Overview

Choline is an important nutrient. Choline supplements are commonly used to increase choline levels. They may also be used for other reasons, but their benefits are not well defined. Common side effects with high doses of choline can include a fishy body odor, vomiting, low blood pressure, and increased sweat or saliva. Before taking choline, tell your health care provider about all of your health conditions and any medicines or supplements you may be using.

Uses

What is choline used for?

Choline is commonly used to increase levels of choline in the body. It is also sometimes used for heart, brain, and liver health, but its benefits for these uses are not well defined.

Choline may also be used for other conditions as determined by your health care provider.

Note: The FDA has not reviewed choline for safety and effectiveness. Learn more about dietary supplements here.

Choline is available as a dietary supplement in various strengths and dosage forms, including in products that contain phosphatidylcholine or lecithin. It may also be found as an ingredient in some multivitamins or other supplements.

How does choline work (mechanism of action)?

Choline is an important nutrient that your body uses for many purposes, including sending signals and transporting substances in your nerves, brain, and liver. It is also an important part of some fatty substances that make up the membranes that surround your cells, such as phosphatidylcholine. In the womb, choline plays an important role in brain and liver development.

In the United States, choline is found in many foods in the diet, including meat, eggs, chicken, fish, potatoes, and dairy products. It is also found in many grains, beans, nuts, and seeds. For most adults, the adequate daily intake of choline is 425 to 550 milligrams (mg). But most people in the United States do not get enough choline from their diets. If you are not getting enough choline from your diet, it is important to try to eat more foods that contain choline. If this is not possible, you can take choline supplements to replace what you are not getting from your diet.

Choline is a building block for an important brain chemical called acetylcholine. Higher levels of acetylcholine can increase a type of communication in the brain called cholinergic activity. Choline is also a building block of phosphatidylcholine, a substance that helps keep your brain cells working properly. But it is not clear if choline supplements can increase acetylcholine or phosphatidylcholine levels in your brain. Also, the benefits of taking choline for brain health or dementia are not well defined.

Choline supplements are sometimes used to help reduce the risk of heart disease or liver problems, such as fatty liver disease. But it is not clear if choline can help with any of these problems. Some studies show that taking choline may be helpful, but taking too much choline may be harmful. Speak to your health care provider if you are unsure whether you need a choline supplement.

How should I store choline?

You should store choline according to the product label. Most dietary supplements should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of choline?

The most common side effects of choline are listed below. These side effects may vary depending on the specific product you are using, and may be more likely with higher doses. Tell your health care provider if you have any of these side effects that bother you.

• Fishy body odor
• Increased amounts of sweat or saliva
• Low blood pressure, or hypotension (see below)
• Vomiting

There may be other side effects of choline that are not listed here. Contact your health care provider if you think you are having a side effect of a supplement. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of choline?

While less common, the most serious side effects of choline are described below, along with what to do if they happen.

Severe Allergic Reactions. Choline may cause allergic reactions, which can be serious. Stop taking choline and get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching or skin rash
• Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Low Blood Pressure (Hypotension). High doses of choline may cause low blood pressure. If you feel faint or dizzy, lie down. Tell your health care provider right away if you have any of the following symptoms of low blood pressure.

• Dizziness, feeling lightheaded, or fainting
• Confusion
• Feeling weak or tired

Heart Attack and Stroke.Some research has found that taking choline supplements in high doses for a long time may increase your risk of a heart attack or stroke. But not all research agrees. For now, the long-term risk of taking choline supplements is unclear. If you have had a heart attack or stroke, or these problems run in your family, speak to your health care provider before taking choline supplements. Get emergency help if you have any of the following symptoms of a heart attack or stroke.

• Chest pain or pressure
• Fast or abnormal heartbeat
• Trouble breathing
• Pain in your back, jaw, throat, or arm
• Sweating, upset stomach, vomiting, or dizziness
• Sudden weakness on one side of your body
• Sudden and severe headache
• Slurred speech or trouble understanding speech

Liver Damage.Some people who take choline have had liver damage, also called hepatotoxicity. The risk may be higher at higher doses or with long-term use. However, it is not clear which dose may be more likely to cause liver damage. Call your health care provider right away if you have any of the following symptoms of liver damage.

• Nausea or vomiting
• Stomach or belly pain
• Fever
• Weakness or unusual tiredness
• Itching
• Loss of appetite
• Light-colored poop
• Dark-colored urine (pee)
• Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Precautions

Who should not use choline?

Allergies to Ingredients. People who are allergic to any of the following should not take choline.

• Choline
• Choline bitartrate
• Any of the ingredients in the specific product

Your pharmacist can tell you all of the ingredients in the specific choline products they stock.

What should I know about choline before using it?

Choline is a dietary supplement. It cannot be marketed to treat or cure a disease.

Read and follow the directions on the specific product you are taking, or take it as recommended by your health care provider.

Keep choline out of the reach of children.

Although choline supplements can help meet your daily needs, too much choline may be harmful for some people. Some research has found that taking high doses of choline for a long time might increase the risk of serious side effects, such as heart and liver problems. High doses of choline can also cause low blood pressure. If you are not sure how much choline you need or whether you need a choline supplement, talk to your health care provider.

Dietary supplements may provide choline in many different forms. Some examples include choline bitartrate, phosphatidylcholine, and lecithin. Each of these forms can increase the levels of choline in your body.

The FDA has not tested choline products to confirm that they contain the ingredients stated on their labels. Some dietary supplements have been tested by third-party organizations to confirm that they contain the ingredients listed on their labels and do not contain any harmful chemicals. Learn more about how to choose a safe dietary supplement product here.

What should I tell my health care provider before using choline?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if choline is right for you.

In particular, make sure that you discuss any of the following.

Soy Allergy.Some choline supplements contain lecithin, which may be made from soy. If you are allergic to soy, you may also have an allergy to products made from soy. But you should be able to take choline supplements that are made from other sources. Read the label carefully and talk to your health care provider before taking lecithin-based products if you have a soy allergy.

Other Current and Past Health Conditions.Tell your health care provider if you have any of the following.

• A genetic condition that changes the way your body uses choline, folate, or methionine
• Heart problems
• Liver problems

Pregnancy. Tell your health care provider if you are pregnant or plan to become pregnant. Your health care provider will let you know if you should take choline while you are pregnant or trying to get pregnant.

Breastfeeding. Choline passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should take choline while breastfeeding.

Interactions

Does choline interact with foods or drinks?

There are no known interactions between choline and foods or drinks.

It is unknown if drinking alcohol will affect choline.

Does choline interact with medicines (drug interactions)?

There are no known interactions between choline and medicines. Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

The interactions between choline and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with choline is incomplete. Always check with your health care provider before taking choline with any medicines.

Dosing

What should I do if I accidentally use too much choline?

If you or someone else has used too much choline, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

Choline may come in many different doses and forms, and may be included in products that contain other ingredients. Read the product label closely and speak with a health care provider about how to take choline safely. Do not take double or extra doses, even if you miss a dose.