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December 21, 2023 | Life in Balance | admin

Choline Supplementation: A Double-Edged Sword for Liver Health

The subject of liver health and its myriad intricacies is an ongoing area of interest for researchers and medical professionals worldwide. Among the numerous nutrients and compounds that play a role in maintaining a healthy liver, choline has emerged as a noteworthy player. This essential nutrient, though beneficial, presents a nuanced picture when considering its source and mode of intake.

Introduction to Choline and Liver Health:

First integrated into the liver health regimen in 1949 [1], choline’s role in the body, especially concerning lipid metabolism, can’t be understated. Lipid metabolism is the process by which fats are broken down and utilized within the body. Choline, acting as a methyl donor in various metabolic processes, aids in the transport of lipids from the liver. A deficiency in choline can disrupt these processes, leading to an accumulation of fats in the liver, a condition that can potentially pave the way for diseases like non-alcoholic fatty liver disease (NAFLD).

The Dual Nature of Choline Supplementation:

While the importance of choline for liver health and overall metabolic function is clear, the source from which we obtain this nutrient is equally vital. Herein lies the dual nature of choline – the difference between its supplemental and dietary forms.

  • Choline Supplements: Supplements are often concentrated forms of nutrients intended to bolster intake when dietary sources are insufficient. In the case of choline, while they can address deficiencies and potentially alleviate fat buildup in the liver, they aren’t without caveats. Supplementation has been linked with increased platelet reactivity, a factor that could potentially increase the risk of clot formation. Moreover, choline supplements can elevate levels of Trimethylamine Noxide (TMAO)[2], a compound associated with heart disease.
  • Dietary Choline: Naturally occurring choline found in foods is a different story altogether. Foods rich in choline, such as eggs, liver, and certain fish, provide this nutrient in a matrix of other compounds that may mediate its absorption and effects in the body. Interestingly, dietary choline doesn’t exhibit the same propensity to elevate TMAO levels [2], making it a safer and preferable source of this essential nutrient.
  • Conclusion: Choline’s role in liver health and lipid metabolism is undeniable. Yet, as with many nutrients, the source matters. While choline supplements offer a convenient way to address deficiencies, they come with potential risks. On the other hand, obtaining choline from natural dietary sources offers benefits without the same level of associated risks. It underscores the timeless adage: nature often knows best.


  1. Best CH, Hartroft WS, Lucas CC, Ridout JH. Liver damage produced by feeding alcohol or sugar and its prevention by choline. Br Med J, 2 (4635) (1949),1002- 1006.
  2. Wilcox J, Skye SM, Graham B, Zabell A, Li XS, Li L, Shelkay S, Fu X, Neale S, O’Laughlin C, Peterson K, Hazen SL, Tang WHW. Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial. Am J Med. 2021 Sep;134(9):1160-1169.e3.