Choline: the nutrient almost nobody meets, and almost nobody discusses

Choline was only formally recognised as an essential nutrient fairly recently, and intakes still show it. Most people in the United States take in less than the recommended amount, and among pregnant women the shortfall is close to universal.

What it does in the body

• Choline supplies methyl groups for metabolism, builds the phospholipids in cell membranes and is needed to make the neurotransmitter acetylcholine. Evidence E source
• The body makes some choline in the liver, but not enough to meet human needs. Evidence E source

How much you need

• The Adequate Intake for choline is 550 mg a day for adult men and 425 mg for adult women, 450 mg in pregnancy and 550 mg when breastfeeding. — adults Evidence E source
• Average choline intake in the United States is 402 mg a day in men and 278 mg in women, and most people take in less than the Adequate Intake. — US adults Evidence C source
• The recommended choline intake comes from feeding adults a choline-free diet until their livers were damaged and then seeing what fixed it. — adults, and separately pregnant and lactating women Evidence C source
• Choline sits mostly in animal foods, so eating less of them makes the recommended intake harder to reach. — Nordic and Baltic populations, with particular attention to women of childbearing age and infants Evidence C source
• Two boiled eggs give roughly half the choline a man is advised to get in a day, which is why eggs dominate every list of choline foods. — United States food supply, portion sizes as eaten Evidence E source
• Choline is the one nutrient in this group where most Americans really do fall short of the recommendation. — United States, all ages Evidence E source
• Europe sets a single choline figure of four hundred milligrams for all adults, where the United States sets two different ones by sex. — European population, adults and adolescents aged 15 to 17 Evidence E source

How well your body absorbs it

• In very preterm babies, added choline lifted blood choline back to the level a fetus would have had. — inborn preterm infants under 32 weeks postmenstrual age, Germany Evidence B source
• The body makes some of its own choline through a pathway that oestrogen switches up, and that is the stated reason men are told to eat more of it than women. — general population, both sexes Evidence C source
• Cooking keeps most choline, and a boiled egg holds about four fifths of what a raw one has. — not applicable, reference dataset applied to raw foods Evidence E source

What too little does

• Choline deficiency can cause muscle damage, liver damage and non-alcoholic fatty liver disease. — people with deficiency Evidence E source

Who is most likely to fall short

• Roughly 90–95% of pregnant women consume less choline than the Adequate Intake. — pregnant women Evidence C source
• Across a dozen studies, about one pregnant woman in nine reached the recommended choline intake. — pregnant women, international Evidence C source

What the evidence does and does not show

• Gut bacteria convert some choline into TMA, which the liver turns into TMAO, a substance linked to higher cardiovascular risk. Evidence E source
• Several large observational studies have found no significant association between choline intake and cardiovascular or peripheral artery disease. — adults in observational studies Evidence C source
• Pooling ten trials in over four thousand stroke patients, the choline drug citicoline made no difference to death or disability. — adults with acute ischaemic stroke, any setting Evidence A source
• In pregnancies heavily exposed to alcohol, choline supplements improved the child's memory. — children of alcohol-exposed pregnancies, supplemented before or after birth Evidence A source
• Egg yolk choline improved verbal memory in older adults and made their processing speed worse at the same time. — Japanese adults aged 60 to 80 without dementia, 43.9% female Evidence B source
• Europe lets choline be advertised for the liver, for fat metabolism and for homocysteine, and for nothing else. — general population, EU food labelling Evidence E source
• Europe specifically refused the claim that choline is needed for infant brain development. — EU food labelling, claims directed at infants and young children Evidence E source
• The memory claims made for lecithin and for citicoline were both refused in Europe. — EU food supplement labelling Evidence E source

What too much does

• The Tolerable Upper Intake Level for choline is 3,500 mg a day for adults. High intakes cause fishy body odour, vomiting, sweating, low blood pressure and liver toxicity. — adults Evidence E source

What to do with this

Choline is unusual in that the practical advice fits in one line. If you eat eggs, you are probably fine. If you avoid eggs and liver, you are probably not.

One egg a day covers roughly a third of the reference amount without any planning. If eggs are off the table, the rest of the food supply is thinner and it takes deliberate choices across a day, mostly fish, poultry, pork, soy foods and legumes.

Pregnancy is where the shortfall is both largest and most worth raising with a midwife or doctor, because prenatal supplements differ enormously in whether they contain choline at all. That is a specific question to ask rather than something to solve from a website.

Why a choline number means something different from a vitamin number

Your body makes some of its own choline. The enzyme that does it, PEMT, is turned up by oestrogen, and that is the stated reason the American recommendation gives men 550 mg a day and women 425. So the figure on this page is a reference point rather than a straight measure of what you have to eat, and how much you need depends partly on your own hormones and on common variations in the PEMT gene.

The recommendation was built the hard way, and knowing how makes it easier to read. Adults were fed a choline-free diet until their livers showed damage, and 500 mg a day corrected it. That one endpoint is the base under the adult number. In pregnancy a comparison of 480 against 960 mg a day found no consistent difference in outcomes. Europe looked at the same ground and published a single figure of 400 mg a day for every adult and for teenagers from 15, where the United States publishes two. All of them are Adequate Intakes, the label a body uses when it could not derive a requirement.

Eggs, with the arithmetic

A boiled egg carries 134 mg of choline, so two of them come to 268 mg, about half of a man's 550 and nearly two thirds of a woman's 425. A raw egg holds 167.5 mg, which makes boiling about an 80 per cent job. Cooking is otherwise gentle with choline: the retention factor is 100 per cent for 170 of 269 methods and the lowest anywhere is 60 per cent.

Choline sits mostly in animal foods, and that is the whole practical story. Liver, eggs and wheat germ head the list, and meat, dairy, eggs and grain carry most of what people actually eat. A plant-based pattern generally delivers less, and among women of childbearing age a vegetarian-leaning diet went with a lower intake. If eggs are off your plate, the number takes deliberate work across the day.

The shortfall is real and it is wide. The median American adult takes in 280 mg a day, 242 among women and 330 among men, against Adequate Intakes of 425 and 550. Eighty-seven per cent of adults and 93 per cent of adult women come in below the 550 mg Daily Value. Choline is the one nutrient on this site where most people genuinely sit under the recommendation.

What choline supplements have and have not done

Myth. Citicoline does not improve the outcome of a stroke. Pooling ten trials in more than 4,000 people with acute ischaemic stroke, deaths were 17.3 per cent on citicoline against 18.5 on placebo, disability was 21.7 against 19.2 per cent, and serious cardiovascular events did not differ. Europe refused the memory claims for citicoline and for lecithin separately, and the American regulator authorises no choline health claim at all.

Unsettled. In older adults the one trial with a positive memory result carries a cost in the same table. Japanese adults aged 60 to 80 given egg yolk choline did better on verbal memory at six and twelve weeks. At those same visits their processing speed and their physical quality of life scores came out significantly worse than the placebo group's. A result that moves in both directions at once is a reason to wait for another trial rather than to buy anything.

Where choline has earned a randomised result, it is narrow and it belongs to clinicians. In children of pregnancies heavily exposed to alcohol, choline before birth improved memory on moderate-certainty evidence. In very preterm babies it lifted blood choline back towards what a fetus would have had. Neither is a reason for anybody else to start a supplement.

Where to get it from food

The bottom line

Choline is worth knowing about because the gap between what people eat and what is recommended is unusually wide, and because eggs and liver dominate the food supply of it. People who avoid both are the most likely to fall short. The cardiovascular worry through TMAO is real as a mechanism, but it has not shown up as disease risk in large observational studies. Pregnancy is where the shortfall matters most. The European claims register is where this page gets sharp. Three choline claims are authorised, for normal liver function, normal homocysteine metabolism and normal lipid metabolism, and 25 were refused. Among the refusals is the one that sells choline to parents: that choline is needed for the development of the brain of infants and young children from birth to three years. The memory claims for lecithin and for citicoline were refused as well. Refused means the evidence did not meet the bar at assessment, and it is not a finding that choline does nothing for a developing brain. In children of pregnancies heavily exposed to alcohol, choline supplements did improve memory. Both statements stand together, and the jurisdiction matters, because this is the European register and not FDA, which authorises no choline health claim of its own.

Sources

1. chol-01 · Position of an expert body · expert body statement
   Choline is needed to produce acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions.
   NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
2. chol-03 · Position of an expert body · expert body statement
   Humans can produce choline endogenously in the liver, mostly as phosphatidylcholine, but the amount that the body naturally synthesizes is not sufficient to meet human needs.
   NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
3. chol-02 · Position of an expert body · expert body recommendation
   19+ years [Male]: 550 mg/day; 19+ years [Female]: 425 mg/day; Pregnancy: 450 mg/day; Lactation: 550 mg/day (value from the source's table, not a sentence)
   NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
4. chol-04 · Observational data · national survey data
   The average daily choline intake from foods and beverages is 402 mg in men and 278 mg in women.
   NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
5. ch-d-06 · Observational data · scoping review for dietary reference values
   Choline intake recommendations by the EFSA and IOM were based on depletion-repletion studies among adults who showed liver damage after cutting choline from the diet, and this sign was corrected after administering 500 mg choline/d.
   Food & Nutrition Research, 2023 · checked 2026-09-21 · independently re-checked
6. ch-d-07 · Observational data · scoping review for dietary reference values
   Generally, a plant-based diet contains less choline than an animal-based diet (40).
   Food & Nutrition Research, 2023 · checked 2026-09-21 · independently re-checked
7. ch-d-10 · Position of an expert body · reference dataset
   Egg, whole, boiled or poached — Choline, total 268 MG на 100 г [fdc_id 2707154] · 1 egg 50 г 134.0 MG · Egg, whole, raw — Choline, total 335 MG на 100 г [fdc_id 2707152] · 1 egg 50 г 167.5 MG (value from the source's table, not a sentence)
   USDA FNDDS 2021-2023 (Food and Nutrient Database for Dietary Studies) · checked 2026-09-21 · independently re-checked
8. ch-d-11 · Position of an expert body · national dietary survey
   choline_mg (мг) · NHANES 2021-2023, зважено · усі 19+ n=4886 медіана 280 · ж 19+ n=2738 медіана 242 · ч 19+ n=2148 медіана 330 · частка нижче Daily Value 550 мг: ж 19+ 93%, усі 19+ 87% (value from the source's table, not a sentence)
   NHANES 2021-2023, dietary recall, CDC National Center for Health Statistics · checked 2026-09-21 · independently re-checked
9. ch-d-15 · Position of an expert body · regulatory reference value opinion
   400 mg for adults and adolescents aged 15-17 years.
   EFSA, Dietary reference values: EFSA publishes advice on choline, news release 2016 · checked 2026-09-21 · independently re-checked
10. ch-d-04 · Randomised controlled trial(s) · randomised controlled trial
    30 mg/kg/day additional choline supplementation increases plasma choline to near-fetal concentrations, dilutes the D9-choline tracer via increased precursor concentrations and improves DHA homeostasis in preterm infants.
    European Journal of Nutrition, 2020 · checked 2026-09-21 · independently re-checked
11. ch-d-05 · Observational data · scoping review for dietary reference values
    In females, the endogenous production of choline is subject to hormonal upregulation, which was the argument used by IOM to define higher AIs for males compared to females.
    Food & Nutrition Research, 2023 · checked 2026-09-21 · independently re-checked
12. ch-d-09 · Position of an expert body · reference dataset
    choline_mg · 269 методів · 100% (втрат немає): 170 методів із 269 · найнижчий фактор: 60% · медіана: 100% (value from the source's table, not a sentence)
    USDA Table of Nutrient Retention Factors, Release 6 (2007), Agricultural Research Service · checked 2026-09-21 · independently re-checked
13. chol-06 · Position of an expert body · expert body statement
    Choline deficiency can cause muscle damage, liver damage, and nonalcoholic fatty liver disease (NAFLD or hepatosteatosis).
    NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
14. chol-05 · Observational data · survey data cited by expert body
    Approximately 90%–95% of pregnant women consume less choline than the AI.
    NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
15. ch-d-08 · Observational data · systematic review with meta-analysis of prevalence and observational associations
    Meta-analysis of 12 prevalence studies revealed a concerning 11.24% (95% confidence interval, 6.34-17.26) prevalence of pregnant women with adequate choline intake recommendations.
    Nutrition Reviews, 2025 · checked 2026-09-21 · independently re-checked
16. chol-07 · Position of an expert body · expert body statement
    Some choline...are converted to trimethylamine (TMA) by intestinal bacteria. The TMA is then absorbed and converted by the liver into trimethylamine-N-oxide (TMAO), a substance that has been linked to a higher risk of cardiovascular disease.
    NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
17. chol-08 · Observational data · observational studies cited by expert body
    Several large observational studies have found no significant associations between choline intakes and cardiovascular or peripheral artery disease risk.
    NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted
18. ch-d-01 · Meta-analysis or systematic review · Cochrane meta-analysis of randomised controlled trials
    A pooled analysis of eight trials indicates there may be little or no difference in all-cause mortality comparing citicoline with placebo (17.3% versus 18.5%; RR 0.94, 95% CI 0.83 to 1.07; I² = 0%; low-quality evidence due to risk of bias).
    Cochrane Database of Systematic Reviews, 2020 · checked 2026-09-21 · independently re-checked
19. ch-d-02 · Meta-analysis or systematic review · meta-analysis of randomised controlled trials
    Prenatal supplementation likely benefits memory (SMD 0.61, 95 % CI 0.19 to 1.02; Pr(SMD>0) = 96.29 %; I2 = 0 %; 2 trials; 94 participants; moderate-certainty evidence).
    Pediatrics and Neonatology, 2025 · checked 2026-09-21 · independently re-checked
20. ch-d-03 · Randomised controlled trial(s) · randomised double-blind placebo-controlled trial
    The results suggested that continued 300 mg/day intake of egg yolk choline improved verbal memory, which is a part of cognitive functions. To confirm the observed effects of egg yolk choline, more well-designed and large-scale studies are warranted.
    Lipids in Health and Disease, 2023 · checked 2026-09-21 · independently re-checked
21. ch-d-12 · Position of an expert body · regulatory register entry
    POL-HC-6354 Choline Choline contributes to the maintenance of normal liver function Authorised (value from the source's table, not a sentence)
    EU Register on nutrition and health claims (European Commission) · checked 2026-09-21 · independently re-checked
22. ch-d-13 · Position of an expert body · regulatory register entry
    POL-HC-8455 Choline Choline is needed for the development of brain of infants and young children from birth to three years -/- Non-authorised (value from the source's table, not a sentence)
    EU Register on nutrition and health claims (European Commission) · checked 2026-09-21 · independently re-checked
23. ch-d-14 · Position of an expert body · regulatory register entry
    POL-HC-7500 Lecithin Lecithin (a phospholipid containing choline) supports memory and concentration. Non-authorised (value from the source's table, not a sentence)
    EU Register on nutrition and health claims (European Commission) · checked 2026-09-21 · independently re-checked
24. chol-09 · Position of an expert body · expert body recommendation
    High intakes of choline are associated with a fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity.
    NIH Office of Dietary Supplements, Health Professional Fact Sheet: Choline · checked 2026-09-15 · extracted