By Joy Stephenson-Laws, JD, Founder

When it comes to managing our personal nutrition, there are lots of things to keep track of: What should I eat? How much should I eat? When should I eat?

It really depends on the individual, but one thing’s for certain for us all: we need six essential nutrients to stay healthy. These nutrients are water, carbohydrates, proteins, fats, vitamins and minerals.  

Water, carbs, proteins and fats are considered macronutrients (which are necessary in larger quantities), and the vitamins and minerals are considered micronutrients (needed in smaller quantities). To be clear, micronutrients are just as important to our health as macronutrients are. 

If you have a basic understanding of good nutrition, you likely already know many of the popular essential micronutrients such as iron, magnesium, vitamin C, potassium, sodium, vitamin D and calcium (to name a few).

But one micronutrient you may not be too familiar with is choline.

The Institute of Medicine (IOM) did not recognize choline as an essential nutrient until 1998. But there’s no denying choline’s important role in keeping us healthy. This nutrient is involved in a large number of very important physiological functions which affect various organs such as the brain, heart and liver. Simply put, the body needs choline to function normally and optimally. 

And perhaps one of choline’s most praised attributes is that it appears to play an important role in weight loss. A study from 2014 involved female taekwondo and judo athletes, who may have attempted to reduce their body mass a few days before competition in order to have a competitive advantage over their lighter opponents. 

So in order to lose weight quickly, some of these athletes implemented choline supplementation as one of their nutritional strategies. And basically what researchers found when the athletes took choline tablets one week before competition, is that the athletes were able to “...rapidly reduce body mass without any side effects on biochemical levels or static strength.”

Choline plays an important role in controlling fat and cholesterol buildup in the body. It has even been suggested that choline helps the body burn fat, which may result in easier weight loss and better metabolic health.

“Without an adequate supply of choline for phosphatidylcholine synthesis, triacylglycerides will accumulate, which leads to fatty liver condition,” according to the National Institutes of Health.

Given the association between choline and weight loss, it is not surprising that there is continuing interest in this nutrient. Remember, well over 65% of Americans are overweight or obese, so this is an issue that touches our lives in one way or another. And healthy solutions, like getting more choline in the diet, may make a difference for some.  

Furthermore, there is credible evidence that sub-optimal choline levels in humans are associated with liver and muscular damage. 

“The importance of choline in the diet extends into adulthood and old age. In a study of healthy adult subjects deprived of dietary choline, 77% of the men and 80% of the postmenopausal women developed signs of subclinical organ dysfunction (fatty liver or muscle damage),” according to this report from the NIH.

Basically, a choline deficiency can cause an abnormal deposition of fat in the liver, which may result in nonalcoholic fatty liver disease.

It is also extremely important that pregnant women get a sufficient intake of choline. 

“In humans, low maternal choline intake during pregnancy can alter DNA methylation in the placenta and cord blood [65]. Notably, there is an inverse relationship between the risk of neural tube defects and maternal choline intake or plasma choline concentrations, independent of dietary folate [another very critical nutrient pregnant women must consume] or supplemental folic acid intakes…,” reports the NIH.

“In addition, other birth defects associated with choline deficiency include cleft lip, hypospadias, and cardiac defects.”

The truth is, you may be deficient in choline.

According to the NIH’s Office of Dietary Supplements, most people in the United States consume less than the adequate intake (AI) for choline.

Recommended intakes for choline based on age and sex are listed below (note these amounts may differ if a woman is pregnant or lactating):

• 1-3 years, 220mg/day for both males and females
• 4-8 years, 250mg/day for both males and females
• 9-13 years, 375mg/day for both males and females
• 14-18 years, 550mg/day for males, 400mg/day for females
• 19 and up, 550mg/day for males, 425mg/day for females

Data from the 2013–2014 National Health and Nutrition Examination Survey revealed that the average choline intake from foods and beverages among children and teens (ages 2-19) was only 256mg. Furthermore, the average intake for adult males was only 402mg and 278mg in adult females. Overall, most people do not get choline from supplements, which perhaps means that more people may need to seek the advice of a competent healthcare professional regarding choline supplementation if they cannot get an adequate intake through diet.

Some sources say less than nine percent of adults in the United States are meeting their daily choline needs! One report states 90 percent of Americans do not get enough choline.

Our livers can produce choline, but the amount it may produce is not enough to meet our needs. We really have to depend on dietary sources and maybe supplements in order to get enough choline.

So what are some dietary sources of choline?

Animal foods, particularly eggs and beef liver, are rich in choline. So if you are vegan or vegetarian, you definitely want to get a nutrient test to see if you are deficient in choline and if you are, discuss supplementation with a competent healthcare professional.

“Strict vegetarians, who consume no meat, milk, or eggs, may be at risk for inadequate choline intake,” according to the Linus Pauling Institute. 

And some sources even say that if you don’t eat eggs on the regular, you may have difficulty getting enough choline in your diet. Well, not everyone eats eggs which is why, again, it’s important to be proactive by knowing what nutrients you are deficient in.

Since it appears that so many Americans (whether they eat animal foods or not) are choline deficient, we all might want to consider being proactive when it comes to getting enough of this critical nutrient.

There are plant-based sources of choline such as potatoes, Brussel sprouts, mushrooms, cabbage, broccoli and certain beans, nuts and whole grains. Educate yourself about the foods that are rich in choline, and make the effort to include them in your diet. For a list of additional foods rich in choline, read here. 

How else can you be proactive about choline deficiency?

• Know all your options.

Some health professionals recommend “Lipotropic (Lipo) Injections.” These injections include choline which may aid in the reduction of fat when combined with a healthy lifestyle. Here at pH, we have choline injections and it is referred to as “The Melt.” 

• Healthcare professionals should have choline on their radars.

This report from 2009 emphasizes the immediate need to increase awareness among health professionals and consumers of choline as an essential nutrient which is deficient in many people.

“These data indicate that there is a need to increase awareness among health professionals and consumers regarding potential suboptimal intakes of choline in the United States, as well as the critical role that choline plays in health maintenance throughout the lifespan. Food scientists and the food and dietary supplement industries should consider working collectively with government agencies to discuss strategies to help offset the percentage of the population that does not meet the AI [adequate intake].”

• Be aware of certain conditions that may make you prone to this deficiency.

There are certain groups of people who are more likely than others to have trouble getting enough choline. These include pregnant women, people with genetic conditions and those who are being fed intravenously. And remember, diets like certain strict vegetarian types which do not include milk or eggs may be choline deficient.

Educate yourself about this important nutrient, especially if you have been told you have non-alcoholic fatty liver disease (NAFLD) or are struggling with weight issues.

Enjoy your healthy life!

The pH professional health care team includes recognized experts from a variety of healthcare and related disciplines, including physicians, attorneys, nutritionists, nurses and certified fitness instructors. This team also includes the members of the pH Medical Advisory Board, which constantly monitors all pH programs, products and services. To learn more about the pH Medical Advisory Board, click here.