Choline, also called vitamin B4, is an essential nutrient that's found in many foods and abounds in animal foods.
The average American’s daily intake falls short, which matters because this often-overlooked nutrient plays key roles in the nervous system, brain, liver, and beyond.
Indeed, there’s ample evidence that we need ample dietary choline to ensure optimal brain performance — and probably to help delay or ease the symptoms of dementia.
Why does our sub-headline say that fish "pack a one-two punch"? They're the only good food sources of choline and the omega-3s (DHA and EPA) needed for brain and mood health.
The results of a university study from Finland add more good evidence linking higher choline intakes to better brain performance and reduced dementia risks.
Let’s get to the details of the new study, recall the best food sources, and then review choline’s critical role in brain and overall health.
Higher choline intakes linked to sharper brains and reduced dementia risk
The encouraging results of the new study echo and build on the results of prior studies, including one published two years ago by the same University of Eastern Finland scientists.
In that earlier study, the Finns looked for links between men’s egg intakes and their risk for dementia 22 years later. As they wrote, “… moderate egg intake may have a beneficial association with certain areas of cognitive performance.” (Ylilauri MP et al. 2017)
The Finnish scientists suspected that eggs' choline — which is contained within their abundant phosphatidylcholine — likely accounted for a substantial portion of the observed brain benefits.
Now, a follow-up study by the same University of Eastern Finland team is reportedly the first to link higher dietary intakes of choline to a reduced risk of dementia.
Better yet, the results also linked higher choline intakes to enhanced brain (thinking/memory) performance (Ylilauri MPT et al. 2019).
Specifically, the study’s authors concluded that — compared to the men with the lowest estimated choline intakes — the risk of dementia was 28% lower in the men with the highest estimated choline intakes.
The men with the highest estimated choline intakes also displayed superior memory and linguistic abilities on standard tests designed to measure those capacities.
The chief sources of choline in the participants’ self-reported diets were eggs (39% of dietary choline) and meat (37% of dietary choline).
These findings are significant, considering that more than 50 million people worldwide suffer from memory disorders that can lead to dementia, and that number is expected to grow.
Delaying or deterring dementia takes a combination of lifestyle and diet factors and each can contribute to reducing the overall risk.
Although the Finnish team’s analysis linked higher choline intakes to better cognitive health, they stressed that it isn’t necessary — or necessarily wise — to overdo eggs or meat, because a well-balanced diet of whole foods can provide ample amounts of the vitamin-like nutrient.
More detail on the new Finnish study
The data for the two-decade-plus study — led by Maija Ylilauri, Ph.D. — came from the Kuopio Ischemic Heart Disease Risk Factor Study or KIH.
At the outset of that study in 1984-1989, the KIH researchers recorded the diets, lifestyle habits, and general health of 2,497 Finnish men aged between 42 and 60.
In addition, after an average follow-up period of 22 years, the researchers accessed the participants' hospital records, cause-of-death records, and drug-reimbursement records.
Then, four years after the study began, 482 of the participating men took standard tests designed to measure their memory and cognitive processing.
As part of their analysis, the researchers accounted for the known effects of other lifestyle and nutritional factors that can influence performance on cognitive tests and the risk for dementia — including the presence or absence of the APOE4 gene, which predisposes people to Alzheimer's disease.
What are the best food sources of choline?
Choline can be made in the liver, but most of our choline comes from whole foods.
Unfortunately, most Americans don’t consume the recommended daily adequate intakes: 425mg for women and 550mg for men.
The 2007-2008 National Health and Nutrition Examination Survey found that American women average only 260mg per day, while men average only 396mg daily, while a large, lengthy University of North Carolina study found that daily intakes averaged 294mg among women and 332mg among men.
The average American gets most of their choline from meat, poultry, fish, dairy foods, pasta, rice, and eggs — and most of it comes as part of a fatty molecule called phosphatidylcholine, which is about 13% choline by weight.
Lecithin contains phosphatidylcholine and is commonly added to processed/packaged foods, but only adds about 10mg to the average American’s daily choline intake.
Eggs and liver are the top food sources — providing 300-400mg per 100-gram (3.5-ounce) serving — followed by meats, poultry, fish, dairy foods, nuts, beans, peas, spinach, and whole grains.
(Spinach, beets, whole wheat, and shellfish are also sources of betaine: a related compound that can reduce the body's choline requirements.)
The USDA choline figures below are averages. Choline levels vary for livestock by breed, feed, and cut — such as bacon versus pork chop or chicken thigh versus breast — and for wild fish by harvest year and location.
Milligrams of choline per 100-gram (3.5-ounce) serving, unless otherwise noted
You can also obtain choline from dietary supplements, including choline chloride, choline bitartrate, citicoline (CDP-choline), lecithin, and phosphatidylcholine. Look for the amount of choline listed per serving, because that can vary considerably.
What is choline and why is it critical?
Choline plays fundamental roles in our cell membranes — primarily as a component of phosphatidylcholine — and in brain, nervous system, liver, and metabolic functions.
And because it’s critical to brain and nervous system development, FDA regulations require the addition of choline to non-dairy infant formulas.
Choline is needed to make the key neurotransmitter called acetylcholine, low circulating levels of which are associated with Alzheimer’s.
Some Alzheimer’s drugs reduce the rate at which the body reabsorbs circulating acetylcholine, thereby keeping more available. And choline is a key ingredient in medical drinks designed to help ease symptoms in early stages of Alzheimer's.
Choline’s role in building acetylcholine and phosphatidylcholine largely explains why it appears critical to memory, thinking, muscle movement, heartbeat, and other basic functions.
Unsurprisingly — given growing evidence for strong links between diet and gene “expression” — some of choline’s beneficial effects appear to be "epigenetic".
The genome is the totality of the DNA in our cells that makes each person unique, and the “epigenome" is all the proteins and other chemicals that can turn genes on or off.
Some epigenetic compounds — including choline — provide methyl molecules that proteins can attach to DNA, thereby affecting the actions of individual genes.
As a University of Cambridge researcher wrote, “many nutrients, foods and diets have both immediate and long-term effects on the epigenome, including … micronutrients involved in DNA methylation, for example, folate, vitamins B6 and B12, choline, and methionine.” (Dauncey MJ 2014)