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Healthy ways to optimise your Choline intake

Choline is an essential nutrient required for optimal health.

An organic, water-soluble compound, choline is neither a vitamin nor a mineral however it is often grouped with B group vitamins as it shares a number of similarities and is vital to our daily functions. Choline, like folate,  is a methyl donor, which means it provides a methyl group to many important reactions in the body.

Choline is important for liver function, healthy brain development, muscle movement, our nervous system and metabolism.

Choline can be produced in the body by the liver but the amount that the body makes naturally is not sufficient to meet our needs. Therefore it is important to include foods containing choline in our diet each day.

What does choline do?

Builds cell structure:

Along with other nutrients such as the essential (polyunsaturated) fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) also folate, vitamins B6, B12, C, E and selenium, choline is important for the structure and function of cells in the body.1

Aids neurotransmitter production

Choline is important for the production of acetylcholine an important neurotransmitter. important for memory, mood, intelligence and for regulating basic functions such as our heartbeat. 2

Aids fat transportation and metabolism.

Choline assists in the transportation of fats and cholesterol away from our liver thereby improving liver function and reducing the risk of fatty liver disease.

Assists DNA synthesis

Choline along with vitamin B12 and folate aids DNA synthesis important for cell replication, tissue growth and repair.

How much choline do we need?

Requirements for choline differ with age, sex and individual need but following nutrient reference levels have been set for Australia and NZ to provide an adequate intake (AI) value 2

NHMRC recommended daily nutrient reference values for choline

Age mgs/day Comments
Children
0-6 months 125 Breast milk, milk formula and
7-12 months 150 foods are sufficient during infancy
1-3 years 200
4-8 years 250
9-13 years 375
14-19 years
Female 400
Male 550
Adults
Men 550
Women 425
Pregnant 14-18yrs 415
Pregnant 19-50yrs 440
Lactation 14-18yrs 525
Lactation 19-50yrs 550

Recent research from the University of Wollongong, NSW, Australia reported that fewer than 10% of Australians across all age and gender groups were consuming the adequate intake for Choline based on the Nutrient Reference values for Australian and NZ (listed above).

The study estimated that the average daily intake (AI) of choline consumed by Australians was around 265 mg. The study found only 1.2% of elderly men (65-85 years) are meeting their AI and <1% of pregnant and lactating women.3

US Food sources of choline per 100g food 4

FOOD (100g) CHOLINE (mgs) FOOD(100g) CHOLINE (mgs)
Eggs (2 large) 270 Broccoli 40
Milk low-fat 16 Brussel Sprouts 41
Cheese-cheddar 17 Cabbage 46
Yoghurt 16 Cauliflower 39
Beef 78 Green peas 28
Lamb 100 Potato 15
Chicken 62 Tomato 6
Pork 87 Baked beans 32
Salmon 91 Soy beans 120
Tofu 28 Edame beans 56
Margarine 11 Cashews 61
Butter 19 Walnuts 32
Olive oil 0.3 Peanut 53
Wholegrain bread 27 Almond 52
White bread 15 Flaxseed 79
All Bran 49 Rice-brown 9
Oats 13        -white 2
Wheatbran 81 Quinoa 70
Cornflakes 2 Avocadl 14
White flour 10 Kiwifruit 8
Wholegrain flour 31 Banana 10


Groups at risk of deficiency

While a deficiency of choline is rare some groups of the population may be more at risk than others:

Pregnant women

Recent research has found that pregnant women who have sufficient folic acid, increased intakes of vitamins B6 and B12, choline, methionine and betaine may have reduced risk of neural tube defects. 5 Adequate levels of choline during pregnancy can also help to prevent the risk of complications such as pre-eclampsia, premature birth and low birthweight 6

Although choline is available as a supplement choline is readily available in inexpensive whole foods such as eggs, meat and fish.

Breast feeding women

Choline is naturally available in breast milk provided that maternal dietary choline intake remains optimal babies get an average of around 107mg of choline per day7  The Australian and NZ food standards codes also legislates that choline is an essential ingredient in infant formula and must contain a minimum of 1.7mg and maximum of 7.1mg per 100kJ.1 (NB:This upper level of 7.1 mg is currently under consideration)8

Infants

There is evidence that an adequate intake of choline may be important for neurological and cognitive development 9,10and is easily incorporated into an infant’s diet when solids are introduced at the appropriate times around 4-6 months of age. Choline can be found in eggs, milk, fish and meat.

People with genetic conditions

Some people with a polymorphism genetic condition may have an impaired ability to produce sufficient choline within their body when dietary levels of choline are low, 11and so these folk may benefit from a dietary assessment and nutrition education from a Dietitian to get help with the quantities of food they need for good health.

Post-menopausal women

Oestrogen is important for the synthesis of choline within the body and is also a key source of the long-chain omega-3 fatty acid DHA. Both of these nutrients have a neuroprotective effect on the brain. Postmenopausal women with lower oestrogen concentrations may therefore need more choline (from their diet) than premenopausal women.10, 12

People who are fed intravenously

Patients who are dependent on parenteral nutrition in hospital, especially if long-term, need to receive choline supplementation from their medical team.13

Elderly people

Recent research has reported that Alzheimer patients have lower levels of choline in their brain and spinal fluids.14,15 There is some evidence that a choline-rich diet may help to build stronger bone16 and lower BMI and waist circumference (the latter being due to reduced insulin resistance).17

Vegetarians and vegans

While choline is found in animal-based foods, ovo-lacto vegetarians can still maintain a good choline intake eating milk and eggs. For those wanting to pursue a more plant-based diet choline can be derived from green vegetables, lentils, tofu, nuts, seeds and grains. However particular care may need to be taken during times of increased need e.g. during pregnancy and lactation 18,19

Endurance athletes

Numerous studies have focused on the effects of exercise on choline levels. These have failed to prove any significant drop in choline levels or change in performance or levels of fatigue with exercise, with or without supplementation.20

Toxicity

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

This may include a drop in blood pressure, sweating, fishy body odour, diarrhoea, nausea, vomiting, heavy sweating and salivation and liver damage. Some research also suggests a high amount of choline may increase the risk of heart disease.13

The federal government’s 2020-2025 Dietary Guidelines for Americans notes that “Because foods provide an array of nutrients and other components that have benefits for health, nutritional needs should be met primarily through foods. … In some cases, fortified foods and dietary supplements are useful when it is not possible otherwise to meet needs for one or more nutrients (e.g., during specific life stages such as pregnancy).” 13

Further research into choline is required to fully understand the benefits of optimal choline intake and the implications of consuming less than the AI 1.  In the meantime be guided by your GP.  Endeavour to consume a healthy diet and if your are in doubt as to what that might be to meet your needs for better health then contact me for a nutritional assessment

 

References

  1. Position Statement on Choline intake in Australia. ANACE August 2019 https://www.australianeggs.org.au/assets/Uploads/2019-position-statement-on-choline-intake-in-Australia.pdf
  2. National Health and Medical Research Council; Australian Government Department of Health and Ageing; New Zealand Ministry of Health. NHMRC Nutrient Reference Values for Australia and New Zealand, https://www.nrv.gov.au/nutrients/choline
  3. Probst Y, Guan V, Neale E. Development of a Choline Database to Estimate Australian Population Intakes. Nutrients 2019;11.
  4. Patterson K, Bhagwat, S.A, Williams, J.R, Howe,J.C, Holden, J.M. USDA Database for choline content of common foods, Release two. https://www.ars.usda.gov/ARSUserFiles/80400525/data/choline/choln02.pdf
  5. Petersen JM, Parker SE, Crider KS, Tinker SC, Mitchell AA, Werler MM. One-Carbon Cofactor Intake and Risk of Neural Tube Defects Among Women Who Meet Folic Acid Recommendations: A Multicenter Case-Control Study. Am J Epidemiol 2019;188:1136-43.
  6. Zeisel,S.H. Nutrition in pregnancy: the argument for including a source of choline. Int. J. of Women’s Health 2013 April22; 5: 193-9
  7. Wiedeman AM, Whitfield KC, March KM, et al. Concentrations of Water-Soluble Forms of Choline in Human Milk from Lactating Women in Canada and Cambodia. Nutrients 2018;10.
  8. AUSTNZ Food Standards Code: Infant formula Proposal P1028 April 2022, 196-22. https://www.foodstandards.gov.au/code/proposals/Documents/SD2%20-%20Nutrient%20Composition.pdf
  9. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J 2018;32:2172-80.
  10. Mun JG, Legette LL, Ikonte CJ, Mitmesser SH. Choline and DHA in Maternal and Infant Nutrition: Synergistic Implications in Brain and Eye Health. Nutrients 2019;11.
  11. L.M et.al. Dietary choline requirements of women: effects of estrogen and genetic variation.Am. J.Clin. Nut 2010 Nov.
  12. J, Klatt.K, Wallace.T. Adv.Nut. 2021 Nov 27;13(2) 376-387.
  13. Fact sheet for health professionals. NIH https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/
  14. Dementia Australia. Souvenaid – a dietary treatment for mild Alzheimer’s disease, online document https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA23-Souvenaid_english.pdf [accessed 22 July 2019]. 2013 (reviewed 2019).
  15. de Wilde MC, Vellas B, Girault E, Yavuz AC, Sijben JW. Lower brain and blood nutrient status in Alzheimer’s disease: Results from meta-analyses. Alzheimers & Dementia (New York, NY) 2017;3:416-31.
  16. Oyen J, Gjesdal CG, Karlsson T, et al. Dietary Choline Intake Is Directly Associated with Bone Mineral Density in the Hordaland Health Study. The Journal of Nutrition (Norway) 2017;147:572-8.
  17. Gao X, Wang Y, Randell E, et al. Higher Dietary Choline and Betaine Intakes Are Associated with Better Body Composition in the Adult Population of Newfoundland, Canada. PloS One 2016;11:e0155403.
  18. Kim S, Fenech MF, Kim PJ. Nutritionally recommended food for semi- to strict vegetarian diets based on large-scale nutrient composition data. Scientific Reports 2018;8:4344.
  19. Wallace TC, Blusztajn JK, Caudill MA, et al. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutrition Today 2018;53:240-53.
  20. Warber.J.P, Patton. J.F, Tharion.W.J, Zeisel. S.H, Mello.R.P, Kemnitz. C.P, Lieberman. H.R. The effect of choline supplements on physical performance. In.J. Sports Nut.Ed.Met. 2000,June 10,(2):170-181

About the author View all

Lea Stening

Lea is one of New Zealand’s leading paediatric dietitians and also specialises in Sports Nutrition. She has specialised in Paediatric Nutrition for 31 years and in 1985 was the first paediatric dietitian to enter private practice in New Zealand. Lea helps families through her private consultations, public lectures, newspaper and magazine articles as well as television and radio interviews. Read more »

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