Choline

by Jack Norris, Registered Dietitian

Contents

• Essential Information
  • Summary
  • Table 1: DRI for Choline
  • Table 2: Plant Sources of Choline
  • Table 3: Choline in a 2,000-Calorie Vegan Menu
  • Anecdotal Musings
• Research
  • Daily Needs
  • Average U.S. Choline Intakes
  • Birth Defects
  • Child Cognitive Development
  • Breast Milk
  • Choline and Cognitive Function in Adults
  • Heart Disease
  • Choline and Cancer
  • Supplemental Forms and TMAO
  • Betaine and Folate
  • Vegan Plasma Choline
• References
  • Reviewed but Not Cited

Note: I used AI for the literature review, data analysis, claim verification, and editing of much of this article. Last updated: August 2026.

Essential Information

Summary. Vegans should choose numerous high-choline foods each day; this is especially true if you’re planning a pregnancy.

Choline helps prevent fatty liver by transporting fat out of the liver. It also helps produce acetylcholine, a neurotransmitter involved in mood, memory, and muscle control (Office of Dietary Supplements).

Researchers identified choline as an essential nutrient in the 1990s. Although our bodies can make small amounts of choline, it’s not enough to meet its needs.

The dietary reference intake (DRIs) for choline is an adequate intake (AI). AIs are used when there isn’t enough evidence to determine a recommended dietary allowance (RDA). The AI is 500 mg for men, and 425 mg for women; see Table 1 for other age groups and life stages.

The AI for choline is based on a small body of research and cannot pinpoint the exact amount most people need. While most vegans probably don’t meet the AI, aiming for 300 mg/day is a reasonable target—it’s well above the levels shown to cause deficiency and within ranges not associated with increased disease risk. In fact, most Americans don’t meet the choline AI; on average, daily intakes are about 258 to 273 mg for women and 396 to 405 mg for men.

Choline has been hypothesized to prevent birth defects. In populations where food hasn’t been routinely fortified with folate, there are links between neural tube defects (NTDs) and low choline intake, but not in populations with folate fortification; intakes above roughly 30% of the AI might help prevent cleft lip.

Although choline is considered important for neurological development in children, differences between groups at typical choline intakes haven’t found a reliable benefit. Vegan and vegetarian mothers who breastfeed appear to have similar breast milk choline levels as non-vegetarian mothers.

Research suggests low choline intake (≤219 mg/d) may be a risk factor for dementia, but it’s unclear whether a high intake offers additional protection; supplementation trials haven’t found a clear benefit for improving cognition. Choline has been hypothesized both to decrease heart disease risk by lowering homocysteine and to increase risk by raising TMAO; no area of findings is strong. Choline doesn’t seem to have a strong causal role in cancer risk, protective or harmful.

The safe upper limit for choline intake is 3,500 mg/day; excessive intake is associated with fishy body odor, nausea, low blood pressure, and liver toxicity. If you choose to take choline supplements, stick with a low dose and avoid choline bitartrate.

We don’t have rigorous studies of choline intake among vegans. The USDA database of the choline content of foods shows small but consistent amounts across a range of plant foods; see Table 2. Plant Sources of Choline and Table 3. Choline in a 2,000-Calorie Vegan Menu. Foods contain choline in several different forms, which include free choline, phosphatidylcholine (aka lecithin), sphingomyelin, glycerophosphocholine, and phosphocholine.

Common plant foods supply betaine and folate, which might reduce dietary choline needs; it hasn’t been quantified, so we can’t give specific recommendations.

The one study that has directly measured plasma choline levels in vegans — including some following a whole-food vegan diet without additional supplements — found levels within the normal range. However, plasma choline isn’t considered a reliable biomarker of choline status.

Anecdotal musings. If someone knew I had worked on this article for dozens, possibly 100, hours, they might be surprised. Because as you read it, it seems almost like much ado about nothing. There isn’t strong evidence that vegans generally need to worry about choline. However, I’ve seen posts on message boards from vegans claiming to crave eggs. I find this a little more interesting than a typical craving might be — I’ve never liked the smell of eggs, and after years of being vegan, I find it actively unpleasant. If that’s a common experience among vegans, then a genuine craving for eggs, despite an aversion to their smell, might be pointing to something. I know research generally doesn’t support nutrient-specific cravings, with only a few exceptions. But if these cravings are real and don’t stem simply from missing the taste or memory of eggs, I know a few potential explanations.

A low-protein or low-fat vegan diet could drive a desire for something more calorie-dense and satiating, which then gets channeled into a craving for a specific, familiar food from someone’s pre-vegan life—eggs, in this case, rather than tofu or lentils. It’s also conceivable, though speculative, that an inadequate choline intake contributes to a general sense of low energy or brain fog that someone associates with life before going vegan, prompting a craving for the foods they ate back then — but this is a guess, not something with real evidence. For what it’s worth, in 2011 I experimented with taking choline supplements myself just to see if they made any difference in how I felt, and they didn’t.

If you’re interested in more thoughts I have about choline and vegan diets, see Much Ado about Choline and To Quit or Not to Quit Veganism: Part Two.

Table 1. DRI for CholineA
Age	Female(mg)	Male(mg)
0-6 mos	125	125
7-12 mos	150	150
1-3 yrs	200	200
4-8 yrs	250	250
9-13 yrs	375	375
14-18 yrs	400	550
≥ 19 yrs	425	550
Pregnant	450
Breastfeeding	550
A. DRIs, 1998.

 

Table 2. Plant Sources of CholineA
Food	Choline(mg)
BlueBonnet Nutrition lecithin granules, 1 scoop (7.5 g)	225
Soymilk, original and vanilla, unfortified, 1 cup	57.3
Potatoes, red, baked, flesh and skin, 1 large	56.5
Roasted soynuts, ¼ cup	53
Kidney beans, canned, ½ cup	45
Quinoa, cooked, 1 cup	43
Navy beans, cooked, boiled, ½ cup	40.7
Collards, cooked, boiled, ½ cup	36.5
Tofu, firm, prepared with calcium sulfate and magnesium chloride (nigari), ½ cup	35.4
Chickpeas, cooked, boiled, ½ cup	35.1
Lentils, cooked, boiled, ½ cup	32.4
Brussels sprouts, boiled, ½ cup	32
Broccoli, boiled, ½ cup	31.3
Pinto beans, cooked, ½ cup	30.2
Black beans, cooked, boiled, ½ cup	28.1
Shiitake mushrooms, cooked, ½ cup	26.7
Wheat germ, 2 tbsp	25.3
Soy protein powder, 1 oz	24
Peanuts, dry roasted, ¼ cup	24
Cauliflower, boiled, ½ cup	24
Peas, boiled, ½ cup	24
Peanut butter, smooth, 2 tbsp	20
Orange, 1 large	15.5
Almonds, dry roasted, 1 oz	15
Tomato sauce, ½ cup	12.2
Carrot juice, canned, ½ cup	11.7
Banana, raw, 1 medium	11.6
Oatmeal, instant, fortified, plain, prepared with water, 1 cup	11
Walnuts, English, 1 oz	11
Potatoes, boiled, with skin, ½ cup	10.5
Dates, medjool, 4	9.5
Bread, whole-wheat, commercially prepared, 1 slice	8.7
Zucchini, boiled, ½ cup	8.5
Spaghetti, cooked, enriched, 1 cup	8
Apples, raw, with skin, 1 large	7.6
Tahini, 2 tbsp	7.6
Lettuce, cos or romaine, 1 ½ cups	7
Avocado, ¼ cup cubes	5.4
A. USDA, 2019. • For comparison, liver (356 mg per 3-ounce serving) and eggs (147 mg for a large hard-boiled egg) are the animal foods highest in choline (ODS, 2022).

 

Table 3. Choline in a 2,000-Calorie Vegan MenuA
Breakfast	Choline (mg)	Calories
1 cup oatmeal, cooked in water	17.3	166
2 tablespoons chopped English walnuts	5.8	96
1 tablespoon wheat germ	25.3	54
1 banana	11.6	105
1 cup soy milk	57	104
Total	117	525
Snack
1 navel orange	11.8	69
1/4 cup dry-roasted almonds	18	206
Total	29.8	275
Lunch
2 corn tortillas	6.4	104
1 cup pinto beans	60.4	245
1/2 cup cooked sliced portobello mushrooms	19.9	18
1/4 cup sliced avocado	5.2	59
1/4 cup sliced tomatoes	3	8
Total	94.9	434
Snack
1/2 cup raw sliced carrots	5.35	25
1/2 cup raw cauliflower florets	23.7	13
1/4 cup hummus	17.1	109
Total	46.15	147
Dinner
1 cup cooked quinoa	42.6	222
1 cup cooked broccoli	62.6	55
1 cup tofu	71.4	188
1/4 cup peanut sauce (includes 2 tablespoons peanut butter)	20.2	191
Total	196.8	656
Daily Total	485	2,037
A. USDA, 2019.

Research

Daily needs. The AI for choline is based on a small body of research and cannot pinpoint the exact amount most people need:

• The requirement for choline was discovered in patients on long-term, intravenous nutrition who developed fatty liver disease that resolved once choline was added to their feeding regimen. Without choline, they couldn’t make phosphatidylcholine, a compound needed for fat metabolism and transport (Buchman, 1992; Buchman, 1995; Buchman, 2001; Hollenbeck, 2010).
• The AI (550 mg/day for men, 425 mg/day for women) comes from a single 1991 University of North Carolina (UNC) study: 8 men given 50 mg/day or less of choline developed deficiency markers (elevated liver enzymes, fatty liver, elevated creatine phosphokinase), which resolved with a 500 mg/day supplement. The study never tested doses between 50 and 500 mg (Zeisel, 1991).
• At least five follow-up studies, all from the same UNC research group, induced deficiency with diets of about 50 mg/day or less; a large proportion of subjects developed dysfunction markers within six weeks, suggesting few people can stay healthy on less than 50 mg/day (da Costa, 2004; da Costa, 2006; Fischer, 2007; Fischer, 2010; Kohlmeier, 2005).
• The amount needed to reverse deficiency varied widely between studies: 138 mg of choline per 170 lbs of body weight normalized creatine phosphokinase in one small, all-male study that didn’t measure liver function (da Costa, 2004).
• Another study found that when switched from their normal diet to an acclimation phase diet containing 550 mg/day of choline, 6 out of 26 men developed elevated liver enzymes (AST/ALT) and, in most of these six, sharply elevated CPK (a muscle-damage marker). It’s not clear why. Ten days might not have been long enough for those 6 men to acclimate. It’s also possible they have genetics that affect how their bodies handle choline. To normalize, one man received 825 mg (per 170 lbs of body weight) of choline—the amount needed for repletion for the other 5 men wasn’t reported. The current AI fully resolved deficiency in 81% of subjects overall (across both sexes and diet phases). However, this study was too small and not designed to determine such men’s long-term choline needs (Fischer, 2007).
• Premenopausal women were much less likely to develop deficiency, possibly because estrogen offsets the effect of a genetic variant that otherwise raises choline requirements (da Costa, 2006; Fischer, 2010).

Average U.S. choline intakes. Most Americans don’t meet the choline AI; on average, daily intakes are about 258 to 273 mg for women and 396 to 405 mg for men:

• A 2011 USDA analysis of NHANES data (2007–2008), independent of industry funding, estimated mean choline intake at 302 mg/day overall — 396 mg/day for men and 260 mg/day for women (Chester, 2011). A later analysis of more recent NHANES cycles (2009–2014) found similar averages (338 mg/day overall; 405 mg/day men, 273 mg/day women) and estimated only about 8% of adults meet the AI; that analysis’s lead author discloses funding from choline- and egg-industry-linked sources (Wallace, 2017).
• An older, smaller UNC Chapel Hill study asked 32 healthy adults to keep a 3-day food record of their usual home diet. Reported intake averaged 398 mg/d in men (72% of the AI) and 258 mg/d in women (61% of the AI) — well below the AI for both sexes, though a 3-day window may not fully capture typical intake given how much choline content can vary day to day depending on what’s eaten. The same subjects later ate more choline, an average of 631 mg/d for men and 443 mg/d for women, when housed in a research center and choosing meals from a hospital kitchen menu, but this reflects a short, atypical eating context more than habitual intake. Betaine intake from the food records was also substantial (3.2 mg/kg/d men, 2.8 mg/kg/d women), which may have modestly reduced these subjects’ effective need for choline, since betaine is also a methyl donor Fischer, 2005.

Birth defects. In populations where food hasn’t been routinely fortified with folate, there are links between neural tube defects (NTDs) and low choline intake, but not in populations with folate fortification; intakes above roughly 30% of the AI might help prevent cleft lip:

• NTDs and choline intake in pre-folate fortification populations. A pre-fortification California case-control study found that women in the highest quartile of choline intake (>498 mg/d) had roughly half the odds of an NTD-affected pregnancy versus the lowest quartile (Shaw, 2004).
• NTDs and choline intake in post-folate fortification populations. A post-fortification California study found no significant association between dietary choline intake and NTD risk across the full observed range (25th–75th percentile: 293–506 mg/d) — though it can’t tell us where any meaningful threshold might be, or whether one exists at all in a folate-replete population (Carmichael, 2010). Another post-fortification U.S. study of women already meeting folic acid recommendations found no association between intakes of choline and several other one-carbon nutrients and NTD risk — but roughly 95% of participants consumed at least 200 mg/day, leaving a very small lower-intake reference group and making it difficult to draw meaningful conclusions about choline’s role (Petersen, 2023).
• NTDs and blood choline. A study measuring serum (rather than dietary) choline in over 180,000 pregnant women in a folate-fortified population (California, 2003–2005) found a strong, statistically significant dose-response relationship: women in the lowest decile of serum choline had roughly 2.4 times the odds of an NTD-affected pregnancy, and those in the highest decile had roughly 0.14 times the odds, relative to the middle 50% (adjusted trend p=0.0006). However, several factors complicate interpreting this as evidence about dietary choline specifically: serum choline is only weakly linked to actual intake, since it’s also shaped by endogenous synthesis (estrogen- and genotype-dependent) and whole-body membrane turnover — the study had no dietary or supplement data at all, so it’s unclear whether the association reflects diet, metabolic differences, or reverse causation from the affected pregnancy itself. Blood was also drawn 15–18 weeks into pregnancy, about 12 weeks after neural tube closure, which may not reflect the periconceptional exposure window that matters biologically (the authors argue this bias would likely underestimate any true effect, though this claim isn’t independently verified). The extreme-decile comparisons driving the headline numbers rest on small samples (as few as 1 case in the top decile), and the more robust quartile-level comparisons, while consistent in direction, have adjusted confidence intervals that touch 1.0. The study authors themselves describe this as a preliminary finding needing replication, potentially via a designed trial, before firm conclusions or recommendations can be drawn (Shaw, 2009). Another study found no correlation between maternal plasma choline and NTD risk, though it also measured mid-pregnancy plasma choline rather than periconceptional dietary intake (Mills, 2014).
• Cleft lip/palate, post-folate fortification, and choline intakes. A study using National Birth Defects Prevention Study data found that women in the highest quartile of choline intake (>265 mg/d) had a lower risk of cleft lip with or without cleft palate than the lowest quartile (Shaw, 2006).

Child cognitive development. Although choline is considered important for neurological development in children, differences between groups at typical choline intakes haven’t found a reliable benefit:

• A systematic review identified four RCTs and five observational studies of prenatal choline and child neurodevelopment; most outcomes across both study types were null, and the trials reporting a benefit each tested multiple outcomes with no group differences on most of them. The reviewers flagged small sample sizes, high attrition, non-validated outcome measures, and selective reporting as limitations undermining the positive findings; Australian Eggs Ltd partially funded the review, though the authors declared no conflict of interest (Gould et al., 2025).
• Included in the meta-analysis above by Gould et al. was one trial of 20 children that found a benefit: children whose mothers received a total of 930 mg/day of choline (about twice the AI) during the third trimester scored better on a sustained-attention task at age 7 than children whose mothers received about the AI (0.71 vs. 0.56; p=.02) (Bahnfleth, 2022). This is the same small feeding trial that earlier reported an infant attention benefit (Caudill, 2018) — so it reflects one small, repeatedly tested cohort rather than independent replication, and the trial’s choline supplement was manufactured by, and this analysis partly funded by, Balchem, along with the Egg Nutrition Center. These are lab-measured attention tasks, not real-world outcomes like school performance; a 14-year follow-up assessing memory and mental health in adolescence has completed data collection but, as of August 2026, hadn’t yet been published (Roth, 2025).

Breast milk. Vegan and vegetarian mothers who breastfeed appear to have similar breast milk choline levels as non-vegetarian mothers:

• Although a woman’s choline intake may affect levels in breast milk (Davenport, 2015), a study of 74 healthy lactating women found no difference in levels of water-soluble choline (the predominant form of choline in breast milk) among women following vegan, vegetarian, and non-vegetarian diets (Perrin, 2019).

Choline and cognitive function in adults. Research suggests low choline intake (≤219 mg/d) may be a risk factor for dementia, but it’s unclear whether a high intake offers additional protection; supplementation trials haven’t found a clear benefit for improving cognition:

• The Framingham Offspring Study found that higher choline intake was associated with better verbal and visual memory among adults (Poly, 2011). A 16-year follow-up of 3,224 Framingham Offspring Study participants found that low choline intake (≤219 mg/d) was associated with roughly double the risk of developing dementia (HR ≈2.3, 95% CI ≈1.2–4.3) compared to medium intake (220–516 mg/d), after adjusting extensively for confounders including APOE ε4 genetic status. Alzheimer’s disease, which accounted for 72% of the dementia cases (177 of 247), showed a similar pattern. High choline intake (≥517 mg/d) was not significantly associated with risk (HR ≈0.82, 95% CI ≈0.23–2.93), though the high-intake group was small (82 people, with only 9 dementia cases). These HRs and CIs were AI-calculated from the study’s reported beta coefficients and standard errors: HR = e^β, 95% CI = e^(β±1.96×SE) (Yuan, 2022).
• A 2015 systematic review of 13 studies found no improvement in cognitive function among healthy adults taking choline supplements (Leermakers, 2015). A Cochrane review of clinical trials of lecithin supplementation in people with memory loss, Alzheimer’s disease, or Parkinson’s dementia found no clear benefit (Higgins, 2004). As of August 2026, no follow-up appears to have been published.
• A systematic review of choline intake and Alzheimer’s disease was registered in 2023, though results do not yet appear to be published (Aguree, 2023).

Heart disease. Choline has been hypothesized both to decrease heart disease risk by lowering homocysteine and to increase risk by raising TMAO; no area of findings is strong:

• Higher choline intake has been linked to lower homocysteine, though it didn’t test whether this translated into reduced cardiovascular disease risk (Cho, 2006).
• Four larger studies found no relationship at all between choline intake and actual cardiovascular events: the Dutch arm of EPIC (Dalmeijer, 2008), the Atherosclerosis Risk in Communities study (>14,000 adults, 14 years) (Bidulescu, 2007), an analysis of over 100,000 Nurses’ Health Study and Health Professionals Follow-up Study participants looking at peripheral artery disease (Bertoia, 2014), and a 2017 meta-analysis of six prospective cohort studies (Meyer, 2017).
• A 2024 meta-analysis of 6 cohorts (~483,000 people) looking at mortality rather than disease incidence found that each 100 mg/day increment in choline intake was associated with a relative risk of 1.06 for all-cause mortality and 1.11 for cardiovascular mortality — but the pooled studies showed high heterogeneity for all-cause mortality (I²=84%) and moderate heterogeneity for cardiovascular mortality (I²=54%), tested multiple outcomes without discussing correction for multiple comparisons, and mostly didn’t separate choline from eggs and red meat, a major potential confounder the study’s own authors acknowledge as a limitation (Sharifi-Zahabi, 2024). One of the six cohorts, using phosphatidylcholine intake specifically, did test this directly (Zheng, 2016); after adjusting for egg, red meat, and fish intake, people in the highest intake quintile (a median of 235–261 mg/d across the two cohorts, versus 130–140 mg/d in the lowest) still had a relative risk of 1.07 (1.02–1.13) for all-cause mortality compared to those in the lowest. Phosphatidylcholine is only one of several dietary forms of choline (along with free choline, glycerophosphocholine, phosphocholine, and sphingomyelin); one study found it accounted for 44% of total choline intake in a Norwegian population (Van Parys, 2022), so participants’ total choline intake, which Zheng didn’t report, was likely substantially higher than these phosphatidylcholine figures alone suggest — potentially at or above the AI in the highest quintile, rather than clearly below it.
• Separately, gut bacteria convert choline to a compound called TMAO, which several cohort studies have linked to cardiovascular risk, including a MESA cohort study of 6,767 adults (32% higher risk in the highest vs. lowest TMAO quintile, though this became non-significant after adjusting for kidney function) (Budoff, 2025), the EPIC-Norfolk cohort (Tang, 2021), and a Cardiovascular Health Study/MESA analysis of heart failure (Tang, 2024), building on earlier work tying TMAO and egg-derived choline to cardiac events (Wang, 2011; Tang, 2013).
• Nearly all of this TMAO evidence comes from one Cleveland Clinic research group led by Stanley Hazen, who holds a U.S. patent on using TMAO as a cardiovascular risk predictor (USPTO, 2024). An independent group found no association between TMAO and 10-year survival at all (Bjørnestad, 2022), and the null finding for choline and CVD incidence in Meyer et al.’s 2017 meta-analysis further undercuts the TMAO hypothesis.

Choline and cancer. Choline doesn’t seem to have a strong causal role in cancer risk, protective or harmful:

• A study of 90,663 premenopausal women (Nurses’ Health Study II) found no evidence that higher choline intake reduced breast cancer risk (Cho and Holmes, 2007).
• A study of 39,246 women found that higher choline intake was associated with an increased risk of colorectal adenomas (Cho and Willett, 2007).
• A study of 47,302 men (Health Professionals Follow-up Study) found no significant association between choline intake and colorectal cancer (Lee, 2010).
• A case-control study of breast cancer found the highest quintile of choline intake was associated with modestly lower risk, though the finding was only borderline significant (Xu, 2008).
• A follow-up analysis of the same research group found higher choline and betaine intake was associated with lower all-cause and breast-cancer-specific mortality among women already diagnosed with breast cancer (Xu, 2009).
• A 2023 meta-analysis on breast cancer specifically found no association in prospective cohort studies, but a significant protective association in case-control studies, which are more prone to recall bias and reverse causation (Van Puyvelde, 2023).

Supplemental forms and TMAO. If supplementing with choline, phosphatidylcholine or CDP-choline (citicoline) may be preferable to free choline (such as choline bitartrate), which appears to raise TMAO in a way that choline from food, or other supplement forms, doesn’t:

• A 2021 randomized trial found that ~400 mg/day of free choline (bitartrate) significantly raised TMAO and platelet reactivity after 4 weeks, while 4 eggs/day or phosphatidylcholine capsules did not — suggesting free choline reaches the large intestine, where gut bacteria convert it to TMAO, more readily than choline bound in other forms (Wilcox, 2021).
• A small study found that 450 mg/day of choline bitartrate for two months raised TMAO more than 10-fold and significantly increased platelet aggregation in both vegans/vegetarians (n=8) and omnivores (n=10) — in the omnivore group, enough to partly blunt the antiplatelet effect of low-dose aspirin. Whether this translates to higher cardiovascular event risk in otherwise healthy people is unknown (Zhu, 2017).
• CDP-choline (citicoline) breaks down into cytidine (converted to uridine, thought to support synaptic function and neuronal membrane formation) and choline, and may resist breakdown in the intestinal lumen in a way that limits its conversion to TMAO — though this hasn’t been directly tested in humans (Świątkiewicz, 2023).

Betaine and folate. Common plant foods supply betaine and folate, which might reduce dietary choline needs; it hasn’t been quantified, so we can’t give specific recommendations:

• Some plant foods contain betaine and/or folate, compounds that can serve as a methyl donor in place of choline in some cases, reducing the need for dietary choline (Office of Dietary Supplements).
• Wheat-based products tend to be high in betaine, but spinach and beets contain significant amounts (Williams, 2004).
• Leafy green vegetables, beans, and oranges are high in folate (Office of Dietary Supplements).

Vegan plasma choline. The one study that has directly measured plasma choline levels in vegans — including some following a whole-food vegan diet without additional supplements — found levels within the normal range. However, plasma choline isn’t considered a reliable biomarker of choline status:

• MultiVeg trial. A 4-month randomized, double-blinded trial in Germany gave 72 healthy vegan adults (35 intervention, 37 control) a multinutrient capsule plus a soy lecithin powder providing ~320 mg/day of choline, or a matched placebo. They didn’t assess dietary choline intake because the German food composition database they used lacks choline data. Both groups’ plasma choline was within the normal reference range (728–1287 µg/L) at baseline and after 4 months; levels rose more in the intervention group (+224.5 vs. +126.6 µg/L), but the difference wasn’t statistically significant. The authors note plasma choline is a poorly validated biomarker of choline status, compliance with the study powder was only moderate (54–60%), and the study was funded by a vegan supplement company (Zerback, 2026).

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