Why choline belongs in a brain-friendly diet

If you’re eating for brain health, your regular menu is likely home to polyphenol-packed berries, lutein-rich leafy greens and omega-3s from oily fish.

But your menu might be missing foods rich in choline, such as soybeans, eggs, red potatoes and kidney beans. Consuming enough of this B-like vitamin has been tied 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 a sufficient amount in your diet.

Choline basics

While not a vitamin, choline is grouped with the B vitamins owing to some of their similar functions. While your liver makes a small amount of choline, most of your body’s choline must come from diet.

Choline is vital for the proper functioning of the brain and nervous system. It’s used to build strong cell membranes and the fatty sheath that protects nerve fibres.

Choline is also needed to produce acetylcholine, a brain chemical (neurotransmitter) important for memory, mood, circadian rhythm and muscle control.

An adequate intake of choline also helps maintain liver health.

Choline and brain health

Choline plays an important role in early brain development. Some, but not all, studies have found that a 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 of memory tasks in healthy adults.

The effect of choline on dementia risk, however, has been unclear. A large study out of Finland in 2019 reported a significantly lower dementia risk 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 risk of developing Alzheimer’s dementia among 3,224 adults. Participants, average age 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 with an intake between 216 mg and 552 mg. The researchers accounted for risk factors such as age, sex, education, BMI, dietary pattern, 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’s used for energy and other functions. Without choline, fat and cholesterol build up in the liver and can lead to non-alcoholic fatty liver disease (NAFLD).

It’s not known to what extent a suboptimal choline intake contributes to NAFLD in healthy people. An observational study from China from 2014 tied a low choline intake to a greater risk of NAFLD in men and women.

A US study in 2012 from Johns Hopkins School of Medicine showed that an inadequate choline intake was associated with more liver fibrosis in post-menopausal women. Fibrosis occurs in NAFLD when excessive amounts of scar tissue build up in the liver.

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

How much, which foods

Choline intake recommendations are based on preventing liver damage.

For adults aged 19 and older, males are advised to consume 550 mg of choline a day; females should get 425 mg. During pregnancy and breastfeeding, daily recommended choline intakes increase to 450 mg and 550 mg, respectively.

The richest food sources of choline are animal foods including eggs (147 mg per one 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 supply about 40 mg per one cup.

Plant sources include soybeans (107 mg per half-cup), kidney beans (51 mg per half-cup), chickpeas, red potatoes, quinoa, Brussels sprouts, broccoli, shiitake mushrooms, cauliflower, peanuts and green peas.

Who’s at risk of getting too little

Most US adults consume less than the recommended daily intake for choline. There aren’t 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 inadequacy, both from consuming too little from foods 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 who follow a vegan diet, however, may benefit from a supplement.

Supplements of choline are available as citicoline, choline chloride and choline bitartrate. Phosphatidylcholine supplements contain only 13 per cent choline by weight.

As always, consult your health care provider about using supplements safely.

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

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