Move Over Folic Acid, Choline is Here!
If you live in the United States, you were taught that folic acid, also known as B9 or folate, is a necessary and important vitamin for pregnant women. You were probably told that studies show taking it during pregnancy reduces the risk of Neural Tube Defects (NTD).
Over time, we've since learned that synthetic, unconverted folic acid is detrimental for all people. It increases the risk of cancer, and it is harder for the body to absorb and utilize, resulting in what researchers call a pseudo deficiency. This is where the body is receiving tons and tons of folic acid, but cannot convert it or use it in the methylation cycle, so it remains deficient. This tends to cause high serum levels of folic acid on blood tests, so doctors reassure their clients that they are not deficient.
This caused educated people to begin avoiding folic acid, and all unconverted B vitamins. They moved to methylated vitamins, which are bioavailable and easier to use in the body. This is also important for all the mothers who might have MTHFR or related genetic polymorphisms, to make sure they get enough B vitamins even though their bodies find it harder to absorb and use them.
With all that being said, as the constant drum roll to take tons of folic acid continues and as the fight for methylated B vitamins marches on, what we all need to do is take a look at another nutrient called Choline.
What is Choline?
Choline is typically not considered a vitamin or mineral, but a water-soluble nutrient grouped in with B vitamins. And it's a huge piece of the puzzle that all pregnant and breastfeeding women need to know about right now.
Choline is an important part of the methylation process. So, just like folate, it's necessary to make hundreds of functions work properly in the body. Without choline, homocysteine cannot properly convert to methionine for mental health. Without choline, the liver cannot detox the body properly. Without choline, the brain cannot function or grow properly.
What evidence do we have about Choline's importance?
The importance of choline for pregnant and breastfeeding women is shown in the available medical literature. For example, this study
(https://www.ncbi.nlm.nih.gov/pubmed/25956258) found that MTHFR defects, folate deficiency, or choline deficiency caused organized cell death in the brain and short term memory deficits in offspring.
Another study (https://www.ncbi.nlm.nih.gov/pubmed/26700730) found that not only does a low choline diet for the mother increase the risk of NTDs, it also alters the way the cerebral cortex grows. Even worse, the lead researcher noted that there appeared to be a "sensitive window of time" during neurological development and that even if exposed to adequate choline later down the road, the original damage does not change.
Researchers are also learning through this study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319504/) that choline deficiency is connected to the mechanism of cancer development. These researchers observed that choline deficiency seems to alter the repair of DNA and increase the rate of genetic mutations, which is considered a pathway to cancers.
The evidence is piled up when it comes to this nutrient. But, the most important points for childbearing women include:
Choline is part of homocysteine conversion. High homocysteine levels are associated with increased risk of miscarriage and heart defects.
Choline is necessary to build neurological connections and to balance brain growth for the baby during pregnancy, and after birth in the breastfeeding infant. Choline deficiency is associated with memory problems, lower test scores, depression, and more. It is needed throughout the entire brain, so the problems that can happen here are staggering.
Choline is necessary to build a healthy midline through the brain and spinal cord. Choline deficiency is associated with increased risk of NTDs and midline defects.
Choline is necessary for neurochemical balance in the brain. Altered metabolism of this nutrient is implicated in things such as anxiety and depression. A study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687891/) found that altered levels of it in certain parts of the brain are associated with pediatric depression, even when age and sex matched.
Choline is absolutely vital for healthy liver function, so a deficiency during pregnancy could be associated with several common complications such as pre-eclampsia, HELLP syndrome, and cholestasis.
Choline is excreted in the milk after birth, and continues to support healthy brain growth and methylation during childhood.
With all the focus on folic acid, our society forgot that nutrition is multi-faceted. What's worse is that researchers didn't show much interest in choline, and since it is present in a variety of foods, many health officials still believe that a regular diet is good enough to get ample choline during pregnancy and while breastfeeding.
What they didn't realize is that just like the MTHFR genetic mutation, a large portion of women also have choline mutations. Surzenko, the lead researcher in the study short term memory problems from choline deficiency, laid out this problem succinctly when she said,
“Around 45 percent of women carry a polymorphism in the gene required to produce choline during pregnancy as a response to estrogen, which makes them vulnerable to choline deficiency. Without enough dietary choline, the developing fetuses in these mothers are at a risk for hindered brain development.”
These PEMT mutations could be in a majority of the population, meaning even if women are eating ample amounts of healthy, varied foods, they might not be absorbing enough choline. And for those women who avoid certain foods such as eggs and animal livers, their overall intake might already be severely restricted.
What could be worse?
So, this nutrient is necessary during pregnancy to protect the child from NTDs and to grow the child's brain adequately. It helps to run the methylation cycle, so it's connected to every major system in the body including the immune system, excretion (detox) system, and neurological health. It's vital for liver health and a deficiency can increase the risk of things such as nonalcoholic fatty liver disease and glucose imbalance (PCOS, diabetes, hypoglycemia, etc). A lot of women might have polymorphisms that make it harder for them to obtain this nutrient from food. What could be worse?
Choline is connected to gallbladder health!
How many women are feeling some puzzle pieces slamming together right now? Gallbladder attacks, stones, and pain are so common during pregnancy that it's almost considered a normal pregnancy scenario. Many women are constantly watching their diet to avoid painful attacks, and many more go on to surgically remove their gallbladder for relief. Why? Why would pregnancy seem to trigger a gallbladder to go insane? Choline deficiency starts to create a working picture here. As estrogen creation and usage is increased through things such as pregnancy, it increases the need for methylation to break down this hormone and excrete it from the body.
So conceiving, birthing, and breastfeeding can represent large burdens on the gallbladder and liver through the methylation system. As methylation is disrupted and the body begins to run out of necessary methyl donors such as folate and choline, it switches to a glucose system called glucoronidation. Sugar cravings and hormone swings, a liver that's dying and a finicky gallbladder...is anything sounding familiar yet?
This sticky, substitute bile can't be excreted thoroughly, so it starts to stagnate inside the gallbladder. It basically reduces down until it crystallizes into gallbladder stones.
So, pregnant women who develop gallbladder stones are literally looking at a red flag that they are choline deficient, B vitamin deficient, and have a disrupted methylation cycle. This should be considered somewhat of an urgent crisis and a call for careful, bioavailable supplementation! Instead, women are told to restrict their diet and wait it out!
Choline does not have a well established RDA, as it's been fairly neglected in the medical world until recently. It does not have a very potent toxicity. Massive dosages such as 16,000mg daily are associated with vomiting, odor, and sweating. Various converted forms such as acetylcholine and phosphatidylcholine are now easily available online. It used to be that most companies only offered the precursor and only derived from soy, but these days people can purchase lecithin supplements derived from sunflower seeds.
It's time to spread the word on choline, how it functions in the body, and how it's absolutely vital during the childbearing years. When you hear women complain about joint pain during pregnancy, tell them about choline. When women are worried about pre-e, HELLP, and liver conditions, share a choline link. If you hear of a woman suffering from gallbladder issues, make sure she hears about choline. The doctors likely won't tell anyone about this, so it's up to us to use our tribe to share the information and to empower each other to restore our own health.