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- This fact sheet supports the assertion that choline from animal sources is not necessary and may be harmful to health.
- In general, the nutrient choline is most highly concentrated in animal-derived foods such as eggs and meat. This has led to claims that vegans are at risk of becoming deficient in choline.
- A 2019 editorial published in the journal BMJ made headlines by expressing concern about choline deficiency in those eating plant-based diets.
- In the USA, recommendations for the Adequate Intake (AI) of choline are based on very limited data (one study done on adult men). The AI for women and other age groups has been extrapolated from this data and so may not be accurate. Additionally, the original study was limited as it only compared intakes of 500 mg/day and 50 mg/day, finding that the latter caused deficiency. Intermediary values were not considered, so the recommended AI may be higher than true requirements — especially as the body produces some of its own choline.
- The European Food Safety Authority sets the AI for adults at a lower figure of 400 mg/day. This figure is based on the average intake of healthy populations, and is arguably more accurate than the study mentioned above. However, it still does not establish the minimum amount of choline required for good health.
- Choline produces a by-product called TMAO in the body. A study in the New England Journal of Medicine found that TMAO increases the likelihood of stroke, heart disease, and even death. The study recommends that excess choline intake should be avoided and suggests that a high-fiber or vegetarian diet is an effective way to do this.
- Another study also found that high choline intake is linked to heart disease, but noted that vegans and vegetarians are protected from its effects.
- Other research has supported this by showing that since vegans have different gut flora to omnivores, they produce very little TMAO.
- Egg consumption has been linked to an increased risk of prostate cancer, and researchers suggest that choline may be the culprit.
- TMAO has also been linked to chronic kidney disease.
- In some people, excess choline consumption causes a strong fishy body odor, including the breath, urine, and sweat.
- The USDA has published a database of the choline content of various foods. It shows that eggs are extremely high in choline, containing about three times as much as meat and fish. However, wholegrains contain almost as much choline as meat and fish, and breakfast cereals are also a good source. Overall, fruits and vegetables are a better source than milk. The database also shows that some individual plant foods have a very high choline content, such as wheat germ, soy flour, quinoa, and peanut butter.
- One of the most common symptoms of choline deficiency is the development of non-alcoholic fatty liver disease (NAFLD). However, plant-based and vegetarian diets have been shown to reduce the risk of NAFLD, making it unlikely that these diets are deficient in choline.
- In 2019, an article was published in the journal BMJ claiming that those eating plant-based diets may be at risk of choline deficiency. In the media, the article was referred to as a study, but in reality it is an editorial and the author did not carry out any of her own research. Moreover, she has ties to the egg and meat industries and so the article cannot be considered unbiased.
- Two studies carried out in 2004 and 2009 appeared to show that low choline intake in pregnant women could increase the risk of babies being born with neural tube defects. However, more recent research does not support this claim. In contrast, up to 70 percent of neural tube defects are linked to inadequate folic acid intake, and those eating plant-based or vegetarian diets typically have higher folate levels than omnivores.
- The National Institutes for Health (NIH) state that cruciferous vegetables and some beans are "rich in choline." They show that soybeans contain more choline than ground beef, chicken breast, or cod, while mushrooms and potatoes contain more than tuna and dairy products. Quinoa, wheat germ, and kidney beans are also good sources.
- According to the NIH, most people in the USA do not achieve the Adequate Intake for choline. This is despite eating a diet high in animal products. However, it claims that actual rates of choline deficiency are very low, again suggesting that the AI is not accurate.
- The Physicians' Committee for Responsible Medicine recommends choosing plant-based sources of choline because animal sources (such as eggs) are often very high in saturated fat. It points out that high saturated fat consumption increases the risk of heart disease and dementia.
- Eggs, which are by far the greatest dietary source of choline, are extremely high in cholesterol and have been shown to significantly increase the risk of heart disease. The USDA's Dietary Guidelines recommend eating "as little dietary cholesterol as possible."
- Tom Sanders, Professor Emeritus of Nutrition and Dietetics at King's College London, has stated that "There is no justification for suggesting that plant-based diets risk damaging brain development...My own research on vegans and those of others in Europe and USA find the growth and development of vegans and vegetarians is normal." He points out that the body can make some of its own choline and that the nutrient is "abundant" in several plant-based foods.
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This fact sheet was originally authored by Greg Fuller and copyedited by Isaac Nickerson. The contents may have been edited since that time by others.