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Writer's pictureDr. Amy Knaperek, PharmD

Choline



Choline is a water-soluble vitamin-like micronutrient that is related to the B-vitamins (like folate and vitamin B-12). It is an essential component of the methylation pathway for detoxification, DNA synthesis, and nerve signaling by donating its methyl groups to this process. Choline is a precursor for the synthesis of acetylcholine, which is a key neurotransmitter that affects functions in the heart, lungs, gut, bladder, pancreas, and endocrine organs. Acetylcholine is also important for cognitive function, mood, and memory.


Choline plays a key role in cell signaling. Cellular signaling is essential for bodily functions like clotting, cardiac function, immune function, and the inflammatory pathway. Choline is also used to create certain phospholipids required for making cell membranes and is a key component for bile acids (used for digestion).


Recommended daily amounts for choline:

AGE GROUP

RECOMMENDED DAILY AMOUNT

UPPER INTAKE LEVEL

Infants and Babies

125 - 150 mg

***

1 - 8 years old

150 - 250 mg

1000 mg

9 - 13 years old

250 - 375 mg

2000 mg

Female 14 +

425 - 550 mg

3000 mg (14 - 18 yo) 3500 mg (19+)

Male 14 +

550 mg

3000 mg (14 - 18 yo) 3500 mg (19+)

Pregnant Women

450 - 550 mg

3000 mg (14 - 18 yo) 3500 mg (19+)

Breastfeeding Women

550 mg

3000 mg (14 - 18 yo) 3500 mg (19+)

***Not possible to establish; breast milk, formula, and food should be the only sources of choline for infants.


Choline is used to support cognitive function, reduce anxiety and depression, help muscle signing, and improve bone health. It has also been shown to reduce the risk for neural tube defects during pregnancy.


A choline-rich diet may be associated with a lower risk of Alzheimer's disease and dementia according to a recent study of middle-aged men in Finland. This and other studies suggest that choline helps to support cognitive processing, as well as visual and verbal memory. More double-blinded, placebo-controlled studies are needed for more definitive results, but the initial studies are promising.


Signs and symptoms of a choline deficiency may include:

o Decreased energy levels/fatigue

o Memory loss & cognitive decline

o Learning disabilities

o Muscle aches or nerve damage

o Mood changes or disorders



Dietary sources for choline include:

Organ meats Beef

Bacon Chicken

Pork Eggs

Soybeans Broccoli

Peanuts Peas

Spinach Mushrooms

Cabbage Avocado


Choline toxicity is rare, but doses higher than the recommended upper limit have led to dizziness, nausea, and diarrhea. High amounts of dietary choline in animal models have shown that the microbiome creates a product called trimethylamine. Trimethylamine can be converted to trimethylamine oxide (TMAO), which is linked to higher rates of obesity, non-alcoholic fatty liver disease, type 2 diabetes, cardiovascular disease, inflammatory bowel disease, and chronic kidney disease. Studies in human subjects have been inconclusive.



As usual, this should not be a concern if certain guidelines are followed. Eat your rainbow! Include ½ to ¾ of your meal as fruits and vegetables. Eat a variety of the different colors that are available. Include lean proteins, grass-fed beef, fatty fish (salmon, mackerel, anchovies, sardines, or herring), or vegetable proteins, nuts, and seeds. Limit processed foods. A good rule of thumb if it comes in a package is to check to see if it has 5 or more ingredients or if the ingredients look like a lab experiment vs a pantry item. Limit sugar intake (watch your beverages).

Use oils like olive oil, coconut oil, and avocado oil. Remember, some of the benefits of olive oil are destroyed by heat, so drizzle some olive oil over your food after cooking.


Are you ready to PIVOT to functional health and wellness?


References:

1. Buchman AL, Ament ME, Sohel M, Dubin M, Jenden DJ, Roch M, et al. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J Parenter Enteral Nutr 2001;25:260-8.

2. Caudill MA. Pre- and postnatal health: evidence of increased choline needs. J Am Diet Assoc 2010;110:1198-206.

3. Caudill MA, Miller JW, Gregory JF, 3rd, Shane B. Folate, choline, vitamin B12, and vitamin B6. In: H. SM, Caudill MA, eds. Biochemical, Physiological, and Molecular Aspects of Human Nutrition. 3rd ed; 2012:565-608.

4. Corbin KD, Zeisel SH. The nutrigenetics and nutrigenomics of the dietary requirement for choline. Prog Mol Biol Transl Sci 2012;108:159-77.

5. Fischer L.M., da Costa K.A., Galanko J., Sha W., Stephenson B., Vick J., Zeisel S.H. Choline intake and genetic polymorphisms influence choline metabolite concentrations in human breast milk and plasma. Am J. Clin. Nutr. 2010;92:336–346. doi: 10.3945/ajcn.2010.29459.

6. Mehedint M.G., Niculescu M.D., Craciunescu C.N., Zeisel S.H. Choline deficiency alters global histone methylation and epigenetic marking at the Re1 site of the calbindin 1 gene. FASEB J. 2010;24:184–195. doi: 10.1096/fj.09-140145.

7. Nurk E, Refsum H, Bjelland I, Drevon CA, Tell GS, Ueland PM, et al. Plasma free choline, betaine and cognitive performance: the Hordaland Health Study. Br J Nutr 2013;109:511-9.

8. Zeisel SH. Choline. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:416-26.

9. Zeisel S.H. Choline: Critical role during fetal development and dietary requirements in adults. Annu. Rev. Nutr. 2006;26:229–250. doi: 10.1146/annurev.nutr.26.061505.111156.


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