The Choline Chronicles

The Choline Chronicles

Even some of the most health savvy, diligent researchers among us might not be in the loop on choline. After all, it was only acknowledged as a nutrient deserving of a RDA (recommended daily allowance) in 1998. (I know what you’re thinking. Culturally, 1998 feels like eons ago, but in terms of scientific development - and especially in the world of young and rapidly developing nutrition science - that’s fairly recent when it comes to receiving an official, universally recognized stamp of acknowledgement.)  In fact, since choline is so on the “more-recently-discovered-and-focused-on” side, it wouldn’t surprise me if many had never even heard of it!

But it’s time to change that.

And what’s more, it’s pretty crucial to the reproductive vitality of both men and women.

See? (Now, needs differ between the sexes, so we will circle back to that. Keep reading.)

In terms of how we view vital nutrients, think of choline as the new kid in school, just trying to find somewhere to sit in the cafeteria.

Because this organically occurring nutrient functions similarly to several B vitamins, choline is often grouped in with B complexes. If it had been discovered earlier, say, at the turn of the nineteenth century, it likely would’ve been labeled and classified as B [insert very large number]. On the surface, that makes sense: both are key nutrients that affect several vital bodily functions, playing important roles in maintaining healthy brain function and regulating several bodily systems that shuttle nutrients throughout the body.* Both are considered essential nutrients.

And for women, when it comes to pregnancy, choline appears to be involved in many of the same metabolic pathways as folate (B9), including methylation, which suggests, and research supports, that it plays a role in promoting neural tube development (1).*

This is important to take note of, because, reproductive health aside, choline intake can help promote a healthy liver and facilitate cognitive function (2).

The tricky thing about choline, though, is that it’s neither a vitamin nor a mineral.

Call it an identity crisis. It’s hard to lump the nutrient in with another group because it does have its own unique properties and functions. 

(So while choline might hang out with B vitamins from time to time, it doesn’t really consider itself one of them. They don’t align perfectly enough to commit to a seat at the B crowd’s lunch table.)

Choline has a hard time finding a group with which to fully identify because it is so diverse. The human brain and nervous system utilize choline to regulate memory, mood, and muscle control (talk about all-encompassing talents).* Choline is also handy, playing a big part in helping form the membranes that surround the body's cells.*

Considering its power, both men and women need specific amounts of choline, especially if they are conscious of nurturing reproductive health and fertility.

The official RDA for choline currently sits at (3):

Men | 19+ years = 550 mg/day

Women (not pregnant or lactating) | 19+ years = 425 mg/day 

However, since choline is still relatively new, the data used to set that recommendation was fairly weak, based on a depletion-repletion study carried out on adult men & set at a minimum level to support liver function*. So it’s safe to say that individual needs could vary substantially based not only on case-by-case, individual lifestyle factors that we expect while creating RDAs, but simply based upon sex.

In fact, many RDAs are foundationally supported by studies specifically conducted on men. Often, RDAs for women are simply adjusted proportionally/mathematically without further research or evidence that takes anatomical and/or hormonal differences into account. 

When pregnancy and lactation come into play, these figures that were initially estimated for women are again adjusted upwards based upon conjectures of fetal needs. 

Women | Pregnancy = 450 mg/day

Women | Lactation = 550 mg/day

Data from animal models suggest that fetal and infant choline demand is so high that a mother’s stores are significantly depleted during pregnancy and lactation (Nutrition Today, 2018).

In other words, many of the current RDAs for pregnancy and lactation are simply scientific guesses.

This includes choline.

My good friend and brilliant colleague, Lily Nichols, RD, author of Real Food for Pregnancy, ​​has joined me in writing and lecturing on why prenatal nutrition guidelines are in need of a drastic makeover on many an occasion. This is because new studies suggest choline RDAs for pregnant and lactating women should, in reality, be more than double the current RDA (that’s a whopping 930mg over the current value of 450 mg!). While more research is needed, early observations are suggesting that this expanded dose has been linked to supporting cognitive function in infants, supporting placental function, and could possibly promote healthy blood pressure levels in moms (FASEB, 2013; FASEB, 2017).*

The scary part of that equation is, even with the notion of a double RDA dose of choline aside, around 94% of women already do not meet that daily recommended intake. And, per The Choline Information Council, 90% of the entire US population is choline deficient, which means men are also having a hard time ensuring they are getting enough, too (4). 

CHOLINE PERKS 

For both men and women choline can help support normal:

  • Cognitive function
  • Liver health
  • Heart health
  • Physical performance (especially in athletes or those who perform regular, rigorous physical activities)

This is so important to know before trying to conceive so that you can supplement accordingly and focus on incorporating the most choline-dense foods into your diet, like liver, fatty fish, and eggs with yolks! For those stuck in the cholesterol-phobic past, rest easy: the current research shows that most of the cholesterol in our body is made by our liver - it doesn't come from cholesterol we eat (4). Supplementation should be considered for vegan and vegetarian men and women alike. While choline is naturally found in some plant foods, the quantities available pale in comparison to the above listed animal foods. Incorporate what you can into your diet, but be aware that you will likely need to think about how to get more choline from supplemental sources, especially if you are following a vegan or vegetarian diet.

When it comes to fertility, choline specifically supports both men’s and women’s reproductive systems.*

IN MEN

Choline has been studied to support the liver, improving detoxification efforts and reducing oxidative stress.* Additionally, a healthy liver promotes healthy male sexual function overall because the liver is responsible for providing an enormous blood supply to the body.*

Dietary choline may be necessary for the synthesis of certain phospholipids needed to provide reproductive energy for sperm motility. Some studies show that ensuring your choline intake is adequate as little as seven days in advance of beginning to try to conceive may support sperm motility (5), though in my private practice, I suggest analyzing intake and considering supplementation anywhere between 1-3 months prior, depending on the individual and their respective diet since sperm mature over a roughly 3 month period of time.*

IN WOMEN / DURING PREGNANCY

Nutrition science is constantly evolving, and though recommendations on newer and/or understudied nutrients are often made gently, the data on the benefits of choline in regards to pregnancy health and brain development is quite strong.

Studies have demonstrated and repeated that high choline intake during pregnancy and early on in the postnatal period supports baby’s brain health and development. Data from animal studies highlights that adequate choline supply during pregnancy supports fetal DNA and histone methylation, which suggests that a concerted epigenomic mechanism contributes to positive long-term effects in utero (Clin Chem Lab Med, 2013). Human studies are showing similar results and benefits, suggesting that choline also facilitates an energy-efficient transport of nutrients across the placenta (J Nutri, 2017; Metabolism, 2008).* I trust this science because choline is one of the few nutrients that we have numerous randomized controlled trials for, comparing varying degrees of supplementation on pregnancy health and infant outcomes. As discussed above, many of these studies have compared quantities close to the RDA choline intake of 480 mg per day to a much greater one of 930 mg per day. The women receiving 930 mg per day consistently displayed supportive outcomes, as did their babies, and the conclusions keep repeating themselves, heavily pointing to the fact that we need more choline.* 

We have even been able to observe some of the longer term effects of choline. For example, a study of 7 year-old children found that those born to mothers with the highest intake of choline during pregnancy had superior visual memory when compared to those born to mothers with much lower intakes.* 

The takeaway

As a fertility expert, any time I am educating clients or other healthcare practitioners on optimizing nutrition for conception, I tend to always end up spending a significant amount of time on choline. Such a strong consensus of compelling and reinforcing research is uncommon, but there is little debate over choline’s importance, despite its uniqueness and classification-adverse behaviors. Men and women must be aware of how the nutrient not only benefits their own individual bodies, but of how incredibly important it is for the creation of cell membranes, neurotransmission, methyl metabolism, and brain development + tissue expansion for baby.* Throw in the potential benefits of supporting neural tube development, and deciding to focus more on choline intake is a no-brainer.*

FullWell’s prenatal vitamin for women contains a substantial supplementary dose of 300mg, while our Vitality + Virility for men holds 50mg. Incorporating a supplement that contains significant amounts of choline into a focused diet can help ensure you are getting everything you need to keep yourselves healthy and provide the proper nutritional support for your baby, no matter where you are in the conception process.

*The information provided on this website is provided for educational purposes only and should not be treated as medical advice. FullWell makes no guarantees regarding the information provided or how products may work for any individual. If you suffer from a health condition, you should consult your health care practitioner for medical advice and before introducing any new products into your health care regimen. For more information please read out terms and conditions.

REFERENCES

  1. Lisa M. Sanders, PhD, RD and Steven H. Zeisel, MD, PhD. Choline: Dietary Requirements and Role in Brain Development. National Center for Biotechnology Information. Web. Published Aug 2008. Accessed May 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518394/.
  2. Steven H Zeisel, Kerry-Ann da Costa. Choline: an essential nutrient for public health. National Center for Biotechnology Information. Web. Published Nov 2009. Accessed May 2022. https://pubmed.ncbi.nlm.nih.gov/19906248/
  3. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/#h2
  4. Choline: Fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements. Web. Accessed May 2022. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/#h2.
  5. Ask the Doctor: Are eggs risky for heart health? Harvard Health Publishing. Web. Published Dec 2021. Accessed May 2022. https://www.health.harvard.edu/heart-health/are-eggs-risky-for-heart-health.
  6. Zeisel, Steven H. "The fetal origins of memory: the role of dietary choline in optimal brain development."
  7. The Journal of pediatrics 149.5(2006):S131 S136. 1 Shaw, Gary M., et al. "Choline and risk of neural tube defects in a folate fortified population." Epidemiology 20.5(2009):714-719