5 and 24.9, consuming 412 milligrams (mg) of choline per day was associated with a lower fatty liver disease risk compared to those consuming 179 mg per day.

Help Manage Fertility Issues in PCOS

Choline and inositol, despite having different functions in the body, effectively work together to manage PCOS. Combining choline with inositol supplements may improve menstrual cycle regularity, ovulation, and pregnancy rates in individuals with PCOS. Furthermore, they can aid in regulating insulin levels, providing potential benefits for PCOS women dealing with insulin resistance and diabetes.

Inositol and choline supplementation can contribute to BMI reduction in women dealing with both PCOS and obesity. These supplements specifically improve insulin sensitivity and regulate hormone levels, potentially providing benefits for individuals experiencing severe menstrual disorders, including PCOS.

In a 12-week supplementation study, women with PCOS, regardless of obesity status, benefited from choline and inositol supplementation. Choline supplementation also influences ovarian follicular development. Additionally, choline’s role in fat metabolism contributes to increased satiety, potentially leading to reduced calorie intake and overall weight loss.

Summary

Choline offers diverse health benefits. It reduces the risk of heart disease by converting homocysteine to methionine. In pregnancy, it supports the baby’s brain development, preventing neural tube defects. Choline lowers preeclampsia risk and stress hormone levels in babies. It improves brain function by aiding neurotransmitter production and DNA synthesis. Supplementation enhances memory in adults and may modestly improve memory in early Alzheimer’s. Choline also helps manage fatty liver disease and, when combined with inositol, improves fertility in PCOS by regulating menstrual cycles, ovulation, and insulin levels.

Who is at Risk of Choline Deficiency?

Choline deficiency is rare, but many people fail to maintain sufficient choline levels, even when consuming foods rich in this nutrient. The body can find it hard to absorb choline in certain conditions, like after bypass surgery, kidney transplant, or dealing with liver issues like cirrhosis. Also, using anticonvulsant drugs for a long time can add to the risk of choline deficiency. It’s essential to be mindful of choline intake, especially if you have these health conditions, to avoid potential deficiencies.

Choline deficiency is also more likely in specific demographic groups, such as;

  • Postmenopausal Women: Oestrogen, which aids in choline production, tends to decrease in postmenopausal women. Consequently, postmenopausal women may be at a higher risk of choline deficiency.
  • Pregnant Women: Choline requirements rise during pregnancy, likely due to the developing baby’s need for choline in its development.
  • Endurance athletes: Choline levels may decrease during prolonged endurance exercises like marathons. 
  • Heavy Drinkers: People with high alcohol intake, particularly when combined with a diet lacking in choline-rich foods, may be at an increased risk of choline deficiency.

Summary

Choline deficiency is uncommon, yet many struggle to maintain sufficient levels, even with choline-rich foods. Factors like bypass surgery, kidney transplant, liver issues, and prolonged anticonvulsant use hinder choline absorption. Mindful intake is crucial, especially with these conditions, to prevent deficiencies. Specific groups at higher risk include postmenopausal women due to decreased oestrogen, pregnant women with increased choline needs, endurance athletes during prolonged exercises, and heavy drinkers. 

Symptoms of Choline Deficiency

It’s important to note that reaching a choline level low enough for deficiency is very difficult. However, here are the potential signs and symptoms you should be looking out for if your choline levels are too low:

  • Non-alcoholic fatty liver disease
  • Cognitive decline
  • Learning disabilities
  • Muscle aches
  • Mood changes
  • Nerve damage

As choline plays a role in maintaining neurotransmitters, a deficiency may contribute to age-related cognitive decline, leading to issues like memory loss and Alzheimer’s disease. Also, as a person ages, there can be a decline in nerve signalling, potentially resulting in symptoms of dementia.

Summary

It’s rare to reach deficient choline levels, but symptoms include non-alcoholic fatty liver disease, cognitive decline, learning disabilities, muscle aches, mood changes, and nerve damage. Choline’s role in neurotransmitter maintenance may contribute to age-related cognitive decline, causing memory loss and Alzheimer’s disease. 

How Can You Increase Your Choline Intake?

The most effective way to ensure sufficient choline intake is by maintaining a varied, balanced diet. Various foods naturally contain high levels of choline, along with other essential nutrients. Such as:

Eggs

Eggs stand out as an excellent choline source, providing 235 mg per whole boiled or poached egg (50g). It contributes around 30-38% of the recommended adequate intake for adults. Notably, choline is concentrated in the egg yolk, not the egg white. 

The yolk, rich in high-quality protein, healthy fats, vitamins, minerals, and antioxidants, complements the egg white’s 60% protein content. The satisfying nature of eggs promotes feelings of fullness, reducing hunger and the urge for mid-afternoon snacks, which is beneficial for weight management.

Beef Liver

Beef liver, classified as organ meat alongside kidney and heart, may not suit everyone’s taste due to its strong flavour and texture. However, it packs a notable choline concentration, providing 333 mg per 100g, along with essential vitamins, minerals, and nutrients. 

Rich in B12, riboflavin, pantothenic acid, niacin, folate, B6, and thiamine, beef liver supports healthy red blood cell production. Its high content of B vitamins and iron makes it suitable for preventing anaemia. A study in Egypt looked at how eating fried liver meatballs affects anaemia, vitamin A deficiency, and thinking skills in mildly anaemic children aged 3–9. The results show the liver increased iron and vitamin A in all kids’ diets and showed signs of improving cognitive function.

Chickpeas

Chickpeas are packed with nutrients, including brain-supporting choline, with a 100 g serving offering 42.8 mg. This legume, rich in protein, serves as a great meat alternative in vegetarian and vegan dishes. Its high protein and fibre content helps you feel full, potentially reducing calorie intake during meals.

Chickpeas can aid in blood sugar management through various mechanisms. Their relatively low glycemic index (GI), indicating a slower rise in blood sugar after consumption, aligns with diets promoting blood sugar control. Furthermore, the fibre and protein content in chickpeas may regulate blood sugar levels.

Dairy Products

Dairy products serve as a rich source of choline. A cup of whole milk supplies 43.4 mg of choline, and 100 g of cottage cheese offers 18.4 mg. Besides choline, dairy is abundant in calcium, selenium, riboflavin, and B12. Health experts recommend 2–3 daily servings of dairy for sufficient calcium to support bone health.

Fish

Seafood, including salmon, tuna, and cod, is a notable source of choline. For instance, 100 g of salmon provides 78.5 mg of choline, covering 30% of daily needs. Some studies link low fish intake to reduced blood choline levels. For example, pregnant women consuming 75 grams or less of fish per week had lower choline and DHA than those having 150 grams or more of fish per week.

Fish also provides omega-3 fatty acids and essential vitamins like D and B2 (riboflavin). It is also a rich source of calcium, zinc, phosphorus, iodine, iron, magnesium, and potassium.

Shiitake Mushrooms

Shiitake mushrooms serve as a valuable plant-based source of choline. A cup (145 grams) of cooked shiitake mushrooms provides 116 mg, covering 21% of daily needs. These mushrooms are also abundant in vitamin B5, selenium, and copper, providing potential immune health benefits.

Soybeans

Soybeans are another excellent plant-based choline source. One cup (93 grams) of roasted soybeans provides 214 mg, meeting 39% of the recommended intake. Apart from choline, soybeans offer plant-based protein, fibre, manganese, magnesium, zinc, and folate. 

Whole soybeans, being low in carbs and having a low glycemic index (GI), are suitable for individuals with diabetes. The low GI indicates that soybeans have a minimal impact on the rise in blood sugar after a meal.

For those at high risk of choline deficiency, opting for choline supplements made from whole food sources and of high quality is advisable. Various choline supplements are available, with differences in absorption and effectiveness. Consulting with a nutritionist, accessible through wellness platforms like HealthifyMe, can help determine the most suitable approach for your choline needs.

HealthifyMe app’s advanced testing and assessment tools cater to diverse individual needs, considering variations in metabolism, food sensitivities, lifestyles, PCOS, and health goals. The Metabolic panel precisely measures BMI, blood glucose, and resting metabolic rate, offering data to customise macronutrient ratios and calorie intake for optimal efficiency. It ensures that nutritional plans align directly with individual lifestyles, activity levels, and health objectives.

Summary

Ensuring sufficient choline intake is best achieved through a varied diet. Notable sources include eggs, which provide 235 mg per yolk, support weight management, and are packed with nutrients. Beef liver, rich in choline and vital nutrients, aids red blood cell production. Chickpeas, with 42.8 mg per 100g, are a plant-based choline source aiding blood sugar management. Dairy, fish, shiitake mushrooms, and soybeans also offer significant choline, promoting overall health and well-being.

What is the Recommended Choline Intake?

There is no Reference Daily Intake (RDI) for choline due to the lack of sufficient evidence. However, there is an adequate intake (AI) value for choline to prevent negative consequences of deficiency, such as liver damage.

The following list shows the recommended AI values of choline based on age, gender, and pregnancy/breastfeeding status.

  • Birth to 6 months: 125 mg per day
  • 7–12 months: 150 mg per day
  • 1–3 years: 200 mg per day
  • 4–8 years: 250 mg per day
  • 9–13 years: 375 mg per day
  • 14–19 years: 550 mg per day for men and 400 mg per day for women 
  • Adult women: 425 mg per day
  • Adult men: 550 mg per day
  • Breastfeeding women: 550 mg per day
  • Pregnant women: 450-550 mg per day

Breastfeeding women require significantly higher levels of choline to meet both their own needs and those of their babies. Breast milk serves as a good source of choline only when a nursing mom has sufficient choline herself. Alternatively, they can choose infant formula, as it also includes choline.

Mothers need to include choline in their diet during breastfeeding to ensure there’s enough choline in breast milk. Sufficient choline levels in breast milk support the growth of the baby, maintain the mother’s immune function, and promote intestinal health. The dietary choline requirements increase from 425 mg/day for non-pregnant, non-lactating women to 550 mg/day for lactating women.

Summary

There’s no established Reference Daily Intake (RDI) for choline due to limited evidence, but there’s an Adequate Intake (AI) value to prevent issues like liver damage. Recommended choline levels vary by age, gender, and pregnancy/breastfeeding status. For example, adult women need 425 mg/day, and pregnant women require 450-550 mg/day. Breastfeeding women need higher choline levels for both themselves and their babies. Breast milk is a good source when the mother has enough choline, or they can choose choline-containing infant formula. Dietary choline requirements increase from 425 mg/day for non-pregnant, non-lactating women to 550 mg/day for lactating women.

Potential Risk of Choline Toxicity

Exceeding the recommended upper intake limits for choline may lead to choline toxicity. It can lead to symptoms such as a fishy body odour, excessive sweating and salivation, vomiting, hypotension, and liver toxicity. 

High choline intake leads to the overproduction of trimethylamine N-oxide (TMAO), a substance causing an increased risk of cardiovascular disease. Gut bacteria metabolise choline and carnitine found in foods like red meat, fish, and eggs into trimethylamine, which the liver then converts into TMAO.

Summary

Exceeding recommended choline intake limits can cause choline toxicity, manifesting in symptoms such as a fishy body odour, excessive sweating, vomiting, hypotension, and liver issues. Additionally, high choline consumption triggers the overproduction of trimethylamine N-oxide (TMAO), which triggers cardiovascular disease. 

HealthifyMe Suggestion

Try this choline-rich salad recipe to meet your daily requirement. In a large bowl, combine 1 cup cooked quinoa, 1 cup boiled chickpeas, 1 diced red bell pepper, 1 diced cucumber, 1/4th cup finely chopped onion, 2 tablespoon chopped parsley, 1 tablespoon chopped mint, 2 tablespoon crumbled feta cheese, and few chopped walnuts. In a small bowl, whisk together the 2 tablespoons of olive oil, 1 tablespoon lemon juice, 1 teaspoon Dijon mustard, salt, and pepper to make the dressing. Pour the dressing over the salad and toss gently to combine. Serve the salad immediately, or refrigerate it for later. Enjoy your choline-rich quinoa salad.

The Final Word

Choline is a vital nutrient with a broad spectrum of benefits for overall health. From supporting heart health to managing fatty liver disease and influencing fertility in PCOS, choline’s impact on overall health is significant. Incorporating choline-rich foods into one’s diet is the most effective way to ensure optimal intake. 

While choline offers numerous benefits, exceeding recommended upper intake limits can lead to toxicity, resulting in symptoms like a fishy body odour and liver issues. Therefore, it’s crucial to strike a balance in choline consumption.

Disclaimer: The purpose of this article is just to disperse knowledge and raise awareness. It does not intend to replace medical advice from professionals. For further information, please contact our certified nutritionists Here.

Research Sources

1. Choline supplementation influences ovarian follicular development.

2. Effect of Choline Supplementation on Rapid Weight Loss and Biochemical Variables Among Female Taekwondo and Judo Athletes

3. Maternal Choline Supplementation during Normal Murine Pregnancy Alters the Placental Epigenome: Results of an Exploratory Study

4. Feeding a Mixture of Choline Forms during Lactation Improves Offspring Growth and Maternal Lymphocyte Response to Ex Vivo Immune Challenges

5. Dietary Choline and Betaine Intakes and Risk of Cardiovascular Diseases: Review of Epidemiological Evidence

6. A double-blind, placebo-controlled trial of high-dose lecithin in Alzheimer’s disease

7. The US Department of Agriculture on Eggs

8. The US Department of Agriculture on Beef liver

9. Development and evaluating the biopotency of ready-to-eat liver meatballs in fighting anaemia and vitamin A deficiency, improving selected nutritional biochemical indicators and promoting cognitive function among mildly anaemic Egyptian children aged 3-9 years

10. The US Department of Agriculture on chickpeas

11. The US Department of Agriculture on cottage cheese

12. The US Department of Agriculture on whole milk

13. The US Department of Agriculture on salmon

14. The US Department of Agriculture on Shiitake mushrooms

15. The US Department of Agriculture on soybeans

Frequently Asked Questions (FAQs)

Q: How to check choline levels?

A: Healthcare professionals can check a person’s choline levels by taking a blood sample and examining the amount of choline present. However, the choline concentration in blood samples can be affected by different testing procedures. That’s why blood tests may not reliably indicate whether a person is getting enough choline.

Q: What is choline?

A: Choline is a crucial nutrient that helps with essential body functions and overall health. It doesn’t belong to the vitamin or mineral categories, but its similarities often place it within the vitamin B complex. While the body produces some choline, people must include choline-rich foods in their diet to ensure an adequate intake.

Q: What does choline do for your body?

A: Choline, an essential water-soluble organic compound, help promote a healthy pregnancy and is often referred to as the “brain-building” nutrient. It influences liver function, supports healthy brain development, aids in muscle movement, and contributes to the well-being of your nervous system and metabolism.

Q: Is choline good for diabetes?

A: Men who had a higher intake of choline, specifically phosphatidylcholine, showed a reduced risk of developing type 2 diabetes. Among men and women with an average age of 43.4 years and an average choline intake of 305 mg/day, there was a beneficial association between their dietary choline intake and glucose metabolism indices.

Q: What is choline used for?

A: Choline plays a vital role in numerous processes, such as shaping cell structure, facilitating messaging, transporting and metabolising fat, synthesising DNA, and maintaining the nervous system. Its importance is particularly emphasised during pregnancy, as a low choline intake may increase neural tube defect risk in unborn babies.

Q: What foods are high in choline?

A: Choline in diets mainly comes from phosphatidylcholine found in lecithin, a type of fat. Choline-rich foods include beef liver, eggs, salmon, nuts, cauliflower, soybean oil, and broccoli. You can also obtain choline through supplements, with CDP-choline and alpha-GPC considered among the most effective types.

Q: How much choline is needed to reverse fatty liver?

A: There is insufficient information regarding accurate choline levels for fatty liver. However, the National Institutes of Health recommends 425 mg per day for adult females and 550 mg per day for adult males to prevent liver damage.

Q: How does choline relate to PCOS management and weight loss?

A: After 12 weeks of supplementation, both obese and non-obese women with PCOS experienced success with choline and inositol supplementation. Fatty liver, affecting 15% to 55% of women with PCOS, is associated with a choline deficiency. Moreover, choline supplementation plays a role in influencing ovarian follicular development. The effective metabolism of fats by choline is also connected to a heightened sense of satiety, leading to reduced calorie intake and, consequently, overall weight loss.

Q: Are choline levels commonly affected in individuals with PCOS?

A: Yes, individuals with PCOS commonly experience changes in choline levels. Women with PCOS show a higher prevalence of fatty liver, and this condition is associated with a deficiency in choline. A significant percentage of women with PCOS are affected by fatty liver. Researchers have explored choline supplementation as a potential intervention to address the associated metabolic effects in individuals with PCOS.

Q: Can choline supplementation help regulate hormones associated with PCOS?

A: Supplementing with inositol and choline helps lower BMI among women with PCOS and obesity. Specifically, it enhances insulin sensitivity and balances hormone levels, offering potential benefits for those facing severe menstrual disorders such as PCOS.

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