Choline Is a Major Deficiency Nutrient
In 1998, the IOM recognized choline as an essential nutrient needed by humans and critical for proper fetal and child development. The adequate intake (AI) recommendation for choline is 550 mg/day for men, 425 mg/day for women, 450 mg/day for pregnant women, and 550 mg/day for lactating women.1
While the need for choline is great, data from the 2007–2008 National Health and Nutrition Examination Survey (NHANES) evaluation showed that only 10% or less of the U.S. population across all age groups had a usual choline intake at or above the AI. Only young children are generally meeting AI levels.2
Liver, eggs, egg yolks, and a variety of meats are the richest sources of choline, but their consumption has decreased in recent years. Supplementing the diet with choline is almost essential in order to ensure adequate consumption for optimal health.
The opportunity exists to promote choline for all ages. The U.S. FDA recently proposed adding choline to the list of nutrients permitted to be listed voluntarily on the Nutrition Facts panel on food labels. FDA has also mandated choline as an ingredient in infant formula.
Because the IOM has documented choline’s functionality in health promotion and disease prevention, robust health claims are possible for this nutrient.
Choline is associated with cognitive function, including development of the memory center. It has been shown to help prevent neural tube defects (NTDs) during pregnancy, support liver health and help prevent fatty liver disease, support heart health, and aid in sports performance.
Choline, an essential nutrient that is functionally complementary to B vitamins and omega-3 fatty acids, is critical to overall health and healthy cognitive function. Choline is a critical component of the building blocks of the nervous system, including neurotransmitters that form the mechanistic basis for memory. Choline is part of the brain’s messaging system and functions directly and indirectly in brain activities and in cognitive development of the fetus and infant.
Specifically, choline is a precursor to the neurotransmitter acetylcholine. Choline also functions as part of phosphatidylcholine, a structural component of the phospholipid membrane of all cells, including glial and neuronal cells. Choline supports the communication between neurons in the brain and promotes better availability of neurotransmitters for signaling within the brain. The availability of choline at different stages of human development and aging appears to be a significant determinant in improving the density and branching of dendrites, which results in more contact points for neurotransmission,3 thereby affecting the strength of neuronal response to stimulation in the parts of the brain responsible for memory.4,5,6
The level of choline in the brain is directly affected by its levels in plasma, which is supported through dietary intake and supplementation.7,8,9 Oral intake of choline affects blood levels of both choline and acetylcholine.9,10,11,12
Cognitive decline in aging is due in part to oxidative events. Such oxidative events occur when high levels of homocysteine are present. Homocysteine is a metabolically generated amino acid that is directly and inversely associated with choline intake.13 Homocysteine may play a role in cognitive decline in normal aging and may atrophy parts of the brain hippocampus and cortex.14 Increasing choline intake may help to maintain cognitive function in the otherwise healthy, aging individual.
The opportunities for choline in the brain health market are great. In 2013, U.S. consumers spent $660 million on brain health supplements.15 Just under half (45%) of supplement users took a supplement to keep their heart healthy, while 28% took a supplement to boost their brain function/memory.16 According to survey data from HealthFocus International, maintaining mental sharpness as we age is the number one consumer concern, while lack of mental sharpness is also among the top 10 concerns.17 Mental/aging and aging/memory are both strong nutraceutical mass markets, on a par with vitamin D or omega-3s.18
Strong evidence indicates that adequate choline intake supports normal liver functions and helps to prevent nonalcoholic fatty liver disease (NAFLD) and fatty liver, conditions that result either from choline deficiency or alcohol consumption.
Choline’s role as part of the phospholipid phosphatidylcholine is critical in healthy liver function. As mentioned, phosphatidylcholine is a primary structural component of the phospholipid membrane of all cells. This phospholipid is also needed in the construction of very-low-density lipoprotein (VLDL), which functions in fat transport.
The effect of choline on preventing fatty liver has been evident for some time. Research published in 1958 reported the positive effects of choline on liver health. A single dose of choline administered to choline-deficient animals increased the oxidation of liver fat as well as the synthesis of liver phosphatide P32. 19
NAFLD affects one-third of U.S. adults, including one-half of obese men as well as 11% of adolescents. One in 10 adults has liver disease. While liver health is still a relatively small supplement category, sales of liver/detox supplements topped $115 million in 2013, up 7.2% from 2012. The side effects of prescription medications, especially statins, are also raising concerns for liver health.20
Choline affects heart health through a variety of mechanisms. First, choline helps lower levels of homocysteine, which otherwise causes oxidative stress and damage to LDL cholesterol, leading to plaque formation.
Choline also works to support a strong heart muscle with regular contractions, leading to a controlled and lower heart rate with less stress to the heart over time. Acetylcholine is a neurotransmitter used by nerve cells that control the heart, muscles, and lungs. Acetylcholine supports communication between nerves and the heart muscle. Acetylcholine is released at the junction between nerve and muscle cells, called the motor end-plate. This release signals calcium ions to begin muscle contraction.
As the heart health market shifts from targeting prevention to targeting risk factor reduction, there are great opportunities for supplements that help reduce the risk of blood plaque formation, especially considering that one in five consumers recognize that atherosclerosis is an important health concern and that 32% of women and 53% of men have high levels of blood plaque.21
Pregnancy and Lactation
Folate, choline, and betaine serve as hydroxymethyl group donors, and are all important in the prevention of NTDs that result in birth defects, including anencephaly and spina bifida. These birth defects occur early in pregnancy, between the 21st and 27th days after conception, when many women do not realize that they are pregnant.22 Pregnant and lactating women are among the many shown to have suboptimal intakes of choline.
The benefits of adequate choline intake are invaluable. Human studies show that women in the highest quartile of choline intake had a 72% lower risk of NTD-affected pregnancy, and those with the lowest levels of serum choline had 2.4-fold greater risk of an NTD-affected pregnancy.23
Large amounts of choline are delivered to the fetus across the placenta; choline concentration in amniotic fluid is 10-fold greater than that present in maternal blood.24 Plasma or serum choline concentrations are significantly higher in pregnant women than non-pregnant women and are six- to seven-fold higher in the fetus and newborn than in adults.25 Human milk is rich in choline; therefore, the need for choline in lactation is greatest, and maternal stores are generally depleted for extended periods of time.
In the women and children’s supplements market, choline should be of prime consideration. Half (46%) of children younger than age four take a supplement, while 70% of children aged 4-6 take a supplement.25 In 2012, 3.8 million women in the United States used prenatal supplements, while four of the top 10 bestselling women’s supplements were prenatal.26
Through its activity at a cellular level, choline can enhance muscle performance during exercise and improve stamina. Choline supports communication with muscle fibers and promotes muscle recovery following repetitive motion, resulting in better overall output during training. Choline also protects the body’s natural pool of nitric oxide. Nitric oxide expands arterial walls, increasing oxygen-rich blood flow to exercising muscles; however, nitric oxide is a molecule that lasts for only a second in the bloodstream and then has to be replaced. Choline supports optimal nitric oxide functions in the body, which is good for all athletes, especially body builders.
With sales of sports nutrition supplements reaching $4.5 billion in 2013 (up 13% from 2012), this category remains among the fastest-growing supplement sectors.27
In December 2013, Gallup research found that just 15% of Americans are aware of choline. But awareness is growing. New choline supplements nearly doubled to 555 in the global marketplace in 2012, up from 292 in 2011.28
According to Sloan Trends’ TrendSense Model, choline quietly became a mass-market opportunity in 2009–2010 and has continued to accelerate in terms of its marketability ever since.19
Catherine Adams Hutt, PhD, RD, CFS, is chief science and regulatory officer for Sloan Trends Inc. (Aubrey, TX). Adams Hutt is a registered dietitian and certified food scientist, and supports companies with strategic business direction and regulatory compliance.
- IOM-NAS (1998) Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline.
- Wallace TC, McBurney M, Fulgoni VL (2014) Multivitamin/Mineral Supplement Contribution to Micronutrient Intake in the United States, 2007-2010. J Am Coll Nutr 33(2):94-102
- McCann JC, Hudes M, Ames BN (2006) An overview of evidence for a causal relationship between dietary availability of choline during development and cognitive function in offspring. Neurosc Behav Rev 30:696-712
- Glen MJ, Gibson EM, Kirby ED, Mellott TJ, Blusztajn JK, Williams CL (2007) Prenatal choline availability modulates hippocampal neurogenesis and neurogenic responses to enriching experiences in adult female rats. Eur J Neurosci 25:473-82
- Jones III JP, Mech WH, Williams CL, Wilson WA, Swartzwelder HS (1999) Choline availability to the developing rat fetus alters adult hippocampal long-term potentiation. Dev Brain Res 118:159-67
- Li Q, Guo-Ross S, Lewis DV, Turner D, White AM, Wilson WA (2004) Dietary prenatal choline supplementation alters postnatal hippocampal structure and function. J Neurophysiol 91:1545-55
- Wurtman RJ, Cansev M, Ulus IH. (2009) Choline and its products acetylcholine and phosphotidylcholine. In: Tettamani G, Goracci G editors. Handbook of Neurochemistry and Molecular Neurobiology: Neural Lipids. 3 ed. New York: Springer pp. 443-500
- Babb SM, Ke Y, Lange N, Kaufman MJ, Renshaw PF, Cohen BM (2004) Oral choline increased choline metabolites in human brain. Psych Res Neuroimag 130:1-9
- Hirsch MJ, Growdon JH, Wurtman RJ (1978) Relations between dietary choline or lecithin intake, serum choline levels, and various metabolic indices. Metabolism 27(8):953-60
- Cohen EL and Wurtman RJ (1975) Brain acetylcholine: increase after systemic choline administration. Life Sci 16(16):1095-102
- Cohen EL and Wurtman RJ (1976) Brain acetylcholine: control by dietary choline. Science 191(4227):561-2
- Zeisel SH (1981) Dietary choline: Biochemistry, physiology, and Pharmacology. Ann Rev Nutr 1:95-121
- Olthof MR, Brink EJ, Katan MB, Verhoef P (2005) Choline supplemented as phosphotidylcholine decreases fasting and postmethionine-loading plasma homocysteine concentrations in healthy men. Am J Clin Nutr 82:111-7
- Garcia A and Zanibbi K (2004) Homocysteine and cognitive function in elderly people. Can Med Assoc J 171(8):897-904
- Nutrition Business Journal (2014) Condition Specific Supplement Data Sheets
- Mintel, Vitamins, Minerals and Supplements - US - December 2013
- HealthFocus, 2013. HealthFocus U.S. Trend Study. HealthFocus Intl., St. Petersburg, Fla. www.healthfocus.com
- Sloan, A.E. 2014. TrendSense(TM) predictive model report. Sloan Trends Inc., Escondido, Calif. www.sloantrend.com
- Zilversmit DB and Diluzio NR (1958) The role of choline in the turnover of phospholipids. Am J Clin Nutr 6(3):235-41
- Hartman Group, 2013. Reimagining Health & Wellness. The Hartman Group, Bellevue, Wash. www.hartman-group.com
- AHA. 2014. Heart and stroke statistics. American Heart Assn., Dallas, Texas. www.heart.org
- Pitkin RM (2007) Folate and neural tube defects. Am J Clin Nutr 85(1):2855-2885
- Shaw GM, Finnell, RH, Blom, HJ, Carmichael, SL, Vollset, SE, Yang, W, and Ueland, PM (2009) Choline and risk of neural tube defects in a folate-fortified population. Epidemiol 20(5):714-719
- Shaw GM, Carmichael SL, and Yang W (2004) Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol 160(2):102-109
- MSI, 2011. Multi-Sponsor’s Survey’s 2011 Gallup Study of Children’s Supplement Use
- Packaging Facts (2012) Nutritional Supplements in the U.S, 5th Edition, September 2012
- Nutrition Business Journal (2014) XIX (6/7): 1-47
- Innova Marketing Insights (2013) www.innova-food.com
Photo © iStockphoto.com/Dominik Pabis