Choline is essential for healthy liver function, and research links choline deficiency to fatty liver disease. There is no evidence to suggest that choline can reverse fatty liver disease but it may help to prevent the condition.

This article explores choline and how it affects the liver. It explains different types of fatty liver disease and how a person may manage them. Additionally, it outlines daily requirements for choline and how a person may consume choline in foods and supplements.

Choline is an essential nutrient that people need to maintain overall health. Although the body produces some choline, people also need to consume it in food to obtain the amounts they require. Choline has several functions in human health, such as:

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There are several types of fatty liver disease that are mainly defined by whether excess fat is caused by alcohol or other factors. Doctors may also the term “hepatic steatosis” to refer to fatty liver disease.

Nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat builds up in the liver. Excess fat may build up due to someone’s diet, genes, or health conditions such as metabolic syndrome or diabetes.

NAFLD is a common liver disorder among people who have more weight or obesity.

Nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) is a type of NAFLD that includes inflammation and damage to the liver. NASH can cause scarring in the liver and may lead to liver cancer.

Alcohol-associated liver disease

A person may develop steatosis (fatty liver) if they drink excessive amounts of alcohol, causing too much fat to build up in the liver. This is the earliest stage of alcohol-associated liver disease.

Research on humans and other mammals suggested that choline is necessary to maintain the liver’s normal function. Scientists in the 1930s demonstrated that choline deficiency caused fatty liver disease in dogs and rats. The scientists introduced choline to the animals’ diet and found that this resolved the disease.

Choline plays a role in the metabolism of amino acids and methylation reactions in the body. Methylation reactions are essential for gene expression.

Choline also plays an integral part in fat metabolism in the liver and regulating homocysteine. Furthermore, choline supports the membranes of mitochondria, which are the energy components in cells.

The body can produce choline from phosphatidylcholine which is a type of specialized fat molecule, or phospholipid. However, people also need to consume choline from foods to obtain enough of the nutrient and keep the liver healthy.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), there are no approved medications to treat NAFLD. Healthcare professionals recommend treating NAFLD with weight loss.

However, scientists have studied the effects of choline on fatty liver disease.

For example, an older study in China indicated that the highest choline intake of 412 milligrams (mg) a day, was associated with a lower risk of fatty liver disease in women with a moderate body mass index (BMI), between 18.5–24.9. This lower risk was in comparison to the lowest intake of 179 mg a day.

However, the researchers found no association between choline intake and lower risk of fatty liver disease in women with obesity or more weight.

Another older study of 664 individuals with NAFLD or NASH found that postmenopausal women with deficient choline intake had worse fibrosis. However, the researchers did not identify choline as a contributor to disease severity in other groups of people.

A recent 2022 case-control study found that a combined high intake of choline and betaine was associated with an 81% reduction in visceral obesity-related fatty liver disease. However, the ideal dosage of choline remains unclear.

Further conclusive research into the effects of choline on fatty liver disease is necessary.

The National Institutes of Health (NIH) advises that the amount of choline someone depends on several factors:

  • the amount of methionine, betaine, and folate in the diet
  • gender
  • pregnancy and lactation
  • stage of development (age)
  • individual ability to produce choline in the body
  • genetic mutations that affect individual choline requirements

There is insufficient information for experts to establish an accurate average requirement of choline. However, the NIH advises that the following amounts of choline are adequate to prevent liver damage:

  • 425 mg a day for adult females
  • 550 mg a day for adult males
  • 450 mg a day during pregnancy
  • 550 mg a day during lactation

Food sources of choline include:

Choline is available in dietary supplements either alone or combined with vitamins and minerals. Choline amounts in nutritional supplements typically range from 10 mg-250 mg.

Choline supplements may be in the form of choline bitartrate, phosphatidylcholine, or lecithin.

Oregon State University advises that phosphatidylcholine supplements can provide choline. However, choline only comprises about 13% of their weight. For example, a supplement with 4,230 mg of phosphatidylcholine would contain 550 mg of choline.

Lecithin supplements originating from vegetable oils contain varying levels of phosphatidylcholine from 20%-90%.

A person should speak with their doctor before taking any supplements, as some can interact with medications.

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High intakes of choline may cause adverse effects. The NIH advises that healthy adults’ tolerable upper intake level from food or supplements is 3,500 mg per day.

Adverse effects from too much choline can include:

Doctors may recommend that a person loses weight to treat NAFLD or NASH. Losing weight can reduce fat in the liver and prevent inflammation and scarring.

The NIDDK advises that losing at least 3%-5% of body weight can reduce fat in the liver. Additionally, someone may need to lose up to 7%-10% of their body weight to reduce liver inflammation and fibrosis.

Physical activity can help a person lose weight, and it is still beneficial without weight loss. In addition, people can lose weight gradually by eating a balanced diet and limiting their portion sizes. Rapid weight loss can worsen liver disease.

Usually, NAFLD is a silent disease, so people may have few or no symptoms. However, symptoms may include tiredness and a feeling of discomfort in the upper right side of the abdomen.

A doctor may conduct a physical exam and ask a person about their medical history to help diagnose NAFLD. They may also arrange blood tests, imaging tests, or a liver biopsy.

If someone with NAFLD wishes to try a choline supplement, they should check with their doctor first as it may be unsuitable or interact with their medication.

Scientists have not identified how much choline can reverse fatty liver disease. However, it is clear that choline is an essential nutrient for liver health, and choline deficiency may contribute to fatty liver disease.

Choline also plays a vital role in brain health and fat metabolism. Therefore, it is essential for a person to consume choline for overall health. People can consume choline in animal protein and plant sources. They may decide to take a choline supplement following a doctor’s advice.

A person should speak with a healthcare professional if they think they have fatty liver disease.