Choline

Definition

Choline is a nutrient required by the body. It does not meet the classic definition of a vitamin—a nutrient that the body needs in small amounts to remain healthy but cannot manufacture for itself—because the body makes some choline, but it does not make enough. The remainder must be acquired through diet. Choline is often grouped with the B-complex vitamins because it is a water-soluble compound that performs some similar functions to these vitamins.

Purpose

Choline has several actions in the body. It is incorporated into the fat-containing structures in cell membranes and is necessary for the formation of certain signaling chemicals made by cells to activate other molecules. Choline is also necessary for the formation of acetylcholine. Acetylcholine is a neurotransmitter that transfers information from nerves to muscles. Acetylcholine is thought to be important to memory and learning in the brain.

Choline

Age

Adequate intake (mg)

Tolerable upper intake level (mg)

Children 0-6 mos.

125

Not established

Children 7-12 mos.

150

Not established

Children 1-3 yrs.

200

1,000

Children 4-8 yrs.

250

1,000

Children 9-13 yrs.

375

2,000

Boys 14-18 yrs.

550

3,000

Girls 14-18 yrs.

400

3,000

Men 19≥ yrs.

550

3,500

Women 19≥ yrs.

425

3,500

Pregnant women 18≤ yrs.

450

3,000

Pregnant women 19≥ yrs.

450

3,500

Breastfeeding women 18≤ yrs.

550

3,000

Breastfeeding women 19≥ yrs.

550

3,500

Food

Choline (mg)

Beef liver, fried, 3 oz

356

Egg, 1 large

147

Beef, chuck roast, 3 oz

101

Brussels sprouts, cooked, 1 cup

63

Broccoli, cooked, 1 cup

62

Soymilk, 1 cup

58

Peanut butter, 2 tbsp

20

Milk chocolate, 1.5 oz

20

mg = milligram

SOURCE: Office of Dietary Supplements. National Institutes of Health. “Choline: Fact Sheet for Health Professionals.” https://ods.od.nih.gov/factsheets/Choline-HealthProfessional (accessed April 1, 2018).

Like several of the B vitamins, choline is active in the metabolic pathway that breaks down homocysteine and removes it from the body. Homocysteine is an amino acid that circulates in the blood. Research has shown that people who have high levels of homocysteine in the blood are more likely to develop cardiovascular diseases such as coronary artery disease and stroke, and too much homocysteine may also adversely affect fetal health and development.

Description

Choline has not been studied as much as many of the other micronutrients, and it was not declared to be an essential nutrient until 1998. Research suggests that the body makes only between 10% and 20% of the choline it needs to maintain health, so the rest must come from diet.

Dietary requirements

The Food and Nutrition Board of the United States Institute of Medicine (IOM), a part of the National Academy of Sciences, develops values called Dietary Reference Intakes (DRIs) for many vitamins, minerals, and essential micronutrients. The DRIs consist of three sets of numbers: the recommended dietary allowance (RDA), which defines the average daily amount of the nutrient needed to meet the health needs of 97%–98% of the population; adequate intake (AI), an estimate set when there is not enough information to determine an RDA; and tolerable upper intake levels (UL), the average maximum amounts that can be taken daily without risking negative side effects. The DRIs are calculated for children, adults, and pregnant and breastfeeding women.

The IOM has not set RDAs for choline because of the scarcity of large, long-term dietary studies on this micronutrient. Instead, AI levels have been established for all age groups based on the best research information available. For choline, the AI level was established as the average daily amount needed to prevent the development of a condition called fatty liver, and it may not be the amount needed for other conditions. A 2008 study on Mexican American men found that higher levels were needed to accommodate rises in homocysteine. The IOM's recommended AI and UL levels of choline for each age group (in milligrams) are:

Choline for children younger than 12 months should come from breast milk and infant formula or food and never from dietary supplements.

Sources of choline

Foods rich in choline include beef liver, egg yolks, peanuts, and soybeans. Most choline in foods is in the form of phosphatidylcholine, which is also known as lecithin. Most people can meet the AI levels of choline through their normal diet. Sources of choline include:

Choline chloride and choline bitartrate are also sold as a dietary supplements. Choline is also found in dietary supplements marketed as lecithin. Soybeans are the most common source for lethicin in dietary supplements. These supplements contain a much smaller and more variable amount of choline than choline chloride or choline bitartrate supplements. Consumers should read the lethicin labels carefully. Some children's multivitamins also contain choline.

Precautions

Moderate choline deficiency is associated with an increase in the blood levels of homocysteine. High levels of this molecule are known to increase the risk of cardiovascular disease. Extreme choline deficiency can result in a condition called fatty liver. Fat accumulates in liver cells where, in the absence of choline, it cannot be packaged and transported through the body. As a result, fats in the blood called triglycerides increase, creating an increased risk of heart disease and other health problems. Choline deficiency in pregnant women appears to have a negative effect on the development of the fetal brain and may cause learning, memory, and attention problems later in life.

KEY TERMS
Amino acids—
Molecules that are the basic building blocks of proteins.
B-complex vitamins—
A group of water-soluble vitamins that often work together in the body. These include thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7 or vitamin H), folate/folic acid (B9), and cobalamin (B12).
Fatty liver—
A condition in which liver cells accumulate fat. The condition is associated with alcohol abuse, obesity, and pregnancy and can result in serious damage to the liver.
Neurotransmitter—
One of a group of chemicals secreted by a nerve cell (neuron) to carry a chemical message to another nerve cell, often as a way of transmitting a nerve impulse. Examples of neurotransmitters include acetylcholine, dopamine, serotonin, and norepinephrine.
Triglycerides—
A type of fat found in the blood. High levels of triglycerides can increase the risk of coronary artery disease.
Water-soluble vitamin—
A vitamin that dissolves in water and can be removed from the body in urine.

Large excesses,.35 oz. (10 g) or more, of choline can cause nausea and extreme sweating. However, the most noticeable symptom of excess is the development of a highly unpleasant fishy body odor that results from the excretion of a choline breakdown product from the skin, urine, and breath. Large doses of choline dietary supplements do not appear to improve either physical or mental performance, nor do they appear to confer any specific health benefits.

Interactions

Methotrexate, a drug used to treat cancer, psoriasis, and rheumatoid arthritis, causes choline deficiency in laboratory animals. Individuals taking this drug should discuss possible side effects with their physician. Choline also is involved in many of the same metabolic pathways as other B-complex vitamins. Deficiencies or excesses of any of these B vitamins may potentially alter choline metabolism.

QUESTIONS TO ASK YOUR DOCTOR

Complications

No complications are expected when choline is taken in amounts equal to or exceeding the AI level. Doses much higher than the UL level have been tolerated without any obvious serious negative side effects (but also without any observed benefits). Adequate levels of choline are obtained through a healthy diet, and supplementation is not needed unless recommended by a physician.

Parental concerns

Animal studies suggest that choline has a positive effect in stimulating the developing brain of the fetus and that choline supplements given after birth may offset some of the effects of fetal alcohol exposure. Some dietary supplement sellers have exaggerated these results, calling choline a “miracle brain supplement.” Pregnant and breastfeeding women do need to eat a diet that provides adequate intake of choline, as choline deficiency may adversely affect brain development. However, there is no evidence that choline supplements will produce the opposite effect and increase an infant's intelligence.

See also Detoxification diets ; Dietary reference intakes (DRIs) ; Dietary supplements ; Vitamins .

Resources

BOOKS

Wildman, Robert E. C., ed. Handbook of Nutraceuticals and Functional Foods. 2nd ed. Boca Raton, FL: CRC/Taylor & Francis, 2007.

PERIODICALS

Signore, Caroline, et al. “Choline Concentrations in Human Maternal and Cord Blood and Intelligence at 5 Years of Age.” American Journal of Clinical Nutrition 87, no. 4 (2008): 896–902.

Thomas, Jennifer D., et al. “Choline Supplementation Following Third-Trimester-Equivalent Alcohol Exposure Attenuates Behavioral Alterations in Rats.” Behavioral Neuroscience 121, no. 1 (February 2007): 120–30.

Veenema, K., et al. “Adequate Intake Levels of Choline Are Sufficient for Preventing Elevations in Serum Markers of Liver Dysfunction in Mexican American Men but Are Not Optimal for Minimizing Plasma Total Homocysteine Increases after a Methionine Load.” American Journal of Clinical Nutrition 88, no. 3 (September 2008): 685–92.

Zeisel, Steven H., and Kerry-Ann da Costa. “Choline: An Essential Nutrient for Public Health.” Nutrition Reviews 67, no. 11 (November 2009): 615–23. http://dx.crossref.org/10.1111%2Fj.1753-4887.2009.00246.x (accessed March 15, 2018).

WEBSITES

Contie, Vicki. “Choline Deficiency May Hinder Fetal Brain Development.” NIH Research Matters. National Institutes of Health. July 26, 2010. https://www.nih.gov/news-events/nih-research-matters/choline-deficiencymay-hinder-fetal-brain-development (accessed March 15, 2018).

Higdon, Jane, Victoria J. Drake, and Barbara Delage. “Choline.” Linus Pauling Institute, Oregon State University. January 2015. http://lpi.oregonstate.edu/infocenter/othernuts/choline (accessed March 15, 2018).

U.S. Department of Agriculture, National Agricultural Library. “DRI Tables and Application Reports.” Food and Nutrition Information Center. https://www.nal.usda.gov/fnic/dri-tables-and-application-reports (accessed March 15, 2018).

ORGANIZATIONS

Food and Nutrition Information Center, National Agricultural Library, 10301 Baltimore Ave., Rm. 105, Beltsville, MD, 20705, (301) 504-5414, Fax: (301) 504-6409, fnic@ars.usda.gov, http://fnic.nal.usda.gov .

Institute of Medicine, National Academy of Sciences, 500 Fifth St. NW, Washington, DC, 20001, (202) 334-2352, iomwww@nas.edu, http://www.iom.edu .

Helen M. Davidson

  This information is not a tool for self-diagnosis or a substitute for professional care.