Choline Deficiency Symptoms & Gluten

Choline and Gluten

Gluten sensitivity is a common cause of malabsorption and nutritional deficiency.  Choline is no exception to this rule.  While choline has existed just as long as any other nutrient, it has only recently started to get some well deserved attention.

Choline was only recognized as an essential nutrient by the Food and Nutrition Board of the National Academies of Medicine beginning in 1998. It is also a recent addition to most food nutrition labels and dietary supplement labels.

Below you will learn about the following:

• What is choline?
• What does choline do for your health?
• What are some common choline deficiency symptoms?
• What is the relationship between celiac disease and choline?
• What diseases are associated with a choline deficiency?
• What gluten free foods contain choline?
• Can you take a choline supplement to meet your needs?
• What are some gluten free recipes that contain choline?

What is Choline?

Choline is an essential nutrient found in all living cells in the body. This means that while the body can produce some choline itself, it needs you to consume choline in order to meet its needs.

Choline is closely related to the B vitamin family. Most of the choline in the body is a component of other compounds, like the neurotransmitter acetylcholine, a chemical used in the transmission of brain impulses between nerves, muscles, and organs. And phosphatidylcholine, a type of phospholipid that helps protect the cell and maintain its shape.

Key Body Functions of Choline

Choline’s metabolites have structural, metabolic, and regulatory roles within the body, including:

• Liver function
• Muscle function
• Brain function and cognition
• Lipid metabolism
• Cellular membrane composition and repair
• Bile and fat metabolism
• Healthy energy levels

In addition, a significant body of evidence suggests that maternal choline intake during pregnancy, and possibly lactation, has lasting beneficial neurocognitive effects on the growing child.

Choline Deficiency Symptoms

As mentioned above, choline, and choline deficiency, can often be overlooked as the cause of many gluten sensitivity related issues. Choline is an essential nutrient and it must be included in our daily diets if we want to avoid the symptoms caused by a deficiency. Because choline has not spent much time in the spotlight, most people do not know the correct amount of choline they should be striving to consume on a daily basis. Here are the recommended daily choline consumption amounts for both men and women:

Adult men need 550mg and women need 425 mg of choline per day. Pregnant and breastfeeding women need 550mg. However, it is estimated that 90% of the U.S. population does not meet this recommended intake.

Because choline is found predominantly in animal-derived foods, vegetarians and vegans may have a greater risk for choline deficiency. Later in the article you will find a list of gluten friendly, choline rich foods you can include in your diet, some of which are vegetarian and vegan friendly. Choline supplement options are listed below as well for those who prefer to consume choline in that form.

Gluten sensitivity can be responsible for a variety of symptoms and health issues, and many of these symptoms are also caused by a lack of choline.  Choline deficiency symptoms include the following:

• Fatigue
• Brain fog
• Mood disturbances
• Memory concerns
• Muscle aches
• Nerve pain or tingling
• Non-alcoholic fatty liver disease
• Insulin resistance

Gluten Sensitivity, Celiac Disease, & Choline Deficiency

A large and growing body of research has supported the idea that common genetic variants in genes required for choline, folate, and 1-carbon metabolism influence dietary choline requirements. Some research has suggested that those with celiac disease share some of these common genetic variants.  More specifically, research has explored the theory that those with celiac disease have lower concentrations of choline and choline-derived lipids. This is attributed to potential alterations in one-carbon metabolism between those with and without celiac disease. One study found “minor but significant metabolic differences” between celiac patients and healthy individuals without celiac disease. In addition, choline status has been linked to the composition of the gut microbiome, which is often altered in those with celiac disease and gluten sensitivity.

Diseases Linked to Choline Deficiency

As choline supports a wide variety of critical functions within the body, the effects of choline deficiency are widespread and can be devastating if experienced long term. Complications due to choline deficiency include the following:

• Liver damage and disease
• Muscle damage
• Impaired cognition
• Neural tube defects and cleft palates in babies when the maternal diet is deficient in pregnancy

Patients with rheumatoid arthritis and psoriasis may have an increased risk for developing choline deficiency if they are being medicated with the drug, methotrexate.

Gluten Free Food Sources of Choline

Humans can produce small amounts of choline endogenously (that is, within the body, from other substances in the body). However, the nutrient must be consumed through food or supplementation to prevent signs of deficiency.

Choline is found most abundantly in animal foods, although it is found in some plant foods as well. The following foods are naturally gluten free and contain choline:

• Eggs – 140 mg per egg (Note that the choline is present in the yolk, not the white, so eat the whole egg! In addition, check out this post to understand how to avoid cross contamination in eggs, and how to select the highest quality eggs).
• Liver – 240 mg per 3-ounce serving of beef liver
• Caviar/fish roe – 285 mg per 3-ounce serving
• Salmon – 187 mg per 3-ounce serving
• Beef – 115 mg per 3-ounce serving
• Chicken or turkey – 72 mg per 3-ounce serving
• Shiitake mushrooms – 116 mg per cup
• Cauliflower – 72 mg per cup cooked
• Brussels sprouts – 30 mg per cup cooked
• Broccoli – 30 mg per cup cooked

As you can see, animal products provide substantially more choline per serving. If you avoid animal products, a choline supplement may be necessary.

Choline Supplementation

If choline needs cannot be met through diet, you may look to supplementation. Choline supplementation is available in the following forms:

• Choline Citrate: This inexpensive form of supplemental choline is considered a nootropic, as it supports the natural production of acetylcholine in the brain and muscles.  Research shows that it can improve verbal and visual memory, as well as enhance athletic performance.
• Choline bitartrate: Choline bitartrate is an economical source of choline. Research has suggested that it may not cross the blood brain barrier as readily as other sources of choline, and that it may metabolize into trimethylamine (TMA) or trimethylamine oxide (TMAO) which may pose health risks.  In addition, this form of choline can contain corn starch, making it a definite no for those with gluten issues.
• Citicholine: Citicoline quickly breaks down into choline and cytidine after consumption. The choline becomes usable by the body while the cytidine rapidly metabolizes into uridine, which crosses the blood-brain barrier. Once in the brain, uridine helps to resynthesize choline into phosphatidylcholine for nerve-cell membrane growth.
• Phosphatidylcholine: note that choline only makes up about 13% of phosphatidylcholine, so you’ll need to take a lot of phosphatidylcholine to meet your needs

Supplementing with choline is very safe, but toxic levels can be reached in excess of 7,500 mg/day.  Symptoms can include the following:

• Lower blood pressure
• Increased sweating
• Increased salivation
• Fishy body odor
• Dizziness

Gluten Free Recipes Rich in Choline

So what is the best way to incorporate choline into your diet? Here is some inspiration for some healthy and delicious recipes that are both gluten free and rich in choline:

• Pesto Deviled Eggs
• Warrior Eggs Benedict
• Salmon Cobb
• Speedy Salmon Cakes
• Dill and Lemon Salmon
• A collection of cauliflower recipes

The Bottom Line

Choline is needed for a number of critical functions in the body, but it must be consumed through diet or supplementation in order to meet your needs. Research shows that a vast majority of the population is deficient in choline. Those who avoid animal products may be at a particularly high risk since the richest sources of choline are found in animal foods. Those with celiac disease and gluten sensitivity may also be at a higher risk of deficiency since research has suggested a link between choline metabolism and celiac disease.

Given its high importance in the body and significant risks associated with deficiency, it is worth evaluating your choline intake and making adjustments to your diet to ensure adequate intake.