Choline: Critical for Mental and Physical Health

7 min read

Struggling with brain fog? Trouble focusing? Feeling stressed and overwhelmed?

These common complaints are often attributed to burnout, aging, or just the pressures of modern life. But what if there's a missing piece of the puzzle? What if a simple nutritional deficiency could be contributing to these frustrating symptoms?

Today, we're diving deep into the world of choline—an essential nutrient that a staggering 90% of people are deficient in, yet it remains surprisingly overlooked. Choline is absolutely vital for brain function, liver health, metabolism, and long-term well-being. Because it's not routinely tested in standard blood panels, most people are completely unaware they're running on empty.

This isn't just a "nice-to-have" nutrient. Your body cannot function without it. When choline levels drop, the repercussions are felt throughout your entire system—from the microscopic level of your cells to the intricate workings of your nervous system, impacting how you think, feel, and function every single day.

This blog is a bit longer than usual, but I promise the information is life-changing. We'll break down choline's crucial roles into five key areas, and at the end, I’ll provide practical steps on how to assess your levels and optimize your intake.

What is Choline? Why Does It Matter?

Choline is a foundational building block for your cells, your brain, and your body's detoxification processes. It's involved in a wide range of critical functions, including:

Brain function & memory: Choline is a precursor to acetylcholine, a neurotransmitter essential for learning, memory, and cognitive function.
Cell membrane integrity: Choline is a key component of phosphatidylcholine (PC), a crucial phospholipid that makes up the structure of all cell membranes.
Liver function & fat metabolism: Choline plays a vital role in liver function, including fat transport and metabolism, preventing fatty liver disease.
Gut health & inflammation control: Choline is essential for maintaining the integrity of the gut lining and regulating inflammation.
Methylation & DNA expression: Choline is involved in methylation processes, which are crucial for DNA repair, gene expression, and overall cellular health.

Before we go further, there is one extremely important concept: you can't simply "eat healthy" and assume you're getting enough choline. The primary dietary sources are egg yolks, beef liver, and beef and cod—foods that many people avoid or don't consume frequently enough. While we can make choline if we’re not getting enough from the diet, not everyone can. I will talk about this further in the video as this makes many people more. susceptible to deficiency.

Let's delve deeper into why choline is so crucial at the cellular level, starting with one of its most important forms: phosphatidylcholine.

1. Phosphatidylcholine (PC): The Foundation of Your Cells

Phosphatidylcholine (PC) is a phospholipid—a specialized fat—that forms the very fabric of your cell membranes. Every single cell in your body depends on this structure to function correctly.

Imagine your cell membranes as the protective walls surrounding each cell. Without PC, these walls become weak and vulnerable, leaving your cells susceptible to damage. PC also acts as a gatekeeper, ensuring cells receive the nutrients they need while keeping out harmful substances like toxins. It's essential for cell membrane fluidity; without it, membranes become stiff and dysfunctional, increasing the risk of chronic diseases.

Your mitochondria, the powerhouses of your cells responsible for energy production, have cell membranes made of PC. A healthy mitochondrial membrane is crucial for ATP energy production; without it, you'll experience fatigue, brain fog, and metabolic decline.

Cellular membranes also facilitate communication between cells. Cell receptors embedded in these membranes rely on PC to properly send and receive signals, impacting everything from hormone signaling to immune responses.

Protects & stabilizes your cells: Without PC, cell membranes become rigid and dysfunctional, contributing to chronic inflammation and disease.
Supports mitochondria & energy production: PC protects your mitochondria, preventing fatigue and metabolic issues.
Facilitates cell communication: PC is essential for cell signaling, affecting hormone balance and immune function.

When PC levels are low, cells become fragile and inefficient, paving the way for neurodegeneration, immune dysfunction, and metabolic disorders.

2. PC is also key for Liver Health: Preventing Fatty Liver & Detox Overload

Your liver is your body's primary detoxification center, responsible for clearing toxins, metabolizing medications, and regulating fat storage.

When PC levels are low, your liver struggles to transport fat effectively, leading to non-alcoholic fatty liver disease (NAFLD). This increasingly common condition, affecting roughly 25% of the population, is a major driver of inflammation, insulin resistance, and can progress to liver failure. Projections estimate a further 63% increase in NAFLD by 2030.

Low PC also impairs your liver's ability to:

Process hormones: Affecting the balance of estrogen, testosterone, and cortisol.
Clear out toxins: Leading to sluggish detoxification and increased oxidative stress.
Regulate cholesterol levels: Increasing the risk of cardiovascular disease.

While limiting sugar and alcohol is important for liver health, adequate PC is essential for optimal liver function.

3. PC & Gut Health: The Barrier Between You & Chronic Inflammation

The gut lining is protected by a mucus layer, 90% of which is made up of PC. This layer acts as a crucial barrier against damage.

Low PC levels can contribute to ulcerative colitis, a condition affecting millions. More commonly, it contributes to leaky gut, where a compromised intestinal barrier allows toxins, bacteria, and undigested food particles to pass through, triggering widespread inflammation.

Low PC can also lead to bloating, food sensitivities, autoimmunity, and can hinder fat digestion, potentially causing gallbladder issues and nutrient malabsorption.

While probiotics are beneficial for gut health, PC is essential for maintaining the gut's protective barrier and supporting the growth of beneficial gut bacteria.

4. PC & Methylation: The Key to Longevity & DNA Repair.

Methylation is one of the most important biochemical processes in your body. I’m giving you a very abbreviated version here. Many of you may have heard of methylation as it relates to the MTHFR genetic variation that affects around 45% of the population. But most of the literature focuses on the need for B12 and folate. These are extremely important but choline is also essential and the missing piece of the puzzle.

Explaining methylation is a long video itself but in brief, methylation is a critical component that happens in every cell of your body. It is at the heart of your biochemistry, health and longevity.

Methylation is important for:

DNA expression & repair (crucial for preventing cancer & aging)
Detoxification (removing heavy metals, chemicals, and waste)
Neurotransmitter production (affecting mood, memory, and focus)

Choline deficiency hinders efficient methylation. Low methylation is associated with increased risk of inflammation, dementia, and chronic disease.

5. Choline & Brain Health: The Power of Acetylcholine and Sphingomyelin

Choline is essential for the production of sphingomyelin, a key component of cell membranes, particularly the myelin sheath surrounding neurons. This myelin sheath, rich in choline, significantly impacts nerve signal transmission speed. A healthy myelin sheath ensures rapid communication between nerve cells, crucial for cognitive function and reflexes. Damage to myelin, as seen in multiple sclerosis, leads to decreased processing speed, muscle weakness, and fatigue

Choline is also a precursor to acetylcholine, a neurotransmitter vital for:

Memory & cognitive speed
Focus & mental clarity
Muscle coordination & reflexes
Parasympathetic nervous system function (rest & digest)

Low acetylcholine levels are linked to Alzheimer's disease, dementia, brain fog, and slow reaction times.

Women are at greater risk of choline deficiency due to estrogen's role in choline production. Estrogen is the driver to signal the enzyme PEMT to tell the liver to make Choline. With lower estrogen levels, you have less ability to make choline.
Vegans and vegetarians may be at risk due to the primary sources of choline being animal products.
Individuals with genetic variations in the PEMT enzyme may have difficulty producing choline. This is true for both men and women.

But Women are disproportionately affected by Alzheimer's disease, with two out of three patients being women. Research suggests that declining estrogen levels play a significant role, impacting both brain health and choline production.

How to Know If You’re Deficient

While standard blood tests can test for choline levels, their accuracy is variable. I typically measure choline levels using a specialized test called the ProdromeScan. This blood test can accurately assess phosphatidylcholine levels.

However, if you're not regularly consuming choline-rich foods like beef liver and egg yolks, you're likely not getting enough.

Common symptoms of choline deficiency include:

Brain fog, poor memory, slow thinking
Difficulty relaxing, feeling stressed
Fatty liver, high cholesterol
Digestive issues, leaky gut
Muscle weakness, slow recovery
Mood instability, anxiety, poor focus

Given that an estimated 90% of people are deficient, it's safe to assume most of us could benefit from increasing our choline intake.

How to Get Enough Choline

Dietary sources of choline include:

Egg yolks (a rich source). 147mg or 27% of DV
Beef liver (the most concentrated source). 356mg per serving which is 65% of DV (Daily Value)
Beef, Fish & chicken. 3oz = 72mg or 13% of DV

If you don't consume these foods regularly, supplementation is a good option.

Many studies have evaluated the benefits of choline supplementation and it may be arguably the most practical and well controlled method of increasing choline status

How much choline you need depends on if you are pregnant, postmenopausal, have a genetic variation in the PEMT enzyme, even exercising at a high intensity. This is why personalized medicine is so important. Not everyone needs the same amount. But, please refer to your physician before taking a supplement as you can get too much choline.

Best Choline Supplements

Phosphatidylcholine (PC): The foundational form for cell membranes and liver health.
CDP-Choline (Citicoline) & Alpha-GPC: These forms cross the blood-brain barrier to support cognition and neurotransmitter function.

Personally, I take both phosphatidylcholine and CDP-Choline. This is because I’m postmenopausal, have several variations for the PEMT gene, I don’t eat beef liver and not enough animal protein and as a practicing physician and Medical Director I need my brain to always be sharp, focused and processing information quickly.

If this sounds like you, you and you would like more information about testing your choline levels please let us know.

Click HERE for a pdf version if choline foods

Click HERE for a downloadable version of How To Supplement