Choline

Choline is an essential nutrient that is naturally present in some foods and available as a dietary supplement. Choline is a source of methyl groups needed for many steps in metabolism. In addition, choline is needed to produce acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions.

Where to get it

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Active compounds & mechanisms

Key compounds:

The body needs choline to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital for cell membranes.

Research & evidence

Strong support Some support Weak or no supportColours show how well the sources back each point. The reason is next to each one.

NIH says choline deficiency can cause muscle damage, liver damage, and nonalcoholic fatty liver disease (NAFLD or hepatosteatosis).

Strong evidenceStrong support. Stated plainly by NIH or an FDA label

Study details

NIH ODS: "Choline deficiency can cause muscle damage, liver damage, and nonalcoholic fatty liver disease (NAFLD or hepatosteatosis)."

NIH says some researchers have suggested that choline might protect cardiovascular health by reducing blood pressure, altering lipid profiles, and reducing levels of plasma homocysteine. Other research suggests that higher dietary choline might increase cardiovascular disease risk. NIH says additional research is needed.

Mixed evidenceSome support. Results are mixed

Study details

NIH ODS: "Some researchers have suggested that choline might protect cardiovascular health by reducing blood pressure, altering lipid profiles, and reducing levels of plasma homocysteine." "Other research suggests that higher dietary choline might increase cardiovascular disease risk because some choline and other dietary ingredients, such as carnitine, are converted to trimethylamine (TMA) by intestinal bacteria." "Additional research is needed to determine the relationship between choline intakes and cardiovascular and peripheral artery disease as well as the potential risks and benefits of choline supplementation to reduce the risk of these diseases."

NIH says future studies are needed to clarify the relationship between choline intakes and cognitive function and determine whether choline supplements might benefit patients with Alzheimer's disease or other forms of dementia.

Limited evidenceSome support. Reviewers rated the certainty low

Study details

NIH ODS: "Future studies are needed to clarify the relationship between choline intakes and cognitive function and determine whether choline supplements might benefit patients with Alzheimer's disease or other forms of dementia."

NIH says only limited data are available on the use of choline to treat NAFLD.

Limited evidenceSome support. Reviewers rated the certainty low

Study details

NIH ODS: "Only limited data are available on the use of choline to treat NAFLD."

Dosage

FormAmount
Any formAdequate Intake (AI): 550 mg/day for adult men, 425 mg/day for adult women. CDP-choline (citicoline): 250–500 mg/day; Alpha-GPC: 300–600 mg/day; Choline bitartrate: 500–1,000 mg/day. Tolerable upper intake level: 3,500 mg/day.
Dosage varies by body weight, age, sex, existing health conditions, current medications, and pregnancy/breastfeeding status. The amounts above reflect commonly studied or commonly recommended amounts, not a personal prescription. Always consult a healthcare provider before starting a new supplement, especially if you are pregnant, breastfeeding, managing a chronic condition, or taking medication.

Side effects

Well documented Reported (case reports, anecdotal or one study) None reportedThe circle shows how well documented an effect is, not how serious it is. A rarely reported effect can still be serious, so always read ‘When to stop’.

EffectFrequencyWhen to stop
Fishy body odor, vomiting, excessive sweating and salivation (with high intakes)Well documentedListed plainly by NIH, MSK or LiverToxNot statedStop and talk to a doctor if you notice any unexpected or concerning symptoms.
Hypotension (low blood pressure) (with high intakes)Well documentedListed plainly by NIH, MSK or LiverToxNot statedStop and talk to a doctor if you notice any unexpected or concerning symptoms.
Liver toxicity (with high intakes)Well documentedListed plainly by NIH, MSK or LiverToxNot statedStop and talk to a doctor if you notice any unexpected or concerning symptoms.
Higher production of TMAO, a substance linked to a higher risk of cardiovascular diseaseWell documentedListed plainly by NIH, MSK or LiverToxDose-dependent, in adultsStop and talk to a doctor if you notice any unexpected or concerning symptoms.

Safety & interactions

Safety

High intakes of choline are associated with a fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity. Choline consumption has been shown to increase production of TMAO, a substance that has been linked to a higher risk of cardiovascular disease, in a dose-dependent manner in adults. Choline is not known to have any clinically relevant interactions with medications.

Contraindications

The FNB was unable to establish upper limits for infants due to the lack of data on adverse effects in this age group. The upper limits apply to healthy children and adults but not to those taking high doses of choline under medical supervision. See Safety.

Drug interactions

GeneralNone listed

NIH ODS choline fact sheet does not list drug interactions. However, choline may interact with drugs that affect acetylcholine neurotransmission — consult a healthcare provider if taking cholinergic or anticholinergic medications.

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