Choline

Foods high in the essential nutrient choline, including poultry, beef, cottage cheese, yogurt, eggs, beans, and cruciferous vegetables like broccoli.

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]

Recommended Amounts

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 and Health

Food Sources

Choline is found in a variety of foods. The richest sources are meat, fish, poultry, dairy, and eggs.

Signs of Deficiency and Toxicity

Deficiency  

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:

  • Pregnant women—In addition to low average dietary intakes in the general public, prenatal supplements do not typically contain choline.
  • Patients dependent on intravenous nutrition—Total parenteral nutrition (TPN) is administered through a vein to people whose digestive tracts cannot tolerate solid food due to disease, surgery, or other digestive conditions. Choline is not typically included in TPN formulas unless specified. [13] NAFLD has been observed in long-term TPN patients. [1]

Toxicity

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.

Did You Know?

  • Multivitamins do not typically contain choline.
  • Although foods rich in choline—liver, egg yolks, and red meat—tend to be higher in saturated fat, choline can also be found in foods lower in saturated fat including salmon, cod, tilapia, chicken breast, and legumes.

Related

B Vitamins
Vitamins and Minerals

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