Choline is a water-soluble nutrient in the vitamin B family that we think is far too little talked about. Red meat, egg yolk, yeast extract, wheat sprouts, legumes, and intestinal food are common and good sources in our diet. It is not classified as vitamin as it can to some extent be created endogenously in the body. However, the body does not produce sufficient amounts, so we have a need for intake through the diet. In the United States, the substance is classified as essential and an estimated 90% of the population receives too little. Although choline is present in our foods, we ask ourselves the question, do we get optimal quantities?
Facts About Choline
- Adequate intake of AI: 400mg / day for an adult (EU) 
- Daily Value DV: 550mg / day for an adult (US) 
- Upper limit UL: 3,500mg / day (US) 
- Low levels lead to fatty liver and liver damage
- Forms the signal substance acetylcholine
- Important for myelin
- High levels have anti-inflammatory properties
- The metabolite phosphatidylcholine accounts for 40-50% of the cell membranes
- Important for fat metabolism
Choline And Our Health
Choline is crucial to our health and plays an essential role in, for example, our fat metabolism, liver health, cardiovascular health, infant development, and our cognitive functions. The substance can be regarded as one of the basic building blocks of our cognition as it forms, among other things, acetylcholine and phosphatidylcholine.
In the diet, it occurs either in free form or in ester form. The most common forms in the diet are phosphatidylcholine (PC), phosphocholine, alpha-gpc, sphingomyelin, citicoline, and free choline. Phospholine, free choline, and alpha-gpc are water-soluble, while phosphatidylcholine and sphingomyelin are fat-soluble. Many of the cholinergic substances are included in the endogenous choline cycle illustrated below.
The liver is the body’s largest gland and a well-functioning liver is extremely important for our health. People with low intake of choline can develop fatty liver and liver damage. Non-alcoholic fatty liver is the most common liver disease in Sweden and affects 15% of the population (20% globally). In people with obesity/obesity it is more common.[4,5]
In one study, healthy adults developed fatty liver when given a diet poor on choline. The symptoms ceased when they received more choline in the diet. Thus, there is a direct link between liver health and choline.
Choline is a precursor to acetylcholine, a neurotransmitter found among other things in the synapses between nerves and muscles. Acetylcholine is important for our cognitive health and impairment is partially caused by low levels. An increased intake of choline has been shown to have positive effects on cognitive functions, partly through increased levels of acetylcholine.
In other words, the levels of acetylcholine can positively affect focus, attention, memory, motivation and decision-making, as well as give better results in training.
Myelin is a vital substance that surrounds and isolates the axon of the nerve cells. Healthy myelin is crucial for our cognitive health and increases the speed of communication of nerve cells. Choline is found in many endogenous substances, including citicoline, which has been shown to increase re-myelination in studies.
Homocysteine is an amino acid containing a thiol and formed by methionine. In recent years, high levels of homocysteine have been noted as a risk factor for cardiovascular disease. The link is not completely clear because it is so complex, but it is being researched in the field. High levels of homocysteine are also a national factor for cancer.
Choline is involved in the metabolism of homocysteine where it is converted into betaine acting as methyl donor. 
Choline As A Dietary Supplement
Deficiency symptoms are very rare, and we theoretically receive sufficient amounts through diet and endogenous production. However, studies show that we probably have a greater need than previously thought.
An increased focus on choline through the diet should provide a stable foundation to cover the basic need and a supplement in addition to it can bring positive health effects. There are many different sources with different good uptake and quality. In order to use a dietary supplement of choline, it is important to choose one with high bioavailability and good quality.
Common variants on the market are choline bitartrate, phosphatidylcholine, citicoline, and alpha-gpc. As a rule of thumb when it comes to dietary supplements, you usually get what you pay for.
A lot of supplements for cognitive health contain choline bitartrate as a choline source. Choline bitartrate contains 41% by weight choline, which makes it one of the most choline-rich substances. Unfortunately, this variant is very difficult to cross the blood-brain barrier, which in practice makes it ineffective in this regard. Choline bitartrate is a typical example where costs are prioritized above quality.
In a study in healthy young men, choline bitrate had no direct effect on memory, although overall plasma levels of choline increased. Choline bitartrate can be taken as a good source of choline for the body and not the brain, so we consider this to be an inferior source of choline for cognitive health.
Phosphatidylcholine (PC) is a phospholipid found in the cell membrane of all our cells, where the incidence is up to 50%. Phosphatidylcholine, which is one of the most common phospholipids, is often equated with lecithin which is not. Choline is a component of phosphatidylcholine which in turn is a component of lecithin.
Although phosphatidylcholine is important for health and cell membrane integrity, too much through the diet can lead to elevated levels of trimethylamine n-oxide (TMAO). TMAO is a risk factor for cardiovascular disease. However, the association of healthy individuals is limited and more evident in patients with diabetes.
A 2017 study found that low levels of phosphatidylcholine are related to Alzheimer’s.
Phosphatidylcholine is fat-soluble and contains around 13% by weight of choline so the substance is no longer dense. Relatively large doses of the substance are required to obtain choline, 3 grams corresponding to 400 mg of choline. Although phosphatidylcholine is both important and useful, there are better alternatives, especially in terms of cognitive health.
Citicoline (CDP-choline) is a very popular dietary supplement for cognitive health and one of the highest quality products. Citicoline contains 18% by weight of choline but consists not only of choline but also of cytidine. Cytidine is a precursor to uridine that is important for brain health.
Although citicoline only contains 18% by weight, the combination with cytidine is powerful and effective, especially when it comes to the cognitive functions where it strengthens the synapses and neurons. Cytidine itself has strong nootropic effects.
Alpha-gpc (glycerylphosphorylcholine) is a phospholipid metabolite naturally occurring in the brain and found in foods such as liver, soy, milk and red meat. Alpha-GPC contains 40% choline and easily crosses the blood-brain barrier, making it one of the best and fastest-acting choline sources.
In a pilot study, it has also been seen that alpha-gpc can contribute to increased training performance and the subject is popular among athletes and in fitness environments.
As we have seen, choline is an important topic for our health, not least for our cognitive health. It is not a nutrient you usually think of in your diet, but we want to change that. It is relatively common in our foods in various forms, but a larger daily intake and an increased awareness probably won’t hurt.
If you feel the diet may not meet your needs, there are many good supplements. If you intend to use a choline supplement, it is of high importance to consider whether it is for health in general or if it is for cognitive health. Generally, you run no risk of overdosing on choline, the upper daily limit in the US is 3.5 grams and probably a conscious strategy is needed to achieve these amounts.
Because of its important function in the development of the fetus, pregnant women have an increased need and are at greater risk of deficits, whereby an increased focus should be considered.
A daily dose contains 150mg of pure choline and can be a good supplement to the diet.
As always, we want to point out that looking after your health, in general, is important, and if you suffer from any medical condition you should consult your doctor if you intend to use a dietary supplement.
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Braingineers develop innovative and effective, high quality supplements for primarily cognitive health. Our attitude is that the body has an innate ability to regulate our functions that can be supported, restored and optimized.
Our products are designed to help the body regulate its own biochemistry and achieve balance. Our goal is to support the integrity of the internal processes to make them more robust and better functioning over time, providing benefits even after discontinued use.