The Overlooked Nutrient: What is the most neglected vitamin?

October 1, 2025 •

4 min read

According to the National Institutes of Health, a staggering 90% of American adults may not be consuming enough choline, making it a strong contender for the title of what is the most neglected vitamin. While public attention often focuses on more familiar vitamins like C and D, this essential nutrient plays a critical, yet often forgotten, role in human health.

Quick Summary

This article explores the nature and function of choline, a critical nutrient frequently overlooked in public health discourse. It examines the populations at highest risk of deficiency, highlights the potential health consequences, and provides practical advice on improving intake through diet and supplementation.

Key Points

Prevalence of Inadequacy: Up to 90% of American adults may not meet the adequate intake for choline, despite its essential functions.
Crucial for Vital Functions: Choline is vital for liver function (preventing fatty liver disease), brain development, and the production of a key neurotransmitter.
High-Risk Groups: Pregnant women, lactating women, vegans, and those with certain genetic factors are at a higher risk of deficiency.
Rich Food Sources: Excellent sources of choline include eggs, liver, meat, and fish, with smaller amounts found in certain vegetables and nuts.
Inclusion in Prenatal Care: Choline intake during pregnancy is critical for fetal brain development, a fact often overlooked in standard prenatal advice.
Supplementation Considerations: For those at risk, supplementing with choline can help fill the nutritional gap, but should be done in consultation with a healthcare provider.
Long-term Consequences: Long-term deficiency can lead to severe issues like liver dysfunction, muscle damage, and impaired cognition.

The Case for Choline as the Most Neglected Vitamin

While not classified as a vitamin in the traditional sense, choline is an essential nutrient that the body cannot produce in sufficient quantities and must be obtained through diet. Its widespread deficiency across different populations, coupled with a general lack of public awareness, makes it arguably the most neglected nutrient in modern nutrition discussions. Unlike fat-soluble vitamins stored in the liver, choline is used and excreted relatively quickly, requiring a consistent daily intake.

What Exactly Is Choline and Why Is It So Important?

Choline is a water-soluble compound vital for numerous bodily functions. It's a precursor to acetylcholine, a neurotransmitter essential for memory, mood, and muscle control. It is also a component of cell membranes and is crucial for lipid transport and metabolism within the liver. A sufficient supply of choline is particularly critical during pregnancy for proper fetal brain development.

Why Does Choline Get Overlooked?

Several factors contribute to choline's neglected status:

Less Publicized: Choline doesn't have the same marketing power or public health campaigns as vitamins like C and D. Its name is less familiar to the average consumer, making it a lower priority for many people.
Complex Classification: Its ambiguous status as a vitamin-like essential nutrient, rather than a clear vitamin, often excludes it from mainstream discussions about vitamin deficiencies.
Rich Sources Often Avoided: The richest dietary sources of choline, such as eggs and liver, are foods that some people limit due to dietary choices or health concerns.

Who Is at Risk for Choline Deficiency?

While intake recommendations exist, many groups struggle to meet them through diet alone. Those at higher risk include:

Pregnant and Lactating Women: The demand for choline increases significantly during these life stages to support the development of the fetal or infant brain.
Vegans and Vegetarians: Since animal products are the primary source of dietary choline, those on plant-based diets may have a harder time meeting their needs.
Individuals with Genetic Variations: Some genetic polymorphisms can increase an individual's predisposition to choline deficiency.
Those with Chronic Illnesses: Conditions that affect nutrient absorption or increase metabolic demand can also impact choline status.

The Consequences of Neglecting Choline

Neglecting choline intake can lead to serious health issues, particularly concerning liver and cognitive function. A lack of choline can disrupt the transport of lipids from the liver, leading to the accumulation of fats and potentially causing non-alcoholic fatty liver disease (NAFLD).

Furthermore, its role in brain health is significant. In infants, insufficient maternal choline intake has been linked to impaired neurodevelopment. In adults, deficiency can contribute to cognitive decline and impact memory. While the symptoms of mild deficiency, such as headaches or fatigue, might be mistaken for other issues, chronic neglect can have severe consequences.

Comparing Choline to a Well-Known Nutrient

To highlight why choline is so neglected, let's compare it to Vitamin C, a widely recognized and celebrated nutrient.


Feature	Choline (Often Neglected)	Vitamin C (Well-Known)
Function	Critical for liver function, brain development, and cellular integrity. A precursor to the neurotransmitter acetylcholine.	Essential for collagen production, immune system support, and iron absorption. A powerful antioxidant.
Recommended Intake	550 mg/day for adult males, 425 mg/day for adult females.	90 mg/day for adult males, 75 mg/day for adult females.
Common Sources	Primarily animal products: eggs, liver, meat, fish. Also found in smaller amounts in some vegetables and nuts.	Fruits (citrus, berries) and many vegetables (peppers, broccoli).
Prevalence of Inadequacy	Very high; up to 90% of American adults may not meet the adequate intake.	Lower; around 46% of the U.S. population had inadequate intake based on one study, but it's generally a more recognized nutrient gap.
Public Perception	Low awareness; often not included in nutrient discussions unless specifically focusing on brain or liver health.	High awareness; often associated with immunity and found in many everyday supplements and fortified foods.
Deficiency Risks	Fatty liver, muscle damage, and cognitive issues, especially in at-risk groups.	Scurvy in severe cases; fatigue and impaired immune function in less severe cases.

How to Improve Your Choline Intake

Most people can increase their choline levels through simple dietary adjustments, but supplements are also an option for those at high risk of deficiency. For instance, consuming eggs with the yolk is one of the easiest ways to boost intake.

Dietary Sources:

Eggs: One of the best and most bioavailable sources.
Liver: The richest source of choline.
Meat and Fish: Includes beef, chicken, salmon, and cod.
Dairy Products: Milk and cheese contain moderate amounts.
Cruciferous Vegetables: Broccoli, Brussels sprouts, and cauliflower offer smaller amounts.
Soybeans and Nuts: Soybeans, wheat germ, and almonds are good plant-based sources.

For those on vegan or vegetarian diets, prioritizing plant-based sources and considering supplementation, particularly during pregnancy and lactation, is prudent. When supplementing, it is best to consult with a healthcare provider to determine the appropriate dosage.

Conclusion: Prioritizing Neglected Nutrients

Ultimately, the question of what is the most neglected vitamin highlights a broader issue in nutrition: a focus on a few well-known nutrients while others, like choline, fall by the wayside. The evidence for choline's critical role in preventing fatty liver disease and supporting brain function is substantial. By broadening our nutritional focus beyond the usual suspects and paying attention to essential but less-talked-about nutrients, we can achieve a more comprehensive and robust approach to our overall health. Being mindful of neglected nutrients like choline is a proactive step toward filling significant nutritional gaps and supporting long-term wellness.

Frequently Asked Questions

While symptomatic deficiency is rare in healthy adults, some signs can include liver damage (often detected through blood tests), fatigue, muscle weakness, and, in severe cases, cognitive impairment.

Yes, newborns are at high risk for vitamin K deficiency bleeding (VKDB) because very little vitamin K crosses the placenta, and their gut bacteria aren't yet developed enough to produce it. This deficiency is publicly known because a vitamin K injection is standard practice at birth to prevent a life-threatening bleeding disorder, making it part of routine medical care.

It is more challenging to get enough choline from a purely plant-based diet because the richest sources are animal products like eggs and liver. Vegans and vegetarians may need to focus on plant sources like soybeans, nuts, and cruciferous vegetables, and might consider supplementation, especially during pregnancy or lactation.

The Adequate Intake (AI) for choline is 550 mg per day for adult males and 425 mg per day for adult females. Requirements increase during pregnancy (450 mg/day) and lactation (550 mg/day).

Choline is a vitamin-like essential nutrient, but not officially a B vitamin, though it works in similar pathways involving methyl groups. Unlike true vitamins, the body can produce small amounts of choline, but not enough to meet its needs, making dietary intake essential.

Yes, choline is a precursor to acetylcholine, a neurotransmitter critical for memory and other cognitive functions. Adequate intake is important for brain health throughout life and may help mitigate age-related cognitive decline.

Most people can meet their choline needs through diet alone by incorporating choline-rich foods. However, if you are in a high-risk group, such as pregnant or lactating, or if your diet is limited, a supplement may be beneficial. Always consult a healthcare provider before starting any new supplement.