Choline: The Most Important Micronutrient You’ve Never Heard Of

Never heard of choline? We don’t blame you. Although the micronutrient is incredibly important for the health of both body and mind, it was only officially recognized as an essential nutrient in 1998 [1], arriving into our lexicon around the same time as Google and Viagra. But while the latter two made waves all over the world, choline caused barely a ripple, and has remained decidedly under-the-radar ever since. 

Found predominantly in meat, fish, eggs and dairy products, choline is particularly important in pregnancy, when it contributes to the healthy growth of a baby's brain. In fact it’s considered so important for brain health that experts are starting to sound the alarm of a ‘choline crisis’ caused by the trend towards plant-based diets.

Writing in the BMJ Nutrition, Prevention & Health journal, nutritionist Dr Emma Derbyshire said, “Given the important physiological roles of choline and authorisation of certain health claims, it is questionable why choline has been overlooked for so long in the UK.” [2]

Unlike other vitamins, minerals and probiotics, you won’t find choline mentioned on food labels, in food composition databases or in many official dietary guidelines - it’s not even on the NHS website. Could choline be the most important micronutrient you’ve never heard of?

What is choline?

Choline is water soluble micronutrient. Although it shares similarities with the B-complex vitamins, it’s actually neither a vitamin or a mineral. It’s called ‘essential’ because, although a small amount of choline can be synthesised in the body by our liver, this isn’t enough to meet our needs. To get the levels of choline needed for good health, we have to eat it.

What does choline do in the body?

Choline has a huge number of functions within the human body. We need it to produce the neurotransmitter acetylcholine, which helps with memory, mood and cognitive function. Choline is also important for many of the body’s detoxification processes, including maintaining a healthy liver. It also regulates healthy homocysteine levels, an amino acid that maintains our nervous system, muscles and even our heartbeats, but when present in the body in high amounts, can have a detrimental effect on our health. 

Choline has such a diverse and important range of roles within the body that deficiency is thought to have an impact on illnesses such as liver disease, neurological disorders and even heart disease.

Choline is best known, though, for its critically important role in the healthy development of the foetus, ensuring that a growing baby’s brain and cognitive function develop as normal while also reducing the risk of neural tube defects in newborns [3][4]. Deficiency in choline has also been attributed to other birth defects, including cleft lip, hypospadias, and cardiac defects [5].

Who would benefit from getting more choline in their diet?

Although true choline deficiency is rare, studies suggest that most people fail to get an adequate intake through their food - the amount needed to support optimal health. Some lifestyle practices such as drinking alcohol or exercising at great levels of intensity can both deplete your body’s supply. And, because estrogen helps women produce choline, levels of the important nutrient can drop post-menopause [6].

Pregnancy, too, is a time of greater need for choline because the nutrient plays such a critically important role in the development of growing babies. 

During pregnancy, choline is delivered to the foetus across the placenta. The concentration of choline in the amniotic fluid is ten times higher than the circulating levels of choline in the mother’s blood. Additionally, circulating levels of choline are much higher in pregnant women than non-pregnant women and are six to seven times higher in the new born baby than they are in an adult.

There is a huge demand placed upon the mother from the developing foetus for choline and, during pregnancy, maternal choline stores will deplete. Breast milk is also rich in choline and this will further diminish maternal choline stores. 

Researchers have found that pregnant mothers with deficient dietary choline intake have up to four times the risk of giving birth to a child with a neural tube defect (compared to pregnant mothers consuming adequate amounts of choline) [7]. The recommended Adequate Intake (AI) for pregnant women is 450 mg/d and 550 mg/d for lactating women, but according to The United States Department of Agriculture, the average woman consumes 290 - 303 mg per day, making it important to consider increasing intake of choline-rich foods during pregnancy, as well as using a supplement which contains choline. 

Is choline really a brain booster? 

Choline is vital to the structure of all our cells and crucial to the messaging between them, and nowhere is this more important than when it comes to our brain function. In fact, many experts extol the benefits of choline when it comes to cognitive function because the micronutrient is needed to produce acetylcholine,  an important neurotransmitter for mood and memory, along with various other brain and nervous system functions [8].

Can choline protect against certain diseases?

Choline and heart disease - Choline is known to lower blood levels of homocysteine by converting it to methionine, something that’s helpful when you consider that high homocysteine levels are a risk factor for heart disease. In a 2018 study of almost 4,000 African-American participants followed for nine years, higher choline intakes were also associated with a lower risk of ischemic strokes [9].

Choline and nonalcoholic fatty liver disease - There is a link between choline deficiency and liver disease [10]. Phosphatidylcholine (a class of phospholipids that incorporate choline) carries fats away from the liver, so a choline deficiency can cause the liver to store too much fat. 

Choline and breast cancer - Higher dietary intakes of choline have been associated with a significant decrease in the risk of developing breast cancer. Data shows that, women who consume a higher choline diet, may have their risk of developing breast cancer reduced by up to 24% [11].

While the mechanism of higher choline dietary intakes reducing breast cancer risk hasn’t fully been explained, it is thought that it may be to do with the impact of choline deficiency on DNA damage and apoptosis (controlled cell death) [12].

How to ensure you’re eating enough choline

There are many dietary sources of choline, both plant and animal based. Offal, whole eggs, oily fish and certain grains (like quinoa and wheat germ) are among the most concentrated and provide the greatest amount of choline per serving.

It is important to include choline rich food sources within your diet to minimise inadequate intake risk. Here is a list of both plant and animal-based choline sources which will help you achieve the required daily amount.

So, should you take a choline supplement?

Choline is an essential nutrient that plays critical roles in the development of the nervous system and brain. Having a more focused and planned diet can help you ensure you achieve the adequate intakes of choline needed for optimal health. So is there really a need for choline supplementation?

Many studies have evaluated the benefits of choline supplementation and it may be arguably the most practical and well controlled method of increasing choline status, particularly in times of increased need such as pregnancy [13].

The Inessa Pregnancy Multinutrient contains an industry leading serving of choline and is a perfect complement to a balanced diet, as well as being a “safety net” to prevent inadequate choline intake and support a healthier mum and new born baby.

If you enjoyed reading this article, you might like Aliza's Simple Nutrition Tips for Pregnancy.

 References

1. Food and Nutrition Board, Institute of Medicine. (1998). Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B012, Pantothenic Acid, Biotin, and Choline. Washington, D.C.: National Academy of Sciences; pp. 390–422.
2. Derbyshire E. (2019). Could we be overlooking a potential choline crisis in the United Kingdom?. BMJ nutrition, prevention & health, 2(2), 86–89. https://doi.org/10.1136/bmjnph-2019-000037

3. Rees W, Wilson F, Maloney C. (2006). Sulfur amino acid metabolism in pregnancy: the impact of methionine in the maternal diet. J Nutr. 136, 1701S–1705S.

4. Shaw, G. M., Carmichael, S. L., Yang, W., Selvin, S., & Schaffer, D. M. (2004). Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. American journal of epidemiology, 160(2), 102–109. https://doi.org/10.1093/aje/kwh187

5. Wiedeman, A. M., Barr, S. I., Green, T. J., Xu, Z., Innis, S. M., & Kitts, D. D. (2018). Dietary Choline Intake: Current State of Knowledge Across the Life Cycle. Nutrients, 10(10), 1513. https://doi.org/10.3390/nu10101513

6. Zeisel S. H. (2006). Choline: critical role during fetal development and dietary requirements in adults. Annual review of nutrition, 26, 229–250. https://doi.org/10.1146/annurev.nutr.26.061505.111156

7. Shaw, G. M., Carmichael, S. L., Yang, W., Selvin, S., & Schaffer, D. M. (2004). Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. American journal of epidemiology, 160(2), 102–109. https://doi.org/10.1093/aje/kwh187

8. https://pubmed.ncbi.nlm.nih.gov/27651265/#:~:text=Choline%20is%20an%20essential%20nutrient,and%20may%20alter%20brain%20function.

9. https://link.springer.com/article/10.1007/s00394-016-1296-8

10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3729018/

11. Xu, X., Gammon, M. D., Zeisel, S. H., Lee, Y. L., Wetmur, J. G., Teitelbaum, S. L., Bradshaw, P. T., Neugut, A. I., Santella, R. M., & Chen, J. (2008). Choline metabolism and risk of breast cancer in a population-based study. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 22(6), 2045–2052. https://doi.org/10.1096/fj.07-101279

12. da Costa, K. A., Niculescu, M. D., Craciunescu, C. N., Fischer, L. M., & Zeisel, S. H. (2006). Choline deficiency increases lymphocyte apoptosis and DNA damage in humans. The American journal of clinical nutrition, 84(1), 88–94. https://doi.org/10.1093/ajcn/84.1.88

13. Wallace, Taylor C. PhD, CFS, FACN; Blusztajn, Jan Krzysztof PhD; Caudill, Marie A. PhD, RD; Klatt, Kevin C. MS; Natker, Elana MS, RD; Zeisel, Steven H. MD, PhD; Zelman, Kathleen M. MPH, RD, LD (2018). Choline, Nutrition Today: 11/12 - Volume 53 - Issue 6 - p 240-253 doi: 10.1097/NT.0000000000000302