Choline sounds like chlorine; in contrast, it’s a nutrient essential for your brain, cardiovascular system and liver.
If ever there was a nutrient that epitomised “is my diet enough?” then choline would at least be in the top two.
In this article, we’re going to introduce why.
For example, one study published in 2016 found that some of the population in the USA only consumed ten per cent of the daily adequate choline intake.[1]
What is Choline?
Choline is part of a group of nutrients called phospholipids. In the 1970s, scientists considered this group of specialised fats merely as building blocks of our cells. As time went by, researchers found phospholipids to be essential to how cells function.
For example, although these functions were seemingly small on the surface, researchers eventually found their contribution to be essential when it came to neurological disorders, atherosclerosis, obesity and diabetes.[2]
In fact, if you break it down, neurological disorders, cardiovascular disease, obesity and diabetes are in the top ten killers globally, according to the world health organisation (WHO).[3]
It wasn’t until 1998 that the Institute of Medicine recognised choline as an essential nutrient.[4]
As part of this group of phospholipids, choline is essential from birth. Adequate amounts of choline are critical for optimal brain and cognitive development and for preventing neural tube defects.[5]
The importance extends throughout adult life and into old age. A good example is a study of healthy people deprived of dietary choline. Out of the group of men and women, seventy-seven per cent of the men and eighty per cent of the postmenopausal women developed signs of organ dysfunction in the form of muscle damage or fatty liver.[6]
Choline is available in a variety of foods.
Eggs are by far the richest source of choline, along with animal products such as chicken liver, salmon, grass-fed steak and milk.
Shitake mushrooms, beans, brussels sprouts, and other cruciferous vegetables can also be good sources of choline.[7]
Dietary choline deficiency can cause evident problems.
You might already be familiar with some of the problems. For example, people whose dietary choline consumption was corrected had their mild fatty liver, elevated liver enzymes and creatine phosphokinase levels (check your blood tests!) saw these levels resolve when.[8]
Choline deficiency can also affect how your liver deals with cholesterol.
Most notably, low-density lipoproteins or LDL and triglycerides. Both markers you’ll see in an average annual checkup. A form of choline called phosphatidylcholine, commonly prescribed as a supplement but also synthesised by the body in small amounts, is an essential part of the very low-density lipoproteins that help to transport triglycerides out of the liver.[9]
Unfortunately, it doesn’t end there when it comes to choline and your cholesterol.
A choline deficiency can also reduce your amount of “good cholesterol,” or HDL, by inhibiting its production and increasing its removal from the liver.[10]
It brings new meaning to using diet to treat cholesterol.
I’ve mentioned how nutrients are often forms of currency for the body in different articles in the past. In the case of choline, we are looking at an essential resource the body uses to build what it needs, similar to what we see with amino acids from protein.
Don’t get me wrong; it’s good to focus on minimising certain foods to assist with your cholesterol. Sometimes, it can be vital to ensure a nutrient deficiency isn’t responsible for your situation.
Another good example in the case of cholesterol is improving a fibre deficiency and decreasing cardiovascular risk.[11]
Supplemental choline can reduce the risk of cardiovascular disease.
It’s not only cholesterol that benefits from choline intake. Choline plays a critical role in managing homocysteine. If you have had a cardiovascular-themed blood test, you might have seen homocysteine pop up.
Elevated homocysteine levels are associated with a higher risk of chronic illnesses, including cognitive decline, bone fractures, and cardiovascular disease.
One study examined supplementing choline in men over fifty with high homocysteine levels for just two weeks. The results showed choline to be effective in lowering homocysteine, concluding that it can help with cardiovascular disease risk.[12]
Diets rich in choline can also improve inflammatory markers associated with cardiovascular disease.
Aside from homocysteine, one of the important markers for cardiovascular disease is C-reactive protein or C-RP. Findings from a study looking into just over fifteen hundred men saw that those with higher levels of choline in their diet had just over twenty per cent lower levels of c-reactive protein and another cardiovascular marker, interleukin-6.[13]
It’ll be interesting to see if the more extensive studies confirm this, as it could well be another dietary intervention to reduce this big killer.
What about the brain and choline?
It is not unusual to recommend choline supplementation or dietary attention to foods high in choline during pregnancy and early life. One of the critical reasons for this is down to brain development which we’ve touched on earlier.
In later life, however, a form of choline called CDP-choline or citi-choline (its nickname) has improved memory and behaviour deficits in elderly subjects.[14]
Another study examined over two thousand three hundred older people and their dietary choline consumption. This study found that just over two hundred milligrams of choline daily reduced the risk of low cognition by up to fifty per cent compared to diets of less than two hundred milligrams.[15]
To put that into context, one large egg yolk is almost one hundred and forty milligrams, and liver can be up to two hundred milligrams per serving!
Choline is a vital resource when it comes to memory and learning.
It plays a vital role in creating a neurotransmitter called acetylcholine.
I mean, it’s in the name, right?
Many of my patients have experienced low acetylcholine levels when complaining of forgetfulness. Some studies suggest that acetylcholine can assist with episodic memory after brain damage.[16]
In one of my favourite animal studies around acetylcholine, researchers repeatedly gave healthy rats almonds. These almonds increased their acetylcholine levels and improved their memory after being given amnesia![17]
Sadly, this didn’t translate to a randomised controlled trial in adults over six months. However, in the group of subjects in this study who were having eight five grams of almonds a day (which is quite a few), there were positive changes in working memory.[18]
Working memory allows us to get our tasks done during the day actively and is a crucial part of our executive function.[19]
All from increasing our acetylcholine levels via almonds!
But wait, there’s more!
Choline influences the parts of the brain that create energy. Mitochondria are components of cells that generate the chemical energy that drives a cell’s ability to take part in biochemical reactions.[20]
Poor function in the mitochondria, referred to as mitochondrial dysfunction primarily drives decreased cognitive performance in Alzheimer’s disease.[21]
More recently, this same energy creation for the brain has been highlighted as a feature in long-COVID. A combination of inflammation from the virus and the subsequent immune response has made “brain fog” a characteristic experience for people still recovering.[22]
Symptoms from COVID-induced brain fog include impaired attention or poor concentration, anxiety, depression and poor memory.[23]
Even writing this at the beginning of 2023, researchers are still working to reveal the effects of long-COVID.
Although, CDP-choline seems to have promise across multiple elements of the brain-associated symptoms in long-COVID.[24]
For example, CDP-choline has two functions that can help. The first is an anti-inflammatory effect on the brain[25] , and the second reduces the mitochondrial dysfunction we mentioned earlier.[26]
Combine these two critical functions with the effects of acetylcholine we’ve touched on earlier for working memory. This lesser-known nutrient can have a big part to play in assisting millions of people to recover their brains from even mild COVID infections.
Certain people may need more choline than others because of their genes.
Now that’s all I will say about this for now as it can be a little complicated. However, for the average person, between four hundred milligrams per day and five hundred and fifty milligrams per day can be a good place to aim for if you want to review how much choline you are currently getting in your diet.
It may well help you with your cholesterol, liver, metabolism and your brain at the same time!
Hope this helps xx
References
[1] Wallace TC, Fulgoni VL 3rd. Assessment of Total Choline Intakes in the United States. J Am Coll Nutr. 2016;35(2):108-112. doi:10.1080/07315724.2015.1080127
[2] Lagace TA, Ridgway ND. The role of phospholipids in the biological activity and structure of the endoplasmic reticulum. Biochim Biophys Acta. 2013;1833(11):2499-2510. doi:10.1016/j.bbamcr.2013.05.018
[3] https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death, viewed 21st February 2023.
[4] Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B012, Pantothenic Acid, Biotin, and Choline.Washington, D.C.: National Academy of Sciences; 1998. pp. 390–422
[5] López-Sobaler AM, Lorenzo Mora AM, Salas González MªD, Peral Suárez Á, Aparicio A, Ortega RMª. Importancia de la colina en la función cognitiva [Importance of choline in cognitive function]. Nutr Hosp. 2021;37(Spec No2):18-23. doi:10.20960/nh.03351
[6] Zeisel SH, da Costa KA. Choline: an essential nutrient for public health. Nutr Rev. 2009;67(11):615-623. doi:10.1111/j.1753-4887.2009.00246.x
[7] Wallace TC, Blusztajn JK, Caudill MA, et al. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today. 2018;53(6):240-253. doi:10.1097/NT.0000000000000302
[8] da Costa KA, Badea M, Fischer LM, Zeisel SH. Elevated serum creatine phosphokinase in choline-deficient humans: mechanistic studies in C2C12 mouse myoblasts. Am J Clin Nutr. 2004;80(1):163-170. doi:10.1093/ajcn/80.1.163
[9] Cole LK, Vance JE, Vance DE. Phosphatidylcholine biosynthesis and lipoprotein metabolism. Biochim Biophys Acta. 2012;1821(5):754-761. doi:10.1016/j.bbalip.2011.09.009
[10] Cole LK, Vance JE, Vance DE. Phosphatidylcholine biosynthesis and lipoprotein metabolism. Biochim Biophys Acta. 2012;1821(5):754-761. doi:10.1016/j.bbalip.2011.09.009
[11] Soliman GA. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients. 2019;11(5):1155. Published 2019 May 23. doi:10.3390/nu11051155
[12] Olthof MR, Brink EJ, Katan MB, Verhoef P. Choline supplemented as phosphatidylcholine decreases fasting and postmethionine-loading plasma homocysteine concentrations in healthy men. Am J Clin Nutr. 2005;82(1):111-117. doi:10.1093/ajcn.82.1.111
[13] Detopoulou P, Panagiotakos DB, Antonopoulou S, Pitsavos C, Stefanadis C. Dietary choline and betaine intakes in relation to concentrations of inflammatory markers in healthy adults: the ATTICA study. Am J Clin Nutr. 2008;87(2):424-430. doi:10.1093/ajcn/87.2.424
More references!
[14] Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst Rev. 2005;(2):CD000269. Published 2005 Apr 18. doi:10.1002/14651858.CD000269.pub3
[15] Liu L, Qiao S, Zhuang L, et al. Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States. Behav Neurol. 2021;2021:2962245. Published 2021 Oct 29. doi:10.1155/2021/2962245
[16] Croxson PL, Browning PG, Gaffan D, Baxter MG. Acetylcholine facilitates recovery of episodic memory after brain damage. J Neurosci. 2012;32(40):13787-13795. doi:10.1523/JNEUROSCI.2947-12.2012
[17] Batool Z, Sadir S, Liaquat L, et al. Repeated administration of almonds increases brain acetylcholine levels and enhances memory function in healthy rats while attenuates memory deficits in animal model of amnesia. Brain Res Bull. 2016;120:63-74. doi:10.1016/j.brainresbull.2015.11.001
[18] Mustra Rakic J, Tanprasertsuk J, Scott TM, et al. Effects of daily almond consumption for six months on cognitive measures in healthy middle-aged to older adults: a randomized control trial. Nutr Neurosci. 2022;25(7):1466-1476. doi:10.1080/1028415X.2020.1868805
[19] Baddeley A. Working memory. Science. 1992;255(5044):556-559. doi:10.1126/science.1736359
[20] https://www.genome.gov/genetics-glossary/Mitochondria, viewed 23rd February 2023
[21] Sharma C, Kim S, Nam Y, Jung UJ, Kim SR. Mitochondrial Dysfunction as a Driver of Cognitive Impairment in Alzheimer’s Disease. Int J Mol Sci. 2021;22(9):4850. Published 2021 May 3. doi:10.3390/ijms22094850
[22] Hugon J, Msika EF, Queneau M, Farid K, Paquet C. Long COVID: cognitive complaints (brain fog) and dysfunction of the cingulate cortex. J Neurol. 2022;269(1):44-46. doi:10.1007/s00415-021-10655-x
[23] Blomberg B, Mohn KG, Brokstad KA, et al. Long COVID in a prospective cohort of home-isolated patients. Nat Med. 2021;27(9):1607-1613. doi:10.1038/s41591-021-01433-3
[24] Turana Y, Nathaniel M, Shen R, Ali S, Aparasu RR. Citicoline and COVID-19-Related Cognitive and Other Neurologic Complications. Brain Sci. 2021;12(1):59. Published 2021 Dec 31. doi:10.3390/brainsci12010059
[25] Turana Y, Nathaniel M, Shen R, Ali S, Aparasu RR. Citicoline and COVID-19-Related Cognitive and Other Neurologic Complications. Brain Sci. 2021;12(1):59. Published 2021 Dec 31. doi:10.3390/brainsci12010059
[26] Turana Y, Nathaniel M, Shen R, Ali S, Aparasu RR. Citicoline and COVID-19-Related Cognitive and Other Neurologic Complications. Brain Sci. 2021;12(1):59. Published 2021 Dec 31. doi:10.3390/brainsci12010059
