October 2019

Choline deficiency in meat free diets

What is choline and why is it needed in the diet?

Choline is a water-soluble essential nutrient which is a constituent of lecithin, a fatty substance predominantly found in eggs and animal organs. It is produced endogenously in the liver but similarly to omega-3, the amount produced is not sufficient for what the body needs and so this extra choline must be obtained from dietary sources. The current recommendations suggest adults should consume at least 425mg per day (this would be equivalent to around 2 hard-boiled eggs). However, choline is not yet included in food composition databases, nutrition surveys nor official recommendations.

Choline is needed in the diet for several different functions, primarily as a component of cell membranes which is needed to provide the animal and/or plant with structural integrity.

Choline intake is greatly concerning during pregnancy as the nutrient is actively transported to the foetus in utero. It has been advised that increasing intakes to upwards of 550mg a day can increase infant information processing. This would mean an infant could react and respond to what has been said to them quicker (e.g. when asked what their name is, they respond within a second instead of 3 seconds). Choline is critical for foetal development as it modifies brain and spinal cord structure via apoptosis (controlled, normal cell death) and cell proliferation. A deficiency in choline is likely to impact lifelong memory functionality and create a risk for neural tube defects.

Other functions of choline:

As well as the reasons listed above, the European Food Safety Authority have already published health claims for choline, showing that it is an essential nutrient which is needed as part of a healthy and balanced diet. The claims are regarding lipid metabolism, healthy liver functionality and a reduction in homocysteine levels (which lowers your risk of heart disease).

So, what are the best sources of Choline?

The table below shows a variation of different food sources which provide choline. The figures below show the total value of choline per 100g of product.

Source: Data has been extracted from Wiedeman et al 2018.

A you can see the richest sources of choline are animal products, especially cooked beef liver which is almost double the 2nd richest choline food (egg).

The highest animal-product free food is almonds at 52.5mg of choline per 100g of almonds. This is almost 8 times less than the richest source of choline (beef liver) at 431mg per 100g.

To put this into perspective, the average steak is 8 ounces (or 227g) and so if the whole steak was eaten, or even just half, this would easily surpass your daily choline intake. However, if you were a vegan, you would need to eat just over 800g of nuts or over 1kg of brocolli!

So, for those who are following a vegetarian diet or especially a vegan diet, individuals may be at risk of choline deficiency due to the lack of animal products in their diet.

Choline and the decline in consumption of animal products

The European Food Safety Authority recognises that choline plays an important role in the human body and have established dietary reference values as to prevent deficiency from occurring. However, in light of the EAT-Lancet report, choline deficiency could be a likely possibility for those who are following it. While the report is a step forward in creating an environmentally-concerned diet, the reduced intakes of whole milk, eggs and animal products could impact on choline status.

The below table is a summary of what the EAT-Lancet report proposes in terms of daily animal-product intakes.

As you can see, the daily target of 425mg/day is not being reached. In fact, only around 30% of required choline intake is met through this diet. Granted that there will be more choline from the consumption of other foods, but this may be of minimal value and cannot guarantee that your daily needs of this essential nutrient are met.

Choline deficiency

As well as not consuming enough choline, there is also evidence that not all of the choline you consume is actually absorbed into the body. This could be due to genetic factors. For example, researchers have suggested that 50% of the population has the gene which increases dietary methyl requirements, and since choline is a major source of the methyl process, it is imperative that you are at least meeting your daily targets.

Deficiency of this micronutrient may result in:

Potential side effects of choline deficiency

Even though a diet with reduced intakes of animal products while maintaining an adequate intake of choline is possible, this would need to be monitored very closely due to consuming foods which have a lower choline content. It is advisory to consult a doctor before you exclude/ drastically reduce any component of your diet as this may cause deficiencies and illness.