Choline is an important nutrient that you might not have thought much about.Our bodies produce small amounts of choline, but not enough to prevent deficiency and promote health. Choline is crucial for the liver, muscle, and brain and it plays important roles in memory, mood, muscle control and preventing atherosclerosis.Healthy men and women who are fed a choline-deficient diet develop fatty liver disease and increased levels of creatine phosphokinase that indicates muscle damage; when choline is added back to their diets, these situations resolve.Choline is even more important during pregnancy, lactation, and early childhood because fetal and infant needs for choline are so high that maternal choline stores are easily depleted. Low choline intake during pregnancy increases the risk of both neural tube defects and cleft palate. In addition, optimal development and functioning of the placenta during pregnancy relies on adequate amounts of choline. Impairments to the placenta can result in preeclampsia and poor fetal growth. Women who are pregnant need 450 mg of choline per day, and women who are breastfeeding need 550 mg of choline per day. A small randomized study showed that higher maternal choline intake during pregnancy resulted in positive effects on the children’s attention, memory and problem-solving skills into the school-age years.Why haven’t we heard about choline?Choline wasn’t well known in 1998 when the Food and Nutrition Board of the National Academy of Medicine (NAM) first established an Adequate Intake (AI) for choline. Adequate Intakes are used when there isn’t enough data to calculate the more specific recommended dietary allowance (RDA).Since 1998, there has been more research on choline’s role in health, and in February 2018 a Choline Science Summit brought together scientists to address the latest choline research, including the role of choline in health and development through the lifecycle, the role in genetics in influencing the amount of choline necessary for health, and the gaps in the choline AI compared with actual dietary intakes.How much choline do we need?The current Adequate Intake for choline per day is:Only about 10% of Americans and 8% of pregnant women currently meet their gender- and life-stage-specific AI for choline. Premenopausal adult women are the least likely (gender and life-stage) group to meet the AI, and vegetarians have the lowest intake.Recent research shows that common genetic variants significantly impact dietary choline requirements. Further research is needed to be able to accurately identify people with the genetic variants that lead to increased choline needs.Which foods contain choline?Choline is largely present in animal foods, which often means that vegetarians and especially vegans need to make sure they’re including more choline-containing foods in their diet.  HEre's a rundown of various foods that contain choline...

• 3 oz salmon have 187 milligrams (mg) of choline
• 1 large egg has 147 mg choline
• ½ cup of roasted soybeans has 107 mg choline
• 1 cup of collard greens has 72 mg choline
• 1 cup of Brussels sprouts has 63 mg choline
• 3 oz of chicken has 56 mg choline
• ½ cup of shitake mushrooms has 58 mg choline
• 3 oz of beef has 55 mg choline
• 1 oz of wheat germ has 51 mg choline
• 1 cup of Swiss chard has 50 mg choline
• 1 cup of cauliflower has 48 mg choline
• ½ cup of kidney beans has 45 mg choline
• 1 cup of cooked quinoa has 43 mg choline
• 1 cup of milk has 38 mg choline
• 1 oz almonds has 15 mg choline

Choline intakes have been shown to be driven by egg intake and animal protein foods (meat, poultry, and seafood). Incorporating 1 to 2 eggs per day as a substitute for processed and/or red meat increases choline intakes without altering other essential nutrients and maintaining cholesterol intakes within a healthy range.Choline safetyConsuming too much choline, typically from supplements, is associated with a fishy body odor, vomiting, excessive sweating, low blood pressure, and liver toxicity. 3500 mg of choline per day is the tolerable upper limit for adults.Animal studies show that consuming choline increases the production of trimethylamine N-oxide (TMAO) which is a possible risk factor for cardiovascular disease. However, this connection is not established in humans and current epidemiological studies do not show a link between dietary choline intake and cardiovascular disease. There is not enough evidence to show a possible impact of TMAO and heart disease, and more human research needs to be conducted.Our choline tips:

• Salmon is an excellent source of choline and is also high in omega-3 fatty acids that help promote a healthy cardiovascular system.
• Even though eggs contain cholesterol, they are an excellent source of choline and can be included in an overall healthy diet by choosing mono-unsaturated sources of fat such as olive oil instead of butter, replacing processed meats with seafood or skinless poultry, avoiding crispy fried snacks, and enjoying fruit for a sweet dessert instead of cookies, cakes, or pies.
• Enjoy 1-2 cups of vegetables that are good sources of choline each day.
• While eating a plant-based diet is important for good health, it’s important to include nutrient-dense animal foods such as eggs, seafood, and dairy products for adequate amounts of important nutrients such as choline.

By Lynn Grieger, RDN, CDE, CPT, CHWCReferences:

1. Choline: The underconsumed and Underappreciated Essential Nutrient. Wallace, Taylor C., PhD, CFS, FACN; Blusztajn, Jan Krzysztof, PhD; Caudill, Marie A., PhD, RD; Klatt, Kevin C., MS; Natker, Elana, MS, RD; Zeisel, Steven H., MD, PhD; Zelman, Kathleen M., MPH, RD, LD. Nutrition Today: November/December 2018 - Volume 53 - Issue 6 - p 240–253. doi: 10.1097/NT.0000000000000302
2. National Institutes of Health. Office of Dietary Supplements. Choline Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/choline-healthprofessional/ Updated 9-26-18; accessed 2-24-19.