Choline is considered essential for liver health and brain function, yet many of us have never even heard of it.

If you haven’t heard of choline until now, then you won’t be alone.

Even though it’s essential for human health (severe deficiency can cause non-alcoholic fatty liver disease, also called NAFLD) it rarely gets a mention.

Recent research, however, indicates that this little-publicised nutrient may be essential for brain health, affecting us even before we are born.

How much choline do pregnant women need?

According to researchers from Cornell University, USA, children whose mothers consumed around twice the ‘adequate intake’ of choline during pregnancy were found to have faster information processing skills when tested in infancy, and a longer attention span when tested at the age of seven.

The study had followed the progress of 21 children whose mothers had consumed “tightly controlled” levels of choline and other nutrients (vitamin B12, folic acid and vitamin B6) during the third trimester of pregnancy.

One group of women consumed 450mg/day (considered the daily ‘adequate intake’) whilst another group consumed 930mg/day.

Although the study was small, its authors said their findings suggested that the current ‘adequate intake’ for choline may not be enough “to produce optimal cognitive abilities in offspring”.

They also pointed out that current recommendations were based on what was needed to prevent liver dysfunction in men — not what was needed to support pregnancy.

Whilst it is worth noting that the research was partly funded by the egg and beef industries, both of which will have vested interests because eggs and meat are rich sources of choline, the importance of choline was already established.

What does choline do?

Choline was classed as an ‘essential nutrient’ in 1998 by the Institute of Medicine, USA. At time of writing, it’s not mentioned on the NHS website’s list of vitamins and minerals.

But elsewhere, it’s sometimes referred to as an unofficial member of the B vitamin family and is considered important throughout the entire lifespan.

Whether it is during foetal development or old age, choline plays a role in forming cell membranes, cell signalling, nerve impulse transmission, muscle control, memory function and metabolism.

As already mentioned, it is also essential for liver health, being important for building fat-carrying proteins and breaking down cholesterol.

Previously, choline was also thought to act in a similar way to folic acid (folate) by reducing the risk of spina bifida (caused by neural tube defects).

In 2006, however, experiments on mouse embryos found that this may be more to do with genes that metabolised choline rather than how much choline was consumed.

In 2012, it was also suggested that increased choline intake (930 vs. 480 mg/day) during the third trimester of pregnancy may lead to less stressed babies.

By sampling maternal blood, cord blood and placenta tissue, researchers found in the higher choline group epigenetic changes (genes being instructed to switch on or off) associated with lower levels of the stress hormone cortisol.

Choline has also been found to affect brain health in animals.

Much of this research has been carried out on rodents, but one 2015 study on pigs — which are closer to humans in terms of metabolism and brain development — found that choline-deficient mothers produced offspring with lower brain weight.

Choline is also thought to help support the brain against cognitive decline and Alzheimer’s disease, and muscle wastage as we age.

How to get enough choline

Choline is found in a range of foods including: beef liver, egg yolks, red meat, poultry, fish, dairy, legumes such as peanuts or soya beans (e.g. edamame, tofu, tempeh and miso), nuts, shiitake mushrooms, quinoa, and cruciferous vegetables such as cauliflower and Brussels sprouts.

Currently, there is no recommended dietary allowance (RDA), although the US National Institutes of Health (NIH) states that pregnant women, people with some genetic conditions and people who are fed intravenously may be more at risk of deficiency.

After the ‘adequate intake’ was established, based on what is needed to prevent liver damage, the European Food Safety Authority published in 2016 slightly lower values of 400mg/day for all adults, with 480mg during pregnancy and 520mg whilst breastfeeding.

However, research has also indicated that what we need may depend upon biological sex, health status, genetics, age, and even our gut bacteria.

Too much or too little choline

Severe choline deficiency is associated with a range of symptoms including non-alcoholic fatty liver disease, muscle damage, low energy, memory loss, cognitive decline, muscle aches, nerve damage, and mood changes or disorders.

However, very high intake has been associated with a fishy body odour, vomiting, excessive sweating and salivation, low blood pressure and liver toxicity.

For all adults, a ‘tolerable upper intake’ level has been suggested as 3,500mg.

Because choline is available through a range of animal and plant-based foods, it should be possible to take in through a varied diet.

However, focusing on gut health — as studies into other nutrients are also beginning to reveal — may be important in order to reap the benefits.

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