The Benefits of Choline and Why Your Brain Needs It

Choline is a crucial nutrient for cognition and healthy aging. However, it isn’t very well-known — it wasn’t even recognized as an essential nutrient until 1998 when researchers began to realize its importance in fetal and infant brain development. 

Now, choline is researched for its wide-reaching benefits throughout the entire life cycle, including protecting the health and integrity of the brain in older age. 

In this article, learn more about this vitamin-like nutrient, including what foods contain choline, the benefits of choline to your brain, and the best way to supplement with it.

What Does Choline Do in the Body? 

Although choline is not technically a vitamin, it behaves very similarly to those in the B-vitamin family. Our bodies can produce a small amount of choline, but we need to get most of it through food or supplements. 

It’s rare to be completely deficient in choline, but low or inadequate levels are widespread, impacting brain health as we age. It’s estimated that only 10% of Americans consume the recommended amount of choline each day, which is 425 mg for women and 550 mg for men.

Choline is needed to synthesize phospholipids, which are fats that comprise the majority of our cell membranes. The most common choline-containing phospholipid is phosphatidylcholine, which accounts for about 95% of the choline in our tissues. This means that choline is a crucial component of maintaining the structure and integrity of cell membranes. 

Additional functions of choline include its involvement in cell signaling, fat transport and metabolism, and neurotransmitter synthesis. Choline is a precursor to acetylcholine, a neurotransmitter responsible for muscle contractions, pain responses, and memory regulation and circadian rhythm. 

What Foods Have Choline?

Choline is found in higher amounts in animal foods than plant foods, with the best food sources being egg yolks, liver, and seafood. Good plant sources of choline include Brussels sprouts, soybeans, and broccoli. For reference, approximately four egg yolks would supply the recommended daily choline needs for men, while almost nine cups of Brussels sprouts would be needed to provide the same amount.

The 4 Brain-Boosting Benefits of Choline

From the gestation period to the geriatric years, choline is a necessary nutrient for healthy brain function. In animal and human studies, choline has shown neuroprotective abilities, especially with improving memory and cognitive function. Research has also linked choline to improved outcomes after a stroke and a reduced risk of developing neurodegenerative diseases. 

1. Linked to Improved Memory and Cognitive Function

The majority of choline’s benefits to the brain are due to its synthesis of phosphatidylcholine in cell membranes, including the membranes of brain cells like neurons and glial cells. 

In addition, acetylcholine is necessary for preventing the loss of cholinergic neurons; dysfunction or reduction of these choline-requiring nerve cells is a leading cause of impairment in attention, memory, and learning. 

A study of healthy adults, published in December 2011 in the American Journal of Clinical Nutrition, found that those who consumed more dietary choline had better verbal and visual memory test scores. Also, those who consumed more choline had a reduction in the presence of white-matter hyperintensity, which is a common finding in patients with cognitive impairment. 

In a review published in April 2005 in the Cochrane Database of Systematic Reviews, results from 14 studies looking at CDP-choline (a precursor to phosphatidylcholine) and cognition were analyzed. The researchers concluded that short- or medium-term CDP-choline supplementation is associated with improved memory and behavior in adults with cognitive deficits.

2. May Reduce the Risk of Neurodegenerative Disease

In addition to its role in promoting neurotransmitter synthesis, choline also functions as a methyl donor; disruptions in methylation pathways are implicated in Alzheimer’s disease (AD). 

In a study published in Aging Cell in December 2019, researchers gave choline supplements to mice who were genetically susceptible to developing AD. They found that lifelong choline supplementation was linked to significantly reduced amyloid-beta plaque buildup in their brains, which is a classic indicator of AD. 

In those mice, choline also improved spatial memory and reduced the overactivation of microglial cells. Although microglial cells are crucial for brain health, chronic activation is associated with neuroinflammation, neuronal death, and AD progression. 

A study published in February 2014 in Neurobiology of Aging analyzed the plasma from three groups: people with AD, people with mild cognitive impairment, and age-matched controls. The researchers found that plasma phosphatidylcholine was significantly reduced in patients with AD compared to the other two groups. 

As several pharmaceutical medications for AD are cholinergic drugs that mimic acetylcholine’s actions, it seems likely that choline supplementation would provide similar effects. However, long-term clinical trials with humans have not yet been done.

3. May Improve Recovery After Stroke

According to the Centers for Disease Control and Prevention, it’s estimated that one out of every four survivors of stroke will go on to have another one. Therefore, it’s essential to consider ways to improve post-stroke outcomes and reduce this risk of recurrence. 

In an animal study, rats given choline supplementation after having ischemic strokes had significant improvements in neurological deficits and nerve cell loss, compared to rats receiving the control drug. As ischemic strokes tend to have high disability rates, choline may be a simple way to protect the brain in a recovery setting. 

In addition to improving stroke recovery, consuming enough choline may help prevent an initial stroke incidence. A prospective cohort study, published in February 2018 in the European Journal of Nutrition, found that African Americans with the highest dietary choline intake levels experienced the lowest incidence of ischemic stroke during the 9-year follow-up period.

4. Reduces Neuroinflammation

Lastly, choline has been found to reduce inflammation and oxidative stress in the brain, both of which are risk factors for neurodegenerative disorders. 

The link between choline and neuroinflammation involves homocysteine, an amino acid associated with an increased risk of dementia when its levels are elevated. High homocysteine promotes oxidative stress and neuronal cell death. 

As discussed in a September 2013 review published in Nutrients, choline acts as the methyl donor in one of the pathways that convert homocysteine into methionine. This conversion effectively reduces levels of circulating homocysteine and, therefore, its neuroinflammatory potential. 

Choline Supplements and Safety 

If you are vegan, vegetarian, or don’t tend to consume choline-rich foods daily, a supplemental form may be beneficial. 

There are many forms of supplemental choline, including CDP-choline (also known as citicoline) and Alpha-GPC (L-Alpha glycerylphosphorylcholine), which can cross the blood-brain barrier. 

Many choline supplements are made of choline salts, which include choline chloride and choline bitartrate. However, choline salts do not cross the blood-brain barrier in humans and are likely not as effective. 

Phosphatidylcholine is also available as a supplement, although choline is not concentrated in this form, with only about 13% choline by weight. 

Choline supplements are generally considered safe, although high doses over 10,000 mg per day are associated with a fishy body odor, vomiting, salivation, and sweating. The tolerable upper intake level (UL) for adults is currently set at 3,500 mg per day. 

Key Takeaway: 

• Choline is necessary for maintaining cell membrane integrity, acetylcholine synthesis, and reducing neuroinflammation.
• Consuming high amounts of dietary or supplemental choline is associated with better memory, cognition, and recovery after stroke and reducing the risk of neurodegenerative diseases. 
• The best food sources of choline are egg yolks, seafood, and liver; supplemental forms are also easily accessible. 

References:

Blusztajn JK, Slack BE, Mellott TJ. Neuroprotective Actions of Dietary Choline. Nutrients. 2017;9(8):815. Published 2017 Jul 28. doi:10.3390/nu9080815

“Choline.” Linus Pauling Institute, 23 Mar. 2020, www.lpi.oregonstate.edu/mic/other-nutrients/choline.

Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst Rev. 2005;(2):CD000269. Published 2005 Apr 18. doi:10.1002/14651858.CD000269.pub3

Hampel H, Mesulam MM, Cuello AC, et al. The cholinergic system in the pathophysiology and treatment of Alzheimer's disease. Brain. 2018;141(7):1917-1933. doi:10.1093/brain/awy132

Jin X, Wang RH, Wang H, Long CL, Wang H. Brain protection against ischemic stroke using choline as a new molecular bypass treatment. Acta Pharmacol Sin. 2015;36(12):1416-1425. doi:10.1038/aps.2015.104

Millard HR, Musani SK, Dibaba DT, et al. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study. Eur J Nutr. 2018;57(1):51-60. doi:10.1007/s00394-016-1296-8

Obeid R. The metabolic burden of methyl donor deficiency with focus on the betaine homocysteine methyltransferase pathway. Nutrients. 2013;5(9):3481-3495. Published 2013 Sep 9. doi:10.3390/nu5093481

Poly C, Massaro JM, Seshadri S, et al. The relation of dietary choline to cognitive performance and white-matter hyperintensity in the Framingham Offspring Cohort. Am J Clin Nutr. 2011;94(6):1584-1591. doi:10.3945/ajcn.110.008938

“Recovering From Stroke.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 31 Jan. 2020, www.cdc.gov/stroke/recovery.htm .

Velazquez R, Ferreira E, Knowles S, et al. Lifelong choline supplementation ameliorates Alzheimer's disease pathology and associated cognitive deficits by attenuating microglia activation. Aging Cell. 2019;18(6):e13037. doi:10.1111/acel.13037

Wallace TC, Blusztajn JK, Caudill MA, et al. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today. 2018;53(6):240-253. doi:10.1097/NT.0000000000000302

Whiley L, Sen A, Heaton J, et al. Evidence of altered phosphatidylcholine metabolism in Alzheimer's disease. Neurobiol Aging. 2014;35(2):271-278. doi:10.1016/j.neurobiolaging.2013.08.001