A macronutrient I have been obsessed with recently is choline. It is something I have been personally taking since pregnancy and into my bub’s first year, and using more and more in clinical practice of which I’ll explain why.

Its role in the body ranges from liver function, gall bladder support, nerve support, DNA production and brain and memory development.

A water soluble nutrient, choline is found naturally in the form of phosphatidylcholine, which is actually a structural component of fat, found in foods such as peanut butter, liver, eggs and cauliflower. The body also has a way of producing choline though this cannot always be relied upon, which I’ll explain below, and many individuals are suffering from deficiency due to dietary restriction, higher demand, reduced ability to absorb and utilise fats from food, gall bladder problems or liver issues.

So lets talk about choline’s importance in a little more detail.

Pregnancy and Postpartum

Choline requirements increase in pregnancy to support the production, growth and integrity of new cells (the baby), as choline is a major component of our cell membranes. Choline also plays a vital role in memory and the brain and with baby’s brain undergoing rapid growth it is obviously in very high demand.  With an ability to travel across the placenta, liver stores of choline are seen to be depleted in pregnant women when compared with non pregnant women eating the same diet. This makes pregnant women more vulnerable to deficiency and I believe plays a role in the classic baby brain picture! Studies have also shown higher risk of developmental problems in children of choline deficient mothers.

This effect is carried over to breastfeeding as well.  Choline is a major nutrient within breast milk, for similar reasons to the above, supporting the growth and development of baby’s brain and cells, amongst other things. Research has shown that a woman’s choline demands are even higher during lactation with blood levels of choline in infants up to three times higher than maternal levels putting women at very high risk of deficiency post partum.

In rat studies, pups of mothers supplemented with choline even showed better memory function, potentially due to choline’s involvement in the development of synapses in the brain. The body has an ability to make choline with oestrogen being a key player in the ability to ramp up production. When oestrogen levels drop post partum, so does endogenous production meaning dietary and supplemental sources are of even higher importance.

Given oestrogen is the biggest stimulator of our body’s own ability to make choline means there are two very vulnerable times in a woman life. Menopause when natural oestrogen levels diminish and post partum when levels drop to basically menopause levels and are kept low by the production of prolactin (required to produce breastmilk). Add to this what the baby needs and you can see why breastfeeding women are at very high risk of deficiency negatively effecting memory, digestion and potentially mood.

Brain Function

Our brain is predominately made of fat and when it comes to fat, the old expression of you are what you eat has never been more true. Each of our cells are enclosed within a membrane made up of lipids (fats) and when our cells regenerate, fat is required and the body will seek out what is available for the process. If that is deep fried fast food, then this is what the body will use.

The important, well known healthy fats are the omega 3 group coming predominately from oily fish. The major fatty acids in fish oil is eicosapentaenoic acid (EPA), well known for its anti inflammatory effects, and Docosahexaenoic acid (DHA) which actually has a more crucial role in brain development and cell membranes especially in the nervous system.

Comparatively, choline has been shown to have a similar role as DHA in the brain being a vital part of nerve signalling, ie the communication between two nerves which assists with cognition, heart function and is showing great potential in the treatment of Alzheimer’s disease, dementia and other cognition related disorders.

The effect on nerve function also translates to our muscles with choline shown to reduce muscle aches, prevent fatigue and improve recovery time, again through supporting the communication channels from nerve to muscle.

Taking this one step further, our nerves are surrounded by something called myelin which is a little bit like the rubbery stuff covering our electrical wires, it makes the signals travel faster and more efficiently. A break down in myelin is what happens in conditions like Multiple Sclerosis (MS) which ultimately can cause brain and nerve function to deteriorate over time. A huge component of myelin is phosphatidylcholine, keeping the myelin sheaths stable and thus supporting nerve signals in the brain and throughout the body.

Methylation

Choline plays a role in and relies on something called methylation which you can read more about here. Some of the vital processes in the body that require methylation are DNA creation (ie making a baby) and repair, histamine metabolism (think allergic reactions), detoxification of chemicals and heavy metals, dampening down the stress response, assisting with hormonal balance and supporting neurotransmitters related to depression and anxiety.

Methylation insufficiency, amongst other things, can cause an elevation in homocysteine which at high levels is associated with heart disease. Choline plays a role in reducing homocysteine levels and supporting the methylation cycle. This is through a very tight relationship with folate so it is vital to ensure we are getting a suitable form of folate for our individual genetic and environmental needs.

In the absence of folate either due to intake or methylation insufficiency, choline will step in pick up the slack. This can mean pulling reserves of choline out of cell membranes where 90% of body stores are found. This can have detrimental effects on the body for all the reasons discussed above and through creating inflammation and oxidative stress which can trigger other chronic conditions. If there are any genetic polymorphisms on the PEMT gene responsible for choline production, deficiency could potentially be even worse if it is not coming from diet/supplementation resulting in elevated LDL (bad) cholesterol, muscle aches and pains and  further issues discussed below.

Fatty Liver

Choline plays an important role in lipid transport and metabolism or in real language getting fat or namely cholesterol out of the liver and to where it belongs such as in the manufacture of hormones. Deficiency of choline due to dietary deficiency or often times genetic polymorphism in the PEMT gene can result in fatty liver. Once free of fat accumulation the livers ability to detoxify ramps up improving the bodies ability to rid itself of toxins, excess hormones and produce energy.

Early markers to look out for on bloods are disturbed ratios between your liver enzymes, ie ALT being significantly higher than AST, or elevation in GGT which is suggestive of an inability to recycle our master antioxidant glutathione which relies on, you guessed it, choline!

Fat Digestion and Bile

When it comes to fat digestion and effective utilisation we need bile, produced by our liver and stored in our gall bladder. Bile is like detergent which allows fat to essentially dissolve or be utilised by a water based system. Think of oil floating on waters surface, that is essentially what happens without adequate detergent, and those of you who suffer fat digestion issues no doubt have seen this phenomenon in their toilet bowl or suffer from something like SIBO.

Bile relies on two key nutrients, taurine and choline. Often deficiencies in either – but today lets stick with choline, can lead to gall bladder issues and ultimately removal – which is many doctors knee jerk reaction when things aren’t working properly. A good early marker that something could be a miss is an elevation in bilirubin on your bloods.

Where Do I Find It?

Any finally where do we go to find it.

Generally found in higher mounts in animal products such as fish, chicken, eggs, turkey, beef, liver and milk. However great vegan/vegetarian options are nuts including peanuts, cruciferous vegetables like broccoli, brussel sprouts and cauliflower. Legumes such as chick peas, navy beans, peanuts and lecithin (found in soy though I’d recommend sourcing it from sunflower). If you are worried you may be deficient in choline please reach out and I’d be happy to discuss your options.