By Karen Kier
Pharmacist on behalf of the ONU HealthWise team

It is believed the idiom “enough to go around” evolved during the 19^th century to describe things like horse racing in which events were done on a circular track. The saying became known for having a sufficient quantity or supply to be shared or distributed. 

Pertaining to choline supplementation, is there enough in our diets to go around or do we need to add more to our daily diet? It depends!

Choline is a very critical substance in the body to help maintain metabolism and cell function.  All plant and animal cells need choline to help with the cell structure and integrity. Choline is necessary for the body to produce acetylcholine. Acetylcholine is an essential neurotransmitter helping nerves (neurons) communicate with muscles, glands, and other tissues. This communication can affect memory, mood, muscle control, lipid (fat) transportation and metabolism, and early brain development in babies. 

Choline is not a substance we routinely measure in the blood to see if we are getting enough with our diets. It can be measured, but mostly for research purposes. The need for choline depends on our age and gender, and is important before and during pregnancy. The National Health & Nutrition Examination Survey (NHANES) indicated those individuals between 2-19 years of age consumed about 256 mg (milligrams) per day of choline. Adult females consumed 278 mg per day compared to adult males who had a high daily consumption at 402 mg per day. 

The need for choline increases as we age. Newborns to 6 months of age require 125 mg per day of choline, while males 14 years and older should consume 500 mg per day.  Women ages 14 years and older should take in 425 to 550 mg per day. Based on the NHANES data, women are falling significantly below the daily recommended choline levels, while men are closer to the daily recommended totals. 

Why is routine choline supplementation not recommended if it is so essential for many functions in the body? The reason is so many foods contain choline that one should be able to get enough choline in their diet. However, NHANES data would indicate some deficiencies exist. 

Choline can be found in multiple food sources with meat, fish, poultry, eggs, nuts, and diary products providing the largest amounts.  One large egg can provide 147 mg of choline and 3 ounces of either chicken or ground beef provides 72 mg. A large potato is a source of 57 mg of choline. About 40 mg can be found in 1 cup of either milk or yogurt.  Seafood such as oysters can be high in choline and 3 ounces of salmon can provide 187 mg. 

Most multivitamins do not contain choline and a supplement would be needed. Choline supplements can be a little tricky to interpret due to the difference forms available.  These forms can include choline bitartrate, choline chloride, choline dihydrogen citrate, citicoline (CDP-Choline), and phosphatidylcholine. It is important to note that not all labels will tell you the salt form used to manufacturer their product. Different salt forms have different absorption levels of choline.

For example, one major brand recommends 800 mg of choline per day taken as 3 capsules.  This is more than the recommended daily choline intake. However, the company uses the salt form of choline bitartrate. The absorption of choline from choline bitartrate is about 40%, so the daily dose absorbed is 320 mg. 

Other salt forms such as citicoline and phosphatidylcholine have much higher absorption rates. Citicoline is usually promoted for brain health, while phosphatidylcholine is promoted for liver health. 

Choline has been studied in various clinical research trials to determine the impact on health. The studies evaluating cardiovascular health have not really proven a strong benefit even though it can help reduce blood pressure and homocysteine levels. Some small observational studies have linked choline to cognitive function in adults showing a potential benefit in brain health. A study from Norway evaluated 2,195 adults between the ages of 70 and 74 years and found those with low choline levels had poorer cognitive function. The Framingham Offspring study done in the U.S. evaluated 1,391 individuals between the ages of 36-83 and found a relationship between high choline blood levels and better verbal and visual memory. 

The most recent evidence indicates significant benefit in women who are considering pregnancy or who are pregnant. Choline is essential during pregnancy for neural tube formation and brain development. Folic acid has been a major focus to help prevent neural tube birth defects and this remains a foundational supplement before pregnancy and during early pregnancy (first trimester). There is recognition now that choline is as important in prenatal and pregnancy care as folic acid in helping with brain and nervous system development. 

Research on choline supplementation during pregnancy shows benefit in all trimesters and even post delivery for the mother and the baby via breastfeeding. Most prenatal vitamins do not contain choline and in those products that do, the amount is usually insufficient. The American College of Obstetrics & Gynecology and the National Institutes of Health recommend 450 mg per day during pregnancy and 550 mg per day while breastfeeding. 

Talk to your healthcare provider or your ONU HealthWise pharmacist to make sure there is enough choline to go around!