Why Choline Belongs in a Brain-Friendly Diet

If you’re eating for brain health, chances are your regular menu is home to polyphenol-packed berries, lutein-rich leafy greens, and omega-3 fatty fish.

But your menu may be missing choline-rich foods like soy, eggs, red potatoes, and beans. Sufficient consumption of this B-like vitamin has been linked to better cognitive performance and, more recently, to a lower risk of Alzheimer’s dementia.

Here’s what you need to know about this under-consumed nutrient and its benefits for brain health and beyond, and how to get enough of it in your diet.

Choline Basics

Although not a vitamin, choline is grouped with the B vitamins because of some of their similar functions. Although the liver produces a small amount of choline, most of the body’s choline must come from the diet.

Choline is vital for the proper functioning of the brain and nervous system. It is used to build strong cell membranes and the fatty sheath that protects nerve fibers.

Choline is also needed to make acetylcholine, a brain chemical (neurotransmitter) important for memory, mood, circadian rhythm and muscle control.

Adequate choline intake also helps maintain liver health.

Choline and brain health

Choline plays an important role in early brain development. Some, but not all, studies have found that higher (compared to lower) choline intake during pregnancy is associated with cognitive benefits in toddlers and young children.

Two large observational studies have also linked higher choline intake to better performance on memory tasks in healthy adults.

The effect of choline on dementia risk, however, has been unclear. A large study conducted in Finland in 2019 reported a significantly lower risk of dementia with a higher intake of phosphatidylcholine, the most common source of dietary choline.

A new study, published Aug. 2 in the American Journal of Clinical Nutrition, examined the link between choline intake and the risk of developing Alzheimer’s dementia among 3,224 adults. The participants, with an average age of 55, were followed for 16 years.

A daily choline intake of less than 216 mg was associated with an increased risk of Alzheimer’s dementia compared with an intake between 216 mg and 552 mg. The researchers took into account risk factors such as age, sex, education, BMI, dietary pattern, alcohol consumption, smoking and physical activity.

Choline and liver health

Choline is essential for transporting fat stored in the liver to other parts of the body where it is used for energy and other functions. Without choline, fat and cholesterol build up in the liver and can lead to non-alcoholic fatty liver disease (NAFLD).

The extent to which suboptimal choline intake contributes to NAFLD in healthy individuals is not known. A 2014 observational study from China linked low choline intake to an increased risk of NAFLD in men and women.

A 2012 US study from the Johns Hopkins School of Medicine showed that inadequate choline intake was associated with more liver fibrosis in postmenopausal women. Fibrosis occurs in NAFLD when excessive amounts of scar tissue build up in the liver.

Few data are available on the use of choline to treat NAFLD.

How much, which foods

Choline intake recommendations are based on the prevention of liver damage.

For adults 19 years and older, men are recommended to consume 550 mg of choline per day; women should get 425 mg. During pregnancy and lactation, the recommended daily intake of choline increases to 450 mg and 550 mg, respectively.

The richest food sources of choline are animal foods, including eggs (147 mg per large yolk); beef (117 mg per three ounces); chicken (72 mg per three ounces); salmon (77 mg per three ounces); and cod (71 mg per three ounces). Milk and yogurt provide about 40 mg per cup.

Plant sources include soybeans (107 mg per half cup), kidney beans (51 mg per half cup), chickpeas, red potatoes, quinoa, Brussels sprouts, broccoli, shiitake mushrooms, cauliflower, peanuts, and peas.

Who runs the risk of staying too little

Most American adults consume less than the recommended daily intake of choline. There is no consumption data for Canadian adults, but studies suggest that pregnant women and young children are not getting enough.

Pregnant women are especially at risk of choline deficiency, both because they consume too little from food and because prenatal multivitamins contain little or no choline.

About choline supplements

A varied diet should provide enough choline for most people. Pregnant women and people following a vegan diet, however, may benefit from a supplement.

Choline supplements are available as citicoline, choline chloride, and choline bitartrate. Phosphatidylcholine supplements contain only 13% choline by weight.

As always, consult your health care provider about using supplements safely.

Leslie Beck, a dietitian in private practice based in Toronto, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

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