What does it mean when your choline is low?

January 8, 2026 •

4 min read

Despite its critical importance for brain function, metabolism, and liver health, some studies suggest that a large portion of the population doesn't meet the recommended daily intake for choline. This often-overlooked deficiency can manifest in various ways, from subtle signs like fatigue to more serious health concerns.

Quick Summary

Low choline levels can lead to concerning symptoms like fatigue, memory impairment, and mood changes, with a long-term risk of developing non-alcoholic fatty liver disease (NAFLD) and muscle damage.

Key Points

Low Choline Symptoms: Key signs include liver damage (NAFLD), brain fog, memory issues, and muscle weakness.
Essential for Body Functions: Choline is crucial for producing the neurotransmitter acetylcholine, maintaining cell membranes, and transporting fat from the liver.
High-Risk Groups: Pregnant women, postmenopausal women with specific genetic traits, and vegans are particularly susceptible to low choline.
Dietary Intake is Key: The most common cause is insufficient intake from food, despite the body's ability to produce small amounts.
Easily Corrected: Increasing consumption of eggs, liver, soybeans, and other rich foods can correct low choline levels, and supplements are also an option.
Long-term Risks: Chronic deficiency can lead to serious health problems, including permanent liver dysfunction and neurological issues.

Understanding the Essential Nutrient Choline

Choline is a nutrient similar to B vitamins that plays a critical role in several vital bodily processes. While the body can produce some choline in the liver, the amount is not sufficient to meet all human needs, making dietary intake essential. It is a precursor to acetylcholine, a crucial neurotransmitter involved in memory, mood, and muscle control. Choline is also necessary for the synthesis of phospholipids, which are integral components of cell membranes, and aids in lipid transport from the liver. When choline is low, these essential functions are compromised, leading to a cascade of potential health issues.

The Warning Signs of Low Choline

Recognizing the signs of low choline is the first step toward correcting the issue. Symptoms can be diverse and affect multiple systems within the body.

Impact on the Liver

Non-alcoholic fatty liver disease (NAFLD): Without enough choline, the liver struggles to export fats, causing them to accumulate. This can lead to NAFLD, a condition where fat builds up in the liver.
Elevated liver enzymes: Blood tests may show higher-than-normal levels of liver enzymes, indicating liver stress and damage.
Fat metabolism issues: Choline is required to produce very low-density lipoproteins (VLDL), which transport fat out of the liver. Low choline disrupts this process.

Cognitive and Neurological Effects

Brain fog and poor memory: As choline is a precursor to the memory neurotransmitter acetylcholine, low levels can lead to cognitive impairment, including memory loss and difficulty concentrating.
Mood changes: Inadequate choline can influence mood, potentially leading to increased anxiety, restlessness, or depression.
Fatigue: Many people with low choline experience unexplained fatigue or sluggishness.

Muscle and Physical Symptoms

Muscle weakness and damage: Choline is involved in muscle function and cell integrity. A deficiency can cause muscle aches, weakness, and, in some cases, damage.
Elevated creatine kinase: Blood tests for muscle health may reveal elevated creatine kinase levels, which is another indicator of muscle damage.

Common Causes of Low Choline Levels

Choline deficiency doesn't happen without a cause. Here are some of the most common contributing factors:

Inadequate dietary intake: The most common reason for low choline is simply not consuming enough choline-rich foods. This is particularly relevant for those on diets with limited animal products, such as vegan diets, as animal sources are often highest in choline.
Genetics: Some individuals have genetic variations (SNPs) that increase their dietary requirement for choline. A specific polymorphism in the PEMT gene, for example, makes some women less efficient at producing choline internally.
Pregnancy and lactation: The demand for choline increases significantly during pregnancy and breastfeeding to support fetal and infant brain development. Studies show that a high percentage of pregnant women do not meet the adequate intake.
Alcohol consumption: Heavy alcohol use can negatively impact liver function and choline metabolism, contributing to deficiency.
Malabsorption issues: Conditions that impair nutrient absorption can also lead to lower choline levels, even with an adequate diet.

How to Correct Low Choline and Boost Your Intake

Correcting low choline involves a targeted approach focusing on diet and, if necessary, supplementation. Consulting a healthcare provider is recommended before starting any supplement regimen.

Dietary Interventions

Focus on incorporating a variety of choline-rich foods into your daily meals. The top sources are often animal-based, but many plant-based options are also available.

Top animal sources: Eggs (especially the yolk), beef liver, chicken breast, and fish like salmon and cod.
Top plant-based sources: Soybeans, quinoa, potatoes, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts), and certain nuts and seeds.

Supplementation Options

If dietary changes are not enough or a specific condition warrants it, supplements can be used. Common forms include choline bitartrate, phosphatidylcholine, and lecithin. Supplements can be taken on their own or as part of a multivitamin. Pregnant and breastfeeding women should discuss supplementation with their healthcare provider.

Comparison of Choline Sources


Source	Recommended Daily Intake (Approx.)	Rich Food Examples	Key Benefit	Considerations
Dietary Intake	Men: 550 mg/day; Women: 425 mg/day (higher for pregnancy/lactation)	Eggs, beef liver, soybeans, cruciferous vegetables	Provides choline in its natural food matrix with other nutrients	May require careful meal planning, especially for vegans
Supplements	Variable, typically 10-250mg or higher under medical advice	Choline bitartrate, phosphatidylcholine, lecithin	Provides a concentrated, controlled dose	Should be used under medical supervision, high doses can cause side effects
Body Synthesis	Insufficient for most people, especially high-risk groups	Liver production	Provides a baseline level of the nutrient	Influenced by genetics and life stage (e.g., estrogen levels)

Conclusion

Low choline levels can have a significant and varied impact on health, affecting key areas like liver function, cognitive abilities, and muscle health. While the body produces some choline, it's rarely enough to meet total needs, making dietary intake essential. Symptoms such as fatigue, memory issues, or signs of fatty liver disease should prompt consideration of choline status. By prioritizing choline-rich foods and, when necessary, discussing supplements with a healthcare professional, individuals can help ensure optimal levels and prevent the health risks associated with a deficiency.

For more detailed nutritional information, including Adequate Intake (AI) levels and rich food sources, refer to resources like the NIH Office of Dietary Supplements(https://ods.od.nih.gov/factsheets/Choline-Consumer/).

Frequently Asked Questions

Choline serves several critical functions, including acting as a precursor for the neurotransmitter acetylcholine, which is vital for memory and mood regulation. It also helps synthesize phospholipids for cell membranes and assists in transporting fats from the liver.

Early signs of low choline can be non-specific, but often include unexplained fatigue, mental sluggishness or 'brain fog,' muscle aches, and mood changes like anxiety or restlessness.

Yes, a low choline intake can contribute to the development of non-alcoholic fatty liver disease (NAFLD). Without sufficient choline, the liver cannot properly export fats, leading to an accumulation of fat within the liver cells.

Pregnant and lactating women have a higher demand for choline. Additionally, individuals on low-choline diets (such as vegans) and those with specific genetic variations that increase their choline requirement are at greater risk.

You can increase your choline by consuming foods such as eggs, beef liver, fish, chicken, soybeans, potatoes, and cruciferous vegetables like broccoli and cauliflower. Eggs and liver are particularly rich sources.

For many, increasing dietary intake of choline-rich foods is enough to correct a deficiency. However, some individuals, especially those with genetic predispositions or special dietary needs, may benefit from supplementation under a doctor's guidance.

According to some data, yes. Research suggests that a significant majority of Americans do not consume the recommended daily intake of choline, with pregnant women being particularly prone to low intake.