Expert Q & A

  1. Why haven’t I ever heard of choline?
  2. Does the body make choline?
  3. Is it possible to get too much choline in your diet?
  4. What can I do to prevent choline deficiency while pregnant and/or breast feeding?
  5. What is choline?
  6. What role does choline play in decreasing birth defects?
  7. What are the deficiency symptoms of choline?
  8. What is the best way to meet the Adequate Intake (AI) level for choline?
  9. What are the best food sources of choline and how can I incorporate them into my diet?
  10. Eggs are an excellent source of choline, but should individuals eat only the whites because of the cholesterol in the yolk?
  11. Do infant formulas provide choline?
  12. How do other nutrients interact with choline?
  13. What factors interfere with choline absorption and utilization?
  14. Do choline needs differ for women during different stages of life?
  15. Do choline needs differ for aging adults?
  16. Is it recommended that men consume the same amount of choline as women?
  17. Are there other health benefits of choline?

  1. Why haven’t I ever heard of choline?

Expert Answer: Marie Caudill, PhD, RD
Although the importance of choline in the prevention of fatty liver was recognized over 70 years ago, it was not until 1998 that choline was officially recognized as an essential nutrient. In 1998, the Food and Nutrition Board of the Institute of Medicine established an Adequate Intake (AI) level of 425 and 550 mg/d for women and men respectively. Because the requirement for choline increases during pregnancy and lactation, intake levels of 450 and 550 mg/d are recommended during this time period. Based on food intake data from observational studies, a substantial number of women of childbearing age in the U.S. are not meeting the AI guidelines, and consumer research shows that almost three out of four moms are not familiar with the benefits of choline. Likewise, choline consumption appears inadequate in the majority of the U.S. population, including several groups that can benefit from it the most, such as nursing moms.

Importantly, most regular and prenatal vitamins do not contain adequate choline so it is important to incorporate foods that contain choline in your daily diet. Good dietary sources include eggs, beef, salmon, cauliflower, certain nuts and legumes. Although liver (either beef or chicken) contains high levels of choline, it also contains high levels of Vitamin A which can be harmful to fetuses when consumed in excess.

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  1. Does the body make choline?

Expert Answer: Marie Caudill, PhD, RD
While the body makes some choline, it doesn’t produce enough to supply the amounts the body needs; therefore, we need to get enough choline from the foods we eat. Choline is a particularly important nutrient for pregnant and lactating women and the Adequate Intake (AI) level for these sub-groups is greater than for women who are not pregnant or lactating.

Breastmilk is rich in choline and the body prioritizes choline in breastmilk over circulating choline for the mother. Therefore, identifying choline-rich foods is important for breastfeeding women because, without adequate dietary choline, the choline produced within the body is likely inadequate to meet the mother’s needs.

If you or someone you know is breastfeeding, the important thing to remember is that you should try to consume 550 milligrams of choline per day in your diet. This will ensure that both you and your baby get the amount of choline you need for proper health and development. While breastfeeding, your body will automatically divert choline to your breast milk which may reduce the amount of choline available for the needs of your own body.

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  1. Is it possible to get too much choline in your diet?

Expert Answer: Marie Caudill, PhD, RD
The average dietary choline intake is ~ 300 mg/d and ranges from 100 to 1000 mg. The upper level of tolerance (highest recommended amout) is 3500 mg/d, an amount that likely exceeds what could be provided by food. Choline toxicity may occur with choline supplementation over the upper limit and result in fishy body odor, vomiting, increased salivation, increased sweating and decreased blood pressure.

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  1. What can I do to prevent choline deficiency while pregnant and/or breast feeding?

Expert Answer: Marie Caudill, PhD, RD
Choline is an important nutrient for pregnant and lactating women. In particular, data emerging from animal studies show that choline exposure in utero has beneficial and long lasting effects on brain development and function in the infant. The importance of choline is also suggested by the findings that human babies are born with blood levels that are at least three times higher than the mothers; and breastmilk choline is 10 to 15 times higher.

The best way to meet the Adequate Intake (AI) level (450 milligrams for pregnant women and 550 milligrams for breast feeding women) is to include choline-rich foods in the diet. Most prenatal vitamins and regular multivitamins do not contain choline or provide far less than the AI for choline. Good sources for pregnant and nursing moms are eggs, lean meats, fish and poultry, as well as cauliflower, tofu, nuts and legumes.

  1. Fetal Development, Memory and Cognition
  2. Heart Health
  3. Breast Cancer Risk
  4. Choline Needs and Consumption

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  1. What is choline?

Expert Answer: Steven Zeisel, MD, PhD
Choline is an essential nutrient for humans and is necessary for the normal function of all cells. The importance of choline in the diet begins before birth and extends throughout all stages of life. Choline is critical during fetal development, particularly during the development of the brain, where it can influence neural tube closure and lifelong memory and learning functions. Pregnancy and lactation are critical time periods when adequate choline intake may help prevent lifelong health consequences; it has been demonstrated that prenatal deficiencies of choline have a negative impact on the development of areas in the brain related to learning and memory.

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  1. What role does choline play in decreasing birth defects?

Expert Answer: Kerry-Ann da Costa, PhD
Adequate maternal choline intake is vital to a healthy pregnancy, and the body’s demand for choline is especially high during pregnancy. Like folate, choline intake may be important for preventing neural tube birth defects. Choline is critical to the maturation of cells in the brain during critical periods of fetal and infant brain development. In addition, low intakes of choline are associated with elevated levels of homocysteine, which may be an important risk factor for several adverse pregnancy outcomes, including preeclampsia, premature birth and very low birth weight.i Women with low intakes of dietary choline have four times the risk of having a child with a neural tube defect, compared to women with the highest intakes.ii This research emphasizes the importance for pregnant women to identify and consume choline-rich foods to help decrease the risk of birth defects.

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  1. What are the deficiency symptoms of choline?

Expert Answer: Steven Zeisel, MD, PhD
Although the body can synthesize choline, it cannot synthesize enough to maintain proper health and functioning. If dietary choline is insufficient, it is possible to become deficient in this essential nutrient. Also, a variety of hospital procedures, including total parenteral nutrition (TPN), can cause choline deficiency. Some people have common gene variations that increase the amount of choline they must eat. Dietary choline deficiency can cause men and women to develop signs of fatty liver, liver damage and muscle damage.

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  1. What is the best way to meet the Adequate Intake (AI) level for choline?

Expert Answer: Kerry-Ann da Costa, PhD
The best way to meet the AI (Adequate Intake) level for choline is to include choline-rich foods in the diet. Most prenatal vitamins and regular multivitamins do not contain choline or provide far less than the AI for choline. Excellent food sources include beef liver, eggs and chicken liver. An “excellent” food source provides 20 percent or more of the daily recommended amount of choline per serving. It is important to note that the March of Dimes recommends that pregnant women limit their intake of beef liver and chicken liver due to its high levels of vitamin A, which can be harmful to fetuses when consumed in excess.

Other good sources of choline (foods that provide 10 percent of the daily recommended amount) include lean beef, salmon and cauliflower among other foods. Please refer to the choline chart for information on AI levels for difference populations. The recipe section of this site provides ideas for making choline-rich meals and more recommendations for increasing choline intake.

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  1. What are the best food sources of choline and how can I incorporate them into my diet?

Expert Answer: Elizabeth Ward, MS, RD
It’s easy to get the choline you need from food. Eggs are an excellent sources of choline. Just one large egg satisfies roughly one-quarter of the daily choline needs for women, pregnant women, and a man’s and a nursing mother’s daily choline needs. Beef liver and chicken liver are also excellent sources of choline, however, the March of Dimes recommends that pregnant women limit their intake of beef and chicken liver due to its high levels of vitamin A, which can be harmful to fetuses when consumed in excess. Lean beef, salmon and cauliflower contain enough choline to be considered good sources of choline. The best way to enjoy the choline you need is by eating a balanced diet rich in choline-containing foods.

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  1. Eggs are an excellent source of choline, but should individuals eat only the whites because of the cholesterol in the yolk?

Expert Answer: Kerry-Ann da Costa, PhD
Individuals should eat the whole egg because the yolk contains all of the choline in an egg. In addition, the yolk provides protein and antioxidants. Many Americans have shied away from eggs for fear of dietary cholesterol; however, more than 30 years of research has shown that healthy adults can eat eggs without significantly influencing their risk of heart disease or stroke. Additionally, recent research supports the role of choline in lowering blood homocysteine, a marker of chronic inflammation and cardiovascular disease.

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  1. Do infant formulas provide choline?

Expert Answer: Elizabeth Ward, MS, RD
Yes, infant formulas made in the United States provide choline; however, soy- and casein-derived infant formulas generally contain less choline than human milk unless it is added during processing. The U.S. Food and Drug Administration (FDA) oversees the nutritional content of infant formula and is guided by the Infant Formula Act of 1980, which ensures safety and nutrition.

Choline is central to the development of a child’s brain, especially the hippocampus, which is considered the memory center. According to the Food and Nutrition Board of the National Academy of Sciences, infants from 0 to 5 months old require 125 milligrams of choline every day, while infants ages 6 to 12 months need 150 milligrams.

To determine how much choline a child is receiving from their infant formula, you need to know how much formula that child consumes as well as the concentration of choline in the infant formula. If you have any questions, ask your pediatrician to help you figure out your child’s choline consumption (bring the infant formula label with you!).

But what about mom? Even though she’s not nursing a child, choline is critical for her well-being, too. Several population studies show that choline intake may be linked to a lower risk for breast cancer in women.

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  1. How do other nutrients interact with choline?

Expert Answer: Kerry-Ann da Costa, PhD
Choline is part of a complicated chemical cycle called the SAM cycle (s-adenosyl-methionine cycle), where choline is closely linked to many other nutrients including vitamins B-6, B-12 and folate, as well as amino acids and other molecules. The movement of chemical structures around the SAM cycle is particularly dependent on folate. Therefore, folate deficiency may potentially disrupt the SAM cycle balance, and in turn, choline status.

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  1. What factors interfere with choline absorption and utilization?

Expert Answer: Steven Zeisel, MD, PhD
There is a relationship between folate and choline metabolism in the liver, so folate deficiency may potentially disrupt choline status. Several common factors can cause folate deficiency, from impaired absorption and utilization to increased demand or excretion and alcohol intake.

Certain diseases, such as celiac disease, other malabsorption syndromes and congenital disorders can impair the absorption of folate. Additionally, drugs such as phenytoin, primidone and barbiturates can contribute to folate malabsorption. Also, congenital or acquired enzyme deficiencies can interfere with the utilization of folate, as can “folate antagonists” drugs such as methotrexate (commonly used to treat arthritis and other rheumatic conditions), triamterene (a potassium-sparing diuretic used to treat edema) and trimethoprim (an antibiotic often used to treat urinary tract infections and pneumonia).

Certain stages in the lifecycle, such as infancy, pregnancy and lactation can increase the demand for folate, while renal dialysis can increase the excretion rate of folate. Alcohol intake interferes with folate intake, absorption, metabolism, renal excretion and reabsorption.

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  1. Do choline needs differ for women during different stages of life?

Expert Answer: Elizabeth Ward, MS, RD
Yes, a woman’s choline needs vary with age and life stage. Women ages 19 and older who are not pregnant or nursing require 425 milligrams of choline a day. Pregnancy and nursing increase choline needs to 450 milligrams daily (pregnancy) and 550 milligrams a day (nursing).

Choline is critical throughout pregnancy. In the first month or so, choline helps to reduce the risk of neural tube defects, such as spina bifida. In addition, studies suggest that choline is key to the proper development of the hippocampus, the brain’s memory center, during pregnancy and nursing.

In addition to nourishing a child, women need choline for their own well-being. Several population studies show that choline intake may be linked to a lower risk for breast cancer in women.

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  1. Do choline needs differ for aging adults?

Expert Answer: Elizabeth Ward, MS, RD
Choline is important for people of any age. Many older people do not consume adequate choline. According to a report from the 2007 National Nutrient Data Bank Conference, men and women over the age of 71 consume only an average of 264 milligrams of choline daily – roughly half the recommended level.

Older women and men aren’t the only ones coming up short for choline. Nine out of ten women, including pregnant women, do not consume the recommended adequate intake of choline. Women can easily close the choline consumption gap with a balanced diet that includes choline-rich foods such as beef liver, eggs, chicken liver, lean beef, salmon and cauliflower. However, the March of Dines recommends that pregnant women limit their intake of beef liver and chicken liver due to high levels of vitamin A, which can be harmful to fetuses when consumed in excess.

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  1. Is it recommended that men consume the same amount of choline as women?

Expert Answer: Elizabeth Ward, MS, RD
Men need more choline than women – 550 milligrams a day vs. 425 milligrams a day for women who are not pregnant or nursing. (Nursing women need the same amount of choline as men.)

Studies show that men are not getting the choline they need. In fact, just 1 in 10 men meet their choline quota on a daily basis. To make matters worse, research suggests that men may need even more choline than the current Adequate Intake (AI) level indicates.

Research suggests that aging affects choline requirements. Many older men don’t get enough choline, according to a report from the 2007 National Nutrient Data Bank Conference: men and women over the age of 71 consume, on average, only 264 milligrams of choline daily – roughly half the recommended intake.

Men can easily close the choline gap by choosing a balanced diet that includes choline-rich foods such as eggs, lean beef, cod, salmon, broccoli, cauliflower and wheat germ. For example, one large egg supplies roughly one-quarter of a man’s daily choline needs.

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  1. Are there other health benefits of choline?

Expert Answer: Steven Zeisel, MD, PhD
Choline is well-recognized as a vital nutrient for fetal brain development and memory function, but scientists are beginning to recognize additional health benefits associated with choline, including cardiovascular health and breast cancer prevention. Choline has been shown to play an important role in reducing homocysteine, an amino acid in the blood that may be associated with an increased risk of chronic inflammation, which is associated with heart disease risk. Elevated plasma homocysteine concentrations are also thought to be a risk factor for bone disease, dementia and Alzheimer’s disease.

Also, research suggests that choline consumption is linked to reduced breast cancer risk. A recent study funded by a grant from the National Institutes of Health (NIH) concluded that dietary choline is associated with a 24 percent reduced risk of breast cancer. The research shows that women who consume higher amounts of dietary choline are at a lower risk of developing breast cancer than those who consume the least choline.

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i Vollset S, Refsum H, Irgens L, et al. Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study. Am J Clin Nutr 2000;71:962-968.

ii Shaw G, Carmichael S, Yang W, Selvin S, Schaffer D. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol 2004; 160:102-109.

Research show that only 1 out of 10 women get enough cholineEating Tips for Pregnant MomsHealthcare Professionals : Download Patient Resources Here!