How Much Choline is Needed to Reverse Fatty Liver — Roles and Requirements

How much choline is needed to reverse fatty liver? Choline is essential and plays a role in liver health. Many people with fatty liver disease must ensure that they take adequate choline. In fact, it is part of an effective treatment strategy. Most adults need around 425-550 mg of choline daily. But therapeutic doses for people with fatty liver disease (FLD) is higher at about 800-2000 mg daily under medical supervision. Choline alone cannot reverse FLD. But it can be an important adjunct (additional) management. The approach includes dietary changes, weight management, and regular physical activity.

Key Takeaways

• Enough choline intake (425-550 mg daily) helps in preventing fatty liver disease, while therapeutic dose for treatment may be 800-2000 mg daily

• Choline helps transport fat out of the liver, which prevents accumulation that leads to fatty liver disease

• Eggs, liver, meat, fish, and soybeans are excellent dietary sources of choline

• Choline works best as an adjunct (added) management approach that includes dietary changes, exercise, and weight management

• Individual choline needs vary based on different factors like gender, pregnancy status, and genetic variations

What is Fatty Liver Disease and Its Types?

Fatty liver disease (FLD) occurs when fat builds up inside liver cells causing them to swell. When this happens, the liver cannot function right. The condition affects about 25% of people worldwide, which is about 1 in 4 people with extra fat in their livers.

There are two main types of fatty liver disease:

• Non-alcoholic fatty liver disease (NAFLD)
• Alcoholic liver disease (ALD)

What Causes Fatty Liver Disease?

Fatty liver sneaks up on you. Main causes of the disease include eating too much sugar and fat, which is mostly a result of an unhealthy diet. It is also related to being overweight and obese, particularly with too much belly fat. Sedentary lifestyle, not moving your body enough, is also one of the main culprits along with people who have diabetes (high blood sugar levels) and even related to genetics.

How Common is Non-Alcoholic Fatty Liver Disease?

NAFLD has become very common. About 24% of adults in the US, which is about 1 in 4 adults, have NAFLD. Globally, it is estimated that about 40% of males and 26% of females have NAFLD. And this global numbers vary substantially per world region and is contributed by different rates in factors such as socioeconomic status and genetic makeup as well as variations in the rates of obesity.

What Are The Differences Between NAFLD And ALD?

NAFLD and ALD are related but they are totally different conditions.

NAFLD is usually a result of an unhealthy diet and being overweight. Your liver gets excess fat from the diet even though you don’t drink much alcohol. It is sneaky in nature because you feel fine in its early stages until it gets worse.

ALD, on the other hand, is usually a result of too much alcohol drinking for a very long time. The alcohol will damage your liver cells and fat gets deposited inside these cells, which cause problems. ALD can get far worse than the NAFLD.

Both types of conditions can lead to serious problems in the liver if left untreated. But the good thing is that its early stages can often be fixed with health changes.

How Does Choline Affect Liver Health?

Choline is an essential nutrient needed for optimal liver function. But many people are not familiar with this, despite its importance.

What Roles Does Choline Play in The Body?

Choline serves several functions and roles in your body, including:

• Forms structural components of your cell’s membranes
• Facilitates neurotransmission (a process that allows nerves to communicate with each other)
• Supports the function of your nervous system
• Allows fat transport from the liver
• Works alongside folate metabolism (a process that transforms a nutrient to its active form)
• Contributes to the production of chemical messengers like acetylcholine, which is essential for memory and muscle control

Your liver needs choline to properly package and transport fats from the liver. And without sufficient levels of choline, fat accumulation can occur in the liver.

How Does Choline Deficiency Lead to Fatty Liver?

When there is not enough choline, it can lead to impairment of the liver’s ability to transport fat properly. This results in fat accumulation within the liver cells.

A study in the University of North Carolina shows that 80% of premenopausal women consuming diets deficient in choline developed fatty liver. A higher choline level in the diet was required to resolve the signs of fatty liver disease particularly those with genetic problems and estrogen-related issues. While this alone does not conclusively prove that low choline in diet can lead to fatty liver, it goes to show how important adequate choline is in the diet for optimal liver function.

The liver needs choline to produce a protein called Very Low-Density Lipoproteins (VLDL), which are responsible for the transportation of fat from the liver to other parts of the body. Insufficient supply of choline compromises this process, which results in liver fat accumulation.

Can Choline Reverse Fatty Liver Disease?

This is a complex question that requires a complex answer. And it is not entirely clear how much choline is needed to reverse fatty liver.

Is There Scientific Evidence That Choline Can Reverse Fatty Liver?

There is little known evidence that choline may be more effective in the prevention of fatty liver rather than reversing an established disease. However, intake of choline may still offer benefits.

There are animal studies published in the Journal of Nutrition that show choline supplementation can reduce the damage brought by fat accumulation in the liver. The studies done on human subjects have mixed outcomes. Some small-scale research studies suggest that choline supplements can help reduce liver fat in NAFLD patients. This warrants larger, more extensive studies to prove this is the case.

There is also a study published in Biomedicines that found the inverse relationship between dietary choline intake and risk of fatty liver. This shows that choline may prevent the development of fatty liver disease.

However, all the studies so far have been non-conclusive as to the role of choline in reversing an established fatty liver disease. Though one thing is certain, choline is a beneficial component in the diet and the management of FLD, not a standalone solution.

What Are The Recommended Daily Choline Intakes?

Adequate choline intake is important for everyone, not just those who are concerned about conditions like fatty liver or liver health in particular. However, a lot of people still consume insufficient amounts.

How Much Choline do Men and Women Need Daily?

There is insufficient data that establishes the estimated average requirement for choline but the recommended adequate intake, as follows, ensures nutritional sufficiency:

• Men: 550 mg per day
• Female: 425 mg per day

Men generally require higher amounts than females because of the differences in body mass and hormone profiles.

The recommendations just represent the minimum amount needed to prevent a deficient intake in healthy adults.

Do Requirements Change with Age or Health Conditions?

Yes, choline requirements will vary based on individual circumstances. Examples are as follows:

• Pregnant women: 450 mg per day (to give the baby adequate brain development support)
• Breastfeeding (lactating women): 550 mg per day (choline is transferred to baby through the mother’s milk)
• Children: 200-375 mg per day
• Older adults: No information regarding the exact amount but generally assumed to be higher due to changes in the efficiency of absorption

Genetic factors also influence the daily choline requirements. Approximately 50% of people have genetic variations that increase their needs for dietary choline.

People with established liver disease may also benefit from higher choline intake, although this should be discussed in detail with your healthcare provider.

Which Foods Are High in Choline?

Dietary sources are preferred over supplementation to ensure adequate choline intake. Food provides choline alongside complementary nutrients needed for its utilization.

What are the Top Dietary Sources of Choline?

Foods with high choline content include the following (top 5 highlighted):

Animal-derived sources generally contain the highest choline levels although plant sources are also good alternatives that can provide significant amounts.

How Can You Incorporate More Choline Into Your Diet?

Adding choline foods to your daily meals is straightforward. You may:

• Include eggs in breakfast meals
• Cook chicken, fish, or beef meat into salads or main dishes
• Choose peanuts as snacks or add them to yogurt
• Use beans in different dishes such as salads and soups
• Create meal plans with quinoa, beans, eggs, and vegetables
• Use mushrooms when cooking

Sample meal plan that can provide adequate choline 

• Breakfast: 2 eggs with spinach and whole grain toast (294 mg of choline)
• Lunch: Quinoa bowl with chicken and broccoli (151 mg of choline)
• Snack: Handful of peanuts (15 mg of choline)
• Dinner: Salmon with baked potato and side salad (153 mg of choline)
• Total daily intake: 613 mg of choline — which is more than daily recommendations for men and women

Are Choline Supplements Effective for Fatty Liver?

When dietary intake of choline is insufficient, supplements may be beneficial. However, supplementation is not for everyone.

When Should You Consider Choline Supplementation?

Choline supplementation is generally recommended only when dietary intake is not met. It is worth considering if:

• You follow a vegan or vegetarian diet
• You have difficulty consuming sufficient choline-rich foods
• Laboratory testing indicates potential choline deficiency
• Your healthcare provider advised you to get supplementation based on your liver health
• You’re pregnant or breastfeeding and struggling to meet the daily dietary requirements

You should always consult your healthcare provider before you start with any supplementation especially if you are concerned about liver health.

What Are The Potential Benefits and Risks of Choline Supplementation?

With supplements readily available in the market, it is important to understand its potential benefits and risks so you can make informed decisions.

Potential benefits include:

• Prevention of choline deficiency especially if you are struggling with daily recommended dietary intake
• Support for liver function when dietary intake is insufficient
• Alternative source for those who are unable to obtain it from food

Potential risks include:

• Excessive intake (more than 3500 mg daily) can cause less serious effects like fishy body odor and sweating to more serious effects like hypotension
• May cause gastrointestinal discomfort in some individuals
• Some forms such as choline bitartrate supplements can produce unpleasant odor
• Possible drug-to-drug interactions in patients who are taking maintenance medications or other forms of medications

For liver health support, it is often recommended that you start with the lowest recommended amount. Or, consult your healthcare provider about appropriate dosing.

Always remember that supplementation is mostly effective when used alongside dietary modifications, physical activity, and other healthy lifestyle changes—but not as substitutes for them.

Conclusion

Knowing how much choline is needed to reverse fatty liver may not be as important as knowing how much your intake would be to maintain liver health. After all, prevention is always thought to be better than going for treatment. Suffice to say that understanding what choline is and its daily recommended intake helps healthy lifestyle practices such as improving your diet and avoiding physical inactivity.

CTA: Want to live your life the healthy way? Get tested at Ribbon Checkup now.

Frequently Asked Questions

Can I get enough choline just from diet?

Yes, most people can get enough choline just from their diet. Foods considered to have high choline content include eggs, beef liver, meat, fish, and certain vegetables.

Will choline supplements work if I don’t make improvements in my diet?

No, choline supplements generally work well if it is used together with improvements in diet like low sugar intake and avoiding processed foods. It is also beneficial to use it together with physical exercise and limit alcohol intake.

Is taking too much choline harmful?

Yes, too much choline intake can be harmful. It can cause hypotension, which is serious but it also has less serious effects like fishy body odor, sweating, and tummy discomfort.

Written by Jaclyn P. Leyson-Azuela, RMT, MD, MPH
Jaclyn P. Leyson-Azuela, RMT, MD, MPH, is a licensed General Practitioner and Public Health Expert. She currently serves as a physician in private practice, combining clinical care with her passion for preventive health and community wellness.

References

1. Al Rajabi, A., Castro, G. S. F., da Silva, R. P., Nelson, R. C., Thiesen, A., Vannucchi, H., Vine, D. F., Proctor, S. D., Field, C. J., Curtis, J. M., & Jacobs, R. L. (2013). Choline Supplementation Protects against Liver Damage by Normalizing Cholesterol Metabolism in Pemt/Ldlr Knockout Mice Fed a High-Fat Diet. The Journal of Nutrition, 144(3), 252–257. https://doi.org/10.3945/jn.113.185389 

2. Fischer, L. M., da Costa, K.-A., Kwock, L., Galanko, J., & Zeisel, S. H. (2010). Dietary choline requirements of women: effects of estrogen and genetic variation. The American Journal of Clinical Nutrition, 92(5), 1113–1119. https://doi.org/10.3945/ajcn.2010.30064 

3. Mehedint, M. G., & Zeisel, S. H. (2013). Choline’s role in maintaining liver function: new evidence for epigenetic mechanisms. Current Opinion in Clinical Nutrition and Metabolic Care, 16(3), 339–345. https://doi.org/10.1097/MCO.0b013e3283600d46

4. National Institute of Diabetes and Digestive and Kidney Diseases. (2019, November 27). Definition & Facts of NAFLD & NASH. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts 

5. National Institutes of Health. (2017). Office of Dietary Supplements - Choline. Nih.gov. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/ 

6. Sherriff, J. L., O’Sullivan, T. A., Properzi, C., Oddo, J.-L., & Adams, L. A. (2016). Choline, Its Potential Role in Nonalcoholic Fatty Liver Disease, and the Case for Human and Bacterial Genes. Advances in Nutrition, 7(1), 5–13. https://doi.org/10.3945/an.114.007955 

7. Shiau, S.-Y., & Lo, P.-S. (2000). Dietary Choline Requirements of Juvenile Hybrid Tilapia, Oreochromis niloticus × O. aureus. The Journal of Nutrition, 130(1), 100–103. https://doi.org/10.1093/jn/130.1.100 

8. Teng, M., Cheng Han Ng, Huang, D. Q., En Chan, K., Jun, D., Wen Kwang Lim, Ju Dong Yang, Xiang, E., & Muthiah, M. D. (2022). Global incidence and prevalence of nonalcoholic fatty liver disease. Clinical and Molecular Hepatology, 29(Suppl), S32–S42. https://doi.org/10.3350/cmh.2022.0365 

9. Zeisel, S. H., & da Costa, K.-A. (2009). Choline: an essential nutrient for public health. Nutrition Reviews, 67(11), 615–623. https://doi.org/10.1111/j.1753-4887.2009.00246.x