What Happens if You Don't Have Enough Choline?

January 14, 2026 •

4 min read

According to the National Institutes of Health, a large percentage of Americans, particularly women, do not meet the adequate intake for choline. This can have significant consequences, but what happens if you don't have enough choline and why is it so important for overall health?

Quick Summary

Choline deficiency can lead to severe health issues, including liver and muscle damage, cognitive decline, and mood changes. It is an essential nutrient for cell membranes, fat metabolism, and neurotransmitter synthesis.

Key Points

Liver Damage: A common consequence of choline deficiency is the accumulation of fat in the liver, leading to non-alcoholic fatty liver disease (NAFLD).
Cognitive Impairment: Low choline levels can impair brain function, causing memory problems, 'brain fog,' and mood changes, due to its role in producing the neurotransmitter acetylcholine.
Muscle Weakness: Insufficient choline can result in muscle damage and overall weakness, affecting physical performance.
Pregnancy Complications: Pregnant women have increased choline needs for fetal brain development, and low intake can raise the risk of neural tube defects.
Higher Risk Groups: Individuals on plant-based diets, pregnant women, and those with specific genetic variations are at a higher risk of deficiency.
Dietary Prevention: Eating choline-rich foods like eggs, meat, fish, and certain vegetables is the primary way to prevent deficiency.

What Is Choline and Why Is It Essential?

Choline is a nutrient similar to B vitamins that is crucial for many physiological processes, from fetal development to adult health. Although the human body can produce a small amount in the liver, this is not sufficient to meet metabolic needs, making it necessary to obtain choline through diet.

Choline plays several key roles:

Cellular Structure: It is a component of phospholipids like phosphatidylcholine and sphingomyelin, which are vital for maintaining the structural integrity of cell membranes.
Neurotransmission: Choline is a precursor for acetylcholine, a neurotransmitter critical for memory, mood, muscle control, and other brain and nervous system functions.
Fat Metabolism: It is essential for transporting fats and cholesterol from the liver. Without enough choline, fat can accumulate in the liver.
Methylation: Choline, through its metabolite betaine, provides methyl groups needed for many metabolic processes, including gene expression.

The Health Risks of Choline Deficiency

When dietary choline intake is insufficient, it can lead to various health problems, some of which can be severe. The liver is often the first organ to show signs of damage.

Liver Damage and Fatty Liver Disease: Choline deficiency is a known cause of non-alcoholic fatty liver disease (NAFLD). NAFLD occurs when fat accumulates in the liver due to impaired fat transport. If left unaddressed, this can lead to inflammation, fibrosis, cirrhosis, and liver failure.
Muscle Damage: Insufficient choline can also result in muscle damage and weakness, which has been observed in both human and animal studies. This can manifest as unexplained muscle pain or fatigue.
Neurological and Cognitive Impairment: Because choline is required to produce acetylcholine, low levels can have a significant impact on brain health. Symptoms can include memory problems, brain fog, difficulty concentrating, and mood changes. Research has also suggested a link between low choline intake and an increased risk of neurodegenerative disorders like Alzheimer's disease.
Impact on Pregnancy: The need for choline dramatically increases during pregnancy to support fetal brain development and neural tube formation. Inadequate maternal choline status has been associated with a higher risk of neural tube defects.
Cardiovascular Concerns: While research is mixed, some studies link low choline to higher levels of the amino acid homocysteine, which is a risk factor for cardiovascular disease. Conversely, gut bacteria can convert choline into trimethylamine N-oxide (TMAO), which has also been linked to increased cardiovascular risk.

Who Is at Risk for Low Choline Intake?

While severe, symptomatic choline deficiency is relatively rare, suboptimal intake is common. Several groups are at higher risk:

Vegans and Vegetarians: The most concentrated sources of choline are animal products, especially eggs and liver. Those on strict plant-based diets need to be diligent about consuming plant-based choline sources like soybeans, cruciferous vegetables, and nuts.
Pregnant and Lactating Women: The demand for choline increases significantly to support the developing fetus and nursing infant. Many prenatal supplements contain little to no choline.
Individuals with Genetic Variants: Some people have genetic variations that affect their ability to produce choline endogenously, increasing their dietary requirement.
Patients on Total Parenteral Nutrition (TPN): Individuals receiving long-term TPN that doesn't contain choline are at high risk of deficiency and associated liver abnormalities.

Comparison of Choline-Rich Food Sources


Food Source	Serving Size	Choline Content (mg)	Source Category
Beef Liver	3 oz cooked	356	Animal-based
Eggs	1 large egg	147	Animal-based
Soybeans	½ cup cooked	107	Plant-based
Cod	3 oz cooked	71	Animal-based
Chicken Breast	3 oz cooked	72	Animal-based
Broccoli	½ cup chopped	31	Plant-based
Brussels Sprouts	½ cup cooked	32	Plant-based
Quinoa	1 cup cooked	43	Plant-based

How to Prevent Choline Deficiency

Preventing a choline deficiency involves focusing on a balanced diet and, in some cases, supplementation under a doctor's supervision.

Diversify Your Diet: Incorporate a variety of foods from both animal and plant sources to ensure a broad spectrum of nutrient intake.
Prioritize Choline-Rich Foods: Make an effort to regularly include high-choline foods in your meals, such as eggs, beef, fish, and cruciferous vegetables.
Consider Supplements: If you are in a high-risk group (pregnant, vegan, have a genetic predisposition) or struggle to get enough from food, discuss a choline supplement with your healthcare provider. Different forms are available, including choline bitartrate and citicoline.
Address Other Nutrient Gaps: Choline metabolism is closely linked with folate and vitamin B12. Ensuring adequate intake of these nutrients can also impact your body's choline needs.

Conclusion

Choline is a profoundly important nutrient for a wide range of bodily functions, from the structure of our cells to the health of our brains. While our bodies can produce some, dietary sources are necessary to avoid the serious consequences of deficiency, which include liver and muscle damage, cognitive decline, and potential birth defects. Given that a significant portion of the population does not meet the adequate intake, being mindful of choline-rich foods is a critical step toward protecting long-term health. For those unable to meet their needs through diet alone, strategic supplementation can be a valuable tool to ensure optimal well-being. For further information on recommended intake levels and food sources, consult the NIH Office of Dietary Supplements.

Frequently Asked Questions

Choline has several primary functions, including supporting cell membrane structure, aiding in fat metabolism in the liver, and serving as a precursor for the neurotransmitter acetylcholine, which is crucial for brain health.

In severe cases, the first signs of a deficiency can be liver damage, indicated by elevated liver enzymes, or muscle damage. Milder symptoms might include fatigue, memory problems, and difficulty concentrating.

The most concentrated dietary sources of choline include animal-based products such as beef liver, eggs, meat, and fish. Plant-based sources include soybeans, cruciferous vegetables like broccoli and Brussels sprouts, and quinoa.

Yes, it is possible to get enough choline on a plant-based diet, but it requires careful planning as the highest concentrations are in animal products. Excellent plant-based sources include soybeans, quinoa, potatoes, and cruciferous vegetables.

The Adequate Intake (AI) for choline varies by age and sex. For adult males, it is 550 mg per day, and for adult females, it is 425 mg per day. Needs increase during pregnancy and lactation.

For most healthy individuals who eat a balanced diet, supplementation is not necessary. However, supplementation may be needed for those in high-risk groups, such as pregnant women or those on strict vegan diets. Consulting a healthcare provider is recommended.

Without sufficient choline, the liver cannot properly transport fats, leading to an accumulation of fat within the liver cells. This can result in non-alcoholic fatty liver disease (NAFLD) and potential liver damage.