Nutrient Is Linked to Healthy Babies

Graphic: Which foods are high in choline?

Scientists who study fetal development are abuzz over a nutrient most people have never heard about. Choline, pronounced KO-leen, is a vitamin B-like compound found in high quantities in eggs, beef and chicken liver, wheat germ and soybeans. The latest studies suggest that in pregnancy it plays a critical role in brain development, and may even lower the risk of neural-tube defects such as spina bifida, in the same way that folic acid does.

In 1998, the Institute of Medicine, part of the National Academy of Sciences, deemed choline an essential nutrient, meaning that humans must obtain most of what they need from diet in order to stay healthy. The Food and Drug Administration permits food manufacturers to use “Good source” or “Excellent source” labeling on their products if they contain specified minimum amounts.

But choline has yet to find its way onto the public’s radar screen.

Low Visibility Is a Hurdle

“From a marketing standpoint it has been a slow go, mainly because of the lack of customer awareness of what choline is,” says Roger Lantz, a sales director at the Solae Co., which produces soy-based ingredients for food makers, including Rumford Naturals Cornbread & Muffin mix, one of the few items on store shelves that touts choline on its label.

Generally speaking, except for women who are pregnant or breastfeeding, choline deficiency is rare, because the nutrient is present in many basic protein foods. Women, more than men, can produce a significant amount of it in their livers. But during pregnancy, the demand becomes too great to be met by what the body can make on its own.

“During pregnancy, enormous quantities of choline are pumped across the placenta. It’s 15 times more concentrated in the fetus than it is in the mother,” says Steven Zeisel, who runs the nutrition department at the University of North Carolina in Chapel Hill and is recognized as an expert on choline.

This drawdown in the mother persists into breastfeeding, he says, evident from the high levels of choline in breast milk. It is the reason why the FDA requires that all infant formulas contain the nutrient, which generally isn’t included in prenatal vitamins.

Dr. Zeisel worries most about the choline intake of pregnant vegans and those he dubs “pastatarians.” “If you’ve cut out eggs, milk and meat you should carefully think about whether or not you’re getting enough overall choline,” he says.

Choline helps regulate the transport of nutrients into and out of cells. It also forms acetylcholine, a neurotransmitter involved in learning and memory functions. According to Dr. Zeisel, who published findings this year in the Journal of Neurochemistry, choline also seems to regulate the division of stem cells that go on to form the memory areas of a baby’s brain by turning off the expression of certain genes in DNA. If there isn’t enough choline, those genes are expressed and the stem cells stop dividing.

Animal Studies Play Role

Until now, the majority of the science linking prenatal choline intake to brain function has come from animal studies at Duke University in Durham, N.C. Researchers there have shown that giving extra choline to a pregnant rat during a key window of development permanently changes the way the brains of its offspring are organized and function.

For example, those offspring performed 30% better on tasks relating to memory and attention than control animals that were not given prenatal choline supplements.

In a study published this year in the Journal of Neurophysiology, Duke researchers showed that the neurons in the offsprings’ brains were bigger and could make more neural connections.

“The amazing part of these studies is that the effects lasted the animal’s entire life, even though it never received any more extra choline except for that one six-day period in the womb,” says Dr. Zeisel. This summer, Dr. Zeisel began a study to see if the same outcome will happen with pregnant women and their babies when they get extra choline.

The detriment of not having enough choline in the diet was the subject of a paper in last month’s issue of the American Journal of Epidemiology. The authors — led by Gary Shaw, a research director of the California Birth Defects Monitoring Program — based their study on the medical records of California women who were pregnant in the late 1980s and early 1990s.

‘Sizable Risk Reduction’

Dr. Shaw selected a group of 864 women — 424 whose pregnancies resulted in babies or fetuses with neuraltube defects, and 440 who delivered normal babies. In the months that followed delivery, all of the women took part in an eating-habits survey. They were asked to complete a detailed food questionnaire in which they listed the frequency and portion size of the foods, including vitamin supplements, they had eaten in the months before and around the time of conception. From this, Dr. Shaw and his colleagues then were able to calculate each woman’s estimated daily choline intake using a database that lists the choline content of common foods, published by Dr. Zeisel’s group last year.

The researchers found that women whose daily choline intake was greater than 498 mg had about half the risk of delivering a baby with a neural-tube defect, compared with expectant mothers whose choline intake was 290 mg or less.

“That’s a sizable risk reduction,” says Dr. Shaw. Most startling is that this reduction occurred independently of intake of folic acid, a nutrient found in leafy greens that’s now added to staples such as bread because it’s been proven to reduce birth defects.

“Many of us have been targeting folic acid as the way to prevent birth defects, and this has certainly worked,” Dr. Shaw says. “But issues remain as to why it doesn’t work in everyone. How do we prevent birth defects in women who take folic acid? … We started thinking about other exposures. Choline and its metabolite, betaine, are good candidates because they play similar biochemical roles to folic acid.”

Experts aren’t ready to recommend supplementing a normal diet with choline.

“Right now, we don’t know if there are any benefits of women taking extra choline. Without knowing what the benefits are, any potential risks are not worth it,” says Dr. Zeisel. For now, the advice is simply to consume choline-rich foods.

Originally published in the Wall Street Journal