Choline
In brief
Section titled “In brief”- Diet and lifestyle are the main approach for MASLD; supplements are never the foundation
- Choline is mainly relevant with low intake; with normal intake, supplementation is usually not necessary
- Main sources: eggs, fish, meat, soy and cabbage varieties
- If supplementation is needed, phosphatidylcholine (PC) is preferred over ‘free choline’
- With TKB, choline intake often increases naturally
What is choline?
Section titled “What is choline?”Choline is an essential nutrient with multiple functions:
| Function | Role |
|---|---|
| Cell membranes | Building block for phospholipids (including phosphatidylcholine) |
| Nervous system | Precursor for acetylcholine |
| Methylation | Role in methylation processes |
| Liver | Helps package and transport fat out of the liver |
A clearly low choline intake can promote fatty liver.
Reference values
Section titled “Reference values”| Group | Adequate intake (EFSA) |
|---|---|
| Adults | 400 mg/day |
| Pregnancy | 480 mg/day |
| Breastfeeding | 520 mg/day |
Food first
Section titled “Food first”Main sources
Section titled “Main sources”| Category | Examples |
|---|---|
| Eggs | Especially the yolk (richest source) |
| Fish | Fish, shellfish |
| Meat | Meat, poultry, organ meat (liver) |
| Dairy | Variable content |
| Plant-based | Soy, legumes, cabbage varieties |
When to consider supplementation?
Section titled “When to consider supplementation?”Supplementation is not standard. Only consider if there is a clear reason that food is not sufficient:
- Structurally few or no choline sources (vegan/vegetarian without good alternatives, or strong aversion to eggs/fish/meat)
- Pregnancy/breastfeeding with low intake, or specific medical advice
Preference: phosphatidylcholine
Section titled “Preference: phosphatidylcholine”If supplementing, preferably choose phosphatidylcholine (PC), often delivered as lecithin.
High doses of ‘free choline’ are usually not necessary if the goal is to supplement a low intake.
Practical trial approach
Section titled “Practical trial approach”| Step | Approach | Duration |
|---|---|---|
| 1. Optimize nutrition | Build in regular choline sources | 2-4 weeks |
| 2. Possibly PC as trial | Only with persistently low intake, start low | Evaluate 8-12 weeks |
| 3. Stop | If continuation is not necessary | - |
Safety
Section titled “Safety”The safe upper limit (UL) for adults is 3500 mg choline per day (food plus supplement).
With high intake, symptoms may occur:
- Diarrhea
- Sweating
- Low blood pressure
- ‘Fishy odor’
Metabolic basis for MASLD
Section titled “Metabolic basis for MASLD”Reference point from European guidelines for MASLD and overweight:
| Goal | Weight reduction |
|---|---|
| Decrease liver fat | minimum 5% |
| Improvement liver inflammation | 7-10% |
| Improvement fibrosis | minimum 10% |
Lifestyle approach
Section titled “Lifestyle approach”- Nutrition: unprocessed/minimally processed; limit sugary drinks and ultra-processed products
- Exercise: combine aerobic training and strength training; maintain muscle mass and take recovery seriously
Veelgestelde vragen
What is choline?
Choline is an essential nutrient. It is a building block for cell membranes, precursor for acetylcholine and plays a role in methylation processes. For the liver, it helps package and transport fat out of the liver.
How much choline do I need?
EFSA maintains an adequate intake of 400 mg per day for adults. During pregnancy this is 480 mg and when breastfeeding 520 mg.
Which foods contain choline?
Especially eggs (particularly the yolk), fish, shellfish, meat and poultry. Plant-based: soy, legumes and cabbage varieties. With TKB, choline intake often increases naturally.
Should I take choline for a fatty liver?
No, 'I have MASLD so I need to take choline' is not an indication. Diet and lifestyle are the main approach. Choline is only relevant with structurally low intake. The biggest gain comes from metabolic improvement.
Which form of choline is best as a supplement?
If supplementing, preferably choose phosphatidylcholine (PC), often delivered as lecithin. High doses of 'free choline' are usually not necessary.
What are side effects of too much choline?
With high intake, symptoms may occur such as diarrhea, sweating, low blood pressure or 'fishy odor'. The safe upper limit is 3500 mg per day (food plus supplement).
Medische Disclaimer: De informatie van Stichting Je Leefstijl Als Medicijn over leefstijl, ziektes en stoornissen mag niet worden opgevat als medisch advies. In geen geval adviseren wij mensen om hun bestaande behandeling te veranderen. We raden mensen met chronische aandoeningen aan om zich over hun behandeling goed door bevoegde medische professionals te laten adviseren.
Medical Disclaimer: The information provided by Stichting Je Leefstijl Als Medicijn regarding lifestyle, diseases, and disorders should not be construed as medical advice. Under no circumstances do we advise people to alter their existing treatment. We recommend that people with chronic conditions seek advice regarding their treatment from qualified medical professionals.