Choline challenge

bracconiere

probably end up saving you money on groceries too! like shooting pool and getting called on slop...

Try Bob's Red Mill Lecithin Soy Granules, i got 600mg with 980kcal, with all the things we've been talking about with just 7g's of it...not a complete nutrient profile for the day but close....

if it were me i'd make a hamburger bun out of lentils and gluten, make a shredded sweet potato burger, make some vegan mayonnaise with wheat germ oil and the lecithin, maybe a parsley pesto, call it...something that's edible, lol

DonnaLH

Thanks for your friendly exchange of ideas today.

bracconiere

thanks for letting/giving me the chance to do it, this kinda stuff is what i had fun with in the beginning! and this would be something i'd have to link to the other thread about motivational inspiration i posted in...so much 'fun' ! how can you not stay motivated!

Susan_RD_101

Hello All!

This is a really good summary on choline (although a little science-heavy, so let me know if anything is unclear):

https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

The key message I'd suggest taking away is according to their stats, most people that we see (in the US anyways) aren't meeting the AI for choline. Yet, frank choline deficiency is very rare given that the body can meet some of our needs.

This is a nutrient where I would advise consuming plant-foods high in choline (i.e. soy, mushrooms, quinoa, etc.) on a regular basis. If concerned that you are still not meeting the AI, there's nothing wrong with supplementing with a small amount. Also, you can get bloodwork to ensure that liver function is normal and homocysteine isn't elevated. In fact, the latter test is worthwhile for all vegans to ensure that B12 intake is adequate.

Kind regards,

DonnaLH

Thank you Susan. My B12 was flagged as being too high on my last blood test, a result of supplements no doubt, and my folate was at the upper limit, which I now see, due to Cronometer, is due to my high intake of greens .

I'm not sure what that means however, and wondered if it might indicate super adequate intake but under utilization, perhaps? Still I will try to get my homocysteine checked due to my recent DNA test showing I am "compound heterozygous for MTHFR polymorphisms", and that is one of the things it, as well as choline, can effect (from what I am learning). With my new Cronometer guidance, I will be able to work on increasing my intake of choline rich foods.

SO grateful for this new tool, and this new awareness.

Oaxaca

Just my 2 cents on the choline thing...

From wiki: "Choline deficiency is rare in the general population.[4][12] The European Food Safety Authority states there are no Recommended Daily Intakes in the EU and "no indications of inadequate choline intakes available in the EU".[13]"

And also recent research from The Cleveland Clinic published in the journal Circulation highlights the link between dietary choline and TMAO production by bacteria in the gut. They found that in both meat eaters and vegetarians (vegans were not studied), supplemental choline caused sharp rises in the production of TMAO, which is directly linked to risk of heart attacks and strokes. (http://www.clevelandheartlab.com/blog/choline-tmao-heart-health/)

Dr Greger has done some great videos on this... eg, https://nutritionfacts.org/video/carnitine-choline-cancer-and-cholesterol-the-tmao-connection/

DonnaLH

Yes, there is a lot we do not know... seems that many nutrients are like the proverbial double edged sword.

I had read this the other day: https://lpi.oregonstate.edu/mic/other-nutrients/choline

DonnaLH

@Oaxaca I do see that of our combined references the one you posted from the Cleveland Clinic is the most recent, and Dr. Greger's the oldest. The Cleveland Clinic article concludes that:

"If you haven’t already, give the Mediterranean Diet a try. It emphasizes abundant fruits and vegetables, lean protein like fish, whole grains, and healthy fats like olive oil. The eating pattern has been shown to lower the risk for heart disease overall, and it turns out to be key to cultivating a healthy gut microbiome—one that helps to keep TMAO levels in check."

Note on Dr. Greger, though I love him and watch his videos regularly, he does have an agenda, works for animal rights, and in my growing awareness seems to cherry pick data to support his stance. I personally have found Dr. Fuhrman more honest in this regard.

BRBWaffles

"The second thing worth mentioning is that DRI's were determined from individuals eating omnivorous diets. Future research is needed to determine if on a vegan diet, the body can adapt to better absorb certain nutrients (as is seen with the absorption of iron)."

I'm not persuaded by this explanation at all. "DRI X was studied in population Y, therefore we don't know if DRI X applies to population Z". Anything is possible, and it's an interesting hypothesis, but there's absolutely no reason to believe that this should guide our behaviour in any way at all. While it may be possible for vegans to have either altered absorbance or altered requirements for choline, there are actually very few things about a vegan diet that we could expect to impact the need for choline. Any diet that is generally high in protein (which isn't something that is unique to either omnivorous or vegan diets) is going to alter the need for choline. High protein likely spares choline, low protein likely depletes choline. Being on a high carbohydrate diet, consuming alcohol, or even having an MTHFR mutation are all probably going to increase the need for choline as well. So, one should not assume that just because they're vegan they're insulated from the potential pitfalls of not getting enough choline. That seems needlessly reckless to me. Considering there doesn't seem to be a downside to mainlining choline in the diet, I'd say try to get as much as you can.

Also, while it is true that you can produce your own choline, you can virtually only produce it by synthesizing phosphatidylcholine. But breaking the choline from the phospholipid so the choline can be oxidized to betaine and go back to supporting methylation isn't a primary fate of phosphatidylcholine, and can't produce a net surplus of choline by itself. So, you're not doing your body any favours by assuming or implying that we can rely largely or even partially on endogenous synthesis in any meaningful way. Especially when this synthesis depletes other important pools of other valuable (and sometimes rather precious) things like glycine and betaine. This is a pathway we definitely want to support with as much external input as possible. As a general principle it's probably prudent to assume you need to meet 100% of your requirement from food alone. Personally, I don't see how this is practical as a vegan without supplementation, but that's my personal bias I suppose.

For those of you scared of TMAO, don't be. It was also an interesting hypothesis, but it doesn't really hold water. While it's true that a proportion of the choline in your diet can convert to TMAO, by and large the most preformed dietary TMAO can be found in fish (orders of magnitude more). TMAO was speculated to uniquely initiate cardiovascular disease in humans. However, nearly every prospective study on people eating fish or eating pescatarian diets shows an inverse relationship in cardiovascular endpoints relative to baseline or control. So, if TMAO was a primary driver of cardiovascular disease, we should actually see that correlating in the data. But we actually see the opposite relationship the vast majority of the time. Correlation does not equal causation, but a lack of correlation throws causation into serious doubt.

TL;DR: Choline is important. Your body does not, and cannot, make enough. Making choline in the body depletes glycine and betaine. Eating higher protein maximally supports choline synthesis. Structure as much choline into your diet as possible. TMAO is very likely a non-issue, and the precautionary tales are just cooked up by some very biased vegans.

DonnaLH

Thx for your input BRBWaffles.

I recently read a study which further supports my concerns voiced above, as I recall and understood, a population of "folate -compromised men" with various versions of the MTHFR polymorphisms were studied and certain groups did better on around 1,100 mg/day of choline than on lower amounts, which is 2xs the current recommendation for the general male pop. "Folate-compromised" might itself be a condition of MTHFR, again my understanding may not be reliable here, but I'd prefer not to take such risks knowing I have this polymorphism, as does my (formerly) vegan son.

Link to the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855263/

DonnaLH

"Foods with the highest total choline concentration (mg/100 g) were: beef liver (418), chicken liver (290), eggs (251), wheat germ (152), bacon (125), dried soybeans (116) and pork (103). The foods with the highest betaine concentration (mg/100 g) were: wheat bran (1339), wheat germ (1241), spinach (645), pretzels (237), shrimp (218) and wheat bread (201)." https://www.ncbi.nlm.nih.gov/pubmed/12730414/

I eat some organic soy & organic wheat, but not all vegans do. This leaves spinach for betaine (and folate) consumption, betaine is choline sparing, but not choline producing.... Enter (non-fertile, humanely produced, pastured...) eggs.

BRBWaffles

Precisely, yes. Personally I try to get at least two egg yolks per day and eat liver and shellfish at least once per two weeks. I'm convinced that this alone is not enough, despite the fact that I always max my choline in Cronometer by the end of the day anyway. But, I'm also convinced that I'm insulated to a greater extent against choline deficiency than the average vegan.

Susan_RD_101

@BRBWaffles

I appreciate your comment and your attention to scientific detail. Just to clarify, I'm not saying that a vegan is protected against a choline deficiency, rather that we just don't have the evidence to be able to support such hypotheses (i.e. high quality systematic reviews and meta analyses haven't been carried out in this population).

While there is nothing wrong with maximizing choline intake in your diet and ensuring you meet the AI, over-focusing on one nutrient isn't sage advice. Nutrition research is starting to focus more on dietary patterns vs. individual nutrients as we know that the sum of what we eat is greater than the individual parts.

At the end of the day, it's important to consider what the outcome of being below the AI for choline is. Given the belief that most people aren't getting enough choline, we should see widespread liver damage associated with this nutrient. And while I do work with people with NAFLD, I have yet to see this occur in someone following a plant-based diet (not saying that it can't happen, but it does seem to be a very rare issue).

From a nutrition standpoint, there is no one right way to eat. However, we do know that eating an unprocessed diet that is plant-centric carries the lowest risk of disease and is linked to the longest lifespan. Ensuring you are meeting essential nutrients along the way is also important and it may be that a combination of supplements plus diet is required for some individuals.

Kind regards,

BRBWaffles

Look up Raw Kristina on YouTube. She gave herself severe atherogenic dyslipidemia on a raw vegan diet. I'd bet money she has NAFLD. It should also be noted that impaired VLDL secretion is a long term downstream effect of choline deficiency. First you might see methylation-related issues like high homocysteine or mental health related issues. Vegetarianism and veganism actually do tend to correlate with certain mental health conditions in the literature. Not saying this is an example of cause and effect, but undermethylation would be a darn good hypothesis.

But this is beside the point. The point is, what is the most prudent and nutritionally robust path toward assuring adequacy. I think veganism is probably one of the riskiest, least robust paths, personally. It's an uphill battle for no sound reason so far as I can tell. At the very least I think someone on a vegan diet should probably supplement with a vegan choline supplement like soy lecithin or something.

DonnaLH

Lack of liver damage is not a very lofty goal, while optimal health is my focus - that is what I am talking about. I'm guessing most people here (Cronometer) have related interests beyond simply avoiding measurable organ damage.

I recently read "The Longevity Diet" by Professor Valter Longo, Director of the Longevity Institute at USC. He is a scientist, and a leading expert in human health and diet, both in controlled clinical studies as well as research into the so called Blue Zone diets. His work focuses on the mechanisms involved such as IGF-1, PKA and the MTor pathways. https://scholar.google.com/scholar?q=IGF-1,+PKA+and+the+MTor+pathways.&hl=en&as_sdt=0&as_vis=1&oi=scholart

Prof. Longo recommends what he calls a "vegan-pescatarian" diet consisting of mostly plant proteins but with the addition of certain fish/seafoods 2-3x/week, and with increased consumption of fish, eggs, and optionally fermented goat/sheep milk products (yogurt, aged cheese) as one reaches my age (mid-60s). His recommendations might anger some advocates, but they are based on science and observation of long-lived populations around the globe.

Further, I just read a study which mentioned postmenopausal women showing less resilience to low choline intakes... I conclude that advice givers should be very cautious about dispensing generalized assurances that might impact at-risk individuals who fall into genetic and/or age groups where such advice might do them long-term irreversible harm, such as muscle, nerve and cognitive damage. If I were less of a nerd, and did not look up related information myself, I might have been more easily persuaded by those with a "belief" and an agenda. I DO welcome help in understanding applying the science, but let's be honest here.

I am forever grateful to Cronometer quantifying the facts about this issue as it relates to my personal health: that my personal dietary pattern was consistently low in certain nutrients which are very important to my personal health. I did not know this, and would not have known this had I continued to rely on the generalized assurances of the commited vegan voices out there. For years I had relied on these reassurances that my diet provided higher amounts of calcium, potassium, as well as the B vitamins than the numbers actually demonstrate. I do understand that not all nutrients are always fully represented in the databases, and that variations exist in the actual vs tested foods, but over time I saw an alarming pattern and for that I am forever grateful to Cronometer, and I am awakened.

Beware agendas, search for truth. Example, Dr. Greger is paid by an animal rights organization...

I do see that Cronometer has other admins on staff, and I wonder why we are not hearing from any of them on this sciency thread.

BRBWaffles

No matter what we choose we have to bootstrap non-trivial assumptions from thin air. But essentially we have three options with regards to vegan vs omnivore:

1) We can believe the observational/epidemiological/prospective data on populations like the Blue Zones. Which have rich outcome data, but the lifestyle data is so confounded that we really have no idea if their diets meaningfully contributed to their good health. If we choose this and this alone as our basis for evidence, heavily plant-centric diets tend to win, occasionally bested only by pescatarianism. Relying merely on this data is dubious.

2) We can believe the RCT data, wherein we have a really firm grasp on what sorts of dietary protocols produce what sorts of general effects in random samplings of people. Which seems great, but we have no outcome or endpoint data on those protocols in most cases. But, if we consider the totality of the RCT data alone we'd have to go with some sort of lower carb paleo/ketogenic type of diet, with veganism barely moving the needle on most metrics of interest. Sometimes even moving the needle in the wrong direction, too. But I don't think merely following RCT data is wise in most cases either.

3) We choose diets based on our own preferences, tolerances, genetics, and perhaps even needs, and we routinely monitor our health and adjust our diets accordingly. This seems like the most logical option to me. This might lead some people from standard diets to veganism, or from veganism to omnivory or vice versa. Who knows. But I think personalized nutrition makes the most sense. It's just the most amount of work.

DonnaLH

A significant portion of Longo's book is devoted to evaluating any approach by "The Five Pillars" which include:
Basic Research
Epidemiology
Clinical Studies
Centenarian Studies
Study of Complex Systems

As he points out in various contexts (such as living in a ketotic state for extended periods of time, and other madness) committing to an untested/unproven protocol violates most of the pillars. I'm interested in advancing science, but not by being a data point in a failed experiment.

BRBWaffles

To be fair, some people seem to need to live in chronically ketotic states. That's not to say their health won't suffer long term as a consequence, but there is more to choosing optimal nutrition than these five pillars. I think the personalized approach trumps his five pillars by far.

While I will admit that this sounds like a reasonable starting place, I doubt it's where most people would end up. If you commit solely to his five pillars you in essence cancel the opportunity to explore nuances that relate specifically to you as an individual. My point is that we're all n=1 experiments, regardless of what the population/RCT data says.

DonnaLH

Yes, admittedly he is dealing with populations and statistics. His 5 day "Fasting-Mimicking Diet" protocol relies on ketosis to jumpstart stem cell activation... no doubt that the future is a more personalized approach.

Susan_RD_101

Thanks again for commenting. I do just want to emphasize that this isn't a case of omnivore vs. vegan; both diets can be nutritionally complete and beneficial and I think an individual should be supported on whatever health journey they choose with the best possible science available (which is my practice mandatate ).

You do bring up a good point though; many nutrition books are fraught with cherry-picked and biased information. If you can look for meta-analyses that use GRADE approaches, they will often tell you the risk of bias with each study to form a better opinion overall.

Kind regards,

Susan_RD_101

This discussion has also inspired me to look more closely at the research... I'll dig into PubMed to see what information I can find. Look for a blog later this month or next month! (Will also be sure to post it here when complete!)

DonnaLH

Prof. Longo seems to disagree with your assertion here that, "vegan diets can be nutritionally complete", well, maybe "can be" but he argues that they are typically not, and are not well enough tested in all ethnicities or age groups to be recommended generally. Genetics matter, a lot, and apparently most Northern Europeans for example may not have the ability to compensate without fish, given the long evolutionary arch they evolved in. This is likely to be a self-correcting error as genetic tests become more available to people, who may begin to realize that just because certain populations might thrive on a specific traditional diet, that does not mean all humans can. We are not all the same.

DonnaLH

Thank you Susan.

BRBWaffles

"...omnivore vs. vegan; both diets can be nutritionally complete..."

I would push back against this. Researchers aren't anywhere near close to figuring out what compounds in food even constitute nutrients or not. It's a constant topic of debate. But, regardless, there are established nutrients and beneficial compounds exclusive to animal foods that vegans don't get access to without supplementation. I've actually yet to come across a nutrient that is exclusive to plant foods, but plant foods are extremely valuable nonetheless.

But, just to paint a very general picture, it is typically the case that animal foods will have preformed nutrients and plant foods will contain precursors. It's not always the case, but it's generally true. But the reverse is almost never true. I can't think of a single case where a plant food has a preformed nutrient whereas the animal food has the precursor. But this is HUGELY practical for a variety of reasons related to genetics, and how our genetics determine the expression of enzymes that make these metabolic conversions possible.

SNPs of interest:
BCMO1 polymorphisms can impair the conversion of carotenoids to retinol, and is not rare by any stretch of the imagination. Up to 30% of Caucasians and 70% of Asians have an SNP that impairs this conversion by 59%. But it's not clear whether or not this means you just need more carotenoids. I suspect not, due to the fact that the enzyme is rate-limiting. It's a bottleneck, and relying entirely on carotenoids alone is a dice-roll. A vegan would either need to supplement with synthetic retinol, or eat an animal product containing retinol.

UbiAD1 polymorphisms have unknown prevalence, but impair one's ability to derive MK-4 from phylloquinone and other menaquinones. Which may mean that certain vegans eating MK-7 in their natto or tempeh might not be converting their MK-7 to MK-4 after all. Vegans who are particularly risk-adverse should find it prudent to supplement with synthetic MK-4 or eat animal foods, particularly liver, eggs, aged cheeses, and dark poultry meat. But then it's not even clear what else a vegan closes the door to in terms of K2. So far we know of about 20 different forms of K2, and the research is pointing to most of them having unique biological activity.

PNPO polymorphisms also have largely unknown prevalence, but impair one's ability to convert pyridoxine (provitamin B6) to its active form, pyridoxal-5-phosphate. Vegans looking to cover their bases should supplement with pyridoxal-5-phosphate or eat animal foods such as liver or poultry.

FADS1 polymorphisms affect about 50% of people, and generate about fourfold variation in one's ability to derive DHA, EPA, and AA from their plant precursors, alpha-linolenic acid and linoleic acid. Mendelian randomization and observational research correlates the prevalence of these polymorphisms with a host of diseases, ranging from cardiovascular diseases to poor IQ scores in children born to mothers with these polymorphisms. Vegans should supplement with algae or eat oily fish.

B12 and D3 aside, this isn't even beginning the conversation about other nutrient-like compounds in meat, like carnitine, carnosine, creatine, taurine, glycine, or even short-chain collagen peptides. The more I read the literature on these compounds, even at normal nutritional/non-supraphysiological doses, the more I'm persuaded that these compounds should be considered nutrients because it's obvious that they confer health benefits.

So, to be clear, when we say a vegan diet can be nutritionally complete, we have to include the caveat that this may or may not involve heavy supplementation that would be virtually unnecessary on a balanced omnivorous diet.

DonnaLH

My very first hint that I may have to reconsider my "vegan identity" came a couple of years ago when I read about the issue of South Asians (in India) who had a tradition of veganism ("Jainism") encountering problems on a Western diet due to their handling certain fats differently than Westerners, which illustrated the flip side of certain Western populations having lost the ability to form long-chain fatty acids from the precursors found in plant foods. I'm going on memory so far, I will try to find a reference to that as well as to a map I saw more recently illustrating similar genetic findings... here is the first: https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/cornell-study-finds-some-people-may-be-genetically-programmed-to-be-vegetarians/?noredirect=on&utm_term=.5f29f4c00893

A quote from related research, "“Our study is the first to connect an insertion allele with vegetarian diets, and the deletion allele with a marine diet,” said co-lead author Kaixiong Ye in a recent statement. He said the two genetic variations probably emerged early in our evolutionary history, when people around the world migrated to different environments. “Sometimes they ate a plant-based diet and sometimes they ate a marine-based diet, and in different time periods these different alleles were adaptive.”

Can't find the map I saw right now, but it was just a graphic depiction of this fact.

DonnaLH

BEWARE well meaning assurances that you can get plenty of choline, don't take anyone's word for it, carefully monitor YOUR intake. Choline deficiency can cause non-alcoholic fatty liver disease which can lead to permanent scarring and cirrhosis, and even to death from liver cancer, it is not well known, nor is it a joke.

I just found out I may have suffered this fate, blood tests shown elevated liver enzymes consistent with advanced liver damage, having an ultrasound next month to verify. Post menopausal women with the PEMT gene polymorphisms relating to choline deficiency are the most vulnerable, I fit this profile.

DonnaLH

I don't see any promised follow-up by Susan_RD_101, anyone?

There is plenty of data about choline deficiency and the risk of fatty liver... I found it easily once I knew to look.

Susan_RD_101

@DonnaLH

Choline is certainly a nutrient that we can expect to hear more about as it is currently trending. While there is some very good research coming out, we still don't have enough robust, long-term, well-designed studies to provide a daily recommendation of intake for choline (right now, we only have an AI which is an estimate of how much choline health experts believe to be adequate for human needs).

Vegan diets are often pointed as being choline-deficient and while they may have significantly lower intakes than those eating a mixed diet, we don't know if there is any clinical relevancy since the occurrence of liver disease appears very low among those following a plant-based diet.

Hope this helps to provide some clarification!

BRBWaffles

@Susan_RD_101

This is one instance where we might actually agree. I actually think that vegan diets could lower choline requirements if they're based on starch. If they're based around fruit or high in fat I think they could potentially run into issues because not only is the diet low in choline, it is low in nearly all of choline's precursors. Except for betaine. But the primary determinant of liver fat accumulation is obesity. I think it is unlikely that vegans are uniquely vulnerable to choline deficiency in most cases. But I think there could be circumstances where a vegan diet could be uniquely detrimental to those with certain predispositions.

DonnaLH

Anyone reading this might look into "Lean NAFLD", or "choline deficient NAFLD" or combinations thereof, as there is documentation of choline deficiency leading to liver disease in lean, non diabetic, like myself (I weight 119, a19.5 BMI, an hbA1c of 5.5... non-alcoholic "SUPER healthy VEGAN" diet(?) for 7 years...). We should be WARNING people, not reassuring them that it might be possible to be healthy...