CHOLINE

Choline is an under-consumed and underappreciated essential nutrient. It was recognized as an essential nutrient by the Institute of Medicine (IOM) in the year 1998.

Choline is neither a vitamin nor a mineral but an organic, water-soluble compound. Humans can produce small amounts of choline in the body (liver). Yet, it must be consumed exogenously to prevent signs of deficiency.

Choline has a wide range of roles in human metabolism, from cell structure to neurotransmitter synthesis. 

Why is Choline essential for the human body?

Choline helps in the synthesis of two major phospholipids that are vital for the cell membranes.

In addition, it is needed to produce acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain functions. 

Choline also plays an important role in modulating gene expression, lipid transport and metabolism, and early brain development.

Choline, along with vitamin B9 – folate, helps to lower homocysteine levels in the blood by converting it to methionine. A high amount of homocysteine is a risk factor for heart disease. Choline may also help to reduce blood pressure and stroke.

What are the signs and symptoms of choline deficiency?

Choline deficiency is now thought to have an impact on liver disease, atherosclerosis, and also neurological disorders.

Most humans eat less than the average intake of choline. But a deficiency of choline is rare in healthy persons, as some amount of choline is produced by the body. Also, the amount of dietary choline an individual needs can vary depending on many factors. For example, in premenopausal women, higher estrogen levels stimulate the creation of choline in the body. Hence, they may have lower requirements for dietary choline.

Whereas a person with a genetic variation may have a higher choline requirement due to interference in the normal metabolism of choline. 

A true choline deficiency can lead to muscle or liver damage and non-alcoholic fatty liver disease.

Pregnant women are at higher risk of choline deficiency. Most prenatal supplements do not contain choline.

Patients dependent on intravenous nutrition—Total parenteral nutrition (TPN) are also at a high risk of deficiency of this nutrient. Choline is not typically included in TPN formulas unless specified.

Choline deficiency can cause:

• muscle damage
• liver damage
• non-alcoholic fatty liver disease (NAFLD)

How much Choline is required daily by humans?

There is a lack of information on the recommended dietary intake of choline. Instead, the Food and Nutrition Board (FNB) has given an Average Intake (AI) for choline:

What are the food sources of choline?

The main dietary sources of choline consist of animal-based products like meat, poultry, fish, dairy products, and eggs. Cruciferous vegetables (like cabbage, broccoli) and beans are also rich in choline.

Other dietary sources of choline include nuts, seeds, and whole grains. Choline is also present in breast milk and is added to most commercial infant formulas.

Can excess choline lead to toxicity?

Very high intakes of choline (more than 3500 mg) can lead to low blood pressure (hypotension) and liver toxicity.

Other symptoms may include excessive sweating, fishy body odour, and nausea or vomiting.

• Most foods rich in choline (liver, egg yolks, and red meat) are high in saturated fats. But choline can also be found in foods like salmon, chicken breast, and legumes that are low in saturated fat.
• Most multivitamins do not contain choline.