If you have never heard of choline and aren’t sure why your intake of this essential nutrient is so important, you’re not alone. The Institute of Medicine first recognized choline as an essential nutrient in 1998, and since then, more research has been conducted on choline’s role in the body and the many benefits it offers.  Choline is available in many different foods, including both plant and animal products, but not everyone receives an adequate amount of choline. 

Choline intake is important for everyone, but it is especially important for women who are pregnant, planning to become pregnant, or breastfeeding.So, exactly what is choline and what is it good for?

What is choline?

Choline is an essential nutrient that is neither a vitamin nor a mineral. Choline comes in five different forms, some of which are water-soluble and some of which are fat-soluble, depending on their source. The body transports and absorbs choline differently depending on which form the nutrient is received in; water-soluble forms of choline are transported to the liver and converted into a type of fat called lecithin, while fat-soluble choline molecules are transported to and absorbed by the digestive tract, since they usually come in food. The body produces some choline endogenously in the liver, but the amount of the nutrient produced by the liver is not enough to meet human needs. Therefore, the body must receive enough choline by eating it through different foods. Choline plays several roles in the body, including the following:

• Cell maintenance: Choline is used by the body in order to create the fats that make up cellular membranes, thereby preserving normal function of the cells. 
• Metabolism: Choline helps metabolize fats.
• DNA synthesis: Choline plays a role in how different genes are expressed, as do other nutrients such as folate and vitamin B-12, which can cause birth deficiencies if not received in adequate quantities during pregnancy.
• Nervous system functioning: Choline is naturally converted by the body into a neurotransmitter that impacts how the nerves function and plays a role in the regulation of certain automatic bodily functions, including heart rate and breathing. 

What is choline good for?

The body needs choline in order to perform many essential functions, but the nutrient also has a whole host of benefits. Choline is good for protecting heart health, lowering the risk of pregnancy complications, improving memory and cognition, supporting a healthy weight, and reducing the symptoms of cystic fibrosis.

Protecting heart health

Heart disease, heart attack, and stroke are among the leading causes of death in the United States among all age groups and races, but choline may be able to help lower your risk of experiencing these conditions. A study done in 2018 featuring nearly 4,000 African-American participants found that a higher daily intake of choline lowered the risk of experiencing ischemic stroke over an average follow up period of nine years.

Lowering the risk of pregnancy complications

Choline is an essential nutrient for pregnant women, and it is recommended that women who are pregnant take a prenatal vitamin that contains choline. Choline impacts the expression of genes in developing fetuses and has been shown to influence pregnancy outcomes in several studies. A study conducted in 2013 examined the impacts of choline supplementation on women in their third trimester of pregnancy, with one group taking 480 mg of choline and the other taking 930 mg of choline per day. The results of the study showed that the group of pregnant women who took 930 mg per day were less likely to experience preeclampsia, which is a dangerous condition in which pregnant women experience symptoms such as dangerously high blood pressure, swelling, and severe headaches. Therefore, choosing a prenatal supplement that contains choline and ensuring that you receive plenty of choline from dietary sources is especially important for pregnant women.

Improving memory and cognition

In addition to preventing pregnancy complications, choline is also important during pregnancy to support the brain development of the fetus and support the memory and cognition of the mother. Choline is also recommended for senior citizens who may be experiencing reduced cognitive function as they age. An observational study of more than 2,000 participants in their early 70s conducted in 2012 found that participants with higher choline levels showed better cognitive function than those with low choline levels. Another study, conducted in 2019, showed that older men were more likely to have a poor working memory when they had low levels of choline, vitamin C, and zinc.

Supporting healthy weight

In addition to all of the other benefits of choline, the nutrient may also help support a healthy weight. Choline is a source of methyl groups, which are used by the body in many different steps of metabolism, including metabolizing fats. A study conducted in 2014 showed that female athletes who took a choline supplement had lower body mass indexes and levels of leptin, a hormone that controls body fat, compared to the control group. More research is needed on this topic, but it appears that choline helps boost the metabolism and thereby supports a healthy weight. 

Reducing the symptoms of cystic fibrosis

Although the existing body of evidence is small, it is possible that choline supplementation may also be able to help reduce the symptoms of cystic fibrosis, a chronic and frequently fatal lung disease. People with cystic fibrosis often experience pancreatic insufficiency, which contributes to a choline deficiency that ultimately impacts the function of the lungs and liver. A 2018 study found that supplementing with choline helped to improve lung function and reduce the symptoms of fatty liver disease in adult men with cystic fibrosis.

What are some natural sources of choline?

Choline is found naturally in numerous foods, but it is most often available  in the form of phosphatidylcholine from lecithin, a type of fat. Both animal products and plant-based foods contain choline, so even those who follow a strict plant-based diet, such as vegans and vegetarians, should be able to receive enough of the nutrient from eating a healthy and well-balanced diet. Natural sources of choline include:

• Beef liver
• Egg
• Beef top round
• Soybeans
• Chicken breast
• Fish
• Red potatoes
• Wheat germ
• Kidney beans
• Milk
• Yogurt
• Brussels sprouts
• Broccoli
• Shiitake mushrooms
• Cottage cheese 
• Peanuts
• Peas
• Sunflower seeds
• Brown rice 
• Pita bread
• Cabbage
• Tangerines
• Beans
• Kiwi
• Carrots
• Apples

People who do not get enough choline from their daily diets can experience choline deficiency.

What are the symptoms of choline deficiency?

Choline deficiency is relatively uncommon, since the nutrient is found in many different whole foods, including both plant and animal products. Choline deficiency usually does not cause many obvious symptoms, but it can contribute to the development of serious health conditions, including:

• Cardiovascular disease
• Nonalcoholic fatty liver disease
• Muscle damage
• Neurological conditions, such as Alzheimer’s disease, and impaired cognitive function
• Neural tube irregularities and deformities in infants born to women with a choline deficiency

Because some forms of choline are fat-soluble, it is possible to receive too much choline from your daily diet and supplementation. Although it is uncommon, consuming too much choline can cause the following symptoms:

• Low blood pressure
• Vomiting
• Liver toxicity
• Sweating
• Excessive salivation
• Fishy body odor 

In order to minimize the risk of experiencing either a choline deficiency or consumption of too much choline, the Office of Dietary Supplements of the Institute of Medicine recommends the following recommended dietary allowances for choline:

• Infants ages 0 to 6 months: 125 mg per day
• Infants ages 7 to 12 months: 150 mg per day
• Children ages 1 to 3 years: 200 mg per day
• Children ages 4 to 8 years: 250 mg per day
• Children ages 9 to 13 years: 375 mg per day
• Males ages 14 years and older: 550 mg per day
• Females ages 14 to 18 years: 400 mg per day
• Females ages 19 and older: 425 mg per day
• Pregnant females ages 14 and older: 450 mg per day
• Lactating females ages 14 and older: 550 mg per day

Just like pregnant women must ensure that they receive enough choline during pregnancy, lactating women also need to intake higher levels of choline to support healthy brain development in breastfeeding infants, as well as reduce the symptoms of “mommy brain” that plague many women in the postpartum period. Women may benefit from taking postnatal vitamins containing choline in order to support healthy brain function for both themselves and their babies.

Sources:

https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/ 

https://www.medicalnewstoday.com/articles/327117 

https://www.webmd.com/vitamins/ai/ingredientmono-436/choline 

https://www.healthline.com/nutrition/what-is-choline

https://link.springer.com/article/10.1007/s00394-016-1296

https://www.fasebj.org/doi/abs/10.1096/fj.12-221648

https://www.cambridge.org/core/journals/british-journal-of-nutrition

https://pubmed.ncbi.nlm.nih.gov/31328680/ 

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3218734 

https://academic.oup.com/nutritionreviews/article/67/11/615/1850648