Choline: Which nutrient is often referred to as the forgotten nutrient?

October 8, 2025 •

4 min read

According to studies, as many as 90% of adults may not be consuming enough of this vital compound, making choline the nutrient often referred to as the forgotten nutrient. Despite being essential for numerous critical bodily functions, including brain and liver health, choline frequently goes overlooked in common dietary discussions. This article sheds light on why choline is so important and how you can ensure you are getting enough of it.

Quick Summary

This article discusses choline, an essential nutrient often overlooked in dietary plans. It covers its critical functions in brain and liver health, potential deficiency symptoms, and provides a guide on excellent food sources to increase intake.

Key Points

Choline's Essential Status: While the body can produce some choline, it is not enough to meet metabolic needs, making dietary intake essential for optimal health.
Crucial for Brain and Liver: Choline is a precursor for the neurotransmitter acetylcholine and is vital for transporting fats out of the liver, protecting against conditions like fatty liver disease.
Commonly Deficient in Diets: A large portion of the population does not meet the recommended daily intake of choline, with pregnant women, vegans, and specific genetic groups being particularly vulnerable.
Signs of Deficiency: Inadequate choline can cause fatigue, memory problems, muscle damage, and the accumulation of fat in the liver.
Accessible Food Sources: Choline is readily available in foods like eggs, liver, meat, and cruciferous vegetables, making dietary adjustments a simple way to increase intake.
Genetic Influence: Certain genetic variations can increase an individual's need for dietary choline, highlighting the importance of personalized nutrition.

What Exactly is the Forgotten Nutrient?

Choline is an essential, water-soluble compound that is structurally similar to B vitamins. In 1998, the U.S. Institute of Medicine recognized it as an essential nutrient, confirming that the body's natural production is not enough to meet all metabolic needs. While a healthy liver can produce small amounts, the majority of our choline must come from our diet. Its underappreciated status comes from a general lack of public awareness and a low prevalence of severe, overt deficiency, though widespread suboptimal intake is common.

The Critical Roles of Choline in the Body

Choline is a powerhouse nutrient involved in several fundamental biological processes. Understanding these roles highlights why it should not be neglected in any diet.

Brain and Nervous System Function: Choline is a precursor for acetylcholine, a neurotransmitter critical for memory, mood, muscle control, and other brain functions. It is also essential for the formation of phospholipids, which are vital components of cell membranes, including those in the brain. Adequate choline intake is especially crucial during pregnancy and infancy for proper fetal brain development.
Liver Health: A primary function of choline is to assist in the transportation of fats and cholesterol out of the liver. Without enough choline, fat can accumulate in the liver, leading to a condition known as non-alcoholic fatty liver disease (NAFLD). This makes it a crucial nutrient for maintaining liver health and preventing liver damage.
Fat Transport and Metabolism: Choline is a key component of very-low-density lipoproteins (VLDL), which are needed to carry lipids from the liver to other parts of the body. This helps regulate fat and cholesterol metabolism throughout the body.
DNA Synthesis: Along with folate and vitamin B12, choline is involved in methylation, a process essential for DNA synthesis and gene expression. Proper methylation is vital for countless biological processes and overall cellular health.

Symptoms of Choline Deficiency

While severe deficiency is rare, inadequate intake can lead to subtle but significant health issues. Some potential symptoms include:

Fatty liver disease: One of the most prominent signs of choline deficiency is the buildup of fat in the liver. This can lead to liver damage over time if not addressed.
Cognitive issues: Since choline is vital for brain function, a lack can manifest as poor memory, brain fog, and other cognitive difficulties.
Muscle damage: Some individuals on a choline-deficient diet have shown signs of muscle damage and fatigue.
Mood changes: Impaired neurotransmitter function may contribute to mood swings or anxiety.

How to Get More Choline in Your Diet

Increasing your choline intake is straightforward, as many common and delicious foods are excellent sources. Incorporating these items into your regular diet can help ensure you are meeting your daily needs.

Foods high in choline:

Eggs: The yolk of a large egg is one of the richest sources of choline.
Beef Liver: A powerhouse of nutrition, beef liver is exceptionally high in choline.
Meats and Poultry: Foods like beef, chicken, and fish (especially salmon and cod) are great sources.
Cruciferous Vegetables: Vegetables such as broccoli, Brussels sprouts, and cauliflower contain good amounts.
Legumes: Certain beans, including kidney beans and soybeans, provide a plant-based source of choline.
Nuts and Seeds: Peanuts and almonds contain smaller but still beneficial amounts.
Milk: Dairy products also contribute to daily choline intake.

Choline vs. Other Key Nutrients

While often compared to B vitamins due to its similar functions, choline's unique roles set it apart. This table highlights how choline compares to other well-known nutrients that also play roles in brain and fat metabolism.


Feature	Choline	Omega-3 Fatty Acids (DHA/EPA)	B Vitamins (B9, B12)	Protein
Classification	Essential nutrient (grouped with B vitamins)	Essential fatty acids	Water-soluble vitamins	Macronutrient
Primary Role in Body	Precursor for acetylcholine, cell membrane structure, liver fat transport	Brain development, reducing inflammation, cardiovascular health	Red blood cell formation, DNA synthesis, nerve function	Building and repairing tissues, enzyme production, immune support
Key Dietary Sources	Eggs, liver, meat, fish, cruciferous vegetables	Fatty fish (salmon, mackerel), walnuts, flaxseed	Leafy greens, fortified cereals, meat, dairy	Meat, fish, eggs, legumes, nuts
Role in Brain	Neurotransmitter production, membrane integrity	Brain cell structure, cognitive function	Cognitive function, nerve cell communication	Neurotransmitter synthesis, brain structure
Fat Metabolism	Fat transport from the liver (VLDL production)	Regulates blood triglyceride levels	Supports energy metabolism	Minimal direct role, but aids enzyme production

Increasing Awareness for Better Health

The lack of widespread awareness about choline is often a result of historical factors; it was not officially recognized as an essential nutrient until relatively recently, and severe deficiencies are uncommon in developed nations. However, the prevalence of suboptimal intake is concerning, particularly for vulnerable populations such as pregnant women, vegetarians, and those with specific genetic variations. Campaigns like those led by the American Medical Association to include choline in prenatal vitamins show a growing recognition of its importance. By focusing on a diverse diet rich in eggs, meat, and vegetables, or through supplementation when necessary, individuals can improve their intake and support their brain and liver health for the long term. The simple act of remembering the 'forgotten nutrient' can have profound effects on overall well-being.

Conclusion

In the landscape of modern nutrition, choline stands out as a critical yet often overlooked player. Its foundational roles in brain development, nervous system function, and liver health make it an indispensable part of a balanced diet. Given that many people do not meet the recommended adequate intake, increasing awareness of choline's importance is crucial. By prioritizing choline-rich foods such as eggs, liver, and cruciferous vegetables, or considering supplements when dietary intake is insufficient, individuals can help prevent health issues associated with deficiency and support their long-term cognitive and metabolic health. It's time to remember the forgotten nutrient and give it the recognition it deserves in our daily nutritional planning.

Link: The Linus Pauling Institute provides comprehensive, science-based information on choline and its importance for health.

Frequently Asked Questions

The Adequate Intake (AI) for choline is 550 mg per day for adult men and 425 mg per day for adult women. These recommendations increase during pregnancy and lactation.

As a precursor to the neurotransmitter acetylcholine, choline is important for memory and cognition. While animal studies show potential benefits, human studies are still ongoing to fully understand the effects of supplementation on cognitive function.

Yes, because many of the richest sources of choline are animal products like eggs and meat, vegans and vegetarians must pay extra attention to getting enough from plant-based sources like soybeans, nuts, and cruciferous vegetables.

Excessive intake of choline, typically from high-dose supplements, can cause side effects such as a fishy body odor, sweating, diarrhea, and a drop in blood pressure. The Tolerable Upper Intake Level (UL) for adults is 3,500 mg per day.

Choline is vital during pregnancy for the healthy development of the fetal brain and nervous system. Adequate maternal intake is associated with better cognitive outcomes for the child.

Yes, an insufficient intake of choline can impair the liver's ability to transport fat, leading to the accumulation of fat in the liver, a condition known as non-alcoholic fatty liver disease (NAFLD).

Since choline is widely distributed in the body, standard blood tests may not accurately reflect overall status. It's often diagnosed by a healthcare provider based on symptoms, dietary assessment, and ruling out other conditions.