Choline
Choline is the precursor for acetylcholine, a neurotransmitter involved with memory; it’s an integral component of two important phospholipids; and the liver uses it to process fats and package lipids. The real authority on choline is Chris Masterjohn of the Daily Lipid blog. In fact, I’ll refer to his series of choline posts from time to time, because they do a far better job of explaining than abstracts from PubMed.
Deficiency Symptoms
Fatty liver – The research is pretty clear that a choline deficiency is majorly responsible for fatty liver.
Lowered VLDL – Without choline, very low-density lipoprotein synthesis in the liver is disrupted. While reducing VLDL might make your lipid panel happy, it also sets you up for developing fatty liver, since the fat isn’t being packaged into lipoproteins for dispersal.
Elevated ALT levels – Elevated alamine transaminase levels could indicate liver problems, which are often caused by a choline deficiency.
Elevated homocysteine – A choline deficiency results in a reduced capacity to methylate homocysteine (PDF).
Impaired memory – Since choline is the precursor for acetylcholine, a choline deficiency often manifests as a memory impairment. One study even found that choline supplementation improved memory in humans who were deficient.
Why Might Deficiency Occur?
You’re still scared of dietary fat and cholesterol. The best sources of choline come packaged with fat and cholesterol. I imagine this fear explains the “silent epidemic” of fatty liver across America that Chris Masterjohn discusses, but don’t let it get to you.
You’re still scared of offal. Yeah, yeah, it’s icky, it has a very distinct taste, your grandma used to overcook liver and force you to eat it, whatever. Liver and other offal bits are awesome and essential.
You’re not scared of dietary fat and cholesterol. Huh? Doesn’t this contradict number one? Not exactly. Most of you are all about the fat, and that’s awesome, but eating more fat increases the need for choline. This doesn’t mean you have to reduce the fat; you simply have to increase your choline intake (luckily, Primal fat sources are also often choline sources, as you’ll see below).