Choline is an essential nutrient that is naturally present in certain foods and available as a supplement. The body can also produce small amounts on its own in the liver, but not enough to meet daily needs. Choline is converted into a neurotransmitter called acetylcholine, which helps muscles to contract, activates pain responses, and plays a role in brain functions of memory and thinking. Most choline is metabolized in the liver where it is converted into phosphatidylcholine, which assists in building fat-carrying proteins and breaking down cholesterol. It is also &#;food&#; for beneficial gut bacteria. [1]

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Recommended Amounts

There is not enough data to establish a Recommended Dietary Allowance for choline. [2] The Food and Nutrition Board established an Adequate Intake (AI) for choline based on the prevention of liver damage.

AI: The Adequate Intake for men and women ages 19+ years is 550 mg and 425 mg daily, respectively. For pregnancy and lactation, the AI is 450 mg and 550 mg daily, respectively.

UL: A Tolerable Upper Intake Level (UL) is the maximum daily dose unlikely to cause adverse side effects in the general population. A UL has not been established for choline, because a toxic level has not been observed from food sources or from longer-term intakes of high-dose supplements.

Choline and Health

Choline has been suggested to both protect and increase the risk of cardiovascular disease (CVD). Choline, along with the B vitamin folate, helps to lower blood levels of homocysteine by converting it to methionine. High homocysteine levels are a risk factor for CVD. Choline may also help to reduce blood pressure and stroke. In a study of almost 4,000 African-American participants followed for 9 years, higher choline intakes were associated with a lower risk of ischemic strokes. [3]

But choline may also act negatively toward the heart. Choline is converted by gut bacteria into a byproduct called trimethylamine (TMA), which is then converted in the liver to trimethylamine-N-oxide (TMAO). Higher blood levels of TMAO have been associated with a higher risk of CVD in animal studies. [4,5] However, it is unclear what is TMAO&#;s relationship to CVD, or if it is just a marker of an underlying disease process that leads to CVD. A large cohort of men and women from the Nurses&#; Health Study and Health Professionals Follow-up Study, followed for 20-25 years, found that higher phosphatidylcholine intakes were associated with an increased risk of deaths from CVD and other causes. [6] There was a 26% increased risk of CVD deaths when combining data from both cohorts comparing the highest intakes of phosphatidylcholine with the lowest. Furthermore, having diabetes heightened that risk. It is believed that circulating TMAO may promote atherosclerosis by preventing the removal of cholesterol in the liver. However, it was noted that TMAO blood levels were not measured in this study, only choline from foods reported in diet questionnaires.

Other earlier, large epidemiological studies found the contrary, with no association of high choline intakes with a higher risk of cardiovascular diseases, though these studies also did not specifically measure TMAO blood levels. [7,8]

There appears to be an association with diets high in choline-rich foods and cardiovascular disease, but the reasons for this link need further study.

In three large cohorts of men and women, higher intakes of phosphatidylcholine were associated with an increased risk of type 2 diabetes mellitus (T2DM). [9] Those who had the highest dietary intakes of choline showed a 34% increased risk of T2DM compared with the lowest intakes. The exact mechanism of this association is unclear and warrants further research.

There is a link between choline deficiency and liver disease. Phosphatidylcholine carries fats away from the liver, so a choline deficiency can cause the liver to store too much fat. This increases the risk for nonalcoholic fatty liver disease (NAFLD), which may then progress to cirrhosis (an inflammation of liver cells, followed by thickening and hardening of liver tissue), liver cancer, or liver failure. This ultimately interferes with normal liver function. Changes in the metabolism of choline or phosphatidylcholine can also negatively impact certain biochemical pathways that lead to NAFLD. [10] NAFLD occurs most often in  individuals with excess weight or obesity, and the main treatment is to reduce body fat with calorie restriction and exercise. Although a choline deficiency can lead to liver dysfunction, it is not yet clear if dietary choline or choline supplementation can treat NAFLD. 

Choline is associated with brain health because it is converted into acetylcholine, which plays a role in memory and thinking. Studies have found that people with Alzheimer&#;s disease have lower levels of an enzyme that converts choline into acetylcholine, and therefore theorize that higher dietary intakes of choline may prevent cognitive decline. [11] Although some  observational studies have found that higher intakes of choline are associated with higher levels of cognitive function like memory, clinical trials have not found that choline supplementation significantly improves these cognitive measures. [1]

Food Sources

Choline is found in a variety of foods. The richest sources are meat, fish, poultry, dairy, and eggs.

Signs of Deficiency and Toxicity

Deficiency  

Most Americans eat less than the AI for choline but a deficiency is very rare in healthy persons, as the body can make some choline on its own. Also, the amount of dietary choline an individual needs can vary widely and depends on various factors. For example, premenopausal women may have lower requirements for dietary choline because higher estrogen levels stimulate the creation of choline in the body. A higher choline requirement may be needed in persons who have a genetic variation that interferes with the normal metabolism of choline. [10] A true choline deficiency can lead to muscle or liver damage, and nonalcoholic fatty liver disease. [12]

Groups at higher risk of deficiency:

• Pregnant women&#;In addition to low average dietary intakes in the general public, prenatal supplements do not typically contain choline.
• Patients dependent on intravenous nutrition&#;Total parenteral nutrition (TPN) is administered through a vein to people whose digestive tracts cannot tolerate solid food due to disease, surgery, or other digestive conditions. Choline is not typically included in TPN formulas unless specified. [13] NAFLD has been observed in long-term TPN patients. [1]

Toxicity

Very high intakes of choline can lead to low blood pressure (hypotension) and liver toxicity. It may also lead to the excess production of TMAO, which is associated with a higher risk of cardiovascular disease. Other symptoms include excessive sweating, fishy body odor, or nausea/vomiting. The Tolerable Upper Intake Level (UL) for choline for adults 19 years and older is 3,500 mg daily and is based on the amount that has been shown to produce these side effects. [1] Reaching this high amount would most likely be caused by taking very high dose supplements rather than from diet alone.

Did You Know?

• Multivitamins do not typically contain choline.
• Although foods rich in choline&#;liver, egg yolks, and red meat&#;tend to be higher in saturated fat, choline can also be found in foods lower in saturated fat including salmon, cod, tilapia, chicken breast, and legumes.

Related

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Vitamins and Minerals

Last reviewed March

Terms of Use

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

Read below for how to use the database and how much choline you should get, or just start searching now!

FOOD

CATEGORY

Egg Yolk Equivalents

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How to Use the Database

This database allows you to search for specific foods, or to do a blank search to list all the foods in the database in declining order of choline content. You can change the category from &#;all foods&#; to one of the other choices and do a blank search to rank all the foods within that category.

If you search for specific foods, it is best to search for a single keyword, as the database tends to get tripped up with phrases.

By default, the database gives you the results as &#;total egg yolk equivalents.&#; This takes the amount of choline in the food, plus the amount of a related molecule known as betaine, and expresses them as the number of 20-gram large egg yolks you would have to eat to get the same amount of choline.

I recommend getting up to half your choline requirement as betaine, but not more than that. To separate out the betaine from the choline, you can choose to rank the foods by &#;egg yolk choline equivalents&#; or &#;egg yolk betaine equivalents.&#;

You can also choose to rank the foods by the amount of choline or betaine in 100 grams, or by specific subtypes of choline.

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Finally, you can rank the foods by the percentage of their choline present as glycerophosphocholine, the form that best supports muscular strength, learning, memory, and focused attention; or the percentage as phosphatidylcholine, the form that best prevents fatty liver disease and supports gall bladder health and fat digestion.

No matter how you choose to rank the foods, you can click on &#;view more details&#; under each food in the search results to see all of the choline-related data for that food, and where the data came from.

How Much Choline Do You Need?

You can see the official recommendations here.

I recommend all adults shoot for at least 550 milligrams per day (mg/d), which is the equivalent of four egg yolks.

People with low MTHFR activity should consume 900- mg/d, which is the amount in seven to nine egg yolks.

If you don't know your MTHFR status, you can ask your doctor to do a test, or you can get a 23andMe or Ancestry analysis of your genome and submit it to a third-party app that will give you a report on your methylation genetics. If you choose the latter route, I recommend using StrateGene, created by Dr. Ben Lynch. If you use this link I will earn a small commission at no extra cost to you, and that will help support the free work I put out, such as this database.

For children, I recommend taking the adult target, dividing it by 2, and getting that number for every Calories the child eats on average.

What Are the Best Forms of Choline?

What form you emphasize should depend on your goals:

• Phosphatidylcholine is best for preventing or reversing fatty liver disease, supporting gall bladder health, and supporting fat digestion. Phosphatidylcholine is also least likely to generate TMAO. This is a compound that gut microbes make from choline that you don't absorb, and some researchers believe it contributes to heart disease (see below).
• Glycerophosphocholine is best for supporting muscular strength, learning, memory, and sustained, focused attention.
• Betaine (trimethylglycine) is best for supporting methylation, which supports many aspects of your mental and physical health. For more on methylation, see this primer.

What Are the Best Choline-Rich Foods?

Your basic choline requirement is four egg yolk equivalents, and with low MTHFR activity you should add an additional 3-5 egg yolk equivalents.

In the following list, the meat is measured before cooking, while the nuts, seeds, and flours are measured after drying or roasting.

The following foods primarily provide choline. You can mix-and-match any of these foods to satisfy your entire requirement. Each of these is equal to one, large, 20-gram egg yolk:

• One egg yolk
• One tablespoon of lecithin (lecithin hasn't been added to the database yet, but will be soon)
• 40 grams of (g) beef liver, measured before cooking
• 44 g veal liver
• 62 g turkey liver
• 71 g chicken liver
• 143 g salmon
• 135-285 grams of most meat, fish, or shellfish
• 172 g flax seeds
• 185 g pistachios, quinoa, amaranth, or pinto beans
• 215 g pumpkin or squash seeds, or cashews
• 250 g pine nuts, edamame, buckwheat, sunflower seeds, peanuts, or almonds

The following foods primarily provide betaine. You can mix-and-match any of them to satisfy up to half of your requirement:

• 24 g quinoa
• 25 g wheat germ
• 37 g wheat bran
• 44 g raw lambsquarters
• 57 g canned beets
• 83 g dark rye flour
• 105 g frozen spinach
• 112 g raw beets
• 140 g whole wheat flour
• 143 g raw kamut

What Are the Best Choline Supplements?

When seeking a choline supplement, there are several issues to consider:

• Some supplements may list the amount of choline in a product, while others list the amount of the molecule that contains the choline, and this can lead to confusion about the dose.
• Some forms of choline are better for some purposes than others.
• Some researchers believe that TMAO generated in the gut from the choline we eat may contribute to heart disease. Certain forms of choline generate more TMAO than others.

Here are the forms I consider most useful and why.

Betaine (trimethylglycine, TMG)

Betaine is best for supporting methylation (see here for a primer on methylation). When you use choline for methylation, you turn it into betaine first, and you use the betaine directly for that process. Betaine generates 100 times less TMAO than choline, and some researchers believe TMAO contributes to cardiovascular disease. I recommend only getting half of your requirement from betaine because you can't use it directly to make phosphatidylcholine or acetylcholine.

You can use this link to purchase betaine, called trimethylglycine or TMG in supplements, and I will earn a small commission at no extra cost to you that will help support the free work I put out, including this database. A 500 mg capsule of TMG is the equivalent of getting 445 mg of choline.

Phosphatidylcholine

Phosphatidylcholine prevents fatty liver disease (see here for a primer on fatty liver disease), supports gallbladder health, and assists with fat digestion. It is the least likely form of choline to generate TMAO, generating either none at all, or four times less than similar doses of choline bitartrate (see here and here). Phosphatidylcholine supplements list the amount of phosphatidylcholine on the label, but only 15% of that is choline. It is impractical to meet the choline requirements discussed in this post with phosphatidylcholine capsules. Therefore, I recommend using lecithin, which can be incorporated into smoothies, sauces, and dressings in tablespoon amounts.

You can use this link to purchase a soy-free, organic sunflower lecithin and I will earn a small commission at no extra cost to you that will help support the free work I put out, including this database.

alpha-GPC

alpha-GPC, equivalent to &#;glycerophosphocholine&#; in this database, is more easily converted into acetylcholine than other forms of choline. Acetylcholine supports muscular strength, learning, memory, and sustained, focused attention. It is very important for the prevention of age-associated cognitive decline. The rate at which alpha-GPC is converted to TMAO is not known. Acetylcholine might enhance REM sleep but interfere with deep sleep, so if you take this, be careful about using high doses at night. One study that showed benefit in Alzheimer's patients used mg/d, divided as 800 mg at 8am and 400mg at 4pm.

You can use this link to purchase alpha-GPC and I will earn a small commission at no extra cost to you that will help support the free work I put out, including this database.

Should You Care About TMAO?

The potential role of trimethylamine oxide (TMAO) in heart disease is controversial. I have written about it here and here.

Gut microbes convert choline that you don't absorb into trimethylamine (TMA), and your liver converts it into TMAO.

The most compelling evidence to date for the hypothesis that TMAO contributes to heart disease was published more recently in . The researchers fed 500 mg/d choline bitartrate for 2 months. It raised TMAO levels in the subjects. When they drew their blood and mixed it with factors that cause clotting, their blood clotted more after the choline supplementation than before. They didn't include a control group, and they didn't show any clinical endpoints (such as actual heart disease), so the study isn't very compelling, but it does add to the data suggesting TMAO might not be so great for heart disease.

On a scale of 0 to 10, my concern for minimizing TMAO is currently a 3. My confidence in this is about 10%, so I consider it highly likely I could change my mind in either direction as new research is published.

At the end of the day, choline that your gut microbes turn into TMAO is choline you didn't absorb, so, at best, it was a waste.

If you want to minimize TMAO production, you can use the following strategies:

• Get half of your choline requirement in the form of betaine (TMG).
• Get the rest of your choline as phosphatidylcholine, unless you use alpha-GPC to support acetylcholine production.
• Spread your choline out evenly across meals. TMAO production from two eggs per meal is zero in many people and minimal in everyone tested.
• Get a uBiome Explorer test. I have no affiliate relationship with them. They will tell you if you have a microbiome that favors TMAO production and, if so, give you strategies to reduce TMAO production.

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