Almost as famous (nutritionally) as the lesser known Hemsworth brother. (If you were about to Google it, I’ll save you the trouble – his name is Luke).
Choline has recently stepped forward from the shadows and into the spotlight, becoming the missing piece of the jigsaw puzzle for many of my complex cases. But when I talk about choline with my patients, I usually get blank stares in return. So, this blog is for them, and also for you – because you need to know about it too.
Conditions associated with choline deficiency
Choline has such a varied and diverse role in the body, a deficiency of which can result in numerous health conditions including:
- birth defects
- cognitive decline
- fatty liver disease
- cardiovascular disease
- insulin resistance, type 2 diabetes
What does choline actually do?
1. Acts as a methyl donor
Put simply, methylation is a complex cycle that happens throughout the body (but especially in the liver) and is a key part of our detoxification system. It requires folate and vitamin B12 to function, but it also requires adequate choline. At the end of the cycle, we end up with a methyl donor and this acts as a switch to turn genes on and off as needed.
If we don’t methylate, we die. Now clearly, if we are breathing, we still DO methylate, but when the cycle is down regulated, we don’t produce enough methyl donors. For example, if you have hormonal issues such as heavy periods, mental health issues or addictions, just to name a few, then it is likely that you will have some methylation issues. Additionally, if you are on the oral contraceptive pill, I can virtually guarantee that you will have methylation issues as the pill is known to deplete several nutrients including vitamin B12 and folate. The same is true for other medications including proton pump inhibitors (e.g. Nexium).
Did you know that over one-third of the Australian population have genetic variations that impact on folate and B12 metabolism that can significantly slow down their methylation cycle?
2. Required for the synthesis of acetylcholine
Acetylcholine is an important neurotransmitter that switches on our parasympathetic nervous system (or our ‘rest and digest’ mode). It helps us to sleep – specifically deep REM sleep – and keeps us alert, focused and able to recall information. This is the antidote to stress, ageing and oxidative stress, so we need acetylcholine in our life.
Acetylcholine also triggers the release of gastric acid and digestive enzymes and stimulates peristalsis (that is the wave like motions that helps us to move food throughout our digestive tract), so it is essential for gut health.
If you have short-term memory issues, age-related cognitive decline, difficulty with learning or attention span, are a light sleeper, hold tension in your muscles, have constipation or digestive dysfunction or struggle with chronic stress, then you may be deficient in acetylcholine (and hence choline).
3. Acts as a precursor to phosphatidylcholine
Phosphatidylcholine is the most abundant phospholipid in the body. It forms a key part of our cellular membranes and is essential for neurodevelopment and cognition. It is a key nutrient in preconception and pregnancy care as it supports development of the baby and prevents numerous birth defects (there is some evidence that this may be even more important than folate). Scientists now believe that choline deficiency during pregnancy may result in age-related cognitive decline in the child in later life.
There is also a very strong link between choline deficiency and non-alcoholic fatty liver disease (NAFLD), as well other conditions affecting the liver. A lack of choline (in as little as three weeks in some studies) can result in damage to the cell membranes and tissue in the liver. It also leads directly to an accumulation of triglycerides (fats), resulting in a fatty liver. Further, choline plays a key role in cholesterol synthesis and solubility, so deficiency can result in gallstones.
I am seeing more and more patients in clinic who have a variation in a gene called PEMT, which effectively reduces their own production of choline in the body, making it even MORE important to source choline in the diet or to supplement if necessary. If you have been told you have a ‘fatty liver’ by your GP, have experienced gallstones (or had your gall bladder removed), have trouble losing weight or have a family history of these conditions, then you may have a variation in your PEMT gene.
Dietary sources of choline
The highest levels of choline are found in animal products, therefore vegetarians and vegans are at a much greater risk of deficiency.
The following foods are ranked from highest to lowest in their levels of choline (per 100g):
- liver e.g. beef (431 mg)
- eggs (226 mg)
- beef steak (104 mg)
- salmon (90 mg)
- pork (78 mg)
- chicken (62 mg)
- nuts, almonds (53 mg)
- broccoli (40 mg)
- navy beans/baked beans (31 mg).
Breast milk is the optimal source of choline for babies, who require significant amounts for growth and development. Choline is found in formula as well, but the amount can vary greatly from brand to brand.
Choline is metabolised in both the small and large intestine by gut microbiota before absorption, so optimal gut health is essential to ensure your body can utilise as much dietary choline as possible.
Recommended daily intake
The average intake recommended by the Australian government is 550 mg/day for men and 425 mg/day for women.
However, for women going through perimenopause and menopause (who are not on hormone therapy), your requirement for dietary choline is even higher, especially if you are one of the 40 per cent of women who have the PEMT variant.
The guidelines for preconception care and pregnancy are not high enough in my opinion but give a good foundation for the minimum intake of choline you need each day. Current recommendations are 440 mg/day. This needs to increase during breastfeeding to 550 mg/day.
It is definitely time for choline to have its moment in the spotlight. If you’ve never heard of it before, I hope this blog has inspired you to dig a little deeper into the research, expand your understanding and evaluate just how much choline you are currently getting in your diet. As I said at the start, choline is often the missing link in complex cases. It can seriously be a game changer.
Would you like to learn more about choline and your diet? Book an appointment today. We are now operating fully online via Zoom or telephone appointments, meaning you can still receive the quality care and support you need. We’d love to help you.
Written by Denise Berry BHSc
Corbin, K. D., & Zeisel, S. H. (2012). Choline metabolism provides novel insights into nonalcoholic fatty liver disease and its progression. Current opinion in gastroenterology, 28(2), 159–165. https://doi.org/10.1097/MOG.0b013e32834e7b4b
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
NHMRC. (2014). Nutrient Reference Values for Australia and New Zealand: Choline. Retrieved from: https://www.nrv.gov.au/nutrients/choline