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Choline

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Also listed as: Trimethylethanolamine
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Beta-hydroxyethyl trimethylammonium hydroxide, CDP-choline, choline bitartrate, choline chloride, choline citrate, citicholine, citicoline, cytidine 5-diphosphocholine (CDP-choline), intrachol, lecithin, lipotropic factor, PhosChol®, phosphatidylcholine, TRI, tricholine citrate (TRI), trimethyl-beta-hydroxyethylammonium, trimethylethanolamine.
  • Note: Choline should not be confused with choline salicylate, choline magnesium trisalicylate, choline theophyllinate, or succinylcholine. Citicoline is covered in a separate Natural Standard monograph.

Background
  • Choline is an essential nutrient that is made naturally in the body as well as eaten in the diet. The largest source of choline in the diet is egg yolk. Choline may also be found in high amounts in other foods, including liver, peanuts, fish, milk, soybeans, and other beans. Other sources include meat, chicken, and many vegetables.
  • Pure choline is rarely used because of its fishy odor side effect. Choline-containing fatty substances are used in pill or powder form. However, these may cause stomach discomfort. Choline chloride, which comes as a liquid, is sometimes preferred, as it causes less stomach discomfort.
  • Choline is particularly important for fetuses during pregnancy. In addition, choline may help prevent memory loss associated with aging, protect against liver damage, help lower cholesterol, protect against cancer, or relax muscles.
  • Limited clinical research has examined the effects of choline supplementation on brain injury, bronchitis, memory impairment, and tardive dyskinesia. However, more research is needed before conclusions can be made.
  • In 1998, the National Academy of Sciences issued recommended dietary intakes (RDI) for choline, but many American may not be meeting these guidelines. Choline has been discussed in various reviews, including some that describe the importance of choline as a dietary supplement.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Choline is a B-vitamin needed by the body. Reports state that the U.S. Food and Drug Administration (FDA) requires that infant formulas from a source other than cow's milk be supplemented with choline.

A


Choline may help treat asthma when taken by mouth. Choline supplements may decrease the severity and length of asthma symptoms. The need to use other asthma drugs may be reduced. There is some evidence that higher daily doses might be more effective than lower doses daily. Further research is needed before a conclusion can be made.

B


Limited evidence suggests that choline supplementation does not affect symptoms of Alzheimer's disease. More well-designed trials are needed before a conclusion can be made.

C


Limited evidence suggests that supplementation with choline may benefit patients with rapidly cycling bipolar disorder. More well-designed trials are needed before a conclusion can be made.

C


Limited research indicates that early treatment with choline may be safe. When taken in combination with other treatments, choline may benefit patients with brain injuries. Additional research is needed before a conclusion can be made.

C


According to limited research, supplementation with choline may benefit patients with airway inflammation caused by dust. More well-designed trials are needed before a conclusion can be made.

C


Cerebellar ataxic disorders are movement disorders caused by damage to a certain part of the brain. According to limited research, choline may benefit patients with ataxic disorders. More well-designed trials are needed before a conclusion can be made.

C


When taken by mouth, choline may relieve symptoms of hay fever. Further research is needed before a conclusion can be made.

C


According to limited research, choline supplementation may benefit patients with coronary thrombosis (a type of heart disease) and myocardial infarction (heart attack). Better studies are needed before a conclusion can be made.

C


Studies have linked low levels of choline in the body with an increased risk of liver dysfunction, liver cancer, and certain liver disease. Choline has been injected into the vein to treat TPN-associated liver steatosis (fat deposits in the liver) and other liver dysfunction. Research has also studied the effects of choline on symptoms of hepatitis. However, more studies are needed before a conclusion can be made.

C


According to limited research, choline may improve memory loss. However, more studies are needed before a conclusion can be made.

C


Limited research has studied the effects of choline in patients with schizophrenia. Choline may increase depression in schizophrenic patients. More studies are needed before a conclusion can be made.

C


Tardive dyskinesia, a condition in which uncontrolled movements occur, may be caused by certain psychiatric drugs. Limited research has studied the effects of choline for treating symptoms of this movement disorder. More studies are needed before a conclusion can be made.

C


According to limited research, the effect of choline on improving physical performance or delaying tiredness after exercise is lacking. More studies are needed before a conclusion can be made.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Aging, Alzheimer's disease, anaphylaxis inhibition (preventing serious allergic reactions), antioxidant, ataxia (uncontrolled muscle movement due to multiple sclerosis), attention-deficit hyperactivity disorder (ADHD), autism (brain problem), bodybuilding, cancer prevention, cerebral ischemia (lack of blood flow to the brain), cognitive enhancement (improved thinking and learning), concussion (postconcussion symptoms), dementia (early-onset memory loss), depression, dizziness, Friedreich's ataxia (inherited nerve disorder), gallbladder complaints, growth, hemorrhage (loss of blood from veins in the brain), Huntington's chorea/disease, hyperhomocysteinemia (high levels of homocysteine), hyperlipidemia (high cholesterol), inflammation, muscle mass / body mass, muscle relaxant, musculoskeletal conditions (Pisa syndrome), obesity, Parkinson's disease (uncontrolled body movements), post-surgical recovery, psychological conditions (disturbed consciousness), respiratory distress (breathing disorder in newborns), seizures, Tourette's syndrome (nervous system disorder), traumatic brain injury (cranioencephalic), vertigo (dizziness).

Dosing

Adults (18 years and older)

  • In general, adequate choline (400-900 milligrams) can be taken by mouth by eating an "average" diet. However, it is unclear whether a dietary supply of choline is needed at all ages.
  • The U.S. Food and Nutrition Board of the Institute of Medicine recommends that men over the age of 18 years consume 550-3,500 milligrams of choline daily; women aged 18 years old are advised to consume 400-3,000 milligrams of choline daily, while those who are older may consume 425-3,500 milligrams. Pregnant women are advised to consume 450 milligrams of choline daily, while breastfeeding women are advised to consume 550 milligrams daily. Higher doses are not recommended for people with the metabolic disorder trimethylaminuria, kidney disease, liver disease, depression, or Parkinson's disease.
  • For hay fever, 500 milligrams of tricholine citrate has been taken by mouth three times daily for eight weeks.
  • For asthma, 500-1,000 milligrams of choline has been taken by mouth three times daily. Also, 500 milligrams of choline citrate syrup has been taken by mouth three times daily for 18 weeks.
  • For brain injuries, one gram of choline alphoscerate has been injected into the vein daily for 14 days, and then 0.8 grams has been taken by mouth daily for an additional 28 days.
  • For cerebellar ataxia, a movement disorder caused by damage to a certain part of the brain, choline chloride has been taken by mouth for six weeks.
  • For heart disease, 12 grams of choline has been taken by mouth daily.
  • For preventing liver disorders in women, 425 milligrams of choline has been recommended, to be taken by mouth daily. Doses of two grams of choline chloride in combination with total parenteral nutrition (TPN) have been taken by mouth for 24 weeks. Doses of 15 milligrams of choline have been taken by mouth daily.
  • To improve memory, two grams of choline chloride in combination with TPN has been taken by mouth for 24 weeks. Doses of 50 milligrams of choline per kilogram of body weight have been taken my mouth before exercise.
  • For physical endurance, 50 milligrams of choline per milligram of body weight have been taken by mouth before exercise. Doses of 8.425 grams of choline citrate have been taken by mouth before and midway through exercise. Doses of 2.43 grams of a choline bitartrate-containing drink have been taken by mouth one hour after exercise.
  • For the mental disorder schizophrenia, 20 grams of choline chloride has been taken by mouth daily.
  • For dental pain, choline salicylate gel has been applied to the skin.
  • For airway inflammation (bronchitis), 3-5 milliliters of a 20% choline chloride solution has been inhaled once daily for 7-10 days.

Children (under 18 years old)

  • The Committee on Nutrition of the American Academy of Pediatrics recommends that infant formula be fortified with at least seven milligrams choline per 100 kilocalories. The committee advises that children aged 1-8 years avoid taking more than one gram of choline by mouth daily, that children aged 9-13 years avoid more than two grams of choline daily, and that children aged 14-18 years avoid more than three grams of choline by mouth daily.
  • The U.S. Food and Nutrition Board of the Institute of Medicine recommends that infants up to six months old take 125 milligrams of choline by mouth daily, that infants 6-12 months old take 150 milligrams of choline by mouth daily, that children 1-3 years old take 200-1,000 milligrams of choline by mouth daily, that children 4-8 years old take 250-1,000 milligrams of choline by mouth daily, and that children 9-13 years old take 375-2,000 milligrams of choline by mouth daily. Girls 14-18 years old are advised to take 400-3,000 milligrams of choline by mouth daily, while boys 14-18 years old are advised to take 550-3,500 milligrams daily.
  • For infants, choline is recommended to be taken by mouth only from formula, breast milk, and food.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or sensitivity to choline, lecithin, phosphatidylcholine, or products containing these components.

Side Effects and Warnings

  • In general, choline is regarded as safe, and it appears to be well tolerated. However, when taken in high amounts, it may cause agitation, anorexia, constipation (blocked bowel movements), delusions, diarrhea, epilepsy (repeated seizures), fecal incontinence (uncontrolled bowel movements), feelings of hopelessness, fishy odor, gastroenteritis (inflammation of the lining of the stomach), headache, increased saliva flow, insomnia (lack of sleep), movement disorders, nausea, paranoia, respiratory depression (inadequate breathing), severe depression, skin rashes, steatorrhea (excess fat in stools), stomach discomfort, stunted growth, sweating, thoughts of suicide, urinary incontinence (leakage of urine), vertigo (dizziness), and vomiting.
  • Choline may cause low blood pressure. Caution is advised in people taking drugs, herbs, or supplements that lower blood pressure.
  • Choline may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Use cautiously in people taking drugs to lower cholesterol levels.
  • Use cautiously in people with depression, fish odor syndrome, high cholesterol levels, kidney disease, liver disease, or Parkinson's disease.
  • Use cautiously in children and in women who are pregnant or breastfeeding.
  • Avoid using doses of choline at the upper level (UL) intake levels in people with fish odor syndrome, kidney disease, liver disease, or Parkinson's disease.
  • Avoid in people with a known allergy or sensitivity to choline, lecithin, or phosphatidylcholine.

Pregnancy and Breastfeeding

  • Use cautiously in children and in women who are pregnant or breastfeeding. While these individuals may consume choline within the recommended adequate intake (AI) parameters, supplementation outside of dietary intake may not be necessary.
  • The Food and Nutrition Board of the Institute of Medicine of the National Academy of Science states that choline is necessary in prenatal supplementation. During pregnancy, choline taken by the mother may affect brain development in the growing infant.
  • The U.S. Food and Nutrition Board of the Institute of Medicine recommends that pregnant women take 450 milligrams of choline by mouth daily. Breastfeeding women are advised to take 550 milligrams of choline by mouth daily.
  • Taking choline by mouth before becoming pregnant and during early pregnancy may reduce the risk of cleft palate. Low levels of choline in the blood of pregnant women may increase the risk of neural tube defects such as anencephaly (absence of part of the brain) and spina bifida (incomplete closure of backbone and spinal canal).

Interactions

Interactions with Drugs

  • Choline may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Choline may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.
  • Choline may interact with anticholinergics (agents that block the neurotransmitter acetylcholine), caffeine, drugs that lower cholesterol levels, drugs that stimulate the central nervous system, eritadenine, fluoxetine, isoniazid, lithium, methotrexate, methylphenidate, penicillamine, phenothiazine, scopolamine, and selective serotonin reuptake inhibitors (SSRIs).

Interactions with Herbs and Dietary Supplements

  • Choline may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Choline may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.
  • Choline may interact with anticholinergics, antioxidants, betaine, caffeine, carnitine, herbs and supplements that affect heart disease, herbs and supplements that lower cholesterol levels, herbs and supplements that stimulate the central nervous system, lecithin, vitamin A, and vitamin E.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Blusztajn JK. Choline, a vital amine. Science 1998;281(5378):794-795.
  2. Canty DJ, Zeisel SH. Lecithin and choline in human health and disease. Nutr Rev 1994;52(10):327-339.
  3. Das S, Gupta K, Gupta A, et al. Comparison of the efficacy of inhaled budesonide and oral choline in patients with allergic rhinitis. Saudi Med J 2005;26(3):421-424.
  4. Deuster PA, Singh A, Coll R, et al. Choline ingestion does not modify physical or cognitive performance. Mil Med 2002;167(12):1020-1025.
  5. Glunde K, Jacobs MA, Bhujwalla ZM. Choline metabolism in cancer: implications for diagnosis and therapy. Expert Rev Mol Diagn 2006;6(6):821-829.
  6. Ghoshal AK. New insight into the biochemical pathology of liver in choline deficiency. Crit Rev Biochem Mol Biol 1995;30(4):263-273.
  7. Gossel TA, Wuest JR. Natural products: Choline to coenzyme Q10. Nebraska Mortar and Pestle (USA) 2006;69:21-24.
  8. Penry JT, Manore MM. Choline: an important micronutrient for maximal endurance-exercise performance? Int J Sport Nutr Exerc Metab 2008;18(2):191-203.
  9. Sarter M, Parikh V. Choline transporters, cholinergic transmission and cognition. Nat Rev Neurosci 2005;6(1):48-56.
  10. Shaw GM, Carmichael SL, Laurent C, et al. Maternal nutrient intakes and risk of orofacial clefts. Epidemiology 2006;17:285-291.
  11. Shaw GM, Finnell RH, Blom HJ, et al. Choline and risk of neural tube defects in a folate-fortified population. Epidemiology 2009;20(5):714-719.
  12. Tammenmaa IA, McGrath JJ, Sailas E, et al. Cholinergic medication for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev 2002 (3):CD000207.
  13. Tamminga C, Smith RC, Chang S, et al. Depression associated with oral choline. Lancet 1976;2(7991):905.
  14. Zeisel SH. Choline: critical role during fetal development and dietary requirements in adults. Annu Rev Nutr 2006;26:229-250.
  15. Zeisel SH. Choline: needed for normal development of memory. J Am Coll Nutr 2000;19(5 Suppl):528S-531S.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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