Choline: What Is It And Why Is It Important?

Looking after our brain and nervous system is hugely important. In light of this, the research on choline has soared in nutrition science, with good reason. Arguably, choline is now considered just as important as folate to develop the nervous system. And while it’s not technically a vitamin, it is an essential nutrient for health

So what exactly is choline and why’s it so important? Do you know which foods contain choline? And here’s the big one - are you getting enough?

What Is Choline?

Choline is a vitamin-like compound which is similar to protein when used in the body. The majority of choline is found within phospholipids, which are essential components of cell membranes. Our body makes its own choline, yet in very small amounts. This is why we need to obtain choline from the food we eat. Choline is also crucial for proper fat metabolism in the body.

Some emerging research asserts that choline protects against neural tube defects, similar to the function of folate. It’s important therefore, for pregnant women to be consuming adequate choline as part of a healthy and varied diet. Animal studies reveal that choline is necessary for optimal brain function and cognition, particularly in ageing populations. So, choline seems like a necessary nutrient for many body functions. Ranging from preconception to old age, evidence suggests, choline intake matters. 

Choline foods for breakfast, eggs and brocolini on a plate

What Is the RDI for choline?

  • Women: 425mg/day
  • Men: 550mg/day
  • Pregnancy: 450mg/day
  • Breastfeeding: 550mg/day

Health Benefits of Choline

Choline is a chemical compound at the centre of various body processes. This nutrient forms part of the phospholipid bilayer of cell membranes. This means it can help cells communicate with other nearby cells. There’s a range of ways choline benefits our health. Here’s a dive into choline and the research supporting its therapeutic potential.

Choline Is Crucial For The Nervous System

Choline is also required to produce acetylcholine, which is an important neurotransmitter. Acetylcholine is involved in many different functions of the central and peripheral nervous system. In the brain, acetylcholine is active in the cerebral cortex and hippocampus. These brain regions are responsible for higher order thinking, executive function, planning and memory. Crucially, in the peripheral nervous system, acetylcholine activates muscle contractions and is the primary neurotransmitter of the autonomic nervous system.

Choline Supports Brain Development During Pregnancy

For decades, the research in favour of folate for pregnant mothers has been well supported. Folic acid decreases the incidence of neural tube defects, such as spina bifida in developing babies. What most people don’t realise, is that the nervous system develops within the first 30 days following conception. Importantly, this is often before many women even know they’re pregnant. Therefore, adequate folate intake is critical for proper brain and nervous tissue generation. 

Doctor speaking to pregnant lady

In recent years, choline has entered the spotlight of perinatal nutrition. According to recent research, it’s possibly considered just as important as folate for foetal development. A large case-controlled study established that women consuming diets high in choline had a 51% lower risk of neural tube defect-affected pregnancy. Contrastly, other recent clinical studies have found a negative or nil effect of choline with respect to negative neonatal outcomes. 

Given what we know about dietary choline and how it’s used in the body, it makes sense to continue to include choline-rich foods to support brain and nervous system development. This remains true despite the conflicting clinical evidence in pregnancy-related nutrition.

Choline Supports Liver Function

Choline deficiency is linked to muscle damage and abnormal fat accumulation in the liver. This is one of the causes of non-alcoholic fatty liver disease. Getting enough choline in the diet ensures fat is transported and delivered to target tissues. A Chinese observational study by Yu et al. (2014) found that choline intake was associated with a lower risk of fatty liver disease. In animal studies, choline deficiency has been linked to a higher incidence of liver cancer. Consuming choline appears to have some protection against damage caused by hepatic (liver) chemical exposure.

Choline Supplementation Improves Brain Injury Outcomes

Choline supplementation improves verbal and visual memory recall, according to a 2011 study published in the American Journal of Clinical Nutrition. In this study, individuals consuming choline had better overall cognitive performance. Intriguingly, the MRI results from this study showed that choline intake was linked to reduced brain atrophy and associated cognitive decline. This finding is echoed by other research which links acetylcholine deficiency to Alzheimer’s disease development. 

Another interesting study published in the Lancet observed a large group of elderly stroke patients. These patients displayed a progressive decline in their mental acuity and were administered a choline supplement called citicoline. At the end of this study, the citicoline treatment was associated with higher cognitive scores and brain function. These results endorsed choline supplementation in the treatment of stroke-induced brain damage.

A systematic review from 2014 found that choline supplementation mitigates the cerebral damage caused by traumatic brain injuries (TBI). Research shows that high dose choline supplements can speed up recovery of neurological disorders due to TBIs. As if this wasn’t promising enough, evidence suggests that headaches, dizziness, fatigue and memory are all improved with choline supplementation.

Summary of Choline & Why We Need It

  • Forms part of cell membranes
  • Supports intracellular communication
  • Precursor molecule to acetylcholine
  • Involved in fat transport and liver metabolism
  • Aids central and peripheral nervous system functions
  • Protects against neural tube defects
  • Reduces the impacts of Alzheimer’s symptoms cognitive decline
  • Found abundantly in eggs, red meat, peanuts, dairy, cruciferous veg

Close up of eggs containing choline

Choline Deficiency: Signs & Symptoms

Choline is found mostly in animal products and dairy. There’s some choline in cruciferous or brassica vegetables. For the most part, true choline deficiency is rare. Yet, while a bare minimum choline intake is achievable for most of us, reaching optimal levels to support the body may be more difficult. This is especially true in certain populations, such as for vegans or vegetarians. 

Furthermore, people who consume a diet high in refined carbohydrates, devoid of nutrients are at risk of developing severe choline deficiency. Naturally, if a diet is high in carbs and also low in quality protein and fats, metabolic problems will ensue. These health issues include obesity, cardiovascular disease, high blood pressure and diabetes. The combination of these conditions also drives the occurrence of non-alcoholic fatty liver disease. The end point of all of this is liver cirrhosis and major liver failure. 

Other symptoms associated with choline deficiency will be regarding the musculoskeletal system and nervous system. If there’s not enough choline in the body, there’ll also be insufficient acetylcholine. Acetylcholine is broadly involved with nervous system activation, nerve transmission and muscle function. A true choline deficiency can lead to severe musculoskeletal and neurological symptoms.

Signs of choline deficiency include:

  • Hypertension
  • Insulin resistance
  • Obesity
  • Metabolic syndrome
  • Extreme muscle fatigue
  • Atrophy
  • Impaired cognitive function
  • Liver cirrhosis

When you consider how integral a nutrient like choline is to the body, it’s easy to see why dietary sources of it are important. It’s also a relief to know that simply augmenting your diet to include high choline foods can support brain health, musculoskeletal function and liver health. 

Foods High in Choline

If eggs, meat and dairy are on regular rotation in your diet, chances are choline is plentiful and you’ll be well. Other food sources of choline include broccoli, Atlantic cod, salmon, peanuts and wheat germ. If you’re on a vegan diet, it can be really difficult to get the right balance of nutrients to support your health. So, take extra care and seek the help of a trusted health provider if you have any doubts.

Choline containing foods

As part of a healthful and balanced diet, ensure to include an array of foods from this list for optimal choline intake. Here’s a list of foods high in choline:

Food Source

Choline Content

100g beef liver

356 mg

1 cup wheat germ

202 mg

1 large egg

147 mg

2 cooked scallops

94 mg

100g tinned salmon or cooked chicken

74 mg

200ml dairy milk

38 mg

1 cup cooked brussel sprouts or broccoli

63 mg

2 tbsp. peanut butter

20 mg

Recipes High in Dietary Choline

While red meat and fish are very rich in choline, it’s important to diversify your dietary choline sources. Not only does this keep things interesting in the kitchen, it affords an opportunity to gain other nutrients that may be crucial for a similar biological need. For example, if you’re trying to boost choline, chances are you could be low in other nutrients that support brain or muscle function. Without a doubt, quality fats and protein are the go-to brain foods to focus on. That said, here’s a couple of recipes to get you upping your choline intake. 


Brain Boosting Smoothie

While great for anyone, this smoothie recipe is particularly ideal for pregnant or postpartum mums. I see this delicious smoothie as ‘one for you, one for your baby’ type eating. Getting enough brain-boosting fats, and of course, choline in your diet is one way to combat fatigue that accompanies the perinatal period. If you’re suffering from ‘baby-brain’, I believe nature is giving a hint as to what we need to nourish ourselves.


  • ¼ cup peanut butter
  • ½ banana
  • ¼ cup tahini
  • 1 or 2 chopped Brazil nuts
  • ½ avocado
  • 1 cup dairy milk
  • 2 tbsp. Cacao powder or carob powder


Blitz everything in a blender and enjoy.

Brassica Veg & Quinoa Salad

For a healthy boost of eggs and cruciferous veggies, doubling down on your choline intake - you can’t go past this salad. Cabbage, baby kale and broccoli sprouts make for a fresh, crunchy salad. The addition of boiled eggs means it’s loaded with essential fats, protein and yes, more choline! Enjoy this hearty salad as it is or alongside grilled salmon or marinated tofu. 



  • 2 cups quinoa, cooked
  • 200g fresh baby kale, rinsed
  • 1 small purple cabbage, julienned
  • 1 small handful of broccoli sprouts, washed
  • 1 pinch fresh dill, chopped
  • 4 boiled free range eggs


  • 1/3 cup white wine vinegar
  • 1/4 cup extra virgin olive oil
  • Pinch of crushed black pepper


  1. Combine quinoa, kale, cabbage and broccoli sprouts together in a bowl.
  2. Sprinkle the dill on top.
  3. Add the oil and vinegar and mix to make the dressing
  4. Serve each portion of salad with a boiled egg.

Article References

Alzheimer's Society. (2014). Drug treatments for Alzheimer's disease. Retrieved from, Viewed 13 June 2022

Dalmeijer, G. W., Olthof, M. R., Verhoef, P., Bots, M. L., & van der Schouw, Y. T. (2008). Prospective study on dietary intakes of folate, betaine, and choline and cardiovascular disease risk in women. European journal of clinical nutrition, 62(3), 386–394.

Dávalos, A., Alvarez-Sabín, J., Castillo, J., Díez-Tejedor, E., Ferro, J., Martínez-Vila, E., Serena, J., Segura, T., Cruz, V. T., Masjuan, J., Cobo, E., Secades, J. J., & International Citicoline Trial on acUte Stroke (ICTUS) trial investigators (2012). Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet (London, England), 380(9839), 349–357.

Mills, J. L., Fan, R., Brody, L. C., Liu, A., Ueland, P. M., Wang, Y., Kirke, P. N., Shane, B., & Molloy, A. M. (2014). Maternal choline concentrations during pregnancy and choline-related genetic variants as risk factors for neural tube defects. The American journal of clinical nutrition, 100(4), 1069–1074.

Pellanda H. (2013). Betaine homocysteine methyltransferase (BHMT)-dependent remethylation pathway in human healthy and tumoral liver. Clinical chemistry and laboratory medicine, 51(3), 617–621.

Poly, C., Massaro, J. M., Seshadri, S., Wolf, P. A., Cho, E., Krall, E., Jacques, P. F., & Au, R. (2011). The relation of dietary choline to cognitive performance and white-matter hyperintensity in the Framingham Offspring Cohort. The American journal of clinical nutrition, 94(6), 1584–1591.

Putignano, S., Gareri, P., Castagna, A., Cerqua, G., Cervera, P., Cotroneo, A. M., Fiorillo, F., Grella, R., Lacava, R., Maddonni, A., Marino, S., Pluderi, A., Putignano, D., & Rocca, F. (2012). Retrospective and observational study to assess the efficacy of citicoline in elderly patients suffering from stupor related to complex geriatric syndrome. Clinical interventions in aging, 7, 113–118.

Shaw, G. M., Carmichael, S. L., Yang, W., Selvin, S., & Schaffer, D. M. (2004). Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. American journal of epidemiology, 160(2), 102–109.

Tan, H. B., Danilla, S., Murray, A., Serra, R., El Dib, R., Henderson, T. O., & Wasiak, J. (2014). Immunonutrition as an adjuvant therapy for burns. The Cochrane database of systematic reviews, (12), CD007174.

Yu, D., Shu, X. O., Xiang, Y. B., Li, H., Yang, G., Gao, Y. T., Zheng, W., & Zhang, X. (2014). Higher dietary choline intake is associated with lower risk of nonalcoholic fatty liver in normal-weight Chinese women. The Journal of nutrition, 144(12), 2034–2040.

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Zafonte, R. D., Bagiella, E., Ansel, B. M., Novack, T. A., Friedewald, W. T., Hesdorffer, D. C., Timmons, S. D., Jallo, J., Eisenberg, H., Hart, T., Ricker, J. H., Diaz-Arrastia, R., Merchant, R. E., Temkin, N. R., Melton, S., & Dikmen, S. S. (2012). Effect of citicoline on functional and cognitive status among patients with traumatic brain injury: Citicoline Brain Injury Treatment Trial (COBRIT). JAMA, 308(19), 1993–2000.