Vitamins & Supplements · Nutrient
Choline supplement forms
Choline · also called Colina, choline bitartrate, choline chloride, phosphatidylcholine, lecithin
Choline is an essential nutrient the body needs for the liver, cell membranes and a nerve messenger called acetylcholine. Eggs, liver, meat, fish and soybeans are rich sources. Controlled studies show that missing choline causes fatty liver and muscle damage, but evidence that extra choline helps memory or a baby's brain is weak or mixed. Very large amounts can lower blood pressure, so ask a doctor or pharmacist before supplements.
General information, not medical advice. Last substantive update · Not medically reviewed. A named clinician has not signed off on this page. How this page is made
About Choline supplement forms
Choline is an essential nutrient found in many foods and sold in several supplement forms. The strongest evidence is about what happens when it is missing. For people who eat enough, trials of supplements are few, small or negative, and very large amounts cause side effects.
What choline is
Choline is a nutrient the body needs to build cell membranes, to move fat out of the liver and to make acetylcholine, a messenger between nerve cells. The 1998 US Institute of Medicine report says it is also a precursor of betaine, which the body uses to handle methyl groups.
A 2018 review explains that food choline comes in water-soluble forms (free choline, phosphocholine, glycerophosphocholine) and fat-soluble forms (phosphatidylcholine, sphingomyelin). Human milk is mostly water-soluble forms; foods eaten later are mostly fat-soluble.
The supplement forms
The Institute of Medicine says choline is sold as choline chloride or choline bitartrate and as lecithin, which usually contains about 25% phosphatidylcholine, or 3 to 4% choline by weight. It also says choline chloride has more choline by weight than choline bitartrate, so labels need reading with care. Alpha-GPC and citicoline are related compounds that have their own page.
In a 2022 crossover study of six men, four forms gave the same blood choline overall, but only the water-soluble forms quickly raised TMAO. No trial compared the forms for liver, brain or heart outcomes, so it is not known whether one form is better.
Where choline comes from in food
USDA data (SR Legacy, per portion): one large hard-boiled egg about 147 mg; 3 oz of braised beef liver about 362 mg; 3 oz of cooked farmed salmon about 77 mg; 3 oz of broiled ground beef about 70 mg; half a roasted chicken breast about 73 mg; a cup of roasted soybeans about 214 mg; a cup of cooked kidney beans about 54 mg; an ounce of dry-roasted peanuts about 18 mg; a cup of 2% milk about 40 mg; half a cup of cooked broccoli about 31 mg.
The Institute of Medicine names milk, liver, eggs and peanuts as especially rich sources. The FDA label Daily Value for choline is 550 mg; this is a labelling figure, not a recommendation to take a supplement.
When choline is short
In a 2007 controlled study of 57 healthy adults, a very low-choline diet caused fatty liver or muscle damage in 77% of men, 80% of postmenopausal women and 44% of premenopausal women, and six men developed signs while eating the US Adequate Intake. Organ function returned when choline was added back. Folic acid did not change this.
In adults fed by vein, low blood choline went with fatty liver. Lecithin by mouth and choline added to the feeding solution improved liver fat in two small trials. These are specific situations and do not apply to people eating normal diets.
What the research shows
For people who already eat enough, the evidence is weak. A single large dose of bitartrate did not improve memory in healthy young adults. In pregnancy, one larger capsule trial found no effect on infants and two small feeding studies found some benefits, and a 2025 review called the evidence insufficient. For endurance and common fatty liver, no clear evidence was found.
Observational studies link higher blood TMAO, higher blood choline and higher dietary choline to more heart disease or death. These cannot show that choline causes harm, and none tested pills.
Too much choline
The Institute of Medicine says the main harm from very large amounts is low blood pressure, with sweating, drooling, vomiting, diarrhoea and a fishy body odour also reported. It set a Tolerable Upper Intake Level of 3.5 g a day of choline for adults. This is a regulator statement from 1998, not advice to take choline. People with trimethylaminuria, kidney or liver disease, depression or Parkinson's disease may be at higher risk.
The NIH Office of Dietary Supplements and EFSA pages could not be read, so newer statements are not given here.
Food versus pills
Food brings choline with other nutrients. In a crossover trial, three eggs a day raised blood lutein and zeaxanthin, and a choline bitartrate supplement did not. Almost all trial results on this page are for supplements, while food amounts come from USDA tables. This page gives no amounts to take; if you wonder about your own needs, ask a doctor, pharmacist or dietitian.
At a glance
Traditional uses history, not proof
- An essential nutrient from food
- Sold as supplements for memory, pregnancy and liver support
Studied for research
- Essential role and deficiency, high certainty
- Food sources, high certainty
- How the supplement forms compare in the blood, low certainty
- Memory in adults, mixed certainty
- Pregnancy and a child's brain, insufficient evidence
- TMAO and heart risk (a possible concern), very low certainty
- Endurance and common fatty liver, insufficient evidence
Main compounds
- Choline bitartrate
- Choline chloride
- Phosphatidylcholine (lecithin)
- Alpha-glycerophosphocholine (alpha-GPC)
Common forms
- Food sources (eggs, liver, meat, fish, soybeans, peanuts)
- Capsules, tablets and powders of the salts
- Lecithin and phosphatidylcholine capsules and granules
Research links: Institute of Medicine 1998: choline chapter (Adequate Intakes and upper levels) · 2022 trial: four choline supplement forms compared in the blood · 2025 review: choline in pregnancy and child brain development · 2007 study: low-choline diet and fatty liver or muscle damage · 2016 trial: choline bitartrate and memory in healthy adults · Research Library · Genes & Biomarkers Library
What it is and its history
- Accepted scientific name
- Choline (an essential nutrient, sold in several forms)
- Common names
- Choline (English); Colina (Spanish)
- Family or group
- Essential nutrient. The 1998 Institute of Medicine report says choline is a precursor of acetylcholine, phospholipids and the methyl donor betaine. It is not a vitamin in the strict sense, and it is a Daily Value nutrient on US labels.
- Harvest and processing
- Lecithin is a phosphatidylcholine-rich fraction prepared during commercial purification of phospholipids (Institute of Medicine). Soy lecithin is a common source (USDA lists soy lecithin oil).
- Look-alikes and adulterants
- Name: Citicoline and alpha-GPC; Note: Separate compounds that contain choline and are sold for memory; each has its own page. Evidence for choline does not transfer to them.; Name: Lecithin; Note: A mixture of phospholipids; the Institute of Medicine says it usually contains about 25% phosphatidylcholine, or 3 to 4% choline by weight, so a lecithin product is not automatically a choline supplement.; Name: Phosphatidylserine; Note: A different membrane lipid, also sold for memory; separate page.
- Sustainability and conservation
- Not assessed.
What is inside, and how it may work
What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.
Main compounds
| Compound | Family | Where it is concentrated | Activity studied | Level of evidence |
|---|---|---|---|---|
| Choline bitartrate | choline salt | Choline content by weight was not read from a source. | Named by the Institute of Medicine as a supplement form. It raised blood choline similarly to other forms in a small crossover study and was tested in memory and metabolic syndrome trials. 20 4 15 | Human data |
| Choline chloride | choline salt | The Institute of Medicine says it contains more choline by weight than choline bitartrate. | A supplement form used in older clinical studies and added to intravenous feeding in one trial. 20 3 4 | Human data |
| Phosphatidylcholine (lecithin) | phospholipid | Lecithin usually contains about 25% phosphatidylcholine or 3 to 4% choline by weight (Institute of Medicine). | The main food form of choline. Egg phosphatidylcholine peaked later in blood and did not raise TMAO in a 6-man study; lecithin raised blood choline in a trial of adults fed by vein. 20 4 2 6 | Human data |
| Alpha-glycerophosphocholine (alpha-GPC) | water-soluble choline compound | Not read from a source. | Included in the 6-man crossover study; it raised TMAO like the other water-soluble forms. It has its own page with citicoline. 4 | Human data |
Mechanisms, receptors and pathways
| Target or pathway | Gene or receptor | What was found | Level |
|---|---|---|---|
| Acetylcholine, phospholipids and betaine | Not specified in the sources read | Choline is a precursor of acetylcholine, phospholipids (such as phosphatidylcholine) and the methyl donor betaine (Institute of Medicine and 2018 review). 20 17 | Human data |
| Gut bacteria and TMAO | Not specified in the sources read | Gut bacteria turn choline and phosphatidylcholine into trimethylamine; the liver makes TMAO. The 2011 study showed in mice that choline or TMAO promoted atherosclerosis and that gut bacteria were needed. 16 4 | Animal research |
| Moving fat out of the liver | Not specified in the sources read | Without enough choline, fat builds up in the liver; this was shown in a controlled low-choline diet study and in adults on intravenous feeding. 7 3 2 | Human data |
Absorption, metabolism and elimination
- Absorption
- In a 6-man crossover study, blood choline overall was the same after choline chloride, bitartrate, alpha-GPC and egg phosphatidylcholine; egg phosphatidylcholine peaked later (about 3 hours).
- Distribution
- The Institute of Medicine says choline is delivered to the fetus through the placenta and is secreted in human milk. Details were not read.
- Metabolism
- Converted to betaine; gut bacteria also make trimethylamine, which the liver converts to TMAO.
- Elimination
- Not described in the sources read, apart from trimethylamine being excreted (fishy odour).
- Bioavailability
- Similar blood choline across four forms in six men; TMAO differed. Not compared in larger or longer studies.
Isolated compounds versus whole extracts
Food choline and supplement choline are not the same thing. Foods bring other nutrients: in a crossover trial, eggs raised blood lutein and zeaxanthin and a choline bitartrate supplement did not. Most trial results on this page are for supplements, while food amounts come from USDA tables.
Nutritional composition
Choline content of foods is from USDA FoodData Central SR Legacy (April 2018 release), read 2026-10-26 from the official download; values are per 100 g and per household portion, see the Food sources item and the USDA source note.
2 high certainty1 mixed findings1 low certainty2 very low certainty3 not enough evidence
What was looked at
The 9 benefits and uses checked for Choline supplement forms, each with how strong the evidence is. Tap one to open it.
- Essential nutrient: liver and muscle when choline is shortHigh certainty
- Food sources of cholineHigh certainty
- How the supplement forms compare in the bloodLow certainty
- Pregnancy and a child's brain developmentNot enough evidence
- Memory and thinking in adultsMixed findings
- TMAO and heart disease riskVery low certainty
- Choline intake and death or heart disease (observational)Very low certainty
- Endurance exerciseNot enough evidence
- Common fatty liver diseaseNot enough evidence
Lab markers tracked in the studies
Plasma free choline (blood choline)Liver fat on CT scanLiver enzymes (ALT, AST)TMAO (trimethylamine N-oxide)Blood choline and later cardiovascular diseasePlasma lutein and zeaxanthin
What is Choline supplement forms good for?
The main studied uses and how strong the human evidence is for each. Most results are for people who may have been short of choline, and some are only blood markers.
Benefits, one by one
Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.
Essential nutrient: liver and muscle when choline is short
High certaintyCholine is a nutrient the body needs to move fat out of the liver, build cell membranes and make a nerve messenger called acetylcholine. When choline was withheld in controlled studies, many healthy adults developed fatty liver or muscle damage. Choline given to people fed by vein reversed liver changes. These are deficiency findings, not proof that extra choline helps people who eat enough.
4 studiesFree choline and food choline in the deprivation study; choline chlor…
Studies, doses and limits
What the trials found
In a 2007 controlled study, 57 healthy adults ate a very low-choline diet for up to 42 days. Fatty liver or muscle damage appeared in 77% of men, 80% of postmenopausal women and 44% of premenopausal women. Six men developed these signs while eating the US Adequate Intake. In two small trials of adults fed by vein, oral lecithin (1992) and choline added to the feeding solution (2001) raised blood choline or improved liver fat and liver enzymes; fatty liver returned after the choline was stopped.
Results
Choline is essential and a shortage causes real liver and muscle problems. Extra choline is expected to help people who are short of it. This page found no trial showing that extra choline helps people who already get enough.
Effect sizes as reported
Deprivation study: organ dysfunction in 77% of men, 80% of postmenopausal women, 44% of premenopausal women. Feeding-by-vein trial: liver density gain 13.3 versus 5.8 Hounsfield units at week 4 (p = 0.04).
Why this rating
High that choline is essential and that a shortage has recognised signs (controlled deprivation study and two randomised trials). The trials are small (15 people each), so this is not a measure of any supplement's benefit in well-fed people.
Form and dose studied
Free choline and food choline in the deprivation study; choline chloride added to a drip in one trial; lecithin by mouth in the other. Amounts are in the studies table only.
Who was studied
Healthy adults in the deprivation study; adults on long-term intravenous feeding in the two trials.
Limits
Deprivation shows a requirement but not how much a supplement adds. The trials were tiny and in an unusual group. Abstracts only.
Why researchers looked
People ask whether they get enough choline, and the official intake figures were set from liver-damage studies.
Traditional use
Choline is an essential nutrient. Its role in the body is well established; that is different from showing that choline pills treat a condition.
Proposed mechanism Established nutrition
The 1998 US Institute of Medicine report says choline is a precursor of acetylcholine, phospholipids and the methyl donor betaine, and that it is needed for the structure of cell membranes and for moving fat and cholesterol. This is established nutrition.
A proposed mechanism does not show that the effect happens in people.
Too much choline also causes problems; see the Safety tab.
Food sources of choline
High certaintyMost choline in food is phosphatidylcholine. Eggs, liver, meat, fish, soybeans and peanuts are among the richer sources. Amounts are from USDA food tables; pills are a different thing.
3 studiesMostly phosphatidylcholine in food; human milk is mostly water-solubl…
Studies, doses and limits
What the trials found
By USDA SR Legacy data: one large hard-boiled egg has about 147 mg; 3 oz (85 g) of braised beef liver about 362 mg; 3 oz of cooked farmed salmon about 77 mg; 3 oz of broiled ground beef patty about 70 mg; half a roasted chicken breast about 73 mg; a cup of roasted soybeans about 214 mg; a cup of cooked kidney beans about 54 mg; an ounce of dry-roasted peanuts about 18 mg; a cup of 2% milk about 40 mg; half a cup of cooked chopped broccoli about 31 mg. The 1998 Institute of Medicine report says milk, liver, eggs and peanuts are especially rich and that most food choline is phosphatidylcholine.
Results
Choline is widely spread in foods, with animal foods and soybeans the richest per portion in these tables.
Effect sizes as reported
No effect sizes: these are food values per portion.
Why this rating
High because these are laboratory food tables; they say nothing about benefit.
Form and dose studied
Mostly phosphatidylcholine in food; human milk is mostly water-soluble forms (2018 review).
Who was studied
General population.
Limits
SR Legacy is from 2018 and values vary by brand and cooking. Newer USDA data may differ.
Why researchers looked
People want to know where choline comes from before thinking about a supplement.
Traditional use
Food choline has been eaten forever; a food table is a fact about content, not a health claim.
Proposed mechanism Nutrient composition
Not applicable: this is food content.
A proposed mechanism does not show that the effect happens in people.
A 2024 meta-analysis of cohorts linked higher dietary choline to higher death risk; see the Evidence tab. That is observational.
How the supplement forms compare in the blood
Low certaintyCholine is sold as choline bitartrate, choline chloride, lecithin (phosphatidylcholine) and related compounds. In a very small crossover study, four forms raised blood choline about the same amount. The three water-soluble forms (chloride, bitartrate and GPC) quickly raised a blood marker called TMAO; egg phosphatidylcholine did not. What this means for health is not known.
3 studiesCholine chloride, choline bitartrate, alpha-GPC and egg phosphatidylc…
Studies, doses and limits
What the trials found
In 6 healthy men, single doses (550 mg choline equivalent) of choline chloride, choline bitartrate, GPC and egg phosphatidylcholine gave the same blood choline overall. Egg PC peaked later (about 3 hours). Betaine rose similarly with all four. TMAO rose quickly after the water-soluble forms but not after egg PC. In 23 adults with metabolic syndrome, 4 weeks of three eggs a day or choline bitartrate (400 mg choline equivalent) gave no significant change in TMAO from baseline in either arm, and plasma lutein and zeaxanthin rose after eggs but not after the bitartrate. The 1998 Institute of Medicine report adds that lecithin usually contains about 25% phosphatidylcholine, or 3 to 4% choline by weight.
Results
The forms look alike for blood choline in one tiny study. TMAO results differed between the two studies, so the picture on TMAO is unclear. No trial compared the forms for liver, brain or any health outcome.
Effect sizes as reported
No difference in choline AUC between forms (6 men). TMAO: no significant change from baseline in either arm (23 adults).
Why this rating
Low: one 6-person crossover study and one 23-person crossover trial, single or 4-week exposure, blood markers only.
Form and dose studied
Choline chloride, choline bitartrate, alpha-GPC and egg phosphatidylcholine; the second trial compared eggs with bitartrate. Amounts are in the studies table.
Who was studied
Six healthy men; 23 adults with metabolic syndrome.
Limits
Blood markers are not health outcomes. Tiny and short. Commercial products vary in how much choline they supply.
Why researchers looked
The forms are sold side by side and people ask whether one works better or is safer.
Traditional use
Different forms were developed for different uses; trials rarely compare them.
Proposed mechanism Proposed mechanism
The authors suggest water-soluble forms are partly broken down by gut bacteria before they are absorbed, which makes trimethylamine and then TMAO, while phosphatidylcholine is taken up later. This is a proposed explanation, not proven in this study.
A proposed mechanism does not show that the effect happens in people.
TMAO is discussed on the Evidence tab and the Safety tab.
Pregnancy and a child's brain development
Not enough evidenceOfficial intake figures are higher in pregnancy and breastfeeding because the baby takes choline. Whether extra choline in pregnancy improves a child's thinking is not settled: a 2025 review found the evidence insufficient either way. A phosphatidylcholine capsule did not change infant memory or language at 10 and 12 months; a small controlled-feeding study found some benefits for the higher-choline group.
5 studiesPhosphatidylcholine capsule in one trial; the form is not stated in t…
Studies, doses and limits
What the trials found
In 140 pregnant women eating about 360 mg choline a day, 750 mg phosphatidylcholine a day or placebo from 18 weeks to 90 days after birth made no significant difference to infant memory, language or development at 10 and 12 months. In a controlled-feeding study of 26 women, those given 930 mg choline a day in the third trimester had infants with faster reaction times than those given 480 mg a day (13 per group). A 7-year follow-up of 20 of those children found better sustained attention in the 930 mg group. A 2025 systematic review of 4 randomised trials and 5 observational studies found most outcomes did not support benefit and called the evidence insufficient.
Results
Mixed and small. No clear evidence that extra choline in pregnancy improves a child's brain development when mothers already eat moderate amounts.
Effect sizes as reported
Capsule trial: no significant difference. Feeding study: faster mean reaction time with 930 versus 480 mg a day; follow-up: sustained attention score p = 0.02.
Why this rating
The 2025 review's own conclusion is insufficient evidence. The positive studies are tiny (13 per group, 20 children) and the larger trial was null.
Form and dose studied
Phosphatidylcholine capsule in one trial; the form is not stated in the abstract of the feeding study. Amounts are in the studies table; they are research designs, not advice.
Who was studied
Pregnant women, mostly eating moderate choline already; their infants and children.
Limits
Few trials, very small groups, many outcomes tested, short follow-up in the larger trial.
Why researchers looked
Choline moves to the baby through the placenta and in breast milk, so researchers ask whether more helps brain development.
Traditional use
Not a traditional use; this is a modern nutrition question.
Proposed mechanism Animal hypothesis
Not established. Animal studies suggest maternal choline can affect offspring brain development (stated in the trial abstracts), but this has not been shown in people.
A proposed mechanism does not show that the effect happens in people.
The Institute of Medicine's upper limit for pregnancy is the same as for other adults; see the Safety tab. Ask a doctor or midwife about supplements in pregnancy.
Memory and thinking in adults
Mixed findingsCholine makes acetylcholine, a brain messenger, so it is sold for memory. In healthy young adults, a single large dose of choline bitartrate did not improve memory in three experiments. A 2023 review of memory supplements found some evidence for choline but said the marketing claims lack a solid scientific foundation.
2 studiesCholine bitartrate in the trial. The review does not say which forms.
Studies, doses and limits
What the trials found
In three double-blind, placebo-controlled experiments in healthy young students (28, 26 and 40 people), a single dose of choline bitartrate about an hour before testing did not improve visuospatial working memory, picture memory or verbal working memory, and Bayesian analysis strongly supported no effect. The 2023 review of over-the-counter memory supplements found some current evidence of memory benefit for choline, but it concluded that brain supplements as a group lack a solid scientific foundation and need rigorous, longer studies.
Results
No benefit from a single dose in healthy young adults. Long-term use, older adults and people with low choline were not covered by the trial read.
Effect sizes as reported
No significant effect in any of the three experiments.
Why this rating
Mixed: a clear null result for single-dose bitartrate in young adults, against a narrative review that reports some evidence without details in the abstract.
Form and dose studied
Choline bitartrate in the trial. The review does not say which forms.
Who was studied
Healthy young adults (trial); mixed populations (review).
Limits
Single dose, young students, short test window. The review is narrative and its abstract has no numbers for choline.
Why researchers looked
Acetylcholine is involved in memory, so people hope more choline means a better memory.
Traditional use
A modern supplement idea, built on the acetylcholine link.
Proposed mechanism Theoretical
Choline is a raw material for acetylcholine. Whether extra choline raises acetylcholine in the brain of well-fed adults is not shown in the studies read.
A proposed mechanism does not show that the effect happens in people.
See the Safety tab for side effects at high intakes.
TMAO and heart disease risk
Very low certaintyGut bacteria turn some choline into trimethylamine, which the liver converts to TMAO. High blood TMAO is linked to more heart events and death in observational studies, and in mice choline and TMAO promoted artery disease. No trial has shown that choline supplements raise heart disease in people. This is a possible concern, not a proven harm, and it is not a benefit.
4 studiesMostly blood levels; supplement forms in the two crossover studies.
Studies, doses and limits
What the trials found
A 2017 meta-analysis of 17 studies (26,167 people) found high TMAO linked to more deaths (hazard ratio 1.91, very different results between studies) and more major cardiovascular events (1.67). A 2011 study linked blood choline, TMAO and betaine to cardiovascular risk in a clinical cohort and showed promotion of atherosclerosis in mice only. In the crossover studies of supplements, TMAO rose after water-soluble forms in 6 men but showed no significant change from baseline in 23 adults after 4 weeks of choline bitartrate.
Results
TMAO is a risk marker in observational studies. Whether taking choline pills raises heart risk through TMAO has not been tested in a trial of heart outcomes.
Effect sizes as reported
TMAO and death HR 1.91 (95% CI 1.40 to 2.61); events HR 1.67 (1.33 to 2.11); RR 1.07 per 10 micromole/L.
Why this rating
Very low for any effect of choline supplements on heart risk: the evidence is observational for TMAO and mouse-based for cause, and the supplement studies measured only TMAO.
Form and dose studied
Mostly blood levels; supplement forms in the two crossover studies.
Who was studied
Adult cohorts with heart disease risk; healthy men; adults with metabolic syndrome.
Limits
TMAO also comes from fish and other foods. Observational links cannot show cause. Results differ widely between studies.
Why researchers looked
Choline supplements raise TMAO in some studies, and TMAO is a heart risk marker.
Proposed mechanism Animal and human observational
Gut bacteria break down choline and phosphatidylcholine to trimethylamine; the liver makes TMAO. In mice, choline or TMAO promoted atherosclerosis and the effect needed gut bacteria (2011 study).
A proposed mechanism does not show that the effect happens in people.
See the Safety tab. People with heart or kidney disease should ask a doctor before taking choline supplements.
Choline intake and death or heart disease (observational)
Very low certaintyLarge cohort studies suggest that people with higher choline in food or blood had somewhat higher risk of death or heart disease. These are associations, probably muddied by what else those people eat, and they do not show that choline causes harm. They also do not show it is safe to take more.
2 studiesDietary choline (food) and blood choline; not pills.
Studies, doses and limits
What the trials found
A 2024 meta-analysis of 6 cohorts (482,778 people) linked each 100 mg a day higher dietary choline to 6% higher risk of death from any cause and 11% higher risk of cardiovascular death, with large differences between studies. In the CARDIA cohort of 3,444 adults followed 19 years, higher blood choline was linked to more cardiovascular disease (HR 1.24 per standard-deviation unit), while TMAO and betaine were not linked overall.
Results
Associations in the harmful direction. Not a measure of supplements.
Effect sizes as reported
All-cause death RR 1.06 (1.03 to 1.10); cardiovascular death RR 1.11 (1.06 to 1.16) per 100 mg a day; CARDIA HR 1.24 (1.09 to 1.40).
Why this rating
Very low because cohorts cannot show cause, differences between studies are large, and only six cohorts were pooled.
Form and dose studied
Dietary choline (food) and blood choline; not pills.
Who was studied
Adults in large cohorts.
Limits
Choline comes with other foods; confounding is likely. Authors ask for better-designed studies.
Why researchers looked
Choline-rich foods such as eggs and meat have been debated for heart health.
Proposed mechanism Unproven
Not established. TMAO is one proposed route.
A proposed mechanism does not show that the effect happens in people.
Stated here because it points in the opposite direction to a benefit; it is not a reason to avoid food choline.
Endurance exercise
Not enough evidenceBlood choline falls during very long, hard exercise, so choline has been tried for endurance. A 2008 review concluded that supplements might help only in activities that push blood choline below normal. No recent trials were read.
2 studiesNot stated in the abstract.
Studies, doses and limits
What the trials found
The 2008 review says most people eat adequate choline, that only strenuous prolonged exercise seems to lower blood choline, and that oral choline might raise endurance only in activities that lower circulating choline below normal. The abstract gives no numbers. The controlled low-choline study also found muscle damage in people deprived of choline, which is a deficiency finding.
Results
No clear benefit shown for most athletes.
Effect sizes as reported
No numbers in the abstract.
Why this rating
Based on a 2008 narrative review with no pooled numbers; individual trials were not read.
Who was studied
Endurance athletes (review).
Limits
Old narrative review. Abstract only.
Why researchers looked
Choline is used by muscles and nerves, and prolonged exercise can lower blood choline.
Traditional use
Sold to athletes; no traditional use.
Proposed mechanism Proposed
Not established. The review proposes that exercise may increase demand for choline.
A proposed mechanism does not show that the effect happens in people.
See the Safety tab.
Common fatty liver disease
Not enough evidenceMissing choline causes fatty liver, but most fatty liver in clinics has other causes. This page found no trial showing that choline supplements treat common fatty liver disease.
3 studiesNot applicable.
Studies, doses and limits
What the trials found
The trials found were in choline-deficient settings: fatty liver in a low-choline diet study and in adults on intravenous feeding. No trial in people with common fatty liver disease was read.
Results
No evidence either way for common fatty liver disease.
Why this rating
No relevant trial was read.
Limits
A single PubMed search did not find a usable trial; absence from this page is not proof of absence.
Why researchers looked
Because choline moves fat out of the liver, people ask whether it treats fatty liver.
Proposed mechanism Theoretical
Choline is needed for phosphatidylcholine, which helps carry fat out of the liver (stated in the Institute of Medicine report). Whether this applies to common fatty liver disease is not shown.
A proposed mechanism does not show that the effect happens in people.
People with liver disease may be more sensitive to high choline (Institute of Medicine); ask a doctor.
Connections to the rest of health
How Choline supplement forms connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.
Explore every connection: goals, body systems, organs, symptoms, genes
A. Wellness goals
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Balanced Nutrition | High certainty | Essential nutrient: liver and muscle when choline is short: Choline is a nutrient the body needs to move fat out of the liver, build cell membranes and make a nerve messenger called acetylcholine. When choline was withheld in controlled studies, many healthy adults developed fatty liver or muscle damage. Choline given to people fed by vein reversed liver changes. These are deficiency findings, not proof that extra choline helps people who eat enough. | 20 7 3 2 | |
| Liver Support | High certainty | Essential nutrient: liver and muscle when choline is short: Choline is a nutrient the body needs to move fat out of the liver, build cell membranes and make a nerve messenger called acetylcholine. When choline was withheld in controlled studies, many healthy adults developed fatty liver or muscle damage. Choline given to people fed by vein reversed liver changes. These are deficiency findings, not proof that extra choline helps people who eat enough. | 20 7 3 2 | |
| Balanced Nutrition | High certainty | Food sources of choline: Most choline in food is phosphatidylcholine. Eggs, liver, meat, fish, soybeans and peanuts are among the richer sources. Amounts are from USDA food tables; pills are a different thing. | 22 20 17 | |
| Balanced Nutrition | Low certainty | How the supplement forms compare in the blood: Choline is sold as choline bitartrate, choline chloride, lecithin (phosphatidylcholine) and related compounds. In a very small crossover study, four forms raised blood choline about the same amount. The three water-soluble forms (chloride, bitartrate and GPC) quickly raised a blood marker called TMAO; egg phosphatidylcholine did not. What this means for health is not known. | 4 15 20 | |
| Womens Wellness | Not enough evidence | Pregnancy and a child's brain development: Official intake figures are higher in pregnancy and breastfeeding because the baby takes choline. Whether extra choline in pregnancy improves a child's thinking is not settled: a 2025 review found the evidence insufficient either way. A phosphatidylcholine capsule did not change infant memory or language at 10 and 12 months; a small controlled-feeding study found some benefits for the higher-choline group. | 6 5 1 8 20 | |
| Brain Health | Mixed findings | Memory and thinking in adults: Choline makes acetylcholine, a brain messenger, so it is sold for memory. In healthy young adults, a single large dose of choline bitartrate did not improve memory in three experiments. A 2023 review of memory supplements found some evidence for choline but said the marketing claims lack a solid scientific foundation. | 10 9 | |
| Memory Support | Mixed findings | Memory and thinking in adults: Choline makes acetylcholine, a brain messenger, so it is sold for memory. In healthy young adults, a single large dose of choline bitartrate did not improve memory in three experiments. A 2023 review of memory supplements found some evidence for choline but said the marketing claims lack a solid scientific foundation. | 10 9 | |
| Heart Health | Very low certainty | TMAO and heart disease risk: Gut bacteria turn some choline into trimethylamine, which the liver converts to TMAO. High blood TMAO is linked to more heart events and death in observational studies, and in mice choline and TMAO promoted artery disease. No trial has shown that choline supplements raise heart disease in people. This is a possible concern, not a proven harm, and it is not a benefit. | 12 16 4 15 | |
| Heart Health | Very low certainty | Choline intake and death or heart disease (observational): Large cohort studies suggest that people with higher choline in food or blood had somewhat higher risk of death or heart disease. These are associations, probably muddied by what else those people eat, and they do not show that choline causes harm. They also do not show it is safe to take more. | 13 14 | |
| Physical Stamina | Not enough evidence | Endurance exercise: Blood choline falls during very long, hard exercise, so choline has been tried for endurance. A 2008 review concluded that supplements might help only in activities that push blood choline below normal. No recent trials were read. | 11 7 | |
| Liver Support | Not enough evidence | Common fatty liver disease: Missing choline causes fatty liver, but most fatty liver in clinics has other causes. This page found no trial showing that choline supplements treat common fatty liver disease. | 3 7 20 |
B. Body systems
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Whole Body | Biological association | High certainty | Studied for: Essential nutrient: liver and muscle when choline is short Studied for: Food sources of choline | 20 7 3 2 22 17 4 15 |
| Hepatic System | Biological association | High certainty | Studied for: Essential nutrient: liver and muscle when choline is short Studied for: Common fatty liver disease | 20 7 3 2 |
| Nervous System | Biological association | Not enough evidence | Studied for: Pregnancy and a child's brain development Studied for: Memory and thinking in adults | 6 5 1 8 20 10 9 |
| Cardiovascular System | Biological association | Very low certainty | Studied for: TMAO and heart disease risk Studied for: Choline intake and death or heart disease (observational) | 12 16 4 15 13 14 |
| Musculoskeletal System | Biological association | Not enough evidence | Studied for: Endurance exercise | 11 7 |
E. Health conditions
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Trimethylaminuria | Authoritative guidance | A rare condition that causes fishy body odour; the Institute of Medicine lists it as a group at higher risk with choline at the upper level. Preparation or compound: Choline supplements |
20 | |
| Choline deficiency | Clinical trial evidence | Withholding choline caused fatty liver or muscle damage in most men and postmenopausal women in a controlled study. Preparation or compound: Dietary choline |
7 3 | |
| Trimethylaminuria | Adverse effect or risk | Authoritative guidance | A rare condition that causes fishy odour; listed as a higher-risk group. Preparation or compound: Choline supplements |
20 |
I. Biomarkers
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| TMAO | Observational | Water-soluble choline forms raised TMAO in one small study; high TMAO is linked to heart risk in observational studies. Preparation or compound: Choline bitartrate, chloride and GPC |
4 12 | |
| Plasma free choline (blood choline) | Biological association | Low certainty | Measured in trials: higher with supplements. A lab change is not the same as a health benefit. | 2 4 |
| Liver fat on CT scan | Biological association | Low certainty | Measured in trials: less liver fat. A lab change is not the same as a health benefit. | 3 2 |
| Liver enzymes (ALT, AST) | Biological association | Low certainty | Measured in trials: lower when choline was missing from the feeding solution. A lab change is not the same as a health benefit. | 3 20 |
| TMAO (trimethylamine N-oxide) | Biological association | Low certainty | Measured in trials: higher after water-soluble choline forms in one study; no change in another. A lab change is not the same as a health benefit. | 4 15 12 |
| Blood choline and later cardiovascular disease | Biological association | Very low certainty | Measured in trials: higher level linked to more events. A lab change is not the same as a health benefit. | 14 |
| Plasma lutein and zeaxanthin | Biological association | Low certainty | Measured in trials: higher after eggs, not after choline bitartrate. A lab change is not the same as a health benefit. | 15 |
K. Biological pathways
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Betaine | Preliminary mechanism | Human | Choline is converted to betaine, which takes part in homocysteine handling (existing summary; not re-read). | 4 |
| Folate | Preliminary mechanism | Human | Choline need is influenced by folate and methionine supply (Institute of Medicine). | 20 7 |
L. Active compounds
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Choline bitartrate | Biological association | Human | Named by the Institute of Medicine as a supplement form. It raised blood choline similarly to other forms in a small crossover study and was tested in memory and metabolic syndrome trials. | 20 4 15 |
| Choline chloride | Biological association | Human | A supplement form used in older clinical studies and added to intravenous feeding in one trial. | 20 3 4 |
| Phosphatidylcholine (lecithin) | Biological association | Human | The main food form of choline. Egg phosphatidylcholine peaked later in blood and did not raise TMAO in a 6-man study; lecithin raised blood choline in a trial of adults fed by vein. | 20 4 2 6 |
| Alpha-glycerophosphocholine (alpha-GPC) | Biological association | Human | Included in the 6-man crossover study; it raised TMAO like the other water-soluble forms. It has its own page with citicoline. | 4 |
Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 26, 2026).
Evidence at a glance: what the research found for 9 outcomes
Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.
The evidence
The research centre for Choline supplement forms. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.
Evidence by outcome
Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).
How we rate evidence
High certainty
Several well-run trials or reviews agree; further research is unlikely to change the picture much.
Moderate certainty
Good trials point the same way, but some doubt remains.
Low certainty
Small, short or inconsistent trials. The finding could change with better research.
Very low certainty
Very little or very weak human data. Treat as a possibility only.
Mixed findings
Trials or reviews disagree with each other.
Not enough evidence
Not enough human research to say either way.
Evidence against
Good research found no benefit, or found harm.
We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We started from our existing choline summary, read the 1998 US Institute of Medicine choline chapter and the FDA label table, checked food values in the USDA SR Legacy data, and re-read PubMed abstracts for trials, reviews and cohorts. Only abstracts were read for studies. The NIH Office of Dietary Supplements and EFSA pages were blocked and are marked unread.
Study library: every study we checked 22
| Study | Design | People | Product, dose, length | Result |
|---|---|---|---|---|
| Bahnfleth 2022 Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J · PMID 34962672 · DOI |
Randomised controlled trial |
20 20 children, aged 7, whose mothers took part in the controlled feeding trial in the third trimester |
Choline in a tightly controlled diet Controlled feeding; form of choline not stated in the abstract 480 mg choline a day versus 930 mg choline a day for the mother in late pregnancy Third trimester; children tested at age 7 · vs 480 mg a day group |
Children in the 930 mg group scored better on the main attention score (p = 0.02) and kept up their correct hits better over the 12-minute session. There were no group differences for false alarms, omissions or off-task behaviour. Better sustained-attention score with 930 mg (p = 0.02) (Not given in the abstract) Methods, limits and fundingOutcomes: Sustained attention (a signal detection task) Limitations: Only 20 children, one main test, and a group difference in a lab task; this does not show better school results. Read from the abstract only. Funding and conflicts: PubMed lists US National Institutes of Health extramural and US government support. Read: abstract |
| Buchman 1992 Lecithin increases plasma free choline and decreases hepatic steatosis in long-term total parenteral nutrition patients. Gastroenterology · PMID 1551541 |
Randomised controlled trial |
15 Adults on long-term home parenteral nutrition with low plasma free choline; half had fatty liver |
Oral lecithin (a phosphatidylcholine-rich product) Lecithin by mouth 6 weeks · vs Placebo |
Plasma free choline rose by 53.4% at 2 weeks with lecithin and stayed up at 6 weeks. In the placebo group it fell by 25.4% at 6 weeks. Liver fat fell steadily in the lecithin group (liver-spleen density up 7.5 units at 2 weeks and 13.8 at 6 weeks); changes in the placebo group were not significant. Plasma free choline +53.4% (lecithin) versus -25.4% (placebo, week 6) (Not given in the abstract (p = 0.04 at 2 weeks for the rise)) Methods, limits and fundingOutcomes: Plasma free choline; liver fat (CT liver-spleen density) Limitations: A very small trial in people on intravenous feeding. The abstract does not give the lecithin amount. Read from the abstract only. Funding and conflicts: PubMed lists US Public Health Service research support. Read: abstract |
| Buchman 2001 Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J Parenter Enteral Nutr · PMID 11531217 · DOI |
Randomised controlled trial |
15 Adults who got at least 80% of their nutrition through a vein (parenteral nutrition) and had liver abnormalities |
Choline chloride added to the intravenous feeding solution Added to intravenous nutrition (not an oral product) 2 g choline chloride added to the feeding solution for the treated group 24 weeks, with follow-up to week 34 · vs Usual intravenous feeding without added choline |
Liver density on CT improved from week 4 in the choline group (13.3 versus 5.8 Hounsfield units, p = 0.04). ALT fell compared with placebo at several time points, and AST by week 24. Fatty liver came back by week 34, 10 weeks after choline was stopped. Liver density gain 13.3 +/- 5.0 HU with choline versus 5.8 +/- 5.2 HU with placebo at week 4 (p = .04 (no confidence interval in the abstract)) Methods, limits and fundingOutcomes: Liver fat on CT scan; liver enzymes (ALT, AST, alkaline phosphatase) Limitations: Only 15 people, all on long-term intravenous feeding, so it does not apply to people who eat normally. Intravenous, not oral. Read from the abstract only. Funding and conflicts: PubMed lists US government (PHS) research support. Read: abstract |
| Böckmann 2022 Differential metabolism of choline supplements in adult volunteers. Eur J Nutr · PMID 34287673 · DOI |
Randomised crossover trial |
6 Six healthy adult men |
Four choline supplements compared: choline chloride, choline bitartrate, alpha-glycerophosphocholine (GPC) and egg phosphatidylcholine (PC) Single doses of each form, taken at least 1 week apart, in random order A single dose of 550 mg choline equivalent of each form Blood taken over 6 hours after each dose · vs Each person took all four forms |
Blood choline over time was not different between the four forms. Choline peaked latest for egg PC (about 3 hours). All four raised betaine in a similar way. The three water-soluble forms (chloride, bitartrate and GPC) quickly raised TMAO; egg PC did not. No difference in choline AUC between forms; TMAO rose after the water-soluble forms but not after egg PC (Medians and ranges are in the paper; not in the abstract) Methods, limits and fundingOutcomes: Blood choline, betaine and TMAO; total phosphatidylcholine Limitations: Only 6 men and a single dose each, so it says little about long-term use. TMAO is a blood marker, not a health outcome. Read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Registration: DRKS00020454 Read: abstract |
| Caudill 2018 Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J · PMID 29217669 · DOI |
Randomised controlled trial |
26 26 women in the third trimester of pregnancy; 24 infants tested |
Choline in a tightly controlled diet Controlled feeding; form of choline not stated in the abstract 480 mg choline a day versus 930 mg choline a day From the third trimester until delivery · vs 480 mg a day group (about the US Adequate Intake) |
Infants of mothers in the 930 mg group had faster reaction times on average across the four ages. The authors say this suggests that about twice the recommended amount in late pregnancy improves infant processing speed. Faster mean reaction time with 930 mg than 480 mg a day (details in the paper) (Not given in the abstract) Methods, limits and fundingOutcomes: Infant information processing speed and visuospatial memory at 4, 7, 10 and 13 months Limitations: Very small (13 per group), one measure of reaction time, and the amounts tested are a research design, not advice. Read from the abstract only. Funding and conflicts: PubMed lists non-US-government and US government research support. Read: abstract |
| Cheatham 2012 Phosphatidylcholine supplementation in pregnant women consuming moderate-choline diets does not enhance infant cognitive function: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr · PMID 23134891 · DOI |
Randomised controlled trial |
140 140 pregnant women eating about 360 mg of choline a day in food; 99 of their infants were tested |
Phosphatidylcholine supplement Phosphatidylcholine capsule 750 mg phosphatidylcholine a day From 18 weeks of pregnancy to 90 days after birth · vs Placebo (corn oil) |
The groups did not differ in any of the infant measures. The supplements were well tolerated. The authors say later effects are possible and that mothers eating much less choline might respond differently. No significant difference between groups (Not given in the abstract) Methods, limits and fundingOutcomes: Infant visuospatial memory, episodic memory, language and global development at 10 and 12 months Limitations: Infants were tested only up to 12 months. Women ate moderate amounts of choline already. Read from the abstract only. Funding and conflicts: PubMed lists US National Institutes of Health extramural support. Read: abstract |
| Fischer 2007 Sex and menopausal status influence human dietary requirements for the nutrient choline. Am J Clin Nutr · PMID 17490963 · DOI |
Randomised controlled trial |
57 26 men, 16 premenopausal women and 15 postmenopausal women, all healthy adults |
Choline withheld from food (a controlled low-choline diet), with or without folic acid Food (controlled diet); no choline supplement was tested Diet of 550 mg choline per 70 kg a day for 10 days, then under 50 mg per 70 kg a day for up to 42 days; folic acid 400 microgram a day in half of the people Up to 42 days on the low-choline diet · vs Same people before and during the low-choline diet; folic acid versus none |
When choline was withheld, 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage, against 44% of premenopausal women. Six men developed these signs while eating the US Adequate Intake. Organ function returned to normal when choline was added back. Folic acid did not change the response. Signs of organ dysfunction in 77% of men, 80% of postmenopausal women and 44% of premenopausal women (Not given in the abstract) Methods, limits and fundingOutcomes: Fatty liver (on MRI), muscle damage, and whether the problems reversed when choline was added back Limitations: A deprivation study, so it shows what happens without choline, not what a supplement does for people who eat enough. Small groups. Read from the abstract only. Funding and conflicts: PubMed lists US National Institutes of Health extramural research support. Read: abstract |
| Gould 2025 Choline During Pregnancy and Child Neurodevelopment: A Systematic Review of Randomized Controlled Trials and Observational Studies. Nutrients · PMID 40077755 · DOI |
Systematic review |
4 randomised trials and 5 observational studies of choline in pregnancy (20 publications) | Choline in pregnancy (supplements and dietary intake) Mixed |
Most outcomes in both the trials and the observational studies did not support better child brain development with higher prenatal choline. A few trial outcomes were better with choline but most were null. The authors conclude the evidence is insufficient to support or refute benefit. Insufficient evidence (authors' conclusion) (Not applicable) Methods, limits and fundingOutcomes: Child neurodevelopment tests Limitations: Critical limitations in the trials and observational studies, according to the authors. Read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| Hersant 2023 Over the Counter Supplements for Memory: A Review of Available Evidence. CNS Drugs · PMID 37603263 · DOI |
Narrative review |
Review of the 18 most common ingredients in 103 over-the-counter memory supplements | Memory supplement ingredients, including choline Mixed |
The authors found some current evidence of memory benefit for choline (and ashwagandha, curcumin, ginger, Lion's Mane, polyphenols, phosphatidylserine and turmeric) and no compelling evidence for several others. They conclude that brain supplements lack a solid scientific foundation for their marketing claims and that more rigorous, longer studies are needed. No numbers for choline in the abstract (Not applicable) Methods, limits and fundingOutcomes: Whether published studies support memory benefit for each ingredient Limitations: A narrative review, not a systematic one; the abstract does not say which choline studies were used or how strong they were. Read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| Lippelt 2016 No Acute Effects of Choline Bitartrate Food Supplements on Memory in Healthy, Young, Human Adults. PLoS One · PMID 27341028 · DOI |
Randomised crossover trial |
Healthy young students: 28, 26 and 40 people in three double-blind placebo-controlled experiments | Choline bitartrate Supplement (bitartrate), taken about 60 minutes before the tests 2.0 to 2.5 g of choline bitartrate, a single dose, in the experiments A single dose, tested 1 to 2 hours later · vs Placebo |
Choline did not improve memory in any of the tasks. Bayesian analysis strongly supported no effect. No significant memory benefit in any task (Not given in the abstract) Methods, limits and fundingOutcomes: Visuospatial working memory, declarative picture memory and verbal working memory Limitations: Healthy young adults and a single dose, so it says nothing about long-term use or about older adults or people with low choline. Read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| Penry 2008 Choline: an important micronutrient for maximal endurance-exercise performance? Int J Sport Nutr Exerc Metab · PMID 18458362 · DOI |
Narrative review |
Review of studies linking endurance exercise and choline | Choline and oral choline supplements in endurance exercise Mixed |
The authors say most people eat enough choline, though current recommendations might be too low for some men. Only strenuous, prolonged exercise seems to lower blood choline, and oral choline might help endurance only in activities that push blood choline below normal. No numbers in the abstract (Not applicable) Methods, limits and fundingOutcomes: Whether choline supplements improve endurance performance Limitations: A narrative review from 2008 and not a trial; the abstract gives no pooled numbers. Read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| Schiattarella 2017 Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis. Eur Heart J · PMID 29020409 · DOI |
Systematic review meta analysis |
26167 17 clinical studies, 26,167 people, average follow-up 4.3 years |
Blood TMAO level (a gut-bacteria product of choline, carnitine and others); not a supplement trial Blood marker Average follow-up 4.3 years · vs Lower versus higher TMAO |
High TMAO was linked to more deaths (hazard ratio 1.91) and more major cardiovascular events (hazard ratio 1.67). Each 10 micromole per litre rise in TMAO went with 7.6% higher risk of death. The link held in all groups examined. All-cause death HR 1.91; major events HR 1.67; RR 1.07 per 10 micromole/L TMAO (Death 1.40 to 2.61 (I2 = 94%); events 1.33 to 2.11; dose-response 1.04 to 1.11) Methods, limits and fundingOutcomes: All-cause death; major cardiovascular and cerebrovascular events Limitations: Observational: it shows TMAO is a risk marker, not that choline supplements raise heart risk. Very large differences between studies for death (I2 94%). Read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| Sharifi-Zahabi 2024 Higher dietary choline intake is associated with increased risk of all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of cohort studies. Nutr Res · PMID 39341000 · DOI |
Systematic review meta analysis |
482778 6 cohort studies of dietary intake, 482,778 people; 57,235 deaths from any cause |
Choline from the usual diet (not supplements) Food Per 100 mg a day higher dietary intake Cohort follow-up (varies) · vs Lower versus higher intake |
Each 100 mg a day higher dietary choline went with 6% higher risk of death from any cause and 11% higher risk of death from cardiovascular disease. The authors note the small number of studies and the differences between them and ask for better-designed studies. All-cause death RR 1.06; cardiovascular death RR 1.11 per 100 mg/day (1.03 to 1.10 (I2 = 83.7%); 1.06 to 1.16 (I2 = 54.3%)) Methods, limits and fundingOutcomes: Death from any cause, from cardiovascular disease and from stroke Limitations: Observational, very different results between studies, and people who eat more choline-rich foods (eggs, meat) differ in other ways. It is about food, not pills. Read from the abstract only. Funding and conflicts: PubMed lists non-US-government research support. Read: abstract |
| Shea 2024 Choline metabolites and incident cardiovascular disease in a prospective cohort of adults: Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr · PMID 37865185 · DOI |
Prospective cohort |
3444 3,444 White and Black US adults aged 33 to 45 with no heart disease at the start; 221 events over 19 years |
Blood levels of choline, TMAO and betaine; not a supplement trial Blood markers 19 years · vs Lower versus higher levels |
Higher blood choline was linked to more cardiovascular disease (hazard ratio 1.24 per standard-deviation unit). TMAO and betaine were not linked overall. In people with lower kidney function, TMAO was linked to more disease and betaine to less. Plasma choline HR 1.24 per SD (1.09 to 1.40) Methods, limits and fundingOutcomes: Heart disease and stroke Limitations: Observational, so it cannot show cause. Blood choline can rise for many reasons. Read from the abstract only. Funding and conflicts: PubMed lists US National Institutes of Health extramural and other research support. Read: abstract |
| Thomas 2022 Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome. Nutrients · PMID 35334836 · DOI |
Randomised crossover trial |
23 Adults with metabolic syndrome |
Three eggs a day (phosphatidylcholine in food) versus a choline bitartrate supplement Whole eggs versus choline bitartrate Both arms supplied 400 mg choline equivalent a day 4 weeks per arm, after a 2-week washout · vs The two arms were compared with each other and with baseline |
Plasma TMAO did not differ between the egg and bitartrate arms compared with baseline. Gut bacteria diversity did not change. Plasma lutein and zeaxanthin rose after eggs, not after the bitartrate supplement. TMAO: no significant change from baseline in either arm (p > 0.05); lutein and zeaxanthin higher after eggs (p < 0.01) (Not given in the abstract) Methods, limits and fundingOutcomes: Gut bacteria, plasma TMAO, betaine, methionine, dimethylglycine, and plasma lutein and zeaxanthin Limitations: Small crossover trial of 4 weeks in people with metabolic syndrome. Read from the abstract only; funding is not stated there. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| Wang 2011 Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature · PMID 21475195 · DOI |
Mixed human and animal study human and mouse |
Human plasma cohort for the marker work; mice for the experiments | Dietary phosphatidylcholine and its metabolites choline, TMAO and betaine Metabolomics in people; choline and TMAO added to the diet of mice |
Three metabolites of phosphatidylcholine (choline, TMAO and betaine) were linked to cardiovascular risk in a large clinical cohort. In mice, feeding choline or TMAO promoted atherosclerosis, and the effect depended on gut bacteria. Association in people; causal effect shown in mice only (Not given in the abstract) Methods, limits and fundingOutcomes: Blood levels of choline, TMAO and betaine and their link to cardiovascular risk; atherosclerosis in mice Limitations: The causal evidence is from mice. In people it is an association between blood markers and risk. It does not test choline supplements in people. Read from the abstract only. Funding and conflicts: PubMed lists US National Institutes of Health extramural support. Read: abstract |
| Wiedeman 2018 Dietary Choline Intake: Current State of Knowledge Across the Life Cycle. Nutrients · PMID 30332744 · DOI |
Narrative review |
Review of choline recommendations, forms in food and intakes across life stages | Dietary choline in its water-soluble and lipid-soluble forms Food |
Choline is needed to make acetylcholine, betaine and phospholipids. Recommendations are Adequate Intakes for total choline. Food choline comes as water-soluble forms (free choline, phosphocholine, glycerophosphocholine) and lipid-soluble forms (phosphatidylcholine, sphingomyelin). Human milk is mostly water-soluble forms, later foods mostly lipid-soluble. No numbers in the abstract (Not applicable) Methods, limits and fundingOutcomes: Choline roles, dietary forms and recommendations Limitations: A narrative review; read from the abstract only. Funding and conflicts: Funding is not stated in the abstract. Read: abstract |
| s-efsa-2016-choline European Food Safety Authority: Dietary reference values for choline (2016) · Source |
Reference database n/a |
Methods, limits and fundingRead: not-read | ||
| s-fda-daily-values US Food and Drug Administration: Daily Value on the Nutrition and Supplement Facts Labels (content current as of 2024-03-05) · Source |
Reference database n/a |
Methods, limits and fundingRead: full-text | ||
| s-nam-iom-1998-choline Institute of Medicine (now National Academy of Medicine): Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, chapter 12 Choline (1998) · Source |
Reference database n/a |
Methods, limits and fundingRead: full-text | ||
| s-ods-choline NIH Office of Dietary Supplements: Choline fact sheet for health professionals · Source |
Reference database n/a |
Methods, limits and fundingRead: not-read | ||
| s-usda-sr-legacy-choline USDA FoodData Central, SR Legacy (April 2018 release): total choline (nutrient 1180) in common foods · Source |
Reference database n/a |
Methods, limits and fundingRead: full-text |
What we do not know yet
- No trial was read showing that extra choline helps people who already eat enough.
- No trial compared the supplement forms for liver, brain or heart outcomes.
- The NIH Office of Dietary Supplements and EFSA pages could not be read, so newer official statements are missing.
- No source was read on contamination or label accuracy of choline products.
- No trial tested choline pills for heart disease; TMAO results are mixed.
How new research is added
New studies are found by a saved PubMed search and placed in a review queue before the page changes.
Lab markers
What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".
Other 6
Plasma free choline (blood choline)
Higher with supplements in trials
The amount of unattached choline in blood plasma.
Low certaintyResults and what it means
Why it was measured
To see whether a supplement raises choline in the blood and whether people short of choline have low levels.
Statistical vs. clinical meaning
Shows that choline in these forms reaches the blood. It does not show a health benefit. There is no routine clinical test for choline status.
Safety implication
Higher blood choline was linked to cardiovascular disease in one cohort (observational); see the Evidence tab.
| Study | Result | People | Product |
|---|---|---|---|
| 2 | Oral lecithin raised plasma free choline by 53.4% at 2 weeks, while placebo fell 25.4% by 6 weeks | 15 adults on long-term intravenous feeding | Oral lecithin versus placebo |
| 4 | Same choline overall (AUC) after choline chloride, bitartrate, GPC and egg phosphatidylcholine; egg PC peaked later | 6 healthy men | Single doses of four forms |
Liver fat on CT scan
Less liver fat in trials
How dense the liver looks on a CT scan compared with the spleen; a lower liver density means more fat.
Low certaintyResults and what it means
Why it was measured
To see whether choline reverses fatty liver in people who are short of it.
Statistical vs. clinical meaning
A real effect in people whose choline was low, but with 15 people per trial and an unusual group, it should not be applied to people who eat normally.
Safety implication
None reported in the abstracts.
| Study | Result | People | Product |
|---|---|---|---|
| 3 | Liver density gain 13.3 versus 5.8 Hounsfield units at week 4 with choline versus placebo; fat returned 10 weeks after stopping | 15 adults on parenteral nutrition | Choline chloride added to the feeding solution |
| 2 | Liver-spleen density rose 7.5 and 13.8 units at 2 and 6 weeks with lecithin; placebo changes not significant | 15 adults on home parenteral nutrition | Oral lecithin |
Liver enzymes (ALT, AST)
Lower when choline was missing from the feeding solution in trials
Blood enzymes that rise when liver cells are stressed or damaged.
Low certaintyResults and what it means
Why it was measured
The official Adequate Intake was set using the prevention of liver damage measured by ALT.
Statistical vs. clinical meaning
Supports the idea that liver enzymes track choline status in deficiency.
Safety implication
None reported.
| Study | Result | People | Product |
|---|---|---|---|
| 3 | ALT fell more with choline than placebo at weeks 6, 12, 20 and 24; AST by week 24 | 15 adults on parenteral nutrition | Choline chloride in the feeding solution |
| 20 | The Institute of Medicine used prevention of liver damage, measured by serum ALT, as the main criterion for the Adequate Intake | Healthy adults (older studies) | Not applicable |
TMAO (trimethylamine N-oxide)
Higher after water-soluble choline forms in one study; no change in another in trials
A substance made when gut bacteria and the liver process choline, carnitine and other nutrients.
Low certaintyResults and what it means
Why it was measured
TMAO is a proposed risk marker for heart disease.
Statistical vs. clinical meaning
Unclear. The two supplement studies disagree, and TMAO as a risk marker is observational.
Safety implication
A possible reason for caution, not a proven harm.
| Study | Result | People | Product |
|---|---|---|---|
| 4 | TMAO rose quickly after choline chloride, bitartrate and GPC but not after egg phosphatidylcholine | 6 healthy men | Single doses of four forms |
| 15 | No significant change in TMAO from baseline with three eggs a day or choline bitartrate for 4 weeks | 23 adults with metabolic syndrome | Eggs versus choline bitartrate |
| 12 | High TMAO linked to death (HR 1.91) and major events (HR 1.67) in observational studies | 17 studies, 26,167 people | Not applicable |
Blood choline and later cardiovascular disease
Higher level linked to more events in trials
A person's blood choline level compared with whether they later had heart disease or stroke.
Very low certaintyResults and what it means
Why it was measured
To see whether higher blood choline predicts heart disease.
Statistical vs. clinical meaning
An association from one cohort; it does not show that choline causes heart disease.
Safety implication
Not a reason to avoid food choline.
| Study | Result | People | Product |
|---|---|---|---|
| 14 | HR 1.24 per standard-deviation unit of plasma choline (95% CI 1.09 to 1.40) | 3,444 adults followed 19 years | Not applicable |
Plasma lutein and zeaxanthin
Higher after eggs, not after choline bitartrate in trials
Blood levels of two yellow plant pigments found in eggs and leafy vegetables.
Low certaintyResults and what it means
Why it was measured
Eggs supply choline together with other nutrients; this shows a difference between food and a pill.
Statistical vs. clinical meaning
Shows that a food with phosphatidylcholine brings other nutrients that a pill does not; it is not a choline effect.
Safety implication
None.
| Study | Result | People | Product |
|---|---|---|---|
| 15 | Plasma lutein and zeaxanthin rose after three eggs a day compared with baseline or bitartrate (p < 0.01) | 23 adults with metabolic syndrome | Eggs versus choline bitartrate |
Safety
What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.
Main points to know 4
- Very large amounts cause low blood pressure, sweating, fishy body odour and stomach upset. The US Institute of Medicine (1998) says the main harm from too much choline is low blood pressure, with sweating, drooling, vomiting and diarrhoea and a fishy body odour also reported. It set a Tolerable Upper Intake Level of 3.5 g a day of choline for adults, using a lowest-effect level of about 7.5 g a day. This is a regulator statement, not advice to take choline. Authoritative guidance 20
- Some people should be more careful. The Institute of Medicine lists trimethylaminuria (a rare gene condition that causes fishy body odour), kidney disease, liver disease, depression and Parkinson's disease as conditions in which choline at the upper level may carry a higher risk of harm. It says supplements may worsen Parkinson's symptoms, based on mild signs seen at very high amounts in people with tardive dyskinesia. Ask a doctor before using a choline supplement if you have one of these. Authoritative guidance 20
- A possible heart concern is not settled. Higher blood TMAO and higher blood choline were linked to heart disease or death in observational studies, and higher dietary choline was linked to higher death risk in a 2024 meta-analysis. The studies cannot show cause and did not test pills. TMAO rose after water-soluble choline forms in one tiny study and did not change in another. Observational and small trials 12 14 13 4 15
- Check the label: forms supply different amounts of choline. The Institute of Medicine says the upper level applies to the weight of the choline part of a product, and that choline chloride contains more choline by weight than choline bitartrate. It also says lecithin usually contains about 25% phosphatidylcholine, or 3 to 4% choline by weight. Reading a label can therefore be misleading; ask a pharmacist. Authoritative guidance 20
Side effects 4
| Effect | How often | Severity and recovery | Evidence |
|---|---|---|---|
| Low blood pressure The 1998 report cites a pilot study of seven patients with Alzheimer-type dementia who developed low blood pressure on large amounts of choline chloride. | The Institute of Medicine based its upper level on this effect, from a case report and small studies with very large amounts. No frequency for normal use was available. | Can cause dizziness or fainting Not described in the sources read. | Authoritative guidance 20 |
| Sweating, drooling, vomiting and diarrhoea These are described as cholinergic effects, meaning effects like those of the nerve messenger acetylcholine. | Reported in older studies with very large amounts, such as 10 to 16 g a day of choline chloride in people with movement disorders. No frequency for ordinary supplement use was found. | Usually uncomfortable rather than dangerous Not described. | Authoritative guidance 20 |
| Fishy body odour Caused by bacteria turning choline into trimethylamine, which is then excreted. | Reported in the same high-amount studies; more likely in people with trimethylaminuria. The report says lecithin makes little trimethylamine, so it does not carry the same risk of fishy odour. | Not harmful in itself but often distressing Not described. | Authoritative guidance 20 |
| No side effects reported at the amounts used in the pregnancy capsule trial One trial, with a limited follow-up period; it does not prove safety. | In 140 pregnant women, phosphatidylcholine supplements were well tolerated. | Not applicable Not applicable | Randomised controlled trial 6 |
Liver
The Institute of Medicine says choline doses orders of magnitude above food intake have been associated with body odour, sweating, salivation, low blood pressure and liver toxicity in humans, and that people with liver disease may be more sensitive because their blood choline rises more after supplements. A liver-safety reference (LiverTox) was not opened for this page. Missing choline, not too much, is what caused fatty liver in the studies read. 20
How often. No frequency was found.
Monitoring. No agency monitoring advice was found.
This is a safety connection. It is not evidence that Choline supplement forms supports liver health.
Medicines and supplements 5
| With | Why it matters | Importance | Evidence | What to do |
|---|---|---|---|---|
| Medicines and conditions that affect the cholinergic (acetylcholine) system, for example Alzheimer's medicines and anticholinergic medicines prescription | Choline is a raw material for acetylcholine, so an effect on these medicines is theoretically possible. | No source read tested or described this interaction. It is listed as a question to ask a pharmacist, not as a finding. | Theoretical Not enough evidence | Ask a doctor or pharmacist if you take any of these. |
| Folate (folic acid) and methionine in the diet nutrient | The Institute of Medicine says the amount of choline needed is influenced by the supply of methionine and folate. In a controlled study, 400 microgram folic acid a day did not change the response to a low-choline diet. | Folic acid did not prevent fatty liver or muscle damage when choline was withheld. | Randomised controlled trial and authoritative guidance Low certainty 20 7 | No action is advised here. |
| Other choline-containing supplements (citicoline, alpha-GPC and lecithin) supplement | Citicoline, alpha-GPC and phosphatidylcholine all supply choline; taking several adds their choline together. | The upper level applies to total choline. How much choline each product supplies is rarely stated clearly on labels (see key safety). | Authoritative guidance Low certainty 20 | Ask a pharmacist to add up the choline from all products. |
| Trimethylaminuria, kidney disease and liver disease condition | People with kidney or liver disease have higher blood choline after supplements; trimethylaminuria causes fishy odour from trimethylamine. | These are the groups the Institute of Medicine says may be at higher risk at upper-level intakes. | Authoritative guidance Low certainty 20 | Ask a doctor before using a choline supplement. |
| Parkinson's disease and depression condition | Mild Parkinson-like signs appeared at very high amounts in people with tardive dyskinesia, and the report says large amounts have in rare cases been linked to depression. | The report says supplemental choline may worsen Parkinson's symptoms; this is an inference from small, old studies. | Authoritative guidance Very low certainty 20 | Ask a doctor first. |
Who should check first 5
| Situation | Advice | Evidence |
|---|---|---|
| Pregnancy and breastfeeding | The Institute of Medicine's Adequate Intake is higher in pregnancy (450 mg a day for ages 14 and over) and during breastfeeding (550 mg a day), because choline passes to the baby and into milk. These are intake targets, not advice to take pills. The Tolerable Upper Intake Level in pregnancy and breastfeeding is 3 g a day (ages 14 to 18) and 3.5 g a day (19 and over). Trials of supplements in pregnancy were small and did not show clear benefit for the child. Ask a doctor or midwife before any supplement. | Authoritative guidance and randomised controlled trial 20 6 |
| Infants and children | The Institute of Medicine could not set an upper level for infants; their choline should come from milk, formula and food only. Upper levels for children are 1 g a day (ages 1 to 8), 2 g a day (9 to 13) and 3 g a day (14 to 18). Do not give a child a choline supplement without a doctor's or pharmacist's advice. | Authoritative guidance 20 |
| Trimethylaminuria, kidney disease, liver disease, depression or Parkinson's disease | The Institute of Medicine names these as conditions that may raise the risk of harm at upper-level intakes. Ask a doctor before using a choline supplement. | Authoritative guidance 20 |
| Heart disease or high TMAO risk | Observational links between TMAO, blood choline and heart disease exist (not proof of cause). People with heart disease should talk to their doctor before choline supplements. | Observational 12 14 |
| Allergy to eggs, soy or other source foods | No allergy information was read for choline products. Lecithin and phosphatidylcholine are often made from soy or egg, so check the label and ask a pharmacist if you have an allergy. | Gap |
Overdose, product quality and regulators
Summary. Choline is essential, but very large amounts cause low blood pressure, sweating and fishy body odour. The Institute of Medicine set the adult upper level at 3.5 g a day of choline, starting from a lowest-effect level of about 7.5 g a day.
Animal. The 1998 report says animal data supported a low degree of toxicity for choline. Details were not read.
High dose or long term signals. The report cites body odour, sweating, salivation, low blood pressure and liver toxicity at amounts far above food intake, and says no adequate data show a no-effect level. Long-term effects of ordinary supplements were not found in the sources read.
Overdose response. If someone has swallowed a lot of choline or has fainting, severe sweating or vomiting, get medical help or call poison control.
Genotoxicity. Not researched.
Contamination and label accuracy of choline products were not researched for this page. A 2023 review notes that in the United States the FDA does not approve dietary supplements for safety, effectiveness or labelling before they go on sale.
How much choline a product actually supplies. Forms differ: the Institute of Medicine says choline chloride contains more choline by weight than choline bitartrate, and lecithin contains about 3 to 4% choline by weight. The report says there are no reliable estimates of how much of these supplements people use. 20
Supplement regulation. The 2023 review of memory supplements says manufacturers are responsible for safety and truthful claims, and that the FDA often does not review supplements before sale. 9
| Body | Action | Date |
|---|---|---|
| Institute of Medicine / National Academy of Medicine (United States and Canada) (United States and Canada) | Adequate Intakes for choline: infants 0 to 6 months 125 mg a day, 7 to 12 months 150 mg, 1 to 3 years 200 mg, 4 to 8 years 250 mg, 9 to 13 years 375 mg, males 14 to 18 years 550 mg, females 14 to 18 years 400 mg, men 19 and over 550 mg, women 19 and over 425 mg, pregnancy 450 mg, breastfeeding 550 mg. Tolerable Upper Intake Levels: 1 g a day for ages 1 to 8, 2 g for 9 to 13, 3 g for 14 to 18, 3.5 g for adults including in pregnancy and breastfeeding; not set for infants. The critical effect for the upper level is low blood pressure, with fishy body odour as a second consideration. These are intake targets and limits, not advice to take pills. source | 1998 |
| US Food and Drug Administration (United States) | Lists a label Daily Value for choline of 550 mg in its reference table of Daily Values for the Nutrition and Supplement Facts labels. A Daily Value is a labelling figure, not a recommendation to take a supplement. source | 2024-03-05 |
When to get medical help
- Fainting, severe dizziness or very low blood pressure after taking a lot of choline: seek urgent medical help.
- Someone has swallowed a large amount of a choline product, or has heavy sweating, drooling, vomiting or watery diarrhoea afterwards: call poison control or emergency services.
- A child has swallowed a choline or lecithin product: call poison control or a doctor.
- Fishy body odour that is new or will not go away: stop the product and see a doctor.
- New tremor, stiffness or slowness in someone with Parkinson's disease, or worsening mood, after starting choline: stop it and see a doctor.
Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.
General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.
Frequently asked questions
What is choline?
What foods have choline?
What is the difference between choline bitartrate, chloride and phosphatidylcholine?
Is lecithin the same as a choline supplement?
Not automatically. The Institute of Medicine says lecithin usually contains about 25% phosphatidylcholine, or 3 to 4% choline by weight, so it supplies much less choline than a choline salt of the same weight.
What happens if you do not get enough choline?
In a controlled study, most men and postmenopausal women on a very low-choline diet developed fatty liver or muscle damage, and it reversed when choline was added back. True shortage is uncommon in people who eat normally; ask a doctor if you are concerned.
Does choline improve memory?
Does choline help a baby's brain in pregnancy?
Does choline help fatty liver?
What is TMAO and should I worry?
Can you take too much choline?
Yes. The Institute of Medicine says very large amounts cause low blood pressure, sweating, drooling, vomiting, diarrhoea and fishy body odour, and set an adult upper level of 3.5 g a day as a regulator limit. This is not advice to take any amount.
Is choline safe in pregnancy, for children and with other conditions?
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Editorial transparency
- Written by
- AlternativeMed editorial team. Research compiled with AI assistance, then checked against the sources listed.
- Medical review
- None. This page has not been reviewed by a physician or pharmacist.
- First published
- 2026-10-26
- Last substantive update
- 2026-10-26
- How we research
- We started from our existing choline summary, read the 1998 US Institute of Medicine choline chapter and the FDA label table, checked food values in the USDA SR Legacy data, and re-read PubMed abstracts for trials, reviews and cohorts. Only abstracts were read for studies. The NIH Office of Dietary Supplements and EFSA pages were blocked and are marked unread.
- How we rate evidence
- See "How we rate evidence" in the Evidence tab.
- Independence
- No product is promoted on this page. No affiliate links are shown. Trials of supplements may have manufacturer links not stated in abstracts.
Sources 22
Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.
- Bahnfleth CL, Strupp BJ, Caudill MA et al.. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial.. FASEB J. 2022. PMID 34962672. DOI 10.1096/fj.202101217R. (abstract)
- Buchman AL, Dubin M, Jenden D et al.. Lecithin increases plasma free choline and decreases hepatic steatosis in long-term total parenteral nutrition patients.. Gastroenterology. 1992. PMID 1551541. (abstract)
- Buchman AL, Ament ME, Sohel M et al.. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial.. JPEN J Parenter Enteral Nutr. 2001. PMID 11531217. DOI 10.1177/0148607101025005260. (abstract)
- Böckmann KA, Franz AR, Minarski M et al.. Differential metabolism of choline supplements in adult volunteers.. Eur J Nutr. 2022. PMID 34287673. DOI 10.1007/s00394-021-02637-6. (abstract)
- Caudill MA, Strupp BJ, Muscalu L et al.. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study.. FASEB J. 2018. PMID 29217669. DOI 10.1096/fj.201700692RR. (abstract)
- Cheatham CL, Goldman BD, Fischer LM et al.. Phosphatidylcholine supplementation in pregnant women consuming moderate-choline diets does not enhance infant cognitive function: a randomized, double-blind, placebo-controlled trial.. Am J Clin Nutr. 2012. PMID 23134891. DOI 10.3945/ajcn.112.037184. (abstract)
- Fischer LM, daCosta KA, Kwock L et al.. Sex and menopausal status influence human dietary requirements for the nutrient choline.. Am J Clin Nutr. 2007. PMID 17490963. DOI 10.1093/ajcn/85.5.1275. (abstract)
- Gould JF, Hines S, Best KP et al.. Choline During Pregnancy and Child Neurodevelopment: A Systematic Review of Randomized Controlled Trials and Observational Studies.. Nutrients. 2025. PMID 40077755. DOI 10.3390/nu17050886. (abstract)
- Hersant H, He S, Maliha P et al.. Over the Counter Supplements for Memory: A Review of Available Evidence.. CNS Drugs. 2023. PMID 37603263. DOI 10.1007/s40263-023-01031-6. (abstract)
- Lippelt DP, van der Kint S, van Herk K et al.. No Acute Effects of Choline Bitartrate Food Supplements on Memory in Healthy, Young, Human Adults.. PLoS One. 2016. PMID 27341028. DOI 10.1371/journal.pone.0157714. (abstract)
- Penry JT, Manore MM. Choline: an important micronutrient for maximal endurance-exercise performance?. Int J Sport Nutr Exerc Metab. 2008. PMID 18458362. DOI 10.1123/ijsnem.18.2.191. (abstract)
- Schiattarella GG, Sannino A, Toscano E et al.. Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis.. Eur Heart J. 2017. PMID 29020409. DOI 10.1093/eurheartj/ehx342. (abstract)
- Sharifi-Zahabi E, Soltani S, Asiaei S et al.. Higher dietary choline intake is associated with increased risk of all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of cohort studies.. Nutr Res. 2024. PMID 39341000. DOI 10.1016/j.nutres.2024.09.002. (abstract)
- Shea JW, Jacobs DR Jr, Howard AG et al.. Choline metabolites and incident cardiovascular disease in a prospective cohort of adults: Coronary Artery Risk Development in Young Adults (CARDIA) Study.. Am J Clin Nutr. 2024. PMID 37865185. DOI 10.1016/j.ajcnut.2023.10.012. (abstract)
- Thomas MS, DiBella M, Blesso CN et al.. Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.. Nutrients. 2022. PMID 35334836. DOI 10.3390/nu14061179. (abstract)
- Wang Z, Klipfell E, Bennett BJ et al.. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease.. Nature. 2011. PMID 21475195. DOI 10.1038/nature09922. (abstract)
- Wiedeman AM, Barr SI, Green TJ et al.. Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.. Nutrients. 2018. PMID 30332744. DOI 10.3390/nu10101513. (abstract)
- . European Food Safety Authority: Dietary reference values for choline (2016). . . (not-read)
- . US Food and Drug Administration: Daily Value on the Nutrition and Supplement Facts Labels (content current as of 2024-03-05). . . (full-text)
- . Institute of Medicine (now National Academy of Medicine): Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, chapter 12 Choline (1998). . . (full-text)
- . NIH Office of Dietary Supplements: Choline fact sheet for health professionals. . . (not-read)
- . USDA FoodData Central, SR Legacy (April 2018 release): total choline (nutrient 1180) in common foods. . . (full-text)
Where to buy
Check the label first. Whatever you buy, look for these:
- The amount of the active ingredient per serving, not just the front-label claim
- A third-party testing mark (USP, NSF or ConsumerLab)
- Other ingredients and allergens
- Ask a pharmacist about interactions with your medicines
Talk to a pharmacist or doctor before you start any supplement, especially if you take medicines. See the Safety tab for interactions.
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