Of all the vital vitamins, minerals and nutrients your body needs each day, some are more familiar than others. Vitamin C, for example, is one most of us know all about. It’s good for boosting the immune system and can be found in citrus fruits.
Others are less familiar sounding, but still just as critical to overall health and wellness. Take choline, for example. If you haven’t heard of it before, you’re not alone, but most of us could do with trying to get more of it in our diets.
According to a literature review and discussion from the 2018 Choline Science Summit that was published in the journal Nutrition Today, recent research suggests the vast majority of Americans may not be getting enough choline.
“Researchers who examined data from the USDA and from National Health and Nutrition Surveys in 2016 had estimated that only about 10% of Americans and 8% of pregnant women” are getting enough choline every day, says Elena Gagliardi, clinical nutrition services manager in the ambulatory nutrition services department at Santa Clara Valley Medical Center in San Jose, California.
However, whether you’re deficient in this essential nutrient or not, choline is an important element of some of the foods we eat, and “it’s important to make sure you obtain enough daily choline from foods for optimum health and well-being,” she adds.
What Is Choline?
Choline was first discovered in 1862, but its importance as an essential nutrient “was not determined until 1998,” Gagliardi says. That’s when the Food and Nutrition Board of the National Academies of Medicine officially recognized it.
Choline was once known as vitamin B4, but “it isn’t actually a vitamin at all,” Gagliardi explains. Rather, it’s “a chemical compound vital for its many roles in the body.”
These roles include:
— Cellular health.
— Heart health.
— Liver health.
— Newborn health.
— Brain health.
Though the liver can make small amounts of choline, it’s not enough. Therefore, choline must be obtained from what we eat and drink.
“Choline is part of every cell membrane as a fat molecule called a phospholipid,” Gagliardi says. The cell membrane is the outer shell of a cell. A phospholipid called phosphatidylcholine is formed from choline and helps provide cell structure and facilitates cellular communication.
This nutrient is also important in preventing damage to the lining of the arteries and preventing blood vessel blockages. Choline does this by lowering levels of homocysteine, an amino acid associated with cardiovascular disease, Gagliardi says. “High levels of homocysteine can cause a heart attack, a stroke or a pulmonary embolism, which is a blood clot in a lung artery.”
“Choline transports fat and cholesterol out of the liver,” Gagliardi says. So, if you’re not getting enough choline in your diet, “fatty liver disease can result.”
Fatty liver disease, also called non-alcoholic fatty liver disease or NAFLD, affects about a third of American adults and 10% of kids, making it one of the most common causes of liver disease in the U.S.
In those with NAFLD, too much fat gets stored in liver cells, which can lead to liver inflammation, scarring (or cirrhosis) and liver failure. The damage done to the liver is similar to what’s seen in individuals who abuse alcohol and develop alcoholic cirrhosis of the liver.
Getting enough choline is also important for pregnant woman and those seeking to become pregnant. “Choline is needed for the prevention of neural tube birth defects in newborns,” Gagliardi says. Similar to how the B-vitamin folate works, choline can help prevent deficiencies during a baby’s brain development. “If a woman is choline-deficient during pregnancy, the chance of her baby developing permanent neural tube defects or cleft palates increases.”
While it’s not 100% clear exactly how choline might be able to support brain health as we age, it’s an active area of research.
Ongoing research into the role that choline plays in brain health has shown promise as potentially providing a new means of preventing or managing Alzheimer’s disease and other forms of dementia. One 2011 study found dietary choline to be critical for maintaining brain function because it’s converted by the body into neurotransmitters that enable brain cells to communicate with each other.
Choline’s ability to help strengthen cell walls also comes into play in the maintenance of the structure of brain cells.
We also know that “nerves use choline to make the neurotransmitter acetylcholine, which is responsible for alertness, focus, memory, mood and muscle control,” Gagliardi says. Some research suggests that getting adequate acetylcholine may help protect against Alzheimer’s disease by reducing brain inflammation and cellular death.
“In those with existing Alzheimer’s disease, levels of acetylcholine are generally lower. More studies would be beneficial to determine if choline supplementation will significantly help improve memory or dementia symptoms.”
It stands to reason that choline, along with other nutrients, likely does contribute to healthy brain aging because the brain is always changing, says Heather M. Snyder, vice president, medical and scientific relations at the Alzheimer’s Association in Chicago. “There’s a lot of things that happen in our brain as we age,” which may be more visible when you’re a child, but “those changes don’t stop when you reach a certain age. Those changes are reflected throughout our entire lives.”
Snyder notes that these brain changes occur “on a very small scale at the cellular level,” so providing your brain with the nutrients it needs to build and maintain healthy cells that can communicate with each other could be a big component of future treatments for Alzheimer’s and other forms of dementia.
For the time being, she encourages a “wholly balanced diet. When we look at the body of literature around eating for brain health, it’s not just one supplement or one particular aspect. It’s having all the components and aspects that seems necessary. It’s a complicated puzzle that we’re still trying to understand,” but an overall healthy diet that’s rich in all the necessary nutrients is a safe bet. That includes getting enough choline.
[See: Best Foods for Brain Health.]
How Much Do You Need?
Eating a healthy and varied diet can help prevent deficiencies of choline, but certain groups may be at higher risk for deficiencies.
“For example, those who are strict vegans or vegetarians or females who are pregnant or lactating may have difficulty obtaining adequate choline” because a growing fetus and a breastfeeding baby require that the mother have more choline to support that development, Gagliardi says.
“Choline deficiency may result in fat accumulation in the liver and muscle damage. The good news is that these symptoms resolve when choline is added back appropriately in the diet,” she adds.
So how much should you be consuming? The Food and Nutrition Board of the Institute of Medicine set Adequate Intakes (AI) for choline in 1998. These guidelines were based on prevention of liver damage, so there’s some debate as to whether or not optimal intake should actually be higher.
The established AIs are:
— Infants 0 to 6 months: 125 mg/day
— Infants 7 to 12 months: 150 mg/day
— Children 1 to 3 years: 200 mg/day
— Children 4 to 8 years: 250 mg/day
— Children 9 to 13 years: 375 m/day
— Adolescents 14 to 19 years: 400 mg/day for females; 550 mg/day for males
— Adults older than 19 years: 425 mg/day for females; 550 mg/day for males
— Pregnant women (all ages): 450 mg/day
— Breastfeeding women (all ages): 550 mg/day
“Genetic variants also play a role” in how much choline you need, Gagliardi says, “so individual choline needs may be different.” Talk with your doctor about your specific choline needs to arrive at an appropriate daily intake level for you.
[See: Foods High in Vitamin K.]
Foods High in Choline
While many Americans may not be getting enough choline, some foods are very good sources of it. Adding some of the following foods to your diet could help boost your intake of this essential nutrient.
— Beef liver (3 ounces): 355 mg.
— Chicken liver (3 ounces): 246 mg.
— Egg (1 large, hard boiled): 147 mg.
— Mushrooms (shitake, 1 cup cooked): 116 mg.
— Beef (top round, 3 ounces): 115 mg.
— Shrimp (3 ounces or 12 large): 115 mg.
— Pork chop (100 grams or about 3.5 ounces): 111 mg.
— Soybeans (1/2 cup, roasted): 107 mg.
— Lamb (ground, 3 ounces): 79 mg.
— Chicken breast (3 ounces): 72 mg.
— Beef (ground, 3 ounces): 72 mg.
— Cod (3 ounces): 71 mg.
— Salmon (Atlantic, farmed, 3 ounces): 67 mg.
— Black beans (1 cup): 56 mg.
— Tuna fish (1 can, in oil): 50 mg.
— Quinoa (1 cup): 43 mg.
— Milk (8 ounces): 40 mg.
— Chicken (dark meat — drumstick or thigh): 32 mg.
— Broccoli (1/2 cup, cooked): 31 mg.
— Peanut butter (chunky, 2 Tbsp): 20 mg.
Should I Supplement?
If you’re struggling to get enough choline from food sources, you might consider taking a choline supplement. “Supplementation is an option but should not be relied on as a replacement for choline-rich food sources,” Gagliardi says. Currently, there are different types of over-the-counter choline supplements, “but no studies have compared the bioavailability (or how readily the body can use the choline in these supplements) from these different forms.”
She notes that lecithin is one of the most widely available supplement options. “Lecithin is a source of phosphatidylcholine — the main phospholipid in cells. Usually made from the oils of soybeans, sunflower seeds or rapeseeds (canola), lecithin is appropriate for vegans and vegetarians.” Lecithin supplements may only contain 3% to 4% choline, so consider whether the cost of such supplements is warranted to meet your choline needs.
Other forms of choline include:
— Choline bitartrate, which contains approximately 40% choline.
— Choline citrate, which contains approximately 50% choline.
— CDP-choline, which contains approximately 20% choline.
Talk over your options with your health care provider to determine which supplement will work best for your needs and whether you need one at all.
Overdoing It With Choline
If you’re wondering, yes, it is possible to take in too much choline, Gagliardi says. High doses of choline have been associated with a number of unpleasant side effects, including:
— A fishy body odor.
— Nausea, vomiting and diarrhea.
— Excess salivation.
— Increased sweating.
— Low blood pressure.
“It’s not likely that diet alone would cause excessive choline amounts in the body, but if you choose to supplement, do so with caution,” Gagliardi says, and be sure to talk with your health care professional before adding any kind of supplement.
In addition, the Food and Nutrition Board of the Institute of Medicine has set upper limits for choline intake based on life stage. “These limits were based on preventing low blood pressure and fishy body odor,” Gagliardi says.
— Birth to 12 months: Not established.
— Children 1 to 8 years: 1,000 mg.
— Children 9 to 13 years: 2,000 mg.
— Teens 14 to 18 years: 3,000 mg.
— Adults over age 19 years: 3,500 mg.
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