Approved Health Claims
- It contributes to normal homocysteine metabolism.
- It contributes to normal lipid metabolism.
- It contributes to the maintenance of normal liver function.
| Maximum Daily Intake | 550mg/gün yetişkin erkek) 425mg/gün (yetişkin kadın) * |
| Maximum Daily Intake | 275 mg/gün (4-10 yaş) 550 mg/gün/ (11 yaş ve üzeri) |
* Since reliable biomarkers for choline are not available, the required amount cannot be precisely determined. However, EFSA (European Food Safety Authority) has defined “Adequate Intake (AI)” values based on observed intake levels in healthy individuals. This value is 550 mg/day for adult men and 425 mg/day for women.
Minimum Content Requirement for Health Claims
In order for a product to use a “health claim regarding choline,” it must contain at least 82.5 mg of choline per serving, 100 grams, or 100 mL. That is to say:
- If the product is single-serving → One serving should contain 82.5 mg of choline.
- If the product is labeled in 100g or 100mL, then 100g or 100mL should contain 82.5 mg of choline.
This threshold is the minimum ingredient requirement according to the health claim rules of both the European and Turkish Health Authorities. Products containing lower amounts of choline cannot use official health claims on their labels such as “choline contributes to normal liver function”.
Mechanism of Action
- Choline is converted to betaine in the body. Betaine then donates a methyl group to the homocysteine molecule, converting it back to methionine. This reaction occurs via the BHMT (betaine-homocysteine methyltransferase) enzyme. This helps balance homocysteine levels and protects vascular health.
- Choline is essential for phosphatidylcholine synthesis. Phosphatidylcholine is necessary for VLDL production in the liver. VLDL transports triglycerides from the liver to the tissues. Sufficient choline → proper VLDL production → correct transport and processing of fats.
- Choline deficiency impairs VLDL production, triglycerides accumulate in the liver, and fatty liver disease may develop. Choline plays a role in the structure of cell membranes and also helps remove fats from the liver. Thus, liver function is protected.
Safe Doses for Choline in Europe and Türkiye
The European Food Safety Authority (EFSA), taking into account potential side effects, has set a safe upper limit of 3500 mg/day for adults.
In Turkey, the upper limits for use in food supplements are set differently from EFSA and are much lower, as can be seen in the table above:
- Maximum 275 mg/day for children aged 4–10 years.
- Maximum 550 mg/day for ages 11 and up.
Excess Choline, TMAO, and Cardiovascular Risk
Choline is absolutely essential, especially for liver and cardiovascular health, and its deficiency causes serious problems. However, it should not be used excessively.
Excessive choline intake increases the production of trimethylamine (TMA) through gut bacteria; this compound is converted to trimethylamine N-oxide (TMAO) in the liver and enters the bloodstream, and in various studies, increased TMAO levels have been associated with an increased risk of cardiovascular disease.
At normal dietary levels (around 425–550 mg/day), TMAO production is limited and generally does not cause clinical problems in healthy individuals.
However, with high-dose supplements, TMAO production can increase significantly (such as 1000 mg-2000 mg/day). This increase has been associated with cardiovascular risks in some studies.
At very high intakes (>3500 mg/day), side effects (fishy odor, hypotension, digestive problems) begin to appear, and TMAO production also reaches its maximum at these levels.
Groups at Risk of Choline Deficiency or Low Levels
- Pregnant and breastfeeding women: Choline requirements increase for fetal and infant development.
- Genetic and Metabolic Factors: High homocysteine levels, fatty liver disease due to choline deficiency, or a frequent family history of similar problems may indicate a genetic predisposition. A doctor should be consulted.
- Vegans and vegetarians: Choline is most abundant in eggs, meat, and fish; plant-based sources are more limited.
- For those following a low-protein diet: Choline is generally found in high concentrations in protein-rich foods.
- Those with high alcohol consumption: Alcohol disrupts choline metabolism, increasing the risk of deficiency.
- Older individuals: the body’s ability to produce choline on its own may decrease, and nutritional deficiencies are more common in old age.
- Postmenopausal women: In postmenopausal women, estrogen decreases. Estrogen supports the body’s ability to produce choline on its own. When this support is lost, the need for choline has to be met more from external sources.
High Dose Risk Groups
It is generally not possible to exceed these doses through diet alone, but a diet rich in choline, combined with high-dose choline supplements, can lead to an overdose. This is especially risky for individuals at risk of cardiovascular disease, diabetes, or impaired kidney function .
References
- EFSA Panel on Dietetic Products, Nutrition and Allergies (2011). Scientific Opinion on Dietary Reference Values for choline. EFSA Journal, 9(4):2056.
- Türkiye Cumhuriyeti Tarım ve Orman Bakanlığı (2020). Takviye Edici Gıdalar Tebliği (2020/7). Resmî Gazete.
- Zeisel, S.H., da Costa, K.A. (2009). Choline: An essential nutrient for public health. Nutrition Reviews, 67(11):615–623.
- Ueland, P.M. (2011). Choline and betaine in health and disease. Journal of Inherited Metabolic Disease, 34(1):3–15.
- Vance, D.E. (2008). Role of phosphatidylcholine biosynthesis in the regulation of lipoprotein homeostasis. Current Opinion in Lipidology, 19(3):229–234.
- Li, Z., Vance, D.E. (2008). Phosphatidylcholine and choline homeostasis. Journal of Lipid Research, 49(6):1187–1194.