6 Choline Deficiency Symptoms

Choline is an important dietary supplement for pregnancy, but are you getting enough? Learn how to spot choline deficiency symptoms.

By OBGYN and fertility expert Dr. Kenosha Gleaton

Choline benefits include improved health, cognitive function, cardiovascular health, metabolism, reproductive health, mental health benefits, and more.^1,2,3 Some groups are at a higher risk of choline deficiency, which can lead to organ dysfunction in rare cases. Read on to find out more about how to prevent deficiency and support your health.²

What Is Choline?

Choline is a vital nutrient necessary for muscle, liver, and brain functions. It also plays an important role in lipid metabolism and cellular membranes. The Food and Nutrition Board of The National Academies of Medicine recognized choline as an essential nutrient in 1998. Choline is produced naturally by the body in small doses, but larger amounts must be consumed in the diet to prevent deficiency.⁴

Both animal and plant sources contain choline; however, animal source foods typically contain more choline per gram of product. Foods high in choline include beef, eggs, chicken, fish, pork, nuts, legumes, and cruciferous vegetables.⁵

Choline and Fertility

An animal study on female infertility and choline supplemented different groups with choline, Omega 3, and choline + Omega 3.⁶ They found that the percentage of antral follicles in the choline + Omega 3 group were higher compared to the control group. To better understand this finding of choline's influence on ovarian function in vivo, scientists analyzed the expression of various genes and ultimately determined insights into the mechanisms behind choline’s positive effect on ovarian development phenotype.

A different study on genotyping found that deletion of a choline related enzyme in males led to diminished sperm motility, abnormal sperm morphology, and diminished function.⁶ These findings suggest that choline may be extremely effective for supporting ovarian function, sperm health, and overall reproductive health.

Choline has also been one of the best natural remedies for anxiety during pregnancy. In addition to choline, many other supplements have been linked to improvements in sperm parameters. Looking for a high-quality, antioxidant-rich multivitamin formulated for male fertility? Consider our prenatal supplement for men.

Choline and Pregnancy

Choline is one of many vitamins and minerals necessary for a healthy pregnancy and has even been called the “brain-building” nutrient by the American Academy of Pediatrics.⁴ Prenatal processes involving membrane biosynthesis, tissue expansion, brain development, and gene expression require ample choline levels in the maternal diet.⁵ Studies have shown that supplementing the diet with choline improves pregnancy outcomes and reduces the risk of negative outcomes such as neural tube defects and preeclampsia.^4,7

What Causes Choline Deficiency?

Some groups are at a higher risk of choline deficiency. These groups include:

• Pregnant women: Around 90% of pregnant women do not consume the recommended amount of choline per day (450 mg)
• People with certain genetic alterations: Anyone with variations in the DNA sequences responsible for choline, folate, and methionine metabolism are more likely to have inadequate choline levels.
• Patients receiving parenteral nutrition (liquid nutrients): Currently, choline is not added to parenteral solutions for infants or adults. If you or a loved one are receiving most or all of your nutrition through parenteral solutions, you may want to talk to your doctor about choline supplementation.

Research also shows that men and postmenopausal women are more likely than premenopausal women to develop signs of organ dysfunction due to dietary choline deficiency.

Low Choline Symptoms

It’s important for overall health and especially for those pregnant or breastfeeding that adequate choline levels are reached through diet or supplementation. If choline levels are too low, serious symptoms and effects of deficiency may arise, including liver and muscle disorders or dysfunction, lymphocyte disorders, and dysfunction of the kidney, pancreas, brain, and nervous system.

Before you get too worried, note that it’s very difficult to reach a choline level low enough for deficiency. Talk to your doctor about potential signs and symptoms of low choline you should be looking out for. A great way to avoid nutrient deficiency is by taking a daily vitamin, such as the Prenatal Daily Packets!

Ways to Treat Low Choline

• Diet and choline rich foods: Following the federal government’s 2020-2025 Dietary Guidelines for Americans will include a substantial amount of choline-rich foods and help you maintain a balanced diet. If you’re looking for foods packed with higher levels of choline, try adding in fish, beef, poultry, eggs, some beans and nuts, as well as many vegetables, fruits, whole grains, and dairy products.
• Supplements: Choline is also available in dietary supplements by itself, or in combination with B-complex vitamins and multivitamins. There are various forms of choline in supplements including choline bitartrate, phosphatidylcholine, and lecithin. So far, there are no studies indicating if one form is more effective or beneficial than the others.

Choline Upper Limits

It’s important to note that there are upper limits for most vitamins and minerals that you should research before adding any supplements to your diet. According to the NIH, the upper limits for choline are:

• Birth to 12 months: no dosage established
• 1-8 years: 1,000 mg
• 9-13 years: 2,000 mg
• 14-18 years (includes pregnant and lactating females): 3,000mg
• 19+ years (includes pregnant and lactating females): 3,500mg

Choline Toxicity

If choline levels surpass tolerable upper intake recommendations, choline toxicity may occur. Extremely high intake of choline is associated with a fishy body odor, excessive sweating and salivation, vomiting, hypotension, and liver toxicity. High choline consumption has also been linked to the production of TMAO, a substance linked to a higher risk of cardiovascular disease.

Key Takeaways

• Choline is an essential nutrient that can benefit your memory, heart, and many other organ functions.
• Choline is found in some dietary sources such as meat, eggs, and dairy, as well as some fruits and vegetables.
• Choline has positive effects on reproductive health by increasing ovarian function and is vital for sperm health.
• Improved pregnancy outcomes are also associated with choline supplementation.
• While hard to reach, dangerously low choline levels may result in organ dysfunction and other disorders.

For more information on nutrition, fertility, and more, visit the Natalist homepage.

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, youth, and mentoring. She is a Scrubs Camp instructor, a program to increase student entry in healthcare, and serves as a Compassion International adoptive parent. She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women.

Sources:

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2. Millard HR, Musani SK, Dibaba DT, et al. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study. European Journal of Nutrition. 2016;57(1):51-60. doi:https://doi.org/10.1007/s00394-016-1296-8
3. Elsawy G, Abdelrahman O, Hamza A. Effect of Choline Supplementation on Rapid Weight Loss and Biochemical Variables Among Female Taekwondo and Judo Athletes. Journal of Human Kinetics. 2014;40(1):77-82. doi:https://doi.org/10.2478/hukin-2014-0009
4. Sanders LM, Zeisel SH. Choline. Nutrition Today. 2007;42(4):181-186. doi:https://doi.org/10.1097/01.nt.0000286155.55343.fa
5. Korsmo HW, Jiang X, Caudill MA. Choline: Exploring the Growing Science on Its Benefits for Moms and Babies. Nutrients. 2019;11(8):1823. doi:https://doi.org/10.3390/nu11081823
6. Zhan X, Fletcher L, Dingle S, et al. Choline supplementation influences ovarian follicular development. Frontiers in Bioscience-Landmark. 2021;26(12):1525-1536. doi:https://doi.org/10.52586/5046
7. Liberto R. Preeclampsia: Causes, symptoms, and treatments. Medical News Today. Published December 22, 2017. https://www.medicalnewstoday.com/articles/252025.php
8. Office of Dietary Supplements - Choline. ods.od.nih.gov. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/#p
9. Fischer LM, da Costa KA, Kwock L, Galanko J, Zeisel SH. Dietary choline requirements of women: effects of estrogen and genetic variation. The American Journal of Clinical Nutrition. 2010;92(5):1113-1119. doi:https://doi.org/10.3945/ajcn.2010.30064
10. Dietary Guidelines for Americans. Home | Dietary Guidelines for Americans. Dietaryguidelines.gov. Published 2020. https://www.dietaryguidelines.gov/