CHOLINE essentials for pregnancy and preconception
When a woman is ttc, pregnant or lactating, they are usually pretty “good” with folate, vitamin D, and DHA. Well ladies, there is a new kid on the vitamin block that NEEDS your attention! This B-vitamin isn’t always provided in a prenatal vitamin and doctors aren’t in the habit talking about it. Any guesses? Want some hints?
· The two richest food-sources are egg yolks and liver
· The Institute of Medicine only recognized it as a required nutrient in 1998
· It may be just as important as folate in early pregnancy for baby’s neural tube health
· It may reduce the risk of your baby and your GRANDBABY from developing Alzheimer’s Disease(!!)
Did you guess riboflavin? If you did, you are incorrect! (hee hee!)
Did you guess choline? Well, my friend, you would be right! Choline is the nutrient that most of my clients are not taking in NEARLY enough to hit the recommended amount. And I am on a mission to change that, starting with this blog post.
WHY YOU SHOULD CARE ABOUT CHOLINE
Choline is categorized as a B-vitamin, and humans can’t make enough of this vitamin to meet their needs. AKA humans need to nourish their bodies with choline by either eating enough through food or supplementing.
Choline plays a role in the human body during every stage of the life-cycle, but for the purposes of this post I will be focusing on a few of the prenatal/postnatal aspect of this nutrient. Just for the record, I have been supplementing choline since my concussion and I provide my daughter with a choline gummy daily. Even if you are ttc, you should start focusing on choline intake just like you focus on folate intake.
NEURAL TUBE DEVELOPMENT AND OTHER CONCERNS IN EARLY PREGNANCY
The neural tube is a hollow structure from which the brain and spinal cord form.
It is formed very early in pregnancy and begins development often before women even realize that they are pregnant! Studies are now suggesting that choline plays a role in the development of the neural tube, and therefore a deficiency may put a woman at risk for giving birth to a baby with a neural tube defect like spina bifida. Of course, women should continue to focus on the other nutrients that are related to neural tube development as well (such as folate, Vitamin B6, and Vitamin B12).
In one study, low maternal dietary choline intake (≤290 mg/day) increased the risk for having a baby with a neural tube defect by approximately two times.
In early pregnancy, extra choline is also required for growth of the placenta and maternal organs like the kidneys and the uterus.
IMPROVEMENT OF INFORMATION PROCESSING SPEED AND MEMORY
When a mama takes in high amounts of choline during her last trimester, their baby’s information processing speed may be improved according to a study that was published last year (2018). In other words, the kiddos were able to understand and process information at a faster rate than kiddos who were born to mothers who did not take in high amounts of choline. How they determined this was they provided mothers with various amounts of choline during pregnancy. Once the baby was born, Infant information processing speed and visuospatial memory were tested at 4, 7, 10, and 13 months of age. This was based on one study, but the results are promising, and considering there is very little risk to taking in adequate choline, it is worth simmering over.
In another study evaluating 895 mothers, the results suggest that higher choline intake during pregnancy was associated with modestly better child visual memory at age 7 years. Who doesn’t want that for their kids? Harvard, here we come!!
REDUCTION OF RISK OF BABY DEVELOPING SCHIZOPHRENIA
Keep in mind that schizophrenia risk has a HUGE genetic component, so I don’t feel comfortable associating choline intake directly to risk of developing this illness. For those who have concern due to genetic reasons, incorporating choline into one’s diet during pregnancy may have it’s benefits. Keeping in mind that the data is limited, researchers suggest that prenatal dietary intake of choline is a possible intervention to promote fetal brain development and thereby decrease the risk of subsequent mental illnesses, with a special focus on schizophrenia.
REDUCTION OF RISK OF DEVELOPING ALZHEIMER’S DISEASE
Again, I do not love to base recommendations off of a single study, but this one just came out and TBH I just think this is so cool. Since the only data available is from a study conducted on mice and not humans, you need to add an extra grain of salt to this one. But it is cool.
Researchers used mice that displayed Alzheimer’s Disease symptoms. These mice were provided with choline supplementation for different lengths of time, and they used a control group of mice who were not provided with choline. Since mice may breed at a faster rate than humans do, researchers were able to follow more than one generation. They found that the mice who were given choline during pregnancy and lactation had offspring who had better spatial memory. This implies that it may have reduced Alzheimer’s Disease pathology.
Not only did the baby mice show this improvement, but the NEXT GENERATION of mice did too, even though they were never exposed to choline. Literally, gene expression was changed due to the choline intake (changed the expression of 27 genes to be exact!!). Yes, it is based off of mice data and yes, it is based off of one study, but I do think it is an amazing concept that choline intake can literally change gene expression!
CHOLINE IN PRENATAL VITAMINS
Women need a lot of choline when they are pregnant and lactating. So much that supplementation is often needed. With so much evidence suggesting that choline should be supplemented, it is amazing that prenatal vitamins are lacking and women are none the wiser! In fact, when the 25 top prenatal vitamins were evaluated for choline, the results were as follows:
· None of them contained the 450-mg daily recommended dose of choline advised by the Institute of Medicine in 1998
· only two contain 50 mg
· six others contained less than 30 mg
· 17 had no choline whatsoever.
Click here to read my post about how I select prenatal vitamins for ttc and pregnancy!
WHAT SHOUD WOMEN WHO ARE TTC, PREGNANT, OR LACTATING DO?
First of all, be aware of the levels that you should shoot for. An adequate intake (AI) for choline was established by the Institute of Medicine and are as follows:
· 0–6 months: 125 mg per day
· 7–12 months: 150 mg per day
· 1–3 years: 200 mg per day
· 4–8 years: 250 mg per day
· 9–13 years: 375 mg per day
· 14–19 years: 400 mg per day for women and 550 mg per day for men
· Adult women: 425 mg per day
· Adult men: 550 mg per day
· Breastfeeding women: 550 mg per day
· Pregnant women: 450 mg per day
Food is always the preferred source for nutrients. Some great sources of choline are:
Beef liver, pan fried, 3 ounces: 356 mg
Egg, hard boiled, 1 large egg: 147 mg
Beef top round, separable lean only, braised, 3 ounces: 117 mg
Soybeans, roasted, ½ cup: 107 mg
Chicken breast, roasted, 3 ounces: 72 mg
Beef, ground, 93% lean meat, broiled, 3 ounces: 72 mg
Fish, cod, Atlantic, cooked, dry heat, 3 ounces: 71 mg
Mushrooms, shiitake, cooked, ½ cup pieces: 58 mg
Potatoes, red, baked, flesh and skin, 1 large potato: 57 mg
Milk, 1% fat, 1 cup 43 mg
Since many women aren’t huge liver eaters (present company included. You couldn’t pay me to even smell it), eggs are the best dietary source of choline.
A word on eggs
Nutrition goals should be tweaked when ttc, pregnant, and lactating. If you have always been eating egg white omlettes and avoided the yolk, I am not here to tell you to turn your world upside-down. It would be a good idea to consider including the yolk during this “season” of life to not only get in the awesome choline, but tons of other nutrients too. Egg yolks are essentially a vitamin in food form. The many nutrients found in eggs are likely very well absorbed and have no risk for contamination like supplements do. They are also super-cheap and come with a boost of protein.
Eating eggs when preparing for breastfeeding in your third trimester and throughout your breastfeeding journey is also highly encouraged. Maternal consumption of eggs during lactation may also enhance the breast‐milk composition of choline, therefore contributing to your baby’s nutrition.
Choline is way too important in pregnancy to be ignored, and women should shoot for 450 mg/day. She can make a point to eat choline-rich foods, take a supplement, or do a combo of the two.
My go-to is Douglas Labs Choline Bitartrate. 20% off through my dispensary
If your prenatal vitamin does not contain any choline or contains a very small amount (often so the supplement company can claim that they provide choline even though the amount is a drop in the bucket), I am always happy to help with a personalized plan with food and possibly a little supplementation too.
(This was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.)
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