Story at-a-glance

• Choline is an essential nutrient that’s required for various physiological processes — from maintaining proper cell structure to supporting nervous system function
• Find out why you need this nutrient and how you can increase your levels to avoid choline deficiency

Choline was first discovered in 1862,1 but it wasn't until 1998 that the Institute of Medicine recognized it as an essential nutrient for optimal health. Being a newly acknowledged nutrient doesn't take away from its worth, though, since it's found to play a vital role on the function of your liver, brain, nervous system and metabolism.2

However, around 90 percent of the U.S. population is not consuming enough choline because popular dietary guidelines limit the consumption of its dietary sources. Most physicians and dietitians are also unware its biological importance.3

In fact, a recent survey shows that out of several nutrients, choline is the least likely to be recommended, with only 10 percent of the surveyed health professionals endorsing choline-rich foods to their patients.4

What Is Choline?

Choline is neither a vitamin nor a mineral — it's an organic water-soluble compound that's often grouped with vitamin B complex, since it has similar functions and properties. It affects many important processes in your body, including:5,6

• Cell structure — Choline is necessary for the synthesis of phosphatidylcholine and sphingomyelin, which are phospholipids that help maintain the structural integrity of the cell membranes.
• Cell messaging — The phospholipids that are synthesized from choline also act as a precursor for the intracellular messenger molecules, diacylglycerol and ceramide.
• Fat transport and metabolism — Choline is necessary for turning fat and cholesterol into lipoproteins called very low density lipoproteins (VLDL). It also helps transport VLDL into the bloodstream and to the extrahepatic tissues, preventing fat and cholesterol from accumulating in the liver.
• DNA synthesis — According to a study published in the journal Mutation Research, choline is a major source of methyl groups necessary for the synthesis of S-adenosylmethionine, which is needed for epigenetic marking of DNA and histones.7
• Nervous system function — Choline is a precursor for acetylcholine, a neurotransmitter involved in various neuronal functions, including muscle control, circadian rhythm and memory.

Because of its extensive role in various physiological functions, being deficient in this nutrient may predispose you to a number of health consequences, including muscle damage, excess fat and cholesterol buildup, and liver disorders like nonalcoholic fatty liver disease (NAFLD).8 Some people are also at a higher risk of choline deficiency than others, including:9

• Pregnant women — Since large amounts of the maternal plasma choline are transported to the fetus during pregnancy, pregnant women are at a higher risk of being deficient. Lactation also increases the demand for choline because breastmilk is rich in this nutrient.10
• Postmenopausal women — Postmenopausal women have a higher demand for choline, since their low estrogen level puts them at a higher risk of developing liver and muscle damage due to choline deficiency.11
• Endurance athletes — Choline levels may decrease during endurance exercises.12
• Alcoholic people — Excessive alcohol consumption increases your choline requirement, making you more susceptible to deficiency.13
• Vegetarians — Since most of the choline-rich foods come from animal-based sources, vegans and vegetarians may not be able to consume enough choline from their diet.14

While your liver has the ability to produce small amounts of choline, you still need to obtain high amounts of it from the foods that you eat. Some people opt to take dietary supplements like choline bitartrate, choline chloride, choline citrate, CDP-choline and alpha-GPC.

Keep in mind, though, that these supplements may not be the best sources of choline. For instance, choline chloride usually ends up as food for gut bacteria because of its low bioavailability. If you really want to optimize your body's levels of this nutrient, I suggest that you consider adding choline-rich foods into your diet first.

What Are the Best Food Sources of Choline

You can effectively increase your body's levels of choline through your diet, since it's found in a variety of foods, including:15

• Grass fed beef liver — A 100-gram serving of braised beef liver contains 430 milligrams (mg) of choline.16

• Organic, pastured egg — One large hardboiled egg provides 146.9 mg of choline.17

• Turkey liver — An 83-gram serving of simmered turkey liver provides 182.8 mg of choline.18

• Brussels sprouts — A half-cup of boiled Brussels sprouts contains 31.7 mg of choline.19

• Pastured chicken — You can obtain 73.4 mg of choline for every 86-gram serving of roasted chicken breast meat.20

• Broccoli — A half-cup of boiled broccoli provides 31.3 mg of choline.21

• Cauliflower — A half-cup of boiled cauliflower contains 24.2. mg of choline.22

• Shiitake mushrooms — A 97-gram serving of stir-fried shiitake mushrooms contains 57.6 mg of choline.23

• Asparagus — A half-cup of boiled asparagus provides 23.5 mg of choline.24

• Cabbage — You can get 15.2 mg of choline by consuming a half-cup of boiled cabbage.25

Some of the other foods that are high in choline include wild-caught Alaskan salmon, collard greens, bok choy, shrimp and sardines.26 Taking krill oil may also help you improve your choline levels, since it provides 69 choline-containing phospholipids, most of which have omega-3 fatty acids.

Health Benefits That You Can Get From Choline

The vital roles that choline plays in various physiological processes accounts for its many health benefits, which include:

• Helps reduce the risk for cardiovascular disease — According to a study in the journal ARYA Atherosclerosis, choline may help prevent cardiovascular disease by converting homocysteine to methionine.27 Homocysteine is an amino acid that may increase your risk for heart disease and stroke if it accumulates in the blood.28

• Helps promote brain function and memory — Choline helps support optimal brain function by acting as a precursor for the neurotransmitter that's responsible for memory, mood and intelligence.29 A study published in The American Journal of Clinical Nutrition shows that higher concurrent choline intake may help improve both the visual and verbal memories of dementia-free participants.30

• Helps support proper fetal development — Choline is a critical nutrient during fetal development, since it affects stem cell proliferation and apoptosis, which may alter the brain and spinal cord structure. High choline levels during pregnancy may increase your baby's lifelong memory function and lower the risk for neural tube defects.31

• Helps manage certain mental disorders — Research shows that low choline intake is associated with increased anxiety levels.32 This nutrient has been used in treating rapid-cycling bipolar disorder, too. A study published in the journal Biological Psychiatry shows that choline supplementation helped reduce the manic and mood symptoms of people with bipolar disorder.33

• Helps lower the risk for liver disease — Research shows that normal-weight women with higher dietary choline intake have a lower risk of developing NAFLD compared to those that consume a low-choline diet.34

• Helps prevent breast cancer — A 2008 study that involves 1,508 women found that those who eat choline-rich foods are 24 percent less likely to develop breast cancer.35

Studies Underscore the Importance of Choline During Pregnancy

During pregnancy, the mother provides high amounts of choline across the placenta to the fetus. The effect of this nutrient on fetal brain development occurs during embryonic days 11 to 17. Studies have shown that higher dietary choline intake during this sensitive window in fetal development may lead to enhanced memory performance in later life.36

Choline is also responsible for improving the signaling mechanisms involved in the formation of new blood vessels in the placenta. Plus, it may help inhibit the pathological precursors of preeclampsia, as well as mitigate the effects of alcohol exposure to the fetus.37

Moreover, choline deficiency during pregnancy may put the baby at risk of neural tube defect and orofacial cleft. In the United States, pregnant women who consume only 150 mg of choline per day are four times more likely to have a baby with neural tube defects,38 while their risk for having a baby with orofacial cleft increases by up to 1.7 percent.39

Take Note of the Side Effects Linked to Choline

The tolerable upper intake level for choline is 3,500 mg per day, according to the Institute of Medicine. It's highly unlikely that you'll exceed this limit if you're going to obtain choline from your diet. The only way for you to go past this level is by taking choline supplements in high doses. However, this may put you at risk of the following side effects:40,41

• Fishy body odor
• Increased sweating
• Nausea
• Low blood pressure level

• Diarrhea
• Salivation
• Vomiting
• Gastrointestinal problems

Are You Eating Choline-Rich Foods Yet?

Choline is an essential nutrient that's almost ignored by many, but the good news is that a deficiency in this nutrient is actually rare, even though you may not be consuming enough choline-rich foods to meet the recommended adequate intake per day.42

This doesn't mean that it's OK to let your choline levels run low, though. Add choline-rich foods into your diet to maintain proper brain and liver function, heart health and fetal development. If you're planning to increase your levels of this nutrient using dietary supplements, make sure that you consult your doctor first.

Frequently Asked Questions (FAQs) About Choline

Q: What is choline bitartrate?

A. Choline bitartrate is a form of choline supplement, which combines choline with the salt of tartaric acid.43

Q: What does choline do?

A. Choline is essential for various physiological processes, including cell messaging, cell structure, fat transport and metabolism, DNA synthesis, and nervous system function. It also helps promote proper fetal development, enhance memory and support brain function.

Q: What foods have choline?

A. Choline is usually found in animal-based foods, but it's present in several vegetables too. Some of the foods that are rich in choline include pastured eggs, beef liver, chicken breast, Brussels sprouts, cauliflower and broccoli.44