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Research · Supplements

Choline

A review of 4 pregnancy trials found most infant brain outcomes unchanged. In children exposed to alcohol before birth, a meta-analysis found better memory with prenatal choline. Low-choline diets caused fatty liver or muscle damage, reversed by choline. Endurance did not change. Choline bitartrate raised TMAO and platelet reactivity. Fishy body odor affected 36% of children on choline.

Add to Bio HackChecked 2026-11-09
Status
Dietary supplement in the US.
Also called
choline bitartrate, choline chloride, choline citrate, phosphatidylcholine, lecithin, PC
Taken for
pregnancy, baby brain development, liver health, fatty liver, memory, focus, exercise performance, endurance

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help2

Reported risks2

What people take it for, and what was found

Shown to help2

Moderate

Children exposed to alcohol before birth

Shown to improve memory in children exposed to alcohol before birth when choline was given in pregnancy, though each pooled result rests on 2 trials.

The numbers and sources
Effect
In a meta-analysis of 5 trials, prenatal choline improved memory (SMD 0.61, 95% CI 0.19 to 1.02, 2 trials, 94 participants, moderate certainty) and postnatal choline improved global cognition (SMD 0.78, 95% CI 0.21 to 1.34, 2 trials, 62 participants, low certainty) [4]. On 2 g of choline a day from mid-pregnancy, infants were more likely than placebo to meet the eyeblink conditioning criterion at 6.5 months. They showed catch-up growth in weight and head size, and higher visual recognition memory at 12 months [5]. In 3 pooled trials of children aged 2.5 to 5.9 with fetal alcohol spectrum disorder, 9 months of choline gave 25% better scores than placebo on a sequential memory task, with no change in executive function or IQ [6]. About 5 years later, children who had received choline scored 9.1% better on non-verbal IQ and 11.3% better on working memory [7].
Population
69 heavy-drinking pregnant women in Cape Town, South Africa [5]. 104 children with fetal alcohol spectrum disorder [6], 58 of them seen at a mean age of 9.1 [7].
Sources
[4], [5], [6], [7]
Caveats
Each pooled estimate rests on 2 trials [4]. The authors call [5] exploratory and describe the memory advantage in [6] as trend-level. The follow-up saw 58 of 104 children [7].
Limited

Fatty liver and muscle damage when choline intake is low

Limited evidence: most adults on very low choline diets developed fatty liver or muscle damage, which reversed when choline was added back.

The numbers and sources
Effect
On a diet with under 50 mg of choline a day, 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage, against 44% of premenopausal women. Organ function returned when choline was added back. Six men developed signs on 550 mg a day [8]. In people on long-term IV nutrition with low choline, 1 to 4 g a day of IV choline chloride resolved fatty liver within 6 weeks, and it returned in one patient after choline stopped [9].
Population
57 adults in a depletion study [8]; 4 adults on IV nutrition for about 10 years [9].
Sources
[8], [9]
Caveats
These are depletion and repletion studies, not trials of supplements in people eating normal diets.

Mixed results1

Limited

Infant brain development (supplements in pregnancy)

Small trials found opposite results: higher maternal choline sped infant reaction times in one, while a larger trial found no change in development. A review called the evidence insufficient.

The numbers and sources
Effect
Sources disagree. In a controlled feeding study, infants of mothers eating 930 mg of choline a day in the third trimester had faster mean reaction times at 4 to 13 months than infants of mothers eating 480 mg [1]. In a larger trial, 750 mg of phosphatidylcholine a day from 18 weeks through 90 days after birth did not change infant memory, language or global development at 10 and 12 months [2]. A systematic review of 4 randomized trials and 5 observational studies found that most neurodevelopmental outcomes did not support a benefit, and judged the evidence insufficient to support or refute one [3].
Population
26 women, 24 infants tested [1]; 140 women, 99 infants tested [2]. Trials and cohorts reported across 20 publications [3].
Sources
[1], [2], [3]
Caveats
Women in [2] ate about 360 mg of choline a day from food. The feeding study had no placebo group and compared two intakes [1]. Each trial tested many outcomes, and the review found critical limitations across the evidence [3].

Not shown to help2

Limited

Endurance and strength performance

One small trial found choline citrate did not change run time to exhaustion or squat performance in 14 soldiers.

The numbers and sources
Effect
Choline citrate before and during 4 hours of loaded treadmill marching raised plasma choline 128% and did not change run time to exhaustion, squat performance or perceived exertion [10].
Population
14 soldiers in a crossover trial [10].
Sources
[10]
Caveats
One small trial. Trials of alpha-GPC and citicoline, including memory and power output, are on the alpha-GPC page.
LimitedStudied in women

Memory and focus in adults (choline bitartrate or chloride)

One small pilot trial found a single 1,650 mg dose did not change working memory in 20 postmenopausal women.

The numbers and sources
Effect
A single 1,650 mg dose of choline bitartrate 3 hours before testing did not change working memory performance on an N-back task against placebo. Brain activation during the task was lower on choline in parts of the right temporal lobe [11].
Population
20 postmenopausal women in a crossover pilot study [11].
Sources
[11]
Caveats
One small pilot trial of a single dose. Brain activation is an imaging measure, not a memory outcome [11].

Doses studied

The pregnancy feeding study compared 480 and 930 mg of choline a day in total intake [1]. The phosphatidylcholine trial used 750 mg a day [2], and the alcohol-exposure trial 2 g of choline a day [5]. Trials in preschool children with fetal alcohol spectrum disorder used 500 mg a day or 19 mg/kg a day for 9 months [6]. IV nutrition patients received 1 to 4 g of choline chloride a day [9]. The exercise trial gave 8.4 g of choline citrate [10].

Risks

Reported risks2

LimitedStudied in childrenVery common

Fishy body odor

Small trials found fishy body odor in 36% of children on choline against 8% on placebo, in children with fetal alcohol spectrum disorder.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across 3 trials, 36% of children on choline reported fishy body odor, against 8% on placebo. Other adverse effects were similar between groups [6].
Population
104 children aged 2.5 to 5.9 with fetal alcohol spectrum disorder, treated for 9 months [6].
Sources
[6]
Caveats
Pooled data from one research group's trials [6].
LimitedHow often is not known

TMAO and platelet reactivity

One trial found choline bitartrate raised TMAO and platelet reactivity over 4 weeks in 82 healthy volunteers, while eggs and phosphatidylcholine did not.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Over 4 weeks, plasma TMAO (P < .0001) and platelet reactivity (P < .01) rose in all three groups taking choline bitartrate. Four eggs a day and phosphatidylcholine supplements did not significantly raise either [12].
Population
82 healthy volunteers with normal kidney function, median age 28 [12].
Sources
[12]
Caveats
TMAO and platelet reactivity are markers. The trial did not measure heart attacks or clots [12].

Checked, no increase found1

Limited

Side effects in pregnancy trials

One trial found 750 mg a day of phosphatidylcholine well tolerated through pregnancy and 90 days after birth in 140 women.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Phosphatidylcholine at 750 mg a day was well tolerated through pregnancy and 90 days after birth [2].
Population
140 pregnant women [2].
Sources
[2]
Caveats
The abstract gives no event rates.

Claims tested and not found

  1. That choline improves endurance. Run time to exhaustion and squat tests did not change [10].
  2. That phosphatidylcholine in pregnancy boosts infant cognition. Infant memory, language and development did not differ from placebo [2].
  3. That a dose of choline bitartrate sharpens working memory. N-back performance did not differ from placebo in 20 postmenopausal women [11].

Sources

  1. Caudill MA, Strupp BJ, Muscalu L, et al. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. The FASEB Journal. 2018. https://doi.org/10.1096/fj.201700692RR
  2. Cheatham CL, Goldman BD, Fischer LM, et al. Phosphatidylcholine supplementation in pregnant women consuming moderate-choline diets does not enhance infant cognitive function: a randomized, double-blind, placebo-controlled trial. The American Journal of Clinical Nutrition. 2012. https://doi.org/10.3945/ajcn.112.037184
  3. Gould JF, Hines S, Best KP, et al. Choline During Pregnancy and Child Neurodevelopment: A Systematic Review of Randomized Controlled Trials and Observational Studies. Nutrients. 2025. https://doi.org/10.3390/nu17050886
  4. Lino GM, de Carvalho IN, de Amorim VOA, et al. Does supplementation of choline during or after pregnancies exposed to alcohol improve neurocognitive development of children? A meta-analysis. Pediatrics & Neonatology. 2025. https://doi.org/10.1016/j.pedneo.2025.02.001
  5. Jacobson SW, Carter RC, Molteno CD, et al. Efficacy of Maternal Choline Supplementation During Pregnancy in Mitigating Adverse Effects of Prenatal Alcohol Exposure on Growth and Cognitive Function: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Alcoholism: Clinical and Experimental Research. 2018. https://doi.org/10.1111/acer.13769
  6. Wozniak JR, Eckerle JK, Gimbel BA, et al. Choline enhances elicited imitation memory performance in preschool children with prenatal alcohol exposure: a cumulative report of 3 randomized controlled trials. The American Journal of Clinical Nutrition. 2025. https://doi.org/10.1016/j.ajcnut.2025.02.009
  7. Wozniak JR, Eckerle JK, Gimbel BA, et al. Long-Term Neurodevelopmental Outcome Following Three Randomized Controlled Trials of Choline in Fetal Alcohol Spectrum Disorder (FASD). Alcohol, Clinical and Experimental Research. 2026. https://doi.org/10.1111/acer.70394
  8. Fischer LM, daCosta KA, Kwock L, et al. Sex and menopausal status influence human dietary requirements for the nutrient choline. The American Journal of Clinical Nutrition. 2007. https://doi.org/10.1093/ajcn/85.5.1275
  9. Buchman AL, Dubin MD, Moukarzel AA, et al. Choline deficiency: A cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation. Hepatology. 1995. https://doi.org/10.1002/hep.1840220510
  10. Warber JP, Patton JF, Tharion WJ, et al. The Effects of Choline Supplementation on Physical Performance. International Journal of Sport Nutrition and Exercise Metabolism. 2000. https://doi.org/10.1123/ijsnem.10.2.170
  11. Dumas JA, Testo A, Miller AS, et al. Oral Choline Reduced Working Memory-Related Brain Activation in Postmenopausal Women: A Pilot Study. Nutrients. 2026. https://doi.org/10.3390/nu18030459
  12. Wilcox J, Skye SM, Graham B, et al. Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial. The American Journal of Medicine. 2021. https://doi.org/10.1016/j.amjmed.2021.03.016

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