Evidence Based
17

Choline: Food sources, Benefits, Side Effects & Deficiency

Written by Aleksa Ristic, MS (Pharmacy) | Reviewed by Ana Aleksic, MSc (Pharmacy) | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Aleksa Ristic, MS (Pharmacy) | Reviewed by Ana Aleksic, MSc (Pharmacy) | Last updated:

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protein
When counting essential nutrients, you would likely skip this one. Still, your brain, liver, and every cell in your body need it. Your brain cells use it to make the memory-boosting neurotransmitter acetylcholine. Read on to learn everything about choline!

What is Choline?

Choline is a nutrient we all require for optimal health. Although the body makes some, we need to get choline from a diet to avoid deficiency. You will sometimes find choline classified as a vitamin B, but it doesn’t actually belong to this group [1].

Choline plays key roles in [2, 3]:

  1. Cellular health: builds phospholipids that give structure to cell membranes
  2. Brain and nerve health: builds acetylcholine, a neurotransmitter essential for cognition, movement, and other vital functions
  3. DNA production: along with folate and vitamin B12
  4. Signaling: builds molecules that act as cell messengers
  5. Heart health: helps remove homocysteine, which raises the risk of heart disease

Snapshot

Proponents:

  • Helps prevent fatty liver
  • May improve cognition
  • Supports fetal development
  • May help with asthma
  • Safe for children and pregnant women

Skeptics:

  • Can cause fishy odor and nausea
  • May not improve mental health and athletic performance
  • May not help with movement disorders
  • May be associated with heart disease and some cancers

Choline Foods & Deficiency

Daily Needs

The Institute of Medicine has recently acknowledged choline as an essential nutrient. They recommend the following daily intakes [4]:

  • Adult men: 550 mg/day
  • Adult females: 425 mg/day
  • Pregnant women: 450 mg/day
  • Nursing women: 550 mg/day

These are in line with adequate daily intakes developed by the National Institutes for Health (NIH) [5].

Deficiency Symptoms and Risk Groups

Most people don’t get enough choline in their diets. Possible symptoms of choline deficiency include [1, 6, 7, 8, 9, 10]:

  • Poor memory and focus (cognitive dysfunction)
  • Liver problems (including fatty liver)
  • Mood imbalances
  • Muscle fatigue
  • Lower endurance in athletes

Luckily, the typical symptoms are rare, despite the widespread lower intake. This is likely due to the ability of our liver to make certain amounts of choline [11].

Groups of people at a higher risk of choline deficiency include [12, 13, 14]:

  • Postmenopausal women
  • Chronic alcohol consumers
  • Pregnant women
  • People with certain genetic variants
  • Athletes
  • People on intravenous nutrition

Choline is an important methyl donor for various methylation reactions. If a diet is low in folate, another methyl donor, choline requirements increase [15].

It turns out that omnivores on unrestricted diets and vegans/vegetarians are all at the same risk of choline deficiency. Carnivores and heavy meat eaters may be at reduced risk, while those who regularly eat eggs are most likely to meet their choline needs [16, 17].

Food Sources

The best choline food sources include beef liver, eggs, chicken, and beans (Table 1) [18, 15, 19].

Table 1: Choline Food Sources

FoodServing sizeMilligrams
(mg) per
serving
% of
Daily
Value
Beef liver, fried3 ounces35665
Egg, hardboiled1 large14727
Soybeans, roasted½ cup10719
Chicken breast, roasted3 ounces7213
Codfish, cooked3 ounces7113
Shiitake mushrooms, cooked½ cup5811
Red potatoes, baked1 large5710
Beans, kidney, canned½ cup458

For example, you would need to eat about 3 ounces of beef liver or 1-2 eggs daily to meet the daily requirements [5].

Choline Benefits

The potential benefits listed below refer specifically to studies with choline. We talk about the benefits of its other forms in our posts about alpha-GPC and citicoline.

Also, keep in mind that potential benefits of higher choline intake might not always translate to choline supplements. Speak with your doctor before taking choline supplements. They can not replace medical treatment for any health condition.

Likely Effective:

The potential benefits listed in this section are backed up by solid clinical evidence, but the regulatory bodies still haven’t approved the use of choline for these conditions.

1) Protects From Fatty Liver

Choline builds phosphatidylcholine, which helps break down fats in the liver. Therefore, low choline levels can lead to fat accumulation in the liver [20].

In a large Chinese observational trial (over 56K people), higher intake of choline lowered the risk of nonalcoholic fatty liver disease (NAFLD) but only in normal-weight women [21].

In 54 healthy adults, low-choline diets raised the risk of fatty liver disease and other liver problems. Introduction of choline into their diets reversed these effects [7].

Another trial with 57 adults confirmed that low-choline diets might cause fatty liver, especially in postmenopausal women [22].

People on total parenteral (intravenous) nutrition are at a higher risk of fatty liver due to choline deficiency. Doctors can successfully prevent this by adding intravenous choline [23, 24].

In many animal studies, higher choline intake and choline supplementation could [25, 26, 27, 28]:

  • Prevent and reverse fatty liver
  • Boost cholesterol metabolism
  • Block oxidative damage and liver scarring
  • Prevent cell mutations and liver cancer

Possibly Effective:

The potential benefits in this section stem from low-quality clinical trials, animal, and cell-based studies. They are not researched well enough to recommend choline supplements for any of the below conditions.

2) May Improve Cognition

Choline builds the protective myelin sheath around neurons and restores the levels of acetylcholine. This effect may help keep cognitive decline at bay [29, 30].

In two observational studies of 3,400 people, choline intake was positively associated with cognitive performance [6, 31].

A review of 50 clinical trials concluded that “choline may have beneficial effects on cognition, but high-quality (intervention) studies are lacking” [32].

In studies on rats and mice, choline supplementation was able to [33, 34, 35, 36, 37]:

  • Reverse memory loss caused by prenatal iron deficiency
  • Improve stroke recovery (with B vitamins)
  • Enhance cognitive skills and coordination
  • Protect the brain against seizure-induced damage

3) May Help With Asthma

Six-month choline supplementation (1,500 mg, 2x/day) brought a significant symptom relief and reduced inflammation in 74 asthmatic patients. Two more studies came to a similar conclusion but didn’t reveal the number of participants [38, 39, 40].

In animal models of asthma, choline reduced inflammation and oxidative stress while improving lung function [41, 42].

The above results are promising, but we need more solid clinical evidence before recommending choline as a complementary approach to asthma.

4) May Support Fetal Development

Choline is essential during fetal development, yet many pregnant women don’t have adequate intakes [43].

Brain Development and Cognition

Multiple reviews of human and animal trials have proclaimed choline a vital nutrient for fetal brain development. Optimal choline intake during pregnancy [44, 45, 46, 47, 48]:

  • Ensures proper brain structure and functioning
  • May enhance memory and cognition
  • Prevents birth defects and mental illnesses

In a clinical trial of 26 pregnant women, doubling the choline intake in the third trimester (to 930 mg/day) significantly improved the infants’ cognition [49].

According to an observational study with almost 900 mothers, increased choline intake in the 2nd trimester may improve visual memory in children [50].

However, a study of 1,210 participants concluded that maternal choline intake (during the 1st and 2nd trimesters) wasn’t associated with their children’s cognition at three years of age [51].

In different animal trials, prenatal choline supplementation could [52, 53, 54, 55]:

  • Enhance fetal brain development
  • Stimulate the genes that control learning and memory
  • Shield the offspring against brain damage
  • Relieve inflammation

Fetal Alcohol Spectrum Disorders

Alcohol consumption during pregnancy can cause a range of physical and mental disorders in the offspring, collectively known as fetal alcohol spectrum disorders (FASD) [56].

A review of 10 Ukrainian studies concluded that prenatal supplementation with choline (750 mg daily) could improve cognition in babies exposed to alcohol during pregnancy [57].

In 69 pregnant women who were heavy drinkers, choline supplementation (2 g/day) improved the growth of infants and reduced their cognitive impairments [58].

Studies on rats and other animals confirmed the beneficial effects of choline supplementation on alcohol-induced fetal damage. The offspring of supplemented mothers showed fewer cognitive defects and had better coordination [59, 60, 61].

Neural Tube Defects

Neural tube defects (NTDs) are severe birth defects that occur when the neural tube fails to close completely during embryonic development. Folate is the most studied supplement for the prevention of NTDs, but other nutrients such as choline may also play vital roles [62].

Choline supports fetal spinal cord development, which helps prevent neural tube defects and other anomalies [63].

In a trial of over 180,000 participants, the offspring of mothers with the lowest choline intake had 2.4x higher rates of NTDs. The effect was independent of folic acid supplementation [64].

Another observational study (860 mothers) came to a similar conclusion. NTDs rates dropped multiple times for the highest vs. lowest consumption of choline, betaine, and methionine [65].

However, two trials with over 1,700 participants failed to establish a connection between choline intake during pregnancy and NTDs [66, 67].

Summary

Increased choline intake during pregnancy may support fetal development, enhance cognition, and prevent birth defects. Larger welldesigned clinical trials should investigate this further.

Insufficient Evidence:

No valid clinical evidence supports the use of choline supplements for any of the conditions in this section. Below is a summary of up-to-date animal studies, cell-based research, or low-quality clinical trials which should spark further investigation. However, you shouldn’t interpret them as supportive of any health benefit.

5) Mental Health

A few studies have shown that choline could help with bipolar disorder in children; it may be a useful addition to drug treatment [68].

In a small clinical trial, 5/6 patients with bipolar disorder experienced notable symptom improvements with choline therapy combined with standard treatment [69].

Choline supplementation (50 mg/kg daily for 12 weeks) lowered the brain purine levels in eight patients with bipolar disorder, which may explain its potentially beneficial effects [70].

In a study of nearly 6,000 participants, lower blood levels of choline were associated with anxiety symptoms. Still, this doesn’t tell us much about the potential effects of choline on anxiety [71].

6) Weight Loss

Many supplements are promoted to stimulate weight loss, but valid clinical research has debunked most of those claims. A healthy, calorie-controlled diet and increased physical activity remain your best allies in weight control [72].

In a clinical trial with 22 female athletes, choline supplementation (2 g daily, 7 days before a competition) reduced body mass index (BMI) by 12% with no side effects on their performance [73].

According to an observational trial with over 3,200 subjects, lower dietary choline intake was linked with [74]:

  • More body fat
  • Increased weight
  • Higher body mass index
  • Greater waist-to-hip ratio

In other words, people who consumed more choline were less likely to become obese.

A study on obese mice confirmed the potential of choline to stimulate weight loss by enhancing mitochondrial function and fat burning [75].

However, a review of 50 clinical trials reported inconsistent effects of choline on body composition [32].

Other

According to limited clinical evidence from low-quality clinical trials, choline may also help with:

  • Cystic fibrosis (rare genetic lung disease) [76, 77, 78]
  • Tardive dyskinesia (a movement disorder caused by antipsychotic drugs) [79, 80, 81]

Still, there’s insufficient evidence to proclaim choline supplements safe and effective for these conditions.

Possibly Ineffective

A couple of smaller, low-quality clinical studies have found no significant effects of choline for:

  • Different movement disorders (ataxia) [82, 83, 84]
  • Schizophrenia [85]
  • Athletic performance [86, 87]
  • Memory loss in the elderly [88, 89]

Conflicting Results

Heart Disease and Stroke

Choline supplies methyl groups essential for converting homocysteine to methionine. Low levels of choline may thus lead to homocysteine buildup, which increases the risk of heart disease and stroke in some people [1, 90, 91, 92].

In almost 4,000 African-American patients, higher intake of choline lowered the risk of stroke [93].

On the other hand, increased consumption of choline-rich foods raises the level of a toxic metabolite: trimethylamineNoxide (TMAO).

High TMAO blood levels are associated with a 2.5 times increased risk of stroke and heart attack, but this is more pronounced in people with other risk factors such as diabetes, kidney disease, and high blood pressure [94, 95].

According to the data from over 120,000 adults, increased choline intake was associated with up to 26% higher cardiovascular mortality (from heart disease and stroke) [96].

All in all, the effects of dietary choline on cardiovascular health are inconsistent, and a review of 50 clinical trials came to this conclusion. Further research is warranted [32].

Cancer

Breast Cancer

In two observational trial of over 4,000 women, higher choline intake was associated with lower rates of breast cancer [97, 98].

Colon Cancer

In a Chinese study of 1700+ patients, the highest choline intake correlated with almost two times lower rates of colon cancer [99].

However, a large observational trial with over 39K women revealed the opposite results. Women with the highest choline consumption had 45% higher rates of colon cancer. The authors noted that other components of choline-rich animal foods likely contributed to this effect [100].

In more than 47,000 men, there was no connection between choline intake and colon cancer [101].

Prostate Cancer

In an observational trial with over 45K men, those with the highest choline intake had 70% higher rates of lethal prostate cancer [102].

Higher choline blood levels were associated with increased rates of prostate cancer in 1,500 patients [103].

Summary

High dietary intake of choline may be associated with lower rates of breast cancer but higher rates of prostate cancer. The connection with colon cancer is inconsistent. These findings require further investigation.

Limitations and Caveats

Choline supplementation may not provide all the perks of optimal dietary intake. Clinical trials with choline supplements are scarce and come with notable limitations such as [69, 49, 73, 3]:

  • Lack of placebo controls
  • Small sample size
  • Poor study design

In addition to that, the possible adverse effects of higher choline intake mentioned above call for extra caution.

Choline Supplements

Despite some potential health benefits, choline supplements have not been approved by the FDA for medical use. In general, regulatory bodies aren’t assuring the quality, safety, and efficacy of supplements. Speak with your doctor before supplementing.

The most common supplements are pills with 350 – 500 mg of choline bitartrate. Other available forms include:

  • Bulk powders
  • Choline and inositol (250 – 400 mg each)
  • Choline-enriched multivitamin supplements

Most manufacturers source choline from soybean and eggs – read the labels carefully if you’re allergic to these foods or avoid animal products. Vegan-friendly supplements are available.

Other choline-containing supplements include:

Our detailed reviews will help you compare the potential benefits and downsides of each one.

Side Effects & Dangers

The below summary of potential side effects might not be a definite one. Work with your doctor to evaluate if choline supplements would be safe for you and determine the optimal dosage based on your health condition.

Choline supplementation was safe in clinical trials and caused only minor side effects such as upset stomach, fishy odor, and diarrhea [73, 69, 70, 79, 38].

According to the FDA, choline as a nutrient is “generally recognized as safe” (GRAS). The upper limit for choline intake in healthy adults is 3,500 mg/day [8, 4].

Unlike many others, choline supplements appear to be safe for children, infants, and pregnant women. Still, these sensitive groups should use them only under strict medical supervision [104, 49, 58, 105].

As mentioned above, increased dietary intake of choline may correlate with heart disease and prostate cancer; caution is warranted.

Dosage

Choline is usually dosed within a range of 500 2000 mg/day.

Prenatal doses of 930 mg/day were used during the 3rd trimester (total intake). Varying doses were able to prevent fetal alcohol spectrum disorders (2 g/day during the second half of pregnancy or 750 mg/day during the entire pregnancy) [58, 49, 57].

People typically use doses of 1 2 g/day for improving brain health and cognition, although clinical studies haven’t backed this up.

If youre just starting out with choline supplements, its wise to work with your doctor, start slow, and track your response over time.

User Reviews

The opinions expressed in this section are solely from the users who may or may not have medical background. Their reviews do not represent the opinions of SelfHacked. SelfHacked does not endorse any specific product, service, or treatment.

Do not consider user experiences as medical advice. Never delay or disregard seeking professional medical advice from your doctor or another qualified healthcare provider because of something you have read on SelfHacked.

Most users report beneficial effects of choline supplements for memory, mental clarity, and energy. Some also find them helpful for liver function, asthma, and weight control.

Women report the benefits of choline + inositol for PCOS, conception, and hair growth.

Fishy body odor and nausea are the most common side effects. Some users experienced no benefits for cognition and weight loss.

Take-Away

Choline is an essential nutrient that supports and protects the liver, brain, nerves, and more. Despite its importance, many people worldwide are not meeting their choline requirements.

Professional athletes, alcohol drinkers, postmenopausal women, and pregnant women have increased needs for choline. The best food sources are beef liver, eggs, chicken, whole grains, and beans.

Choline may help prevent fatty liver, improve the symptoms of asthma, and support cognition and fetal development. There is insufficient evidence for mental health and weight loss, while it probably can’t help with movement disorders and athletic performance.

More research is needed before proclaiming choline supplements safe and effective for any health condition, especially given the fact they may be associated with higher rates of heart disease and some cancers.

About the Author

Aleksa Ristic

Aleksa Ristic

MS (Pharmacy)
Aleksa received his MS in Pharmacy from the University of Belgrade, his master thesis focusing on protein sources in plant-based diets. 
Aleksa is passionate about herbal pharmacy, nutrition, and functional medicine. He found a way to merge his two biggest passions—writing and health—and use them for noble purposes. His mission is to bridge the gap between science and everyday life, helping readers improve their health and feel better.

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