How much choline do you need

Choline deficiency can cause muscle and liver disease and contribute to cardiovascular disease, dementia , and neural tube irregularities in infants.

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Medically reviewed by Elaine K. Luo, M. FDA does not require food labels to list choline content unless choline has been added to the food.

Typical amounts of choline in dietary supplements range from 10 mg to mg. The forms of choline in dietary supplements include choline bitartrate, phosphatidylcholine, and lecithin. No studies have compared the relative bioavailability of choline from these different forms.

Most people in the United States consume less than the AI for choline. An analysis of data from the — National Health and Nutrition Examination Survey NHANES found that the average daily choline intake from foods and beverages among children and teens is mg for ages 2—19 [ 14 ]. In adults, the average daily choline intake from foods and beverages is mg in men and mg in women. Intakes from supplements contribute a very small amount to total choline intakes. Choline deficiency can cause muscle damage, liver damage, and nonalcoholic fatty liver disease NAFLD or hepatosteatosis [ 1 , 2 , 4 , 15 ].

Although most people in the United States consume less than the AI of choline, frank choline deficiency in healthy, nonpregnant individuals is very rare, possibly because of the contribution of choline that the body synthesizes endogenously [ 1 , 5 ]. Prenatal dietary supplements typically contain little if any choline [ 17 ]. Some evidence indicates that lower plasma or serum choline levels e. However, other research found no relationship between plasma choline concentrations during pregnancy and neural tube defects in offspring [ 23 ].

People with certain genetic alterations Genes involved in the metabolism of choline, folate, and methionine play a role in the pathways for choline production and use [ 24 , 25 ]. Humans have variations in the DNA sequences for these genes single nucleotide polymorphisms [SNPs] , and these SNPs can have a strong influence on demands for dietary choline.

The prevalence of SNPs that alter requirements for dietary choline vary by race. In a study of African, Asian, Caucasian, and Mexican Americans, individuals of European ancestry had a higher prevalence of four SNPs that increased the risk of organ dysfunction when these individuals consumed a low-choline diet [ 27 ].

Patients requiring total parenteral nutrition At present, choline is not routinely added to commercial parenteral solutions for infants and adults [ 28 , 29 ]. The American Society for Parenteral and Enteral Nutrition recommends the routine addition of choline to adult and pediatric parenteral nutrition formulations, and calls for the development of a commercially available parenteral product that contains choline [ 28 ].

This section focuses on three conditions in which choline might play a role: cardiovascular and peripheral artery disease, neurological disorders, and NAFLD. Choline is involved in functions that overlap with those of folate and other B vitamins. Many studies do not assess the status of all B vitamins, which can confound results and obscure the true relationship between choline and the observed outcome. Cardiovascular and peripheral artery disease Some researchers have suggested that choline might protect cardiovascular health by reducing blood pressure, altering lipid profiles, and reducing levels of plasma homocysteine [ 3 ].

Other research suggests that higher dietary choline might increase cardiovascular disease risk because some choline and other dietary ingredients, such as carnitine, are converted to trimethylamine TMA by intestinal bacteria.

The TMA is then absorbed and converted by the liver into trimethylamine-N-oxide TMAO , a substance that has been linked to a higher risk of cardiovascular disease [ 33 , 34 ]. Despite the hypothesis that choline might affect heart health, several large observational studies have found no significant associations between choline intakes and cardiovascular or peripheral artery disease risk.

Similarly, a prospective study in 14, middle-aged adults in the Atherosclerosis Risk in Communities Study found that over 14 years, risk of coronary heart disease was not significantly different in the highest choline intake quartile compared to the lowest quartile [ 36 ].

Choline intakes also had no association with cardiovascular disease risk in a study of 16, women participating in the European Prospective Investigation into Cancer and Nutrition [ 37 ].

Additional research is needed to determine the relationship between choline intakes and cardiovascular and peripheral artery disease as well as the potential risks and benefits of choline supplementation to reduce the risk of these diseases. In addition, because phosphatidylcholine can serve as a phospholipid precursor, it might help support the structural integrity of neurons and thus might promote cognitive function in elderly adults [ 8 ]. However, little research conducted to date supports this hypothesis, as described below.

Some small randomized intervention trials have shown that choline supplements improve cognitive performance in adults [ 30 , 41 ]. However, a systematic review of 13 studies on the relationship between choline levels and neurological outcomes in adults found that choline supplements did not result in clear improvements in cognition in healthy adults [ 8 ]. A single drink [e.

Although it is often benign, NAFLD can lead to steatohepatitis, fibrosis, cirrhosis, liver failure, and liver cancer [ 15 ]. Choline, especially phosphatidylcholine, is essential for transporting lipids from the liver [ 1 ]. Therefore, in choline deficiency, fat accumulates in the liver, which can result in NAFLD [ 44 , 45 ]. Data from a single large observational study support a link between choline deficiency and risk of NAFLD.

Specifically, a cross-sectional study of 56, Chinese adults aged 40—75 years found an inverse relationship between dietary choline intakes and risk of NAFLD based on hour dietary recall [ 47 ]. However, choline intake was associated with NAFLD in normal-weight women only and not in those who were overweight or obese.

This difference by weight status was not observed in men. Adequate choline intake is needed for proper liver function and to prevent NAFLD, but more research is needed to further clarify the role of choline in preventing or treating NAFLD [ 50 ]. High intakes of choline are associated with a fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity [ 1 , 2 ].

Choline consumption has been shown to increase production of TMAO, a substance that has been linked to a higher risk of cardiovascular disease, in a dose-dependent manner in adults. The FNB has established ULs for choline from food and supplements based on the amounts of choline that are associated with hypotension and fishy body odor see Table 3 [ 2 ].

The ULs apply to healthy children and adults, but not to those taking high doses of choline under medical supervision. The FNB was unable to establish ULs for infants due to the lack of data on adverse effects in this age group.

The federal government's 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. For more information about building a healthy dietary pattern, refer to the Dietary Guidelines for Americans and the U. Department of Agriculture's MyPlate.

The nutrigenetics and nutrigenomics of the dietary requirement for choline. Prog Mol Biol Transl Sci ; Common genetic polymorphisms affect the human requirement for the nutrient choline.

Faseb j ; Identification of new genetic polymorphisms that alter the dietary requirement for choline and vary in their distribution across ethnic and racial groups. Nutr Clin Pract ; This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice.

We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc. However, the research seems to show that getting more than you need might be a problem too. So, just adding a small supplement to a diet already filled with choline-rich foods might be beneficial.

If we really do need — mg of choline daily, then it appears that we can either consume calories lol or reach for supplements.

Thanks for your comments. This is very complicated stuff! People with higher levels of TMAO in their blood have more than twice the risk of heart attacks, and stroke, compared to those with lower levels.

So, I think you have to be careful about over supplementing. Please note that, as with all dietary supplements, you should discuss this with your health care professional. It may be beneficial to take small doses of choline mg a few times per week to balance out intake. Here is a really good article on this topic.

Sharon, that paper you cite says that the amount of TMAO in some sources of choline is lower in plant-based foods especially compared to fish. Everything in moderation, but I think if one is vegetarian or vegan it would be wise to supplement with several teaspoons of lecithin a week. At my calorie intake and eating a healthy vegetarian diet similar to your meal plan, I would not be getting enough choline to be really healthy and this may have contributed to my current health issue.

I started consuming sunflower lecithin, and even though it was a bit distasteful the first time, my body started to crave it for several days, so I think I was a bit deficient. Hi, thanks for making these points. I agree with you—it might be hard to meet the needs for choline on a plant-based diet, even while considering the impact of TMAO. The overall goal is to get enough without getting too much. So, it seems appropriate that supplementing with a small amount of choline might be beneficial for those not meeting their needs.

I love your suggestion of lecithin, as it does contain choline. Thankful for this useful info on choline Sharon. I will definitely up my intake of broccoli and chickpeas! Hi Sharon, thank you for this sound and balanced advice. Does choline naturally occur in nutritional yeast without the manufacturer specifically adding it?

Most nutritional yeasts do not report on choline content, however some products do report good sources of choline.

I would look at the label of the product, which is not available for me to review. Many nutritional yeasts are fortified, so it would be indicated on the label. Your email address will not be published. Sharon's new book California Vegan is available now!