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 choline to make the memory-boosting neurotransmitter acetylcholine. But taking in more of it than you need is probably not a good idea. Find out why getting just the right amount of choline is so important.

What is Choline?

Choline is a nutrient we all require for optimal health. Although your body makes some, you need to get choline from your 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

PROS

  • Boosts cognition and protects the brain
  • Enhances liver health
  • May support weight loss
  • May help with asthma and cystic fibrosis
  • May lower the risk of breast cancer
  • Safe for children and pregnant women
  • Ensures proper fetal development

CONS

  • May cause fishy odor and nausea
  • May raise the risk of heart disease and prostate cancer

Choline Foods & Deficiency

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].

Despite its vital role in the human body, most people don’t get enough choline in their diet. Symptoms of choline deficiency are rare, but it bears serious health risks. The main symptoms 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
  • Lower rest-and-digest (parasympathetic) activity, which has been linked to pain in healthy people
  • Poor mitochondrial health and low energy levels

Alcoholics, professional athletes, and postmenopausal women have a higher risk of choline deficiency [11, 12, 13].

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 [14, 15].

The best choline food sources include [16, 17, 18]:

  • Organ meats (liver)
  • Eggs
  • Chicken
  • Whole grains
  • Beans

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

As you can see, animal foods top the list of best choline sources, but keep in mind the potential health risks of eating them in high amounts (more details in “Choline Side Effects and Dangers”).

Choline Benefits

The 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.

1) Protects the Brain and Boosts Cognition

Choline builds the protective myelin sheath around neurons and restores the levels of acetylcholine, keeping mental disorders and cognitive decline at bay [19, 20].

In almost 1,400 people, higher choline intake implied better cognitive performance (verbal and visual memory) [6].

A study with over 2K subjects linked low blood levels of choline to poor cognitive performance [21].

Both studies lacked placebo controls so we can’t take the results for granted.

On the other hand, choline had no short-term effect on cognition or memory in 2 clinical trials with 54 young volunteers [22].

In studies on rats and mice, choline supplementation was able to [23, 24, 25, 26, 27]:

  • 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

2) May Help with Bipolar Disorder

A few studies have shown that choline could help with bipolar disorder in children; it may be a useful addition to drug treatment [28].

In a small clinical trial, 5 out of 6 patients with bipolar disorder experienced notable symptom improvements with choline therapy combined with standard treatment [29].

Choline supplementation (50 mg/kg daily for 12 weeks) lowered the brain purine levels in 8 patients with bipolar disorder, which may explain its beneficial effects [30].

3) Ensures Liver Health

Choline builds phosphatidylcholine, which helps break down fats in the liver. Therefore, low choline levels can lead to fat accumulation in the liver [31].

In a large Chinese observational trial (over 56K people), higher intake of choline lowered the risk of nonalcoholic fatty liver but only in normal-weight women [32].

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. MTHFR deficiency increased the negative impact of choline deficiency, but the effect was non-significant [7].

Another trial with 57 adults confirmed that low-choline diets might cause fatty liver, especially in postmenopausal women [33].

In many animal studies, higher choline intake and choline supplementation could [34, 35, 36, 37]:

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

4) May Support Weight Loss

In a clinical trial with 22 female athletes, choline supplementation (2 g daily, 7 days before a competition) boosted weight loss with no side effects on their performance [38].

An observational trial with over 3,200 subjects, lower dietary choline intake was linked with [39]:

  • 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.

Rats supplemented with 15x daily choline intake gained 24-31% less weight on average [40].

A study on obese mice confirmed the potential of choline to stimulate weight loss by enhancing mitochondrial function and fat burning [41].

5) Essential for Fetal Development

Choline is essential during fetal development, yet many pregnant women don’t have adequate intakes [42].

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 [43, 44, 45, 46, 47]:

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

In a clinical trial on 26 pregnant women, doubling the choline intake in the third trimester (to 930 mg/day) significantly improved the infants’ cognition [48].

According to an observational study with almost 900 mothers, increased choline intake in the 2nd trimester may improve visual memory in children [49].

In different animal trials, prenatal choline supplementation could [50, 51, 52, 52, 53]:

  • Enhance fetal brain development
  • Stimulate the genes that control learning and memory
  • Shield the offspring against mental disorders and 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) [54].

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 [55].

In 69 pregnant women who were heavy drinkers, choline supplementation (2 g/day) improved the growth of infants and reduced their cognitive impairments [56].

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 [57, 58, 59].

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 a popular supplement for the prevention of NTDs, but other nutrients such as choline also play vital roles [60].

Choline supports fetal spinal cord development, thus preventing neural tube defects and other anomalies [61].

A comprehensive trial with over 180K pregnant women found a clear connection between choline intake and the risk of neural tube defects. The lowest intake increased the risk by 240% while the highest intake cut the risk by 86%, regardless of folic acid supplementation [62].

Another observational trial (860 mothers) came to a similar conclusion. For the highest vs. lowest consumption of choline, betaine, and methionine, the risk dropped by 83% [63].

Summary

Optimal choline intake and supplementation during pregnancy support fetal development, enhance cognition, and prevent birth defects.

6) Other

According to limited clinical evidence and animal trials, choline may also help with:

  • Cystic fibrosis (rare genetic lung disease) [64, 65, 66]
  • Tardive dyskinesia (a movement disorder caused by antipsychotic drugs) [67, 68, 69]
  • Asthma [70, 71]
  • Inflammation [72, 73]
  • Anxiety [74]

Choline also stimulates the vagus nerve and increases its tone. This “wandering” nerve has a huge influence on your rest-and-digest nervous system and can counteract the fight-or-flight response [8].

Mixed Effects

Heart Disease and Stroke

Choline supplies methyl groups essential for converting homocysteine to methionine. Low levels of choline may thus lead to homocysteine buildup and increase the risk of heart disease and stroke in some people [1, 75, 76, 77].

In almost 4K African-American patients, higher intake of choline lowered the risk of stroke [78].

On the other hand, increased consumption of choline-rich foods raises the level of a toxic metabolite: trimethylamine-N-oxide (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 [79, 80].

A large observational trial (over 14K middle-aged patients) found a 22% higher risk of heart disease for increased dietary intake of choline. The authors regarded this effect as non-significant [81].

In summary, the effects of choline on heart disease and stroke risk are mixed and require further investigation.

Cancer

Breast Cancer

In over 3K women, higher choline intake cut the risk of breast cancer by 24% [82].

A Chinese observational study with more than 1,000 women showed the same results [83].

Colon Cancer

In another Chinese trial (1,700+ patients), the highest choline intake lowered the risk of colorectal cancer by 46%, compared with the lowest intake [84].

However, a large observational trial with over 39K women revealed the opposite results. Women with the highest choline consumption had a 45% higher risk of colon cancer. The authors noted that other components of choline-rich animal foods likely contributed to this effect [85].

In more than 47K men, there was no connection between choline intake and colon cancer [86].

Prostate Cancer

In an observational trial with over 45K men, those with the highest choline intake had a 70% higher risk of lethal prostate cancer [87].

In 1.5K patients, higher choline blood levels implied an increased risk of prostate cancer [88].

Summary

High dietary intake of choline may lower the risk of breast cancer, but it may increase the risk of prostate cancer. In other words, it may be an issue for men and a perk for women. The effects of choline on colon cancer are mixed and don’t point to a definite conclusion.

Limitations and Caveats

Choline supplementation may not provide all the perks of optimal dietary intake. Clinical trials with choline supplements are limited and come with notable limitations such as [29, 48, 38, 3]:

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

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

Choline Side Effects & Dangers

Choline supplementation was safe in clinical trials and caused only minor side effects such as upset stomach, fishy odor, and diarrhea [38, 29, 30, 67, 70].

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

Unlike many other supplements, choline is safe for children, infants, and pregnant women. These sensitive groups should use it only under strict medical supervision [89, 48, 56, 90].

As mentioned above, increased consumption of choline-rich foods may raise the risk of heart disease and prostate cancer.

Choline Supplements

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 each one and decide which is the best choline supplement for you.

Dosage

Choline is usually dosed within a wide range of 500-2,000 mg/day.

According to the clinical trials, bipolar disorder required the highest doses: 2-4 g/day initially, then 3-8 g/day for 4+ weeks. Alternatively, choline was dosed at 50 mg/kg/day for 12 weeks in people with bipolar, which would amount to about 3.5 g/day in a 155-lbs person [29, 30].

For weight loss in athletes, the dosage was 2 g/day for 7 days [38].

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) [56, 48, 55].

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

If you’re just starting out with choline supplements, it’s wiser to go slow and track your response over time. If you’re getting a fair amount of choline from food (i.e. eating a lot of eggs and beef liver), reduce your supplemental dosage.

Reviews

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.

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Take-Away:

Choline is an essential nutrient that supports and protects the whole nervous system. It also maintains liver health and revs fat-burning. Plus, it can enhance your cognitive skills and help combat mental disorders.

Despite its importance, many people worldwide are not meeting their choline requirements. Professional athletes, alcohol drinkers, postmenopausal women, and pregnant women have increased needs.

Increase your choline intake with foods or supplements. The best food sources of choline are beef liver, eggs, chicken, whole grains, and beans. Choline supplements are widely available, safe, and typically only cause mild side effects (digestive issues and fishy body odor).

About the Author

Aleksa Ristic, MSc (Pharmacy)

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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