All About Choline

What is choline? How does it work?

Choline is a precursor for many other compounds, including the neurotransmitter acetylcholine, important chemicals required in the kidney, and compounds needed for the transport and metabolizing of lipids and cholesterol in some people.

Research has shown choline may improve memory and cognitive functioning in all ages of people. Choline deficiencies may be partially responsible for poor memory and brain function in groups such as elderly people living in institutions (Fioravanti &Yanagi 2004, McDaniel et al. 2003). It may also help regulate the amount of carnitine present in urine and blood serum (Hongu & Sachan 2003).

The U.S. Institute of Medicine's Food and Nutrition Board first established Adequate Intake (AI) and Tolerable Upper Limit (UL) for choline supplementation in 1998. The AI for women is 425 mg per day and 550 mg per day for men. Women who are pregnant or nursing should take more choline according to the Board.

Why is choline important?

Choline is important for maintaining a healthy liver and healthy muscles in adults. Women who are pregnant need to have enough dietary choline to reduce the risk of having a baby with a neural tube defect like spina bifida, or a birth defect like cleft palate.

Choline is important for maintaining a healthy liver and healthy muscles in adults. Women who are pregnant need to have enough dietary choline to reduce the risk of having a baby with a neural tube defect like spina bifida, or a birth defect like cleft palate. Choline deficiencies are linked with liver damage such as fatty liver. Fatty liver can be reversed when choline levels are normalized in the diet. Low dietary choline intake has also been linked to higher concentrations of inflammatory compounds in the body as well as to an increased risk of breast cancer.

Choline and the compounds it creates help regulate many basic physiological and neurological processes in the human body.

One of the main functions of choline is the production of acetylcholine, a neurotransmitter that is vital to memory and muscle control. Choline also helps cells build their membranes and keep them strong. Strong, well-maintained membranes around neurons ensure the electrical signals in the brain perform at their best capacity.

Choline helps the body metabolize fats and helps protect the liver from accumulating an unhealthy amount of lipids. It has an anti-inflammatory effect, and can even reduce the level of homocysteine levels in the body. Homocysteine has been implicated in hardening of the arteries and coronary artery disease.

Because choline is water-soluble, the body cannot store it like it can store fat soluble nutrients. People need to consume choline-rich foods and supplements regularly to prevent deficiencies.

Can people produce choline in their bodies, or are there natural sources for it?

Humans can produce some choline in the body, similar to how it produces some of the B vitamins in the liver. However, some people with certain genetic predispositions may not be able to produce it as efficiently. (Zeisel & Blusztajn 1994) ().

Luckily, choline is found in many foods people eat on a regular basis. Liver, muscle meats, fish, peas, spinach, beans, nuts, wheat germ and eggs are all excellent sources of choline in the diet.

Animal products usually contain more choline than plants, so vegetarians will almost certainly need to rely on supplementation. Even eating a choline-rich diet, however, is unlikely to achieve the daily Adequate Intake level of the nutrient, according to a 2005 NHANES study.

What kinds of people benefit from taking choline? What conditions does choline help?

Choline is frequently used in the treatment of liver disease including cirrhosis and chronic hepatitis. It is also regularly prescribed for diseases that affect memory and brain function. Alzheimer's, depression, dementia, memory loss, Huntington's chorea, Tourette's, cerebellar ataxia, schizophrenia and some kinds of seizures respond well to chromium supplementation.

Pregnant women should take choline and folate supplements to help prevent neural tube defects in their babies. It is also used as a supplement in most infant formulas. Other uses for choline include reducing the risk of cancer, controlling asthma and lowering cholesterol. It is important to optimal nervous system functioning.

High-performance athletes, like long distance runners, are at risk of developing a choline deficiency as the muscles use up the nutrient. Frequent heavy consumers of alcohol also tend towards choline deficiency because of the stresses alcohol places on the liver. Choline supplementation for these individuals should be strongly considered. Although vegetarians and vegans clearly should take choline supplements, anyone can develop a choline deficiency if their diet is not rich in choline-packed foods

What are some signs of low levels of choline, or a need to supplement it?

Up to 90% of the population may suffer from choline deficiency to some degree. Mild deficiencies may appear as problems with attention or concentration, slower information procession, memory problems or problems recalling learned information, and learning difficulties.

More serious deficiencies can result in serious cognitive problems, fatigue, fatty liver disease, kidney necrosis, trouble sleeping, muscle or nerve problems and higher lipid levels in the blood. Choline deficiency has been linked with a higher risk of Alzheimer's and other mental disorders in the elderly.

When the body does not get enough choline, it cannot make enough of the neurotransmitter acetylcholine. Maintaining a healthy choline balance through diet and supplementation helps prevent these problems and keeps the brain and body functioning at their best. Other benefits include reductions in chronic inflammation and improved communication between nerves and muscles.

Certain medical conditions can contribute to choline deficiencies. For instance, individuals who have undergone by-pass surgery or kidney transplants are at higher risk, as are those with liver problems like cirrhosis of the liver. People who have been on anti-seizure drugs or who consume high amounts of alcohol, nicotine or refined sugars also increase their risks.

When choline deficiency occurs, the liver struggles to package and transport fats like it should, leading to a build-up of fats in the liver. There may be increased levels of triglycerides in the blood, as well as low levels of VLDL (Very Low Density Lipoprotein), a "good cholesterol" used by the liver to transport fats in the blood.

As people age, their brains are naturally less able to take in choline. Since choline is a nutrient that is critical to nerve and brain function, the lowered presence of choline in the brain contributes to risks for age-related senile dementia.

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Are there side effects, risks or interactions?

Choline is quite safe for use in adults and children when taken in appropriate doses. Even pregnant and nursing women can and should take choline supplements in appropriate amounts to protect their children.

Taking doses of choline in excess of the AI can be unsafe and may result in side effects. It is unknown if these can be dangerous or life threatening, as most consist of merely unpleasant events. The most common side effects of exceeding the UL dosage of choline include nausea, vomiting, sweating, diarrhea and a fishy odor produced by the body. There is some concern that massive daily overdoses of choline may increase the risk of colon and rectal cancers, especially in women

What kinds of people should not take choline?

Choline is safe for most people to take. However, some people should exercise care with taking choline supplements. Anyone with pre-existing kidney or liver disease should always check with their doctor prior to taking choline supplements since choline has such a direct effect on those organs.

For the same reason, patients with Parkinson's disease, depression or inherited trimethylaminuria may be more at risk of negative side effects from using choline near the UL dosages. People who are taking methotrexate for cancer, rheumatoid arthritis, psoriasis or other conditions should consult with their doctors before taking choline supplements because the drugs may interact with each other in unexpected ways.

People who take a certain class of lipid-lowering drugs called fibrates who take choline supplements may see a rise of homocysteine in the blood, especially if the patient also suffers from diabetes or metabolic syndrome. Some studies also indicate that people with bipolar (manic-depressive) disorders should not take any choline supplements.

Some medications, especially those that contain salicylates, magnesium, anticoagulants, medications for diabetes, gout, oral steroids, or the seizure medications Dilantin and Depakote should talk with their doctors before taking choline supplements. Side effects may be worsened when choline is taken at the same time as these kinds of medications.

Other conditions that people should discuss with their doctors prior to taking choline include ulcers, alcoholism, upcoming surgery including dental surgery, or the presence of kidney or liver disease. Finally, children and teens with influenza or chicken pox should not take choline supplements due to an increased risk of contracting Reye's syndrome.

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