L-Choline

With choline, the answer usually starts with what's on your plate. These are the questions our naturopaths ask in store.

A good fit if

• You eat few or no eggs, meat or liver, which is where nearly all the choline in food comes from
• You're pregnant, planning a pregnancy or breastfeeding, when the Adequate Intake goes up
• You want a simple, everyday form and don't need the trial data, which points you to choline bitartrate
• You already buy lecithin and want to know how much choline it's really giving you

Check with us first if

• You take medicine for Parkinson's disease. Citicoline products must carry an interaction warning for it.
• You take carnitine. In one controlled experiment, supplemental choline cut the carnitine passed in urine (the non-esterified kind) by 84%.
• You already eat plenty of eggs and meat and would be adding a supplement on top. The upper limit counts food too.
• A fishy body odour has put you off choline before. In pooled trials it showed up in 36% of people on choline compared with 8% on placebo.
• You avoid soy and are looking at soy lecithin. We couldn't confirm how allergen labelling rules apply to refined soy lecithin.
• You're worried about heart disease risk and have read about TMAO. The observational and randomised evidence disagree on this.

• Choline bitartrate (item 1363). Best known for: The everyday bulk form of choline. Absorption: About 41% choline by weight, worked out from the chemical formula rather than measured. Typical use: Allowed in listed medicines with no conditions, no dose limit and no warning statement.
• Choline dihydrogen citrate (item 1364). Best known for: The other salt, doing the same job under the rules. Absorption: About 35% choline by weight, worked out from the formula; we hold no dedicated human trial. Typical use: Limited by the rules to "Only for use in oral medicines."
• Citicoline / CDP-choline (item 1428). Best known for: A nucleotide that releases cytidine as well as choline, which is the argument for it. Absorption: Almost completely absorbed by mouth, but only about 21% choline by weight, so 500 mg gives you roughly 107 mg of choline. Typical use: Only one company and its authorised partners can use it until 20 June 2027, and only by mouth, at 500 mg a day, for adults.
• Lecithin and egg lecithin (items 2980, 1990). Best known for: A mix of phospholipids from soy, sunflower or egg, also used as a food emulsifier. Absorption: The phosphatidylcholine content varies hugely between grades, so you can't assume how much choline you're getting from the word "lecithin". Typical use: Allowed in listed medicines as an active or inactive ingredient, with no conditions.
• Phosphatidylcholine (item 3866). Best known for: The actual phospholipid that lecithin is a mixture of. Absorption: About 13% choline by weight, worked out from the formula. Typical use: Allowed only as an inactive ingredient, so no listed medicine can present it as its active ingredient.
• Alpha-GPC / choline alphoscerate (absent from Schedule 1). Best known for: The overseas brain supplement, and the supplement form that gives the most choline. Absorption: About 40.5% choline by weight, worked out from the formula, which is the highest of the supplement forms and close to bitartrate. Typical use: It isn't an allowed ingredient here, so no Australian listed medicine can contain it.

Reference values. Choline has an Adequate Intake in Australia rather than an RDI, because there wasn't enough evidence to set one. For adults it's 550 mg a day for men and 425 mg for women. In pregnancy it's 440 mg at 19 to 50 years and 415 mg at 14 to 18. While breastfeeding it's 550 mg and 525 mg. Children range from 200 mg at 1 to 3 years up to 550 mg for boys aged 14 to 18 and 400 mg for girls the same age.

Typical supplemental range. Choline bitartrate is sold in doses measured in grams, and the controlled trial we looked at used 1 g a day. Citicoline products can't go over 500 mg of citicoline a day, which is also the dose used in the memory trial. Lecithin is sold by the gram as granules, capsules or liquid, but how much choline it gives you depends entirely on its grade. Compare products by the milligrams of choline, not the weight of the compound, using the percentages in the forms table.

Upper level. The NHMRC upper limit is 3,500 mg of choline a day for adults, 3,000 mg at 14 to 18 years (including teenage pregnancy and breastfeeding), and 1,000 mg for children aged 1 to 13. No upper limit could be set for babies under 12 months, who should get their choline from breast milk, formula and food only.

Worth knowing. Count what you eat as well as what's on the label, because the upper limit covers your total intake. Stick to Australian figures, too. The US Adequate Intake in pregnancy is 450 mg and its upper limit for 9 to 13 year olds is 2,000 mg, and neither matches the Australian number. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Beef liver, pan fried, 85 g: 356 mg
• Egg, hard boiled, 1 large: 147 mg
• Beef top round, braised, 85 g: 117 mg
• Soybeans, roasted, half a cup: 107 mg, and the highest plant source on the list
• Chicken breast, roasted, 85 g: 72 mg
• Kidney beans, canned, half a cup: 45 mg

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Pregnancy and breastfeeding. Schedule 1 item 1428 states: "Medicines that contain citicoline must be indicated for use in adults only and not in pregnant or lactating women."
• Parkinson's disease medicines. Citicoline medicines must carry a label warning about interactions with Parkinson's disease medicines.
• Children. Item 1428 rules out citicoline for children, and the choline Upper Level for ages 1 to 13 is 1,000 mg a day.
• High intakes of any form. The NIH Office of Dietary Supplements says: "High intakes of choline are associated with a fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity."
• Fishy body odour. It affected 36% on choline against 8% on placebo in pooled trials in children, and it's the most common reason people stop.
• Carnitine. Choline supplements cut the loss of free carnitine in urine by 84% in one controlled experiment.
• The effect on heart risk is unresolved. Six cohort studies link each extra 100 mg a day of choline from food to 6% higher death from any cause (RR 1.06) and 11% higher death from heart disease (RR 1.11), with results varying widely, while a meta-analysis of randomised egg trials found no significant change in TMAO.
• Upper Level. 3,500 mg a day for adults, 3,000 mg at 14 to 18 years and in teenage pregnancy or breastfeeding, and 1,000 mg for ages 1 to 13.
• Soy allergy and soy lecithin. We haven't confirmed the allergen labelling rules for refined soy lecithin, so read the label and ask our team.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.