Choline: dietary sources, pregnancy, and whether to take a supplement

Choline is not classed as a vitamin, though it is often grouped with the B vitamins. It is needed to build phosphatidylcholine, a main component of cell membranes, and acetylcholine, a chemical messenger that helps muscles contract and is involved in memory and thinking. It also helps move fat out of the liver, which is why shortage is linked with fatty liver.

The Harvard Nutrition Source lists beef, egg yolks, chicken, fish and dairy as rich animal sources, and legumes, cruciferous vegetables such as broccoli and potatoes among plant sources. Eggs are often cited as the most concentrated everyday food, which matters for people who avoid eggs altogether.

People who eat little animal food, and particularly those following a vegan diet, may find it harder to reach the intake levels cited in US guidance. Soya, beans, quinoa, peanuts and cruciferous vegetables help, and a dietitian can review the overall pattern.

• Include eggs, fish, poultry or dairy if your diet allows.

• On a plant-based diet, rely on beans, lentils, soya foods, nuts and broccoli.

• Choline-containing foods vary, so there is no need to count milligrams.

Targets differ by country, and the figures here are US adequate intakes quoted by Harvard rather than UK reference values: 550mg a day for men, 425mg for women, 450mg in pregnancy and 550mg during lactation. The sources used for this page did not provide an equivalent UK figure, so these numbers should be read as guides rather than UK targets.

Studies of usual diets suggest that many people fall short of such targets, but because there is no routine blood test for choline status, it is rarely measured in clinical practice and deficiency is rarely diagnosed outright.

Choline is involved in fetal brain and spinal cord development, and requirements are higher in pregnancy and lactation. Prenatal supplements vary: many do not contain choline, or include only small amounts. UK pregnancy advice centres on folic acid and vitamin D rather than choline, so a food-first approach is appropriate unless a midwife or dietitian suggests otherwise.

Pregnant women avoiding fish, eggs or meat for dietary or ethical reasons can ask a midwife for advice about their overall nutrition.

Harvard’s summary describes mixed findings. Higher intake may help lower homocysteine and possibly the risk of stroke, but research on cardiovascular disease and type 2 diabetes has been inconsistent, with some studies suggesting higher intakes were associated with greater risk, mechanisms unclear. Deficiency can contribute to fatty liver disease, though supplements have not been proven to treat it. For cognition, clinical trials have not found supplements significantly improve memory or thinking.

Because of this, choline supplements are not recommended in NHS guidance for general brain health, and claims on product labels should be read critically.

Very high supplement doses, above 3,500mg a day, may cause side effects. Reported effects of excess choline include a fishy body odour, sweating, vomiting, low blood pressure and diarrhoea. Gut bacteria convert choline into trimethylamine, which is linked to the odour and has been studied in relation to heart disease, a point of ongoing research.

People with trimethylaminuria (fish odour syndrome), liver or kidney disease, or those taking medicines should speak to a clinician before using choline products.