Did you know that consuming adequate amounts of dietary choline decreases the risk of mental health-related symptoms such as depression and anxiety? Yep! There is a huge link between having a choline deficiency and your mental health status.

Even if you tend to incorporate lots of choline-rich foods into your diet (like egg yolks, chicken breast, legumes, and fish), it’s still very possible to have a choline deficiency. Certain genetic variations impair your body’s ability to metabolize choline — an essential micronutrient — increasing your need for dietary choline (more about these genetic variations below). 

Since the body only produces small amounts of choline on its own, it’s up to you to ensure you’re getting adequate amounts of choline each day! Muscle damage, nonalcoholic fatty liver disease, cognitive decline, and mental health concerns are all associated with low levels of choline. The nutrient is so important that it’s often lumped in with the B vitamins! And, if you remember from my B vitamin nutrient deficiency blog post, these vitamins play a major role in DNA methylation and mental health!

Below, we’ll discuss how a choline deficiency can affect one’s psychological well-being — and what can be done about it (hint: it all starts with genetic testing!). 

What is Choline?

If this is the first time you’re hearing about choline, you’re not alone! Despite being an essential micronutrient that your brain and nervous system need to aid in mood, memory, and muscle control, choline doesn’t get nearly enough attention. In fact, the Institute of Medicine (IOM) didn’t recognize choline as an essential nutrient until 1998! Other crucial functions of choline are cell membrane protection, cell membrane signaling, lipid transport and metabolism, brain development, and modulation of gene expression. 

The human body can make choline in the liver (mostly as phosphatidylcholine); however, the body does not produce amounts sufficient to meet our needs as humans. This means that we must get choline from the diet! 

We’ll talk more later on in this post about how to get choline from the diet and how much you need, but first, let’s look at how your DNA may impact your need for choline. 

Nutrigenomics & Choline Deficiency

In 1998, it was determined by the IOM that the daily adequate intake (AI) of choline for the prevention of choline deficiency was 550 mg for men, 425 mg for women, 450 mg for pregnancy, and 550 mg for lactation. It wasn’t until recently that researchers began examining how those with certain genetic variations (known as single nucleotide polymorphisms or SNPs) may need to exceed the recommended daily amounts in order to prevent choline deficiency and avoid the physical and mental health outcomes associated with low levels of choline in the body. 

Now, thanks to nutrigenomics research, we understand that the daily requirements for dietary choline are much higher for approximately 50 percent of the population — including those with one or more genetic variants associated with choline metabolism and methylation (me included!). Those of us with genetic variations affecting choline metabolism (like mutations in the MTHFD1, BHMT, and/or PEMT genes) need to be extra diligent about consuming greater amounts of dietary choline each day. 

Likewise, both men and women with low estrogen levels require more dietary choline, as estrogen status also impacts choline production and metabolism. Estrogen triggers the PEMT gene to produce small amounts of choline in the liver, and a lack of estrogen prevents this from happening. As a precaution, it’s a good idea for post-menopausal women to increase their choline intake to protect their organs and prevent choline deficiency.

How Choline Deficiency Impacts Mental Health

Now that we’ve discussed how certain genetic variations impair choline metabolism and increase one’s risk for a deficiency, let’s talk about the very important (and complex) role choline plays in the body. We’ll also discuss how choline levels affect mental health and well-being. 

Choline & Acetylcholine

As a methyl donor micronutrient and cofactor, choline plays a major role in DNA synthesis and methylation, cell division, and detoxification. It’s also a precursor for acetylcholine, a neurotransmitter that sends the body messages from the brain via nerve cells. These “excitatory” messages play a role in controlling muscle movements; secreting substances such as tears and sweat; and processing, retaining, and understanding new information. 

Simply put, the body (specifically, your nerves) can’t make acetylcholine without choline. Acetylcholine deficiency has been linked to Alzheimer’s disease; Myasthenia gravis; Lambert-Eaton myasthenic syndrome; Parkinson’s disease, and impairments in:

• Attention, learning, and alertness.
• Sensory gating (the ability to drown out irrelevant stimuli or background noise). 
• Short- and- long-term memory.

In general, researchers have associated cholinergic dysfunction with other mental health conditions such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and schizophrenia. Studies have shown that supplementing with choline during pregnancy could even reduce a child’s risk of developing mental illnesses like schizophrenia in the future!

Choline & Betaine

Low levels of choline are also associated with depressive symptoms — likely because choline is a precursor to the nutrient known as betaine. Betaine reduces homocysteine levels in the body, and high homocysteine has been linked to depression (particularly in men). One study even found that taking SAMe with betaine was more effective as an add-on treatment for depression than taking SAMe alone. 

Furthermore, a cross-sectional study published in the Journal of Affective Disorders found that consuming more dietary choline could reduce one’s risk for major depressive disorder (MDD) — and an older study linked low choline levels to a higher risk of anxiety. When taken with lithium, choline has also been shown to reduce mania in those with bipolar disorder. 

As you can see, choline plays a huge role in everything from mental health and learning to attention, muscle control, and memory!

Symptoms of Choline Deficiency

Choline deficiency is often asymptomatic, and it’s important to know that if you do get symptoms, they may not be noticeable until the deficiency has become severe. The following can be symptoms & signs of choline deficiency:

• Fatty liver (NAFLD) and liver damage
• Muscle damage and soreness
• Memory impairment
• Reduced cognitive function and cognitive decline
• Mood disorders (such as depression)
• Anxiety
• Neurological disorders

Who’s at Risk? Identifying People Most Vulnerable to Choline Deficiency

Thanks to nutrigenomics testing, I know I’m with the approximately 50 percent of people who have an increased need for dietary choline. Ever since I found this out, I’ve made it a point to eat foods high in choline daily to protect my mental and physical health. 

Genetic testing can help us determine whether you, too, have one or more SNPs associated with choline metabolism and methylation! I use the 3X4 Genetics Test + Blueprint Report in my practice; you can learn more about nutrigenomic testing and download a sample copy of this report here. 

How to Meet Your Choline Needs: Foods for Choline Deficiency Prevention

In the event that genetic testing reveals you have an increased need for dietary choline, there are lots of different ways to incorporate more choline-rich foods into each day! And though beef liver, hard-boiled eggs, beef steak, salmon, pork chops, and chicken breast are some of the richest sources of choline, several other options include:

• Animal products like dairy, fish, meat, and poultry.
• Plant foods such as cruciferous vegetables, shiitake mushrooms, potatoes, and carrots.
• Fruits such as tangerines, kiwis, and apples. 
• Whole grains such as wheat germ, oat bran, brown rice, and quinoa.
• Nuts, seeds, and legumes (including soybeans, peas, and tofu). 

Supplements: Do You Need to Take a Choline Supplement? 

Supplementing with choline is also an option if you can’t get enough choline through diet alone. As a result, some individuals that may benefit from choline supplementation include:

• Pregnant women: choline is crucial for fetal brain development and low choline levels in pregnancy have been linked to neural tube defects and other developmental issues in infants
• Vegans and vegetarians: choline is most abundant in animal-based foods, so those who strictly follow plant-based diets may have a higher risk of developing choline deficiency
• Individuals with mental health conditions: choline deficiency has been linked to mental health disorders including depression and anxiety, so these individuals may benefit from choline supplementation if they are not able to consume enough through food sources alone
• People with liver disease: these individuals may have a higher risk of choline deficiency due to the liver being responsible for the endogenous production and processing of choline

Which Choline Supplements are the Best Quality?

When considering supplementing with choline, it’s important to consider several factors including the form of choline, the dosage, the type of supplement, and the quality. In supplement form, choline is available as citicoline (CDP-choline), phosphatidylcholine (PC), and alpha-GPC. 

How to Choose a Quality Choline Supplement

If you are choosing to supplement with choline, make sure you choose a high-quality supplement from a reputable brand. Search for reputable brands that produce choline supplements, which undergo third-party testing for purity and potency, such as the NSF or USP seal. The choline supplement label should clearly indicate the form of choline and the dosage per serving. Additionally, I recommend checking the list of ingredients to ensure that the supplement doesn’t contain any unnecessary additives or fillers.

I also recommend consulting a healthcare professional such as a registered dietitian nutritionist (like me!) when choosing supplements and determining dosages. 

Is it Safe to Take Choline Supplements?

Taking choline supplements is generally considered safe and rarely causes side effects. However, current guidelines and research suggest that the daily intake of choline, including choline from food sources, should be limited to three grams. It’s important to note that consuming too much choline can cause negative effects! Here are some precautions to be aware of when it comes to exceeding the recommended amounts of choline from supplements and/or food sources:

• Diarrhea, nausea, and vomiting
• Fishy body odor or breath 

Additionally, individuals with kidney or liver disease should avoid high doses of choline since their bodies may not be able to properly metabolize it. 

There are other supplements you can take to increase the availability of acetylcholine in your body. These include ginkgo biloba, huperzine A, ginseng, and Bacopa monnieri. 

As always, you know my approach here at The Fulfilled Fork is to take a food-first approach to nutrition and mental wellness. This means that I recommend attempting to meet your needs for choline first through diet and then supplement under the guidance of a healthcare practitioner – such as a registered dietitian nutritionist who specializes in mental health…hey,  that’s me! 

Is a Choline Deficiency Affecting Your Mental Health? 

Like most nutrient deficiencies, the good news about choline deficiency is that it’s often preventable and reversible — even if you have mutations in the MTHFD1, BHMT, and/or PEMT genes. Genetic testing is an excellent starting point! To get started with nutrigenomics testing and receive personalized nutrition and lifestyle advice, apply for private or collective coaching with Haley here at The Fulfilled Fork.

Ready to improve your mood while nourishing your mind, body, and soul? Learn all about holistic mental wellness, apply for coaching, or become a member of The Fulfilled Fork!  

References:

• https://www.hsph.harvard.edu/nutritionsource/choline/ 
• https://ods.od.nih.gov/factsheets/Choline-Consumer/ 
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782876/
• https://academic.oup.com/advances/article/7/1/5/4524031 
• https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/ 
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954445/ 
• https://my.clevelandclinic.org/health/articles/24568-acetylcholine-ach 
• https://mhanational.org/what-acetylcholine 
• https://uncnri.org/2017/06/01/know-your-neurotransmitters-acetylcholine/ 
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466850/ 
• https://www.sciencedirect.com/science/article/abs/pii/S0165032722000131 
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303396/ 
• https://www.sciencedirect.com/science/article/abs/pii/S030645301300156X 
• https://academic.oup.com/ajcn/article/90/4/1056/4596992 
• https://pubmed.ncbi.nlm.nih.gov/8874839/