Choline and Lecithin Supplements Review (Including
Phosphatidylcholine, CDP-Choline, and Alpha-GPC)
Medically reviewed and
edited by Tod Cooperman, M.D. 
Initially Posted:
09/24/2021
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Table of Contents
Summary
·
What is choline? Choline is an essential nutrient. It is
a component of cell membranes and the neurotransmitter acetylcholine, which is
essential for proper brain function, and it helps remove fat from the liver
(see What It Is). The body naturally produces some
choline, and the rest can be obtained from the diet, but some people are not
able to produce sufficient choline, particularly postmenopausal women and
people with certain genetic traits, putting them at risk for choline
deficiency. In addition, women need extra choline when pregnant or nursing.
·
What does choline do? Getting adequate choline from the diet
helps prevent fatty liver (which can lead to reduced liver function) and muscle
damage. During pregnancy, choline taken by women may reduce the
risk of birth defects, and supplementation was even shown to improve infants'
intellectual processing speeds. Supplemental choline has shown potential
benefit with respect to stroke recovery, cognition, Alzheimer's disease,
asthma, and ulcerative colitis (see What It Does).
·
How to get choline? Many foods are good sources of choline,
particularly egg yolks, meats, and legumes (see Getting It from Food). Lecithin, typically
extracted from raw soybean or sunflower seed oils, is also a convenient food
source of choline due to the phosphatidylcholine that it contains. Supplements
can also provide choline in a variety of forms, including phosphatidylcholine,
alpha-GPC, CDP-choline (citicoline), choline bitartrate, and choline citrate.
We purchased and tested products containing each of these forms.
·
Which form of choline is best? A problem when choosing a choline
supplement is that the different forms provide vastly different amounts of
choline — and these differences are not always clearly labeled (See Comparison of Choline Ingredients in Supplements).
To avoid confusion, we've calculated and shown the amounts of choline expected
from the products we tested — as well as whether or not they contained these
amounts (see the Results Table).
·
How much choline should I take? Adequate daily
intake of choline ranges from 200 mg to 550 mg depending on the person (see
Recommended Intake), but many people get too little. The typical dose used in
disease treatment ranges from 50 mg to several thousand milligrams daily of
specific forms of choline (see Dosage). We found as little as 19.4 mg to as
much as 500 mg of choline per serving in the supplements that we tested.
·
Best choice for choline? Most, but not all, products passed our
tests of quality (see What CL Found), but only a few represent
CL's Top Picks.
We also chose an overall Top Pick that provides a form of
choline that may be safer and better absorbed than others and is also
relatively low cost. We found that you could pay as little at 2 cents to as
much as 58 cents to get an equivalent 100 mg dose of choline from supplements.
·
Safety and side effects of choline: Choline is
generally safe, although gastrointestinal side effects may occur with higher
doses. A small percentage of people may develop a fishy body odor from choline.
Although cause-and-effect relationships have not been demonstrated, higher
intake of choline has been associated with increased risk of colorectal cancer
in women, and some forms of choline increase production of TMAO, which, itself,
is associated with a higher risk of heart attack. (See Concerns and Cautions).
What It Is:
Choline
is a component of cell membranes and the neurotransmitter acetylcholine, a
nerve chemical essential for proper brain function, including memory-related
functions. In developing fetuses, choline is important for brain and memory
development and may decrease the risk of neural tube defects. Choline is also
required for lipid transport from the liver. Inadequate choline intake can
result in fatty liver or muscle damage, as well as atherosclerosis, and
possibly, certain neurological disorders (Zeisel, Nutr Rev 2009).
Our bodies can produce
choline as well as obtain it from the foods we eat, such as egg yolk, meats,
and legumes (see Getting It from Food). However, some people
have less ability to produce choline and, therefore, need to get more choline
from their diets. This is why, since 1998, choline has been considered an
essential nutrient. This reduced ability to produce choline occurs in
postmenopausal women (due to reduced estrogen, which plays a role in choline
production) and those with common genetic variations associated with choline
metabolism. These people are more prone to organ dysfunction (particularly of
the liver and muscles) associated with a low-choline diet -- although symptoms
are not common with mild deficiency. In fact, a U.S. government survey in 2005
indicated that only 2% of postmenopausal women consumed the recommended intake
of choline (Fischer, Am J Nutr
2010; Corbin, Curr Opin Gastroenterol 2013).
Choline intake tends to
decrease with age, and a U.S. government survey in 2004 found that adults ages
71 and older consumed an average of about 264 mg per day, about one-half of the
adequate intake for choline (Zeisel, Nutr Rev 2009).
Choline in Supplements
For many years, the most common source of choline as a supplement was
phosphatidylcholine from soy lecithin. However, unless highly concentrated, soy
lecithin is generally 14% to 21% phosphatidylcholine, of which only 13.7% is
choline — and it's choline that is the likely active component.
As a result, only about 2% to 3% of lecithin is actually choline, although, as
lecithin is a food, it would not be difficult to consume enough to provide a
significant amount of choline: We found 2 teaspoons (4 grams) of soy lecithin
to provide about 134.4 mg of choline.
Many supplements contain
other forms of choline with two to three times as much choline per gram as
phosphatidylcholine. As shown in the comparison chart below, the ingredient
known as CDP-choline has a concentration of choline of 21.4%, and other forms,
such as alpha-GPC, choline citrate and choline bitartrate, are about 40%
choline. This doesn't necessarily make these "better" sources of
choline, but it means you can take less to obtain the same amount of choline.
Most supplements only list the amount of ingredient and not the amount of
choline, so you need to be aware of these substantial differences.
Be aware that consuming
high doses of choline in the form of choline bitartrate has been associated
with the development of kidney stones (see Concerns and Cautions). In addition,
phosphatidylcholine may be preferred source due to better absorption in the gut
and a lower risk of raising levels of TMAO in the blood, which is associated
with atherosclerosis (hardening of the arteries).
Comparison of Choline-containing Ingredients
|
Common Name |
Chemical Name |
% Choline |
|
Lecithin |
Lecithin |
2-3% |
|
Phosphatidyl-choline |
Phosphatidyl-choline |
13.7%* |
|
CDP-choline,
citicoline, Cognizin® |
Cytidine
diphosphate-choline |
21.4% |
|
Choline citrate |
Choline dihydrogen
citrate |
37.4% |
|
Alpha-GPC, choline alfoscerate |
L-alpha
glyceryl-phosphoryl choline |
40.3% |
|
Choline bitartrate |
Choline bitartrate |
41.1% |
|
Choline chloride** |
Choline chloride** |
74.6% |
*For phosphatidylcholine,
% choline may vary by approximately 0.5% depending on the specific fatty acid
composition.
** Choline chloride does not appear to be currently available as a dietary
supplement ingredient in the U.S., although it was generally recognized as safe by the
FDA in 1975 and is used in animal feed.
What It Does:
Choline-containing ingredients have been used in clinical trials
for a variety of disease, suggesting some potential benefits:
Fatty liver disease:
As noted earlier, inadequate choline from the diet can cause nonalcoholic fatty
liver disease (NAFLD) and liver damage. This risk may be increased in people
with certain genetic types (affecting the enzymes choline dehydrogenase (CHDH)
rs12676 and rs9001, methylene tetrahydrofolate dehydrogenase 1 (MTHFD1)
(rs2236225), and PEMT (rs12325817) (Corbin, Curr Opin Gastroenterol 2013). Given intravenously,
choline has been shown to be effective for treating total parenteral
nutrition-associated hepatic steatosis in patients with choline deficiency (Buchman, Hepatology 1995). However, there do
not appear to be studies on the effects of oral choline supplementation for the
prevention or treatment of NAFLD.
Stroke:
Treatment with CDP-choline within the first 24 hours after onset in patients
with moderate to severe stroke increases the probability of complete recovery
at 3 months by about 30%, according to an analysis of several clinical trials.
The most effective dose appeared to be 2,000 mg daily of CDP-choline (428 mg of
choline) (Davalos, Stroke 2002).
Memory and cognition:
Choline supplements have shown very limited ability improve memory and/or
cognition.
A study among older men
and women (average age 67) showed that giving 1,000 mg of CDP-choline twice
daily for 2 months modestly improved short-term recall compared to placebo (Spiers, Arch Neurol 1996). A study among
healthy middle-aged women (average age 47) given either 250 mg or 500 mg of
CDP-choline (Cognizin by Kyowa Hakko Bio
Co., Ltd, which conducted the study) daily for one month modestly improved
certain measures of attention compared to placebo (McGlade, Food Nutr
Sci 2012). Interestingly, those taking the lower dose had slightly
better results than those taking the higher dose.
A study
among 99 healthy men and women (average age 64) found that 500 mg of
CDP-choline (Cognizin) taken once daily with
breakfast for three months did not improve working memory
compared to placebo nor five of the seven other measures of cognitive function,
including attention. However, those who took CDP-choline did have modest,
statistically significant improvements in visual memory and new learning
(Paired Associate test) and composite memory (combined scores for several
memory tests) (Nakazaki, J Nutr 2021). The maker of Cognizin funded the study. Cognizin is an ingredient in Bestvite Cognizin,
tested in this review.
In a small study among
elderly adults given 2,000 mg of choline chloride four times daily for 21 days
--- memory did not improve compared to placebo (Mohs, Neurobiol Aging 1980).
A single, 2,000 mg dose
of choline bitartrate taken with 25 mg of caffeine improved short-term memory
and attention in middle-aged adults 40 minutes after ingestion compared to
caffeine alone or placebo; however, there was no benefit when taking choline
bitartrate with greater amounts of caffeine (50 mg or 100 mg) or taking choline
bitartrate alone (Nagrecha, Clinic Pharmacol Biopharmaceut 2013).
A single dose of choline
bitartrate was also found to have no memory benefit in young adults one to two
hours after ingestion (Lippelt, PLoS One 2016).
During Pregnancy and Lactation:
Choline plays important roles in brain and memory development in the fetus and
appears to decrease the risk of the development of neural tube defects as
does folate — vitamin B9). Large amounts of choline
are being delivered from the mother to the fetus during pregnancy and to the
infant during lactation, which can deplete maternal choline levels (Zeisel, Nutr Rev 2009). A significant increase in choline intake during pregnancy may
be beneficial to infants, as shown in a study of 24 women entering the third
trimester of pregnancy. For 12 weeks they took a supplement containing either
100 mg or 550 mg of choline (as choline chloride) in addition to getting 380 mg
of choline from their diet, as well supplementing with vitamins, minerals and
200 mg of DHA. When tested at 4 through 13 months of age, infants whose mothers
had taken the 550 mg dose of choline had significantly faster information
processing speeds than those whose mothers had taken 100 mg (Caudill, FASEB J 2017).
In June 2017, delegates
at the American Medical Association annual
meeting voted to support evidence-based amounts of choline
in all prenatal vitamins, noting that most prenatals currently contain little if any
choline. As noted below, adequate intake of choline per day is 450 mg for
women who are pregnant and 550 mg for those who are lactating (compared to 425
mg for other women). Considering that young women consume, on average, only 280
mg of choline per day (USDA NHANES 2013-2014),
supplementing with about 200 to 400 mg of choline daily during pregnancy and
about 300 to 600 mg during the third trimester and lactation would seem
appropriate, depending on the amount of choline in one's diet.
Alzheimer's disease and dementia:
As with findings from studies on choline for memory and cognition, it appears
that some forms and sources of choline may be beneficial in Alzheimer's
disease, while others are not.
High daily doses of
lecithin (20 to 30 grams per day), a source of phosphatidylcholine, have
generally not been found to be beneficial in people with Alzheimer's disease (Etienne, Neurology 1981; Little, J Neurol Neurosurg
Psychiatry 1985).
However, a study among
261 men and women (ages 60 to 80) with a diagnosis of mild to moderate probable
or possible Alzheimer's disease found that 400 mg of alpha-GPC taken in the
morning, at lunch, and before dinner (total daily dose of 1,200 mg alpha-GPC)
for six months modestly improved cognition and global function compared to
placebo (Moreno, Clin Ther 2003).
The same daily dose taken with 10 mg of donepezil (Aricept) for 2 years decreased
depression, anxiety and apathy in patients with mild to moderate Alzheimer's
disease in Italy, while donepezil taken with a placebo increased the severity
and frequency of depression, anxiety and apathy. In addition, the combination
of alpha-GPC and donepezil significantly decreased severity and stress of the
patient's caregivers compared to donepezil with placebo (Carotenuto, J Alzheimers Dis 2016). Another study in Italy found
that 1,000 mg of CDP-choline taken with either donepezil (Aricept),
rivastigmine (Exelon), or galantamine (Razadyne)
(drugs that inhibit the breakdown of acetylcholine) for nine months resulted in
modest improvements in cognition compared to drug treatment alone (Gareri, J Alzheimers Dis
2016). There is also evidence that 1,000 mg of CDP-choline
taken with galantamine (Razadyne) may slow the
progression of Alzheimer's disease compared to treatment with galantamine alone
(Castagna, Clin Drug Investig
2016).
Attention:
A study among 75 healthy male adolescents (ages 13 to 18) who took either 250
mg or 500 mg of CDP-choline once daily for one month had slightly improved
measures of attention, psychomotor speed and reduced impulsivity compared to
those who took a placebo (McGlade, J Atten Disord 2015).
Physical performance:
A small study among healthy, college-age men (average age 21) found that 600 mg
of alpha-GPC for 6 days increased lower body isometric muscle strength, but did
not increase upper body muscle strength, compared to placebo (Bellar, J Int Soc Sports Nutr
2015). However, another small study in healthy men found no
improvement in physical or cognitive performance after exhaustive physical
activity following a dose of choline (50 mg per kg of body weight) (Deuster, Mil Med 2002).
Breast cancer:
A study among 3,000 U.S. women found that breast cancer risk was reduced 24%
among women with a high dietary intake of choline (> 488 mg/day) but was
increased 30% among women homozygous for the minor allele of PEMT rs12325817,
a gene of choline metabolism that increases their dietary choline requirements
(Xu, FASB J 2008).
However, there do not appear to be clinical trials investigating the effects of
choline supplementation on breast cancer or breast cancer risk.
Asthma:
A study in India found that, compared to placebo, a dose of either 500 mg or
1,000 mg of choline citrate taken three times daily decreased symptoms and
increased the number of asymptomatic days in patients with asthma (Gupta, Indian J Chest Dis Allied Sci 1997).
Those taking the higher dose of choline citrate also had a decreased need for
asthma medication compared to placebo. Another study in India found that 1,500
mg of choline chloride taken twice daily, in addition to standard medications
(inhaled steroids and long-acting bronchodilators) for six months slightly
improved bronchial reactivity and certain measures of immune inflammation, and
reduced the use of medications, but did not decrease overall symptoms, compared
to treatment with standard medication alone (Mehta, Immunobiology 2010).
Ulcerative colitis:
People with ulcerative colitis may have insufficient amounts of phosphatidylcholine
in the mucus lining of the colon; mucus phosphatidylcholine content may be
reduced by as much as 70% in people with this condition (Stremmel, Dig Dis 2013).
Some research suggests that supplementation with choline may be helpful. One
study among 60 patients in Germany whose ulcerative colitis was poorly
responsive to corticosteroids, for example, found that half of those who took
2,000 mg of phosphatidylcholine (from a 33% phosphatidylcholine enriched
phospholipid delayed-release formula) daily for 3 months had a significant
improvement of symptoms compared to just 10% of those who took a placebo; 80%
of those who took phosphatidylcholine were also able to discontinue corticosteroid
use without a flare-up, compared to 10% of those who took the placebo (Stremmel, Ann Intern Med 2007). However, this
formulation does not appear to be available in the U.S.
Glaucoma:
There is preliminary evidence that citicoline (1,000 mg per day) may help slow
the progression of primary open angle glaucoma (Grieb, Front Aging Neurosci 2016).
Quality Concerns and
Tests Performed:
Neither
the FDA nor any other federal or state agency routinely tests choline
supplements for quality prior to sale. ConsumerLab.com, as part of its mission
to independently evaluate products that affect health, wellness, and nutrition,
purchased several dietary supplements sold in the U.S. claiming to contain
various forms of choline. These were tested for their amounts of each form of
choline claimed. Products containing lecithin or phosphatidylcholine, or herbal
ingredients and/or 250 mg of minerals per daily serving were also tested for
potential contamination with heavy metals (lead, cadmium, and arsenic).
Standard tablets and caplets were also tested for their ability to properly
disintegrate ("break apart") as needed for absorption. See How Products Were Evaluated for more
information about how products were evaluated.
What CL Found:
All but one of the choline supplements we tested contained the
amounts of choline we expected based labeled amounts. The one product that came
up short was Nutricost CDP Choline.
It claimed 300 mg of CDP choline per capsule, but we found only 264.2 mg, or
just 88% of the claimed amount. This means it provided only 88% of the choline
that we expected.
All products providing
lecithin or phosphatidylcholine were tested for potential contamination with
heavy metals, and all passed that testing.
The biggest problem for
consumers with many of these products is that labels don't show the amounts of
choline being provided. Instead, they show amounts of choline-containing
compounds that are only partially choline (see the "% Choline" shown
in the Comparison chart above).
How much choline is in
each product?
To make things easier for you, we calculated the amount of choline that you can
expect from a serving of each supplement. You'll find this information in the
2nd column of the Results table as well as in the graph
below. Choline in a suggested serving ranged from as little as 19.4 mg to as
much as 500 mg. For dosing information for different conditions see Dosage.
How do products compare
on the cost?
We found that you could pay twenty-eight times as much to get
the same amount of choline from one supplement as from another. As shown below,
the cost to get 100 mg of choline ranged from only 2 cents from Vitacost Choline & Inositol to 56
cents from Bestvite Cognizin.
There were also large differences in cost among products providing the same
form, and often the same amount, of choline, as discussed further below.
Top Picks:
For
several reasons, CL's Top Pick among all the choline
supplements is Puritan's Pride Ultra Concentrated Lecithin. It
provides choline in the phosphatidylcholine form (delivering
420 mg of it per softgel for 3 cents, yielding 60 mg
of choline), which may be better absorbed than other chemical forms of choline
and, consequently, leave less choline to be digested in the gut and eventually
turned into TMAO, which can pose cardiovascular risk. Puritan's Pride is
also much less expensive than other supplements that provide
phosphatidylcholine: It is nearly identical to Natural Factors
Phosphatidyl Choline (PC) and Solgar
Phosphatidylcholine, but those cost, respectively, 16 cents and 15 cents
per softgel — about 5 times as much as Puritan's
Pride. All three of these soy lecithin-based supplements have about 3 times
the concentration of choline in Legendairy
Milk Sunflower Lecithin, which, for 10 cents, provided only 19.4 mg of
choline per softgel, as well as Now Non-GMO
Lecithin, which, for about 5 cents, provided 23.8 mg of choline per softgel.
If you prefer to get
phosphatidylcholine from a drink, the liquid in NOW Sunflower Liquid
Lecithin is similar in choline concentration to the soy lecithin
in Puritan's Pride (and Natural Factors and Solgar) softgels, but
costs about twice as much. If you prefer a powdered form, which can be added to
smoothies or sprinkled on foods, the soy lecithin powder from Nuts.com is
actually the least expensive way to get choline in the phosphatidylcholine form
— one level teaspoon (2 grams) costs about 4 cents, and provides 67 mg of
choline — making it our Top Pick for lecithin among packaged
food products.
Should you want alpha-GPC,
which has shown some modest benefit in Alzheimer's disease (while
phosphatidylcholine has not), we tested two that were nearly identical, but
one, Swanson Alpha-GPC (25 cents per capsule) costs about 25%
less than the other, Double Wood Alpha-GPC (33 cent per
capsule), and only Swanson is vegetarian — making it our Top
Pick for this category.
For choline
bitartrate, Solgar and Vitacost offer similar products, each providing
250 mg of choline in a single capsule, but Vitacost is
about one-third the price at 6 cents versus 17 cents per capsule, making it out
Top Pick in this category, although only Solgar is
vegetarian. We do not, however, consider choline bitartrate a desirable form of
choline because has been shown to raise TMAO levels and can contribute to a
form of kidney stones (see Concerns and Cautions).
We only tested one choline
citrate product, Perque, which
is a liquid that is very tart (due to citrate) and needs to be diluted. A
single teaspoon provides a whopping 458.6 mg of choline for 75 cents, so you
may only need a portion of a teaspoon. Calcium citrate has shown some benefit in
people with asthma.
For citicoline
(CDP choline), Nutricost was a less
expensive than Bestvite Cognizin but Nutricost provided
only 88% of what it promised. Our Top Pick in this category
is Bestvite Cognizin,
although this is an expensive way to get choline at $1.20 for 2 vegetarian
capsules providing 213.2 mg of choline. This form of choline was found, at a
relatively small dose, to improve some aspects of cognition.
Test Results by Product:
Listed
alphabetically below are the test results for 14 choline-containing supplements.
Eleven were selected by ConsumerLab.com for testing and three (indicated with a
CL Flask) were included for having passed the same evaluation through ConsumerLab.com's voluntary Quality Certification Program.
Products listed as
"Approved" met their label claim and ConsumerLab.com's
standards for choline supplements. Expected amounts of ingredient and choline
are shown in the second column. Serving suggestions, pricing information, cost
comparisons, notable features, and the full list of ingredients for each
product are found in the additional columns.
Results of
ConsumerLab.com Testing of Choline Supplements
(Click arrows or swipe left or right to see all columns)
Approval Statusⓘ
Product Name
Claimed Amountⓘ and
Form of Cholineⓘ
Heavy metalsⓘ
Pill Sizeⓘ
Suggested Serving on Label
Cost for Suggested Serving
[Price per 100 mg of Choline]
Price
Notable Features
Full List of Ingredients Per Serving
SUPPLEMENTS:
Alpha-GPC:
APPROVED
Double Wood® Alpha-GPC 300 mg
Dist. by Double Wood LLC
2 capsules
600 mg alpha GPC
✔
Cholineⓘ: 243 mg
Heavy metals: NA
Large capsule
Take 2 capsules with food as needed.
$0.66/2 capsules
[$0.27]
$19.85/60 capsules
Non-GMO. Gluten Free.
2 capsules
Alpha GPC 50% (L-alpha-glyceryl-phosphoryl-choline) 600 mg.
Other Ingredients: Gelatin, Cellulose, Silicon Dioxide.
APPROVED
Top Pick
for alpha-GPC
Swanson® Alpha-GPC
Dist. by Swanson Health Products
1 veggie capsule
300 mg alpha-GPC
✔
Cholineⓘ: 121.5 mg
Heavy metals: NA
Large veggie capsule
Take one veggie capsule one to two times per day with water.
$0.25/veggie capsule
[$0.21]
$15.29/60 veggie capsules
None.
1 veggie capsule
Alpha-Glyceryl Phosphoryl Choline (Alpha-GPC) 300 mg.
Other Ingredients: Microcrystalline cellulose (plant fiber), vegetarian capsule
(hydroxypropyl methylcellulose), stearic acid, magnesium stearate, silica.
Choline Bitartrate:
APPROVED
Solgar® Choline/ Inositol 500 mg/
500 mg 
Mfd. by Solgar, Inc.
2 vegetable capsules
Choline: 500 mg (as choline bitartrate)
✔
Heavy metals: NA
Large vegetable capsule
As a dietary supplement for adults, take two (2) vegetable capsules twice daily
preferably at mealtimes, or as directed by a healthcare practitioner.
$0.34/2 vegetable capsules
[$0.07]
$17.09/100 vegetable capsules
Kosher. Free Of: Gluten, Wheat, Dairy, Soy,
Yeast, Sugar, Sodium, Artificial Flavor, Sweetener and Color. Suitable For
Vegans.
2 vegetable capsules
Choline (as choline bitartrate) 500 mg, Inositol 500 mg.
Other Ingredients: Vegetable Cellulose, Silica, Vegetable Magnesium Stearate.
APPROVED
Top Pick
for Choline Bitartrate
Vitacost® Choline & Inositol
Dist. by Vitacost.com, Inc.
1 capsule
Choline: 250 mg (as choline bitartrate)
✔
Heavy metals: NA
Large capsule
Take 1 capsule daily with food or as directed by a healthcare professional.
$0.06/capsule
[$0.02]
$5.99/100 capsules
Inositol 250 mg per capsule
Free of: Milk, Eggs, Peanuts, Tree Nuts, Crustacean Shellfish, Fish, Soy,
Gluten, Titanium Dioxide.
1 capsule
Choline (as choline bitartrate) 250 mg, Inositol 250 mg.
Other Ingredients: Gelatin, vegetable magnesium stearate, silicon dioxide and
rice flour.
Choline Citrate:
APPROVED
Perque Choline Citrate™
Dist. by Perque
Integrative Health
1 tsp
1,300 mg choline citrate
✔
Cholineⓘ: 458.6 mg
Heavy metals: NA
Take one (1) teaspoon in juice or water or as directed by your health
professional.
Taste: Very tart, oily liquid (to be diluted in juice or
water)
$0.75/tsp
[$0.16]
$35.16/7.86 fl oz [250 ml] glass bottle (approx. 47
servings)
Glycerin 1,300 mg per tsp
Does Not Contain: citrus, MSG, wheat, gluten, corn, starch, sugar, soy,
yeast, zein, sulfates, phosphates (other than coenzymes), preservatives, casein
or other milk derivatives. No GMO's; No toxic minerals or metals.
1 tsp
Choline Citrate 1,300 mg, Glycerin (vegetable) 1,300 mg.
Other Ingredients: None.
Citicoline (CDP Choline/Cognizin®):
APPROVED
Top Pick
for Citicoline
Bestvite™ Cognizin®
Mfd. by Bestvite, Inc.
2 vegetarian capsules
1,000 mg Cognizin® citicoline
✔
Cholineⓘ: 213.3 mg
Heavy metals: NA
Large vegetarian capsule
Take 2 capsules in the morning with water.
$1.20/2 vegetarian capsules
[$0.56]
$35.99/60 vegetarian capsules
Stearate Free. Vegan. Non GMO.
Contains No artificial color, sugar, salt, wheat, gluten, soy, milk, egg or
preservatives.
2 vegetarian capsules
Cognizin® Citicoline 1,000 mg.
Other Ingredients: Vegetable Capsule and Ascorbyl
Palmitate.
NOT APPROVED
Nutricost® CDP Choline
Dist. by Nutricost
1 capsule
300 mg CDP Choline (citicoline)
Found only
264.2 mg citicoline (56.4 mg choline) (88% of listed amount)
Heavy metals: NA
Large capsule
Take 1 capsule daily with 8 - 12 oz of water or as directed by your healthcare
professional.
$0.22/capsule
[$0.35 based on amount listed]
[$0.40 based on amount found]
$26.95/120 capsules
Non-GMO. Gluten Free.
1 capsule
CDP Choline (Citicoline) 300 mg.
Other Ingredients: Rice flour, hypromellose
(cellulose capsule), stearic acid (vegetable source).
Phosphatidylcholine:
APPROVED
Natural Factors® Phosphatidyl Choline (PC) 420
mg
Mfd. by Natural Factors Canada
1 softgel
1,200 mg soy lecithin
420 mg phosphatidyl-choline
✔
Cholineⓘ: 60 mg
Heavy metals: Pass
Large softgel
1 softgel 3 times per day or as directed by a health
professional.
$0.16/softgel
[$0.26]
$13.97/90 softgels
Contains no artificial colors, preservatives, or
sweeteners; no dairy, starch, sugar, wheat, gluten, yeast, corn, egg, fish,
shellfish, salt, tree nuts, or GMOs.
Precaution: Contains soy.
1 softgel
Calories 10, Calories from Fat 10, Total Fat 1 g, Lecithin (soy) 1,200 mg,
Phosphatidyl-choline 420 mg.
Other Ingredients: Softgel (gelatin, glycerin,
purified water).
APPROVED
Solgar® Phosphatidyl Choline
Dist. by Solgar, Inc.
2 softgels
840 mg phosphatidyl-choline
✔
Cholineⓘ: 120 mg
Heavy metals: Pass
Large softgel
As a dietary supplement for adults, take two (2) softgels
daily, preferably with a meal or as directed by a healthcare practitioner.
$0.29/2 softgels
[$0.24]
$14.52/100 softgels
Free Of: Gluten, Wheat, Dairy, Yeast, Sugar,
Sodium, Artificial Flavor, Sweetener, Preservatives and Color.
Precaution: Contains soy ingredients.
2 softgels
Calories 20, Total Fat 1.5 g, Phosphatidyl-choline 840 mg.
Ingredients: Soy Lecithin Concentrate, Gelatin, Vegetable Glycerin.
Lecithin Softgels:
Not Ratedⓘ
Unusually low in phosphatidyl-choline
Legendairy Milk® Sunflower Lecithin
Dist. by Legendairy
Milk, LLC
1 softgel
1,200 mg organic sunflower lecithin
Found:
Phosphatidyl-choline: 115.3 mg
Cholineⓘ: 19.4
mg
Heavy metals: Pass
Large softgel
For plugged ducts, take 1 softgel 3 - 4 times daily.
For daily maintenance, take 1 softgel 2 times daily.
$0.10/softgel
[$0.52 based on amount found]
$19.99/200 softgels
Soy Free. Non GMO Project
Verified seal. Fenugreek Free®. Sugar Free. No Additives, No Fillers. Gluten
Free.
1 softgel
Calories 12, Calories from Fat 11, Total Fat 1.2 g, Organic Sunflower Lecithin
1,200 mg.
Other Ingredients: Gelatin, Vegetable Glycerin, Purified Water.
APPROVED
NOW® Lecithin 1,200 mg
Dist. by Now Foods
3 softgels
3,600 mg soy lecithin
500 mg phosphatidyl-choline
✔
Cholineⓘ: 71.4 mg
Heavy metals: Pass
Very large softgel
Take 3 softgels daily.
$0.16/3 softgels
[$0.22]
$5.34/100 softgels
Kosher. Non-GMO. Not manufactured with yeast,
wheat, gluten, corn, milk, egg, fish or shellfish ingredients. Processed in a
GMP facility that processes other ingredients containing these allergens.
3 softgels
Calories 30, Total Fat 2.5 g, Saturated Fat 1 g, Polyunsaturated Fat 2 g, Soy
Lecithin (Non-GMO) 3,600 mg, Phosphatidyl Choline 500 mg.
Other Ingredients: Softgel Capsule (bovine gelatin,
glycerin, water) and Non-GMO Soybean Oil.
APPROVED
Top Pick
for Choline from Supplement
Puritan's Pride® Concentrated Ultra Lecithin
1,200 mg
Mfd. by Puritan's Pride, Inc.
1 softgel
1,200 mg soy lecithin
420 mg phosphatidyl-choline
✔
Cholineⓘ: 60 mg
Heavy metals: Pass
Large softgel
For adults, take one (1) softgel two times daily,
preferably with meals.
$0.03/softgel
[$0.06]
$20.49/six bottles of 100 softgels (600 softgels total)ⓘ
No Artificial Color, Flavor or Sweetener, No
Sugar, No Starch, No Milk, No Lactose, No Gluten, No Wheat, No Yeast, No Fish,
Sodium Free.
Precaution: Contains soy ingredients. Contains bioengineered food
ingredients.
1 softgel
Calories 10, Total Fat 1 g, Soy Lecithin 1,200 mg, Phosphatidyl-choline 420 mg.
Other Ingredients: Gelatin, Vegetable Glycerin.
FOODS (Providing Lecithin):
APPROVED
NOW® Sunflower Liquid Lecithin
Dist. by Now Foods
1 tbsp [15 ml] (16 g)
3,041 mg phosphatidyl-cholineⓘ
✔
Heavy metals: Pass
Blend 1 tablespoon into milk, protein shakes or vegetable juice.
Taste: Bland, somewhat oily, very thick liquid
$0.31/tbsp
[$0.11]ⓘ
$9.96/16 fl oz [473 ml] plastic bottle (approx. 32
servings)
Calcium 23 mg, iron 0.3 mg, potassium 75 mg,
phosphorus 256 mg per tsp
Kosher. Soy Free. Vegetarian/Vegan. Non GMO Project
Verified seal. Not manufactured with yeast, wheat, gluten, soy, corn, milk,
egg, fish, shellfish or tree nut ingredients. Processed in a GMP facility that
processes other ingredients containing these allergens.
1 tbsp
Calories 120, Total Fat 10 g, Saturated Fat 1.5 g, Polyunsaturated Fat 5 g,
Monounsaturated 3 g, Sodium 0 mg, Total Carbohydrate <1 g, Protein 0 g,
Calcium 23 mg, Iron 0.3 mg, Potassium 75 mg, Phosphorus 256 mg.
Ingredients: Liquid Sunflower Lecithin.
APPROVED
Top Pick
for Choline from Food
Nuts.com Soy Lecithin Powder
Dist. by Nuts.com
0.1 oz [4 g] (Approx. 2 level tsp)
4,000 mg soy lecithin powder
Found:
Phosphatidyl-choline: 883.3 mg
Cholineⓘ: 134.4
mg
Heavy metals: Pass
No directions listed
Taste: Bland, slightly oily soft, granular powder
$0.07/0.1 oz
[$0.05 based on amount found]
$7.99/1 lb pouch (approx. 113.6 servings)
Precaution: Contains Soy.
0.1 oz
Calories 28, Total Fat 2 g, Saturated Fat 1 g, Cholesterol 0 mg, Sodium 1 mg,
Total Carbohydrate 0 g, Dietary Fiber 0 g, Sugars 0 g, Protein 0 g, Percent of
recommended daily intake: Vitamin A 0%, Vitamin C 0%, Calcium 1%, Iron 1%.
Ingredients: Soy Lecithin.
Unless otherwise noted, information about the
products listed above is based on the samples purchased by ConsumerLab.com (CL)
for this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's
ingredients differ from what is listed above, it may not necessarily be of the
same quality as what was tested.
The information contained in this report is
based on the compilation and review of information from product labeling and
analytic testing. CL applies what it believes to be the most appropriate
testing methods and standards. The information in this report does not reflect
the opinion or recommendation of CL, its officers or employees. CL cannot
assure the accuracy of information.
Copyright ConsumerLab.com, LLC, 2021 All
rights reserved. Not to be reproduced, excerpted, or cited in any fashion
without the express written permission of ConsumerLab.com LLC
ConsumerTips™:
You can increase your
intake of choline by eating more of the foods listed in the table below, which
contain lecithin, a form of fat that is a major dietary source of choline in
the form of phosphatidylcholine. In fact, choline from phosphatidylcholine may
be better absorbed than choline from choline bitartrate — a synthetic form in
some supplements. A study showed that 3 grams of choline from an egg yolk
phospholipid drink was absorbed four times better than 3 grams of choline from
choline bitartrate (Note: the study was funded by AAK, the maker of the
egg-based product) (Smolders, Nutrients 2019).
Greater absorption of choline is also preferable because choline that is not
absorbed can be converted by bacteria in the gut into TMA, which, in the liver, is converted to TMAO, a
compound associated with increased cardiovascular risk.
Foods Rich in Choline
|
Food |
Total Choline in 100 gram serving: |
|
Whole eggs |
250 mg (all in the yolk, not egg white) |
|
Liver |
200 - 300 mg |
|
Meat and fish |
80 mg |
|
Whole grains |
70 mg |
|
Nuts and seeds |
50 mg (particularly flaxseed) |
|
Dark Chocolate |
46 mg |
|
Legumes/vegetables and fruits |
35 mg (particularly soybeans, cauliflower, peas, and spinach) |
|
Milk |
20 mg |
Source: USDA Database for the Choline
Content of Common Foods (Release Two, January 2008).
In
1998, choline was deemed to be an essential nutrient and the Institute of
Medicine established dietary recommendations for choline intake, estimating a
daily Adequate Intake (AI) of 200 mg for children 1 to 3, 250 mg for those 4 to
8, and 375 mg for those 9 to 13. For males 14 years and older the AI is 550 mg.
For females 14 to 18, the AI is 400 mg, and it increases to 425 mg for those 19
and older. However, the AI for pregnant women is 450 mg and for lactating women
it is 550 mg.
The
upper tolerable intake level (UL) for choline, above which the risk of toxicity
increases, is 1,000 mg for children 1 to 8, 2,000 mg for those 9 to 13, 3,000
mg for those 14 to 18, and 3,500 mg for individuals 19 years and older.
Dosage:
·
For stroke, 2,000 mg of CDP-choline within 24 hours
of onset (Davalos, Stroke 2002).
·
For memory and cognition, 250 mg or 500 mg of
CDP-choline daily has been shown to be beneficial in healthy middle-aged women
(McGlade, Food Nutr
Sci 2012). In older men and women, 1,000 mg of CDP-choline daily may
help to improve short-term recall (Spiers, Arch Neurol 1996).
·
For Alzheimer's disease, 400 mg of alpha-GPC taken
in the morning, at lunch, and before dinner (a total daily dose of 1,200 mg
alpha-GPC) may help improve cognitive function (Moreno, Clin Ther 2003).
A similar dose taken with donepezil (Aricept) may help to reduce depression,
anxiety and apathy in Alzheimer's (Carotenuto, J Alzheimers Dis 2016). CDP-choline (1,000 mg)
taken with acetylcholinesterase inhibitor drugs such as donepezil (Aricept),
rivastigmine (Exelon), or galantamine (Razadyne) may
help improve cognitive function in Alzheimer's (Gareri, J Alzheimers Dis 2016).
·
For attention, 250 mg or 500 mg of CDP-choline once
daily (McGlade, J Atten Disord 2015).
·
For asthma, 500 mg or 1000 mg of choline citrate
daily may decrease symptoms (Gupta, Indian J Chest Dis Allied Sci 1997).
·
For ulcerative colitis, 2,000 mg of phosphatidylcholine
daily (Stremmel, Ann Intern Med 2007).
Concerns and Cautions:
·
Intake of choline is generally considered safe up to the upper
tolerable intake levels (UL) of 3,500 mg per day for adults. However, at high
dosages, gastrointestinal side effects, such as abdominal discomfort, diarrhea,
and nausea, may occur.
·
Choline may lead to a fishy body odor in as
much as one percent of the U.S. population who suffer from a genetic defect (in
the gene FM03). A choline restricted diet would be beneficial for this group of
people as it diminishes body odor (Mitchell, Drug Metab Dispos 2001).
·
A population study found an association between higher intakes
of choline and higher risks of colorectal cancer in women —
although it was not clear if this association was due to choline to other
components in the foods from which choline was derived (Cho, J Natl Cancer Inst 2007).
·
There is conflicting evidence of whether or not higher dietary
intake of choline is associated with higher risk of lethal prostate
cancer in men, with one population study suggesting an association (Richman, Am J Clin Nutr 2012),
while a later population study did not (Han, Cancer Causes and Control 2019).
·
Higher dietary intake of choline (averaging 364 mg daily) was
also associated with a 23% greater risk of death and a 33%
greater risk of death specifically from cardiovascular disease than
lower intakes (averaging 206 mg daily), even after adjusting for factors such
as fiber and meat intake, in a study that followed over 20,000 men and women in
the U.S. for an average of 30 years (Mazidi, Br J Nutr 2019).
[Note: The "higher" intake level in this study is actually below the Recommended Daily Allowance (RDA) for
choline for adults. This study shows only an association and not a
cause-and-effect relationship, so it would not be prudent to limit choline
consumption to less than the RDA.]
·
Although a direct link to heart attack has not
been made, intake of choline temporarily raises blood levels of the
compound TMAO. This is of concern because a 3-year study showed
that people with the highest blood plasma levels of TMAO were 2.5 times as
likely as those with the lowest levels to suffer a heart attack or other major
adverse cardiovascular event (Tang, New Eng J Med 2013).
TMAO is produced from choline by the actions of microbes in the gut, turning
choline into TMA, which is then absorbed and is converted by enzymes in the
liver into TMAO. TMAO may advance atherosclerosis (hardening of the arteries)
by reducing the normal clearing of cholesterol. TMAO has also been associated
with increased instability of atherosclerotic plaque, and
plaque that becomes dislodged in the arteries is a main cause of heart attacks
(Koay,
Cardiovasc Res 2020).
Eating two hard-boiled eggs (which, together, contain about 250 mg of total
choline) temporarily doubles TMAO blood plasma
levels. Nevertheless, a study at the Cleveland Clinic among healthy adults
found that consuming 4 eggs (providing 467 mg of total choline) daily for one
month did not increase fasting plasma TMAO levels (that is,
levels at least 12 hours after eating). Similarly, taking a phosphatidylcholine
supplement (providing 410 mg of total choline per day) for one month did not increase
fasting plasma TMAO levels (measured 12 hours after eating). However, taking
a choline bitartrate supplement (providing a similar amount of
total choline, 411 mg per day) for one month increased fasting TMAO
levels by about 71%. Furthermore, only the choline bitartrate supplement
increased platelet aggregation (a risk factor for atherosclerosis). The
researchers suggested that free choline (as provided by a choline bitartrate)
increases TMAO, while phosphatidylcholine (as in egg yolks, lecithin, or
phosphatidylcholine supplements) has less effect (Wilcox, Am J Med 2021). Excessive
intakes of eggs, however, may still carry risks. A study that followed
96,831 postmenopausal women (average age 63) over approximately 17 years found
that the consumption of one or more eggs per day was associated with a 14%
increased risk of heart attack, ischemic stroke (stroke caused by a blockage or
blood clot) and heart failure, or death from cardiovascular disease, or any
cause, compared to consuming less than one egg per week — although this
association does not prove a cause-and-effect relationship (Chen, Am J Clin Nutr 2020).
·
Choline bitartrate may raise TMAO more than other forms
because it's not well absorbed in the gut, so more is left to be digested by
microbes and then, eventually, converted to TMAO. A study
found that giving a choline supplement (450 mg of choline from choline
bitartrate) twice daily increased plasma levels of TMAO levels more than
10-fold in vegans/vegetarians and 14-fold in people who include meat in their
diets (omnivores) after 1 and 2 months of supplementation. As in the Cleveland
Clinic study noted above, these increases were directly associated with an
increased tendency for platelet aggregation (clotting) — a risk factor for
heart attacks and strokes. Giving daily aspirin (81 mg) was able to reduce but
not eliminate the increase in platelet aggregation (Zhu, Circulation 2017). A Mediterranean or
vegetarian diet is reported to help reduce TMAO (American Heart Association, 2017).
·
Choline bitartrate may, in large doses, also lead to an unusual
type of kidney stone made of crystals of calcium tartrate
tetrahydrate. This type of kidney stone was reported in three men, each of whom
consumed several servings daily for a year or more of the "vitamin and
amino acid" energy supplement Spark (from Advocare). Spark contains
a large amount (500 mg) of "choline (as bitartrate or citrate)" per
serving. Most of the choline bitartrate molecule is tartaric acid (rather than
choline), providing a key building block for calcium tartrate tetrahydrate
crystals. The product also contains a large amount of vitamin C which is also
associated with kidney stone formation. Only one of the men had a prior history
of kidney stones (Kleinguetl, Urology 2019).
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Latest Clinical Research Updates for Choline
5/15/2021
Can choline
supplementation improve cognitive function in older men and women? See what a
recent study found in the Memory and Cognition section of our
Choline Supplements Review. Also see our Top Picks among choline supplements as well
as Concerns and Cautions with choline
supplements.
5/08/2021
The choline in eggs can
raise levels of TMAO, a compound associated with higher risk of heart attack. A
recent study compared the effects of eating eggs versus taking choline
supplements on TMAO levels. Find out which increased TMAO
levels the most. Also, see our Top Pick among choline supplements.
12/23/2020
Do women who eat eggs
every day have a higher risk of heart disease or death? See what a new study
found in the ConsumerTips section
of the Choline Supplements Review.
12/03/2019
A recent study found that
a particular form of choline is not well absorbed. It may also have detrimental
effects. For details, see the Concerns and Cautions section
of the Choline Supplements Review. Also see our Top Pick among choline supplements.
11/09/2019
A large study found that
people with higher intakes of choline from their diets had a higher risk of
death, specifically cardiovascular death, than people with lower choline
intakes. Should you be concerned? See the Concerns and Cautions section
of the Choline Supplements Review.