Choline Under The Spotlight.

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. It has become the missing piece of the jigsaw puzzle for many of my complex cases and when I talk about choline with my patients, I usually get blank stares in return. So this blog post is for them (and 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, therefore a deficiency can result in numerous health conditions including:

  • Birth defectsalzheimer's disease, dementia, heart disease
  • Neurodevelopment
  • Cognitive decline
  • Fatty liver disease
  • Gallstones
  • Cardiovascular disease
  • Insulin resistance, type II diabetes
  • Obesity
  • Cancer

Choline: what does it actually do?

1. Acts as a methyl donor

Methylation is a complex cycle (so I’m only giving you the cliff notes version here) that happens throughout the body (but especially in the liver) and it 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 (so clearly we still DO methylate if we are breathing), but when the cycle is down regulated, we don’t produce enough methyl donors.

If you have hormonal issues such as heavy periods, mental health issues, or addictions (these are just a few examples), then it is likely that you will have some methylation issues.

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 a number of 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 with 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 is essential for gut health.

If you have short-term memory issues, age-related cognitive decline, difficulty with learning or attention span, you 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 3 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. Choline also 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, you have experienced gallstones (or had your gall bladder removed), you have trouble losing weight, or your 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 levels of choline (per 100g):

  • Liver e.g. beef (431mg)
  • Birth defects Neurodevelopment Cognitive decline Fatty liver disease Gallstones Cardiovascular disease Insulin resistance type II diabetes Obesity rutherglen howlong corowa chiltern yarrawonga wodonga albury wangaratta barnawartha cancer choline cognitive decline diabetes fatty liver gallstones methylation NAFDL obesity pregnancyEggs (226mg)
  • Beef steak (104mg)
  • Salmon (90mg)
  • Pork (78mg)
  • Chicken (62mg)
  • Nuts, almonds (53mg)
  • Broccoli (40mg)
  • Navy beans/baked beans (31mg)

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% 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 440mg/day. Needs increase during breastfeeding to 550mg/day.

Final remarks

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 to 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 my complex cases. It can seriously be a game changer.

Want to know more? Book an appointment today. I’d love to help you.

 

References

Corbin, K. D., & Zeisel, S. H. (2012). Choline metabolism provides novel insights into nonalcoholic fatty liver disease and its progression. Current opinion in gastroenterology28(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. Nutrients10(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