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How Choline Benefits Your Brain and Beyond

Written by Dr. Michael Ruscio, DC on October 24, 2022

Written by Dr. Michael Ruscio, DC on October 24, 2022 — Reviewed by Dr. Hannah Hamlin

Everything You Should Know About This Essential Nutrient

• What is Choline?|
• Choline and the Brain|
• Choline and the Gut|
• Other Choline Benefits|
• How Much Choline?|
• Increasing Your Choline Intake|
• The Bottom Line|

If you’re hoping to improve your overall brain health, you may want to optimize your choline intake. People who take in more choline tend to have better brain function [1] and memory [2], and in infants and kids, choline improves neuro- and cognitive development [3]. Choline has also been shown to be an effective add-on treatment in many brain-health diseases from Alzheimer’s to depression [4, 5]. In fact, one systematic review found Parkinson’s patients who supplemented with choline were able to reduce their prescription medication (Levodopa) use by 50% [4].

While the choline benefits for brain health are impressive, this essential nutrient also plays a role in gut and metabolic health, vagal tone, and inflammation [6, 7, 8, 9]. 

In this article, we’ll lay out the choline benefits you need to know about and provide recommended amounts based on your age. Since 90% of Americans are well below the adequate intake level for choline [3], we’ll also give you a list of good food sources of choline (like eggs, beef, poultry, and soybeans) that can help you optimize your intake.

What is Choline?

Choline is an essential nutrient, which just means your body can’t make enough of it, so you need to consume choline in your diet [3]. Choline is a major component of phospholipids (a type of fat), which are important for the structure of every cell in your body [10].

Aside from being found in every cell, choline plays an important role in the following [3]:

• Liver function
• Brain function
• Muscle function
• Kidney function [11]
• Fat metabolism and transport
• Cell membrane composition and repair
• Creation of the neurotransmitter (chemical messenger) acetylcholine
• Regulation of blood homocysteine levels, which are important for heart health (high levels are a strong risk factor for heart disease) [12, 13]
• Works with B vitamins (folate, vitamin B 12, vitamin B 6, and riboflavin) in the metabolism of nucleic acids (DNA and RNA) and amino acids (building blocks of protein) [12]
• Helps in the synthesis of S-adenosylmethionine (SAM), a universal methyl donor that’s crucial for many methylation reactions (biochemical processes important for maintaining good health).

You may run across different forms of choline whether from food or supplements. While food sources of choline are probably the best option, all forms of choline supplements can increase choline levels to a similar extent (14). 

Now that you know what choline is, let’s take a look at some of the brain health benefits you don’t want to miss out on.

Choline Benefits: Brain Health

Since choline can influence the health of both the developing and aging brain, an adequate intake is important throughout the lifespan.

Choline is one of the nutrients that specifically supports neurodevelopment. A few systematic reviews have found supplementing the diet with choline in pregnancy and during the early days of childhood supports normal brain development and cognition, and is possibly protective against fetal alcohol exposure [6, 15, 16].

In healthy adults, higher dietary choline intakes have been associated with better cognitive performance and memory [1, 17]. But supplementing with choline (specifically citicoline) has also been found to be beneficial. 

One randomized controlled trial of healthy older adults with age-related memory decline found 500 mg per day of citicoline (supplemental form of choline) to be associated with greater improvements in overall memory [2].  Another trial of healthy adolescent males found citicoline supplementation improved attention and psychomotor speed [18]. And choline supplementation may also help to reduce symptoms in those who have had a concussion (type of brain injury) [19].

When it comes to choline supplementation (specifically citicoline) in those with cognitive impairment and dementia, several systematic reviews have documented promising results:

• Improved memory and behavior [20].
• Dementia progression was limited and the adverse effects of dementia were reversed [17].
• When combined with medications (acetylcholinesterase inhibitors) for Alzheimer’s, patients had greater improvements in cognition, mood, and behavioral symptoms than with just medication alone [21].

In addition to benefits for brain development and memory, choline supplementation may be an effective add-on therapy for several brain-related conditions:

• Citicoline significantly improved social withdrawal, apathy, and lethargy in patients with schizophrenia [28].
• Parkinson’s patients were able to reduce their pharmaceutical medication (levodopa) by up to 50% and experienced significant improvements in rigidity, voluntary movement, tremors, handwriting, speech, and cognition [4].
• Patients with depression experienced significantly greater symptom improvements and had their depression go into remission more often [5].

But choline benefits aren’t reserved just for the brain, let’s take a look at how this nutrient impacts the health of the gut.

Choline Benefits: Gut Health

When it comes to gut health, choline may have an important role to play. Choline is needed to maintain the structural integrity of all cells in the human body [10, 22] and choline-deficient diets have been found to disrupt the intestinal lining, which can lead to leaky gut (9). In addition, choline is important for proper liver function, which is needed for healthy digestion [3].

Furthermore, choline acts as a precursor to the neurotransmitter, acetylcholine, which among other functions, is the primary neurotransmitter (chemical messenger) of the parasympathetic nervous system (PNS) [12]. When acetylcholine binds to certain receptors throughout the body, it helps the main nerve of the PNS, the vagus nerve, to carry out functions related to gut motility, digestion, and secretion [23].

In addition, choline supplementation may expedite the recovery of heart rate variability post-exercise [8].

While further research on the nature of the choline-HRV-gut relationship is necessary, we know that healthy vagal tone is crucial for proper digestion. Choline appears to have a therapeutic role in this context and for gut health overall. Let’s focus now on some of the other health benefits of choline.

Choline Benefits: Beyond the Brain and Gut

In addition to improving brain and possibly gut health, the beneficial effects of choline extend to several different areas. Choline may enhance metabolic health by improving insulin sensitivity and non-alcoholic fatty liver disease (NAFLD) [6]. In addition, adequate dietary intake of choline may be beneficial for skeletal muscle by improving fat and protein metabolism, reducing inflammation, and regulating autophagy (a natural detoxification process that cleans up damaged cells and encourages new cell growth) [24, 25, 26]. 

Other research trials have found:

• Kids with cystic fibrosis and pancreatic insufficiency who received supplemental choline had increased blood and muscle choline levels and were better able to absorb fat [27]. 
• In kids who had cardiac arrest, citicoline supplementation had a neuroprotective benefit [28].
• Healthy adults who consumed greater than 310 mg per day of choline had significantly lower levels of inflammatory markers [7].
• Citicoline eye drops reduced the progression of glaucoma [29] and citicoline plus vitamin B12 eye drops improved the health and function of corneal (the covering over the front part of the eye) nerves [30], as well as the function of the macula (part of the retina) [31].

So now that you know what choline is and how choline benefits your brain and the rest of your body, let’s look at how much choline you need every day.

How Much Choline Do You Need?

To take advantage of choline benefits, it’s important to focus on your diet and reach the daily  adequate intake (AI) for this nutrient. 

The following table lists the AI values for choline based on your age, sex and pregnancy status [22]

As you can see, the requirement for choline is increased in pregnancy and lactation. Choline is crucial for the proper brain development and cognition of a fetus [6, 15] And human milk is very high in choline, so demands increase during times of lactation and breastfeeding [3]

While all-out choline deficiency in healthy, non-pregnant people is rare [22], about 90% of Americans (including pregnant and lactating women) don’t consume the recommended intake for choline in their diets [3]. Those at higher risk for choline deficiency include [22]:

• Vegans and vegetarians
• Pregnant women
• People with genetic variations that affect choline, folate, and methionine metabolism
• People receiving total parenteral nutrition (TPN – nutrition delivered intravenously)

Frank choline deficiency is rare but can put you at increased risk of muscle damage, neural tube defects, and non-alcoholic fatty liver disease (NAFLD)[3, 11, 12]. But even without an all-out deficiency, not taking in enough choline may cause unwanted side effects related to digestion, brain function, metabolic health, and inflammation [1, 6, 7, 9, 23, 24].  

It’s rare, but choline toxicity is possible. Here’s a chart of the tolerable upper intake levels based on sex and age [22]:

It would be difficult to surpass these levels with food alone but if you’re taking in excessive amounts of choline in supplement form, you may experience:

• Fishy body odor
• Vomiting
• Nausea
• Diarrhea
• Excessive sweating
• Low blood pressure
• Liver toxicity

Let’s review the best food sources of choline and how to tell if you’re getting enough in your diet.

Increasing Your Choline Intake With Food and Supplements

You can increase your choline intake with food or supplements, but you may need a combination of both.

It’s probably best to start with food when it comes to reaching the AI for choline. Beef and chicken livers and eggs have the highest amounts of dietary choline [32]. In fact, people who eat eggs and egg yolks generally have double the intake of choline when compared to those who don’t eat eggs [33]. If eggs aren’t in your meal plan, don’t worry, there are many other animal products like poultry, seafood, meat, and dairy products that also contain good amounts of choline [3, 22, 33]. 

Plant-based sources have much lower amounts of choline, but wheat germ, mustard seeds, and pulses (legumes) tend to have the highest amounts in this category [32, 34]. Cruciferous vegetables (like Brussels sprouts and broccoli), nuts, seeds, whole grains, and shiitake mushrooms are additional options [3, 11, 22].

Here’s a chart from the National Institutes of Health displaying some food sources of choline along with the choline content per serving and the percent daily value for each [22]:

If you want to know about how much choline you’re getting in your diet, consider keeping a food journal for a few days. Use the above chart or other choline databases to determine how many milligrams of choline you’re averaging per day. If you’re falling short of the AI, try consuming more choline-rich foods. If that’s not possible, you may want to discuss a supplement with your healthcare provider. 

Since women who are pregnant or lactating have an increased demand for choline, it’s even more important to focus on choline intake during this time. Food is the best first choice, but you may need a dietary supplement as well [22]. While most multivitamins don’t have much choline [33], many prenatal vitamins do. 

Choline supplements are generally safe, but it’s important to seek medical advice from the appropriate healthcare professionals before adding any dietary supplements. 

Focus on Choline to Support Brain Health and More

Choline is an essential nutrient but many Americans are falling short when it comes to consuming it. This nutrient is found in every cell in your body and has important functions when it comes to brain development but is also crucial for healthy brain function as you age. And choline has been shown to be an effective add-on therapy for many brain health illnesses like schizophrenia, Alzheimer’s, and depression. In addition to promoting brain health, choline may also help maintain good gut and metabolic health and control inflammation. 

If you’re not sure you’re getting enough choline in your diet, keep a food journal for a few days and calculate your average intake. If you’re falling short, it’s best to start with increasing good food sources of choline like beef, eggs, chicken, and soybeans. If you’re still not reaching the AI for choline, or if you’re pregnant or lactating, you may want to consider a separate choline supplement. 

If you’d like to learn more about optimizing your health with nutrition and lifestyle, contact us at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.