Acetylcholine (ACh): What It Is, Function & Deficiency

What is acetylcholine (ACh)?

Acetylcholine (ACh) is a neurotransmitter, a chemical that carries messages from your brain to your body through nerve cells. It&#;s an excitatory neurotransmitter. This means it &#;excites&#; the nerve cell and causes it to &#;fire off the message.&#;

Goto Witspower to know more.

Acetylcholine gets its name from the two substances that it&#;s made from &#; an acetyl group (acetyl coenzyme A, which comes from the sugar molecule glucose) and the nutrient choline. Choline is naturally present in foods, including egg yolks, soy, liver, seeds of vegetables and legumes. Choline is also made in your liver.

Acetylcholine is involved in many important functions in your body. It plays a major role in voluntary muscle movement all over your body. This is muscle movement you control. Nerve cells stimulate muscle nerve cells, causing muscles to contract. It also plays an important role in brain nerve cells, in such processes as memory, thinking and learning.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

How is acetylcholine (ACh) made?

An enzyme called choline acetyltransferase causes a reaction between choline and the acetyl group to create acetylcholine. It&#;s made at the end of nerve cells.

How does acetylcholine (ACh) work?

Acetylcholine is stored at the end of nerve cells until it&#;s triggered to be released. Once released from the end of the nerve cell, it moves into a space called the synaptic cleft. The synaptic cleft is between the nerve cell from which acetylcholine was released (the presynaptic nerve cell) and the next nerve cell acetylcholine is going to (the postsynaptic nerve cell).

Once acetylcholine moves across the synapse, it can bind to two types of receptors: nicotinic receptors and muscarinic receptors. There are two subtypes of nicotinic receptors and five types of muscarinic receptors. After binding to the receptors, the chemical message moves along to the next nerve cell and then the process repeats until the message arrives at its destination.

Acetylcholine in the synapse is broken down by an enzyme called acetylcholinesterase into choline and acetate. These products are reabsorbed and recycled so they can be used again in transmitting another chemical message.

Advertisement

What does acetylcholine (ACh) do?

Acetylcholine has many roles.

When it binds to muscarinic receptors, it:

• Regulates heart contractions and blood pressure and decreases heart rate.
• Moves food through your intestine by contracting intestinal muscles and increasing stomach and intestine secretions.
• Causes glands to secrete substances such as tears, saliva, milk, sweat and digestive juices.
• Controls the release of urine.
• Contracts muscles that control near vision.
• Causes an erection.

When it binds to nicotinic receptors, it:

• Allows skeletal muscle to contract.
• Causes the release of adrenaline and norepinephrine from your adrenal glands.
• Activates your sympathetic system with the release of norepinephrine.

Both types of receptors are involved in memory, including long-term and working memory, memory formation and consolidation and retrieval.

Within your brain, acetylcholine is also involved in motivation, arousal, attention, learning and promoting rapid eye movement (REM) sleep.

Where is acetylcholine (ACh) found?

Acetylcholine is found in your central nervous system (CNS), your brain and spinal cord, as well as in your peripheral nervous system (the nerves that branch out from your CNS and connect with all other parts of your body, including muscles and organs).

Advertisement

Where does acetylcholine (ACh) work?

Acetylcholine is released both in your central nervous system (CNS), your brain and spinal cord, as well as in your peripheral nervous system (the nerves that branch out from your CNS and connect with all other parts of your body, including muscles and organs).

In your brain, acetylcholine originates from two major places: the basal forebrain and the mesopontine tegmentum area.

In your peripheral nervous system, acetylcholine is released into the neuromuscular junction. This is where nerves meet muscle cells.

Acetylcholine also plays a significant role in your autonomic nervous system, a branch of your peripheral nervous system. Your autonomic nervous system regulates many of the automatic functions of your body, such as the proper functioning of your internal organs.

Acetylcholine is also involved in your immune system and is secreted by T lymphocytes. T lymphocytes are a type of body-protective white blood cell.

What medical conditions are associated with low levels of acetylcholine (ACh)?

Low levels (deficiency) of acetylcholine play an important role in several diseases, the most common being:

• Alzheimer&#;s disease. People who have Alzheimer&#;s disease don&#;t have enough acetylcholine in their brains.
• Lambert-Eaton myasthenic syndrome. This disorder is caused by a reduction in the release of acetylcholine from nerve cells.
• Myasthenia gravis. This is an autoimmune disorder in which there&#;s a rapid weakening of skeletal muscles after repeated use. Some of the body&#;s antibodies interfere with acetylcholine receptors at the neuromuscular junction.

What other substances interrupt acetylcholine (ACh)?

Unfortunately, knowledge of how acetylcholine works in the body has been used to cause harm.

Nerve gases, such as sarin, and pesticides inhibit acetylcholinesterase, the enzyme that breaks down acetylcholine. A buildup of acetylcholine in the synapse paralyzes muscles, which can lead to death.

One type of spider causes harm to humans in a unique way. The venom from the bite of a black widow spider dramatically raises the acetylcholine level causing severe muscle contractions, spasms, paralysis and possible death.

What medications target acetylcholine (ACh)?

Cholinesterase inhibitors increase activity at acetylcholine receptors by blocking the breakdown of acetylcholine by the enzyme acetylcholinesterase. The result of blocking this enzyme is that there&#;s a buildup of acetylcholine in the synapse and continuous activation of the cholinergic receptors.

Cholinesterase inhibitors are used to treat Alzheimer&#;s disease and myasthenia gravis. In both of these conditions, there&#;s a severe decrease in the amount of acetylcholine receptor stimulation. Cholinesterase inhibitors, including donepezil (Aricept®), rivastigmine (Exelon®) and galantamine (Razadyne®), increase cholinergic transmission by inhibiting cholinesterase at the synapse. This action provides modest symptomatic benefits in some people with dementia.

Botulinum toxin &#; used to treat muscle spasticity, cosmetic wrinkles and migraines &#; works by preventing acetylcholine release from the end of nerve cells.

Is an acetylcholine (ACh) supplement available?

An acetylcholine dietary supplement isn&#;t available. However, supplements that increase acetylcholine release or that stop the breakdown of acetylcholine are thought to increase acetylcholine levels. One such supplement that increases acetylcholine release is choline. Supplements that stop the breakdown of acetylcholine include Bacopa monnieri, Ginkgo biloba and huperzine A.

Researchers say that more studies are needed to determine if dietary supplements improve memory and brain function, mental health conditions, including depression and bipolar disorder, and fetal growth and brain development.

Always talk with a healthcare provider before taking dietary supplements. They&#;ll offer advice about the benefits or lack of benefits of supplements and let you know if they&#;re known to interfere with medications you may be taking.

Is acetylcholine (ACh) present in food?

Choline, which is converted into acetylcholine, is found in many foods, including:

• Beef liver.
• Eggs.
• Beef top round.
• Roasted soybeans, canned kidney beans.
• Roasted chicken breast.
• Cod.
• Cooked quinoa.
• Cooked shiitake mushrooms, boiled broccoli and Brussels sprouts.
• Milk (1%), nonfat vanilla yogurt.

A note from Cleveland Clinic

Acetylcholine (ACh) is an important neurotransmitter that plays a role in brain functions, such as memory, and body functions, such as muscle contractions to move your muscles. Low levels of acetylcholine are associated with memory issues and muscle disorders. Cholinesterase inhibitors are used to treat Alzheimer&#;s disease and myasthenia gravis. The benefits of a choline supplement have yet to be fully determined.

Barbeau, A. Emerging treatments: replacement therapy with choline or lecithin in neurological diseases. Can.J.Neurol.Sci. ;5(1):157-160. View abstract.

Blusztajn, J. K. Choline, a vital amine. Science 8-7-;281():794-795. View abstract.

Boyd, W. D., Graham-White, J., Blackwood, G., Glen, I., and McQueen, J. Clinical effects of choline in Alzheimer senile dementia. Lancet 10-1-;2():711. View abstract.

Buchman, A. L., Ament, M. E., Sohel, M., Dubin, M., Jenden, D. J., Roch, M., Pownall, H., Farley, W., Awal, M., and Ahn, C. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J.Parenter.Enteral Nutr. ;25(5):260-268. View abstract.

Buchman, A. L., Jenden, D., Suki, W. N., and Roch, M. Changes in plasma free and phospholipid-bound choline concentrations in chronic hemodialysis patients. J.Ren Nutr. ;10(3):133-138. View abstract.

Chawla, R. K., Wolf, D. C., Kutner, M. H., and Bonkovsky, H. L. Choline may be an essential nutrient in malnourished patients with cirrhosis. Gastroenterology ;97(6):-. View abstract.

Chhabra, S. K., Wadehra, N. R., Gaur, S. N., Joshi, A. P., and Agrawal, K. P. Prophylactic treatment of bronchial asthma with theophylline, disodium cromoglycate and choline--a clinical, physiological and biochemical assessment. Indian J.Chest Dis.Allied Sci. ;29(2):65-76. View abstract.

Christie, J. G. Blackburn 1. M. Glen A. I. M. Zeisel S. Shering A. & Yates C. M. Effects of choline and lecithin on CSF choline levels and on cognitive functioning in patients with presenile dementia of the Alzheimer type. Nutrition and the brain ;5

Chuaqui, P. and Levy, R. Fluctuations of free choline levels in plasma of Alzheimer patients receiving lecithin: preliminary observations. Br.J.Psychiatry ;140:464-469. View abstract.

Conlay LA, Wurtman RJ Blusztajn JK Covielia IJ Maher TJ Evoniuk GE. Decreased plasma choline concentrations in marathon runners (letter). NEM ;175:892.

Das, S., Gupta, K., Gupta, A., and Gaur, S. N. Comparison of the efficacy of inhaled budesonide and oral choline in patients with allergic rhinitis. Saudi.Med.J. ;26(3):421-424. View abstract.

Davis, K. L., Berger, P. A., and Hollister, L. E. Letter: Choline for tardive dyskinesia. N.Engl.J.Med. 7-17-;293(3):152. View abstract.

Davis, K. L., Hollister, L. E., Barchas, J. D., and Berger, P. A. Choline in tardive dyskinesia and Huntington's disease. Life Sci. 11-15-;19(10):-. View abstract.

Davis, K. L., Hollister, L. E., Vento, A. L., and Simonton, S. Choline chloride in animal models of tardive dyskinesia. Life Sci. 5-15-;22(19):-. View abstract.

Davis, K. L., Mohs, R. C., Tinklenberg, J. R., Hollister, L. E., Pfefferbaum, A., and Kopell, B. S. Cholinomimetics and memory. The effect of choline chloride. Arch.Neurol. ;37(1):49-52. View abstract.

de la Huerga, J. and Popper H. Urinary excretion of choline metabolites following choline administration in normals and patients with hepatobiliary diseases. J.Clin.Invest. ;30:463.

Deuster, P. A., Singh, A., Coll, R., Hyde, D. E., and Becker, W. J. Choline ingestion does not modify physical or cognitive performance. Mil.Med. ;167(12):-. View abstract.

Domino, E. F., Lipper, S., Landau, S. G., and Domino, S. E. Levels of red blood cell choline after discontinuation of lithium therapy. Am.J.Psychiatry ;139(5):681-682. View abstract.

Etienne, P., Gauthier, S., Johnson, G., Collier, B., Mendis, T., Dastoor, D., Cole, M., and Muller, H. F. Clinical effects of choline in Alzheimer's disease. Lancet 3-4-;1():508-509. View abstract.

Fovall, P., Dysken, M. W., Lazarus, L. W., Davis, J. M., Kahn, R. L., Jope, R., Finkel, S., and Rattan, P. Choline bitartrate treatment of Alzheimer-type dementias. Commun.Psychopharmacol. ;4(2):141-145. View abstract.

Galeone F, Salvadorini F Guarguaglini M Saba P. Effect of intravenous injection of CDP-choline, S-adenosyl-methionine and citiolone in subjects with hyperlipemia. Artery. ;5(2):157-169.

Gelenberg, A. J. Choline and lecithin for the treatment of tardive dyskinesia [proceedings]. Psychopharmacol.Bull. ;15(2):74-75. View abstract.

Gelenberg, A. J., Doller-Wojcik, J. C., and Growdon, J. H. Choline and lecithin in the treatment of tardive dyskinesia: preliminary results from a pilot study. Am J Psychiatry ;136(6):772-776. View abstract.

Gelenberg, A. J., Wojcik, J., Falk, W. E., Bellinghausen, B., and Joseph, A. B. CDP-choline for the treatment of tardive dyskinesia: a small negative series. Compr.Psychiatry ;30(1):1-4. View abstract.

Ghoshal, A. K. and Farber, E. Liver biochemical pathology of choline deficiency and of methyl group deficiency: a new orientation and assessment. Histol.Histopathol. ;10(2):457-462. View abstract.

Growdon, J. H. and Gelenberg, A. J. Choline and lecithin administration to patients with tardive dyskinesia. Trans.Am.Neurol.Assoc. ;103:95-99. View abstract.

Growdon, J. H., Cohen, E. L., and Wurtman, R. J. Effects of oral choline administration on serum and CSF choline levels in patients with Huntington's disease. J.Neurochem. ;28(1):229-231. View abstract.

Harris CM, Dysken MW Fovall P Davis JM. Effect of lecithin on memory in normal adults. Am J Psychiatry. ;140(8):-.

Korzh, E. V. [The efficacy of inhalations of choline chloride in the treatment of patients with chronic dust-induced bronchitis]. Lik.Sprava. ;(1):81-85. View abstract.

Lars G.Forssell, Roland Eklöf Bengt Winblad and Lars Forssell. Early Stages of Late Onset Alzheimer's Disease. Acta Neurologica Scandinavica ;79(S121):27-42.

Levy, R. Choline in Alzheimers disease. Lancet 10-28-;2():944-945. View abstract.

Livingstone, I. R. and Mastaglia, F. L. Choline chloride in the treatment of ataxia. Br.Med.J. 10-13-;2():939. View abstract.

Lu L, Ni J Zhou T Xu W Fenech M Wang X. Choline and/or Folic Acid Deficiency is Associated with Genomic Damage and Cell Death in Human Lymphocytes In Vitro. Nutr Cancer. ;64(3):481-487.

Mandat, T., Wilk, A., Manowiec, R., Koziarski, A., Zielinski, G., and Podgorski, J. K. [Preliminary evaluation of risk and effectiveness of early choline alphoscerate treatment in craniocerebral injury]. Neurol.Neurochir.Pol. ;37(6):-. View abstract.

Mohs RC, Davis KL. Choline chloride effects on memory: correlation with the effects of physostigmine. Psychiatry Res. ;2(2):149-156.

Mohs, R. C., Davis, K. L., Tinklenberg, J. R., Hollister, L. E., Yesavage, J. A., and Kopell, B. S. Choline chloride treatment of memory deficits in the elderly. Am.J.Psychiatry ;136(10):-. View abstract.

Morrison, L. M. and W. F. Gonzales. Choline in coronary atherosclerosis. Amer.Heart J. ;39:729.

Narkewicz MR, Caldwell S Jones G. Cysteine supplementation and reduction of total parenteral nutrition-induced hepatic lipid accumulation in the weanling rat. J Pediatr Gastroenterol Nutr. ;21(1):18-24.

Nasrallah, H. A., Dunner, F. J., Smith, R. E., McCalley-Whitters, M., and Sherman, A. D. Variable clinical response to choline in tardive dyskinesia. Psychol.Med. ;14(3):697-700. View abstract.

Sachan, D. S., Hongu, N., and Johnsen, M. Decreasing oxidative stress with choline and carnitine in women. J.Am.Coll.Nutr. ;24(3):172-176. View abstract.

Are you interested in learning more about Acetone Choline Supplement? Contact us today to secure an expert consultation!

Saito, T. [Choline antagonists and antacids for the treatment of peptic ulcer]. Nippon Rinsho ;42(1):158-162. View abstract.

Sandage BW, Sabounjian LA White R. Wurtman RJ. Choline citrate may enhance athletic performance. Physiologist ;35:236a.

Schmidt, C., Abicht, A., Krampfl, K., Voss, W., Stucka, R., Mildner, G., Petrova, S., Schara, U., Mortier, W., Bufler, J., Huebner, A., and Lochmuller, H. Congenital myasthenic syndrome due to a novel missense mutation in the gene encoding choline acetyltransferase. Neuromuscul.Disord. ;13(3):245-251. View abstract.

Schrader WP, Fan DP. Synthesis of cross-linked peptidoglycan attached to previously formed cell wall by toluene-treated cells of Bacillus megaterium. J Biol Chem. 8-10-;249(15):-.

Shinozuka H, Katyal SL Perera MI. Choline deficiency and chemical carcinogenesis. Adv Exp Med Biol. ;206:253-267.

Sijens, P. E., Oudkerk, M., van Dijk, P., Levendag, P. C., and Vecht, C. J. 1H MR spectroscopy monitoring of changes in choline peak area and line shape after Gd-contrast administration. Magn Reson.Imaging ;16(10):-. View abstract.

Smith, C. M., Swash, M., Exton-Smith, A. N., Phillips, M. J., Overstall, P. W., Piper, M. E., and Bailey, M. R. Choline therapy in Alzheimer's disease. Lancet 8-5-;2():318. View abstract.

Spector SA, Jackman MR Sabounjian LA Sakas C Landers DM Willis VVT. Effect of choline supplementation on fatigue in trained cyclists. Med Sci Sports Exerc ;27(5):669-673.

Stoll, A. L., Sachs, G. S., Cohen, B. M., Lafer, B., Christensen, J. D., and Renshaw, P. F. Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients. Biol.Psychiatry 9-1-;40(5):382-388. View abstract.

Tammenmaa Irina, McGrath John Sailas Eila ES Soares-Weiser Karla. Cholinergic medication for neuroleptic-induced tardive dyskinesia. Cochrane Database of Systematic Reviews ;(3)

Tamminga, C., Smith, R. C., Chang, S., Haraszti, J. S., and Davis, J. M. Depression associated with oral choline. Lancet 10-23-;2():905. View abstract.

Thal, L. J., Rosen, W., Sharpless, N. S., and Crystal, H. Choline chloride fails to improve cognition of Alzheimer's disease. Neurobiol.Aging ;2(3):205-208. View abstract.

von Allworden, H. N., Horn, S., Kahl, J., and Feldheim, W. The influence of lecithin on plasma choline concentrations in triathletes and adolescent runners during exercise. Eur.J.Appl.Physiol Occup.Physiol ;67(1):87-91. View abstract.

Warber, J. P., Patton, J. F., Tharion, W. J., Zeisel, S. H., Mello, R. P., Kemnitz, C. P., and Lieberman, H. R. The effects of choline supplementation on physical performance. Int.J.Sport Nutr.Exerc.Metab ;10(2):170-181. View abstract.

Wood, J. L. and Allison, R. G. Effects of consumption of choline and lecithin on neurological and cardiovascular systems. Fed.Proc. ;41(14):-. View abstract.

Wurtman, R. J., Hirsch, M. J., and Growdon, J. H. Lecithin consumption raises serum-free-choline levels. Lancet 7-9-;2():68-69. View abstract.

Zeisel, S. H., Epstein, M. F., and Wurtman, R. J. Elevated choline concentration in neonatal plasma. Life Sci. 5-26-;26(21):-. View abstract.

Albright CD, Liu R, Mar MH, et al. Diet, apoptosis, and carcinogenesis. Adv Exp Med Biol ;422:97-107. View abstract.

Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J ;36(1):e. View abstract.

Böckmann KA, Franz AR, Minarski M, et al. Differential metabolism of choline supplements in adult volunteers. Eur J Nutr ;61(1):219-230. View abstract.

Boeke CE, Gillman MW, Hughes MD, et al. Choline intake during pregnancy and child cognition at age 7 years. Am J Epidemiol ;177(12):-47. View abstract.

Buchman AL, Dubin MD, Moukarzel AA, et al. Choline deficiency: a cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation. Hepatology ;22:-403. View abstract.

Buchman AL, Sohel M, Brown M, et al. Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study. JPEN J Parenter Enteral Nutr. ;25(1):30-5. View abstract.

Cho E, Willett WC, Colditz GA, et al. Dietary choline and betaine and the risk of distal colorectal adenoma in women. J Natl Cancer Inst ;99:-31. View abstract.

Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, .

da Costa, K. A., Cochary, E.F., Blusztain, J.K., Garner, S.C., Ziesel, S.H. Accumulation of 1,2-sn-diradylglycerol with increased membrane-associated protein kinase C may be the mechanism for spontaneous hepatocarcinogenesis in choline-deficient rats. J Biol Chem. ;268(3):-.View abstract.

Davis KL, Berger PA. Pharmacological investigations of the cholinergic imbalance hypotheses of movement disorders and psychosis. Biol Psychiatry ;13:23-49. View abstract.

Davis KL, Hollister LE, Berger PA. Choline chloride in schizophrenia. Am J Psychiatry ;136:-4. View abstract.

Dibaba DT, Johnson KC, Kucharska-Newton AM, Meyer K, Zeisel SH, Bidulescu A. The association of dietary choline and betaine with the risk of type 2 diabetes: The Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care. ;43(11):-. View abstract.

DiBella M, Thomas MS, Alyousef H, et al. Choline Intake as Supplement or as a Component of Eggs Increases Plasma Choline and Reduces Interleukin-6 without Modifying Plasma Cholesterol in Participants with Metabolic Syndrome. Nutrients. Oct 13;12(10):. View abstract.

Food and Nutrition Board, Institute of Medicine. Choline. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. Washington D.C.: National Academy Press; :390-422.

Gabis LV, Ben-Hur R, Shefer S, Jokel A, Shalom DB. Improvement of language in children with autism with combined donepezil and choline treatment. J Mol Neurosci. ;69(2):224-234. View abstract.

Gaur SN, Agarwal G, Gupta SK. Use of LPC antagonist, choline, in the management of bronchial asthma. Indian J Chest Dis Allied Sci ;39:107-13. View abstract.

Gilman AG, et al, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY: Pergamon Press, .

Gimbel BA, Anthony ME, Ernst AM, et al. Long-term follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder: corpus callosum white matter microstructure and neurocognitive outcomes. J Neurodev Disord ;14(1):59. View abstract.

Golzarand M, Bahadoran Z, Mirmiran P, Azizi F. Dietary choline and betaine intake and risk of hypertension development: a 7.4-year follow-up. Food Funct ;12(9):-. View abstract.

Golzarand M, Mirmiran P, Azizi F. Association between dietary choline and betaine intake and 10.6-year cardiovascular disease in adults. Nutr J ;21(1):1. View abstract.

Grunewald KK, Bailey RS. Commercially marketed supplements for bodybuilding athletes. Sports Med ;15:90-103. View abstract.

Guerrerio AL, Colvin RM, Schwartz AK, et al. Choline intake in a large cohort of patients with nonalcoholic fatty liver disease. Am J Clin Nutr. ;95(4):892-900. View abstract.

Guerrerio AL, Mattis L, Conner KG, et al. Oral choline supplementation in children with intestinal failure. JPGN. ;53(1):115-19. View abstract.

Gupta SK, Gaur SN. A placebo controlled trial of two dosages of LPC antagonist-choline in the management of bronchial asthma. Indian J Chest Dis Allied Sci ;39:149-56. View abstract.

Hunter SK, Hoffman MC, D'Alessandro A, et al. Maternal prenatal choline and inflammation effects on 4-year-olds' performance on the Wechsler Preschool and Primary Scale of Intelligence-IV. J Psychiatr Res ;141:50-56. View abstract.

Klatt KC, McDougall MQ, Malysheva OV, et al. Prenatal choline supplementation improves biomarkers of maternal docosahexaenoic acid (DHA) status among pregnant participants consuming supplemental DHA: a randomized controlled trial. Am J Clin Nutr. ;116(3):820-832. View abstract.

Knott V, de la Salle S, Choueiry J, et al. Neurocognitive effects of acute choline supplementation in low, medium and high performer healthy volunteers. Pharmacol Biochem Behav. ;131:119-129. View abstract.

Lawrence CM, Millac P, Stout GS, Ward JW. The use of choline chloride in ataxic disorders. J Neurol Neurosurg Psychiatry ;43:452-4. View abstract.

Legg, N. J. Oral choline in cerebellar ataxia. Br.Med.J. 11-18-;2():-. View abstract.

Li J, Kang X, Zhang L, Luo J, Zhang D. Dietary choline is inversely associated with depressive symptoms: A cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) to . J Affect Disord ;301:23-29. View abstract.

Liu L, Qiao S, Zhuang L, et al. Choline intake correlates with cognitive performance among elder adults in the United States. Behav Neurol ;:. View abstract.

Liu W, Ren C, Zhang W, Liu G, Lu P. Association between dietary choline intake and diabetic retinopathy: National Health and Nutrition Examination Survey -. Curr Eye Res ;47(2):269-276. View abstract.

Liu ZY, Zhang DM, Yishake D, Luo Y, Fang AP, Zhu HL. Dietary choline, rather than betaine intake, is associated with hepatocellular carcinoma mortality. Food Funct. Sep 23;11(9):-. View abstract.

Meyer KA, Shea JW. Dietary choline and betaine and risk of CVD: a systematic review and meta-analysis of prospective studies. Nutrients ;9(7). pii: E711. View abstract.

Mohs RC, Davis KL, Tinklenberg JR, Hollister LE. Choline chloride effects on memory in the elderly. Neurobiol Aging ;1:21-5. View abstract.

Nguyen TT, Risbud RD, Mattson SN, Chambers CD, Thomas JD. Randomized, double-blind, placebo-controlled clinical trial of choline supplementation in school-aged children with fetal alcohol spectrum disorders. Am J Clin Nutr ;104(6):-92. View abstract.

Rashvand S, Mobasseri M, Tarighat-Esfanjani A. Effects of choline and magnesium concurrent supplementation on coagulation and lipid profile in patients with type 2 diabetes mellitus: a pilot clinical trial. Biol Trace Elem Res. ;194(2):328-335. View abstract.

Ross RG, Hunter SK, McCarthy L, et al. Perinatal choline effects on neonatal pathophysiology related to later schizophrenia risk. Am J Psychiatry. ;170(3):290-8. View abstract.

Sehested P, Lund HI, Kristensen O. Oral choline in cerebellar ataxia. Acta Neurol Scand ;62:124-6. View abstract.

Shaw GM, Carmichael SL, Yang W, et al. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol ;160:102-9. View abstract.

Shronts EP. Essential nature of choline with implications for total parenteral nutrition. J Am Diet Assoc ;97:639-46. View abstract.

Sidhu N, Davies S, Nadarajah A, et al. Oral choline supplementation for postoperative pain. Br J Anaesth ;111(2):249-55. View abstract .

Signore C, Ueland PM, Troendle J, Mills JL. Choline concentrations in human maternal and cord blood and intelligence at 5 y of age. Am J Clin Nutr ;87(4):896-902. View abstract.

Smolders L, de Wit NJW, Balvers MGJ, Obeid R, Vissers MMM, Esser D. Natural choline from egg yolk phospholipids is more efficiently absorbed compared with choline bitartrate; Outcomes of a randomized trial in healthy adults. Nutrients. ;11(11):. View abstract.

Spector SA, Jackman MR, Sabounjian LA, et al. Effect of choline supplementation on fatigue in trained cyclists. Med Sci Sports Exerc ;27:668-73. View abstract.

Sun S, Li X, Ren A, et al. Choline and betaine consumption lowers cancer risk: a meta-analysis of epidemiologic studies. Sci Rep ;6:. View abstract.

Tan J, Bluml S, Hoang T, et al. Lack of effect of oral choline supplement on the concentrations of choline metabolites in human brain. Magn Reson Med ;39:-10. View abstract.

Van Puyvelde H, Dimou N, Katsikari A, et al. The association between dietary intakes of methionine, choline and betaine and breast cancer risk: A systematic review and meta-analysis. Cancer Epidemiol ;83:. View abstract.

Villamor E, Rifas-Shiman SL, Gillman MW, Oken E. Maternal intake of methyl-donor nutrients and child cognition at 3 years of age. Paediatr Perinat Epidemiol ;26(4):328-35. View abstract.

Virtanen JK, Tuomainen TP, Voutilainen S. Dietary intake of choline and phosphatidylcholine and risk of type 2 diabetes in men: The Kuopio Ischaemic Heart Disease Risk Factor Study. Eur J Nutr. ;59(8):-. View abstract.

Warton FL, Molteno CD, Warton CMR, et al. Maternal choline supplementation mitigates alcohol exposure effects on neonatal brain volumes. Alcohol Clin Exp Res ;45(9):-. View abstract.

Wozniak JR, Fuglestad AJ, Eckerle JK, et al. Choline supplementation in children with fetal alcohol disorders: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. ;102(5): -25. View abstract.

Wozniak JR, Fuglestad AJ, Eckerle JK, et al. Choline supplementation in children with fetal alcohol spectrum disorders has high feasibility and tolerability. Nutr Res. ;33(11):897-904. View abstract.

Wu BT, Dyer RA, King DJ, Richardson KJ, Innis SM. Early second trimester maternal plasma choline and betaine are related to measures of early cognitive development in term infants. PLoS One ;7(8):e. View abstract.

Yates AA, Schlicker SA, Suitor CW. Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc ;98:699-706. View abstract.

Yen CL, Mar MH, Zeisel SH. Choline deficiency-induced apoptosis in PC12 cells is associated with diminished membrane phosphatdylcholine and sphingomyelin, accumulation of ceramide and diacylglycerol, and activiation of a caspase. FASEB J ;13:135-42.

Zeisel SH. Choline: an important nutrient in brain development, liver function and carcinogenesis. J Am Coll Nutr ;11:473-81. View abstract.

Zeisel SH. Choline: needed for normal development of memory. J Am Coll Nutr ;19:528S-31S. View abstract.

Ziegler RG, Lim U. One-carbon metabolism, colorectal carcinogenesis, chemoprevention - with caution. J Natl Cancer Inst ;99:-5. View abstract.

Albright, C. D. Tsai A. Y. Friedrich C. B. Mar M. H. and Zeisel S. H. Choline availability alters embryonic development of the hippocampus and septum in the rat. Brain Res Dev Brain Res ;113:13-20.

Are patients with cirrhosis choline deficient? Nutr.Rev. ;48(10):383-385. View abstract.

The company is the world’s best Phosphatidylserine For Anxiety And Depression supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.