Choline

safety

Allergies

Avoid in individuals with a known allergy or hypersensitivity to choline, lecithin, or phosphatidylcholine.

Side Effects and Warnings

Choline is generally regarded as safe and appears to be well-tolerated. High intake of choline may cause low blood pressure, steatorrhea (undigested fat in stool), nausea, vomiting, salivation, diarrhea, constipation, anorexia, dizziness (vertigo), sweating, incomnia and headache. Choline can possibly trigger existing epilepsy. Dosages at the upper limit (UL) intake levels are contraindicated for person suffering from trimethylaminuria, Parkinson's disease, or kidney or liver disease.
Skin rash has been reported. A cold and cough were noted in patients taking citicoline in a trial. Choline should be used cautiously by people with kidney or liver disorders. Agitation, paranoia and severe depression have been reported. Use cautiously in patients with a history of depression.
Because choline is a product of the breakdown of succinylcholine, it may produce similar side effects as the drug, like respiratory depression. A "fishy" odor has been associated with choline. Sweating and stunted growth may occur.

Pregnancy and Breastfeeding

The Food and Nutrition Board of the Institute of Medicine of the National Academy of Science states that choline is vital in prenatal supplementation. During pregnancy, choline intake of the mother may influence memory and brain development in the growing infant. Studies on choline and lecithin supplementation clearly show an increase in blood choline levels following supplementation.
Pregnant and lactating women and children may consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.

dosing

Adults (18 years and older):

The "average" diet supplies 400-900 milligrams of choline daily, which is presumed to be adequate. According to the Institute of Medicine, although the adequate intake (AI) have been set for choline by the Institute of Medicine's Food and Nutrition Board, there are few data to assess whether a dietary supply of choline is needed at all ages, and it may be that the choline requirement can be met by endogenous synthesis at some of these stages.
The recommended daily intake by the U.S. Food and Nutrition Board of the Institute of Medicine for men 18-70+ years: 550 milligrams per day - not to exceed 3.5 grams per day; for women 19-70+ years: 425 milligrams per day - not to exceed 3.5 grams per day; for women 18 years: 400 milligrams per day - not to exceed 3 grams per day; for pregnant women: 450 milligrams per day; for breastfeeding women: 550 milligrams per day.
Upper intake levels (UL) should not exceed 3.5 grams daily for adults and the elderly. Dosages at the upper limit intake levels are contraindicated for persons suffering from trimethylaminuria, kidney disease, liver disease, depression, and Parkinson's disease, as they may be at risk for side effects.
There is no proven effective dose for Alzheimer's disease, asthma, fatty liver, or seizure; however, choline has been studied for the treatment of these conditions at various doses.

Children (younger than 18 years):

The Committee on Nutrition of the American Academy of Pediatrics recommends the fortification of infant formula to at least 7 milligrams choline per 100 kilocalories. This quantity corresponds to roughly 9 ┬▒ 2 milligrams per deciliter of choline present in human breast milk. Patients ages 1-8 years should not exceed 1 gram daily, children ages 9-13 should not exceed 2 grams daily, and children 14-18 years should not exceed 3 grams of choline daily.
Recommended daily intake by the U.S. Food and Nutrition Board of the Institute of Medicine for infants 6-12 months: 150 milligrams per day; for infants up to 6 months: 125 milligrams per day; for children 9-13 years: 375 milligrams per day - not to exceed 2 grams per day; for children 4-8 years: 250 milligrams per day - not to exceed 1 grams per day; for children 1-3 years: 200 milligrams per day - not to exceed 1 gram per day; for girls 14-18 years: 400 milligrams per day - not to exceed 3 grams per day; for boys 14-18 years: 550 milligrams per day - not to exceed 3.5 grams per day.
Upper intake levels (UL) per day should not exceed 1 gram daily by mouth for children 1-8 years; 2 grams daily by mouth for children 9-13 years; 3 grams daily by mouth for adolescents (14-18 years-old). Maximum daily choline upper intake levels for infants are not available; choline should only be from formula or breast milk and food.

interactions

Interactions with Drugs

Choline supplementation has been associated with decreasing urinary excretion of carnitine in young adult women.
A study concluded that chronic treatment with lithium enhances the effects of choline in the brain. A preliminary report of MRI studies did not observe a significant positive relationship between increases in brain choline and increases in brain lithium.
CDP-choline can cause an increase in plasma concentrations of dopa.
Methotrexate may diminish pools of all choline metabolites. Choline supplementation reverses fatty liver caused by methotrexate administration in rats.
Pentazocine exhibits neuromuscular blocking effects in part through a depressive action on cholinoceptive sites on the nerve motor end terminals, presenting a possible interaction if administered with choline.
Although a few studies have linked choline with partially reversing the effects of scopolamine, a later study failed to demonstrate similar effects.
Choline is a product of the breakdown of succinylcholine. Taking choline with succinylcholine may theoretically intensify effects and/or toxicity.

Interactions with Herbs and Supplements

Choline supplementation has been associated with decreasing urinary excretion of carnitine in young adult women.
A study concluded that chronic treatment with lithium enhances the effects of choline in the brain. A preliminary report of MRI studies did not observe a significant positive relationship between increases in brain choline and increases in brain lithium.
Choline, via its metabolism to betaine, works in concert with vitamins B6, B12, and folic acid in the metabolism of the potentially atherogenic substance homocysteine.