Choline is an essential water-soluble nutrient that we all should or let me say: must consume. Most of us could get enough choline from dietary sources. Unfortunately, the majority of the population don’t even have this nutrient on the radar.
What is more, “special populations”, like pregnant or breastfeeding mothers and postmenopausal women are even more prone to deficiency, while their body’s needs for choline increases during those stages of life.
Choline is needed to produce acetylcholine, an essential neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions. So it's a vitamin critical for cell membrane and neurological health.
It supports many vital functions, including detoxification, liver health, brain health, cardiovascular health, and skin health. Animal models of choline supplementation show that increased levels correlate to improved cognitive function, memory and learning.
Choline also plays important roles in modulating gene expression, cell membrane signalling, lipid transport and metabolism, and early brain development. 
What is more, liver and muscle cells die when deprived of choline because mitochondria malfunction, leak free radicals, and trigger apoptotic cell death. 
Humans can produce choline endogenously in the liver (mostly as phosphatidylcholine), but the amount that the body naturally synthesises is not sufficient to meet human needs. Therefore, we must get some of it from our diet. 
Premenopausal women might need less choline from the diet than children or other adults because estrogen induces the gene that catalyses the biosynthesis of choline. When a diet is deficient in folate (vitamin B6, is also a methyl donor), the need for dietary choline rises.
Yap, choline might be more important that you thought…
WHERE CAN I FIND CHOLINE?
Choline is typically eaten in foods like dairy products meats, poultry, fish and eggs (broccoli is an excellent alternate source of this vitamin if eggs are not an option).
A lot of dietary choline in the form of phosphatidylcholine(also called lecithin) is commonly added to food products. For example, phosphatidylcholine is added to chocolate to keep the cocoa in suspension.
PREGNANCY AND BREASTFEEDING
Prenatal vitamins are the first thing your doctor advises you to take when you become pregnant. Folic acid (please read this post about folate, as it is sadly, rarely discussed by doctors) is one of the king vitamins discussed at doctor’s office. While it is known that low intake of folate may raise the risk of neural tube defects in unborn babies, this is sadly overlooked in the case of choline.
Studies are showing that a higher dietary intake around the time of conception is associated with a lower risk of neural tube defects. Furthermore, low choline intake may raise risk of other complications, like preeclampsia, premature birth and low birth weight.
What is more, most prenatal supplements and multivitamins do not contain choline…and if they do, the amount is to low, or it is in choline chloride form, which usually ends up as food for gut bacteria.
WHY IS THAT CHOLINE IS SUCH AN IMPORTANT NUTRIENT TO TAKE AT THIS STAGE?
A mother delivers large amounts of choline across the placenta to the fetus, which significantly increases demand on the choline stores of the mother. Furthermore, after birth, she also delivers large amounts of choline through breastmilk to the baby.
It is critical to address that, although women nowadays are becoming more aware what they put in their mount, there is still approximately 90-95% of pregnant women who are consuming less choline than the recommended amount.
Here’s a quick overlook of what studies are revealing:
Adequate intake of dietary choline may be necessary for an optimal fetal outcome (birth defects, brain development) and maternal liver and placental function.
Choline protects fetuses from certain environmental insults. Exposure of the fetus to alcohol can cause abnormalities in behaviour and organ structures that range from barely detectable, to birth defects, to fetal loss.
Babies whose moms consumed 930 mg/day of choline had significantly faster processing speeds than those whose moms consumed 480 mg/day of choline.
Babies whose mothers consumed approx. Double the recommended dose (930mg), had 33% lower concentrations of cortisol (stress hormone), compared with a control group of pregnant mothers who consumed 480 mg of choline.
And there are also some studies showing benefits in children with schizophrenia…
For in-depth information about choline in pregnant and breastfeeding women look here.
Intense physical activity of long duration has been shown to reduce circulatory choline concentrations in some individuals. More to that, studies examining athletes involved in cycling, weight training and endurance running suggest that Phosphatidylserine might: 
speed up recovery,
prevent muscle soreness,
possess ergogenic properties,
suppress cortisol (under some circumstances).
HOW MUCH CHOLINE DO I NEED?
Your liver has the ability to produce small amounts of choline. That is why plasma choline levels do not decline below 50% of normal, even in individuals who have not eaten for more than a week .
However, you still need to obtain high amounts of it from your diet.
The story of choline it’s not that simple, when we get to the question: “How much choline do I need?”
Why is that?
The reason is that several factors are influencing dietary choline requirements; like certain gut microbes, genetic variations, intake of other B vitamins (particularly other methyl donors), and overall energy intake for more in-depth information about that checkout Chris Masterjohn’s article here.
Because of all those factors, the Institute of Medicine has been unable to come up with a definitive value of choline needs. Therefore they established “Adequate intake”.
Choline supplements are usually in the form of: choline bitartrate, choline chloride, choline citrate, CDP-choline and alpha-GPC. CDP-choline and alpha-GPC are usually higher in choline per unit weight and more easily absorbed than others.
Choline in soy lecithin?
If you’re reading food labels you’ve probably come across ingredient “soy lecithin”. Soy lecithin is one of the most widely used food additives on the market today…and it also contains choline. To be exact only about 20% of choline. Nonetheless, it’s bioavailability is poor.
There is another molecule-betaine, that is involved in the choline story. The body can turn choline into betaine, which is also found in a range of foods. Therefore, getting plenty of betaine in your diet can somewhat reduce the need for choline.
According to the Institute of Medicine, the tolerable upper intake level for choline is 3,500 mg per day. Which is highly unlikely to exceed from your diet. The only way to pass this level is by taking choline supplements in high doses.
However, this might put you at risk of the following side effects: blood pressure, sweating, fishy body odour, diarrhoea, nausea and vomiting.
SIGNS AND SYMPTOMS OF DEFICIENCY
Although most people don’t get the recommended amounts of choline, deficiencies are rear (the reason might be that our bodies can make some choline). However, if a person’s choline levels drop too low, he or she can experience muscle and liver damage as well as deposits of fat in the liver.
Choline may play a key role in our liver function, brain function, heart health and also support fetal development.
Pregnant women, postmenopausal women, athletes, alcoholic people, vegetarians and vegans are at a higher risk of choline deficiency.
Before you take any supplement, a nutrient dense diet should be your first call. Consider eating more choline rich foods such as grass-fed beef liver, organic egg, salmon, broccoli, brussels sprouts etc.
This post provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health.
 Gibson GE, Blass JP. Nutrition and Functional Neurochemistry. In: Siegel GJ, Agranoff BW, Albers RW, et al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Philadelphia: Lippincott-Raven; 1999.Available from: https://www.ncbi.nlm.nih.gov/books/NBK28242/
 U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 28external link disclaimer. Nutrient Data Laboratory Home Page, 2015.
 Gary M. Shaw, Suzan L. Carmichael, Wei Yang, Steve Selvin, Donna M. Schaffer; Periconceptional Dietary Intake of Choline and Betaine and Neural Tube Defects in Offspring, American Journal of Epidemiology, Volume 160, Issue 2, 15 July 2004, Pages 102–109, https://doi.org/10.1093/aje/kwh187
 Steven H Zeisel, Kerry-Ann da Costa; Choline: an essential nutrient for public health, Nutrition Reviews, Volume 67, Issue 11, 1 November 2009, Pages 615–623, https://doi.org/10.1111/j.1753-4887.2009.00246.x
 Marie A. Caudill, Barbara J. Strupp, Laura Muscalu, Julie E. H. Nevins, Richard L. Canfield. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. The FASEB Journal, 2017; fj.201700692RR DOI: 10.1096/fj.201700692RR
 Ross RG, Hunter SK, McCarthy L, et al.. Perinatal Choline Effects on Neonatal Pathophysiology Related to Later Schizophrenia Risk. Am J Psychiatry. 2013
 Jäger, R., Purpura, M., & Kingsley, M. (2007). Phospholipids and sports performance. Journal of the International Society of Sports Nutrition, 4, 5. doi:10.1186/1550-2783-4-5