Soybeans and Cabbage: How to Get Choline In Your Vegan Diet

While a whole food plant diet is the recommendation at the Kahn Center, the science of certain nutrients like creatine and choline is discussed with patients as well as strategies to eat or supplement some nutrients that may be important for optimal health.

Choline, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality is limited and inconclusive.

A new study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S.  This study joins other studies emphasizing the possible protective role of choline for CVD. 

STUDY METHODS

The study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. 

STUDY RESULTS

In the study of 14,289 participants (mean age 48 years, 48% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively. That is to say, those with the highest choline intake had a 30-35% lower risk for CVD.

Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. Moderate choline intake (Q3) was associated with a reduced risk of mortality of about 25%.

The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk.

STUDY CONCLUSIONS

Elevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. 

Some of the best sources of choline from plant-based sources included

• red potatoes
• shiitake mushrooms
• nuts and seeds like almonds, flaxseeds, and raw pumpkin seeds
• whole grains and pseudo-grains like wheat germ and quinoa
• cruciferous vegetables like brussels sprouts, broccoli, cabbage, and cauliflower
• legumes like soybeans (edamame), lima beans, kidney beans, chickpeas, and lentils

There are many choline supplements as capsules and powders but a cautionary note. Choline found in egg yolks may raise blood levels of TMAO and this can be seen with supplements also. TMAO may promote blood clotting and atherosclerosis. At the Kahn Center, all patients get tested for their blood levels of TMAO. If the levels are elevated, the choline supplement is reduced or stopped, as is the intake of red meat and egg yolks.