Reviewed by dietitian Jessica Ball, MS, RD
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Key Points
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Choline is an essential micronutrient for a healthy brain and nervous system.
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Low levels of choline in the blood are linked to a higher risk of Alzheimer’s disease.
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Choline is found in seafood, meat, milk, nuts, potatoes, legumes and whole grains.
Choline is one of those underrated micronutrients that we don’t hear much about—in fact, most Americans aren’t eating enough of it. But every nutrient, no matter how micro, is essential—and choline is no exception. It is necessary for a healthy brain and nervous system and helps regulate mood, memory and muscle control, as well as being essential for forming the membranes around your cells. It is also vital for the proper development of the brain of babies in utero and after birth.
In addition to being undervalued, choline is also a commonly deficient nutrient. And the lack of this micronutrient comes with some potential harm. For example, a recent study linked low choline intake to a higher risk of dementia, including the most common type of dementia, Alzheimer’s disease.
Researchers from Arizona, including Arizona State University and Mayo Clinic Arizona, began to shed more light on the connection between choline and Alzheimer’s disease. They published their findings in Aging and Disease. Let’s break down what they found.
How Was This Study Done?
The researchers wanted to compare choline levels in people with obesity to those with a healthy BMI. They state that previous studies suggest that people with obesity tend to have lower levels of choline in the blood. They also state that obesity is linked to insulin resistance, a condition that predisposes people to type 2 diabetes. Insulin resistance is also a major risk factor for Alzheimer’s disease.
For this study, a total of 30 participants, aged between 29 and 36 years, were recruited: 15 (7 men, 8 women) with what is considered a healthy BMI (18.5 to 24.9 kg/m2) and 15 (8 men, 7 women) with a BMI that is considered obese (>30 kg/m2). All participants were considered healthy based on their medical history, routine physical examination, electrocardiogram, standard blood tests, and urinalysis. The participants were all non-smokers, free of diabetes and had no history of liver, kidney or heart disease. They also did not take any prescription or over-the-counter medications or nutritional supplements, and were not involved in a weight loss regimen.
Body composition was measured and fasting blood samples were collected. The researchers measured choline levels and factors related to diabetes, including glucose, HbA1c and insulin, as well as blood components associated with inflammation and cognitive decline. In addition, liver enzymes were measured, as certain ones can indicate dysfunctional sugar metabolism and brain nerve damage.
In addition, the researchers also drew postmortem blood from people with known mild cognitive decline and Alzheimer’s disease. With this, they can compare the blood levels of the same components in the 30 healthy individuals with those of individuals with known Alzheimer’s disease and cognitive decline.
What Did This Study Find?
After conducting statistical analyses, the researchers found:
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Individuals with obesity had lower levels of choline in the blood, which, in turn, were associated with poor metabolic markers.
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Markers of inflammation and liver enzymes were elevated in people with obesity.
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As blood choline levels decreased, neurofilament light (NfL), a marker of Alzheimer’s disease, increased. Higher levels of NfL suggest that brain cell damage has occurred, increasing the risk of dementia.
Overall, the researchers found that obesity was associated with lower blood levels of choline, dysregulated inflammatory markers and elevated markers of metabolic dysfunction. And all these factors are related to the risk of Alzheimer’s disease.
A major limitation of this study is that the dietary intake of choline was not evaluated, so the researchers cannot conclude whether people with obesity eat less food rich in choline or if there is some other factor involved that concerns the lower levels. The number of participants for this study is considered moderate. Since more participants tend to increase the accuracy of the results, the researchers note that larger sample sizes in the future will be helpful. This study also did not include cognitive assessments, so comparisons of blood work between living and post-mortem participants with cognitive decline should be interpreted with caution.
How Does This Apply to Real Life?
While you can supplement with choline, we believe it is best to try to get your nutrients through food. Like most nutrients, choline is found in many foods, so we recommend eating a wide variety of foods to ensure you get all the nutrients you need. You find choline in eggs, beef, poultry, pork, fish and dairy products. Cruciferous vegetables, soybeans (including tofu), shiitake mushrooms, peanuts, wheat germ, almonds, kidney beans, lima beans, red potatoes and quinoa are plant-based sources of choline.
These researchers note that following a Mediterranean diet model will help ensure that you get enough choline. The MIND diet is a fusion of the Mediterranean and DASH diets, and is full of brain-healthy foods that contain choline, powerful antioxidants and healthy fats, including seafood, chicken, berries, whole grains and leafy greens (to name a few). To get familiar, try our 30-Day MIND Diet Meal Plan for Cognitive Health. Follow as it is or choose recipes that look appealing.
Other lifestyle factors also play a role in brain health, including regular physical activity, plenty of quality sleep and reducing stress levels. Your brain also needs hydration for optimal cognitive function. Even socializing and volunteering can help keep your mind healthy.
Take our Expert
This study adds to the growing body of evidence suggesting a connection between low blood choline levels and Alzheimer’s disease. It also points to a link between obesity and low choline, although researchers admit they still can’t say with confidence why this link exists. Many people are deficient in choline, even though it is found in a variety of foods. Evaluate your diet and start replacing ultra-processed foods with whole foods, such as seafood, meat, milk, nuts, eggs, legumes, cruciferous vegetables, potatoes and whole grains. Following a meal plan designed for cognitive health can help you take the guesswork out of it.
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