Choline is a necessary nutrient for proper human functioning, but it tends to get little attention. This is unfortunate, because a lot of people, in particular pregnant women and vegetarians, may be deficient in choline.
A neuron. Choline is necessary for nerve-signaling, synthesizing cell membranes, and is a precursor of the neurotransmitter acetylcholine. Image source: Wikipedia
Choline is usually considered part of the B vitamin club. Or maybe it is more like a “fellow traveler”. Whatever the case, choline is a quaternary ammonium salt that is used to synthesize cell membranes, for energy production, and also for nerve signaling. It appears to be particularly important for proper brain, and liver functioning.
Choline is also a precursor molecule for making acetylcholine, an important neurotransmitter in the brain that is important for memory and muscle control. Fatty organ meat is the best source of choline, and eggs(the yolk) to a lesser extent, though it can also be found in plant foods like nuts, whole grains and green vegetables, but in smaller amounts. Lecithin, which is used as an emulsifier in food production and as a supplement also has a lot of choline. A healthy person can make their own choline from the amino acid methionine, but many people don’t produce enough.
Unlike most nutrients, choline doesn’t have an RDA(recommended daily allowance). It does, however have an AI(adequate intake, which is 550 milligrams per day for men and 425 for women which was set in 1998), which means experts can’t agree on an RDA since the science is less clear for choline than for nutrients with RDAs, like vitamin C, calcium, vitamin A, and iron, among others. Not getting the RDA for vitamin C can lead to a deficiency disease called scurvy, which is characterized by bleeding gums, weakness, and bone pain.
Lack of choline, on the other hand, doesn’t necessarily lead to any chronic, debilitating deficiency disease, except for non-alcoholic fatty liver disease, in many, but not all people who get inadequate choline. According to – Choline
Dietary Requirements and Role in Brain Development
Lisa M. Sanders, PhD, RD and Steven H. Zeisel, MD, PhD:
When placed on a low-choline diet, only 68% of individuals developed signs of organ dysfunction characteristic of choline deficiency. This suggests that genetic variability among individuals may influence susceptibility to choline deficiency.
So your genes can determine whether or not you show symptoms of choline deficiency. This is one very complex nutrient which is involved with so many metabolic pathways. Most pregnant women do not get adequate choline(in theory, they require more), however, supplementing with choline didn’t appear to help enhance infant cognitive function, according to: Am J Clin Nutr. 2012 Dec;96(6):1465-72. doi: 10.3945/ajcn.112.037184. Epub 2012 Nov 7:
The women studied ate diets that delivered ∼360 mg choline/d in foods (∼80% of the recommended intake for pregnant women, 65% of the recommended intake for lactating women). The phosphatidylcholine supplements were well tolerated. Groups did not differ significantly in global development, language development, short-term visuospatial memory, or long-term episodic memory.
Phosphatidylcholine supplementation of pregnant women eating diets containing moderate amounts of choline did not enhance their infants’ brain function. It is possible that a longer follow-up period would reveal late-emerging effects. Moreover, future studies should determine whether supplementing mothers eating diets much lower in choline content, such as those consumed in several low-income countries, would enhance infant brain development.
What about choline’s effect on dementia, since choline is a precursor for acetylcholine, which is important for brain health and memory production? According to – Clin Ther. 2003 Jan;25(1):178-93:
RESULTS: A total of 261 patients (132 in the CA group, 129 in the placebo group) were enrolled in the study. The mean (SD) age in the CA group was 72.2(7.5) years (range, 60-80 years), and in the placebo group it was 71.7 (7.4) years(range, 60-80 years). The CA group comprised 105 women and 27 men; the placebo group, 94 women and 35 men. The mean decrease in ADAS-Cog score in patients treated with CA was 2.42 points after 90 days of treatment and 3.20 points at the end of the study (day 180) (P < 0.001 vs baseline for both), whereas in patients receiving placebo the mean increase in ADAS-Cog score was 0.36 point <1 after 90 days of treatment and 2.90 points after 180 days of treatment(P < 0.001 vs baseline). In the CA group, all other assessed parameters (MMSE,GDS, ADAS-Behav, ADAS-Total, and CGI) consistently improved after 90 and 180 days versus baseline, whereas in the placebo group they remained unchanged or worsened. Statistically significant differences were observed between treatments after 90 and 180 days in ADAS-Cog, MMSE, GDS, ADAS-Total, and CGI scores and after 180 days of treatment in ADAS-Behav and GIS scores.CONCLUSION: The results of this study suggest the clinical usefulness and tolerability of CA in the treatment of the cognitive symptoms of dementia disorders of the Alzheimer type. (Emphasis mine)
So choline shows some promise when it comes to symptoms of dementia and Alzheimer’s, but more research needs to be done. Some good sources of choline:
Food Serving Total Choline (mg)
Beef liver, pan fried 3 ounces* 355
Wheat germ, toasted 1 cup 172
Egg 1 large 126
Atlantic cod, cooked 3 ounces 71
Beef, trim cut, cooked 3 ounces 67
Brussel sprouts, cooked 1 cup 63
Broccoli, cooked 1 cup, chopped 62
Shrimp, canned 3 ounces 60
Salmon 3 ounces 56
Milk, skim 8 fl oz. 38
Peanut butter, smooth 2 tablespoons 20
Milk chocolate 1.5-ounce bar 20
Source: Linus Pauling Institute of Oregon State University
None of this should be considered a recommendation to take choline supplements(or to eat a lot of meat), though if you look at the chart above it becomes obvious that vegetarians are more likely to become deficient than meat-eaters. Be on the look out for news about choline, and it may be worth talking about choline with your doctor if you show any deficiency symptoms. In the future, maybe there will be a simple liver test to see if we need more choline in our diet.