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Telegraph
12-05-2025
- Health
- Telegraph
Tired all the time? You could have a choline deficiency
The humble egg has undergone a renaissance of late. It was once relegated to flimsy meal deal sandwiches and eaten reluctantly for breakfast when more appealing options were gone, yet it's now touted as a wonder food by nutritionists and athletes alike. And for good reason – we know that eggs are high in protein, low in calories, and rich in vitamins D and B12. Yet, there's another major health benefit of your morning omelette which many of us know little about. Eggs are rich in choline, an essential (yet underappreciated) nutrient which is vital for brain health and liver function. It is recognised as such in the US and by the European Food Safety Authority (EFSA), and both bodies have established recommended daily values – yet, this is still not the case in the UK. It means many of us aren't consuming enough of it – despite it being important for our health. So, what is choline, why do we need it, and how can we tell if we are in a deficit? What is choline? The benefits Signs of deficiency How to get more choline FAQs What is choline? Choline is an 'essential nutrient' says Dr Emma Derbyshire, a science writer and the founder of Nutritional Insight. Whilst every cell in our body contains it, and we produce some in the liver, this isn't enough which means we need to supplement it with our diet. It's neither a vitamin or mineral, Dr Derbyshire explains, but is closely related to the B vitamin family and shares several important functions, particularly related to the brain. 'Because we only produce small amounts and need to consume it from other sources, I'd also liken it to an omega-3 fatty acid,' she adds. It impacts brain development, liver function, and cell maintenance, says Marie Cherrett, a registered functional nutritional therapist at The Forbes Clinic. It's particularly important for mothers to get enough choline during pregnancy and breastfeeding as it plays a key role in building and maintaining a healthy brain. Key sources of choline include eggs, beef, chicken, and soybeans. The benefits of choline 1. It's important for brain function Choline is needed to produce a neurotransmitter called acetylcholine, which carries messages from the brain to the body and is crucially involved in memory, mood, and muscle control and contraction, Cherrett explains. DNA synthesis is another of its important functions. It contributes to the methylation process which impacts brain development, and is important for 'managing inflammation and supporting DNA expression,' Cherrett says. It's therefore vital for pregnant women and babies, Dr Derbyshire explains, as 'in busy phases of the life cycle, like pregnancy, our cells are replicating, growing, and developing at a quicker pace'. One study published in the American Journal of Clinical Nutrition found that choline intake during midlife may help to protect our brains, and that people with a higher choline intake tended to have better memories. Meanwhile, 2022 research published in the same journal found that low intake of choline was associated with increased risk of dementia and Alzheimer's disease, however more research is needed to confirm this relationship. Some studies have also uncovered a possible link between choline intake and mental health with researchers at the University of Bergen finding that a choline deficiency may be associated with higher levels of anxiety. 2. It's key to a healthy liver Choline is excellent for liver health, Cherrett says, as it plays a key role in transporting fats out of the liver. When a person is deficient in choline, this may contribute to non-alcoholic fatty liver disease. One review by researchers at University of North Carolina found that non-alcoholic fatty liver disease can lead to liver injury and hepatocarcinoma (the most common type of primary liver cancer). This highlights the importance of adequate choline intake alongside other measures to improve fat metabolism in the liver, including diet and exercise. Emerging evidence suggests that choline can also affect the liver health of a foetus too, Dr Derbyshire explains. A 2024 study in Nutrients found that during pregnancy and breastfeeding, the liver of the mother becomes depleted of choline, and at the same time, it accumulates in the placenta and liver of the foetus. Therefore, sufficient choline intake during this time is vital to ensure normal liver functioning of the mother, foetus and baby in its early life. 3. It protects heart health Higher choline intake is associated with a reduced risk of heart disease. It plays an important role in converting the amino acid homocysteine to methionine. 'Homocysteine is considered to be toxic and can heighten cardiovascular risk,' Cherrett explains. Therefore a deficiency of choline can result in an accumulation of homocysteine in the blood and the formation of clots. This can be dangerous and is linked to an increased risk of heart disease and strokes. A 2023 study in the Nutrients journal investigated this link and indeed found that higher choline intake was associated with a lower cardiovascular disease risk, especially the risk of stroke. However, they noted that further clinical trials are needed to confirm this finding. How to tell if you're in a choline deficit Whilst most people don't consume enough choline in their diets, serious deficiency is relatively rare. However it can cause real harm – particularly for the liver. Whilst the UK doesn't have set recommendations on choline intake, European guidelines say adults should have 400mg a day, pregnant women require around 480mg a day, and breast-feeding women need 520mg a day. People on restrictive diets may be more at risk of a choline deficiency, Dr Derbyshire says, as well as pregnant and breastfeeding women as they require much more. Symptoms of choline deficiency include: 1. Liver dysfunction This is one of the key signs, Dr Derbyshire says. It could lead to fatty liver disease and early signs of this may include a loss of appetite, weakness, and unexplained weight loss. 2. Lack of focus or brain fog Choline is important for brain function, so cognitive or memory issues may hint at a deficiency. 3. Fatigue Choline's important role in producing the neurotransmitter acetylcholine means a deficiency could result in tiredness and fatigue. 4. Muscle aches Similarly, acetylcholine plays an important role in muscle contraction which means a choline deficiency could lead to impaired muscle function and soreness. How to fix a choline deficit 1. Diet Eating more choline-rich foods is the best way to resolve a deficit, with people on restrictive diets more at risk, Dr Derbyshire says. One study in the Nutrients journal found that people who eat eggs have almost twice the usual choline intake compared with those who don't. The researchers concluded it's therefore 'extremely difficult' for people to eat the right amount of choline without 'consuming eggs or taking a dietary supplement'. However, it is possible to reach that 400mg-per-day benchmark. Eggs, oily fish, beef, liver, and poultry are all rich in choline. Some plant-derived foods include it too, such as nuts, soybeans, shiitake mushrooms, and cruciferous vegetables like broccoli and Brussels sprouts. However, these tend to contain a smaller amount of the essential nutrient. 'It's therefore possible for people on restrictive diets to get enough choline, but they have to work harder for it,' Dr Derbyshire says. 2. Supplements Cherrett says vegans and vegetarians might consider opting for a choline supplement to help boost their daily intake. One of the most well-known choline supplements is phosphatidylcholine, she explains, which can be bought from most major health food shops. 'It supports cell membrane health and is often used by people who want to support their liver function.' A more common and affordable supplement is choline bitartrate, however this is less bioavailable which means the body can't use it quite as well, Cherrett explains. 'These supplements are really worthwhile,' she says. 'We need a significant amount of choline each day but it's not actually that easy, unless you're eating a lot of liver and eggs. Diet intake is quite significant but supplementation really covers all the bases.' FAQs How much choline should you have per day? According to the European Food Safety Authority, adults should have 400mg of choline a day, pregnant women require around 480mg a day, and breast-feeding women need 520mg a day. How much choline is in eggs? Eggs are an important source of choline, Dr Derbyshire says. One large hard-boiled egg contains around 150mg of choline, which is significantly less than a portion of beef liver (which contains around 350mg) but slightly more than a portion of soybeans (which has around 107mg). Is it safe to take choline if you're pregnant? Choline supplements are generally considered safe and beneficial to take during pregnancy, as long as they're within the recommended dosages. A 2023 review in the Cureus journal says pregnant women should follow the guidance of their healthcare provider or nutritionist when considering choline supplementation. The maximum daily intake for choline which is unlikely to cause adverse health effects is set at 3500mg for adults and most supplements contain far less than this, Dr Derbyshire says.
BBC News
09-04-2025
- Health
- BBC News
Choline: The underappreciated nutrient that's vital for our brains
The compound has been linked to improved cognitive performance and reduced anxiety – but are you getting enough of it? You may not have heard of choline before, but studies show that it's crucial for our health, at various stages of life. Choline is neither a vitamin or a mineral – it's an organic compound that's vital to the healthy functioning of the human nervous system. Now there's emerging evidence that consuming more choline can have a wide range of powerful effects, from improving cognitive performance to protecting against neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and dyslexia. The nutrient also seems to play a significant role in human neurodevelopment. In one study, babies who whose mothers took choline supplements during pregnancy gave birth to infants with higher information processing speeds – a measure of healthy cognitive functioning. Scientists say that choline is a wonder-nutrient, but that it has been hugely overlooked. So, where does choline come from – and are you getting enough of it? A crucial nutrient Every cell in our body contains choline, says Xinyin Jiang, professor of health and nutrition sciences at Brooklyn College in New York, US. Choline is an "essential" nutrient, which means we need it for our health, but our bodies don't produce enough on their own. Instead, we need to get some of it from our diets. In this sense, it's similar to omega 3 fatty acids, although it's actually closely associated with B vitamins, says Emma Derbyshire, science writer and founder and CEO of the consultancy Nutritional Insight. Choline can be found mostly in animal-based foods, including beef, eggs, fish, chicken and milk, but it's also in peanuts, kidney beans, mushrooms and cruciferous vegetables such as broccoli – although animal foods tend to contain more choline than plant-based sources. We need choline for numerous functions in our bodies, including liver function. Not having enough can cause a number of problems. "Choline helps fat transport out of the liver, and when a person is deficient, they can get a fatty liver," says Jiang. Choline also helps the body to synthesise phospholipids, which are the main component of the cell membranes in our bodies. Being deficient in the nutrient can affect the expression of genes involved in the process of our cells multiplying. During the development of a foetus, choline deficiency can be particularly harmful because it inhibits cell proliferation in the brain. Choline's role in the brain is crucial – in fact it's primarily a "brain nutrient", says Derbyshire. It's needed for our bodies to produce the neurotransmitter acetylcholine, which is a chemical that carries messages from your brain to your body through nerve cells. Acetylcholine plays a major role in brain nerve cells, which are needed for our memory, thinking and learning. In one study involving almost 1,400 people aged 36 to 83, researchers found that people with a higher choline intake tended to have better memories, and that choline intake during midlife may help to protect our brains. Choline is commonly included as an ingredient in supplements taken as "nootropics" – a diverse group of substances which some people believe can enhance learning and memory. On the other hand, choline deficiency has also been associated with neurodegenerative disorders such as Alzheimer's and Parkinson's disease. Another way choline may affect the brain is our mental health. One study found that higher intake of choline was associated with lower levels of anxiety. In another study, having a higher dietary intake of choline was linked to a lower risk of depression. Having an adequate choline intake can also come with a number of other benefits. A higher dietary intake of this nutrient . Separately, research in mice has found that choline can help to lower the levels of homocysteine, an amino acid which can increase the risk of heart disease. High levels of homocysteine can also be linked to osteoporosis, and research has found that people with higher choline intakes from their diets tend to have a higher bone density – an indicator of strong, healthy bones with a lower risk of being fractured. "Choline can potentially have an effect against bone loss," says Øyen Jannike, a researcher at the Institute of Marine Research in Norway, who has studied the link between choline and bone health. This may partly be because of homocysteine, she says, but also because choline is an essential structure in our cell membranes. The first 1000 days It's well established that a child's first two years are critical for their development, and that the mother's diet during pregnancy and breastfeeding has an integral influence on this. Studies show that choline is vitally important for a baby's development in the womb. In fact, babies are born with three times as much choline as their mothers, which Derbyshire says shows how important it is at this stage of life. Several studies have found that the supply of choline in the womb correlates to the cognitive outcome of the baby, and its benefits may continue for years as the child develops. In one study, pregnant women who had the highest dietary choline intake during the second trimester of pregnancy (from week 13 to week 28) went on to have children who scored higher on a test of short- and long-term memory at the age of seven. Some research even suggests insufficient choline intake when a woman is pregnant could be linked ADHD behaviours in their offspring. "We're seeing a lot more ADHD and dyslexia in schools, and some is genetic, but it's also possible that, in utero, they're not getting key nutrients," Derbyshire says. "These very subtle neurodevelopment changes are occurring and impacting them later on. We're treating the aftermath now." Jiang has studied the relationship between the supply of choline during pregnancy and breastfeeding, and brain development. "In animal findings, when the mum has more choline, the cognitive development of their offspring is better," she says. "We're starting to find similar results in human studies, although, not exactly the same." Feeding the brain A 2020 review of 38 animal and 16 human studies concluded that choline supplementation helps brain development. However, only animal studies currently show a strong link between choline and improved cognitive function. The paper doesn't define the ideal amount of supplementation, but says most human studies use supplements providing up to 930mg choline daily – an amount equivalent to the choline in roughly six chicken's eggs – with no adverse effects reported. There may also be some people that require more choline than the recommended daily amounts, says Øyen – including post-menopausal women, for example, who have lower levels of oestrogen, and people with fatty liver disease. We also know, Derbyshire says, that, due to the genetic differences from one person to another, some people may have higher requirements for choline. (Derbyshire has previously consulted for and advised The Meat Advisory Panel, Marlow Foods (Quorn), the Health Supplement Information Service and the British Egg Information Service, among other organisations). When we eat foods containing choline, it's very easily absorbed into our blood, says Jiang, which should go some way to ensuring we're consuming enough choline. However, several studies show that many of us aren't getting enough. One study found that only 11% of American adults consume the recommended daily amount. Eggs are one of the most potent dietary sources of choline, and there is some concern that those who choose to follow a vegan diet may not be getting enough of this nutrient – though there are many plant-based sources and choline supplements are widely available in developed countries. One study found that people who eat eggs have almost twice the usual choline intake compared with those who don't, leading the researchers to conclude that consuming the daily adequate amount of choline was "extremely difficult" without eating eggs or taking a supplement. But the EFSA's recommendation of 400mg of choline per day is achievable for most people if you plan your diet carefully, says Jiang. Some vegan sources of choline include tofu (28mg of choline per 100g), peanut butter (61-66mg per 100g) and soy beans (120mg per 100g). Anyone concerned they're not getting enough choline can take a daily supplement, Øyen says. In the meantime, she adds, there needs to be more animal and human research to better understand the mechanisms behind some of choline's health benefits. However "clinicians are becoming more aware of [choline]", says Derbyshire. While it often seems to be slightly overlooked, she is hopeful that choline will soon start to enjoy the limelight. -- For trusted insights into better health and wellbeing rooted in science, sign up to the Health Fix newsletter, while The Essential List delivers a handpicked selection of features and insights. For more science, technology, environment and health stories from the BBC, follow us on Facebook, X and Instagram.
