Choline: The Essential Nutrient Most People Still Aren’t Getting Enough Of

By Jordan Casey, MS, Functional Medicine Nutritionist

Choline is one of the most essential nutrients your doctor never told you about. But you really need to know about it.

It plays a central role in cell membrane integrity, brain signaling, fat transport, and liver protection. Yet, many practitioners have not yet heard of this essential nutrient, as it was only recently officially recognized as an ‘essential nutrient’ in 1998 [1]. Just under two decades later, it remains one of the most under-consumed nutrients in the modern diet.

Despite its vital roles across every stage of life—from fetal brain development to adult cognitive performance and liver health—choline still receives very little attention in mainstream nutrition conversations. Even more concerning: the vast majority of the population fails to meet even the minimum daily intake, including over 90% of adults and more than 90% of pregnant women [2].

Read on to find out why choline is essential, why deficiency is so common, why pregnancy needs are especially critical, and how whole-food and highly bioavailable supplements like Krill IQ and B-Complex IQ help bridge this widespread gap.

Choline Was Only Recognized as Essential in 1998

Choline was officially classified as an essential nutrient by the Institute of Medicine in 1998. This designation came after decades of research showed that when humans are deprived of choline, they develop [1]:

• Fat accumulation in the liver

• Liver enzyme elevation

• Muscle damage

• Impaired lipoprotein transport

Unlike many vitamins, choline can be made in small amounts by the liver, but not at levels nearly enough to meet physiological demands. That’s why dietary intake is required for normal health.

Yet because choline was recognized relatively late compared to nutrients like vitamin C or iron, it never became deeply integrated into public nutrition messaging. As a result, even health-conscious individuals often overlook it entirely.

The Three Core Roles of Choline in the Human Body

1. Choline Is a Structural Component of Every Cell Membrane

Choline is a primary building block for phosphatidylcholine, the dominant phospholipid in human cell membranes. These membranes do far more than just hold cells together—they regulate nutrient transport, direct hormone signaling, manage waste removal, and signal cell-to-cell communication [3].

Without adequate phosphatidylcholine, cell membranes become less stable and less efficient at maintaining internal balance. This is particularly important in high-turnover tissues like the liver, brain, and endocrine organs.

2. Choline Is Required for Acetylcholine, the Brain’s Primary Learning Neurotransmitter

Choline is the direct precursor to acetylcholine, one of the most important neurotransmitters in the nervous system. Acetylcholine is involved in memory formation, learning, and attention, all muscle contractions, and autonomic nervous system regulation [3].

Low choline availability limits the body’s ability to synthesize acetylcholine efficiently. This is one reason choline intake is now being studied in relation to cognitive performance, age-related memory changes, and neuromuscular health.

3. Choline Protects the Liver from Fat Accumulation

One of choline’s most clinically established roles is in the transport of liver fat. Choline is required to form very-low-density lipoproteins (VLDL), which export triglycerides out of the liver.

When choline intake is too low, fat becomes trapped in liver cells, increasing the risk for non-alcoholic fatty liver disease (NAFLD). A rise in liver enzymes is often the first clinical sign of choline insufficiency, which highlights the essentiality of choline for proper liver function [4]. Mitochondrial stress also increases due to low choline levels [5].

Controlled human feeding studies show that even short-term choline deprivation leads to fatty liver and muscle damage in otherwise healthy adults [6].

Choline Is Critically Important During Pregnancy

Choline is one of the most important nutrients during pregnancy—yet it is also one of the most unintentionally neglected nutrients.

During fetal development, choline supports neural tube formation, brain cell division and differentiation, formation of lifelong memory and attention circuits, and epigenetic programming of gene expression [7, 8, 9].

Human studies show that higher maternal choline intake is associated with improved infant information-processing speed, better attention span in early childhood, and altered stress receptor regulation in children [7].

Despite this, only about 8% of pregnant women meet the Adequate Intake (AI) for choline, and only about 10% of the general population meets the AI at all [1].

Why “Adequate Intake” Likely Underestimates True Choline Needs

Unlike many nutrients, which have a well-defined Recommended Dietary Allowance (RDA), choline has only an Adequate Intake (AI) level. The AI is defined as the amount thought to prevent overt deficiency diseases, not necessarily the amount required for optimal function.

This means meeting the AI likely only prevents fatty liver and muscle damage, and it does not necessarily reflect optimal intake for:

• Cognitive performance

• Pregnancy and fetal programming

• Long-term liver protection

• Methylation demand

• Acetylcholine synthesis

In other words, “adequate” does not mean “optimal.” And for choline, even reaching the AI is already difficult for most people eating a modern diet.

Adding another layer of complexity, choline also serves as a methyl donor, directly supporting healthy methylation and DNA stability. Methylation is the biochemical process that regulates gene expression, neurotransmitter balance, detoxification, and homocysteine metabolism. 

An estimated 30–60% of the population carries genetic variants in the MTHFR gene, which can reduce methylation efficiency [10]. When this system is compromised, the body becomes more reliant on alternative methyl donors—especially choline and betaine—to maintain normal homocysteine balance and cellular function [11].

This means that for a significant portion of the population, choline demand is likely higher than standard intake targets suggest, particularly during periods of high physiological stress, pregnancy, inflammation, or detoxification load [12].

Which raises a critical question: if choline is this important, why are so few people actually getting enough of it?

Why Most Modern Diets Are Low in Choline

Choline is richest in animal-based foods, particularly:

• Egg yolks

• Liver and organ meats

• Shellfish and fish

• Red meat

Yet modern diets often emphasize:

• Lean muscle meats over organs

• Egg whites instead of whole eggs

• Plant-heavy patterns without choline-rich legumes or wheat germ

• Highly processed convenience foods

As a result, population studies repeatedly show that 90–95% of adults consume less choline than the recommended amount, even when calorie intake is adequate.

Krill IQ: A Highly Bioavailable Source of Choline + Omega-3s

Krill IQ delivers choline as phosphatidylcholine, the same structural form found in human cell membranes and lipoproteins. This form is efficiently absorbed in the gastrointestinal tract, directly supporting membrane synthesis, and delivers choline and omega-3s together in a natural phospholipid matrix [13].

Human clinical trials show that krill oil supplementation increases circulating EPA and DHA, raises plasma choline and betaine, reduces triglycerides, and improves the omega-3 index more efficiently per gram than triglyceride fish oil [13, 14, 15, 16].

This dual delivery of choline + omega-3s from krill oil supports:

• Cell membrane integrity

• Brain signaling

• Liver fat export

• Cardiovascular health

Far more benefits than omega-3s from fish oil alone.

B-Complex IQ: Choline + Methylation + Energy Metabolism

B-Complex IQ provides choline alongside coenzymated B vitamins, inositol, PABA, and alpha-lipoic acid (ALA).

This is important because choline works closely with folate, B12, and B6 in one-carbon metabolism and methylation. Together, these pathways regulate DNA repair, neurotransmitter synthesis, detoxification, and homocysteine metabolism [17].

When choline intake is low, the body shifts the methylation burden onto folate and B12 [18]. When choline intake is adequate, this system becomes more resilient and redundant, especially under stress [19].

ALA further supports mitochondrial energy production and antioxidant regeneration, making B-Complex IQ an excellent metabolic companion to choline-rich Krill IQ.

Is Phosphatidylcholine Better Than Other Choline Supplements?

A common question is whether phosphatidylcholine (PC)—the form of choline found in foods like egg yolks and krill oil—is “better” than standard choline supplements like choline bitartrate or choline chloride.

From a big-picture standpoint, your body can use both. Phosphatidylcholine is broken down in the intestine and liver to release free choline, and choline salts are absorbed directly. In that sense, they all ultimately contribute to the same choline pool the body draws from for acetylcholine, membrane phospholipids, and methylation.

That said, there are some meaningful differences in how they behave:

• In a randomized trial, choline provided as egg yolk phospholipids (phosphatidylcholine) produced a much larger incremental area under the curve (iAUC) for plasma choline—about four times higher—than an equivalent dose from choline bitartrate. Choline’s main metabolites, betaine and dimethylglycine, also rose more after phosphatidylcholine, suggesting more sustained availability for methylation and liver support [20].

• In another crossover study comparing several choline forms (choline chloride, choline bitartrate, α-GPC, and egg-derived phosphatidylcholine), total choline exposure over time (AUC) was similar across forms, but phosphatidylcholine produced a later, more gradual peak in plasma choline and did not acutely raise TMAO, whereas the water-soluble choline salts did [21].

Taken together, these findings suggest:

• Phosphatidylcholine is at least as effective as other forms at delivering choline.

• In some contexts, phospholipid-bound choline may offer advantages, such as more sustained absorption and a potentially more favorable profile for methylation and TMAO.

For practical purposes, this means that phosphatidylcholine-rich sources like krill oil are a legitimate and potentially advantageous way to meet choline needs—especially when you consider that phosphatidylcholine is also the dominant form of choline in many whole foods and in human cell membranes.

So rather than thinking of phosphatidylcholine as an entirely different nutrient, it’s more accurate to say:

It’s the same essential choline, delivered in a form that more closely resembles how it appears in real food and in your own cells—sometimes with better kinetics and a gentler metabolic footprint than simple choline salts. Regardless, choline supplementation provides health benefits across the board.

The Long-Term Consequences of Low Choline Intake

Chronically low choline intake has been associated with:

• Fatty liver disease

• Impaired lipid transport

• Elevated homocysteine

• Cognitive vulnerability with aging

• Increased neural stress during pregnancy

While not everyone will develop overt disease, low choline creates a persistent metabolic bottleneck that makes other systems work harder to compensate.

The Bottom Line

Choline is essential for every cell membrane in your body. It’s your brain’s primary learning neurotransmitter. It optimizes liver fat transport and detoxification, and it’s necessary for fetal brain development and lifelong cognitive programming during gestation periods. 

This vital nutrient should be a non-negotiable for nutrition optimization, yet it still doesn’t receive the spotlight it deserves.

• Only ~10% of adults meet the AI

• Only ~8% of pregnant women meet the AI

• The AI itself likely reflects minimum protection, not optimal function

Because modern diets rarely include organ meats and often minimize egg yolks and seafood, supplementation becomes a practical solution for most people.

Krill IQ supplies phosphatidylcholine alongside omega-3s in a highly bioavailable, membrane-ready form.  B-Complex IQ supplies choline in a metabolic context with coenzymated B vitamins, inositol, and ALA.

Together, they restore one of the most overlooked but essential foundations of human physiology. Don’t overlook one of the most important players in your cellular physiology. Stock up on your foundational, whole-food-based nutrients today.