Choline is important for many cellular pathways such as the making of Acetylcholine. It plays a key role in cognitive function, cardiovascular function, and infant development.

What is Choline?

Jiang, 2014 Maternal choline supplementation: a nutritional approach for improving offspring health?

Source: Jiang, 2014 [R]

Choline is an essential water-soluble nutrient that all humans must consume. At least theoretically, most humans get enough from dietary sources, though some populations have higher requirements. As is the case with many essential nutrients, there may be benefits to supplementation with supra-dietary amounts both generally and in patients with high risk of deficiency [R].

The molecule can be oxidized to betaine or phosphorylated (addition of phosphoryl group) to phosphocholine in cells.

Choline is needed in order to make the neurotransmitter acetylcholine, which is required for cognitive and muscular function [R].

It is also very important in breaking down Homocysteine [R].

Choline Snapshot


  • Great for brain function
  • Helps liver function
  • May lower inflammation
  • Good for physical and mental performance
  • Good for mood


  • Doesn’t taste good
  • Expensive
  • Need to take Alpha-GPC or CDP-choline to have cognitive effects

Health Benefits of Choline

1) Low Choline Levels Will Cause Liver Damage

Choline is needed to make Phosphatidylcholine. Phosphatidylcholine is important in breaking down fats in the liver [R]. Therefore low choline levels can lead to fat accumulation in the liver.

In a study conducted in healthy adults, a large percentage of subjects exposed to low choline diets developed a fatty liver disease and other liver problems [R]. These effects were reversed when more choline was introduced into the diet [R].

Liver damage caused by low choline may in turn cause obesity, hypertension, or insulin resistance [R].

2) Choline May Decrease Inflammation

Higher intake of choline has been associated with lower levels of inflammatory markers in the body. In a survey of 3000 people, those with the highest levels of choline intake (>310 mg/day vs <250 mg/d) had, on average, 22% lower CRP, 26% lower IL-6, and 6% lower TNF-a [R].

Activating some acetylcholine receptors (alpha7nAChR) are directly anti-inflammatory [R].

In one study with 76 people who had Asthma, choline supplementation was able to improve symptoms and lower inflammation [R]. However, a different study of 30 people with asthma did not find any benefit [R].

3) Choline Is Required To Build Myelin And Increases Myelination

Choline is an important nutrient for myelin, which is critical for intelligence and IQ [R].

In animal models of multiple sclerosis, CDP-choline exerted beneficial effects on myelin, oligodendrocytes, and axons [R].

After drug-induced demyelination (animals), CDP-choline effectively enhanced myelin regeneration and reversed motor coordination deficits.

The increased remyelination arose from an increase in the numbers of myelin precursor cells (oligodendrocytes) [R].

4) Choline Can Help Improve Cognitive Performance

Acetylcholine is essential for brain function. Cognitive decline often occurs, in part, because of a shortage of acetylcholine [R].

In 1391 people, higher choline intake was related to better cognitive performance (verbal and visual memory) [R].

By increasing choline intake, subjects can increase acetylcholine levels, decrease cognitive decline [R] and protect the brain from degeneration [R].

One study showed that subjects taking CDP-choline + caffeine beverages had improved cognitive abilities [R].

Some studies have shown that CDP-choline can improve memory [R].

Sixty healthy adult women aged 40 – 60 who took CDP-choline for 28 days had improved attention [R].

In 24 male participants, CDP-choline supplementation (500-1000mg) improved a variety of cognitive processes (processing speed, working memory, verbal learning, verbal memory, and executive function), but only in low cognitive baseline performers (i.e. less intelligent people), while exerting no effects in medium baseline performers, and actually worsening brain function in high baseline performers (more intelligent people) [R].

In animal models, prenatal choline supplementation has led to an improvement in memory function, an effect that lasted even as the offspring got old [R, R].

5) Choline Can Help Improve Symptoms of Alzheimer’s and Parkinson’s Disease

Trials have shown that increased choline intake has improved symptoms of patients with mild Alzheimer’s disease [R].

Parkinson’s disease is a disorder caused by the deterioration of motor neurons, which causes stiffness and trembling in the extremities.

Studies have shown that choline may help to relieve these symptoms [R].

6) Low Choline Levels May Increase Risk of Cancer

High levels of Homocysteine are a known risk factor for Cancer [R].

Without the choline needed to break down Homocysteine, the risk of developing cancer may theoretically increase [R].

However, one study found that higher choline levels were associated with an increased risk of lethal prostate cancer [R].

Choline is highly concentrated in prostate cancer cells, and blood concentrations of choline have been associated with an increased risk of prostate cancer [R].

A study showed that high levels of choline in the diet could decrease the risk of developing breast cancer [R].

The study also showed that mutations in the gene that breaks down choline could increase the risk of breast cancer [R].

Bottom line: Choline is a vital nutrient in preventing breast cancer.

7-9) Choline May Help Schizophrenia, Bipolar, and Autism

Schizophrenia and autism can be caused by maternal iron deficiency during pregnancy [R].

In rats, it was found that prenatal choline supplements can help reduce the likelihood of at-risk subjects developing these disorders later on in life [R].

Schizophrenia and autism developed due to genetic predispositions may also be avoided by prenatal choline supplements [R].

In a study performed on subjects with Schizophrenia, subjects taking CDP-choline showed improved cognition and working memory after treatment [R].

A few studies have shown that choline could help treat bipolar disorder and may be a useful complement to pharmaceutical interventions [RR].

10) Choline May Improve Recovery of Those Suffering From Brain Injuries

Recovery from a brain injury can be a lengthy and even lethal process.

CDP-choline may help the brain recover from traumatic injuries [R].

Citicoline use for acute Traumatic Brain Injury (TBI) is not supported in studies, whereas it may have some benefits in improving the cognitive state in chronic TBI patients [R].

11) High Levels of Choline May Help Increase Athletic Performance

A study showed that high levels of Alpha GPC, a source of choline, helped improve weightlifting and athletic performance [R].

Subjects showed muscle damage when on a low choline diet [R].

12) High Levels of Choline May Decrease Appetite

Levels of CDP-choline of 2000mg/day were shown to decrease a subjects appetite [R].

13) Choline May Help Treat Drug Addiction

Some evidence has shown that CDP-choline can help reduce addiction to drugs such as cocaine [R].

14) Choline is Essential to Fetal Development

Choline is very important in fetal development. Many pregnant women do not consume enough choline [R].

In the early years of infancy, while the mother is breastfeeding, it is important that the mother consumes high amounts of choline.

Choline is essential in building the nervous system, promotes cell division and tissue expansion [R].

As a necessary precursor to acetylcholine, choline is crucial to the development of the fetal brain [R].

Fetal alcohol spectrum disorders are caused by maternal alcohol consumption during pregnancy and are characterized by “physical anomalies, neurodevelopmental abnormalities, and neurocognitive deficits, including intellectual, executive, and memory deficits”[R].

Studies have shown that choline may help mitigate the symptoms of such disorders [R].

15) Choline is Important in Determining Gene Expression During Development

Gene expression is an important part of determining an individual’s characteristics. Some genes in the body may be turned off while others are turned on.

Most aspects of gene expression are determined during fetal development [R].

Some genes are turned off through DNA methylation while other genes remain on [R].

Betaine, a choline metabolite, is essential in providing methylation enzymes with methyl groups [R].

Without a source of methyl groups, methylation cannot occur and gene expression cannot be altered.

16) Low Choline Levels May Prevent Proper Lipid Metabolism in The Intestines

Phosphatidylcholine is essential for lipid metabolism within the intestines [R].

Because choline is needed to make phosphatidylcholine, low choline levels can limit production.

A study done in lactating rats showed that low choline levels led to higher levels of unmetabolized lipids in the intestines [R].

It was also shown that low choline levels lead to a reduction of the absorptive intestinal surface area [R].

17) Choline May Help Improve Symptoms of Glaucoma

Glaucoma is a disease caused by pressure behind the optic nerve. The disease can lead to blindness.

A study showed that when subjects with the disease were given CDP-choline, symptoms of Glaucoma were significantly improved [R].

This suggests that treatment with choline could be a complement to other treatments for Glaucoma [R].

Choline Has a Mixed Effect on Cardiovascular Disease

Choline supplies methyl groups for methylation [R].

Without available methyl groups, Homocysteine cannot be converted to Methionine [R].

Homocysteine, therefore, remains in the system and accumulates [R].

This accumulation can increase the risk of developing cardiovascular disease [R].

CDP-choline has also been shown to slightly lower blood pressure, which may help in preventing cardiovascular disease [R].

However, choline gets degraded by the gut microbiota to TMAO and increased TMAO levels are associated with an increased risk of incident major adverse cardiovascular events [R].

Dietary Sources and Dosing

Foods that are rich in choline include [R]:

  • Eggs
  • Chicken
  • Fish
  • Liver
  • Nuts

Vegans are more likely to be at risk of having low choline levels.

The recommended levels of choline intake per day are as follows:

  • Adult men should consume 550 mg of choline per day.
  • Adult females should take 425 mg of choline per day.
  • Pregnant females should take 450 mg of choline per day.
  • Nursing females should take 550 mg of choline per day.

Risks and Side Effects of Choline

Side effects of taking choline supplements may include upset stomach, vomiting or diarrhea.

However, one study found that higher choline levels were associated with an increased risk of lethal prostatecancer [R].

Choline is highly concentrated in prostate cancer cells, and blood concentrations of choline have been associated with an increased risk of prostate cancer [RR].

Choline gets degraded by the gut microbiota to TMAO and increased TMAO levels are associated with an increased risk of major adverse cardiovascular events [R].

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