What is choline?
DISCLAIMER: CONSULT WITH A DOCTOR BEFORE DECIDING ON A TREATMENT PLAN FOR ANY DISEASE OR INJURY.
Choline is often classified as a member of the B-complex grouping of vitamins, though there’s some controversy around exactly how this nutrient should be categorized. Ultimately, though, the categorization of choline isn’t necessarily what’s important; understanding its importance as a micronutrient and how it functions in the body is more valuable.
Choline is naturally a part of phosphatidylcholine, a phospholipid, and also a part of acetylcholine, a neurotransmitter that is essential for directing muscle movement, brain function, and more. Both of these substances can’t be produced in the body without choline, and therefore, any issue related to low phosphatidylcholine or acetylcholine levels can (often) be traced back to a deficiency of choline or the nutrients that support choline. On the flipside, consumption of foods containing phosphatidylcholine specifically can be an important way that the body can get dietary choline.
As a part of the cell membrane for every cell in the body, choline plays a role in the communication that occurs between cells and nerves, and also in the regulation of the flow of nutrients, toxins, and other substances into and/or out of the cell.
Most sources acknowledge that choline plays an important role in liver function and health, as well as in brain function/development, nervous system function, a healthy metabolism, and more. It is naturally found in the following foods (among others not listed here):
- Cruciferous vegetables
- Eggs (these are especially high in choline)
- Liver meat (specifically beef liver and chicken liver)
- Beef, chicken breast, and other meats
- Cod and salmon
- Soybean oil (cold-pressed)/soybeans
- Wheat germ
- Red potatoes
- Goat’s milk
Like other B-complex vitamins, choline is water-soluble. However, unlike other B-complex vitamins, choline can be produced in small quantities in the body in addition to being consumed in the diet. Because of this, true deficiency is relatively rare, however it’s important to be aware that other deficiencies that impede the natural production of choline in the body may ultimately lead to diminished choline levels. This is especially true for people who follow a strict vegan or vegetarian diet, since most of the best sources of choline exist in animal-based foods (with eggs being the absolute best source of dietary choline that you can get). While there ARE plant-based foods that contain choline, these plant-based foods generally contain comparatively less choline than the animal based foods, so if you’re not eating animal products, you’ll have to work harder to obtain the right amount of choline in your diet and/or supplement with choline. (NOTE: This is another reason why I advocate against veganism or strict vegetarianism; eating some animal products is vital for human survival.)
Choline Deficiency Symptoms and Diseases
Though a true choline deficiency is relatively rare, symptoms may still develop if a person has a mild deficiency or somewhat lower-than-normal levels of this nutrient. In fact, the general consensus is that most people don’t get quite enough choline in their diets, and are therefore likely to harbor a low-level deficiency in choline. Here are some of the symptoms and diseases associated with choline deficiency (besides those directly related to the gallbladder):
- Fatigue/low energy
- Memory loss
- Nervous system damage
- Mood changes and/or mood disorders
- Muscle aches, muscle damage, etc.
- Learning disabilities
- Liver damage and liver disease
- Preeclampsia, low birth weight, and premature birth, as well as neural tube defects in the infant, in women who are pregnant
- Poor memory/cognitive issues
- Alzheimer’s disease and other types of dementia
- Lipid accumulation in the blood and other areas of the body
Folate, also known as vitamin B9, is essential for the production of choline and is also necessary in order for the body to be able to actually use choline that it produces or takes in. Therefore, a folate deficiency can lead to a choline deficiency over time, even if the person gets adequate choline levels from their diet. Vitamin B3 (niacin) deficiency, methionine deficiency, or a deficiency in other amino acids can also ultimately lead to choline deficiency.
In addition, since choline is one of the most important nutrients involved in the methylation process, a process used for DNA synthesis, detoxification, and nerve signaling, people with genes that increase methyl requirements (this accounts for about 50% of the population) may have more trouble obtaining adequate choline levels from their diet. This is because these individuals must consume more choline in order to be able to perform the methylation process effectively. In these cases, a choline deficiency may develop more readily.
Other risk factors for the development of choline deficiency include:
- Fatty liver disease
- Endurance athletics
- Regular alcohol use
- Being postmenopausal (since estrogen plays a role in the production of choline in the body, the postmenopausal drop in estrogen can result in the development of choline deficiency in some women)
- Pregnancy (choline requirements increase during pregnancy and must be met to ensure proper neural tube and brain development in the fetus)
Choline and the Gallbladder
I’ve already talked about phosphatidylcholine, an essential and related nutrient, but how does choline specifically benefit the gallbladder?
Before looking at choline’s impact on the gallbladder specifically, I want to note the importance of choline in terms of liver health (since the liver heavily impacts the gallbladder and vice versa). Choline is one of the most important nutrients that limits and clears fat accumulation in the liver; diseases like non-alcoholic fatty liver disease may therefore be caused in part by choline deficiency. Choline also is responsible for the transport of cholesterol and triglycerides from the liver to other areas of the body. In regard to the gallbladder, if there isn’t enough choline in the body to perform the job of removing cholesterol from the liver to transport it elsewhere, this would ultimately lead to thicker, more cholesterol-rich bile and increased risk of cholesterol gallstone development.
At least some of the choline that the body produces or takes in is processed by the liver. Besides being processed in the liver, choline is also stored in some quantities and recycled for reuse via the liver to the kidneys, lungs, and intestines, as well as to the brain. Thus, if the liver isn’t functioning well, this will ultimately decrease the body’s ability to effectively absorb, process, reuse, and utilize choline. In this case, it’s important to both supplement with choline as well as to work on healing the liver in other ways.
According to one study done on newly hatched baby chicks, choline deficiency leads to gallbladder distension, similar to cholecystitis. Vomiting was a common side effect in the chicks of this cholecystitis caused by choline deficiency. In addition, the bilirubin content was noted to be higher in chicks fed the choline deficient diet, suggesting that a choline deficiency may contribute specifically to the development of pigment gallstones more than the development of cholesterol gallstones (though choline and phosphatidylcholine deficiencies likely play a role in the development of cholesterol gallstones, as well). Additional cholesterol fed to the deficient chicks increased bilirubin levels further.
How to Take Choline for Gallbladder Health
CDP choline (also known as Citicoline) and Alpha GPC choline have been found to be particularly bioavailable. These two types of choline are generally absorbed better by the body, in contrast with other forms of choline that may be minimally absorbed, especially in cases where the patient has liver damage of some kind (since this impedes choline absorption). Other than these, the choline supplement you choose should be from whole foods sources. Supplementation with phosphatidylcholine and/or lecithin may also combat a choline deficiency, though actual choline supplements are ideal.
When supplementing with choline, especially if you’re correcting a known deficiency, it’s essential to also take a vitamin B9 (folate/folic acid) supplement. Without both dietary and/or supplemental vitamin B9 and choline, the body is unable to synthesize choline on its own or to effectively utilize the dietary/supplemental choline that a person takes. Therefore, one should ideally take a B-100 supplement in addition to a choline supplement to ensure that they’re getting adequate levels of both of these nutrients.
The tolerable upper intake level of choline for an adult is 3,500mg per day. When a person takes more than this, the risk of developing unpleasant side effects like diarrhea, nausea/vomiting, a drop or an increase in blood pressure, excessive sweating or salivation, fatigue, dizziness, and a fishy body odor. Most of the time, a person won’t take anywhere near this much choline per day, though (even in a supplement), and when taken in lower but still therapeutic doses, the vast majority of people won’t experience any side effects. As a water soluble micronutrient, choline is expelled from the body relatively quickly, and so the likelihood of taking too much and doing oneself harm is (generally) very low.
 Brown, Mary Jane (2018). What is Choline? An Essential Nutrient With Many Benefits. Retrieved June 23, 2022 from: https://www.healthline.com/nutrition/what-is-choline
 Levy, Jillian (2018). What is Choline? Benefits, Sources, & Signs of Deficiency. Retrieved June 23, 2022 from: https://draxe.com/nutrition/what-is-choline/
 Kubala, Jillian (2021). 16 Foods That Are High in Choline. Retrieved June 24, 2022 from: https://www.healthline.com/nutrition/foods-with-choline
 Komal, Patni (2017). How to spot Choline deficiency? Know the telltale signs. Retrieved June 24, 2022 from: https://stylenrich.com/choline-deficiency/
 N.A. (2014). Estrogen, Choline, and the Gallbladder. Retrieved June 24, 2022 from: https://www.beyondmthfr.com/estrogen-choline-and-the-gallbladder/
 N.A. (2019). The sometimes forgotten but essential nutrient choline. Retrieved June 24, 2022 from: https://blog.cytoplan.co.uk/the-sometimes-forgotten-but-essential-nutrient-choline/
 Seifter, Eli, et. al. (1971). Gall Bladder Distention in Choline-deficient Chicks. Retrieved June 24, 2022 from: https://academic.oup.com/jn/article-abstract/101/9/1233/4777327?redirectedFrom=fulltext