Melis Campbell
Choline is a component of the better-known lecithin and is particularly important for the brain and nervous system, but also for the liver. You can also meet your choline needs with a plant-based diet. We present the tasks and effects of choline, and risk factors for a choline deficiency, and have also compiled a table with foods containing choline.
Choline in the vegan diet
If you change your diet to a vegan diet, sooner or later you could suffer from a choline deficiency, as has been repeatedly warned of late.
Although choline can also be produced by the body itself in the liver, it says there, the amount of choline produced by this self-synthesis is not sufficient, so choline also has to be consumed with food. And since choline is particularly found in animal products – in meat, fish, and eggs – there could be bottlenecks in a vegan diet.
However, a choline deficiency is anything but desirable, since it results in e.g. could the development of fatty liver and an increased risk of dementia. In children, a choline deficiency can lead to developmental disorders.
Since in Germany alone 30 percent of all adults have fatty liver and even a third of overweight children, while only 1.13 percent of the German population eats vegan, a vegan diet clearly cannot be the main cause of fatty liver.
In the following, we will check whether you actually automatically suffer from a choline deficiency on a vegan diet and how you can get enough choline on a vegan diet.
Choline: Building material for lecithin
Chemically, choline is a monohydric alcohol. It is a semi-essential vital substance, i.e. a substance that can be partly produced by the body itself, but which must also be ingested with food – according to the current state of knowledge.
The name choline comes from the Greek word for bile (cholí), as choline was first discovered in pig bile in the 19th century.
In the body, choline is found in particular as a component of the so-called phospholipids. The best-known phospholipid is lecithin (also called phosphatidylcholine). However, lecithin does not only consist of choline, but also of fatty acids, glycerin, and phosphoric acid.
The roles of choline in the body
If you look at the tasks that choline performs in the body, it quickly becomes clear that the substance is actually enormously important:
Choline is needed to make phosphatidylcholine (lecithin), the main phospholipid needed to build cell membranes.
Choline is a component of VLDL (Very Low-Density Lipoproteins). VLDL, in turn, is a transporter protein with the task of transporting fat and cholesterol from the liver to those parts of the body where the two substances are also needed. Without choline, VLDL cannot be produced and the fat accumulates in the liver. A fatty liver develops.
Choline is also required for the production of acetylcholine. This in turn is the most important neurotransmitter in the human organism. It is responsible for the transmission of excitation from nerve fibers to muscle fibers, making it possible for e.g. B. to raise our arm or leg if we want it that way. However, acetylcholine is also responsible for communication between nerve cells in the brain. It also controls functions that take place without our influence, such as breathing or the heartbeat. In Alzheimer’s, the brain suffers from a lack of acetylcholine, which cannot be attributed to a lack of choline, but to the fact that those nerve cells that produce acetylcholine die, and at the same time some enzymes (cholinesterase) that break down acetylcholine are overactive.
Choline is a so-called methyl donor, just like betaine, vitamin B12, folate (natural folic acid), and S-adenosylmethionine (SAMe). They all keep homocysteine levels low. Homocysteine is produced when proteins are metabolized. It is toxic above a certain level, has an inflammatory effect, and can damage blood vessels if not broken down in time, which could contribute to arteriosclerosis. Choline is involved in this breakdown.
Choline also plays an important role in many metabolic reactions, in the regulation of gene expression (which genes are now active and which are not), and in early brain development in the embryo.
The symptoms of a choline deficiency
The possible symptoms of a corresponding deficiency then arise from the tasks and functions of choline listed above. A choline deficiency can lead to muscle damage, liver damage, and what is known as non-alcoholic fatty liver disease (NAFLD, also known as hepatic steatosis). However, this must be a pronounced deficiency, which in general cannot be caused even with a vegan diet.
Therefore, the consequential damage of a choline deficiency is only known from animal studies or from studies when people are deliberately and experimentally put on a choline-free diet. In the case of the latter, it was also shown that after three weeks on a choline-free diet, the choline levels in the plasma fell by an average of 30 percent and the first signs of impaired liver function with the onset of fatty liver appeared.
Further consequences of a choline deficiency are said to be neurological disorders (including neural tube defects = malformations such as spina bifida (Spandau in)) and impaired cognitive functions in children if the mother consumes too little choline during pregnancy.
Choline can be partially produced by the body itself
In the year 2000, it was not yet certain whether choline is an essential nutrient or whether the body could not even produce enough choline itself if it was well supplied with the appropriate building blocks. Because it was assumed that self-synthesis can take place better the body is supplied with methionine (an amino acid), folate, and vitamins B6 and B12.
However, studies from the 1990s already showed that patients on choline-free parenteral nutrition developed symptoms of a choline deficiency, namely fatty liver and liver damage, despite a good supply of methionine and folate, which regressed again when the patients were given choline.
In another study, healthy men were given a choline-free diet but sufficient folate and vitamin B12. Here, too, the plasma choline level fell and liver damage developed (which could be seen from the liver values since the alanine aminotransferase ALAT increased).
Despite supplementation with betaine, methionine, folate, and vitamin B12, the liver damage caused by choline deficiency could not be prevented, which suggests that the body’s own synthesis is generally not sufficient with a choline-free diet.
However, a choline-free diet is not natural either, since so many foods – both animal and plant-based – contain choline, studies with choline-free diets do not provide results that can be extrapolated to realistic situations.
The daily requirement of choline
According to official recommendations (from 1998), you should consume the following amounts of choline daily:
- Babies up to 6 months 125 mg
- Babies 7-12 months 150 mg
- Children 1-3 years 200 mg
- Children 4-8 years 250 mg
- Children 9-13 years 375 mg
- Teenagers 14-18 years Females 400 mg, males 550 mg
- Adults 19 years and older women 425 mg, men 550 mg
- Pregnant women 450 mg
- Breastfeeding 550 mg
Choline requirements vary from person to person
However, a study published in May 2007 in the Journal of Clinical Nutrition shows how much the choline requirement differs from person to person.
Participants in this study were 57 adults (26 men, 16 premenopausal women, and 15 postmenopausal women). They were fed a diet providing 550 mg of choline per day for 10 days. They then received a diet containing less than 50 mg of choline (with or without a folic acid supplement (400 µg)) for 42 days.
Folic acid because it had been assumed on the basis of previous study results that a good supply of folic acid (by taking a folic acid supplement) could prevent the choline level from falling even with a low choline supply (100 to 300 mg).
Over the course of the low-choline phase, 77 percent of men and 80 percent of women (who were postmenopausal) but only 44 percent of women of childbearing age developed fatty liver and/or muscle damage—regardless of folic acid intake. Estrogens appear to decrease choline requirements or increase self-synthesis, which is why pre-menopausal women do not seem to need as much choline as post-menopausal.
Even with only a small choline content of 50 mg in the diet, many participants did not develop any deficiency symptoms. It was also interesting that 6 participants developed fatty liver before the choline-poor phase so not even 550 mg of choline can protect against fatty liver, or in other words: Choline deficiency is not the only factor that can contribute to fatty liver.
Despite the changes in the liver and muscles and the corresponding blood values, the participants felt well throughout the study. So they didn’t feel any symptoms of the disease – a sign of how subtle the development of fatty liver is, no matter what the reason.
If the measured values in the course of the low-choline phase indicated functional disorders of the organs caused by a choline deficiency, then the respective participants could enter the so-called filling phase. This meant they received slowly escalating doses of choline, which in practice looked like this:
In the first step, they received almost 140 mg of choline per day (with or without folic acid) for 10 days. If the readings showed that the choline deficiency could not be corrected, then as a second step they were given a diet that provided 275 mg of choline (again with or without folic acid) for 10 days. If there was no improvement here either, the participants received 412.5 mg choline per day in a further 10-day window. This dose of choline did not help either, so the daily dose was increased to 550 mg.
Here it was shown that in the case of men, regeneration occurred in just as many participants with less than 300 mg choline per day as with 550 mg choline. After menopause, there were at least half as many women who got along with less than 300 mg. The other half required 400 to 550 mg of choline.
Most premenopausal women did not develop a deficiency even with 50 mg of choline.
Can a vegetarian diet protect against fatty liver?
A vegetarian diet can by no means protect against fatty liver, according to a study from 2015, which showed rather the opposite. The vegetarian group examined in it even had a fatty liver slightly more frequently than the meat-eating control group also examined.
However, a closer look reveals that the vegetarian group consisted of Buddhist monks who, while not eating meat, fish, or seafood, did eat eggs, fat milk, yogurt, cheese, bread, biscuits, and cakes. Their diet even contains almost 70 percent carbohydrates, which obviously does not necessarily consist of fruit or potatoes, but largely consists of pastries and cakes. Also, exercise is not so popular among modern Korean monks, instead, obesity is widespread.
From the study mentioned, the conclusion can be drawn that a meatless but otherwise unhealthy diet made up of fatty dairy products and pastries containing fat and sugar in combination with a lack of exercise promotes the development of fatty liver a little more than the usual diet containing meat.
But what about the vegan diet? Can this protect against fatty liver? Or are vegans even more likely to develop fatty liver because they don’t eat the choline frontrunners (meat, eggs, seafood, and dairy products)?
Can a vegan diet protect against fatty liver?
A study published in the Journal of Nutrition in December 2014, using data from more than 37,000 women and men, found that a good choline intake (around 400 mg) can reduce the risk of fatty liver in women. That sounds good at first. However, if you look at the specific figures, the influence of choline seems to be greatly overestimated.
Also, the reduced risk only applies to women of normal weight. Obese women cannot reduce their risk of fatty liver with the help of a good choline supply. The negative (i.e. fatty liver-promoting) influence of being overweight predominates here.
For men, the numbers are even more interesting. Because there were fewer fatty liver cases (582) in those men who also consumed the least choline (205 mg per day). The group of men who consumed the most choline (435 mg per day) also had the most cases of fatty liver, namely 626.
In 2018, 2,127 non-vegetarians and 1,273 vegetarians were shown to have a lower risk of fatty liver disease. If a fatty liver does occur, it occurs with fewer fibrotic changes in the liver than in non-vegetarians. Replacing a serving of soy with a serving of meat or fish increases the risk of fatty liver by 12 percent, the study found, and replacing a serving of whole grains with a serving of refined flour also increases the risk of fatty liver by up to 12 percent.
A year later, data from more than 18,000 participants revealed that those who ate a healthy, plant-based diet had a 21 percent lower risk of the fatty liver than those who ate a plant-based but unhealthy diet (white flour, sugar, etc.). , baked goods, soft drinks, etc.).
A good choline supply alone, which would be secured with animal protein sources, can therefore by no means protect against fatty liver. On the contrary: a plant-based diet – although it provides less choline – seems to offer better protection against fatty liver.
Choline and dementia
If choline – as mentioned at the beginning – is such an important substance for the brain and thus for cognitive functions, a low choline supply should automatically lead to a higher risk of dementia. Does this mean that vegan people are more likely to suffer from dementia? Or can choline protect against dementia?
A 2003 review by The Cochrane Collaboration examined the effect of lecithin supplementation on cognitive function. The conclusion was:
Based on the studies published to date, there is no evidence that lecithin could be useful in the therapy of dementia patients. Only in one study did lecithin have a significant effect on people with memory problems, but these results need to be replicated before a definitive conclusion can be made.
Recent studies show only minor preventive effects on cognitive functions – and then only if you combine the intake of choline with omega-3 fatty acids and other vital substances. If dementia is already present, a choline-rich diet can obviously not do much.
No increased risk of dementia with a vegan diet
Whether a vegan diet promotes dementia or can protect against it depends heavily on the type of vegan diet. Studies show both. An increased risk of dementia may be present with the vegan diet, not because of a possible choline deficiency, but rather if B12 is not considered and if omega-3 fatty acids are forgotten.
A 2002 French study found that the more fish they ate (at least once a week), the less likely it was that elderly people would develop dementia. However, the fish eaters also had a higher level of education, which may also reduce the risk of dementia. (The more educated people are, the healthier they generally live).
If it was actually the fish, one assumes that it is the omega-3 fatty acids in particular that have an anti-inflammatory effect in the brain and contribute to the regeneration of nerve cells.
Therefore, if vegans take care of B12 and omega-3 fatty acids, then there should not be an increased risk here, especially since all other criteria of a healthy plant-based diet tend to protect against dementia: lots of fruit and vegetables, little sugar, lots of fiber, healthy fats, etc.
An older study even showed that vegetarians may have a lower risk of dementia than meat eaters.
Ultimately, when it comes to Alzheimer’s risk, it probably depends less on whether someone is consistently vegan or whether they eat a piece of meat from time to time, but more on the overall package. It is important to practice a healthy diet overall, pay attention to a good supply of antioxidants to ensure exercise, and avoid vital substance deficiencies.
Good betaine supply can protect against choline deficiency
Betaine is not an essential vital substance because the human body can produce the substance from choline if the diet does not provide enough betaine. This aspect could explain why vegan people can get by with little choline or simply have a lower choline requirement than normal people.
Because vegan people generally eat a lot of vegetables and salads, as well as grain products, potatoes, sweet potatoes, and beetroot. All of these foods are excellent sources of betaine, while animal products are low in betaine. In vegans, the choline requirement is reduced because no choline is required for the formation of betaine since enough betaine is consumed with food. On the other hand, if you eat a few vegetables etc., you need more choline so that not only the choline but also the betaine requirement can be covered.
Studies in which the treatment of fatty liver with betaine was successful also show how similar betaine and choline are. So maybe it’s not choline that helps with fatty liver, but betaine, which the body makes from choline.
Betaine helps the liver process fats. Betaine has also been shown to protect the liver against substances that are toxic to the liver, such as alcohol (Vos et al, 2009).
How the mango might increase choline levels
In Brazilian folk medicine, the mango is considered a remedy for dementia. Brazilian researchers examined how the mango could give the brain a boost. They found that the fruit and its bioactive plant substances not only have an antioxidant effect – which alone protects the brain – but also inhibit cholinesterase.
Cholinesterase is an enzyme that breaks down the messenger acetylcholine. The enzyme is overactive in dementia, so this factor also contributes to acetylcholine deficiency. Some anti-Alzheimer’s drugs, therefore, aim to inhibit cholinesterase, which of course they do to a greater extent than mango.
Nevertheless, this indicator shows that there are many aspects of nutrition that affect health and in particular the choline balance.
Conclusion: This is how much choline you should be consuming
The conclusion in terms of choline supply in the diet – not only vegan – is as follows:
- Choline requirements vary from person to person. However, 50 mg of choline per day is not enough for many people.
- Pregnant women should take care to consume 450 mg of choline per day, as it – like folic acid – is said to protect the child from neural tube defects because it is involved in the development of the child’s nervous system.
- Because there is reason to believe that large amounts of choline can contribute to heart disease and other chronic diseases, choline should not be consumed in excess, i.e. no more than officially recommended. Yes, some experts say it’s better to level off your choline intake at 300 mg daily, except for women who are trying to conceive or are already pregnant.
- With a varied vegan diet, you usually automatically provide yourself with sufficient individual amounts of choline – not least because the plant-based diet is rich in betaine, which in turn reduces the choline requirement.
- Anyone who is already taking a vitamin B complex (e.g. also to supply them with vitamin B12) can choose a preparation that also contains choline (but not too much, but e.g. 150 to 200 mg choline per daily dose ( as in the products recommended below.) Conventional choline supplements often provide up to 400 mg of choline, which may be too much since diet also provides choline.
- If you suffer from liver dysfunction or fatty liver, you can try a dietary supplement containing choline – in consultation with your doctor, of course.
- Anyone who finds out with the help of the food table above that they are consuming too little choline is most likely also consuming too little of other nutrients and vital substances and should take appropriate food supplements – possibly after a comprehensive vital substance check with the doctor or naturopath.
