What happens when your choline is low? A detailed look at deficiency symptoms and effects

January 1, 2026 •

4 min read

Studies suggest that a vast majority of US adults may not be getting enough choline from their diets, leaving many wondering what happens when your choline is low and if they are at risk. Although a rare, severe deficiency is uncommon, suboptimal intake can lead to a range of subtle but significant health issues affecting multiple organ systems.

Quick Summary

Low choline can lead to liver damage, cognitive issues like memory loss and brain fog, and muscle weakness. At-risk groups include pregnant and postmenopausal women, as well as those on plant-based diets.

Key Points

Fatty Liver Disease: Low choline is a leading cause of nonalcoholic fatty liver disease (NAFLD), where fat accumulates in the liver due to impaired transport.
Cognitive Impairment: Deficiency can disrupt acetylcholine synthesis, a neurotransmitter crucial for memory and learning, leading to memory loss and brain fog.
Muscle Damage: Insufficient choline levels can cause muscle aches, weakness, and elevated markers of muscle damage, potentially hindering strength gains from exercise.
Increased Risk for Pregnant Women: With higher requirements for fetal development, pregnant and lactating women are at high risk of deficiency, which can impact a baby's brain and spinal cord development.
Dietary Risk for Plant-Based Diets: Since many top choline sources are animal products (eggs, meat, fish), vegetarians and vegans may need extra attention to their intake to avoid deficiency.
Genetic Factors and Choline Needs: Genetic variations can alter an individual's choline requirements, making some people more susceptible to deficiency even with standard intake.

The Critical Role of Choline

Choline is a conditionally essential nutrient, meaning your body produces some of it, but not enough to meet its total needs, making dietary intake vital. It plays a foundational role in many critical biological processes, including:

Cellular Structure: Choline is required for the synthesis of phosphatidylcholine and sphingomyelin, key components of all cell membranes that are essential for their structural integrity.
Brain Function: It acts as a precursor to acetylcholine, a crucial neurotransmitter involved in memory, mood, and muscle control.
Fat Metabolism: It is essential for the transport of lipids from the liver, which prevents the buildup of fat.
Methyl Group Metabolism: As a precursor to betaine, choline is involved in methylation reactions that are vital for modulating gene expression and regulating homocysteine levels, an amino acid linked to cardiovascular health.

Common Signs and Symptoms of Low Choline

When your choline levels dip below optimal, your body can present with a variety of signs, affecting multiple systems.

Neurological and Cognitive Symptoms

The impact on the nervous system and brain is one of the most noted consequences of insufficient choline, linked to its role in producing acetylcholine.

Memory Loss: Difficulties with memory, particularly recalling information and learning new things, are a common cognitive sign of deficiency.
Brain Fog and Concentration Issues: Many people report feeling sluggish, experiencing mental fatigue, and having trouble focusing.
Mood Changes: Low choline levels have been associated with increased feelings of anxiety and restlessness.

Liver Function and Metabolic Issues

The liver is particularly sensitive to choline availability. When there is insufficient choline, the body's ability to transport fats is impaired.

Nonalcoholic Fatty Liver Disease (NAFLD): This is one of the most prominent outcomes of low choline. Fat accumulates in the liver, leading to steatosis, which can progress to more serious conditions like cirrhosis if unaddressed. In a study of adults on a choline-deficient diet, many developed liver dysfunction within weeks.
Elevated Liver Enzymes: Blood tests may reveal elevated levels of liver enzymes, indicating liver stress or damage.

Muscular and Physical Effects

Choline's role in neurotransmission and cell membrane integrity also impacts muscle function.

Muscle Damage and Weakness: Deficiency can lead to muscle aches and general weakness. In severe cases, muscle damage markers like creatine kinase may increase.
Impaired Physical Performance: Studies on older adults undergoing resistance training showed that those with low choline intake had significantly diminished strength gains compared to those with adequate intake.

Who is at Risk for Choline Deficiency?

While frank choline deficiency is rare in otherwise healthy, non-pregnant adults, certain populations are at a significantly higher risk due to dietary choices, life stage, or genetics.

Pregnant and Lactating Women: The demand for choline increases substantially during pregnancy to support fetal brain and spinal cord development. Many pregnant women fail to meet the higher recommended intake, which can increase the risk of neural tube defects.
Postmenopausal Women: Estrogen aids the body's endogenous choline production. As estrogen levels drop after menopause, the body's ability to synthesize choline decreases, increasing dietary needs.
Vegetarians and Vegans: Some of the highest dietary sources of choline are animal products like eggs, meat, and fish. Individuals on plant-based diets may struggle to get adequate amounts without careful planning or supplementation.
Individuals with Certain Genetic Variations: Some people carry genetic mutations that affect choline metabolism, significantly increasing their dietary requirements.
Patients on Long-Term Total Parenteral Nutrition (TPN): Patients receiving long-term intravenous feeding may develop low plasma choline levels, leading to hepatic abnormalities if not supplemented.

Addressing a Choline Deficiency

Fortunately, addressing low choline levels can often be achieved through dietary adjustments and, when necessary, supplementation. It is always wise to consult a healthcare provider before making significant changes.

Dietary Sources of Choline

Incorporating choline-rich foods into your diet is the primary way to maintain adequate levels.

Animal-Based Sources: Eggs, beef liver, chicken, salmon, and other fish are excellent sources.
Plant-Based Sources: Soybeans, wheat germ, potatoes, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts), nuts, and seeds also contain choline.

Consider Supplementation

For those unable to meet their needs through diet alone, supplements may be an option. Common forms include phosphatidylcholine (lecithin), Alpha-GPC, and CDP-choline. Speaking with a healthcare provider is essential to determine the best approach and dosage for your specific needs.

Choline Needs: Dietary Sources Comparison


Food Source	Serving Size	Approximate Choline (mg)	Note
Beef Liver	3 oz.	~247 mg	Highest concentrated source
Large Egg (with yolk)	1 egg	~125 mg	A major source in many diets
Soybeans	1/2 cup, dry	~116 mg	Excellent plant-based source
Salmon	3 oz.	~187 mg	Contains significant amounts
Chicken Breast	3 oz.	~56 mg	Good animal-based source
Brussels Sprouts	1/2 cup	~32 mg	Solid vegetable option

Conclusion

Maintaining adequate choline levels is vital for the health of your brain, liver, and muscles. A deficiency can manifest through a range of symptoms, including memory issues, fatigue, and liver dysfunction. Understanding who is most at risk—such as pregnant women, vegetarians, and those with specific genetic markers—is the first step toward prevention. By focusing on a diet rich in both animal and plant sources of this essential nutrient, or considering supplementation under medical guidance, you can ensure your body has the building blocks it needs to function optimally. For more detailed information on choline's role in health, consult the National Institutes of Health (NIH) Fact Sheet on Choline.

Frequently Asked Questions

The initial signs of low choline are often subtle and can include feeling unusually fatigued, restless, or experiencing mental fogginess and mild memory problems.

Yes, in most cases, low choline and its associated symptoms can be reversed by increasing dietary intake of choline-rich foods or through supplementation under medical supervision.

Choline status is not routinely measured, but deficiency can be suspected based on symptoms, dietary assessment, and evaluation of liver or muscle function markers. A healthcare provider can order tests for elevated liver enzymes or creatine kinase, and diagnose through observation and ruling out other causes.

Yes, choline is involved in synthesizing the neurotransmitter acetylcholine, which affects mood. Low levels have been linked to mood changes, including increased anxiety and restlessness.

Plant-based sources of choline include soybeans, wheat germ, cruciferous vegetables like broccoli and Brussels sprouts, and certain nuts and seeds. Vegetarians and vegans may also consider supplementation, especially if they are in high-risk groups like during pregnancy.

Choline is a precursor to acetylcholine, a neurotransmitter important for memory. While research is ongoing, some studies suggest that adequate choline intake supports cognitive performance and memory, especially when levels are low.

The adequate intake (AI) for choline varies by age and sex. For adult males, it is 550 mg/day, while adult females need 425 mg/day. Requirements increase during pregnancy (450 mg/day) and lactation (550 mg/day).

No, supplementation is not always necessary. For many, increasing the consumption of choline-rich foods like eggs, meat, fish, and certain vegetables is enough to restore adequate levels. Supplements are generally considered for high-risk individuals or those with difficulty getting enough from their diet.