A graphic image of various choline-rich foods beside a large blue orb with white text that reads choline.

What Is Choline? Benefits, Sources, Side Effects, And More

by Dr. Matt Olesiak, M.D.

Though it's a lesser-known nutrient, choline benefits are plentiful.

This article discusses everything you need to know about choline, emphasizing its brain-boosting benefits.

What is Choline?

Choline is a naturally occurring nutrient related to the B vitamins.

It was discovered by German chemist Adolph Strecker in 1862 and synthesized in a lab a few years later. (1)

Choline was officially designated an "essential nutrient" by the Institute of Medicine in 1998. (2)

Does the Body Make Choline?

The body makes a small amount of choline but not enough to meet daily needs. Therefore, you must get choline through your diet or dietary supplement to avoid a deficiency.

How Does Choline Work?

According to the Harvard School of Public Health: (3)

"Most choline is metabolized in the liver where it is converted into phosphatidylcholine, which assists in building fat-carrying proteins and breaking down cholesterol. It is also “food” for beneficial gut bacteria."

The body also converts a significant portion of phosphatidylcholine into acetylcholine, an essential and abundant neurotransmitter in the brain. For this reason, choline is known as a brain nutrient.

Acetylcholine is not only crucial for brain development and function but also stimulates muscle contractions and helps regulate arousal and sleep.

The body also converts a portion of choline into "sphingomyelin (in the myelin sheath of nerve cells), and betaine (in the methylation cycle)." (4)

So, choline is responsible for many varied bodily functions.

Choline Vs. Citicoline

Citicoline, also called CDP-Choline, is a naturally occurring compound found in every body cell. But like choline, the body does not produce enough citicoline to meet your daily needs.

Because there are few food sources of citicoline, the best way to get the optimal amount is to take a daily supplement.

Citicoline offers many of the same health benefits as choline. But it does have an advantage over choline. Namely, it delivers more choline to the brain.

Because choline does not readily cross the blood-brain barrier, much of the brain-enhancing benefits of this nutrient are lost.

But citicoline breaks down into choline and cytidine, which are quickly absorbed by the intestines. Cytidine is then converted into uridine, a compound essential for brain health. These substances then cross the blood-brain barrier separately before reforming into citicoline.

It appears that citicoline's main job is to boost brain levels of choline and support brain function. Indeed, citicoline seems to be the superior form for brain health and cognitive function. (4a)

An image of a variety of fresh fruits and vegetables including strawberries, broccoli, carrots, grapes, red bell peppers, watermelon, cucumber, and carrots.

Health Benefits of Choline and Citicoline

Choline provides numerous health benefits. Here are just a few of them.

Brain Health

Citicoline is crucial for all aspects of brain health and function. Indeed, it is essential for fetal brain development.

Here are other scientifically proven brain benefits of choline.

Improved Memory

Citicoline appears to be a natural memory enhancer. Moreover, numerous studies show that it may be especially effective at reversing age-associated memory impairment (AAMI).

For example, in a recent clinical trial published in The Journal of Nutrition, researchers concluded:

Dietary supplementation of citicoline for 12 wk improved overall memory performance, especially episodic memory, in healthy older males and females with AAMI. The finding suggests that regular consumption of citicoline may be safe and potentially beneficial against memory loss due to aging." (5)

Numerous trials have been conducted on Alzheimer's patients and have shown "consistent but moderate improvement of memory and behavior." (5a)

Increased Attention and Focus

If you struggle with attention and focus issues, you might want to try citicoline.

In a double-blind, randomized, placebo-controlled trial, researchers tested citicoline usage in 60 women aged 40 to 60. Half were given either citicoline or a placebo daily for 28 days. (6)

The results?

An image of a female blue eye staring into the distance.

The women treated with citicoline showed significant improvement in attentional performance.

Another study showed that 250 or500 mg of Citicoline increased motor speed and attention and decreased impulsivity in healthy adolescent males compared to placebo. Those taking 500 mg showed significantly increased accuracy on an attention task. (6a)

Boosted Cognitive Function

In another study, researchers examined the effects of citicoline on 16 healthy men and women. These subjects self-administered a daily dosage of either 500 mg or 2,000 milligrams of citicoline for six weeks.

At the end of six weeks, researchers found that all participants exhibited improvement in cognitive performance regardless of dosage amount.

Specifically, Citicoline increased brain energy (ATP) by 14% and Sped up the creation of brain membranes by a whopping 26%! (7)

Stroke Recovery

Doctors in Japan first used citicoline to treat stroke victims in the 1970s. They discovered if they administered citicoline to their patients within 24 hours of having a stroke, they were able to recover completely.

Numerous studies since then have confirmed the neuroprotective and neuro-repair effects of citicoline, especially in stroke patients.

For example, researchers administered citicoline to first-time ischemic stroke patients in one six-month trial. The results?

Researchers concluded that "citicoline prevented cognitive decline after stroke with significant improvement of temporal orientation, attention, and executive function. Experimentally, citicoline exhibits neuroprotective effects and enhances neural repair." (8)

And in a review of studies on citicoline's usage for stroke recovery, researchers stated, "Citicoline is the only drug that in a number of different clinical stroke trials continuously had some neuroprotective benefit." (9)

Mental Health

Today, mental health is a serious issue, and studies suggest that citicoline may help. Let's look at some of the ways citicoline may help relieve mental health issues.

Anxiety

According to the Anxiety and Depression Association of America, anxiety is the most common mental health issue in the United States, affecting 40 million adults each year. (10)

There has not been much research conducted on the potential effects choline might have on anxiety. But some studies suggest an association between choline levels and anxiety.

For example, researchers found that those with the lowest plasma choline levels had significantly higher anxiety levels than the other groups in one large-scale study. (11)

Bipolar Disorder

Bipolar disorder is a severe mental condition characterized by extreme mood swings -- from mania to depression.

An estimated 5.7 million U.S. adults -- about 2.6 percent of the adult population -- struggle with bipolar disorder. (12)

It is also one of the top causes of hospitalizations globally for those aged 15 to 44. (13)

Research suggests that choline levels may be used to diagnose bipolar disorder, thus helping to prevent a misdiagnosis of a major depressive disorder. (14) A proper diagnosis leads to early treatment, which is crucial for successfully treating this disorder.

In addition, one study found that augmenting lithium -- a commonly used treatment for bipolar disorder -- with cholinebitartrate significantly reduced the manic symptoms in five of six patients. (15)

Autism

Autism or autism spectrum disorder (ASD) is a neurodevelopmental disorder that causes significant social, communication, and behavioral difficulties.

Typically diagnosed within the first three years of life, ASD affects an estimated one in 54 children in the U.S. (16)

Moreover, an estimated5.4 million adults in the U.S are on the autism spectrum. (17)

Can choline help those who have ASD? Incredibly, the answer may be YES.

For example, a 2013 study found that the "majority of children with ASDs between 3 and 11 years of age consume inadequate dietary choline." (18) This was the first study to demonstrate the connection between choline deficiency and autism.

Researchers in another study found that choline supplementation improved social interaction and reduced anxiety-like behaviors in mice with autistic-like symptoms. (19)

Heart Health

Heart disease is the leading cause of death for men and women in the U.S. (20)

Again, an increased choline intake -- whether through diet or choline supplements -- may help.

For example, in a review of epidemiological studies, researchers found that the long-term consumption of choline and the nutrient betaine prevented cardiovascular disease death by reducing common risk factors, such as inflammation. (21)

Liver Function

Choline is essential for the proper transportation of fat from the liver to the cells throughout the body.

Therefore, choline has a liver-cleansing effect that is crucial for health. If fat builds up in the liver, it can lead to fatty liver disease, aka nonalcoholic fatty liver disease.

Fatty liver disease can lead to cirrhosis of the liver and live failure. It is also a risk factor for liver cancer.

And guess what?

Numerous research studies show that diets low in choline increase the risk for fatty liver disease and liver damage.

Why? One reason is that choline "modulates the gene expression in many of the pathways involved in liver function and dysfunction." (22)

Cancer Protection

In a review of epidemiology studies, researchers found that choline and betaine consumption lowered cancer risk. (Betaine is a metabolite of choline.)

The cancers investigated in these studies were:

Colorectal cancer
Breast cancer
Esophageal cancer
Lung cancer
Nasopharyngeal carcinoma
Epithelial ovarian cancer
Renal cell cancer

How Much Choline Do I Need?

According to the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM), males 19+ years old should get 550 m/day of choline, 425 mg for females.Pregnant women should get 450 mg/day, and lactating women should get 550 mg/day. (22)

Do I Get Enough Choline?

There is a good chance that you do NOT get enough choline.

Research shows that most people in the U.S get less than the recommended amount of this essential nutrient.

Symptoms of Choline Deficiency

Though most people get less than the recommended amount of choline, an actual deficiency in healthy non-pregnant individuals is rare. This is because the body's creation of choline may protect against a deficiency.

Symptoms of a choline deficiency include: (23)

Muscle damage
Liver damage
Non-alcoholic liver disease

Symptoms of Insufficient Intake of Choline and Citicoline

Though you may not have an actually choline deficiency, an insufficient intake of this essential nutrient can produce numerous unpleasant symptoms, including:

Cognitive decline
Memory loss
Learning disabilities
Nerve damage
Muscle aches
Mood swings or mood disorders
Fatigue

Am I At Risk of Deficiency?

Those most at risk of choline deficiency include:

Pregnant women due to increased choline requirements.
Post-menopausal women due to the decrease in estrogen levels. This hormone helps produce choline.
Endurance athletes due to a decrease in choline during extended endurance exercises
High alcohol intake due to the increased choline requirements.

Health Risks of Excessive Choline Intake

But don't take more choline supplements than necessary.

Though choline is generally considered safe, it can cause serious health risks if taken in excess. (24)

These risks include:

Fishy body odor
Excessive sweating
Vomiting
Excessive salivation
Hypotension
Liver toxicity

Sources of Choline

You can increase your dietary intake of this nutrient by consuming choline-rich foods, including:

Whole eggs
Organ meats, i.e., liver, kidney
Shrimp
Fish
Chicken breast
Dairy

Some plant-based sources also contain this nutrient.

Examples include:

Chickpeas
Soybeans
Kidney beans
Wheat germ

Eating more of these foods will contribute to optimal health.

What is the Best Form of Choline to Take?

Numerous research studies show that citicoline is the best form of choline to take.

After all, citicoline boosts brain levels of choline, and research shows that it may also help relieve or prevent numerous mental and physical health conditions.

Several trials have demonstrated the effectiveness of citicoline in boosting brain function, improving memory, intensifying concentration, and much more.

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References

1- https://www.acs.org/content/acs/en/molecule-of-the-week/archive/c/choline.html

2- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782876/

3- https://www.hsph.harvard.edu/nutritionsource/choline/

4- https://edu.emersonecologics.com/2019/12/12/citicoline-a-unique-source-of-choline-for-brain-health/

4a - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683073/

5- https://academic.oup.com/jn/article/151/8/2153/6274469

5a- https://pubmed.ncbi.nlm.nih.gov/8239305/

6- https://cognizin.com/storage/app/media/pdfs/improve-attention-cognizin.pdf

6a- https://journals.sagepub.com/doi/abs/10.1177/1087054715593633?journalCode=jada#abstract

7- https://cognizin.com/en/studies/cognizin-citicoline-increases-brain-energy-atp-by-14-and-speeds-up-formation-of-brain-membranes-by-26-in-healthy-adults

8- https://pubmed.ncbi.nlm.nih.gov/21164117/

9- https://pubmed.ncbi.nlm.nih.gov/24739589/

10- https://adaa.org/taxonomy/term/39

11- https://academic.oup.com/ajcn/article/90/4/1056/4596992

12- https://www.betterhelp.com/advice/bipolar/bipolar-disorder-statistics-how-many-people-does-it-affect/

13- https://www.healthyplace.com/bipolar-disorder/bipolar-information/bipolar-facts-and-statistics-bipolar-disorder-is-real

14- https://pubmed.ncbi.nlm.nih.gov/25082110/

15- https://pubmed.ncbi.nlm.nih.gov/8874839/

16- https://www.autismspeaks.org/autism-statistics-asd

17 - https://www.autismcincy.org/autism-facts-statistics/

18- https://pubmed.ncbi.nlm.nih.gov/24396597/

19- https://www.nature.com/articles/s41398-020-01002-1