Choline & Inositol – The Forgotten B Vitamins

Choline & Inositol – The Forgotten B Vitamins

When we talk about B vitamins, we’re all familiar with the B vitamins 1, 2, 3, 5, 6 and 12. Many of us are also aware that folate (folic acid) is classed as a type of B vitamin. But do you ever consider choline and inositol when addressing B vitamin requirements?

Well, you could be missing a trick, especially choline and inositol are classed as essential, in that your body cannot make enough to support daily requirements. So why are these two nutrients so vital to our health and why should we consider supplementation if our diet is deficient?

Inositol

Inositol, once called Vitamin B8, is related to the vitamin B complex group. It’s the precursor of phosphatidyl inositol, a messenger molecule required for normal nerve cell function. Other actions in the body also include; the formation of healthy cell membranes, transport of fats from the liver, and serotonin receptor activity (the pathways that help balance mood and gut function).

Inositol in the Diet

We mainly get inositol from foods that we eat. Phytic acid from fibre found in fruits, nuts, whole grains and vegetables is converted into bio-available inositol in the intestines. However, poor food choices and poor underlying gut health can reduce this conversion causing a decrease in bioavailable inositol. In addition, glucose can inhibit the absorption of inositol through the intestines and into the body’s tissues, making diets high in refined carbohydrates particularly detrimental to inositol availability. Coffee also interferes with inositol absorption in the gut.

Inositol & Mood

A systematic review and meta-analysis of seven randomised placebo-controlled studies (242 subjects) found non-significant benefits for inositol over placebo for depressed mood, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalised anxiety, and a trend toward superior response over placebo for premenstrual dysphoric disorder. Some research findings also suggest that inositol may improve depressed mood.[1] Inositol has also been reported to better support mood and sleep, especially during times of stress.

Inositol & Fertility

Inositol is important for the development of follicles. Studies have shown that with an inositol deficiency, supplementation can promote the healthy maturation of follicles. This may be of interest to women with fertility issues because evidence has shown decreased levels of circulating inositol and increased levels of inositol excreted in the urine, create an overall inositol deficiency in the body in PCOS. [2]

These variety of physiological roles suggest inositol plays an important role in health and levels should be addressed in conditions such as diabetes, high or imbalanced cholesterol, polycystic ovary syndrome (PCOS), and mood disorders such as anxiety, panic attacks or depression.

Choline

Choline (sometimes called Vitamin B4) is required for synthesis of acetylcholine, a neurotransmitter that is important for memory. Choline is also important in the metabolism and transport of fats from the liver with shortfalls linked to defective lipoprotein metabolism, abnormal phospholipid synthesis and oxidative damage.[3]This makes choline critical for liver metabolism and function.

Functionally, choline is a chief methyl donor involved in the methylation cycle regulating levels of homocysteine in the body (important for cardiovascular health), as well as DNA and histone methylation, which play a central role in regulating gene expression modulating brain function.[4] This means choline deficiency may play a role in liver disease, cardiovascular disease and brain health.[5]

Choline in the Diet

In general, beef, eggs, fish, chicken, nuts, milk and certain plant foods such as cruciferous broccoli provide some dietary choline but with the popularity of plant-based vegan diets, this impacts the levels of daily choline intake for many people.

Choline & Brain Health

People whose diets include a lot of choline have been shown to do well on memory and cognitive ability tests. And MRI scans showed that high choline consumption was associated with healthier brain tissue.[6]

Dietary intake of phosphatidylcholine, a form of choline found in lecithin, is associated with a reduced risk of dementia. Phosphatidylcholine was also linked to enhanced cognitive performance. Small scale clinical studies have shown that choline supplementation might reduce the severity of mania symptoms as seen in bipolar disorder, as well as reduce depressive symptoms.[7]

Choline & Pregnancy

The risk of choline inadequacies, either due to low habitual intake or gene polymorphisms, is particularly concerning at key stages of pregnancy and lactation. Choline is actively transported to the foetus in utero, with maternal supplies correlating with cognitive outcomes.[8] This nutrient is particularly critical during foetal development as it modifies brain and spinal cord structure influencing the risk of lifelong memory function and possible risk of neural tube defects.[9]

Choline & Inositol Supplements

A recent British Medical Journal (BMJ) article clearly identifies the mounting evidence of inositol and choline’s importance even recognised in mainstream medical care. It’s therefore essential that we consider and address these two nutrients in health-supporting programmes. This is now more important than ever given that accelerated food trends towards plant-based diets/veganism could have further ramifications on choline intake/status in particular.

But what is the daily amount of choline and inositol we should be eating to support our health? There are no official government recommended daily allowances for these nutrients but Adequate Intake figures suggest adults should be consuming at least 500mg daily to ”ensure nutritional adequacy” though these figures could increase for those with genetic mutations increasing the need for choline intake; pregnancy; fertility and also the ageing brain. In short, many people should be considering choline and inositol supplementation if their diets have a shortfall.

Supplements contain different forms of choline and inositol; they are found in phospholipid form (phosphatidylcholine and phosphatidylinositol) in lecithin-based products (soy or sunflower based powders); lecithin powders also contain other phospholipids. Nutrient-focussed choline and inositol capsules can provide a more convenient dosing form and concentrated levels requiring smaller doses.

Daily doses start around 250-500mg, as found in choline and inositol capsules, increasing to 1-5g taken in either concentrated capsule or lecithin powder form, depending on requirements.

So why not add choline and inositol into your B vitamin and supplement regime, your brain, liver and heart will thank you for it.


Dr Elisabeth Philipps PhD BSc (Hons) BSc Nutr Med AFMCP

Dr Elisabeth Philipps is a clinical neuroscientist and functional medicine practitioner and runs a health consultancy specialising in brain health, the endocannabinoid system and phytocannabinoids including C*B*D. She regularly presents at conferences and events, and provides expert opinion for the national press, specialist healthcare publications and health companies. You can connect with Elisabeth via:

www.drelisabethphilipps.com | instagram – @drelisabethphilipps | Twitter – @drphilipps | Linked In – Dr Elisabeth Philipps


References

[1] https://www.psychologytoday.com/gb/blog/integrative-mental-health-care/201709/inositol-and-choline-in-mental-health-care

[2] Papaleo E., Unfer V., Baillargeon J.P., Chiu T.T.  Contribution of myo-inositol to reproduction.  Eur J Obstet Gynecol Reprod Biol. 2009 Dec;147(2):120-3

[3] Corbin KD  Zeisel SH. Choline metabolism provides novel insights into nonalcoholic fatty liver disease and its progression. Curr Opin Gastroenterol 2012;28:159–65

[4] Bekdash RA. Choline and the brain: an epigenetic perspective. Adv Neurobiol 2016;12:381–99

[5] Derbyshire E. Could we be overlooking a potential choline crisis in the United Kingdom? BMJ Nutrition, Prevention & Health 2019

[6] https://www.health.harvard.edu/staying-healthy/a-possible-brain-food-that-youve-probably-never-heard-of

[7] https://www.sciencedaily.com/releases/2019/08/190806101530.htm

[8] Bernhard W. Choline concentrations are lower in postnatal plasma of preterm infants than in cord plasma. Eur J Nutr 2015;54:733–41

[9] Zeisel SH. Choline: critical role during fetal development and dietary requirements in adults. Annu Rev Nutr 2006;26:229–50

Written By:
Elisabeth Philipps

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