The momentum behind a move to plant-based and vegan diets for the good of the planet is commendable, but risks worsening an already low intake of an essential nutrient involved in brain health, warns a nutritionist in the online journal BMJ Nutrition, Prevention & Health.
Choline is an essential dietary nutrient, but the amount produced by the liver is not enough to meet the requirements of the human body.
It is critical to brain health, particularly during foetal development.
It also influences liver function, with shortfalls linked to irregularities in blood fat metabolism, as well as excess free radical cellular damage, writes Dr Emma Derbyshire of Nutritional Insight, a consultancy specialising in nutrition and biomedical science based in the United Kingdom.
The primary sources of dietary choline are found in beef, eggs, dairy products, fish and chicken, with much lower levels found in nuts, beans and cruciferous vegetables such as broccoli.
In 1998, recognising the importance of choline, the US Institute of Medicine recommended minimum daily intakes.
These range from 425 milligrammes/day for women to 550 mg/day for men, and 450 mg/day and 550 mg/day for pregnant and breastfeeding women respectively because of the critical role the nutrient has in foetal development.
In 2016, the European Food Safety Authority published similar daily requirements.
Yet national dietary surveys in North America, Australia and Europe show that habitual choline intake, on average, falls short of these recommendations.
“This is… concerning given that current trends appear to be towards meat reduction and plant-based diets,” says Dr Derbyshire.
She commends the first report on this (the EAT-Lancet Commission on Food, Planet, Health) for compiling a healthy food plan based on promoting environmental sustainability, but suggests that the restricted intakes of whole milk, eggs and animal protein it recommends could affect choline intake.
“More needs to be done to educate healthcare professionals and consumers about the importance of a choline-rich diet, and how to achieve this,” she writes.
“If choline is not obtained in the levels needed from dietary sources per se, then supplementation strategies will be required, especially in relation to key stages of the life cycle, such as pregnancy, when choline intakes are critical to infant development,” she concludes.
1 Comment
Chris
September 8, 2019 at 2:55 pmA friend alerted me to this article which she found troubling, so here is my response.
It is an interesting article, which is rather economical with facts and appears to be supporting the meat and dairy industries. In the USA, the country where people eat the most meat in the world, a 14-year US prospective study, including over 14,000 middle-aged participants, mean daily intakes of choline were 294 mg and 332 mg in women and men, respectively – and both were LESS than the “recommended daily intake” levels mentioned in the article. These “intake levels” are also based on one small study done in 1998 and are not official RDAs. So how much more meat and dairy does the article suggest everyone should eat?
In any case, the other side of the equation is not mentioned; ie. what happens with over-consumption of choline? Here are some findings:
“Individuals with trimethylaminuria (fish odor syndrome), renal disease, liver disease, depression, and Parkinson’s disease may have increased susceptibility to the adverse effects of choline. Trimethylaminuria results from a rare genetic deficiency that causes excessive excretion of trimethylamine and, therefore, an increased risk of developing fishy body odor (Al-Waiz et al., 1988, 1989; Humbert et al., 1970; Shelley and Shelley, 1984). Individuals with renal or liver disease may have increased susceptibility because of increased levels of plasma choline (after ingestion of supplemental choline) compared with healthy individuals (Acara and Rennick, 1973; Acara et al., 1983; Chawla et al., 1989; Rennick et al., 1976). In rare cases, consumption of large amounts of choline has been associated with depression (Davis et al., 1979; Tamminga et al., 1976). Finally, mild and transient Parkinsonian signs (bradykinesia, tremor, and rigidity) were observed at high doses (12.7 g/day) of choline as a chloride in people with tardive dyskinesia (Gelenberg et al., 1979), which suggests that supplemental choline intake by Parkinsonian patients may exacerbate symptoms.”
More significantly, absorption of dietary choline is affected by gut bacteria, so an unhealthy gut microbiome can negate much of the impact of ingesting more choline.
Interestingly, the 1998 report which established the article’s “intake levels” also stated:
“Sufficient human data are not available for determining whether choline is essential in the human diet, how much is required if it is essential, and the public health impact of poor choline nutriture.” https://www.nap.edu/read/6015/chapter/14 (scroll down to page 413)
Anyway, since 1998, choline has been established to be indeed an important nutrient, but suggesting eating more meat and dairy cannot be the only solution as the evidence suggests that humans can get enough choline from other sources. Additionally, note that demand for dietary choline is modified by metabolic methyl-exchange relationships between choline and three nutrients: methionine, folate, and vitamin B12 (lipotropes).
Regarding the article’s claim about choline benefits for the adult brain, this had been investigated in some detail and there is no evidence of this benefit in young adults: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920398/
The article is therefore accurate only about the requirement for dietary choline for infants.