Choline is a nutrient proven to have a lasting link to a baby’s brain development when taken in pregnancy, but many prenatal vitamins don’t have much choline. The recommended amount is 450 mg/day, and studies show only 10 percent of all pregnant women get enough.
A recent study at Cornell University looked at the benefits of doubling the recommended choline consumption. It showed a link between sustained attention in 7-year-olds and 930 mg of choline during pregnancy. There is also some research backing the possible benefits of giving choline supplements to breastfeeding mothers and toddlers. Host Jessica Rolph is honored to be joined by study authors Dr. Barbara Strupp and Dr. Richard Canfield.
[1:58] What did Dr. Strupp and Dr. Canfield’s human study discover?
[5:44] Choline has been proven (in animal studies) to improve not only attention but also some other benefits.
[9:30] What should pregnant women be doing with this information?
[12:06] Dr. Canfield talks about the different ways to get adequate levels of choline as a pregnant woman.
[13:45] Is there any indication that supplementing to the adequate intake, or even above that amount, is helpful for breastfeeding moms?
[16:00] Dr. Strupp talks about indications that supplementing during childhood can make a difference in future brain health.
[17:59] How do Dr. Canfield and Dr. Strupp approach choline consumption in their adult lives?
[20:48] Jessica shares the highlights of her conversation with the Cornell researchers.
Effects of choline during pregnancy
Jessica: So in a nutshell, what did your human study discover?
Barbara: We were interested in finding out whether the amount of choline that the mom consumes during her pregnancy has lasting effects on her child’s cognitive function. There’s been animal studies with laboratory animals for the past 30 years indicating that the mom’s choline intake was critical for her child’s brain development and ultimate cognitive functioning, but there’s been very few human studies to address this question. So we… And I want to also give credit here to our colleague, Marie Caudill, who was responsible for initiating this trial and for conducting the prenatal portion. She recruited pregnant women to this study and then, in their second trimester and then randomly assigned them to one of two levels of choline intake during their last trimester, either 480 milligrams per day or 930 milligrams per day; 480 is very close to the recommended amount and 930 is approximately twice that.
And importantly, too, with what she did in that portion of the study was to provide all of the foods to these women, so there was absolute sort of assurance that there were these two very different amounts of choline intake during the last trimester. And then when these children were born, we assess their cognitive functioning. Actually, we studied them both when they were infants, but we also did cognitive testing of these children when they… Much later when they were seven years of age. So one thing we first had to find these families and children, because many of them have moved away from the Ithaca area. But anyway, we did bring them back into the lab and assess attentional function of the seven-year-old children, their ability to sustain attention on a very demanding, challenging attention task, which lasted about 12 minutes.
The children born to the women in the 480 group, the moms who had the recommended amount of choline, they started off at a very high level being able to pay attention well. But then across the 12 minutes of the testing, their attention, their performance declined. They were unable to sustain that level of attention. And in contrast the children born to moms in the 930 milligram group, so double the recommended amount, the children in that group showed a remarkable ability to sustain their attention across that 12-minute period. So in a nutshell, that’s what we found. That moms having higher choline intake during the last trimester of pregnancy resulted in children then seven years later who are better able to sustain their attention.
Ability to pay attention
Jessica: That is so fascinating. And in the rodent studies, I remember discovering one of the rodent studies early on when I was pregnant, and I’m sort of like a nerd, I love to read [laughter] some of the… Read these studies. And I remember reading that there were one of the… We have sets of mom mice was given choline and the other set of mom mice were not. And the two groups went through, their babies went through a maze and it was the same, took the same amount of time statistically to go through the maze from both different groups. But then the second time that these, the mice with choline, whose moms had had choline in pregnancy, actually those mice went through the maze much faster the second time than the mice that did not have maternal choline, which I thought was so interesting, which talked about memory, the role of enhancing memory in choline supplementation in utero. Is there anything that you can speak to, maybe not in human studies, but in rodent studies? Can you talk to us a little bit more about not only attention, but also some other benefits?
Barbara: Absolutely. There’s been work done in this area remarkably since the late 1980s, so it is really surprising in a way that so few human studies have addressed this problem in light of the fact that the animal studies have been providing evidence for this for the past 30 years or so.
But briefly, yes, you’re absolutely correct that one of the most common things that people have looked at in rodents is maze performance. They were comparing groups of animals who are born to moms either who got standard amounts of choline, so just the regular amount of choline that’s in regular rodent chow, which has been designed to produce optimal growth, that’s often how those were determined. And then compared that to the offspring born to moms who got maybe four or five times the amount of choline that’s in the normal standard chow.
And what they found, again, is that the animals whose moms had more choline showed markedly reduced numbers of errors. So that often in these mazes, you’re asking the animals to avoid parts of the maze where they’ve already eaten the food, because they’ve eaten the foods, there’s no more left, so they can avoid the arms of the maze that they’ve already been down. And their ability to do that, again, memory function sort of spatial, spatial cognition, spatial mapping is significantly improved by the higher choline intake in the moms.
I should also mention that attentional function again, which is what we were looking at in this study, has also been shown to be improved by maternal choline supplementation, so it’s definitely a point of correspondence between the animal and the human studies.
I mean, certainly in addition to the fact that higher maternal choline intake during pregnancy seems, in both animals and humans, to sort of result in improved ability to pay attention, remember things just throughout the lifespan. But then in addition, if the mom consumes more choline during pregnancy, there seems to be some protective effect in conditions such as Down syndrome and autism. For example, in Down Syndrome, the evidence is that there is improved attentional function in the offspring who have Down syndrome if their moms had more choline relative to those born to just animals whose moms had just the normal amount of choline. And similarly in models of autism, there’s evidence that increased choline intake can cause improved social functioning of those offspring. So I think just in general, that there’s widespread evidence for neuro protection by increased maternal choline intake in not just in typically developing children but also in these other different conditions.
Decreased memory loss
And let me say one more small thing is that one other really remarkable thing about the animal data in this area is showing that giving the moms extra choline during a short… A period of time is five days during the pregnancy, results in a significant lessening of age-related cognitive decline. So rats and mice, like humans, show memory problems when they get old. Actually, this… Tina Williams and Warren Meck, who really were pioneers in this area, they’re in North Carolina. What they found was that giving the moms extra choline significantly lessened this age-related memory loss, and that the animals… Again, these old animals, but born to moms who had extra choline during their pregnancy, did not show this age-related memory decline. So that’s certainly a very provocative finding from the animal work suggesting that maybe how well you age cognitively when you get old may depend on how much choline your mom had during her pregnancy. So it’s a really interesting area.
How to get more choline
Jessica: Only 10% of pregnant women are actually getting even that adequate level. Can you talk to this a little bit more about what should pregnant women be doing with this information?
High choline foods
Richard: Our high choline group, that was about twice the AI, adequate intake level of choline intake was… That level is not easy to get through the diet. We haven’t done enough studies to know what is the minimum effective level of choline, to produce the kinds of effects that we observed in our studies. I think in order to get a high level of choline in the diet, you would have to focus on all the high choline foods and make an effort to regularly consume eggs, beef, fish, chicken, soy beans, milk, all of the… There’s list in various places on the internet you can find where the high choline foods are. And I think the trick would be to look at your normal diet and say, “How can I replace some of what I’m eating with higher choline kinds of foods?” And if, for example, if you’re a vegetarian, it’s going to be more challenging. It’s going to be very challenging.
Jessica: I recall shopping around when I was pregnant, and there were so many different ways to consume choline in a supplement form, because it’s just really hard to get it in your diet and just get to the adequate amounts and calculate everything. And so can you elaborate on some of the different ways to get this adequate levels of choline as a pregnant woman?
Richard: There are really, depending on how you count them, three or four dominant forms of choline, and it is important to be aware of the labelling and the marketing versus what’s really in the supplement. There are two choline salts, choline chloride, which is what we used in our studies, and choline bitartrate, which is also a choline salt. Now, choline salts very high in choline content. For example, the most readily available supplement in a tablet form is choline bitartrate, and it is 41% choline by weight. And so, it’s important to note what the actual choline content is, because another form of choline is phosphatidylcholine, and that is only 13% choline by weight. And then lecithin, is very similar to the phosphatidylcholine, but it’s also much lower in choline content. So, if you’re looking for a supplement, I think the dominant tablet form that you’re going to find on the shelves or on Amazon is going to be a choline bitartrate.
Choline and breastfeeding
Jessica: Choline is naturally found in breast milk and is also found in some infant formulas. Is there any indication that supplementing to the adequate intake or even above that amount is helpful for breastfeeding moms? Because the AI, the adequate intake is something like 450 milligrams when you’re breastfeeding as opposed to 400 milligrams when you’re pregnant.
Barbara: I can just say one small thing about that and Rick can certainly chime in too. This is a little bit outside of the area of expertise of either Rick or I. But our colleague, Marie Caudill, who I mentioned earlier, who actually was the person who initiated the clinical trial that we’ve been talking about, her group, also within the context of that same clinical trial, they also did have two groups of women who they recruited during lactation, so when they’re breastfeeding their babies, and gave them either again, by providing the entire diet, either 480 or 930 milligrams per day during lactation. And what she found was that the higher choline intake, so again, giving double the recommended amount of about 930, total intake, resulted in an increase in the breast milk concentration of choline. I should also mention that breast milk, just naturally contains a lot of choline. So, it’s already a very good source of choline. But what she found, and actually I did discuss this with her, she said her’s is the only study that she’s aware of that’s even looked at this. But they did find a small increase in the breast milk content of choline as a result of doubling the mom’s choline intake. So that’s some information that it may be possible to do that, but probably the effects would be small.
Richard: If I could jump in for just a second. I wanted to just say that the AI, adequate intake for lactating women is 550 milligrams per day. So it goes up from pregnancy to lactation because of the demand to produce choline in breast milk.
Choline in childhood
Jessica: Aah. I thought it… Yes, I was wrong. Then it’s even higher than I was thinking. So that’s very helpful. Are there any indications that taking choline in childhood… So let’s say that you did not take choline during pregnancy as a supplement or you weren’t thinking about how many eggs you were eating every day, any indication that supplementing during childhood can make a difference on future brain health, whether in aging or in memory or attention or emotional resilience?
Barbara: The one… One type of study that only indirectly speaks to that is there have been some studies, one or two studies in children, specifically in children who were exposed to alcohol prenatally. I myself don’t know of any studies in just typically developing children, but in these children who had fairly high exposure to alcohol prenatally, they gave them quite large amounts of choline post-natally and found a significant benefit on some aspects of cognitive function. So those studies would suggest that there certainly can be a benefit of postnatal choline, particularly early postnatally, because actually in this one study, they found that there seemed to be a greater effect of the choline in children who got the choline at I think approximately two and three years than when they were four, if the choline was initiated at four to five years of age. So there may be some greater effect, particularly when the children are very young.
Jessica: And one thing that I read this, the adequate intake levels for my toddler and was thinking, “Okay, I don’t know if they’re loving eggs, or there’s days where they’re not eating a ton of cauliflower.” And so one of the things that I discovered is liquid choline. And so I would just put it into a little bit of juice. Well, just a tiny bit of this liquid, up to 200 milligrams into their juice in the morning. ‘Cause I think it can be tricky to know this data, but then they’re not going to swallow a pill or it’s really hard to manage their diet, and then these toddler supplements generally don’t have very much choline, if any at all. So I just wanted to give that little tip.
And it tastes really salty, so the juice is actually, even though we loved… We don’t want to say that, pump your kids with a lot of juice, it’s actually a great way to mask it, I find that that’s the most effective way. This is so helpful. Let’s talk about the two of you. Do you take a choline supplement? How do you approach choline in your adult lives?
Choline in adulthood
Richard: Well, I’m happy to speak to that because after doing this research for about six or so, seven years, I… And this is not typical for me to be this enthusiastic, I decided that I couldn’t come up with a good reason for not taking choline. And there were many good reasons to take it. There is another observational study of adults and aging and middle-aged adults, and it’s a long-term longitudinal study. And they looked at the choline intake across, I think decades of midlife, and looked at brain function and brain imaging in later life. And there is some evidence that there’s less white matter defects in the brains of aging people who consume more choline consistently through mid-life. So I obviously missed my chance to supplement my mother when she was pregnant, but I came to the conclusion based on what limited data is available and that it’s likely to be of some benefit or possibly of some benefit. And the costs are not large and the potential benefits are very substantial, so that’s what went into my cost-benefit analysis for whether I should take it, and I do.
Jessica: Dr. Strupp?
Barbara: Yeah, well, I’m maybe a little less good about it than Rick in part ‘cause I actually don’t love taking a ton of pills, I’m already taking some others, but I do have choline and I do take it sometimes, so I can’t tell you that I do it every day. I actually have increased my consumption I think of choline-containing foods though, because now I think I do pay a lot more attention to that.
Jessica: Yeah, but it’s just a good reminder. I think that at this stage in life, protecting for aging, I think is, I wish I could get my dad to take choline and my parents, my mom. I just think that it’s so good to protect brain health into aging. So hopefully this…
Richard: We would very much like to have strong data on mid-life and late-life choline intake. I can’t say that I’m taking it because I know it’s beneficial, but I can say I can take it because I know it has no adverse effects and may be beneficial and the potential benefits may be quite substantial.
Here are my takeaways from my interview with the Cornell researchers:
- Studies show that choline is an important nutrient that helps cognitive development in babies, especially if taken while pregnant.
- Only 10% of all pregnant women get enough choline. The recommended amount is 450mg for pregnant women, 550mg if you are breastfeeding.
- Choline is found naturally in eggs, liver, red meat, fish, poultry, legumes, nuts and cauliflower. The highest source is eggs at about 150mg per egg.
- Prenatal vitamins typically do not have more than about 50 – 100mg per dose.
- You can get choline supplements in pill or liquid form.
- If you don’t think you got enough during pregnancy, Dr. Barabara Strupp says studies suggest that there can be a benefit to postnatal choline consumption, particularly when your child is young.
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