by Dr Deborah Lee, Dr Fox Online Pharmacy
What is choline?
Choline is a vital component of the human diet. The body can’t make choline, so it has to be ingested. Although it’s not a true amino acid or a vitamin, choline has an essential role in many aspects of metabolism. To date, it’s been largely overlooked by health professionals and nutritionists.
Why do we need choline?
We need choline for the following reasons –
- Choline is a key ingredient in the formation of phospholipids such as sphingomyelin which makes up a large part of the cell membrane.
- It’s also a constituent of acetylcholine, a major neurotransmitter (chemical messengers that convey nerve impulses)
- Lipoproteins, which transport fats such as cholesterol, also require choline.
- Choline is required for homocysteine metabolism – high homocysteine levels are linked to an increased risk of strokes and heart attacks.
- Normal liver function and cognitive function both need choline.
Which foods contain choline?
Foods which contain choline include –
- Liver and kidneys
- Beef
- Chicken breast
- Whole eggs
- Fish
- Soya beans
- Wheatgerm
- Green leafy vegetables
- Almonds
- Potatoes
- Kidney beans
How common is choline deficiency?
The recommended daily intake of choline is as follows –
- Adult males, 550 mg per day and adult females, 425 mg per day.
- During pregnancy, 450 mg per day, and breastfeeding 550 mg per day.
- Babies from birth to 6 months require 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
- 14-18 years, 550 mg per day
(NIH 2022)
Are we getting enough choline? There is only limited data on the amount of choline in the diet. In one 2015 study, European choline intake was assessed in comparison to the European Food Safety Authority European Comprehensive Food Consumption Database and the United States Department of Agriculture Nutrient Database. The average choline intake was found to be below recommended levels in all age groups, including children. Daily intake of choline was as follows
- Adolescents (10 to 18) 244-373 mg/day
- Adults (18 to 65) 291-468 mg/day
- Older people (65-75) 284-450 mg/day
- Very elderly (75 years and over) 269-444 mg/day
Diet and choline intake
Animal foods have a higher choline content than plant foods. The current trend of eating less meat and more plant-based food has led to concern there could be an appreciable and unrecognised problem of choline deficiency. Meat, milk, eggs and whole grains contain the highest quantities of choline, meaning vegans are at the highest risk.
In one American publication, the authors commented that is extremely difficult to take enough choline without eating eggs. There is still a widely held belief that eating too many eggs is bad for health. We all need to be made aware this is no longer believed to be true and eating 1, 2 or 3 eggs a day has not been shown to be harmful to health. It raises HDL (good) cholesterol. Eggs are relatively inexpensive and a major source of protein. People should be encouraged to eat more eggs.
Dangers of choline deficiency
An inadequate intake of choline results in organ failure with muscle breakdown and non-alcoholic fatty liver disease (NAFLD).
Choline deficiency may also accelerate atherosclerosis, because of its effects on lipoprotein metabolism, and hence exacerbate the risk of cardiovascular disease.
It’s also been linked to Alzheimer’s Disease (AD) – choline-deficient mice show the same pathological brain changes as are found in AD.
Can you have too much choline?
Having too much choline is also dangerous. It can cause a fishy body odour and profuse sweating, low blood pressure and nausea and vomiting. High levels of trimethylamine-N-oxide (TMAO) which is believed to increase the risk of heart disease. It’s unlikely toxic levels of choline could be obtained from diet alone. The majority of cases of choline excess are thought to be due to taking large doses of choline supplements. Of note, standard multivitamins do not routinely contain choline.
Final thoughts
Good human health depends on having a properly balanced diet. By eating a wide range of food we can be sure we are getting enough nutrients, including choline.
Choline is found in eggs, cottage cheese, soy, meat, fish, cruciferous vegetables, shitake mushrooms and almonds. Make sure you incorporate these foods into your weekly diet.
Signs of choline deficiency include fatigue, poor memory and cognitive decline.
In one 2019 Finnish study, those with a high-choline diet had a lower risk of dementia and better cognition scores. Don’t deprive yourself of choline.
- How could you get more choline into your diet?