Choline

Dr. med. Heinz Lüscher

A vitamin-like micronutrient

Choline is a vitaminoid, i.e. a vitamin-like substance. It used to be called vitamin B4, but it was only later discovered that it is not a classic vitamin. In contrast to vitamins, the body can synthesise it itself, at least in certain quantities (semi-essential). However, it is still necessary to obtain it from food. Choline is often mentioned together with the B vitamins, as it fulfils similar metabolic functions and there is a close interaction. The micronutrient owes its “new” name to the ancient Greek word for bile. It was detected and analysed in pig bile in 1862 by the German chemist Adolph Friedrich Ludwig Strecker, which led to the re-evaluation of vitamin B4 and ultimately to its renaming as choline. The substance is found in varying amounts in a variety of foods. Larger amounts are mainly found in animal foods, especially eggs, meat (liver) and sea fish. It is also found in smaller quantities in certain pulses, cereals, nuts and vegetables.

Functions of choline

Formation of cell membranes

It is important for the structure of cell membranes because it is a component of certain phospholipids (fat molecules), in particular phosphatidylcholine (lecithin). These ensure that the membrane is stable and at the same time flexible enough to allow substances to pass in and out. It is also a component of sphingomyelin. This fat helps to organise certain areas in the membrane that are important for signals in the cell. It is a central component of myelin sheaths, which envelop nerve cells and accelerate the transmission of nerve signals. In short, without the micronutrient, cell membranes could not function properly, which is important for the health of cells and the body as a whole.

Support for the brain and nervous system

Choline is a building block of the neurotransmitter acetylcholine. This has numerous functions in the central and peripheral nervous system. Acetylcholine plays a role in cognitive functions such as memory, attention, learning ability and concentration. It also promotes neuroplasticity, i.e. the brain’s ability to regenerate itself. It is also essential for the brain development of unborn babies and can reduce the risk of neural tube defects (e.g. spina bifida). Acetylcholine also ensures the transmission of stimuli from motor nerves to the skeletal muscles. It is also an important neurotransmitter in the autonomic nervous system, which regulates unconscious processes such as breathing, heart function, (energy) metabolism, the immune system and digestion.

Fat metabolism and liver health

It is important for fat metabolism in the liver. Choline builds up phosphatidylcholine, which helps to break down fats in the liver, thereby preventing fatty liver disease (fatty liver or steatosis hepatis). Fatty liver is very common in our latitudes.

DNA synthesis and cell growth

Choline is crucial for DNA synthesis as it supports methyl metabolism. As a result, it ensures DNA methylation, influences purine and pyrimidine synthesis* and protects DNA from damage. A choline deficiency can therefore have a negative impact on cell division and gene expression*.

*Explanation of terms:

Methyl metabolism is a central biochemical process in which methyl groups are transferred between molecules. Methyl groups (-CH3) consist of a central carbon atom bonded to three hydrogen atoms. They are highly stable and are not active even in the presence of very strong acids or bases. Nevertheless, they can be involved in reactions that convert the entire functional group into another compound, in a process known as methylation. These methylations influence numerous biological functions, including DNA synthesis and gene regulation. Methylation of DNA involves the transfer of methyl groups to specific DNA bases. It is an important epigenetic change. DNA methylation is like an “on/off switch” for genes – it decides which genes are active and which are not.

Purine synthesis and pyrimidine synthesis are both essential for DNA and RNA synthesis.

In gene expression, the genetic information in a gene is used to produce a functional product, usually a protein.

Cardiovascular health

It plays an important role in homocysteine metabolism and supports healthy blood lipid regulation. Homocysteine metabolism is a process that takes place in the body in which the amino acid homocysteine, which is produced when the amino acid methionine is broken down, is converted. Excessive homocysteine levels in the blood are associated with an increased risk of cardiovascular disease. The body prevents high homocysteine levels by either converting homocysteine back into methionine – which requires vitamin B12 and folic acid. Or it is broken down into cysteine – for which the body needs vitamin B6.

Choline is converted in the body to betaine, which acts as a methyl group donor. This allows homocysteine to be recycled into methionine via an alternative route – independently of folic acid and vitamin B12. This means that it can help to reduce elevated homocysteine levels, even if there is a deficiency of folic acid or vitamin B12.

If you are interested in the metabolic pathway of choline in more detail, you will find a clear illustration here.

Choline deficiency

A pronounced deficiency is rather rare, as our liver has the ability to produce certain amounts of choline itself, provided the necessary building materials are available and liver function is unrestricted.

The most common cause of a deficiency is insufficient intake through food and an increased requirement. During pregnancy and breastfeeding, after the menopause or during intensive physical activity, the requirement increases and the intake should therefore be increased. Diseases that impair liver function or fat metabolism, as well as alcohol abuse, can also increase the risk of a deficiency. People who have to be fed intravenously for long periods also suffer from choline deficiencies.

Possible effects of a choline deficiency are:

• cognitive dysfunctions, memory and concentration problems
• Liver problems (especially fatty liver)
• Muscle weakness or damage
• Lower endurance in athletes
• Developmental delays in foetuses

Indications

Choline can be used for various diseases and their prevention.

Some examples:

• Neurological diseases, e.g. multiple sclerosis, Parkinson’s disease
• Liver diseases, e.g. non-alcoholic fatty liver, fatty liver inflammation
• Cardiovascular diseases
• Cognitive diseases, e.g. Alzheimer’s, dementia
• Asthma and hay fever*

*Asthma and hay fever

Asthma patients can benefit if they supplement with choline in addition to their asthma medication. It can lead to a reduction in symptoms and bronchial hyperreactivity. Choline can also alleviate hay fever symptoms.

This is because, as already described, choline is a building block of the neurotransmitter acetylcholine. While acetylcholine can trigger bronchoconstriction via the parasympathetic nervous system (which is why so-called anticholinergics are used for asthma), there is also evidence that choline as a nutrient can have positive effects on asthma. On the one hand as an anti-inflammatory; as a precursor of acetylcholine, choline also has an anti-inflammatory effect via the so-called “cholinergic anti-inflammatory signalling pathway”. On the other hand, as a building block for cell membranes, it can also stabilise the lung barrier and reduce the excessive reaction to allergens or irritants. It can also help to regulate excessive mucus production, which is often a problem in asthma.

Supplementation with choline can also be useful in the following situations:

• Increasing muscle performance in sport
• Pregnancy and foetal development

Suitable products

I recommend a product that combines the two expensive but high-quality forms of choline, choline bitartrate and CDP choline. It also contains phosphatidylserine and the B vitamins vitamin B3, pantothenic acid, vitamin B6, folic acid and vitamin B12.

Choline bitartrate combines choline with tartaric acid (bitartrate) to improve bioavailability.

CDP-choline, also known as citicoline (cytidine-5′-diphosphocholine), is a particularly effective form of choline that is split into choline and cytidine in the body. These substances are required for the production of acetylcholine and phospholipids. CDP-choline is even more bioavailable than choline bitartrate. It is particularly recommended for brain function, neuroprotection and to increase energy.

Phosphatidylserine is an essential phospholipid that is found in high concentrations in the cell membranes of the brain. It complements the effect of choline as an important component of the cell membrane and regulates the release of acetylcholine. It improves cognitive performance and communication between nerve cells, lowers cortisol levels (stress hormone) and thus protects the muscles and testosterone levels.

The B vitamins are an ideal supplement because they work very closely with choline. They also support the breakdown of homocysteine to methionine and have other similar functions to choline and support, for example:

• the function of the nervous system
• the psychological function
• the energy metabolism
• the synthesis and metabolism of steroid hormones, vitamin D and some neurotransmitters
• the function in cell division

Dosage recommendation

I recommend a daily dose of 630 mg choline bitartrate, 500 mg CDP choline and 250 mg phosphatidylserine (take 3 capsules throughout the day with sufficient liquid).

More information

More detailed information on choline: https://www.orthoknowledge.eu/artikel/cholin

Studies

Choline: An important nutrient for public health: https://pmc.ncbi.nlm.nih.gov/articles/PMC2782876/#S12

Liver health:

Higher dietary choline intake is associated with a lower risk of non-alcoholic fatty liver disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC4230213/

Long-term parenteral nutrition as a cause of fatty liver can be remedied by intravenous choline supplementation:

https://pubmed.ncbi.nlm.nih.gov/7590654

https://pubmed.ncbi.nlm.nih.gov/11531217

Brain and nervous system:

Crucial role of choline metabolites in remyelination: https://pubmed.ncbi.nlm.nih.gov/25524711/

Supplementation with B vitamins and choline increases neuroplasticity and recovery after a stroke: https://pubmed.ncbi.nlm.nih.gov/28396257/

Positive effects of postnatal choline supplementation on long-term neurocognitive deficits due to fetal-neonatal iron deficiency: https://pubmed.ncbi.nlm.nih.gov/28811181/

Seizure-related memory impairment is reduced by choline supplementation before or after an epileptic seizure: https://pubmed.ncbi.nlm.nih.gov/11823105/

Pregnancy and breastfeeding:

Maternal choline supplementation: a nutritional approach to improving offspring health: https://pubmed.ncbi.nlm.nih.gov/24680198/