Choline Overview

Choline has only recently been recognized as an essential nutrient. Choline is part of the neurotransmitter acetylcholine, which plays a major role in the brain; for this reason, many studies have been designed to look at choline's role in brain function.

Choline functions as a part of a major biochemical process in the body called methylation; choline acts as a methyl donor. Until recently, it was thought that the body could use other substances to substitute for choline, such as folate , vitamins B 6 and B 12 , and the amino acid methionine . But recent evidence has finally shown that, for some people, adequate choline supplies cannot be maintained by other nutrients and must be obtained independently through diet or supplements. ^{1 2}

Choline is widespread in the foods we eat. The average diet provides about 500 mg to 1,000 mg of choline per day. ³ Lecithin, a fatty constituent in foods, is a major source of choline; it is comprised mostly of a type of choline called phosphatidylcholine (PC). Lecithin and PC have been studied separately as treatments for a variety of illnesses; for more information on these supplements, see the full article on Lecithin .

According to US and Canadian guidelines, the recommended daily intake of choline is as follows:

• Infants

• 0-6 months: 125 mg

• 7-12 months: 150 mg

• Children

• 1-3 years: 200 mg

• 4-8 years: 250 mg

• 9-13 years: 375 mg

• Males

• 14 years and older: 550 mg

• Females

• 14-18 years: 400 mg

• 19 years and older: 425 mg

• Pregnant Women: 450 mg

• Nursing Women: 550 mg

Most studies of choline as a treatment for diseases have used between 1-30 g of choline or choline-containing supplements per day. This wide range is due to the existence of several different types of choline supplements, all with varying amounts of the active ingredient.

Alzheimer's Disease

In a 6-month, double-blind, placebo-controlled trial , 261 people with mild to moderate Alzheimer’s disease were given either placebo or choline alfoscerate (a special form of choline) at a dose of 400 mg 3 times daily. ⁴ The results indicated that people receiving the supplement improved slightly over the course of the trial, while those given placebo worsened.

Weak evidence from highly preliminary studies hint that CDP-choline may improve mental function in Alzheimer’s disease. ^{5 6 7} Double-blind trials using lecithin as a source of choline failed to find benefit. ^{8 9}

Strokes

Four double-blind, placebo-controlled studies enrolling a total of 1,372 people have evaluated the potential effectiveness of CDP choline in the treatment of strokes . ¹⁰ Overall, the evidence suggests that use of CDP-choline in the immediate period following a stroke slightly improves the chances of full recovery.

1. Zeisel SH. Choline: an important nutrient in brain development, liver function and carcinogenesis. J Am Coll Nutr. 11(5):473-81.
2. Zeisel SH, Da Costa KA, Franklin PD, Alexander EA, Lamont JT, Sheard NF, Beiser A. Choline, an essential nutrient for humans. FASEB J. 5(7):2093-8.
3. Zeisel SH, Da Costa KA, Franklin PD, Alexander EA, Lamont JT, Sheard NF, Beiser A. Choline, an essential nutrient for humans. FASEB J. 5(7):2093-8.
4. De Jesus Moreno Moreno M. Cognitive improvement in mild to moderate Alzheimer's dementia after treatment with the acetylcholine precursor choline alfoscerate: a multicenter, double-blind, randomized, placebo-controlled trial. Clin Ther. 25(1):178-93.
5. Alvarez XA, Mouzo R, Pichel V, Pérez P, Laredo M, Fernández-Novoa L, Corzo L, Zas R, Alcaraz M, Secades JJ, Lozano R, Cacabelos R. Double-blind placebo-controlled study with citicoline in APOE genotyped Alzheimer's disease patients. Effects on cognitive performance, brain bioelectrical activity and cerebral perfusion. Methods Find Exp Clin Pharmacol. 21(9):633-44.
6. Franco-Maside A, Caamaño J, Gómez MJ, Cacabelos R. Brain mapping activity and mental performance after chronic treatment with CDP-choline in Alzheimer's disease. Methods Find Exp Clin Pharmacol. 16(8):597-607.
7. Cacabelos R, Alvarez XA, Franco-Maside A, Fernández-Novoa L, Caamaño J. Effect of CDP-choline on cognition and immune function in Alzheimer's disease and multi-infarct dementia. Ann N Y Acad Sci. 695():321-3.
8. Heyman A, Schmechel D, Wilkinson W, Rogers H, Krishnan R, Holloway D, Schultz K, Gwyther L, Peoples R, Utley C. Failure of long term high-dose lecithin to retard progression of early-onset Alzheimer's disease. J Neural Transm Suppl. 24():279-86.
9. Weintraub S, Mesulam MM, Auty R, Baratz R, Cholakos BN, Kapust L, Ransil B, Tellers JG, Albert MS, LoCastro S, Moss M. Lecithin in the treatment of Alzheimer's disease. Arch Neurol. 40(8):527-8.
10. Dávalos A, Castillo J, Alvarez-Sabín J, Secades JJ, Mercadal J, López S, Cobo E, Warach S, Sherman D, Clark WM, Lozano R. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke. 33(12):2850-7.