Choline, often overlooked in nutrition discussions, plays a fundamental role in maintaining liver and brain health. This essential nutrient, classified as a semi-vitamin, is involved in critical biological processes. Yet, 77% of men and 80% of postmenopausal women have a choline deficiency, which can lead to various health issues.

Why Is Choline Still Little-Known?

Unlike other nutrients such as vitamin C or iron, choline has not benefited from widespread awareness campaigns. It was only recognized as essential relatively late, in 1998. Additionally, its presence in controversial foods like eggs (often avoided due to their cholesterol content) may hinder its popularity.

However, health and nutrition experts are increasingly calling for greater awareness. Choline, often underestimated, deserves a central place in any discussion on nutrition and overall health. In the new dietary american guidelines, Eat Real Food, eggs and meat are presented as very important. Here is why.

The Three Key Functions of Choline

1. Essential Component of Cell Membranes Choline contributes to the formation of phosphatidylcholine, a key component of cell membranes. These membranes protect cells, regulate exchanges, and enable proper functioning. Without sufficient choline intake, cell membranes become less effective, which can impair organ health, particularly the liver.
2. Precursor for Neurotransmitters The brain uses choline to produce acetylcholine, a crucial neurotransmitter for memory, learning, and muscle control. A choline deficiency compromises acetylcholine production, potentially leading to cognitive disorders and affecting vital functions.
3. Support for Liver Health Through Bile Production Choline also supports proper liver function by facilitating bile production, a substance that eliminates waste and breaks down fats. A choline deficiency can cause fat accumulation in the liver, leading to conditions such as non-alcoholic fatty liver disease (NAFLD).

Consequences of Choline Deficiency

Insufficient choline intake can lead to a range of health problems:

1. Liver Issues Deficiency can cause fat buildup in the liver, which may progress to more serious liver diseases, such as fibrosis or cirrhosis.
2. Neurological Disorders By limiting acetylcholine production, a choline deficit can impair cognitive functions, particularly memory and learning. It may also increase the risk of developing neurodegenerative diseases, such as Alzheimer’s.
3. Pregnancy Complications In pregnant women, a lack of choline affects not only their health but also that of their baby. Choline is essential for fetal brain development and plays a role in preventing neural tube defects.

Choline and Liver Health Through Bile Production

Choline is essential for bile production, a substance needed to eliminate fats and toxins from the liver. A healthy liver relies on balanced lipid metabolism, and choline plays a direct role in this process. By facilitating fat export, it prevents their accumulation in liver cells, which can otherwise lead to non-alcoholic fatty liver disease (NAFLD), or “fatty liver disease.”

Without sufficient choline, liver disorders can develop. Studies have shown that individuals on a low-choline diet face an increased risk of liver dysfunction and chronic inflammation.

Choline and Baby’s Development

Research has clearly linked maternal choline intake to fetal cognitive development. A study published in The FASEB Journal (2018) found that high choline levels during pregnancy improved newborns’ cognitive abilities. Choline contributes to the formation of strong brain structures and robust neural circuits, key elements for optimal mental development.

Furthermore, maternal choline deficiency has been associated with increased risks of neural tube defects, including spina bifida. This is why many nutrition experts recommend choline supplementation, especially during the first trimester of pregnancy.

Much research remains to be done, but choline supplements during pregnancy could influence the likelihood of a child developing disorders such as schizophrenia. Beyond mental disorders, its role in brain function is so important that studies have shown children of mothers who did not meet their needs during pregnancy perform worse cognitively—particularly on memory tests—than children whose mothers met their needs. The cognitive difference remained significant up to age 7. Choline is therefore important for mood and brain function throughout life, but also during conception. If you’re planning to have a child, make sure to meet your needs! Your baby will benefit as much as you will.

(Note: A related study—Boeke et al., 2013, published in American Journal of Epidemiology—found that higher maternal choline intake during the second trimester was associated with modestly better visual memory in children at age 7 years.)

Choline and Prevention of Alzheimer’s Disease

Emerging research also highlights choline’s role in preventing Alzheimer’s disease and other neurodegenerative disorders. A 2019 study published in Molecular Psychiatry showed that choline-supplemented mice had improved memory and fewer signs of brain degeneration. These results suggest that choline may reduce amyloid plaque accumulation and curb neuroinflammation, two key factors in Alzheimer’s.

In humans, although data are still limited, promising associations are emerging between higher choline consumption and reduced age-related cognitive decline. Genetics also play a determining role.

Not Everyone Is Equal: The Importance of Genetics

Choline is more than just a nutrient—it’s a fundamental pillar for liver and brain health. Its roles in cell membrane formation, neurotransmitter production, and liver function make it a valuable ally for the body.

However, depending on your genetics, you may have a less efficient choline metabolism, predisposing you even more to deficiency. The PEMT gene, among others, codes for the enzyme that converts choline into its active form, usable by the liver and brain. To find out if you have a risk variant of the PEMT gene, a nutrigenomic test can provide more information. This could help prevent several issues, such as pregnancy complications, gallstones, and Alzheimer’s risk. Sign up for free at the online Passeport Nutrition school to watch the free NUT TALK “Eating According to Your Genes” for more details!

What Are the Recommended Choline Intakes?

Choline needs vary by age, sex, and physiological state. Here are the general recommendations from the Institute of Medicine:

• Adult men: 550 mg/day
• Adult women: 425 mg/day
• Pregnant women: 450–550 mg/day
• Breastfeeding women: 550 mg/day

Unfortunately, a large portion of the global population does not meet these recommendations. Changes in eating habits, such as reduced consumption of animal products, partly explain this deficiency.

For those with higher needs, such as pregnant women, supplementation may be necessary. However, it is recommended to consult a healthcare professional before adding dietary supplements.

Conclusion

If you are a menopausal woman or a man—especially if vegetarian—it would be important to check which gene variant you have, as you may not produce enough choline on your own, and your diet may not suffice. The liver is an organ that shows signs only when very few functional cells remain. Better to prevent than to cure!

It is becoming clear that choline should no longer be ignored. Adopt a choline-rich diet to protect your health today and that of your future children!

(Reference: Boeke, C.E.; Gillman, M.W.; Hughes, M.D.; Rifas-Shiman, S.L.; Villamor, E.; Oken, E. Choline intake during pregnancy and child cognition at age 7 years. Am. J. Epidemiol. 2013, 177, 1338–1347.)