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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, citicoline, cytidine 5-diphosphocholine (CDP-choline), intrachol, lecithin, lipotropic factor, PhosChol®, phosphatidylcholine, TRI, tricholine citrate (TRI), trimethylethanolamine.
  • Note: Should not be confused with choline salicylate, choline magnesium trisalicylate, choline theophyllinate or succinylcholine.

Background
  • Choline is an essential nutrient related to the water-soluble B-complex vitamins, folate, pyridoxine, and B12, and to the essential amino acid, methionine. It is synthesized in the body as well as consumed in the diet. The largest dietary source of choline is egg yolk. Choline can also be found in high amounts in liver, peanuts, fish, milk, brewer's yeast, wheat germ, soy beans, bottle gourd fruit, fenugreek leaves, shepherd's purse herb, Brazil nuts, dandelion flowers, poppy seeds, mung beans and other beans, and a variety of meats and vegetables, including cabbage and cauliflower.
  • Choline is a major building block of lecithin. Choline is a precursor to acetylcholine, a chemical used to transfer nerve impulses. Therefore, choline is believed to have neurological effects.
  • Choline is a product of the breakdown of the muscle relaxantsuccinylcholine, which is used extensively in anesthesia. Theoretically, choline may exhibit similar muscle relaxing effects.
  • Choline is a constituent of phosphatidylcholine (PC), which is a component of cell walls and membranes. It is involved in fat and cholesterol metabolism and transport. In this form, choline aids in fat metabolism and transport away from the liver.
  • Pure choline is rarely used because of its undesirable side effects of fishy odor. Therefore, lecithin or purified phosphatidylcholine is more commonly used.

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 possibly effective when taken by mouth for asthma. Choline supplements seem to decrease the severity of symptoms, number of symptomatic days and the need to use bronchodilators in asthma patients. There is some evidence that higher daily doses might be more effective than lower daily.

B


Choline, when given intravenously, has orphan drug status for TPN-associated hepatic steatosis (fat deposits in the liver).

B


Choline is likely effective when used orally as a supplement in infant formulas.

B


Choline is likely effective when used intravenously to treat parenteral nutrition-associated hepatic dysfunction.

B


Many studies have assessed the use of choline for hepatitis, although, there is a lack of sufficient evidence to recommend for or against the use of choline in the treatment of acute viral hepatitis.

C


Oral tricholine citrate (TRI) may effectively relieve allergic rhinitis symptoms. Further research is needed before a strong recommendation can be made.

C


Early treatment with choline alphoscerate (CA), a substrate of phosphatydylocholine and a carrier of choline, was shown to be safe. When taken as part of complex pharmacotherapy, it has shown beneficial effects on CCI patients. Additional study is needed to confirm these findings.

C


There is a lack of sufficient evidence to recommend for or against the use of choline in coma patients. Available research is limited.

C


Though many studies have found promising results, others have not shown statistical significance when assessing choline for the treatment of acute ischemic stroke. Due to conflicting data, choline therapy cannot be recommended.

C


There is lack of sufficient evidence for the use of choline for changing body composition, specifically, changing body fat and lean muscle.

C


Data regarding efficacy of choline in the treatment of Parkinson's disease is conflicting and inconclusive.

C


There is a lack of sufficient evidence to recommend for or against the use of choline in patients recovering from surgery.

C


Numerous studies have assessed the use of choline in cerebrovascular diseases, memory performance, dementia and Alzheimer's disease without significant benefit.

D


Choline is possibly ineffective when taken by mouth for treating cerebellar ataxia.

D


Research has shown that choline does not significantly improve performance or delay fatigue during endurance sports.

D


Choline has been studied in schizophrenia with negative results.

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, alcoholism, allergy, anesthesia, ataxia, attention deficit hyperactivity disorder (ADHD), autism, bipolar disorder, body building, brain function improvement, brain injuries (cranio-encephalic), bronchitis (dust-induced), cancer prevention, cardiovascular health, childhood growth promotion, clogged arteries, cocaine dependence, cognitive disorders, colitis (necrotizing enterocolitis), concussions, digestive disorders, dizziness, edema (cerebral), energy, exercise performance enhancement, fatigue, fetal development, gallbladder stones, glaucoma, growth, hemorrhage (intracerebral), hepatitis, high cholesterol, Huntington's chorea/disease, hyperhomocysteinemia, hypoxia (brain), infections, infertility, ischemic injury (focal), jaundice, liver health, liver protection, male tonic, mania, memory loss, mental performance/alertness, nervous system function, reproduction disorders, respiratory distress (newborn syndrome), seizures, tardive dyskinesia, Tourette's syndrome, vascular disorders, vertigo, vision problems (amblyopia), wasting of brain regions (cerebellar), weight loss.

Dosing

Adults (18 years and older):

  • The "average" diet supplies 400-900 milligrams of choline daily, which is presumed to be adequate. According to the Institute of Medicine, although the adequate intake (AI) have been set for choline by the Institute of Medicine's Food and Nutrition Board, there are few data to assess whether a dietary supply of choline is needed at all ages, and it may be that the choline requirement can be met by endogenous synthesis at some of these stages.
  • The recommended daily intake by the U.S. Food and Nutrition Board of the Institute of Medicine for men 18-70+ years: 550 milligrams per day - not to exceed 3.5 grams per day; for women 19-70+ years: 425 milligrams per day - not to exceed 3.5 grams per day; for women 18 years: 400 milligrams per day - not to exceed 3 grams per day; for pregnant women: 450 milligrams per day; for breastfeeding women: 550 milligrams per day.
  • Upper intake levels (UL) should not exceed 3.5 grams daily for adults and the elderly. Dosages at the upper limit intake levels are contraindicated for persons suffering from trimethylaminuria, kidney disease, liver disease, depression, and Parkinson's disease, as they may be at risk for side effects.
  • There is no proven effective dose for Alzheimer's disease, asthma, fatty liver, or seizure; however, choline has been studied for the treatment of these conditions at various doses.

Children (younger than 18 years):

  • The Committee on Nutrition of the American Academy of Pediatrics recommends the fortification of infant formula to at least 7 milligrams choline per 100 kilocalories. This quantity corresponds to roughly 9 ± 2 milligrams per deciliter of choline present in human breast milk. Patients ages 1-8 years should not exceed 1 gram daily, children ages 9-13 should not exceed 2 grams daily, and children 14-18 years should not exceed 3 grams of choline daily.
  • Recommended daily intake by the U.S. Food and Nutrition Board of the Institute of Medicine for infants 6-12 months: 150 milligrams per day; for infants up to 6 months: 125 milligrams per day; for children 9-13 years: 375 milligrams per day - not to exceed 2 grams per day; for children 4-8 years: 250 milligrams per day - not to exceed 1 grams per day; for children 1-3 years: 200 milligrams per day - not to exceed 1 gram per day; for girls 14-18 years: 400 milligrams per day - not to exceed 3 grams per day; for boys 14-18 years: 550 milligrams per day - not to exceed 3.5 grams per day.
  • Upper intake levels (UL) per day should not exceed 1 gram daily by mouth for children 1-8 years; 2 grams daily by mouth for children 9-13 years; 3 grams daily by mouth for adolescents (14-18 years-old). Maximum daily choline upper intake levels for infants are not available; choline should only be from formula or 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 in individuals with a known allergy or hypersensitivity to choline, lecithin, or phosphatidylcholine.

Side Effects and Warnings

  • Choline is generally regarded as safe and appears to be well-tolerated. High intake of choline may cause low blood pressure, steatorrhea (undigested fat in stool), nausea, vomiting, salivation, diarrhea, constipation, anorexia, dizziness (vertigo), sweating, incomnia and headache. Choline can possibly trigger existing epilepsy. Dosages at the upper limit (UL) intake levels are contraindicated for person suffering from trimethylaminuria, Parkinson's disease, or kidney or liver disease.
  • Skin rash has been reported. A cold and cough were noted in patients taking citicoline, which is a source of choline, but not with choline itself.
  • Choline should be used cautiously by people with kidney or liver disorders. Agitation, paranoia and severe depression have been reported. Use cautiously in patients with a history of depression.
  • Because choline is a product of the breakdown of succinylcholine, it may produce similar side effects as the drug, like respiratory depression. A "fishy" odor has been associated with choline. Sweating and stunted growth may occur.

Pregnancy and Breastfeeding

  • The Food and Nutrition Board of the Institute of Medicine of the National Academy of Science states that choline is vital in prenatal supplementation. During pregnancy, choline intake of the mother may influence memory and brain development in the growing infant. Studies on choline and lecithin supplementation clearly show an increase in blood choline levels following supplementation.
  • Pregnant and lactating women and children may consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.

Interactions

Interactions with Drugs

  • Choline supplementation has been associated with decreasing urinary excretion of carnitine in young adult women.
  • A study concluded that chronic treatment with lithium enhances the effects of choline in the brain. A preliminary report of MRI studies did not observe a significant positive relationship between increases in brain choline and increases in brain lithium.
  • CDP-choline can cause an increase in plasma concentrations of dopa.
  • Methotrexate may diminish pools of all choline metabolites. Choline supplementation reverses fatty liver caused by methotrexate administration in rats.
  • Pentazocine exhibits neuromuscular blocking effects in part through a depressive action on cholinoceptive sites on the nerve motor end terminals, presenting a possible interaction if administered with choline.
  • Although a few studies have linked choline with partially reversing the effects of scopolamine, a later study failed to demonstrate similar effects.
  • Choline is a product of the breakdown of succinylcholine. Taking choline with succinylcholine may theoretically intensify effects and/or toxicity.

Interactions with Herbs and Supplements

  • Choline supplementation has been associated with decreasing urinary excretion of carnitine in young adult women.
  • A study concluded that chronic treatment with lithium enhances the effects of choline in the brain. A preliminary report of MRI studies did not observe a significant positive relationship between increases in brain choline and increases in brain lithium.
  • Choline, via its metabolism to betaine, works in concert with vitamins B6, B12, and folic acid in the metabolism of the potentially atherogenic substance homocysteine.

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. Buchman AL, Ament ME, Sohel M, et al. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J Parenter Enteral Nutr 2001;25(5):260-268.
  3. Canty DJ, Zeisel SH. Lecithin and choline in human health and disease. Nutr Rev 1994;52(10):327-339.
  4. Carlson SE, Montalto MB, Ponder DL, et al. Lower incidence of necrotizing enterocolitis in infants fed a preterm formula with egg phospholipids. Pediatr Res 1998;44(4):491-498.
  5. Cohen BM, Renshaw PF, Stoll AL, et al. Decreased brain choline uptake in older adults. An in vivo proton magnetic resonance spectroscopy study. JAMA 1995;274(11):902-907.
  6. Dechent P, Pouwels PJ, Frahm J. Neither short-term nor long-term administration of oral choline alters metabolite concentrations in human brain. Biol Psychiatry 1999;46(3):406-411.
  7. Food and Nutrition Board IoM. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. 1998.
  8. Hirsch MJ, Growdon JH, Wurtman RJ. Relations between dietary choline or lecithin intake, serum choline levels, and various metabolic indices. Metabolism 1978;27(8):953-960.
  9. Kidd PM. Phosphatidylcholine, a superior protectant against liver damage. Altern Med Rev 1996;1:258-274.
  10. Knuchel F. [Double-blind study in patients with alcoholic toxic fatty liver. Effect of essential phospholipids on enzyme behavior and lipid composition of the serum]. Med Welt 1979;30(11):411-416.
  11. Little A, Levy R, Chuaqui-Kidd P, et al. A double-blind, placebo controlled trial of high-dose lecithin in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1985;48(8):736-742.
  12. McNamara JO, Carwile S, Hope V, et al. Effects of oral choline on human complex partial seizures. Neurology 1980;30(12):1334-1336.
  13. Mohs RC, Davis KL. Choline chloride effects on memory: correlation with the effects of physostigmine. Psychiatry Res 1980;2(2):149-156.
  14. Wurtman RJ, Hefti F, Melamed E. Precursor control of neurotransmitter synthesis. Pharmacol Rev 1980;32(4):315-335.
  15. Zeisel SH, Blusztajn JK. Choline and human nutrition. Annu Rev Nutr 1994;14:269-296.

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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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