If you’re eating for brain health, your regular diet likely includes polyphenol-rich berries, lutein-rich leafy greens, and omega-3s from oily fish.
But your diet may be missing choline-rich foods like soybeans, eggs, red potatoes, and kidney beans. Adequate intake of this B-like vitamin has been linked to better cognitive performance and, more recently, a reduced risk of Alzheimer’s dementia.
Here’s what you need to know about this underconsumed nutrient and its benefits for brain health and beyond—and how to get an adequate amount in your diet.
Choline Basics
Although choline is not a vitamin, it is classified as a B vitamin due to some similar functions. While your liver produces a small amount of choline, most of your body’s choline must come from food.
Choline is vital for the proper functioning of the brain and nervous system. It is used to build strong cell membranes and the fatty sheath that protects nerve fibers.
Choline is also needed to produce acetylcholine, a brain chemical (neurotransmitter) important for memory, mood, circadian rhythm, and muscle control.
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 higher (vs. lower) choline intake during pregnancy is associated with cognitive benefits in infants and young children.
Two large observational studies have also linked higher choline intake to better performance on memory tasks in healthy adults.
However, the effect of choline on the risk of dementia has been unclear. A large study from Finland in 2019 reported a significantly reduced risk of dementia with higher intakes of phosphatidylcholine, the most common dietary source of choline.
A new study, published Aug. 2 in the American Journal of Clinical Nutrition, examined the link between choline intake and the risk of developing Alzheimer’s dementia in 3,224 adults. The participants, mean 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 to intakes between 216 mg and 552 mg. The researchers considered risk factors such as age, gender, education, BMI, dietary patterns, alcohol consumption, smoking and physical activity.
choline and liver health
Choline is important in transporting fat stored in the liver to other parts of the body where it is 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 is not known to what extent suboptimal choline intake contributes to NAFLD in healthy people. A 2014 observational study from China linked low choline intake to a higher risk of NAFLD in both men and women.
A 2012 US study from the Johns Hopkins School of Medicine showed that inadequate choline intake was associated with more liver fibrosis in postmenopausal women. Fibrosis occurs in NAFLD when excessive scar tissue builds up in the liver.
There is little data on the use of choline to treat NAFLD.
How much, what food
The recommendations for taking choline are based on the prevention of liver damage.
Adults 19 years and older are recommended to consume 550 mg of choline daily; Women should get 425 mg. During pregnancy and lactation, the recommended daily intake of choline increases to 450 mg and 550 mg, respectively.
The richest dietary sources of choline are animal foods, including eggs (147 mg per 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 provide about 40 mg per cup.
Plant sources include soybeans (107 mg per 1/2 cup), kidney beans (51 mg per 1/2 cup), chickpeas, red potatoes, quinoa, Brussels sprouts, broccoli, shiitake mushrooms, cauliflower, peanuts, and green peas.
Who is at risk of not getting enough?
Most US adults consume less than the recommended daily allowance for choline. There is no consumption data for Canadian adults, but studies suggest pregnant women and young children are not getting enough.
Pregnant women are particularly at risk for choline deficiency, both because they eat too little food and because prenatal multivitamins contain little or no choline.
About choline supplements
A varied diet should provide enough choline for most people. However, pregnant women and people on a vegan diet may benefit from supplementation.
Choline supplements are available as citicoline, choline chloride, and choline bitartrate. Phosphatidylcholine supplements contain only 13% choline by weight.
As always, consult your doctor for safe use of supplements.
Leslie Beck, a Toronto-based nutritionist in private practice, is Medcan’s director of food and nutrition. Follow her on Twitter @LeslieBeckRD
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