Why Choline Belongs in a Brain-Friendly Diet

Why Choline Belongs in a Brain-Friendly Diet

If you eat for brain health, your regular menu probably contains polyphenol-rich berries, lutein-rich leafy greens, and omega-3s from fatty fish.

But your menu may be lacking in choline-rich foods, such as soybeans, eggs, red potatoes, and kidney beans. Consuming enough of this B-type vitamin has been linked to better cognitive performance and, recently, a lower risk of Alzheimer’s dementia.

Here’s what 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 due to some of their similar functions. Although your liver makes a small amount of choline, most of your body’s choline should come from your 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 produce 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 shown that higher (versus lower) choline intake during pregnancy is associated with cognitive benefits in toddlers and young children.

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

The effect of choline on dementia risk, however, is unclear. A large study from Finland in 2019 reported a significantly lower risk of dementia with higher intakes of phosphatidylcholine, the most common source of choline in the diet.

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 in 3,224 adults. The participants, aged on average 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 to an intake between 216 mg and 552 mg. The researchers took into account risk factors such as age, sex, education, BMI, dietary habits, 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, fats and cholesterol build up in the liver and can lead to non-alcoholic fatty liver disease (NAFLD).

It is not known to what extent suboptimal choline intake contributes to NAFLD in healthy people. A 2014 Chinese observational study linked low choline intake to an increased risk of NAFLD in both men and women.

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

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

How much, what foods

Choline intake recommendations are based on preventing liver damage.

For adults ages 19 and older, men are advised to consume 550 mg of choline per day; females should get 425 mg. During pregnancy and lactation, the recommended daily allowances of choline increase to 450 mg and 550 mg respectively.

The richest dietary sources of choline are foods of animal origin, 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 soy (107 mg per half cup), kidney beans (51 mg per half cup), chickpeas, red potatoes, quinoa, Brussels sprouts, broccoli, mushrooms shiitake, cauliflower, peanuts and green peas.

Who risks having too little

Most American adults consume less than the recommended daily allowance of choline. There is no consumption data for Canadian adults, but studies suggest that pregnant women and toddlers don’t get enough.

Pregnant women are particularly at risk for choline insufficiency, both because they consume too little food and because prenatal multivitamin supplements 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 the safe use of supplements.

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

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