Choline is a recently discovered nutrient.

It was only acknowledged as a required nutrient by the Institute of Medicine in 1998.

Although your body makes some, you need to get choline from your diet to avoid a deficiency.

However, many people are not meeting the recommended intake for this nutrient (1).

This article provides everything you need to know about choline, including what it is and why you need it.

What is CholineShare on Pinterest

Choline is an essential nutrient (2).

This means it's required for normal bodily function and human health. Though your liver can make small amounts, you must obtain the majority through your diet.

Choline is an organic, water-soluble compound. It is neither a vitamin nor a mineral.

However, it is often grouped with the vitamin B complex due to its similarities. In fact, this nutrient affects a number of vital bodily functions.

It impacts liver function, healthy brain development, muscle movement, your nervous system and metabolism.

Therefore, adequate amounts are needed for optimal health (1).

Summary Choline is an essential nutrient that must be included in your diet to maintain optimal health.

Choline plays an important part in many processes in your body, including:

  • Cell structure: It is needed to make fats that support the structural integrity of cell membranes (3).
  • Cell messaging: It is involved in the production of compounds that act as cell messengers.
  • Fat transport and metabolism: It is essential for making a substance required for removing cholesterol from your liver. Inadequate choline may result in fat and cholesterol buildup in your liver (4, 5).
  • DNA synthesis: Choline and other vitamins, such as B12 and folate, help with a process that's important for DNA synthesis.
  • A healthy nervous system: This nutrient is required to make acetylcholine, an important neurotransmitter. It's involved in memory, muscle movement, regulating heartbeat and other basic functions.
Summary Choline is involved in many different processes, such as cell structure and messaging, fat transport and metabolism, DNA synthesis and nervous system maintenance.

Due to a lack of available evidence, a Reference Daily Intake (RDI) for choline has not been determined.

However, the Institute of Medicine has set a value for adequate intake (AI) (6).

This value is intended to be sufficient for most healthy people, helping them avoid negative consequences of deficiency, such as liver damage.

Nevertheless, requirements differ according to genetic makeup and gender (7, 8, 9).

In addition, determining choline intake is difficult because its presence in various foods is relatively unknown.

Here are the recommended AI values of choline for different age groups (10):

  • 0–6 months: 125 mg per day
  • 7–12 months: 150 mg per day
  • 1–3 years: 200 mg per day
  • 4–8 years: 250 mg per day
  • 9–13 years: 375 mg per day
  • 14–19 years: 400 mg per day for women and 550 mg per day for men
  • Adult women: 425 mg per day
  • Adult men: 550 mg per day
  • Breastfeeding women: 550 mg per day
  • Pregnant women: 450 mg per day

It is important to note that choline needs may depend on the individual. Many people do fine with less choline, while others need more (2).

In one study in 26 men, six developed symptoms of choline deficiency even when consuming the AI (9).

Summary The adequate intake of choline is 425 mg per day for women and 550 mg per day for men. However, requirements may vary depending on the individual.

Choline deficiency can cause harm, especially for your liver.

One small study in 57 adults found that 77% of men, 80% of postmenopausal women and 44% of premenopausal women experienced liver and/or muscle damage after going on a choline-deficient diet (11).

Another study noted that when postmenopausal women consumed a diet deficient in choline, 73% developed liver or muscle damage (12).

However, these symptoms disappeared once they began getting enough choline.

Choline is especially important during pregnancy, as a low intake may raise the risk of neural tube defects in unborn babies.

One study determined that a higher dietary intake around the time of conception was associated with a lower risk of neural tube defects (13).

In addition, low choline intake may raise your risk of other pregnancy complications. These include preeclampsia, premature birth and low birth weight (2).

While most Americans do not consume adequate amounts in their diets, actual deficiency is rare.

Summary Choline deficiency is associated with liver and/or muscle damage. Low intake during pregnancy is linked to complications.

Although choline deficiency is rare, certain people are at an increased risk (14):

  • Endurance athletes: Levels fall during long endurance exercises, such as marathons. It's unclear if taking supplements improves performance (15, 16).
  • High alcohol intake: Alcohol can increase choline requirements and your risk of deficiency, especially when intake is low (17, 18).
  • Postmenopausal women: Estrogen helps produce choline in your body. Since estrogen levels tend to drop in postmenopausal women, they may be at greater risk of deficiency (6, 19).
  • Pregnant women: Choline requirements increase during pregnancy. This is most likely due to the unborn baby requiring choline for development (20).
Summary People who are at an increased risk of choline deficiency include athletes, those who drink a lot of alcohol, postmenopausal women and pregnant women.

Choline can be obtained from a variety of foods and supplements.

Food Sources

Dietary sources are generally in the form of phosphatidylcholine from lecithin, a type of fat.

The richest dietary sources of choline include (21):

  • Beef liver: 1 slice (2.4 ounces or 68 grams) contains 290 mg.
  • Chicken liver: 1 slice (2.4 ounces or 68 grams) contains 222 mg.
  • Eggs: 1 large hard-boiled egg contains 113 mg.
  • Fresh cod: 3 ounces (85 grams) contain 248 mg.
  • Salmon: A 3.9-ounce (110-gram) fillet contains 62.7 mg.
  • Cauliflower: A 1/2 cup (118 ml) contains 24.2 mg.
  • Broccoli: A 1/2 cup (118 ml) contains 31.3 mg.
  • Soybean oil: 1 tablespoon (15 ml) contains 47.3 mg.

As a single egg supplies about 20–25% of your daily requirement, two large eggs provide almost half (22).

In addition, a single 3-ounce (85-gram) serving of beef kidney or liver can supply all of a woman's daily requirement and most of a man's (23).

Additives and Supplements

Soy lecithin is a widely used food additive that contains choline. Therefore, it is likely that extra choline is consumed through the diet via food additives.

Lecithin can also be purchased as a supplement. However, lecithin tends to only contain 10–20% phosphatidylcholine.

Phosphatidylcholine can also be taken as a pill or powder supplement, yet choline comprises only about 13% of the weight of phosphatidylcholine (24).

Other forms of supplements include choline chloride, CDP-choline, alpha-GPC and betaine.

If you are looking for a supplement, CDP-choline and alpha-GPC tend to be higher in choline content per unit weight. They are also more easily absorbed than others.

Some sources claim that choline in nutritional supplements may reduce body fat, but there is little to no evidence supporting these claims.

Summary Rich food sources of choline include beef liver, eggs, fish, nuts, cauliflower and broccoli. Choline can also be taken as a supplement, of which CDP-choline and alpha-GPC seem to be the best types.

Higher intake of choline is associated with a reduced risk of heart disease (25).

Folate and choline help convert the amino acid homocysteine to methionine.

Therefore, a deficiency of either nutrient can result in an accumulation of homocysteine in your blood.

Elevated levels of homocysteine in your blood are linked to an increased risk of heart disease and strokes (26).

However, evidence is mixed.

Although choline may lower homocysteine levels, the association of choline intake with heart disease risk is not clear (27, 28, 29, 30, 31, 32).

Summary Choline may help reduce your risk of heart disease by lowering homocysteine levels. However, the evidence is mixed.

Choline is required to produce acetylcholine, a neurotransmitter that plays an important role in regulating memory, mood and intelligence (33).

It's also needed for the process that synthesizes DNA, which is important for brain function and development (34).

Therefore, it's not surprising that choline intake is associated with improvements in brain function.

Memory and Brain Function

Large observational studies link choline intake and blood levels to improved brain function, including better memory and processing (35, 36).

Supplementing with 1,000 mg per day led to improved short- and long-term verbal memory in adults aged 50–85 who had poor memory (37).

In a 6-month study, giving phosphatidylcholine to people with early Alzheimer's disease modestly improved memory in one small subgroup (38).

However, other studies on healthy people and those with dementia found no effects on memory (39, 40, 41).

Brain Development

Several animal studies suggest that taking choline supplements during pregnancy may improve fetal brain development (20, 42, 43).

However, there are only a few studies on this in humans.

One observational study of 1,210 pregnant women found that choline intake had no links to mental performance in their children at 3 years of age (44).

Nevertheless, the same study determined that a higher intake during the second trimester was associated with better visual memory scores in the same children at age 7 (45).

In another study, 99 pregnant women took 750 mg of choline per day from 18 weeks of pregnancy to three months after pregnancy. They experienced no benefits for brain function or memory (46).

Mental Health

Some evidence suggests choline may play a role in the development and treatment of certain mental health disorders.

One large observational study linked lower blood levels to a higher risk of anxiety — but not depression (47).

These levels are also used as an indicator for certain mood disorders, and choline supplements are sometimes used to treat bipolar disorder (48).

One study found that choline therapy improved symptoms of mania in individuals diagnosed with bipolar disorder (49).

However, there are currently not many studies available on this.

Summary Choline may boost memory function, improve brain development and treat anxiety and other mental disorders. However, the evidence is mixed.

Choline is associated with the development and treatment of certain diseases.

However, for most of these, the relationship is not clear and research is ongoing (50).

Liver Disease

Although choline deficiency results in liver disease, it's unclear whether intakes below the recommended levels increase your risk of liver disease.

A study in more than 56,000 people found that normal-weight women with the highest intakes had a 28% lower risk of liver disease, compared to those with the lowest intakes (51).

The study showed no association with liver disease in men or overweight women (51).

Another study in 664 people with non-alcoholic liver disease found that lower intakes were associated with greater disease severity (52).

Cancer

Some research indicates that women who eat a lot of choline may have a lower risk of breast cancer (53, 54, 55).

One study in 1,508 women found that those with diets high in free choline were 24% less likely to get breast cancer (55).

However, the evidence is mixed.

Other observational studies found no association with cancer, but test-tube studies suggest that a deficiency may increase your risk of liver cancer (56, 57, 58).

Conversely, higher intakes are also associated with an increased risk of prostate cancer in men and colon cancer in women (59, 60).

Neural Tube Defects

Higher intakes of choline during pregnancy may reduce the risk of neural tube defects in babies.

One study noted that women who had higher intakes around conception had a 51% lower risk of neural tube defects, compared to women with very low intakes (61).

Another observational study discovered that pregnant women with the lowest intakes were more than twice as likely to have babies with neural tube defects (62).

However, other studies observed no link between the mother's intake and the risk of neural tube defects (63, 64).

Summary Limited evidence suggests that choline may reduce the risk of neural tube defects in infants, as well as liver disease. That said, choline’s impact on cancer is unknown. More studies are needed.

Consuming too much choline has been associated with unpleasant and potentially harmful side effects.

These include drops in blood pressure, sweating, fishy body odor, diarrhea, nausea and vomiting (65).

The daily upper limit for adults is 3,500 mg per day. This is the highest level of intake that is unlikely to cause harm.

It is very unlikely that someone could ingest this amount from food alone. It would be almost impossible to reach this level without taking supplements in large doses.

Summary Consuming too much choline has been linked to unpleasant and potentially harmful side effects. However, it’s unlikely that you can ingest such levels from food alone.

Choline is an essential nutrient that is required for optimal health.

It may play a key role in healthy brain function, heart health, liver function and pregnancy.

Although actual deficiency is rare, many people in Western countries are not meeting the recommended intake.

To up your intake, consider eating more choline-rich foods, such as salmon, eggs, broccoli and cauliflower.