Non-alcoholic fatty liver disease (NAFLD) is a growing health concern, characterized by excess fat accumulation in liver cells. It affects many people and can progress to severe liver issues if not managed. Choline is an organic compound essential for cell membrane structure, nerve signaling, and liver health.
The Role of Choline in Liver Function
Choline is involved in the synthesis of phosphatidylcholine, a phospholipid important for cell membranes and liver function. Phosphatidylcholine is required for the assembly and secretion of very-low-density lipoproteins (VLDL) from the liver. VLDL particles, like microscopic “cargo ships,” transport fats (triglycerides) from the liver to other tissues for energy or storage.
The liver continuously processes fats, and VLDL particles are the primary export mechanism. Without sufficient choline, the liver struggles to produce enough phosphatidylcholine, which then impedes VLDL formation. This process ensures fats do not accumulate excessively within liver cells, supporting the liver’s metabolic balance.
Choline Deficiency and the Development of Fatty Liver
A choline shortage compromises the liver’s ability to create and release VLDL particles. This impairment means the “cargo ships” for fat export cannot be adequately formed or dispatched. Consequently, triglycerides begin to accumulate within the hepatocytes, or liver cells.
This buildup of fat within liver cells is known as hepatic steatosis (fatty liver). Research consistently demonstrates this direct link between choline deficiency and liver fat accumulation. Animal studies, such as in rodents, show that a choline-deficient diet rapidly induces fatty liver. Similarly, human patients on intravenous nutrition without choline developed fatty liver, which resolved upon reintroduction. This evidence underscores choline’s preventative role in fatty liver.
Increasing Choline Intake Through Diet
Meeting the body’s choline requirements through dietary intake is an effective strategy to support liver health. Various foods contain choline, with some sources being particularly rich in this nutrient. Animal-based foods provide higher concentrations of choline compared to plant-based options.
Beef liver is an exceptionally rich source, offering approximately 356 milligrams of choline per 3-ounce serving. A large egg contains about 147 milligrams, primarily concentrated in the yolk. Other animal sources include chicken breast, which provides around 72 milligrams per 3 ounces, and cod fish, with approximately 63 milligrams per 3-ounce serving.
Plant-based foods also contribute to choline intake, although in smaller amounts. Soybeans, including tofu, are a good plant-based option, with half a cup of cooked soybeans containing about 107 milligrams of choline. Shiitake mushrooms offer around 58 milligrams per cup, while quinoa provides about 43 milligrams per cooked cup. Broccoli also contains some choline, with approximately 31 milligrams per cooked cup. Incorporating a diverse range of these foods into a balanced diet helps ensure adequate choline consumption.
Choline Supplementation Considerations
For individuals considering choline supplementation, several forms are available, each with distinct characteristics. Choline bitartrate is a common and cost-effective form, while phosphatidylcholine is a component of lecithin and is already in the form required for VLDL synthesis. Citicoline, also known as CDP-choline, is another form that can cross the blood-brain barrier and is often used for cognitive support, but it also provides choline for liver metabolism.
The Adequate Intake (AI) for choline is established at 425 milligrams per day for adult women and 550 milligrams per day for adult men. These levels are considered sufficient for most healthy individuals to prevent deficiency. While supplementation can be an option, it is important for anyone considering choline supplements for a medical condition like fatty liver to consult with a healthcare provider. A doctor can determine the appropriate dosage and assess potential interactions with other medications or existing health conditions.
Excessive intake of choline can lead to potential side effects, although these are generally mild. These adverse effects might include a fishy body odor, which results from the metabolism of choline into trimethylamine. Other less common side effects can include gastrointestinal distress, such as nausea or diarrhea, and in rare cases, a drop in blood pressure. Adhering to recommended dosages and seeking professional medical advice helps ensure safe and effective use of choline supplements.
References
Choline deficiency and fatty liver: a review of the evidence. National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216895/
Choline. National Institutes of Health. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/