Choline; Deficiency Symptoms, Food Source, Health Benefit

Vitamin B4 / Choline

Choline is a basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. Choline is now considered to be an essential vitamin. While humans can synthesize small amounts (by converting phosphatidylethanolamine to phosphatidylcholine), it must be consumed in the diet to maintain health. Required levels are between 425 mg/day (female) and 550 mg/day (male). Milk, eggs, liver, and peanuts are especially rich in choline. Most choline is found in phospholipids, namely phosphatidylcholine or lecithin. Choline can be oxidized to form betaine, which is a methyl source for many reactions (i. e. conversion of homocysteine into methionine). Lack of sufficient amounts of choline in the diet can lead to a fatty liver condition and general liver damage. This arises from the lack of VLDL, which is necessary to transport fats away from the liver. Choline deficiency also leads to elevated serum levels of alanine aminotransferase and is associated with an increased incidence of liver cancer.

Vitamin B4 /Choline is a water-soluble vitamin-like essential nutrient. It is a constituent of lecithin, which is present in many plants and animal organs. The term cholines refers to the class of quaternary ammonium salts containing the N, N, N-trimethylethanolammonium cation(X− on the right denotes an undefined counteranion).

The cation appears in the head groups of phosphatidylcholine and sphingomyelin, two classes of phospholipid that are abundant in cell membranes. Choline is the precursor for the neurotransmitter acetylcholine, which is involved in many functions including memory and muscle control. Lipotropic means that choline possesses properties that prevent the excessive accumulation of fat in the liver. Although not officially deemed a Vitamin per the FDA definition, make no mistake about it, choline is an essential and vital nutrient for our health.

Deficiency Symptoms of Vitamin B4 / Choline

Food Sources of Vitamin B4 / Choline

Some animals cannot produce choline but must consume it through their diet to remain healthy. Humans make a small amount of choline in the liver. In the United States, choline is recommended as an essential nutrient. Possible benefits include reducing the risk of neural tube defects and fatty liver disease. It has also been found that intake of choline during pregnancy can have long-term beneficial effects on memory for the child. Several food sources of choline are listed in

[stextbox id=’custom’]

 Selected Food Sources of Choline 
Food Milligrams
(mg) per
serving		 Percent
DV*
Beef liver, pan fried, 3 ounces 356 65
Egg, hard boiled, 1 large egg 147 27
Beef top round, separable lean only, braised, 3 ounces 117 21
Soybeans, roasted, ½ cup 107 19
Chicken breast, roasted, 3 ounces 72 13
Beef, ground, 93% lean meat, broiled, 3 ounces 72 13
Fish, cod, Atlantic, cooked, dry heat, 3 ounces 71 13
Mushrooms, shiitake, cooked, ½ cup pieces 58 11
Potatoes, red, baked, flesh and skin, 1 large potato 57 10
Wheat germ, toasted, 1 ounce 51 9
Beans, kidney, canned, ½ cup 45 8
Quinoa, cooked, 1 cup 43 8
Milk, 1% fat, 1 cup 43 8
Yogurt, vanilla, nonfat, 1 cup 38 7
Brussels sprouts, boiled, ½ cup 32 6
Broccoli, chopped, boiled, drained, ½ cup 31 6
Cottage cheese, nonfat, 1 cup 26 5
Fish, tuna, white, canned in water, drained in solids, 3 ounces 25 5
Peanuts, dry roasted, ¼ cup 24 4
Cauliflower, 1” pieces, boiled, drained, ½ cup 24 4
Peas, green, boiled, ½ cup 24 4
Sunflower seeds, oil roasted, ¼ cup 19 3
Rice, brown, long-grain, cooked, 1 cup 19 3
Bread, pita, whole wheat, 1 large (6½ inch diameter) 17 3
Cabbage, boiled, ½ cup 15 3
Tangerine (mandarin orange), sections, ½ cup 10 2
Beans, snap, raw, ½ cup 8 1
Kiwifruit, raw, ½ cup sliced 7 1
Carrots, raw, chopped, ½ cup 6 1
Apples, raw, with skin, quartered or chopped, ½ cup 2 0

DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for choline is 550 mg for adults and children age 4 and older. However, the FDA does not require food labels to list choline content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

[/stextbox]

Choline deficiency is rare in the general population. The European Food Safety Authority states there are no Recommended Daily Intakes in the EU and “no indications of inadequate choline intakes available in the EU”.

Dietary Supplements for Choline

Choline is available in dietary supplements containing choline only, in combination with B-complex vitamins, and in some multivitamin/multimineral products [rx]. Typical amounts of choline in dietary supplements range from 10 mg to 250 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.

[stextbox id=’custom’]

The following are choline values for a selection of foods in quantities that people may consume in a day.

Animal and plant foods Food amount (imperial) Food amount (metric) Choline (mg) Choline (mg) in 100g food Calories % of diet to meet AI (smaller is better)
Raw beef liver 5 ounces 142g 473 333 192 9
Cauliflower 1 pound 454g 177 39 104 13
Large egg 1 50g 147 294 78 12
Broccoli 1 pound 454g 182 40 158 19
Cod fish 0.5 pound 227g 190 84 238 28
Spinach 1 pound 454g 113 25 154 30
Wheat germ 1 cup 113g 202 179 432 47
Soybeans, mature, raw 1 cup 186g 216 116 86 51
Milk, 1% fat 1 quart 946mL (976g) 173 18 410 52
Firm tofu 2 cups 504g 142 28 353 55
Sunflower seeds (kernels), raw 1 cup 140 g 77 55 584
Chicken 0.5 pound 227g 150 66 543 80
Cooked kidney beans 2 cups 354g 108 31 450 92
Uncooked quinoa 1 cup 170g 119 70 626 116
Peanuts 1 cup 146g 77 53 828 237
Almonds 1 cup 143g 74 52 822 244

Besides cauliflower, other cruciferous vegetables may also be good sources of choline.

The USDA Nutrients Database has choline content for many foods.

[/stextbox]

Recommended Intakes of Vitamin B4 / Choline

Intake recommendations for choline and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM). DRIs is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and sex, include:

  • Recommended Dietary Allowance (RDA) – Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
  • Adequate Intake (AI) – Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
  • Estimated Average Requirement (EAR) –  Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
  • Tolerable Upper Intake Level (UL) – Maximum daily intake unlikely to cause adverse health effects.



Insufficient data were available to establish an EAR for choline, so the FNB established AIs for all ages that are based on the prevention of liver damage as measured by serum alanine aminotransferase levels. The amount of choline that individuals need is influenced by the amount of methionine, betaine, and folate in the diet; gender; pregnancy; lactation; stage of development; ability to produce choline endogenously; and genetic mutations that affect choline needs.

[stextbox id=’black’]

Adequate Intakes (AIs) for Choline 
Age Male Female Pregnancy Lactation
Birth to 6 months 125 mg/day 125 mg/day
7–12 months 150 mg/day 150 mg/day
1–3 years 200 mg/day 200 mg/day
4–8 years 250 mg/day 250 mg/day
9–13 years 375 mg/day 375 mg/day
14–18 years 550 mg/day 400 mg/day 450 mg/day 550 mg/day
19+ years 550 mg/day 425 mg/day 450 mg/day 550 mg/day

[/stextbox]

Health Benefit of Vitamin B4 / Choline

  • Liver disease caused by exclusive feeding by vein (parenteral nutrition) – Giving choline intravenously (by IV) treats liver disease in people receiving parenteral nutrition who are choline-deficient.
  • Asthma – Taking choline seems to lessen symptoms and the number of days that asthma is a problem for some people. It also seems to reduce the need to use bronchodilators. There is some evidence that higher doses of choline (3 grams daily) might be more effective than lower doses (1.5 grams daily).
  • Neural tube defects – Some research indicates that women who consume a lot of choline in their diet around the time of conception have a lower risk of having babies with a neural tube defect, compared to women with lower intake.
  • Alzheimer’s disease – Taking choline by mouth, alone or together with lecithin, does not reduce symptoms of Alzheimer’s disease.
  • Athletic performance – Taking choline by mouth does not seem to improve athletic performance or lessen fatigue during exercise.
  • A brain condition called cerebellar ataxia – Early research suggests that taking choline by mouth daily might improve motor function in people with a brain condition called cerebellar ataxia. However, other research shows that taking choline does not improve cerebellar ataxia in most people.
  • Memory loss due to age – Taking choline by mouth does not improve memory in older people with memory loss.
  • Schizophrenia – Taking choline by mouth does not reduce symptoms of schizophrenia.
  • Liver disease caused by exclusive feeding by vein (parenteral nutrition).Giving choline intravenously (by IV) treats liver disease in people receiving parenteral nutrition who are choline-deficient.
  • Asthma – Taking choline seems to lessen symptoms and the number of days that asthma is a problem for some people. It also seems to reduce the need to use bronchodilators. There is some evidence that higher doses of choline (3 grams daily) might be more effective than lower doses (1.5 grams daily).
  • Neural tube defects – Some research indicates that women who consume a lot of choline in their diet around the time of conception have a lower risk of having babies with a neural tube defect, compared to women with lower intake.
  • Alzheimer’s disease – Taking choline by mouth, alone or together with lecithin, does not reduce symptoms of Alzheimer’s disease.
  • Athletic performance – Taking choline by mouth does not seem to improve athletic performance or lessen fatigue during exercise.
  • A brain condition called cerebellar ataxia – Early research suggests that taking choline by mouth daily might improve motor function in people with a brain condition called cerebellar ataxia. However, other research shows that taking choline does not improve cerebellar ataxia in most people.
  • Memory loss due to age – Taking choline by mouth does not improve memory in older people with memory loss.
  • Schizophrenia. Taking choline by mouth does not reduce symptoms of schizophrenia.
  • Allergies (hayfever) – Early research suggests that taking a particular type of choline daily for 8 weeks is not as effective as a nasal spray for reducing allergy symptoms.
  • Bipolar disorder – Early research suggests that taking choline might reduce some mood symptoms in people with bipolar disorder who are taking lithium.
  • Bronchitis – Early research suggests that inhaling choline might improve symptoms of bronchitis caused by dust.
  • Mental performance – Early research suggests that taking a single dose of choline does not improve reaction time, reasoning, memory, or other mental functions. Other research suggests choline can improve visual memory, but not other aspects of mental function when given along with intravenous feeding (parenteral nutrition).
  • Seizures – There are reports that taking high doses of choline might be helpful for some people with a type of seizure called complex partial seizures.
  • Early research suggests that taking a particular type of choline daily for 8 weeks is not as effective as a nasal spray for reducing allergy symptoms.
  • Early research suggests that taking choline might reduce some mood symptoms in people with bipolar disorder who are taking lithium.
  • Early research suggests that inhaling choline might improve symptoms of bronchitis caused by dust.
  • Early research suggests that taking a single dose of choline does not improve reaction time, reasoning, memory, or other mental functions. Other research suggests choline can improve visual memory, but not other aspects of mental function when given along with intravenous feeding (parenteral nutrition).
  • There are reports that taking high doses of choline might be helpful for some people with a type of seizure called complex partial seizures.
  • Hepatitis and other liver disorders.
  • Depression.
  • High cholesterol.
  • Huntington’s chorea.
  • Tourette’s syndrome.
  • A crucial component of the neurotransmitter acetylcholine, which is necessary for muscle movement and brain function.
  • The crucial component of phosphatidylcholine which is necessary for cell membrane integrity.
  • The crucial component of sphingomyelin which is found in myelin sheaths (a type of insulating material) that protects and is essential for the proper functioning of the nervous system.
  • Regulates liver function and minimizes excess fat deposits.
  • Necessary for normal fat metabolism.
  • Involved with methylation.
  • Hepatitis and other liver disorders.
  • Depression
  • High cholesterol
  • Huntington’s chorea
  • Tourette’s syndrome


Choline and Healthful Diets

The federal government’s 2015–2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods. Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.”

For more information about building a healthy diet, refer to the Dietary Guidelines for Americansexternal link disclaimer and the U.S. Department of Agriculture’s MyPlate.external link disclaimer

The Dietary Guidelines for Americans describes a healthy eating pattern as one that:

  • Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils.
  • Many vegetables, fruits, whole grains, and dairy products contain choline.
  • Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.
  • Fish, beef, poultry, eggs, and some beans and nuts are rich sources of choline.
  • Limits saturated and trans fats, added sugars, and sodium.
  • Stays within your daily calorie needs.

References

Vitamin B4 / Choline