Choline: The Lesser-Known, Brain-Building Cousin of Folate
Last updated October 26, 2021
Everyone knows the importance of folate before and during pregnancy: This B vitamin supports the baby’s brain development, and taking at least 600-800 mcg in the form of prenatal vitamins can prevent neural tube defects, one of the most common types of birth defects.
There is another nutrient with a very similar role in the baby’s brain development: Choline. The difference? Most people don’t know its crucial importance before, during and after pregnancy. We dive into choline’s role, and what you can do to make sure you have a sufficient supply.
What is choline?
Choline is a B vitamin that all animals and plants need to maintain the cell’s structural integrity. It has multiple other functions, but the most important is its contribution to the fetal brain development, which led the Institute of Medicine to recognize it – belatedly – as an essential nutrient in 1998.
While our body produces some choline in the liver, the amount is too low to satisfy our daily needs without additional intake from food and supplements. Good food sources of choline includes eggs, beef, soybeans and chicken.
Choline builds baby’s brain and supports cognitive functions.
Choline is an essential nutrient in the early development of fetal brain and cognitive functions. Choline is necessary to generate a molecule called phosphatidylcholine. This molecule, in turn, is a building block for nerve cells, including those used to build the baby’s brain. This is why an adequate supply of choline – just like folate – is an important factor in the prevention of neural tube defects in babies.
The baby’s brain – once formed – also relies on choline to function properly. Choline is an essential part of a neurotransmitter called acetylcholine, which regulates how the brain works. Multiple animal and human studies have suggested that an adequate level of choline during pregnancy and while breastfeeding can support healthy development of the baby’s memory, and other cognitive functions after birth.
Choline deficiency is common – far too common.
Our need for choline changes depending on the life stage. Adult women generally need 425 mg/day. The requirement goes up to 450 mg/day for pregnant women and 550 mg/day for women who are breastfeeding.
Pregnancy and lactation is a critical time for choline: As the baby grows in utero, the baby draws a large amount of choline from the mom through the placenta. A healthy baby is born with a much higher concentration of choline than the mom – up to 7 times higher, according to a study. During pregnancy, the mom’s body increases choline production to keep up with the demand, but most women end up getting depleted. Breast milk is also rich in choline (although the levels can vary greatly depending on the mom’s choline status), which further increases the demand on the mom’s body.
Partly because of this increased demand and partly because the need for choline is not well recognized even among OBGYN doctors, a vast majority of pregnant and nursing women are deficient in choline. 90-95% of women, even while taking prenatal vitamins, don’t have enough choline to support the optimal brain health of the baby – let alone their own health.
Who are at risk of choline deficiency?
As we saw, just about everyone is at risk of insufficient choline. However, some people are more prone to choline deficiency than others:
- Vegans and vegetarians: Eggs, beef, chicken – a lot of the food items that top the choline-rich food list are animal-derived, so vegans and vegetarians are more likely to be low on choline.
- Women with some genetic variants: Studies have suggested that certain common variants of the genes involved in the metabolism of choline can alter the way choline is used in the body, raising the risk of choline deficiency even when dietary intake of choline meets the recommended amount.
- Women with low folate levels: Choline and folate work in very similar ways. They are both methyl donors, involved in the detoxication process of homocysteine, a harmful byproduct of metabolic processes. Because they work in similar ways, deficiencies in folate have been shown to increase the need for choline, as the body uses choline to fill in for the folate.
What to do to support the baby's brain health with choline
Unless you eat more than 2-3 eggs on a daily basis, it can be quite difficult to meet the recommended daily amount of choline from food alone. Estimating how much choline is in your typical day’s foods here, then taking a prenatal vitamin that supplies enough choline to close the gap may be a good idea.
Following the American Medical Association’s call in 2017 for prenatal vitamin manufacturers to include enough choline to make a difference, some newcomers to the market include meaningful amounts of choline. However, make sure to read the supplement fact panel –most prenatal vitamins still top out at 100 mg or less (if at all), typically not enough to make a dent in your choline status. Taking a stand-alone choline supplement is also an option.
As an aside: Rebecca Fett's "Brain Health from Birth" goes into details about choline, as well as other factors within your control that contribute to the baby's brain development. It's a great resource, if you haven't read it.
Remember, choline is just as important as folate in the early stage of pregnancy for brain development. Its importance continues throughout the pregnancy into the baby’s first year, as it supports the healthy development of cognitive functions like memory and mood regulation. Reach out with any questions about steps you can take to ensure adequate choline supply to support your baby build the foundation of lifelong brain health. We are with you.
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