Choline is an essential nutrient that is naturally present in certain foods and available as a supplement. The body can also produce small amounts on its own in the liver, but not enough to meet daily needs. Choline is converted into a neurotransmitter called acetylcholine, which helps muscles to contract, activates pain responses, and plays a role in brain functions of memory and thinking. Most choline is metabolized in the liver where it is converted into phosphatidylcholine, which assists in building fat-carrying proteins and breaking down cholesterol. It is also 'food' for beneficial gut bacteria. [1]
Witspower Product Page
There is not enough data to establish a Recommended Dietary Allowance for choline. [2] The Food and Nutrition Board established an Adequate Intake (AI) for choline based on the prevention of liver damage.
AI: The Adequate Intake for men and women ages 19+ years is 550 mg and 425 mg daily, respectively. For pregnancy and lactation, the AI is 450 mg and 550 mg daily, respectively.
UL: A Tolerable Upper Intake Level (UL) is the maximum daily dose unlikely to cause adverse side effects in the general population. A UL has not been established for choline, because a toxic level has not been observed from food sources or from longer-term intakes of high-dose supplements.
Choline has been suggested to both protect and increase the risk of cardiovascular disease (CVD). Choline, along with the B vitamin folate, helps to lower blood levels of homocysteine by converting it to methionine. High homocysteine levels are a risk factor for CVD. Choline may also help to reduce blood pressure and stroke. In a study of almost 4,000 African-American participants followed for 9 years, higher choline intakes were associated with a lower risk of ischemic strokes. [3]
But choline may also act negatively toward the heart. Choline is converted by gut bacteria into a byproduct called trimethylamine (TMA), which is then converted in the liver to trimethylamine-N-oxide (TMAO). Higher blood levels of TMAO have been associated with a higher risk of CVD in animal studies. [4,5] However, it is unclear what is TMAO's relationship to CVD, or if it is just a marker of an underlying disease process that leads to CVD. A large cohort of men and women from the Nurses' Health Study and Health Professionals Follow-up Study, followed for 20-25 years, found that higher phosphatidylcholine intakes were associated with an increased risk of deaths from CVD and other causes. [6] There was a 26% increased risk of CVD deaths when combining data from both cohorts comparing the highest intakes of phosphatidylcholine with the lowest. Furthermore, having diabetes heightened that risk. It is believed that circulating TMAO may promote atherosclerosis by preventing the removal of cholesterol in the liver. However, it was noted that TMAO blood levels were not measured in this study, only choline from foods reported in diet questionnaires.
Other earlier, large epidemiological studies found the contrary, with no association of high choline intakes with a higher risk of cardiovascular diseases, though these studies also did not specifically measure TMAO blood levels. [7,8]
There appears to be an association with diets high in choline-rich foods and cardiovascular disease, but the reasons for this link need further study.
Type 2 diabetes
In three large cohorts of men and women, higher intakes of phosphatidylcholine were associated with an increased risk of type 2 diabetes mellitus (T2DM). [9] Those who had the highest dietary intakes of choline showed a 34% increased risk of T2DM compared with the lowest intakes. The exact mechanism of this association is unclear and warrants further research.
There is a link between choline deficiency and liver disease. Phosphatidylcholine carries fats away from the liver, so a choline deficiency can cause the liver to store too much fat. This increases the risk for nonalcoholic fatty liver disease (NAFLD), which may then progress to cirrhosis (an inflammation of liver cells, followed by thickening and hardening of liver tissue), liver cancer, or liver failure. This ultimately interferes with normal liver function. Changes in the metabolism of choline or phosphatidylcholine can also negatively impact certain biochemical pathways that lead to NAFLD. [10] NAFLD occurs most often in individuals with excess weight or obesity, and the main treatment is to reduce body fat with calorie restriction and exercise. Although a choline deficiency can lead to liver dysfunction, it is not yet clear if dietary choline or choline supplementation can treat NAFLD.
Choline is associated with brain health because it is converted into acetylcholine, which plays a role in memory and thinking. Studies have found that people with Alzheimer's disease have lower levels of an enzyme that converts choline into acetylcholine, and therefore theorize that higher dietary intakes of choline may prevent cognitive decline. [11] Although some observational studies have found that higher intakes of choline are associated with higher levels of cognitive function like memory, clinical trials have not found that choline supplementation significantly improves these cognitive measures. [1]
Choline is found in a variety of foods. The richest sources are meat, fish, poultry, dairy, and eggs.
Most Americans eat less than the AI for choline but a deficiency is very rare in healthy persons, as the body can make some choline on its own. Also, the amount of dietary choline an individual needs can vary widely and depends on various factors. For example, premenopausal women may have lower requirements for dietary choline because higher estrogen levels stimulate the creation of choline in the body. A higher choline requirement may be needed in persons who have a genetic variation that interferes with the normal metabolism of choline. [10] A true choline deficiency can lead to muscle or liver damage, and nonalcoholic fatty liver disease. [12]
Groups at higher risk of deficiency:
Very high intakes of choline can lead to low blood pressure (hypotension) and liver toxicity. It may also lead to the excess production of TMAO, which is associated with a higher risk of cardiovascular disease. Other symptoms include excessive sweating, fishy body odor, or nausea/vomiting. The Tolerable Upper Intake Level (UL) for choline for adults 19 years and older is 3,500 mg daily and is based on the amount that has been shown to produce these side effects. [1] Reaching this high amount would most likely be caused by taking very high dose supplements rather than from diet alone.
B Vitamins
Vitamins and Minerals
Last reviewed March
The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.
Want more information on CDP Choline? Feel free to contact us.
This is a general overview. For more in-depth information, see our health professional fact sheet.
Choline is a nutrient that is found in many foods. Your brain and nervous system need it to regulate memory, mood, muscle control, and other functions. You also need choline to form the membranes that surround your body's cells. You can make a small amount of choline in your liver, but most of the choline in your body comes from the food you eat.
The amount of choline you need each day depends on your age and sex. Average daily recommended amounts are listed below in milligrams (mg).
Life Stage Recommended Amount Birth to 6 months 125 mg Infants 7'12 months 150 mg Children 1'3 years 200 mg Children 4'8 years 250 mg Children 9'13 years 375 mg Teen boys 14'18 years 550 mg Teen girls 14'18 years 400 mg Men 19+ years 550 mg Women 19+ years 425 mg Pregnant teens and women 450 mg Breastfeeding teens and women 550 mgMany foods contain choline. You can get recommended amounts of choline by eating a variety of foods, including the following:
Some multivitamin/mineral supplements contain choline, often in the form of choline bitartrate, phosphatidylcholine, or lecithin. Dietary supplements that contain only choline are also available.
The diets of most people in the United States provide less than the recommended amounts of choline. Even when choline intakes from both food and dietary supplements are combined, total choline intakes for most people are below recommended amounts.
Certain groups of people are more likely than others to have trouble getting enough choline:
Although most people in the United States don't get recommended amounts of choline, few people have symptoms of choline deficiency. One reason might be that our bodies can make some choline. However, if a person's choline levels drop too low, he or she can experience muscle and liver damage as well as deposits of fat in the liver (a condition called nonalcoholic fatty liver disease [NAFLD] that can damage the liver).
Scientists are studying choline to better understand how it affects health. Here are some examples of what this research has shown.
Some research shows that getting enough choline might help keep the heart and blood vessels healthy, partly by reducing blood pressure. Other research suggests that higher amounts of choline might increase cardiovascular disease risk. More research is needed to understand whether getting more choline from the diet and supplements might raise or lower the risk of cardiovascular disease.
Some studies have found a link between higher intakes of choline (and higher blood levels of choline) and better cognitive function (such as verbal and visual memory). However, other studies have shown that choline supplements do not improve cognition in healthy adults or in patients with Alzheimer's disease, Parkinson's disease dementia, or other memory problems. More research is needed to understand the relationship between choline intakes and cognitive function as well as to find out whether choline supplements offer any benefit to patients with dementia.
There may be a link between low intakes of choline and the risk of developing NAFLD. NAFLD is a condition in which fat builds up in the liver of people who do not drink excessive amounts of alcohol. It is a common liver disorder, especially in people who are overweight or have obesity. Getting enough choline is necessary for proper liver function and to prevent NAFLD. However, more research is needed to better understand how choline might help prevent or treat NAFLD.
Getting too much choline can cause a fishy body odor, vomiting, heavy sweating and salivation, low blood pressure, and liver damage. Some research also suggests that high amounts of choline may increase the risk of heart disease.
The daily upper limits for choline include intakes from all sources'food, beverages, and supplements'and are listed below.
Life Stage Upper Limit Birth to 12 months Not established Children 1'3 years 1,000 mg Children 4'8 years 1,000 mg Children 9'13 years 2,000 mg Teens 14'18 years 3,000 mg Adults 3,500 mgCholine is not known to interact with any medications.
Tell your doctor, pharmacist, and other health care providers about any dietary supplements and prescription or over-the-counter medicines you take. They can tell you if the dietary supplements might interact with your medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients such as choline.
People should get most of their nutrients from food and beverages, according to the federal government's Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber, and other components that benefit health. In some cases, fortified foods and dietary supplements are useful when it is not possible to meet needs for one or more nutrients (for example, during specific life stages such as pregnancy). For more information about building a healthy dietary pattern, see the Dietary Guidelines for Americans and the U.S. Department of Agriculture's (USDA's) MyPlate.
For more information, please visit L-Theanine for Cognitive.