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, dairy, nuts, potatoes, legumes and whole grains.
Choline is one of those underrated micronutrients that we don’t hear much about—in fact, most Americans don’t eat 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, plus it is essential for the formation of membranes around cells. It is also vital for the proper development of babies’ brains in the womb and after birth.
In addition to being underrated, choline is also a commonly deficient nutrient. And deficiency of this micronutrient comes with 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 in Arizona, including Arizona State University and Mayo Clinic Arizona, set out 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 conducted?
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 their 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.
A total of 30 participants, aged 29 to 36 years, were recruited for this study: 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. Participants were all non-smokers, non-diabetic, and had no history of liver, kidney, or heart disease. They were also not taking prescription or over-the-counter medications or nutritional supplements, and were not engaging 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 some can indicate dysfunctional sugar metabolism and brain nerve damage.
In addition, the researchers drew post-mortem blood from people with known mild cognitive decline and Alzheimer’s disease. With this, they could compare the blood levels of the same components in the 30 healthy individuals with those of people with known Alzheimer’s disease and cognitive decline.
What did this study find?
After performing some statistical analysis, the researchers discovered:
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Obese people had lower blood choline levels, 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 and increases the risk of dementia.
Overall, the researchers found that obesity was associated with lower blood choline levels, dysregulated inflammatory markers and increased markers of metabolic dysfunction. And all of these factors are linked to the risk of Alzheimer’s disease.
A major limitation of this study is that dietary choline intake was not assessed, so the researchers cannot conclude whether obese people eat fewer choline-rich foods or whether there is another factor involved in the lower levels. The number of participants in 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. Also, this study did not include cognitive assessments, so comparison of blood tests between living participants and those who were postmortem with cognitive decline should be interpreted with caution.
How does this apply in real life?
While you could supplement with choline, we think it’s best to try to get your nutrients through food. Like most nutrients, choline is found in many foods, which is why we recommend eating a wide variety of foods to make sure you’re getting all the nutrients you need. You’ll 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 sources of choline.
These researchers note that following an eating pattern in the Mediterranean diet will help ensure 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 MIND 30-Day Meal Plan for Cognitive Health. Follow it as it is or choose recipes that look appealing.
Other lifestyle factors also play a role in brain health, including regular physical activity, quality sleep, and reducing stress levels. Your brain also needs hydration for optimal cognitive function. Even socializing and volunteering can help keep your brain healthy.
Our expert
This study adds to the growing body of evidence suggesting a link between low blood choline levels and Alzheimer’s disease. It also points to a link between obesity and low choline levels, although the researchers admit they can’t yet say with confidence why the link exists. Many people are deficient in choline, despite the fact that it is found in a variety of foods. Assess your diet and start swapping ultra-processed foods for whole foods such as seafood, meat, dairy, nuts, eggs, legumes, cruciferous vegetables, potatoes and whole grains. Following a meal plan designed for cognitive health can help take the guesswork out of it.
Read the original article on EatingWell