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Choline Supplementation

Before starting any supplement regimen, please consult with your healthcare provider. The information provided in this handout is for educational purposes only and is not intended as a substitute for professional medical advice.

Also always be aware that not all supplements are created equal—choosing products from reputable companies that perform third-party testing is essential for ensuring quality and efficacy. For medicinal-grade products, I personally rely on Fullscript and will provide a link below.

Important Information to Know About Choline

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Choline is a vital nutrient that plays an important role in keeping many of your body’s organs, including your brain, healthy.

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How Choline Works
When you consume choline, your body converts it into phosphatidylcholine. This substance is a major building block for your brain and the membranes of all your cells. Having enough phosphatidylcholine is essential for proper brain and nerve function. Studies suggest that phosphatidylcholine can protect brain cells from the harmful effects of amyloid ß, a protein linked to cell damage and death. Low levels of phosphatidylcholine are often seen in people with cognitive decline, while higher dietary choline has been linked to better visual memory, verbal memory, immediate recall, and delayed recall.

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Why You Need Choline
Not getting enough choline in your diet can lead to problems in various organs, including the liver. For instance, a choline-deficient diet may increase the risk of developing conditions like non-alcoholic fatty liver disease. This risk is particularly higher for men and postmenopausal women because the body’s ability to produce choline is highly regulated by estrogen.

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For pregnant and breastfeeding women, choline is especially important. It supports the proper development of the fetal brain, including critical structures like the neural tube and the hippocampus, which is central to memory.

How Your Body Makes Phosphatidylcholine

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How Your Body Makes Choline

Your body can make phosphatidylcholine through two main pathways:

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1. The PEMT pathway converts phosphatidylethanolamine (PE) into phosphatidylcholine. This process is influenced by estrogen, which is why premenopausal women are generally less at risk for choline deficiency.

 

Also many people have genetic variations with the PEMT gene and thus have difficulty making choline.

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2. The CDP-choline (CDP-C) pathway uses the choline you eat to produce phosphatidylcholine. If the PEMT pathway isn’t producing enough, increasing dietary choline can help boost phosphatidylcholine production through this second route.

Choline Pathway.png

Almost 50% of the population have a genetic variation in the PEMT enzyme and have difficulty making choline. And as a population less than 90% of us are getting enough from our diet.

Choline Supplementation

There are several types of choline supplements available. Depending on the health benefit that is needed one or more of the different types of choline may be necessary. Listed below are three of the different types of choline supplementation.

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Please Note: Supplementation should always be recommended by your physician or health care provider as determining the right dose and type of supplement is individualized based on your health and laboratory results. 

CDP-Choline

Mechanism & Benefits:

CDP‑Choline, or citicoline, is a compound that supplies both choline and cytidine. The cytidine is important also as it crosses both the gut and blood-brain barriers and has many beneficial components. Choline component supports acetylcholine synthesis, whereas the cytidine (converted into uridine) aids in the synthesis and repair of membrane phospholipids. There are excellent outcome studies for citicoline with regards to post-stroke recovery, nerve regeneration and even strabismus.

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This dual action makes CDP‑Choline particularly attractive for conditions such as cognitive decline, stroke recovery, and neurodegenerative diseases. Its support of phospholipid synthesis indirectly benefits mitochondrial function and, by extension, cellular energy metabolism.

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Clinical Insights:

  • Brain Health: Robust evidence supports its role in improving cognitive functions in individuals with vascular cognitive impairment and Alzheimer’s disease.

  • Neuroprotection: Its ability to support membrane repair may protect neurons and enhance recovery post-ischemic injury.

  • Cardiovascular & Mitochondrial Health: By aiding in the maintenance of cell membranes, CDP‑Choline may support both cardiovascular function and mitochondrial integrity.

  • Longevity: While not directly studied for longevity, improved cognitive and cellular health are key components of healthy aging.

 

Dosing

  • Typical adult dose: 250-500mg 2 times per day depending on genomics and what is being treated.

  • The European Union sets the targeted supplementation dose as 250mg BID, expanding to 1g for post-stroke.

  • If cognitive issues, post stroke, nerve or traumatic brain injuries, higher doses up to 1100-2200mg may be beneficial.

Alpha-GPC

Mechanism & Benefits:

Alpha‑GPC is prized for its high bioavailability and its ability to rapidly elevate brain choline levels. Once in the brain, the choline is used to synthesize acetylcholine, a neurotransmitter crucial for memory, learning, and attention. Research has shown that Alpha‑GPC can enhance cognitive performance in older adults and may benefit stroke patients by aiding recovery. Its brain support and ability to fuel the acetylcholine in your brain cells should boost cognition in all age and gender groups. This why alpha-GPC is widely used as a nootropic (Cognitive Enhancement)

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In the context of athletic performance, some evidence suggests that Alpha‑GPC may help improve power output and neuromuscular function. Alpha-GPC has also been found to increase growth hormone.​

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Clinical Insights:

  • Brain Health & Cognitive Function: Studies have demonstrated improvements in attention and memory.

  • Athletic Performance: Some protocols in sports science have used doses up to 1,200 mg/day to support physical performance.

  • Longevity & Mitochondrial Health: While direct studies on longevity are limited, maintaining robust neurotransmission and cell membrane health can contribute to overall cellular vitality.

 

Dosing

  • Typical adult dose: 400mg a day.

  • For Alzheimer’s disease, stroke and dementia: 1200mg a day

  • For increased athletic performance: 200-300mg/day​​

Phosphatidylcholine

Mechanism & Benefits:

Phosphatidylcholine is a primary component of all cell membranes, playing a critical role in membrane fluidity and structure. It acts as a reservoir for choline and is essential for liver and cardiovascular health, and a critical component of cellular membranes throughout the body including those in the brain and mitochondria.

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Dietary phosphatidylcholine supports the structural integrity of cells, including those in the liver, and is critical in preventing the accumulation of fat in hepatic tissues. Although its conversion to free choline is less efficient compared to Alpha‑GPC or CDP‑Choline, its role in overall cellular and membrane health is undeniable.

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Clinical Insights:​

  • Liver Health: Choline deficiency is strongly associated with non-alcoholic fatty liver disease (NAFLD). Supplementation with phosphatidylcholine has been studied as a therapeutic option for restoring normal liver function.

  • Cardiovascular Health: By ensuring the proper function of cell membranes in vascular tissues, phosphatidylcholine may contribute to overall cardiovascular wellness.

  • Brain & Mitochondrial Health: While not as immediately effective in boosting neurotransmitter synthesis, phosphatidylcholine is vital for maintaining the structural integrity of brain cells and mitochondrial membranes.

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Dosing

  • Typical adult dosing: 1500mg to 1800mg per day in divided doses

  • Dose for non-alcoholic fatty liver disease (NAFLD) is 600mg three times a day

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​​​Supplement Recommendations Based on Goals

A tailored approach is recommended taking into consideration one's individual health status and potential interactions. The information I'm listing is for educational purposes only. Please check with your physician to determine what would work best for you. 

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For Longevity & Healthy Aging:
A combination strategy might be most beneficial.

  • CDP‑Choline and Alpha‑GPC can support cognitive and mitochondrial function, which are critical for healthy aging.

  • Phosphatidylcholine helps maintain cell membrane integrity across multiple organ systems (liver, CV, brain).

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For Brain Health & Cognitive Support:

  • Alpha‑GPC (300–600 mg/day) is excellent for a rapid increase in acetylcholine, supporting memory and learning.

  • CDP‑Choline (500–1,000 mg/day) offers dual benefits with neuroprotection and enhanced membrane repair, making it well-suited for patients with cognitive decline or post-stroke recovery.

 

For Mitochondrial & Cellular Health:

  • CDP‑Choline may have an edge through its support of membrane phospholipid turnover.

  • Phosphatidylcholine contributes directly to the structural integrity of mitochondrial membranes, though its action is more gradual.

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For Cardiovascular Health:

  • CDP‑Choline and Phosphatidylcholine both play roles in maintaining cell membrane integrity in vascular tissues.

  • Emerging data with Alpha‑GPC also suggest benefits in vascular function, although more research is needed.

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For Liver Health:

  • Phosphatidylcholine is strongly indicated, as deficiencies are linked with fatty liver disease.

  • Ensuring overall adequate choline intake (from any source) is crucial; some protocols recommend 1–2 grams/day of phosphatidylcholine to support liver function.

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For Athletic Performance:

  • Alpha‑GPC is favored for its rapid action in boosting acetylcholine, which can enhance neuromuscular performance and power output.

  • While CDP‑Choline may indirectly support recovery and focus, direct performance benefits have been most consistently observed with Alpha‑GPC.

 

Clinical Applications

Choosing the best choline source depends on your individual needs. For immediate cognitive support, Alpha GPC or CDP-Choline might be more effective, whereas phosphatidylcholine offers broader benefits for cell membrane health and liver function.

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As always, it is best to test your phosphatidylcholine levels and your genetics to determine what you need and not what is based on average population studies. We are all genetically unique and require different amount of nutrients for optimal health. 

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Please contact our office for testing and more information.

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Sources of supplements from Fullscript.​

 

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