Choline is found naturally in foods in different forms, including the fat-soluble phospholipids <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a> and sphingomyelin and the water-soluble compounds phosphocholine, glycerophosphocholine, and free choline. About half of the dietary choline consumed in the United States is in the form of phosphatidylcholine. 
The main dietary sources of choline are animal-based foods such as meat, poultry, fish, dairy, and eggs, as well as some cruciferous vegetables, beans, nuts, seeds, and whole grains. The top sources of choline are beef liver (3 ounces contains 356 mg of choline), <a href="/foods/eggs/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Eggs&lt;/h6&gt;&lt;p&gt;A shelled vessel for protein and fats in the white and yolk, respectively, that carries a surprisingly large amount of nutrients; especially choline and leucine as well as many carotenoids coloring the yolk. Eggs do not inherently increase circulating cholesterol.&lt;/p&gt;&lt;/div&gt;">eggs</a> (one large egg contains 147 mg of choline), beef (3 ounces contains 117 mg of choline) and soybeans (one half of a cup contains 107 mg of choline).<a href="#ref-1" id="ref-link-1" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;&lt;a href="https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/" target="\_blank" rel="noopener noreferrer"&gt;Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024
&lt;/a&gt;&lt;/p&gt;(2018)&lt;/div&gt;'>[1]</a>
Choline can also be obtained from dietary supplements that contain choline, choline + B vitamins, and multivitamin/multimineral products. Most tend to contain 10–250 mg of choline. The most commonly supplemented form of choline is choline bitartrate.

What foods are rich in choline?

Choline is produced endogenously in the liver (as <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a>), but the amount we make isn’t sufficient to meet our body’s needs. Therefore, it’s essential to obtain choline from the diet and/or supplements. According to some estimates, adults in the United States only consume between 278 and 402 mg of choline per day, which falls below the adequate intake (AI) for choline.<a href="#ref-25" id="ref-link-25" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;&lt;a href="https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/wweia-data-tables/" target="\_blank" rel="noopener noreferrer"&gt;WWEIA Data Tables; United State Department of Agriculture, Agriculture Research Service, cited April 2024, last updated Feb 2022
&lt;/a&gt;&lt;/p&gt;&lt;/div&gt;'>[25]</a> Despite having lower-than-recommended dietary intakes of choline, most adults don’t appear to be choline-deficient, possibly due to the contribution from endogenous choline production.
The liver is the primary site for choline synthesis. Choline synthesis is catalyzed by the enzyme phosphatidylethanolamine N-methyltransferase (PEMT), which synthesizes phosphatidylcholine by methylating phosphatidylethanolamine using the methyl donor <a href="/supplements/s-adenosyl-methionine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;S-adenosylmethionine&lt;/h6&gt;&lt;p&gt;S-adenosylmethionine (SAMe) is a methyl donating compound that circulates in the blood and provides methyl groups to maintain other metabolic reactions. Lowered SAMe levels are associated with depressive symptoms, and supplementation may aid a partial deficiency.&lt;/p&gt;&lt;/div&gt;">S-adenosyl-L-methionine</a> (SAMe).

Does our body make choline?

Choline is an essential nutrient that plays a role in the synthesis of phospholipid membranes and is a source of methyl groups that are needed for many steps in metabolism. It’s also the precursor to the neurotransmitter acetylcholine. Choline has particular relevance for brain development, liver health, and skeletal muscle function. Choline is mostly found in animal foods such as <a href="/foods/eggs/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Eggs&lt;/h6&gt;&lt;p&gt;A shelled vessel for protein and fats in the white and yolk, respectively, that carries a surprisingly large amount of nutrients; especially choline and leucine as well as many carotenoids coloring the yolk. Eggs do not inherently increase circulating cholesterol.&lt;/p&gt;&lt;/div&gt;">eggs</a>, milk, fish, chicken, and beef, but some plant foods also contain choline.<a href="#ref-2" id="ref-link-2" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wiedeman AM, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30332744" target="\_blank" rel="noopener noreferrer"&gt;Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.
&lt;/a&gt;&lt;/p&gt;Nutrients (2018 Oct 16)&lt;/div&gt;'>[2]</a>

What is choline?

Choline deficiency can lead to muscle damage, liver damage, and <a href="/conditions/nonalcoholic-fatty-liver-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Nonalcoholic Fatty Liver Disease&lt;/h6&gt;&lt;p&gt;Non-alcoholic fatty liver disease (NAFLD) is a condition in which excessive fat (more than 5% of liver weight) accumulates in the liver due to causes unrelated to alcohol.&lt;/p&gt;&lt;/div&gt;">nonalcoholic fatty liver disease</a>. However, clinically evident choline deficiency is very rare, likely due to the contribution of the body’s endogenous choline production.
Choline intakes tend to be below the adequate intake for children and adults, who average an intake of 256 mg per day and 278–402 mg per day, respectively.<a href="#ref-25" id="ref-link-25" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;&lt;a href="https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/wweia-data-tables/" target="\_blank" rel="noopener noreferrer"&gt;WWEIA Data Tables; United State Department of Agriculture, Agriculture Research Service, cited April 2024, last updated Feb 2022
&lt;/a&gt;&lt;/p&gt;&lt;/div&gt;'>[25]</a>
Worldwide choline intakes have been estimated to be 284–468 mg per day for men and 263–374 mg per day for women. In the United States and Canada, adult intakes range from 260–396 mg per day and 292–372 mg per day, respectively.<a href="#ref-2" id="ref-link-2" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wiedeman AM, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30332744" target="\_blank" rel="noopener noreferrer"&gt;Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.
&lt;/a&gt;&lt;/p&gt;Nutrients (2018 Oct 16)&lt;/div&gt;'>[2]</a> The United States National Institutes of Health consider adequate intake to be 550 mg/day for men and 425 mg/day for women.<a href="#ref-1" id="ref-link-1" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;&lt;a href="https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/" target="\_blank" rel="noopener noreferrer"&gt;Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024
&lt;/a&gt;&lt;/p&gt;(2018)&lt;/div&gt;'>[1]</a>
Pregnant and lactating women need more choline. During pregnancy, choline demand rises due to its role in neural tube formation, brain development, and lipoprotein synthesis. There’s also evidence that choline may prevent neural tube defects, improve offspring cognitive development, and promote maternal well-being.<a href="#ref-26" id="ref-link-26" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Jaiswal A, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/38074049" target="\_blank" rel="noopener noreferrer"&gt;Choline Supplementation in Pregnancy: Current Evidence and Implications.
&lt;/a&gt;&lt;/p&gt;Cureus (2023 Nov)&lt;/div&gt;'>[26]</a> Most (90%–95%) pregnant women consume less than the adequate intake (AI) for choline,<a href="#ref-27" id="ref-link-27" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Brunst KJ, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/24476840" target="\_blank" rel="noopener noreferrer"&gt;Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population.
&lt;/a&gt;&lt;/p&gt;Public Health Nutr (2014 Sep)&lt;/div&gt;'>[27]</a> and <a href="/supplements/prenatal-vitamins/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Prenatal Vitamins&lt;/h6&gt;&lt;p&gt;Prenatal supplements, also known as prenatal vitamins, are frequently used by women before conception and throughout gestation. Their purpose is to guarantee that both the expectant mother and the developing fetus obtain the necessary quantity of vital nutrients. They usually contain folic acid, iron, and other micronutrients, but the composition varies from brand to brand.&lt;/p&gt;&lt;/div&gt;">prenatal supplements</a> typically don’t contain choline. Women who do not supplement with folic acid, those who have a low vitamin B12 status, or those who have a common variant in the enzyme methylenetetrahydrofolate dehydrogenase are the most at risk for having an inadequate choline status.<a href="#ref-26" id="ref-link-26" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Jaiswal A, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/38074049" target="\_blank" rel="noopener noreferrer"&gt;Choline Supplementation in Pregnancy: Current Evidence and Implications.
&lt;/a&gt;&lt;/p&gt;Cureus (2023 Nov)&lt;/div&gt;'>[26]</a>
Dietary choline requirements are lower in premenopausal women because estrogen induces the enzyme phosphatidylethanolamine N-methyltransferase (PEMT), which synthesizes phosphatidylcholine. However, women who have a genetic mutation in PEMT have less estrogen-induced choline synthesis and therefore higher choline requirements.<a href="#ref-28" id="ref-link-28" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Biswas S, Giri S. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/25923965" target="\_blank" rel="noopener noreferrer"&gt;Importance of choline as essential nutrient and its role in prevention of various toxicities.
&lt;/a&gt;&lt;/p&gt;Prague Med Rep (2015)&lt;/div&gt;'>[28]</a> 
Finally, adults and infants receiving total parenteral (intravenous) nutrition may need to be supplemented with choline because choline is not routinely added to these solutions. Long-term parenteral nutrition has been shown to reduce plasma choline concentrations in adults and infants and is associated with the development of fatty liver and impaired liver function.<a href="#ref-29" id="ref-link-29" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Vanek VW, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/22730042" target="\_blank" rel="noopener noreferrer"&gt;A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products.
&lt;/a&gt;&lt;/p&gt;Nutr Clin Pract (2012 Aug)&lt;/div&gt;'>[29]</a> These changes can be attenuated by providing intravenous choline.<a href="#ref-30" id="ref-link-30" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Buchman AL, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/11531217" target="\_blank" rel="noopener noreferrer"&gt;Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial.
&lt;/a&gt;&lt;/p&gt;JPEN J Parenter Enteral Nutr (2001 Sep-Oct)&lt;/div&gt;'>[30]</a><a href="#ref-31" id="ref-link-31" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Buchman AL, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/11190987" target="\_blank" rel="noopener noreferrer"&gt;Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study.
&lt;/a&gt;&lt;/p&gt;JPEN J Parenter Enteral Nutr (2001 Jan-Feb)&lt;/div&gt;'>[31]</a>

Who is most at risk for a choline deficiency?

Choline supplementation during pregnancy or early childhood has favorable effects on children’s brain function and neurodevelopment, including memory, attention, and visual-spatial learning.<a href="#ref-3" id="ref-link-3" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Obeid R, Derbyshire E, Schön C. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36041182" target="\_blank" rel="noopener noreferrer"&gt;Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.
&lt;/a&gt;&lt;/p&gt;Adv Nutr (2022 Dec 22)&lt;/div&gt;'>[3]</a> Choline supplementation among children with fetal alcohol spectrum disorder improves memory, nonverbal intelligence, visual-spatial skills, <a href="/outcomes/adhd-symptoms/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;ADHD Symptoms&lt;/h6&gt;&lt;p&gt;Common symptoms of Attention Deficit Hyperactivity Disorder (ADHD) are inattention, impulsivity, and hyperactivity. These symptoms can interfere with daily activities and social interactions.&lt;/p&gt;&lt;/div&gt;">ADHD symptoms</a>, <a href="/outcomes/executive-function/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Executive Function&lt;/h6&gt;&lt;p&gt;Executive function is a set of cognitive processes and skills related to self-control and behavior management that include working memory, mental flexibility, focus, emotional control, goal-setting, and following directions.&lt;/p&gt;&lt;/div&gt;">executive function</a>, and white matter microstructure.<a href="#ref-4" id="ref-link-4" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wozniak JR, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/26447156" target="\_blank" rel="noopener noreferrer"&gt;Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial.
&lt;/a&gt;&lt;/p&gt;Am J Clin Nutr (2015 Nov)&lt;/div&gt;'>[4]</a><a href="#ref-5" id="ref-link-5" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wozniak JR, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32164522" target="\_blank" rel="noopener noreferrer"&gt;Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder.
&lt;/a&gt;&lt;/p&gt;J Neurodev Disord (2020 Mar 12)&lt;/div&gt;'>[5]</a><a href="#ref-6" id="ref-link-6" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Gimbel BA, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36526961" target="\_blank" rel="noopener noreferrer"&gt;Long-term follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder: corpus callosum white matter microstructure and neurocognitive outcomes.
&lt;/a&gt;&lt;/p&gt;J Neurodev Disord (2022 Dec 16)&lt;/div&gt;'>[6]</a> These effects occur primarily when choline is supplemented before the age of 5.
Higher choline intakes have been associated with a lower risk for cardiovascular events and <a href="/conditions/stroke/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Stroke&lt;/h6&gt;&lt;p&gt;A stroke is a medical emergency. If you are experiencing stroke symptoms, call emergency medical services, even if they resolve quickly. This page does not discuss acute treatments for stroke, but rather focuses on mitigating the risk of having a stroke and supporting recovery from a stroke. &lt;/p&gt;&lt;/div&gt;">stroke</a>, <a href="/conditions/mild-cognitive-impairment/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Mild Cognitive Impairment&lt;/h6&gt;&lt;p&gt;MCI is a form of cognitive decline where changes are serious enough to be noticed by the affected individual and their family members, but not severe enough to interfere with normal activities of daily living.&lt;/p&gt;&lt;/div&gt;">cognitive impairment</a>, post-stroke <a href="/conditions/depression/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Depression&lt;/h6&gt;&lt;p&gt;Depression is a chronic state of low mood often associated with hopelessness, apathy, and fatigue. Unlike sadness, depression is a disorder that persists for weeks or months and interferes with daily life.&lt;/p&gt;&lt;/div&gt;">depression</a>,<a href="#ref-7" id="ref-link-7" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Miao M, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/34611955" target="\_blank" rel="noopener noreferrer"&gt;Circulating choline pathway nutrients and depression after ischemic stroke.
&lt;/a&gt;&lt;/p&gt;Eur J Neurol (2022 Feb)&lt;/div&gt;'>[7]</a> <a href="/conditions/cardiovascular-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Cardiovascular Disease&lt;/h6&gt;&lt;p&gt;Cardiovascular disease (CVD) is a broad term that refers to various diseases of the heart and blood vessels. Atherosclerotic CVD (ASCVD) is the most common subtype of CVD and causes strokes and heart attacks.&lt;/p&gt;&lt;/div&gt;">cardiovascular disease</a>,<a href="#ref-8" id="ref-link-8" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhou R, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37764819" target="\_blank" rel="noopener noreferrer"&gt;Association between Dietary Choline Intake and Cardiovascular Diseases: National Health and Nutrition Examination Survey 2011-2016.
&lt;/a&gt;&lt;/p&gt;Nutrients (2023 Sep 18)&lt;/div&gt;'>[8]</a> and <a href="/conditions/dementia/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dementia&lt;/h6&gt;&lt;p&gt;Dementia is a term that refers to a decline in cognitive function that interferes with daily life. Dementia can affect language, memory, visual perception, problem-solving, and focus. People with dementia may lose their ability to do everyday activities, including bathing, dressing, eating, and using the bathroom.&lt;/p&gt;&lt;/div&gt;">dementia</a>.<a href="#ref-9" id="ref-link-9" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Ylilauri MPT, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/31360988" target="\_blank" rel="noopener noreferrer"&gt;Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study.
&lt;/a&gt;&lt;/p&gt;Am J Clin Nutr (2019 Dec 1)&lt;/div&gt;'>[9]</a> A higher intake of choline is also associated with lower levels of cardiometabolic risk factors.<a href="#ref-10" id="ref-link-10" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Díez-Ricote L, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36124652" target="\_blank" rel="noopener noreferrer"&gt;One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvención con DIeta MEDiterránea-Plus (PREDIMED-Plus) trial.
&lt;/a&gt;&lt;/p&gt;Am J Clin Nutr (2022 Dec 19)&lt;/div&gt;'>[10]</a> Interestingly, a low choline intake may impair gains in strength and lean mass in response to exercise training<a href="#ref-11" id="ref-link-11" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Lee CW, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37764658" target="\_blank" rel="noopener noreferrer"&gt;The Effect of Choline and Resistance Training on Strength and Lean Mass in Older Adults.
&lt;/a&gt;&lt;/p&gt;Nutrients (2023-Sep-06)&lt;/div&gt;'>[11]</a><a href="#ref-12" id="ref-link-12" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Lee CW, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36629089" target="\_blank" rel="noopener noreferrer"&gt;Low Intake of Choline Is Associated with Diminished Strength and Lean Mass Gains in Older Adults.
&lt;/a&gt;&lt;/p&gt;J Frailty Aging (2023)&lt;/div&gt;'>[12]</a> and reduce cognitive function.<a href="#ref-9" id="ref-link-9" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Ylilauri MPT, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/31360988" target="\_blank" rel="noopener noreferrer"&gt;Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study.
&lt;/a&gt;&lt;/p&gt;Am J Clin Nutr (2019 Dec 1)&lt;/div&gt;'>[9]</a>

What are choline’s main benefits?

Dietary choline undergoes anaerobic metabolism by gut microbes to form trimethylamine (TMA) which is then oxidized by liver enzymes to form trimethylamine N-oxide (<a href="/outcomes/tmao/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;TMAO&lt;/h6&gt;&lt;p&gt;Trimethylamine N-oxide (TMAO) is a compound generated by gut microbial metabolism which is associated increased disease risk. However, it's questionable whether this association reflects causality.&lt;/p&gt;&lt;/div&gt;">TMAO</a>), a newly recognized risk marker for cardiovascular disease.<a href="#ref-32" id="ref-link-32" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Canyelles M, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36768264" target="\_blank" rel="noopener noreferrer"&gt;Gut Microbiota-Derived TMAO: A Causal Factor Promoting Atherosclerotic Cardiovascular Disease?
&lt;/a&gt;&lt;/p&gt;Int J Mol Sci (2023-Jan-18)&lt;/div&gt;'>[32]</a>
However, several dietary sources of choline (e.g., <a href="/foods/eggs/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Eggs&lt;/h6&gt;&lt;p&gt;A shelled vessel for protein and fats in the white and yolk, respectively, that carries a surprisingly large amount of nutrients; especially choline and leucine as well as many carotenoids coloring the yolk. Eggs do not inherently increase circulating cholesterol.&lt;/p&gt;&lt;/div&gt;">eggs</a>) actually contain <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a>, which may not have the same TMAO-elevating effects as choline (as choline bitartrate or other forms). For example, multiple studies have shown that eating up to 3 eggs per day (about 400 mg of choline) elevates plasma choline levels but does not increase TMAO.<a href="#ref-13" id="ref-link-13" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Lemos BS, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/29764315" target="\_blank" rel="noopener noreferrer"&gt;Effects of Egg Consumption and Choline Supplementation on Plasma Choline and Trimethylamine-N-Oxide in a Young Population
&lt;/a&gt;&lt;/p&gt;J Am Coll Nutr (2018 May 15)&lt;/div&gt;'>[13]</a><a href="#ref-33" id="ref-link-33" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wilcox J, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/33872583" target="\_blank" rel="noopener noreferrer"&gt;Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial.
&lt;/a&gt;&lt;/p&gt;Am J Med (2021 Sep)&lt;/div&gt;'>[33]</a><a href="#ref-14" id="ref-link-14" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhu C, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32464420" target="\_blank" rel="noopener noreferrer"&gt;Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women.
&lt;/a&gt;&lt;/p&gt;Nutr Res (2020 Jun)&lt;/div&gt;'>[14]</a><a href="#ref-15" id="ref-link-15" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Missimer A, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/29313753" target="\_blank" rel="noopener noreferrer"&gt;Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations
&lt;/a&gt;&lt;/p&gt;J Am Coll Nutr (2018 Feb)&lt;/div&gt;'>[15]</a><a href="#ref-16" id="ref-link-16" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;DiMarco DM, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/28091798" target="\_blank" rel="noopener noreferrer"&gt;Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population
&lt;/a&gt;&lt;/p&gt;Lipids (2017 Mar)&lt;/div&gt;'>[16]</a><a href="#ref-17" id="ref-link-17" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Thomas MS, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35334836" target="\_blank" rel="noopener noreferrer"&gt;Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.
&lt;/a&gt;&lt;/p&gt;Nutrients (2022 Mar 11)&lt;/div&gt;'>[17]</a> On the other hand, TMAO levels increase up to 3-fold following the intake of 600 mg of choline bitartrate.<a href="#ref-34" id="ref-link-34" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Clara E Cho, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32722424" target="\_blank" rel="noopener noreferrer"&gt;Effect of Choline Forms and Gut Microbiota Composition on Trimethylamine- N-Oxide Response in Healthy Men
&lt;/a&gt;&lt;/p&gt;Nutrients (2020 Jul 25)&lt;/div&gt;'>[34]</a> Adding choline to the diet from beef (3–6 ounces as part of a <a href="/diets/dietary-approaches-to-stop-hypertension-diet/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dietary Approaches to Stop Hypertension Diet&lt;/h6&gt;&lt;p&gt;The DASH diet is an eating plan designed to prevent or treat hypertension (high blood pressure). DASH includes a high intake of whole grains, fruits and vegetables, fish, poultry, legumes, and nuts and limits the intake of sodium (salt), saturated fat, and sugar.&lt;/p&gt;&lt;/div&gt;">Dietary Approaches to Stop Hypertension diet</a>) increases plasma choline by 10% and TMAO levels by 27% in older adults with <a href="/conditions/obesity/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Obesity&lt;/h6&gt;&lt;p&gt;Obesity is a condition of excessive body fat that increases the risk for other conditions such as diabetes and heart disease. Fat is how the body stores extra calories that were eaten but not used. Obesity treatment usually involves restricting the calories eaten or creating negative calorie balance.&lt;/p&gt;&lt;/div&gt;">obesity</a>.<a href="#ref-35" id="ref-link-35" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Tate BN, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37686719" target="\_blank" rel="noopener noreferrer"&gt;Changes in Choline Metabolites and Ceramides in Response to a DASH-Style Diet in Older Adults.
&lt;/a&gt;&lt;/p&gt;Nutrients (2023 Aug 23)&lt;/div&gt;'>[35]</a>
Differences in gut microbiota may explain individual differences in TMAO production following choline intake. For example, high TMAO producers had more abundant lineages of Clostridium and Ruminococcaceae and Lachnospiraceae compared to low TMAO producers.<a href="#ref-34" id="ref-link-34" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Clara E Cho, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32722424" target="\_blank" rel="noopener noreferrer"&gt;Effect of Choline Forms and Gut Microbiota Composition on Trimethylamine- N-Oxide Response in Healthy Men
&lt;/a&gt;&lt;/p&gt;Nutrients (2020 Jul 25)&lt;/div&gt;'>[34]</a>
Overall, because <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a> is the major form of choline in food and phosphatidylcholine doesn’t appear to elevate TMAO levels, there’s no reason to avoid phosphatidylcholine over fears of its TMAO-elevating effects. Furthermore, <a href="/glossary/meta-analysis/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Meta-analysis&lt;/h6&gt;&lt;p&gt;A meta-analysis is usually produced as part of a systematic review. It combines the numerical results from several studies into an average number. Studies that differ too much in design cannot be properly meta-analyzed.&lt;/p&gt;&lt;/div&gt;">meta-analyses</a> have found no association between dietary choline/<a href="/supplements/betaine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Betaine&lt;/h6&gt;&lt;p&gt;Betaine (trimethylglycine) is an active metabolite of choline in the body and a component of beetroot. It serves a vital role in methylation in the body alongside folate, and is an osmoregulator like creatine. Betaine is also a possible ergogenic aid.&lt;/p&gt;&lt;/div&gt;">betaine</a> intake and the risk of <a href="/conditions/cardiovascular-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Cardiovascular Disease&lt;/h6&gt;&lt;p&gt;Cardiovascular disease (CVD) is a broad term that refers to various diseases of the heart and blood vessels. Atherosclerotic CVD (ASCVD) is the most common subtype of CVD and causes strokes and heart attacks.&lt;/p&gt;&lt;/div&gt;">cardiovascular disease</a> outcomes (e.g., <a href="/conditions/coronary-artery-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Coronary Artery Disease&lt;/h6&gt;&lt;p&gt;Coronary artery disease (CAD; sometimes called coronary heart disease, or CHD) is a common kind of heart disease caused by atherosclerosis of the heart’s arteries. Diet and exercise can play a pretty big role to both prevent and treat it. Smoking, family history, high blood pressure and high cholesterol are major risk factors.&lt;/p&gt;&lt;/div&gt;">coronary artery disease</a> or <a href="/conditions/stroke/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Stroke&lt;/h6&gt;&lt;p&gt;A stroke is a medical emergency. If you are experiencing stroke symptoms, call emergency medical services, even if they resolve quickly. This page does not discuss acute treatments for stroke, but rather focuses on mitigating the risk of having a stroke and supporting recovery from a stroke. &lt;/p&gt;&lt;/div&gt;">stroke</a>).<a href="#ref-36" id="ref-link-36" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Katie A Meyer, Jonathan W Shea. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/28686188" target="\_blank" rel="noopener noreferrer"&gt;Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies
&lt;/a&gt;&lt;/p&gt;Nutrients (2017 Jul 7)&lt;/div&gt;'>[36]</a>

Does eating eggs raise TMAO levels?

High/excessive intakes of choline can result in some side effects, including a fishy body odor, vomiting, excessive sweating and salivation, low blood pressure (hypotension), and liver toxicity.<a href="#ref-1" id="ref-link-1" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;&lt;a href="https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/" target="\_blank" rel="noopener noreferrer"&gt;Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024
&lt;/a&gt;&lt;/p&gt;(2018)&lt;/div&gt;'>[1]</a> In addition, choline consumption has been shown to increase the production of trimethylamine N-oxide (<a href="/outcomes/tmao/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;TMAO&lt;/h6&gt;&lt;p&gt;Trimethylamine N-oxide (TMAO) is a compound generated by gut microbial metabolism which is associated increased disease risk. However, it's questionable whether this association reflects causality.&lt;/p&gt;&lt;/div&gt;">TMAO</a>), which is associated with an increased risk of <a href="/conditions/cardiovascular-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Cardiovascular Disease&lt;/h6&gt;&lt;p&gt;Cardiovascular disease (CVD) is a broad term that refers to various diseases of the heart and blood vessels. Atherosclerotic CVD (ASCVD) is the most common subtype of CVD and causes strokes and heart attacks.&lt;/p&gt;&lt;/div&gt;">cardiovascular disease</a>. However, some studies indicate that the amount of choline consumed in 3 eggs per day does not elevate plasma TMAO levels.<a href="#ref-13" id="ref-link-13" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Lemos BS, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/29764315" target="\_blank" rel="noopener noreferrer"&gt;Effects of Egg Consumption and Choline Supplementation on Plasma Choline and Trimethylamine-N-Oxide in a Young Population
&lt;/a&gt;&lt;/p&gt;J Am Coll Nutr (2018 May 15)&lt;/div&gt;'>[13]</a><a href="#ref-14" id="ref-link-14" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhu C, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32464420" target="\_blank" rel="noopener noreferrer"&gt;Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women.
&lt;/a&gt;&lt;/p&gt;Nutr Res (2020 Jun)&lt;/div&gt;'>[14]</a><a href="#ref-15" id="ref-link-15" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Missimer A, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/29313753" target="\_blank" rel="noopener noreferrer"&gt;Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations
&lt;/a&gt;&lt;/p&gt;J Am Coll Nutr (2018 Feb)&lt;/div&gt;'>[15]</a><a href="#ref-16" id="ref-link-16" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;DiMarco DM, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/28091798" target="\_blank" rel="noopener noreferrer"&gt;Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population
&lt;/a&gt;&lt;/p&gt;Lipids (2017 Mar)&lt;/div&gt;'>[16]</a><a href="#ref-17" id="ref-link-17" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Thomas MS, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35334836" target="\_blank" rel="noopener noreferrer"&gt;Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.
&lt;/a&gt;&lt;/p&gt;Nutrients (2022 Mar 11)&lt;/div&gt;'>[17]</a> Some studies have associated higher choline intakes with increased <a href="/conditions/atrial-fibrillation/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Atrial Fibrillation&lt;/h6&gt;&lt;p&gt;&lt;em&gt;Atrial fibrillation&lt;/em&gt; (AF) is the most common type of arrhythmia: a problem with the speed or rhythm of the heartbeat. AF can cause chest pain, dizziness, and fatigue. It also increases the risk of stroke.&lt;/p&gt;&lt;/div&gt;">atrial fibrillation</a> risk<a href="#ref-18" id="ref-link-18" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zuo H, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/29650710" target="\_blank" rel="noopener noreferrer"&gt;Plasma Concentrations and Dietary Intakes of Choline and Betaine in Association With Atrial Fibrillation Risk: Results From 3 Prospective Cohorts With Different Health Profiles.
&lt;/a&gt;&lt;/p&gt;J Am Heart Assoc (2018 Apr 12)&lt;/div&gt;'>[18]</a> and <a href="/conditions/type-2-diabetes/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Type 2 Diabetes&lt;/h6&gt;&lt;p&gt;Type 2 diabetes (T2D) is a disease in which blood glucose levels are too high. It is characterized by insulin resistance in muscle, fat, and pancreas cells and an inability of the pancreas to manufacture enough insulin to control blood glucose levels. T2D is strongly associated with excess body fat, and weight loss induced by lifestyle changes is extremely effective for treating T2D.&lt;/p&gt;&lt;/div&gt;">type 2 diabetes</a>.<a href="#ref-19" id="ref-link-19" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Hosseini-Esfahani F, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37816243" target="\_blank" rel="noopener noreferrer"&gt;Dietary Intakes of Choline and Betaine and Incidence of Type 2 Diabetes: Tehran Lipid and Glucose Study.
&lt;/a&gt;&lt;/p&gt;Metab Syndr Relat Disord (2023 Dec)&lt;/div&gt;'>[19]</a>

What are choline’s main drawbacks?

During pregnancy, the demand for choline increases due to its essential role in neural tube formation, brain development, lipoprotein synthesis, liver function, and lipid metabolism. Large amounts of choline are delivered to the developing fetus across the placenta — the concentration of choline in amniotic fluid may be up to 10 times greater than in maternal blood.<a href="#ref-37" id="ref-link-37" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zeisel SH, da Costa KA. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/19906248" target="\_blank" rel="noopener noreferrer"&gt;Choline: an essential nutrient for public health
&lt;/a&gt;&lt;/p&gt;Nutr Rev (2009 Nov)&lt;/div&gt;'>[37]</a> The delivery of choline to the fetus depletes maternal choline levels, as does lactation. As such, it’s crucial for pregnant and lactating women to maintain high levels of choline while breastfeeding to avoid depleting their choline stores.
Low maternal choline intakes or plasma choline levels are associated with an up to 2.4-fold greater risk for neural tube defects.<a href="#ref-3" id="ref-link-3" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Obeid R, Derbyshire E, Schön C. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36041182" target="\_blank" rel="noopener noreferrer"&gt;Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.
&lt;/a&gt;&lt;/p&gt;Adv Nutr (2022 Dec 22)&lt;/div&gt;'>[3]</a> Intervention studies have shown that higher maternal choline intakes (550 to 1,000 mg per day) during the second half of pregnancy and the early postnatal period are safe and have favorable effects on the offspring’s memory, attention, and visual-spatial learning.<a href="#ref-3" id="ref-link-3" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Obeid R, Derbyshire E, Schön C. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36041182" target="\_blank" rel="noopener noreferrer"&gt;Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.
&lt;/a&gt;&lt;/p&gt;Adv Nutr (2022 Dec 22)&lt;/div&gt;'>[3]</a> Choline is also associated with better maternal health and well-being.<a href="#ref-26" id="ref-link-26" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Jaiswal A, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/38074049" target="\_blank" rel="noopener noreferrer"&gt;Choline Supplementation in Pregnancy: Current Evidence and Implications.
&lt;/a&gt;&lt;/p&gt;Cureus (2023 Nov)&lt;/div&gt;'>[26]</a>
For this reason, the adequate intake (AI) for choline is 450 mg per day for pregnant women and 550 mg per day for lactating women — or 6%–30% higher than the AI for non-pregnant women.
Among women of childbearing age, choline intake from food sources ranges from 244 to 443 mg per day. Women in Europe report an average choline intake of 291 (France) to 374 (Sweden) mg per day, while women in the United States get an estimated 250–443 mg per day, and Australian women have an average choline intake of 244 mg per day. Less than 5% of Australian women had a choline intake that reached or exceeded the AI of 425 mg per day.<a href="#ref-38" id="ref-link-38" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Derbyshire E, Obeid R, Schön C. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/34959942" target="\_blank" rel="noopener noreferrer"&gt;Habitual Choline Intakes across the Childbearing Years: A Review.
&lt;/a&gt;&lt;/p&gt;Nutrients (2021 Dec 8)&lt;/div&gt;'>[38]</a>
Most pregnant women consume below the AI for choline, with average estimated intakes of 190–383 mg per day. Choline intakes for pregnant women in the United States range from 281 to 332 mg per day and are similar among women from Canada (306–383 mg per day), the United Kingdom (338 mg per day), Australia (51 mg per day), Belgium (274–280 mg per day), China (255 mg per day), Jamaica (279 mg per day), New Zealand (310 mg per day), and Latvia (336 mg per day). Lower levels of choline intake have been reported for pregnant women in Bangladesh (190 mg per day). There’s little evidence to indicate that choline intake changes across trimesters of pregnancy or when choline from supplements is included.<a href="#ref-38" id="ref-link-38" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Derbyshire E, Obeid R, Schön C. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/34959942" target="\_blank" rel="noopener noreferrer"&gt;Habitual Choline Intakes across the Childbearing Years: A Review.
&lt;/a&gt;&lt;/p&gt;Nutrients (2021 Dec 8)&lt;/div&gt;'>[38]</a> Choline intake during lactation has been less well characterized but has been reported to be in the range of 257 to 346 mg per day.
In summary, with little exception, few women of childbearing age or who are pregnant/lactating appear to consume enough choline despite its critical relevance for fetal growth and development.

Do pregnant women need more choline?

Dietary choline is a precursor for the neurotransmitter acetylcholine (ACh), which is crucial for normal cognitive and motor function. Choline is irreversibly oxidized into <a href="/supplements/betaine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Betaine&lt;/h6&gt;&lt;p&gt;Betaine (trimethylglycine) is an active metabolite of choline in the body and a component of beetroot. It serves a vital role in methylation in the body alongside folate, and is an osmoregulator like creatine. Betaine is also a possible ergogenic aid.&lt;/p&gt;&lt;/div&gt;">betaine</a> in the liver and kidneys. Betaine is a methyl group donor that participates in the important process of remethylating homocysteine to methionine. Choline is also a precursor for the synthesis of <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a>, the most abundant form of phospholipid in the body.<a href="#ref-2" id="ref-link-2" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wiedeman AM, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30332744" target="\_blank" rel="noopener noreferrer"&gt;Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.
&lt;/a&gt;&lt;/p&gt;Nutrients (2018 Oct 16)&lt;/div&gt;'>[2]</a>
Choline is important for neural tube closure, stem cell proliferation, and apoptosis (programmed cell death) in the fetal brain during early pregnancy. The choline metabolite phosphatidylcholine is also required for packaging and exporting very-low-density lipoproteins from the liver and the secretion of bile acid salts; the disruption of this process can contribute to the accumulation of triglycerides in the liver.<a href="#ref-20" id="ref-link-20" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Bruni C, Hegsted DM. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/4340541" target="\_blank" rel="noopener noreferrer"&gt;Effects of choline-deficient diets on the rat hepatocyte. Electron microscopic observations.
&lt;/a&gt;&lt;/p&gt;Am J Pathol (1970 Dec)&lt;/div&gt;'>[20]</a><a href="#ref-21" id="ref-link-21" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Lombardi B, Pani P, Schlunk FF. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/5725875" target="\_blank" rel="noopener noreferrer"&gt;Choline-deficiency fatty liver: impaired release of hepatic triglycerides.
&lt;/a&gt;&lt;/p&gt;J Lipid Res (1968 Jul)&lt;/div&gt;'>[21]</a><a href="#ref-22" id="ref-link-22" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Emmert JL, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/9498371" target="\_blank" rel="noopener noreferrer"&gt;Hepatic and renal betaine-homocysteine methyltransferase activity in pigs as affected by dietary intakes of sulfur amino acids, choline, and betaine.
&lt;/a&gt;&lt;/p&gt;J Anim Sci (1998 Feb)&lt;/div&gt;'>[22]</a><a href="#ref-23" id="ref-link-23" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Ridgway ND, Vance DE. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/3182819" target="\_blank" rel="noopener noreferrer"&gt;Kinetic mechanism of phosphatidylethanolamine N-methyltransferase.
&lt;/a&gt;&lt;/p&gt;J Biol Chem (1988 Nov 15)&lt;/div&gt;'>[23]</a><a href="#ref-24" id="ref-link-24" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Sowden MP, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/10417327" target="\_blank" rel="noopener noreferrer"&gt;Apolipoprotein B mRNA and lipoprotein secretion are increased in McArdle RH-7777 cells by expression of betaine-homocysteine S-methyltransferase.
&lt;/a&gt;&lt;/p&gt;Biochem J (1999 Aug 1)&lt;/div&gt;'>[24]</a>

How does choline work?

Choline

Brain Health

Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024

Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.

Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.

Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial.

Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder.

Long-term follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder: corpus callosum white matter microstructure and neurocognitive outcomes.

Circulating choline pathway nutrients and depression after ischemic stroke.

Association between Dietary Choline Intake and Cardiovascular Diseases: National Health and Nutrition Examination Survey 2011-2016.

Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study.

One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvención con DIeta MEDiterránea-Plus (PREDIMED-Plus) trial.

The Effect of Choline and Resistance Training on Strength and Lean Mass in Older Adults.

Low Intake of Choline Is Associated with Diminished Strength and Lean Mass Gains in Older Adults.

Effects of Egg Consumption and Choline Supplementation on Plasma Choline and Trimethylamine-N-Oxide in a Young Population

Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women.

Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations

Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population

Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.

Plasma Concentrations and Dietary Intakes of Choline and Betaine in Association With Atrial Fibrillation Risk: Results From 3 Prospective Cohorts With Different Health Profiles.

Dietary Intakes of Choline and Betaine and Incidence of Type 2 Diabetes: Tehran Lipid and Glucose Study.

Effects of choline-deficient diets on the rat hepatocyte. Electron microscopic observations.

Choline-deficiency fatty liver: impaired release of hepatic triglycerides.

Hepatic and renal betaine-homocysteine methyltransferase activity in pigs as affected by dietary intakes of sulfur amino acids, choline, and betaine.

Kinetic mechanism of phosphatidylethanolamine N-methyltransferase.

Apolipoprotein B mRNA and lipoprotein secretion are increased in McArdle RH-7777 cells by expression of betaine-homocysteine S-methyltransferase.

WWEIA Data Tables; United State Department of Agriculture, Agriculture Research Service, cited April 2024, last updated Feb 2022

Choline Supplementation in Pregnancy: Current Evidence and Implications.

Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population.

Importance of choline as essential nutrient and its role in prevention of various toxicities.

A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products.

Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial.

Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study.

Gut Microbiota-Derived TMAO: A Causal Factor Promoting Atherosclerotic Cardiovascular Disease?

Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial.

Effect of Choline Forms and Gut Microbiota Composition on Trimethylamine- N-Oxide Response in Healthy Men

Changes in Choline Metabolites and Ceramides in Response to a DASH-Style Diet in Older Adults.

Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies

Choline: an essential nutrient for public health

Habitual Choline Intakes across the Childbearing Years: A Review.

Nick Milazzo

Conni Covington

Brady Holmer

General Athletic Performance

Anaerobic Capacity

Cognition

Fatigue Symptoms

Memory

Rate of Perceived Exertion

Reaction Time

Training Volume

Working Memory

Anaerobic Exercise Performance

Healthy Aging

Memory & Focus

Vegetarians & Vegans

Cognitive Improvement

Cycling Performance

Memory Improvement

Effect of choline supplementation on fatigue in trained cyclists

Choline ingestion does not modify physical or cognitive performance

The effects of choline supplementation on physical performance

Choline is found naturally in foods in different forms, including the fat-soluble phospholipids <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a> and sphingomyelin and the water-soluble compounds phosphocholine, glycerophosphocholine, and free choline. About half of the dietary choline consumed in the United States is in the form of phosphatidylcholine. 
The main dietary sources of choline are animal-based foods such as meat, poultry, fish, dairy, and eggs, as well as some cruciferous vegetables, beans, nuts, seeds, and whole grains. The top sources of choline are beef liver (3 ounces contains 356 mg of choline), <a href="/foods/eggs/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Eggs&lt;/h6&gt;&lt;p&gt;A shelled vessel for protein and fats in the white and yolk, respectively, that carries a surprisingly large amount of nutrients; especially choline and leucine as well as many carotenoids coloring the yolk. Eggs do not inherently increase circulating cholesterol.&lt;/p&gt;&lt;/div&gt;">eggs</a> (one large egg contains 147 mg of choline), beef (3 ounces contains 117 mg of choline) and soybeans (one half of a cup contains 107 mg of choline).[reference|url=https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/|title=Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024|published=2018]
Choline can also be obtained from dietary supplements that contain choline, choline + B vitamins, and multivitamin/multimineral products. Most tend to contain 10–250 mg of choline. The most commonly supplemented form of choline is choline bitartrate.

Choline is produced endogenously in the liver (as <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a>), but the amount we make isn’t sufficient to meet our body’s needs. Therefore, it’s essential to obtain choline from the diet and/or supplements. According to some estimates, adults in the United States only consume between 278 and 402 mg of choline per day, which falls below the adequate intake (AI) for choline.[reference|url=https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/wweia-data-tables/|title=WWEIA Data Tables; United State Department of Agriculture, Agriculture Research Service, cited April 2024, last updated Feb 2022] Despite having lower-than-recommended dietary intakes of choline, most adults don’t appear to be choline-deficient, possibly due to the contribution from endogenous choline production.
The liver is the primary site for choline synthesis. Choline synthesis is catalyzed by the enzyme phosphatidylethanolamine N-methyltransferase (PEMT), which synthesizes phosphatidylcholine by methylating phosphatidylethanolamine using the methyl donor <a href="/supplements/s-adenosyl-methionine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;S-adenosylmethionine&lt;/h6&gt;&lt;p&gt;S-adenosylmethionine (SAMe) is a methyl donating compound that circulates in the blood and provides methyl groups to maintain other metabolic reactions. Lowered SAMe levels are associated with depressive symptoms, and supplementation may aid a partial deficiency.&lt;/p&gt;&lt;/div&gt;">S-adenosyl-L-methionine</a> (SAMe).

Choline is an essential nutrient that plays a role in the synthesis of phospholipid membranes and is a source of methyl groups that are needed for many steps in metabolism. It’s also the precursor to the neurotransmitter acetylcholine. Choline has particular relevance for brain development, liver health, and skeletal muscle function. Choline is mostly found in animal foods such as <a href="/foods/eggs/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Eggs&lt;/h6&gt;&lt;p&gt;A shelled vessel for protein and fats in the white and yolk, respectively, that carries a surprisingly large amount of nutrients; especially choline and leucine as well as many carotenoids coloring the yolk. Eggs do not inherently increase circulating cholesterol.&lt;/p&gt;&lt;/div&gt;">eggs</a>, milk, fish, chicken, and beef, but some plant foods also contain choline.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30332744|title=Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.|published=2018 Oct 16|authors=Wiedeman AM, Barr SI, Green TJ, Xu Z, Innis SM, Kitts DD|journal=Nutrients|]

Choline deficiency can lead to muscle damage, liver damage, and <a href="/conditions/nonalcoholic-fatty-liver-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Nonalcoholic Fatty Liver Disease&lt;/h6&gt;&lt;p&gt;Non-alcoholic fatty liver disease (NAFLD) is a condition in which excessive fat (more than 5% of liver weight) accumulates in the liver due to causes unrelated to alcohol.&lt;/p&gt;&lt;/div&gt;">nonalcoholic fatty liver disease</a>. However, clinically evident choline deficiency is very rare, likely due to the contribution of the body’s endogenous choline production.
Choline intakes tend to be below the adequate intake for children and adults, who average an intake of 256 mg per day and 278–402 mg per day, respectively.[reference|url=https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/wweia-data-tables/|title=WWEIA Data Tables; United State Department of Agriculture, Agriculture Research Service, cited April 2024, last updated Feb 2022]
Worldwide choline intakes have been estimated to be 284–468 mg per day for men and 263–374 mg per day for women. In the United States and Canada, adult intakes range from 260–396 mg per day and 292–372 mg per day, respectively.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30332744|title=Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.|published=2018 Oct 16|authors=Wiedeman AM, Barr SI, Green TJ, Xu Z, Innis SM, Kitts DD|journal=Nutrients|] The United States National Institutes of Health consider adequate intake to be 550 mg/day for men and 425 mg/day for women.[reference|url=https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/|title=Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024|published=2018]
Pregnant and lactating women need more choline. During pregnancy, choline demand rises due to its role in neural tube formation, brain development, and lipoprotein synthesis. There’s also evidence that choline may prevent neural tube defects, improve offspring cognitive development, and promote maternal well-being.[reference|url=https://pubmed.ncbi.nlm.nih.gov/38074049|title=Choline Supplementation in Pregnancy: Current Evidence and Implications.|published=2023 Nov|authors=Jaiswal A, Dewani D, Reddy LS, Patel A|journal=Cureus|] Most (90%–95%) pregnant women consume less than the adequate intake (AI) for choline,[reference|url=https://pubmed.ncbi.nlm.nih.gov/24476840|title=Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population.|published=2014 Sep|authors=Brunst KJ, Wright RO, DiGioia K, Enlow MB, Fernandez H, Wright RJ, Kannan S|journal=Public Health Nutr|] and <a href="/supplements/prenatal-vitamins/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Prenatal Vitamins&lt;/h6&gt;&lt;p&gt;Prenatal supplements, also known as prenatal vitamins, are frequently used by women before conception and throughout gestation. Their purpose is to guarantee that both the expectant mother and the developing fetus obtain the necessary quantity of vital nutrients. They usually contain folic acid, iron, and other micronutrients, but the composition varies from brand to brand.&lt;/p&gt;&lt;/div&gt;">prenatal supplements</a> typically don’t contain choline. Women who do not supplement with folic acid, those who have a low vitamin B12 status, or those who have a common variant in the enzyme methylenetetrahydrofolate dehydrogenase are the most at risk for having an inadequate choline status.[reference|url=https://pubmed.ncbi.nlm.nih.gov/38074049|title=Choline Supplementation in Pregnancy: Current Evidence and Implications.|published=2023 Nov|authors=Jaiswal A, Dewani D, Reddy LS, Patel A|journal=Cureus|]
Dietary choline requirements are lower in premenopausal women because estrogen induces the enzyme phosphatidylethanolamine N-methyltransferase (PEMT), which synthesizes phosphatidylcholine. However, women who have a genetic mutation in PEMT have less estrogen-induced choline synthesis and therefore higher choline requirements.[reference|url=https://pubmed.ncbi.nlm.nih.gov/25923965|title=Importance of choline as essential nutrient and its role in prevention of various toxicities.|published=2015|authors=Biswas S, Giri S|journal=Prague Med Rep|] 
Finally, adults and infants receiving total parenteral (intravenous) nutrition may need to be supplemented with choline because choline is not routinely added to these solutions. Long-term parenteral nutrition has been shown to reduce plasma choline concentrations in adults and infants and is associated with the development of fatty liver and impaired liver function.[reference|url=https://pubmed.ncbi.nlm.nih.gov/22730042|title=A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products.|published=2012 Aug|authors=Vanek VW, Borum P, Buchman A, Fessler TA, Howard L, Jeejeebhoy K, Kochevar M, Shenkin A, Valentine CJ, Novel Nutrient Task Force, Parenteral Multi-Vitamin and Multi–Trace Element Working Group, American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors|journal=Nutr Clin Pract|] These changes can be attenuated by providing intravenous choline.[reference|url=https://pubmed.ncbi.nlm.nih.gov/11531217|title=Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial.|published=2001 Sep-Oct|authors=Buchman AL, Ament ME, Sohel M, Dubin M, Jenden DJ, Roch M, Pownall H, Farley W, Awal M, Ahn C|journal=JPEN J Parenter Enteral Nutr|][reference|url=https://pubmed.ncbi.nlm.nih.gov/11190987|title=Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study.|published=2001 Jan-Feb|authors=Buchman AL, Sohel M, Brown M, Jenden DJ, Ahn C, Roch M, Brawley TL|journal=JPEN J Parenter Enteral Nutr|]

Choline supplementation during pregnancy or early childhood has favorable effects on children’s brain function and neurodevelopment, including memory, attention, and visual-spatial learning.[reference|url=https://pubmed.ncbi.nlm.nih.gov/36041182|title=Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.|published=2022 Dec 22|authors=Obeid R, Derbyshire E, Schön C|journal=Adv Nutr|] Choline supplementation among children with fetal alcohol spectrum disorder improves memory, nonverbal intelligence, visual-spatial skills, <a href="/outcomes/adhd-symptoms/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;ADHD Symptoms&lt;/h6&gt;&lt;p&gt;Common symptoms of Attention Deficit Hyperactivity Disorder (ADHD) are inattention, impulsivity, and hyperactivity. These symptoms can interfere with daily activities and social interactions.&lt;/p&gt;&lt;/div&gt;">ADHD symptoms</a>, <a href="/outcomes/executive-function/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Executive Function&lt;/h6&gt;&lt;p&gt;Executive function is a set of cognitive processes and skills related to self-control and behavior management that include working memory, mental flexibility, focus, emotional control, goal-setting, and following directions.&lt;/p&gt;&lt;/div&gt;">executive function</a>, and white matter microstructure.[reference|url=https://pubmed.ncbi.nlm.nih.gov/26447156|title=Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial.|published=2015 Nov|authors=Wozniak JR, Fuglestad AJ, Eckerle JK, Fink BA, Hoecker HL, Boys CJ, Radke JP, Kroupina MG, Miller NC, Brearley AM, Zeisel SH, Georgieff MK|journal=Am J Clin Nutr|][reference|url=https://pubmed.ncbi.nlm.nih.gov/32164522|title=Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder.|published=2020 Mar 12|authors=Wozniak JR, Fink BA, Fuglestad AJ, Eckerle JK, Boys CJ, Sandness KE, Radke JP, Miller NC, Lindgren C, Brearley AM, Zeisel SH, Georgieff MK|journal=J Neurodev Disord|][reference|url=https://pubmed.ncbi.nlm.nih.gov/36526961|title=Long-term follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder: corpus callosum white matter microstructure and neurocognitive outcomes.|published=2022 Dec 16|authors=Gimbel BA, Anthony ME, Ernst AM, Roediger DJ, de Water E, Eckerle JK, Boys CJ, Radke JP, Mueller BA, Fuglestad AJ, Zeisel SH, Georgieff MK, Wozniak JR|journal=J Neurodev Disord|] These effects occur primarily when choline is supplemented before the age of 5.
Higher choline intakes have been associated with a lower risk for cardiovascular events and <a href="/conditions/stroke/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Stroke&lt;/h6&gt;&lt;p&gt;A stroke is a medical emergency. If you are experiencing stroke symptoms, call emergency medical services, even if they resolve quickly. This page does not discuss acute treatments for stroke, but rather focuses on mitigating the risk of having a stroke and supporting recovery from a stroke. &lt;/p&gt;&lt;/div&gt;">stroke</a>, <a href="/conditions/mild-cognitive-impairment/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Mild Cognitive Impairment&lt;/h6&gt;&lt;p&gt;MCI is a form of cognitive decline where changes are serious enough to be noticed by the affected individual and their family members, but not severe enough to interfere with normal activities of daily living.&lt;/p&gt;&lt;/div&gt;">cognitive impairment</a>, post-stroke <a href="/conditions/depression/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Depression&lt;/h6&gt;&lt;p&gt;Depression is a chronic state of low mood often associated with hopelessness, apathy, and fatigue. Unlike sadness, depression is a disorder that persists for weeks or months and interferes with daily life.&lt;/p&gt;&lt;/div&gt;">depression</a>,[reference|url=https://pubmed.ncbi.nlm.nih.gov/34611955|title=Circulating choline pathway nutrients and depression after ischemic stroke.|published=2022 Feb|authors=Miao M, Du J, Che B, Guo Y, Zhang J, Ju Z, Xu T, Zhong X, Zhang Y, Zhong C|journal=Eur J Neurol|] <a href="/conditions/cardiovascular-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Cardiovascular Disease&lt;/h6&gt;&lt;p&gt;Cardiovascular disease (CVD) is a broad term that refers to various diseases of the heart and blood vessels. Atherosclerotic CVD (ASCVD) is the most common subtype of CVD and causes strokes and heart attacks.&lt;/p&gt;&lt;/div&gt;">cardiovascular disease</a>,[reference|url=https://pubmed.ncbi.nlm.nih.gov/37764819|title=Association between Dietary Choline Intake and Cardiovascular Diseases: National Health and Nutrition Examination Survey 2011-2016.|published=2023 Sep 18|authors=Zhou R, Yang M, Yue C, Shi Y, Tan Y, Zha L, Zhang J, Chen S|journal=Nutrients|] and <a href="/conditions/dementia/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dementia&lt;/h6&gt;&lt;p&gt;Dementia is a term that refers to a decline in cognitive function that interferes with daily life. Dementia can affect language, memory, visual perception, problem-solving, and focus. People with dementia may lose their ability to do everyday activities, including bathing, dressing, eating, and using the bathroom.&lt;/p&gt;&lt;/div&gt;">dementia</a>.[reference|url=https://pubmed.ncbi.nlm.nih.gov/31360988|title=Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study.|published=2019 Dec 1|authors=Ylilauri MPT, Voutilainen S, Lönnroos E, Virtanen HEK, Tuomainen TP, Salonen JT, Virtanen JK|journal=Am J Clin Nutr|] A higher intake of choline is also associated with lower levels of cardiometabolic risk factors.[reference|url=https://pubmed.ncbi.nlm.nih.gov/36124652|title=One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvención con DIeta MEDiterránea-Plus (PREDIMED-Plus) trial.|published=2022 Dec 19|authors=Díez-Ricote L, San-Cristobal R, Concejo MJ, Martínez-González MÁ, Corella D, Salas-Salvadó J, Goday A, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Tinahones FJ, Lapetra J, Serra-Majem L, Bueno-Cavanillas A, Tur JA, Martín Sánchez V, Pintó X, Gaforio JJ, Matía-Martín P, Vidal J, Mas Fontao S, Ros E, Vázquez-Ruiz Z, Ortega-Azorín C, García-Gavilán JF, Malcampo M, Martínez-Urbistondo D, Tojal-Sierra L, García Rodríguez A, Gómez-Bellvert N, Chaplin A, García-Ríos A, Bernal-López RM, Santos-Lozano JM, Basterra-Gortari J, Sorlí JV, Murphy M, Gasulla G, Micó V, Salaverria-Lete I, Goñi Ochandorena E, Babio N, Herraiz X, Ordovás JM, Daimiel L|journal=Am J Clin Nutr|] Interestingly, a low choline intake may impair gains in strength and lean mass in response to exercise training[reference|url=https://pubmed.ncbi.nlm.nih.gov/37764658|title=The Effect of Choline and Resistance Training on Strength and Lean Mass in Older Adults.|published=2023-Sep-06|authors=Lee CW, Lee TV, Galvan E, Chen VCW, Bui S, Crouse SF, Fluckey JD, Smith SB, Riechman SE|journal=Nutrients|][reference|url=https://pubmed.ncbi.nlm.nih.gov/36629089|title=Low Intake of Choline Is Associated with Diminished Strength and Lean Mass Gains in Older Adults.|published=2023|authors=Lee CW, Galvan E, Lee TV, Chen VCW, Bui S, Crouse SF, Fluckey JD, Smith SB, Riechman SE|journal=J Frailty Aging|] and reduce cognitive function.[reference|url=https://pubmed.ncbi.nlm.nih.gov/31360988|title=Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study.|published=2019 Dec 1|authors=Ylilauri MPT, Voutilainen S, Lönnroos E, Virtanen HEK, Tuomainen TP, Salonen JT, Virtanen JK|journal=Am J Clin Nutr|]

Dietary choline undergoes anaerobic metabolism by gut microbes to form trimethylamine (TMA) which is then oxidized by liver enzymes to form trimethylamine N-oxide (<a href="/outcomes/tmao/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;TMAO&lt;/h6&gt;&lt;p&gt;Trimethylamine N-oxide (TMAO) is a compound generated by gut microbial metabolism which is associated increased disease risk. However, it's questionable whether this association reflects causality.&lt;/p&gt;&lt;/div&gt;">TMAO</a>), a newly recognized risk marker for cardiovascular disease.[reference|url=https://pubmed.ncbi.nlm.nih.gov/36768264|title=Gut Microbiota-Derived TMAO: A Causal Factor Promoting Atherosclerotic Cardiovascular Disease?|published=2023-Jan-18|authors=Canyelles M, Borràs C, Rotllan N, Tondo M, Escolà-Gil JC, Blanco-Vaca F|journal=Int J Mol Sci|]
However, several dietary sources of choline (e.g., <a href="/foods/eggs/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Eggs&lt;/h6&gt;&lt;p&gt;A shelled vessel for protein and fats in the white and yolk, respectively, that carries a surprisingly large amount of nutrients; especially choline and leucine as well as many carotenoids coloring the yolk. Eggs do not inherently increase circulating cholesterol.&lt;/p&gt;&lt;/div&gt;">eggs</a>) actually contain <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a>, which may not have the same TMAO-elevating effects as choline (as choline bitartrate or other forms). For example, multiple studies have shown that eating up to 3 eggs per day (about 400 mg of choline) elevates plasma choline levels but does not increase TMAO.[reference|url=https://pubmed.ncbi.nlm.nih.gov/29764315|title=Effects of Egg Consumption and Choline Supplementation on Plasma Choline and Trimethylamine-N-Oxide in a Young Population|published=2018 May 15|authors=Lemos BS, Medina-Vera I, Malysheva OV, Caudill MA, Fernandez ML|journal=J Am Coll Nutr|][reference|url=https://pubmed.ncbi.nlm.nih.gov/33872583|title=Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial.|published=2021 Sep|authors=Wilcox J, Skye SM, Graham B, Zabell A, Li XS, Li L, Shelkay S, Fu X, Neale S, O'Laughlin C, Peterson K, Hazen SL, Tang WHW|journal=Am J Med|][reference|url=https://pubmed.ncbi.nlm.nih.gov/32464420|title=Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women.|published=2020 Jun|authors=Zhu C, Sawrey-Kubicek L, Bardagjy AS, Houts H, Tang X, Sacchi R, Randolph JM, Steinberg FM, Zivkovic AM|journal=Nutr Res|][reference|url=https://pubmed.ncbi.nlm.nih.gov/29313753|title=Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations|published=2018 Feb|authors=Missimer A, Fernandez ML, DiMarco DM, Norris GH, Blesso CN, Murillo AG, Vergara-Jimenez M, Lemos BS, Medina-Vera I, Malysheva OV, Caudill MA|journal=J Am Coll Nutr|][reference|url=https://pubmed.ncbi.nlm.nih.gov/28091798|title=Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population|published=2017 Mar|authors=DiMarco DM, Missimer A, Murillo AG, Lemos BS, Malysheva OV, Caudill MA, Blesso CN, Fernandez ML|journal=Lipids|][reference|url=https://pubmed.ncbi.nlm.nih.gov/35334836|title=Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.|published=2022 Mar 11|authors=Thomas MS, DiBella M, Blesso CN, Malysheva O, Caudill M, Sholola M, Cooperstone JL, Fernandez ML|journal=Nutrients|] On the other hand, TMAO levels increase up to 3-fold following the intake of 600 mg of choline bitartrate.[reference|url=https://pubmed.ncbi.nlm.nih.gov/32722424|title=Effect of Choline Forms and Gut Microbiota Composition on Trimethylamine- N-Oxide Response in Healthy Men|published=2020 Jul 25|authors=Clara E Cho, Niklas D J Aardema, Madison L Bunnell, Deanna P Larson, Sheryl S Aguilar, Janet R Bergeson, Olga V Malysheva, Marie A Caudill, Michael Lefevre|journal=Nutrients|] Adding choline to the diet from beef (3–6 ounces as part of a <a href="/diets/dietary-approaches-to-stop-hypertension-diet/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dietary Approaches to Stop Hypertension Diet&lt;/h6&gt;&lt;p&gt;The DASH diet is an eating plan designed to prevent or treat hypertension (high blood pressure). DASH includes a high intake of whole grains, fruits and vegetables, fish, poultry, legumes, and nuts and limits the intake of sodium (salt), saturated fat, and sugar.&lt;/p&gt;&lt;/div&gt;">Dietary Approaches to Stop Hypertension diet</a>) increases plasma choline by 10% and TMAO levels by 27% in older adults with <a href="/conditions/obesity/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Obesity&lt;/h6&gt;&lt;p&gt;Obesity is a condition of excessive body fat that increases the risk for other conditions such as diabetes and heart disease. Fat is how the body stores extra calories that were eaten but not used. Obesity treatment usually involves restricting the calories eaten or creating negative calorie balance.&lt;/p&gt;&lt;/div&gt;">obesity</a>.[reference|url=https://pubmed.ncbi.nlm.nih.gov/37686719|title=Changes in Choline Metabolites and Ceramides in Response to a DASH-Style Diet in Older Adults.|published=2023 Aug 23|authors=Tate BN, Van Guilder GP, Aly M, Spence LA, Diaz-Rubio ME, Le HH, Johnson EL, McFadden JW, Perry CA|journal=Nutrients|]
Differences in gut microbiota may explain individual differences in TMAO production following choline intake. For example, high TMAO producers had more abundant lineages of Clostridium and Ruminococcaceae and Lachnospiraceae compared to low TMAO producers.[reference|url=https://pubmed.ncbi.nlm.nih.gov/32722424|title=Effect of Choline Forms and Gut Microbiota Composition on Trimethylamine- N-Oxide Response in Healthy Men|published=2020 Jul 25|authors=Clara E Cho, Niklas D J Aardema, Madison L Bunnell, Deanna P Larson, Sheryl S Aguilar, Janet R Bergeson, Olga V Malysheva, Marie A Caudill, Michael Lefevre|journal=Nutrients|]
Overall, because <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a> is the major form of choline in food and phosphatidylcholine doesn’t appear to elevate TMAO levels, there’s no reason to avoid phosphatidylcholine over fears of its TMAO-elevating effects. Furthermore, <a href="/glossary/meta-analysis/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Meta-analysis&lt;/h6&gt;&lt;p&gt;A meta-analysis is usually produced as part of a systematic review. It combines the numerical results from several studies into an average number. Studies that differ too much in design cannot be properly meta-analyzed.&lt;/p&gt;&lt;/div&gt;">meta-analyses</a> have found no association between dietary choline/<a href="/supplements/betaine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Betaine&lt;/h6&gt;&lt;p&gt;Betaine (trimethylglycine) is an active metabolite of choline in the body and a component of beetroot. It serves a vital role in methylation in the body alongside folate, and is an osmoregulator like creatine. Betaine is also a possible ergogenic aid.&lt;/p&gt;&lt;/div&gt;">betaine</a> intake and the risk of <a href="/conditions/cardiovascular-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Cardiovascular Disease&lt;/h6&gt;&lt;p&gt;Cardiovascular disease (CVD) is a broad term that refers to various diseases of the heart and blood vessels. Atherosclerotic CVD (ASCVD) is the most common subtype of CVD and causes strokes and heart attacks.&lt;/p&gt;&lt;/div&gt;">cardiovascular disease</a> outcomes (e.g., <a href="/conditions/coronary-artery-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Coronary Artery Disease&lt;/h6&gt;&lt;p&gt;Coronary artery disease (CAD; sometimes called coronary heart disease, or CHD) is a common kind of heart disease caused by atherosclerosis of the heart’s arteries. Diet and exercise can play a pretty big role to both prevent and treat it. Smoking, family history, high blood pressure and high cholesterol are major risk factors.&lt;/p&gt;&lt;/div&gt;">coronary artery disease</a> or <a href="/conditions/stroke/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Stroke&lt;/h6&gt;&lt;p&gt;A stroke is a medical emergency. If you are experiencing stroke symptoms, call emergency medical services, even if they resolve quickly. This page does not discuss acute treatments for stroke, but rather focuses on mitigating the risk of having a stroke and supporting recovery from a stroke. &lt;/p&gt;&lt;/div&gt;">stroke</a>).[reference|url=https://pubmed.ncbi.nlm.nih.gov/28686188|title=Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies|published=2017 Jul 7|authors=Katie A Meyer, Jonathan W Shea|journal=Nutrients|]

High/excessive intakes of choline can result in some side effects, including a fishy body odor, vomiting, excessive sweating and salivation, low blood pressure (hypotension), and liver toxicity.[reference|url=https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/|title=Choline: Fact Sheet for Health Professionals; USA: National Institutes of Health Office of Dietary Supplements; last updated 2 June 2022; cited April 2024|published=2018] In addition, choline consumption has been shown to increase the production of trimethylamine N-oxide (<a href="/outcomes/tmao/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;TMAO&lt;/h6&gt;&lt;p&gt;Trimethylamine N-oxide (TMAO) is a compound generated by gut microbial metabolism which is associated increased disease risk. However, it's questionable whether this association reflects causality.&lt;/p&gt;&lt;/div&gt;">TMAO</a>), which is associated with an increased risk of <a href="/conditions/cardiovascular-disease/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Cardiovascular Disease&lt;/h6&gt;&lt;p&gt;Cardiovascular disease (CVD) is a broad term that refers to various diseases of the heart and blood vessels. Atherosclerotic CVD (ASCVD) is the most common subtype of CVD and causes strokes and heart attacks.&lt;/p&gt;&lt;/div&gt;">cardiovascular disease</a>. However, some studies indicate that the amount of choline consumed in 3 eggs per day does not elevate plasma TMAO levels.[reference|url=https://pubmed.ncbi.nlm.nih.gov/29764315|title=Effects of Egg Consumption and Choline Supplementation on Plasma Choline and Trimethylamine-N-Oxide in a Young Population|published=2018 May 15|authors=Lemos BS, Medina-Vera I, Malysheva OV, Caudill MA, Fernandez ML|journal=J Am Coll Nutr|][reference|url=https://pubmed.ncbi.nlm.nih.gov/32464420|title=Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women.|published=2020 Jun|authors=Zhu C, Sawrey-Kubicek L, Bardagjy AS, Houts H, Tang X, Sacchi R, Randolph JM, Steinberg FM, Zivkovic AM|journal=Nutr Res|][reference|url=https://pubmed.ncbi.nlm.nih.gov/29313753|title=Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations|published=2018 Feb|authors=Missimer A, Fernandez ML, DiMarco DM, Norris GH, Blesso CN, Murillo AG, Vergara-Jimenez M, Lemos BS, Medina-Vera I, Malysheva OV, Caudill MA|journal=J Am Coll Nutr|][reference|url=https://pubmed.ncbi.nlm.nih.gov/28091798|title=Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population|published=2017 Mar|authors=DiMarco DM, Missimer A, Murillo AG, Lemos BS, Malysheva OV, Caudill MA, Blesso CN, Fernandez ML|journal=Lipids|][reference|url=https://pubmed.ncbi.nlm.nih.gov/35334836|title=Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.|published=2022 Mar 11|authors=Thomas MS, DiBella M, Blesso CN, Malysheva O, Caudill M, Sholola M, Cooperstone JL, Fernandez ML|journal=Nutrients|] Some studies have associated higher choline intakes with increased <a href="/conditions/atrial-fibrillation/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Atrial Fibrillation&lt;/h6&gt;&lt;p&gt;&lt;em&gt;Atrial fibrillation&lt;/em&gt; (AF) is the most common type of arrhythmia: a problem with the speed or rhythm of the heartbeat. AF can cause chest pain, dizziness, and fatigue. It also increases the risk of stroke.&lt;/p&gt;&lt;/div&gt;">atrial fibrillation</a> risk[reference|url=https://pubmed.ncbi.nlm.nih.gov/29650710|title=Plasma Concentrations and Dietary Intakes of Choline and Betaine in Association With Atrial Fibrillation Risk: Results From 3 Prospective Cohorts With Different Health Profiles.|published=2018 Apr 12|authors=Zuo H, Svingen GFT, Tell GS, Ueland PM, Vollset SE, Pedersen ER, Ulvik A, Meyer K, Nordrehaug JE, Nilsen DWT, Bønaa KH, Nygård O|journal=J Am Heart Assoc|] and <a href="/conditions/type-2-diabetes/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Type 2 Diabetes&lt;/h6&gt;&lt;p&gt;Type 2 diabetes (T2D) is a disease in which blood glucose levels are too high. It is characterized by insulin resistance in muscle, fat, and pancreas cells and an inability of the pancreas to manufacture enough insulin to control blood glucose levels. T2D is strongly associated with excess body fat, and weight loss induced by lifestyle changes is extremely effective for treating T2D.&lt;/p&gt;&lt;/div&gt;">type 2 diabetes</a>.[reference|url=https://pubmed.ncbi.nlm.nih.gov/37816243|title=Dietary Intakes of Choline and Betaine and Incidence of Type 2 Diabetes: Tehran Lipid and Glucose Study.|published=2023 Dec|authors=Hosseini-Esfahani F, Koochakpoor G, Golzarand M, Mirmiran P, Azizi F|journal=Metab Syndr Relat Disord|]

During pregnancy, the demand for choline increases due to its essential role in neural tube formation, brain development, lipoprotein synthesis, liver function, and lipid metabolism. Large amounts of choline are delivered to the developing fetus across the placenta — the concentration of choline in amniotic fluid may be up to 10 times greater than in maternal blood.[reference|url=https://pubmed.ncbi.nlm.nih.gov/19906248|title=Choline: an essential nutrient for public health|published=2009 Nov|authors=Zeisel SH, da Costa KA|journal=Nutr Rev|] The delivery of choline to the fetus depletes maternal choline levels, as does lactation. As such, it’s crucial for pregnant and lactating women to maintain high levels of choline while breastfeeding to avoid depleting their choline stores.
Low maternal choline intakes or plasma choline levels are associated with an up to 2.4-fold greater risk for neural tube defects.[reference|url=https://pubmed.ncbi.nlm.nih.gov/36041182|title=Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.|published=2022 Dec 22|authors=Obeid R, Derbyshire E, Schön C|journal=Adv Nutr|] Intervention studies have shown that higher maternal choline intakes (550 to 1,000 mg per day) during the second half of pregnancy and the early postnatal period are safe and have favorable effects on the offspring’s memory, attention, and visual-spatial learning.[reference|url=https://pubmed.ncbi.nlm.nih.gov/36041182|title=Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies.|published=2022 Dec 22|authors=Obeid R, Derbyshire E, Schön C|journal=Adv Nutr|] Choline is also associated with better maternal health and well-being.[reference|url=https://pubmed.ncbi.nlm.nih.gov/38074049|title=Choline Supplementation in Pregnancy: Current Evidence and Implications.|published=2023 Nov|authors=Jaiswal A, Dewani D, Reddy LS, Patel A|journal=Cureus|]
For this reason, the adequate intake (AI) for choline is 450 mg per day for pregnant women and 550 mg per day for lactating women — or 6%–30% higher than the AI for non-pregnant women.
Among women of childbearing age, choline intake from food sources ranges from 244 to 443 mg per day. Women in Europe report an average choline intake of 291 (France) to 374 (Sweden) mg per day, while women in the United States get an estimated 250–443 mg per day, and Australian women have an average choline intake of 244 mg per day. Less than 5% of Australian women had a choline intake that reached or exceeded the AI of 425 mg per day.[reference|url=https://pubmed.ncbi.nlm.nih.gov/34959942|title=Habitual Choline Intakes across the Childbearing Years: A Review.|published=2021 Dec 8|authors=Derbyshire E, Obeid R, Schön C|journal=Nutrients|]
Most pregnant women consume below the AI for choline, with average estimated intakes of 190–383 mg per day. Choline intakes for pregnant women in the United States range from 281 to 332 mg per day and are similar among women from Canada (306–383 mg per day), the United Kingdom (338 mg per day), Australia (51 mg per day), Belgium (274–280 mg per day), China (255 mg per day), Jamaica (279 mg per day), New Zealand (310 mg per day), and Latvia (336 mg per day). Lower levels of choline intake have been reported for pregnant women in Bangladesh (190 mg per day). There’s little evidence to indicate that choline intake changes across trimesters of pregnancy or when choline from supplements is included.[reference|url=https://pubmed.ncbi.nlm.nih.gov/34959942|title=Habitual Choline Intakes across the Childbearing Years: A Review.|published=2021 Dec 8|authors=Derbyshire E, Obeid R, Schön C|journal=Nutrients|] Choline intake during lactation has been less well characterized but has been reported to be in the range of 257 to 346 mg per day.
In summary, with little exception, few women of childbearing age or who are pregnant/lactating appear to consume enough choline despite its critical relevance for fetal growth and development.

Dietary choline is a precursor for the neurotransmitter acetylcholine (ACh), which is crucial for normal cognitive and motor function. Choline is irreversibly oxidized into <a href="/supplements/betaine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Betaine&lt;/h6&gt;&lt;p&gt;Betaine (trimethylglycine) is an active metabolite of choline in the body and a component of beetroot. It serves a vital role in methylation in the body alongside folate, and is an osmoregulator like creatine. Betaine is also a possible ergogenic aid.&lt;/p&gt;&lt;/div&gt;">betaine</a> in the liver and kidneys. Betaine is a methyl group donor that participates in the important process of remethylating homocysteine to methionine. Choline is also a precursor for the synthesis of <a href="/supplements/phosphatidylcholine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Phosphatidylcholine&lt;/h6&gt;&lt;p&gt;Phosphatidylcholine is a phospholipid with a choline attachment and is found in soy lecithin.&lt;/p&gt;&lt;/div&gt;">phosphatidylcholine</a>, the most abundant form of phospholipid in the body.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30332744|title=Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.|published=2018 Oct 16|authors=Wiedeman AM, Barr SI, Green TJ, Xu Z, Innis SM, Kitts DD|journal=Nutrients|]
Choline is important for neural tube closure, stem cell proliferation, and apoptosis (programmed cell death) in the fetal brain during early pregnancy. The choline metabolite phosphatidylcholine is also required for packaging and exporting very-low-density lipoproteins from the liver and the secretion of bile acid salts; the disruption of this process can contribute to the accumulation of triglycerides in the liver.[reference|url=https://pubmed.ncbi.nlm.nih.gov/4340541|title=Effects of choline-deficient diets on the rat hepatocyte. Electron microscopic observations.|published=1970 Dec|authors=Bruni C, Hegsted DM|journal=Am J Pathol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/5725875|title=Choline-deficiency fatty liver: impaired release of hepatic triglycerides.|published=1968 Jul|authors=Lombardi B, Pani P, Schlunk FF|journal=J Lipid Res|][reference|url=https://pubmed.ncbi.nlm.nih.gov/9498371|title=Hepatic and renal betaine-homocysteine methyltransferase activity in pigs as affected by dietary intakes of sulfur amino acids, choline, and betaine.|published=1998 Feb|authors=Emmert JL, Webel DM, Biehl RR, Griffiths MA, Garrow LS, Garrow TA, Baker DH|journal=J Anim Sci|][reference|url=https://pubmed.ncbi.nlm.nih.gov/3182819|title=Kinetic mechanism of phosphatidylethanolamine N-methyltransferase.|published=1988 Nov 15|authors=Ridgway ND, Vance DE|journal=J Biol Chem|][reference|url=https://pubmed.ncbi.nlm.nih.gov/10417327|title=Apolipoprotein B mRNA and lipoprotein secretion are increased in McArdle RH-7777 cells by expression of betaine-homocysteine S-methyltransferase.|published=1999 Aug 1|authors=Sowden MP, Collins HL, Smith HC, Garrow TA, Sparks JD, Sparks CE|journal=Biochem J|]

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