Everything You Need to Know About Choline

You might be starting to hear a lot about choline. It’s an interesting nutrient, one recently discovered and often lumped in with B vitamins, even though it’s technically not one. Choline is important for many neurological functions, and is especially important during pregnancy. In this article, we explain what choline is, how much choline you should consume, how to best supplement choline, and what happens when you’re deficient in choline.

What is choline, and what does it do? 

Choline is a water-soluble quaternary amine of the vitamin B group. It was considered an essential nutrient by the Food and Nutrition Board of the Institute of Medicine in 1998, as choline must be included in your diet to maintain optimal health. Though your liver can produce small amounts of choline, you must obtain the majority of your needs through your diet. 

Choline is neither a vitamin nor a mineral, though it is often grouped with the vitamin B complex due to its similarities. 

Choline is essential for neurotransmitter synthesis, cell membrane signaling, lipid transport, and methyl-group metabolism. One of the key neurotransmitters choline helps synthesize — acetylcholine — is important for memory, mood, muscle control, and other brain and nervous system functions. Moreover, choline promotes intracellular homeostasis counteracting inflammation, apoptosis, and autophagy.

Choline is necessary to make fats that support the structural integrity of cell membranes, and it’s also involved in the production of substances required for removing cholesterol from your liver. Inadequate choline can cause fat and cholesterol buildup in your liver [1,2], which can lead to a host of problems, including liver and muscle damage.

What is the recommended daily allowance for choline?

F&F provides the Adequate Intake of choline, as there is no established RDA at this point. Adequate dietary intake of this micronutrient is required to properly modulate fat and protein metabolism, which decreases fatty acid synthesis and contributes to muscle growth and function.

Adequate Intakes (AIs) for Choline [2]

Age	Male	Female	Pregnant	Lactating
9-13 years	375 mg/ day	375 mg/ day
14-18 years	550 mg/ day	400 mg/ day	450 mg/ day	550 mg/ day
19+ years	550 mg/ day	425 mg/ day	450 mg/ day	550 mg/ day

What is the best way to get choline?

In food, choline’s primary source is animal-based products, meat, poultry, fish, dairy products, and eggs, which provide choline as phosphatidylcholine [3]. Other foods rich in choline include cruciferous vegetables and certain beans, as well as nuts, seeds, and whole grains. Choline is also found in many processed foods (salad dressings, gravies, margarine) in the form of lecithin, a substance also rich in phosphatidylcholine. 

Phosphatidylcholine is the most common source of choline in foods, and is also a fat-soluble form. The water-soluble forms are phosphocholine, glycerophosphocholine, and free choline. Once ingested, pancreatic and mucosal enzymes break down about only half of these choline compounds into free choline. The free choline is then absorbed in the small intestine, then enters the blood for circulation. Choline is stored in the liver and distributed throughout the body to make cell membranes. The intact choline compounds (the ones that were not broken down into the free form) are absorbed into the chylomicrons (lipoproteins) and released into circulation for distribution into tissues and organs, like the brain and placenta [3]. 

How does choline react with other nutrients?

Choline plays an important role in many processes in the body, interacting with many vitamins to complete these processes. For example, choline works with other vitamins, such as B12 and folate, to assist with DNA synthesis within the body. People with low or deficient folate levels may require more choline. A riboflavin coenzyme, NAD, is required for choline catabolism. 

How does choline interact with medicine? 

According to the National Institutes of Health, “Choline is not known to have any clinically relevant interactions with medication.”

What happens when you’re deficient in choline?

Recent analyses indicate that large portions of the population, including most pregnant and lactating women, are well below the AI for choline. Moreover, the food patterns recommended by the 2015–2020 Dietary Guidelines for Americans are currently insufficient to meet the AI for choline in most age-sex groups. According to the 2013-2014 National Health and Nutrition Examination Survey (NHANES), the average daily choline intake from foods and beverages for children and teens was 256 mg, 402 mg in adult men, and 278 mg in adult women [4].

New and emerging evidence suggests that maternal choline intake during pregnancy, and possibly lactation, has lasting beneficial neurocognitive effects on the offspring. About 90-95% of pregnant women consume less choline than the AI, and most supplements do not contain any choline or very little [5,6]. Because choline is found predominantly in animal-derived foods, vegetarians and vegans may be at a greater risk for inadequacy. Other people at risk of deficiency include endurance athletes, those who have high alcohol intake, and postmenopausal women. 

Can you take too much choline?

High intakes of choline are associated with excessive sweating and salivation, vomiting, fishy body odor, hypotension, and liver toxicity. Specifically worth noting, choline consumption is known to increase the body’s TMAO production, a substance linked to a higher risk of cardiovascular disease. 

For this reason, the Food and Nutrition Board established Tolerable Upper Intake Levels (ULs) for choline from foods and supplements based on the amounts of choline associated with hypotension and fishy body odor. 

Established ULs for Choline [2]

Age	Male	Female	Pregnancy	Lactation
1-8 years	1,000 mg/ day	1,000 mg/ day
9-13 years	2,000 mg/ day	2,000 mg/ day
14-18 years	3,000 mg/ day	3,000 mg/ day	3,000 mg/ day	3,000 mg/ day
19+ years	3,500 mg/ day	3,500 mg/ day	3,500 mg/ day	3,500 mg/ day

How can I get the right amount of choline?

Eating a balanced diet of a variety of vegetables, fruits, whole grains, as well as a variety of protein-rich foods (fish, beef, poultry, eggs, and some beans) will provide an array of nutrients and other compounds that benefit your health.

Because it is known that most people in the United States consume less than the AI for choline, consuming a supplement that contains choline can be beneficial to complementing your diet. 

Sources: 

1. Noga, A. A., Zhao, Y., & Vance, D. E. (2002). An unexpected requirement for phosphatidylethanolamine N-methyltransferase in the secretion of very low density lipoproteins. The Journal of biological chemistry, 277(44), 42358–42365. https://doi.org/10.1074/jbc.M204542200
2. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998.
3. Zeisel SH. Choline. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:416-26.
4. U.S. Department of Agriculture, Agricultural Research Service. Nutrient Intakes from Food and Beverages: Mean Amounts Consumed per Individual, by Gender and Age, What We Eat in America, NHANES 2013-2014. 2016
5. Brunst KJ, Wright RO, DiGioia K, Enlow MB, Fernandez H, Wright RJ, et al. Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population. Public Health Nutr 2014;17:1960-70. [PubMed abstract]
6. Caudill MA. Pre- and postnatal health: evidence of increased choline needs. J Am Diet Assoc 2010;110:1198-206. [PubMed abstract]