A Nutrient That Supports Brain and Liver Health
Choline is an essential nutrient found naturally in foods and produced in small amounts by the liver. Both plants and animals need choline to maintain cell structure. Vitamin E Acetate Lungs
Choline has many functions in the human body, including making specific brain chemicals, ensuring cell membrane integrity, and more.
Your body does not make all the choline necessary, so you must consume the rest from your diet. Choline can also be found as a nutritional supplement.
This article reviews choline, how to get it in your diet, and who is at risk for not getting enough.
In the United States, the Food and Drug Administration (FDA) does not regulate supplements the way it regulates prescription drugs. That means some supplement products may not contain what the label says.
When choosing a supplement, look for third-party tested products (such as the U.S. Pharmacopeia, Consumer Labs, or NSF) and consult a healthcare provider, registered dietitian nutritionist (RD or RDN), or pharmacist.
A choline supplement is a dietary supplement that contains choline. Typically, choline supplements are taken when you can't get enough choline from your diet.
Choline supplements are widely available. They can be found as an individual nutrient supplement, combined with B vitamins, or combined into a multivitamin or multimineral product.
Choline supplements typically come in the form of choline bitartrate, phosphatidylcholine , and lecithin . There is no research available to suggest that one form is better than another.
Typical dosages in supplements range from 10 milligrams (mg) to 250 mg.
Choline is an essential nutrient. It has many functions in the human body, including the following:
According to the Dietary Guidelines for Americans, most choline should be consumed through diet. Foods that contain choline include:
Most people don't consume enough choline in their diet. However, deficiency is rare because your body can make choline.
When it occurs, choline deficiency can eventually lead to the following:
Choline deficiency can happen when you don't get enough from the food you eat.
Choline status is not routinely measured in healthy people. If measured, normal plasma choline levels range from 7 to 20 micromoles/liter (mcmol/L).
The following groups are at higher risk of developing a choline deficiency:
Pregnant women are at risk of choline deficiency because their requirements are higher and they don't get enough choline in their diet. Historically, many prenatal vitamin formulations did not contain choline. Check the supplement facts label for choline content in prenatal vitamins.
The amount of choline you need daily depends on a few factors. The average daily recommended amounts of choline you need are:
Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist (RD or RDN), pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.
Choline plays a role in cardiovascular health, liver disease prevention, and brain function improvement. However, further research is needed to confirm whether supplemental choline helps.
Below are some of the areas where choline supplementation has been studied.
Most choline converts to phosphatidylcholine, a major phospholipid that helps build fat-carrying proteins. Phosphatidylcholine helps carry fat away from the liver. Fat can accumulate in the liver without enough choline. This can increase the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD).
However, limited research exists about whether supplementation can treat the condition once it has developed. One clinical trial evaluating a supplement containing choline and other natural substances found little benefit in people with MASLD.
Choline plays a role in reducing homocysteine levels. High homocysteine levels are a risk factor for heart disease. This has led researchers to consider whether choline might help reduce the risk of heart disease.
However, the results have been mixed:
Further research is needed to determine choline's role in heart health.
Choline is needed to make acetylcholine, which has a role in memory and thinking. Higher intakes of choline have been associated with higher levels of cognitive function. However, that does not necessarily mean that choline supplementation can directly improve cognition.
For example, a systematic review published in 2015 found that choline supplementation did not result in improved cognition in healthy people. Additionally, a Cochrane review concluded that lecithin (a source of choline) supplementation resulted in no clear benefits.
There is also interest in choline's possible role in Alzheimer's disease. In a study of older adults, 300 mg of daily egg yolk choline for six weeks increased verbal memory.
There is not enough evidence to support many uses of choline supplementation. An exception would be people requiring long-term parenteral nutrition (PN) or tube or intravenous (IV) feeding. PN does not routinely contain choline.
Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as nonalcoholic fatty liver disease or NAFLD) has been reported in people who need PN as their sole source of nutrition. The American Society for Parenteral and Enteral Nutrition recommends the routine addition of choline to parenteral nutrition formulations.
If you use PN long-term talk with your healthcare provider to determine whether you need a choline supplement.
Whether you need to use a choline supplement can depend on several factors, including the following:
Speak with your healthcare provider or registered dietitian nutritionist about whether you are getting enough choline and what to do.
Supplementing excessive amounts of choline is more likely to result in side effects. Adults should not take more than 3.5 g daily. Side effects of choline supplementation may include:
In severe cases, hypotension (low blood pressure) or liver toxicity could occur. Side effects involving the gastrointestinal (GI) tract often resolve after discontinuing the supplement.
Though supplementing with choline is likely safe for most people in doses less than 3.5 grams (g) daily, adequate intake (AI) is actually much lower.
For pregnant women, choline supplementation appears to be safe in amounts up to 3 g daily if under 18 or 3.5 g daily if over 19 years of age.
Choline supplementation is likely safe in children in appropriate amounts.
Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage are appropriate for your individual needs.
Not enough evidence is available to provide a recommended dietary allowance (RDA) for choline, but an adequate intake has been established.
Choline supplementation is likely safe for most adults in doses less than 3.5 g daily.
Choline is an essential nutrient. It is made in the body but not in adequate amounts, so you must mostly get it from the foods you eat. It is best to get choline from food sources.
Foods rich in choline include the following:
Some people may need to supplement their diet with choline if they can't get enough. However, research does not support some of the claims about choline supplements.
Talk with a registered dietitian nutritionist or healthcare provider if you have concerns about your choline level and how it may affect your health. If you are pregnant, review your risk of deficiency with your prenatal care provider.
CDP-choline supplements contain both choline and a natural compound called cytidine diphosphocholine (also called citicoline). It is thought that CDP-choline may be more effective than choline for improving cognition. However, more research is needed.
Most pregnant women in the U.S. are not achieving choline intake recommendations of 450 mg/day and would likely benefit from boosting their choline intake through diet and/or supplementation.
Studies have shown that getting enough choline can improve several pregnancy outcomes for the baby and mother.
Talk with your healthcare provider or registered dietitian nutritionist to determine if you need a choline supplement.
National Institutes of Health: Office of Dietary Supplements. Choline.
Sheffler ZM, Reddy V, Pillarisetty LS. Physiology, neurotransmitters. StatPearls [Internet].
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020-2025. 9th ed.
Heras-Sola J, Gallo-Vallejo JL.Importance of choline during pregnancy and lactation.A systematic review [Importance of choline during pregnancy and lactation: A systematic review].They emerge.2024 Jan-Feb;50(1):102089.Spanish.doi: 10.1016/j.semerg.2023.102089
Cerletti C, Colucci M, Storto M, et al. Randomised trial of chronic supplementation with a nutraceutical mixture in subjects with non-alcoholic fatty liver disease. Br J Nutr. 2020;123(2):190-197. doi: 10.1017/S0007114519002484
Millard HR, Musani SK, Dibaba DT, et al. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study. Eur J Nutr. 2018;57(1):51-60. doi:10.1007/s00394-016-1296-8
Bertoia ML, Pai JK, Cooke JP, et al. Plasma homocysteine, dietary B vitamins, betaine, and choline and risk of peripheral artery disease. Atherosclerosis. 2014;235(1):94-101. doi:10.1016/j.atherosclerosis.2014.04.010
Zheng Y, Li Y, Rimm EB, et al. Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men. The American Journal of Clinical Nutrition. 2016;104(1):173-180. doi: 10.3945/ajcn.116.131771
Leermakers ETM, Moreira EM, Kiefte-de Jong JC, et al. Effects of choline on health across the life course: a systematic review. Nutr Rev. 2015;73(8):500-522. doi:10.1093/nutrit/nuv010
Higgins JP, Flicker L. Lecithin for dementia and cognitive impairment. Cochrane Dementia and Cognitive Improvement Group. Cochrane Database of Systematic Reviews. 2000;(4):CD001015. doi:10.1002/14651858.CD001015
Yamashita S, Kawada N, Wang W, et al. Effects of egg yolk choline intake on cognitive functions and plasma choline levels in healthy middle-aged and older Japanese: a randomized double-blinded placebo-controlled parallel-group study. Lipids Health Dis. 2023 Jun 20;22(1):75. doi: 10.1186/s12944-023-01844-w
Vanek VW, Borum P, Buchman A, Fessler TA, et al. A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products. Nutr Clin Pract. 2012 Aug;27(4):440-91. doi: 10.1177/0884533612446706
Zeisel SH, Klatt KC, Caudill MA. Choline. Advances in Nutrition. 2018;9(1):58-60. doi: 10.1093/advances/nmx004
Synoradzki K, Grieb P. Citicoline: A Superior Form of Choline?Nutrients.2019 Jul 12;11(7):1569.doi: 10.3390/nu11071569
Korsmo HW, Jiang X, Caudill MA. Choline: Exploring the Growing Science on Its Benefits for Moms and Babies. Nutrients. 2019 Aug 7;11(8):1823. doi: 10.3390/nu11081823
Jaiswal A, Dewani D, Reddy LS, Patel A. Choline Supplementation in Pregnancy: Current Evidence and Implications. Cureus. 2023 Nov 8;15(11):e48538. doi: 10.7759/cureus.48538
By Jennifer Lefton, MS, RD/N, CNSC, FAND Lefton is a registered dietitian/nutritionist and certified nutrition support clinician with over 20 years of experience in clinical nutrition.
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