Choline

What is choline and what does it do in the body?

Choline is a compound found naturally in some foods and also sold as a supplement. According to NIH ODS, the body uses choline to make phosphatidylcholine and sphingomyelin, the two main phospholipids of cell membranes; all plant and animal cells therefore need choline to maintain their structural integrity. Choline is also needed to make the neurotransmitter acetylcholine, which plays a role in memory, mood, muscle control, and other nervous system functions; it also plays a role in regulation of gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development. Choline is also the source of methyl groups needed for many steps in metabolism. ^[1]

Humans can make choline in the liver, mostly as phosphatidylcholine; however, according to ODS, the amount the body makes naturally is not enough to meet human requirements, so some choline must be obtained from food. Premenopausal women are noted to possibly need less choline from food because estrogen induces the choline biosynthesis gene. If dietary folate is inadequate, choline becomes the primary methyl donor, so the dietary choline requirement increases. ^[1]

Choline status is not routinely measured in healthy people; plasma choline concentration in healthy adults is in the range of 7–20 µmol/L (NIH ODS). The functions of choline overlap with folate and other B vitamins; ODS notes that many studies did not assess the status of all B vitamins and that this can confound results. ^[1]

What are the reference intake values for choline?

According to NIH ODS, the Food and Nutrition Board (FNB) did not find enough data to derive an estimated average requirement (EAR) for choline and set adequate intake (AI) values based on prevention of liver damage (measured by serum alanine aminotransferase level). ^[1]

In EFSA’s 2016 opinion as well, an average requirement and a population reference intake could not be derived for choline, and an adequate intake (AI) was defined. The panel set the AI for adults at 400 mg/day; this value is based on the mean intake observed in healthy populations in the EU and on the amount needed for about 70% of people showing signs of organ dysfunction in a choline depletion–repletion study to recover. AIs of 480 mg/day for pregnancy (scaled by body weight gain in pregnancy) and 520 mg/day for breastfeeding (by adding the amount secreted in breast milk) were set; EFSA also states that there are not enough data to determine the additional requirement in pregnancy and breastfeeding. ^[2]

Because the age ranges and child values of the two institutions differ, only the adult rows are shown. ^{[1] [2]} According to NHANES 2013–2014 data in the U.S., mean daily choline intake from foods and beverages is 402 mg in men and 278 mg in women; ODS states that most people in the U.S. consume less choline than the AI. EFSA reports that mean estimates of total choline intake in adults in the EU range from 269 to 468 mg/day. ^{[1] [2]}

Which foods contain choline?

According to NIH ODS, the main sources of choline in the U.S. are animal foods such as meat, poultry, fish, dairy products, and eggs; cruciferous vegetables and some legumes are also rich, and nuts and seeds and whole grains also contain choline. About half of the dietary choline consumed in the U.S. is in the form of phosphatidylcholine. The table below shows selected values from ODS’s U.S. servings (1 cup ≈240 mL); “%DV” is relative to the U.S. Daily Value (550 mg), and ODS calls 20% and above a “high source.” ^[1]

In supplements, choline is found alone, together with B complex, and in some multivitamin/mineral products; ODS reports the typical amount in supplements as 10–250 mg. Choline bitartrate, phosphatidylcholine, and lecithin forms are used in supplements; no study compares the relative bioavailability of these forms. ^[1]

Who gets choline deficiency?

According to ODS, choline deficiency can lead to muscle damage, liver damage, and nonalcoholic fatty liver disease; however, although most people in the U.S. consume less choline than the AI, overt choline deficiency is very rare in healthy men and non-pregnant women. ^[1]

The 2007 study by Fischer and colleagues measured this relationship directly: 57 adults (26 men, 16 premenopausal women, 15 postmenopausal women) were fed a diet containing 550 mg of choline per day per 70 kg for 10 days, then a diet containing less than 50 mg of choline per day per 70 kg for up to 42 days. 77% of the men and 80% of the postmenopausal women deprived of choline developed fatty liver or muscle damage, and the rate was 44% in premenopausal women. In six men these signs also appeared while taking 550 mg of choline per day per 70 kg; the authors conclude that daily intake at the current AI level was not enough to prevent organ dysfunction in 19 participants. Folic acid supplementation did not change the response. Organ function returned to normal when choline was added to the diet in stages. ^[3]

According to ODS, the groups at high risk of inadequate choline intake are the following: pregnant women (about 90–95% consume less choline than the AI; the risk may be higher in those not using folic acid supplements, those with low B12 levels, and those carrying a common variant in the methylenetetrahydrofolate dehydrogenase enzyme), people carrying certain gene variations in choline metabolism (for example, a common variant in the PEMT gene reduces estrogen-induced choline synthesis), and patients needing long-term total parenteral nutrition (because choline is not routinely added to parenteral solutions, plasma choline level stays low and liver abnormalities can occur). ^[1]

Does choline help the baby’s brain development in pregnancy?

The introduction of the systematic review states that animal studies suggest choline supplementation in pregnancy improves the offspring’s cognitive outcomes; in humans, the evidence is different. ^[5] The 2018 study by Caudill and colleagues is a double-blind controlled feeding study that randomized women in the third trimester to take 480 mg or 930 mg of choline per day until delivery (13 women per group); in 24 infants tested at 4, 7, 10, and 13 months, mean reaction time was significantly shorter in the 930 mg group. ^[4] The study was conducted partly with support from organizations affiliated with the egg and beef industries and from U.S. Department of Agriculture resources; the authors reported no conflict of interest and stated that the funders had no role in the study’s design, analysis, or writing. ^[4] It is a single study with a total of 26 randomized women.

The 2025 systematic review evaluated 4 randomized studies and 5 observational studies (20 publications) examining choline supplementation in pregnancy. In both the studies and the observational data, most neurodevelopmental outcomes did not support the hypothesis that higher prenatal choline is beneficial; in some trials there are instances in which children of mothers receiving choline scored better on one measure, but each study measured multiple outcomes and most outcomes were not significant. The review reports that the evidence base is unreliable owing to critical limitations and that the available evidence is neither sufficient to support nor to refute the hypothesis that increasing choline intake in pregnancy improves the child’s neurodevelopment. ^[5]

For this reason, the row is rated D. EFSA’s AI for pregnancy (480 mg/day) rests not on a measurement of additional requirement but on scaling by body weight gain in pregnancy. ^[2]

Does choline affect cognitive function and dementia?

In Alzheimer’s disease, the level of the enzyme that converts choline to acetylcholine in the brain is low; because lecithin is one of the main dietary sources of choline, it has been suggested that additional consumption could slow dementia progression. The 2003 Cochrane review evaluated 12 randomized studies comparing lecithin with placebo (265 patients with Alzheimer’s disease, 21 with Parkinson’s dementia, 90 with subjective memory problems); no clear clinical benefit of lecithin was reported in Alzheimer’s disease or Parkinson’s dementia. In one study in people with subjective memory problems, a striking result in favor of lecithin was obtained. The authors concluded that the evidence from randomized studies does not support the use of lecithin in the treatment of dementia and that a moderate effect cannot be excluded. ^[6]

ODS also reports that in observational studies, higher choline intake and plasma choline were associated with cognitive performance: in Norway, among 2,195 adults aged 70–74, those with plasma free choline below 8.4 µmol/L performed worse in sensorimotor speed, perceptual speed, executive function, and global cognition, and in the Framingham Offspring study of 1,391 adults, higher choline intake was associated with better verbal and visual memory. A 2015 systematic review of 13 studies, however, showed that choline supplementation did not provide a clear improvement in cognition in healthy adults. ^[1] Because no clear benefit was shown, this row is rated E.

Does choline affect cardiovascular health?

NIH ODS reports that some researchers suggest choline may protect cardiovascular health by affecting blood pressure, lipid profile, and homocysteine level, while other researchers note that gut bacteria convert components such as choline and carnitine to trimethylamine (TMA), the liver converts this to TMAO, and TMAO has been associated with higher cardiovascular risk. No significant association was found in large observational studies: with peripheral artery disease risk in 72,348 women in the Nurses’ Health Study and 44,504 men in the Health Professionals Follow-up Study, and with coronary heart disease risk over 14 years in 14,430 middle-aged adults in the ARIC study. In contrast, a more recent analysis of 80,978 women and 39,434 men from the Nurses’ Health Study and the Health Professionals Follow-up Study found higher mortality risk in those with high choline intake; the authors linked this to TMAO production but did not measure TMAO directly. ODS also states that choline consumption increases TMAO production in adults in a dose-dependent manner. ^[1]

In 52,246 women and 50,485 men participating in the Västerbotten Intervention Programme in Sweden, with a median follow-up of 16 years, total choline intake was not associated with total mortality (HR 1.01, 95% CI 0.97–1.06 in women; HR 1.01, 95% CI 0.98–1.04 in men). A positive association between total choline intake and total mortality was seen in men with high folate intake, and a positive association between phosphatidylcholine intake and total mortality in women aged 55 and over; these are subgroup results. ^[7] Because the results are mixed, the row is rated D.

Choline and fatty liver

According to ODS, nonalcoholic fatty liver disease (NAFLD) is the accumulation of lipids in the liver in people who consume less than 20 g of ethanol per day; because choline, particularly phosphatidylcholine, is needed to transport lipids out of the liver, fat accumulates in the liver in choline insufficiency and NAFLD can develop. In a single cross-sectional study of 56,195 Chinese adults aged 40–75 (using a 24-hour dietary recall), NAFLD risk in the highest choline intake quintile (412 mg/day in women) was 32% lower than in the lowest quintile (179 mg/day), and 25% lower in men (452 vs. 199 mg/day); in women, the association was seen only in those of normal weight. In a cross-sectional study of 664 people in the NASH Clinical Research Network, fibrosis was more severe in postmenopausal women whose choline intake was below 50% of the AI, and no association was seen with the degree of liver fat. ODS states that data on treating NAFLD with choline are limited. ^[1]

Is choline supplementation safe, and what is the upper limit?

According to ODS, high choline intake is associated with fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity. The FNB based the upper limits (UL) of intake from food and supplements for choline on the amounts that cause hypotension and fishy body odor; the UL applies to healthy children and adults and does not apply to people receiving high doses of choline under physician supervision. The upper limit is a ceiling for habitual total daily intake. NIH ODS states that choline has no known clinically significant drug interaction. ^[1]

No UL has been set for infants in the NIH table; it is stated that the source of choline in infants should be breast milk, formula, and food. ^[1]

How is choline supplementation regulated in Türkiye?

Approval from the Ministry of Agriculture and Forestry is mandatory for every dietary supplement to be marketed in Türkiye; approval applications for imported products can be made only to the Istanbul and Ankara Provincial Directorates. ^[9]

In the latest update of the Ministry’s Restricted Substances List for Dietary Supplements (September 21, 2026), the “Choline” row appears with two sources: chemical synthesis and Antarctic krill (at least 95% purity). The columns give values of at most 275 mg/day for ages 4–10 and at most 550 mg/day for ages 11 and over; the publication dates are January 22, 2016 for ages 11 and over and May 2, 2016 for ages 4–10. In the same list, “Phospholipids” (including phosphatidylcholine/lecithin and phosphatidylinositol) is a separate row, and the numeric limit columns contain a dash instead of a figure. ^[8] The values in the list are daily intake upper-limit columns; they are not of the same kind as EFSA’s and NIH’s AI or UL values.

Evidence table: claim, population, and limits

This guide does not recommend personal doses. For pregnancy, liver disease, regular medication use, and multi-ingredient products, the decision depends on individual assessment.