With Alzheimer’s disease boasting stats as the fifth leading cause of death over 65 years and 6.5 million in the US alone facing it, finding effective therapies is on everyone’s mind. Pharma has not hit any home runs, but besides the functional medicine root cause approach, a simple nutrient called choline shows promise for preventing this horrible disease. In a recent study, scientists at Arizona State University linked choline deficiency with neurologic changes in mice that resemble changes found in Alzheimer’s patients. At least for the mice who were bred to be genetically prone to Alzheimer’s, disease, choline deficiency intensified and sped up brain pathology.
Alzheimer’s disease, as previously noted, is stealing trillions of dollars for healthcare but also stealing years of life from individuals and families. The exact mechanisms are not fully understood, but correlate with a buildup of abnormal proteins in the bodies of nerve cells in the brain. There is debate whether these are cause or effects, but still they at least correlated with disease. Beyond the protein buildup, tangles of neurofibrils further disrupt cognitive function. Memory and learning suffer first. Ultimately most succumb to death over a number of years of decline.
Choline deficiency had been linked to other neurological and non-neurological conditions over the years. Considering the estimate that up to 90% of Americans are deficient in their daily intake of this nutrient, the health impacts could be staggering. Much of our choline intake comes from eggs, meat, and liver with smaller amounts coming from plant sources (such as soy lecithin), which have much lower choline contents. With the popularity of plant-based diet, the risk of deficiency has grown over the years. Currently, men are recommended to get 550mg per day and women 425mg/day. Some believe this level is already too low, yet again, maybe 90% of Americans do not get even this bare minimum level on a daily basis.
In the study, researchers controlled the amount of choline fed to two groups of mice. One group of mice were genetically average risk for a mouse form of Alzheimer’s disease. The other group was bred to be at high risk for the disease. The two groups were compared both for high and low daily servings of choline and between the two groups. For mouse fed deficient levels of choline, they found heart, liver, and brain changes upon examination. The genetically prone mice showed more severe changes in the brain than the others.
The choline deficiency resulted in increases in levels of amyloid-beta protein which causes plaques and changes in the tau proteins also believed to be part of the pathology. The deficiency also seemed to increase weight gain and alterations in glucose metabolism. Patients who have mild to moderate elevated glucoses, especially with diabetes have shown to be risk factors for Alzheimer’s in other studies. The mice with lower choline intake also performed more poorly on motor skills testing (Mouse Ninja obstacle course, anyone?).
Besides this study, other cited studies demonstrated that mice with a high choline diet showed various neurological improvements. They demonstrated better spatial memory versus even a normal choline diet during fetal development. The benefits even continued into following generations. The offspring of the high choline mice performed better on the tests also.
Various theories were offered for how choline demonstrated its benefits. Other studies indicate that adequate choline prevents elevations of an amino acid called homocysteine that is known to be neurotoxic. Choline is also important for the production of acetylcholine, a neurotransmitter central to learning and memory. The higher choline intake also altered important networks of brain cells in the mice hippocampi. The hippocampus part of the brain plays a critical role in memory. Lower choline intake appeared to disrupt microtubule function as well as postsynaptic membrane regulation.
As we care for patients with a multitude of root causes, we must always consider what is not only coming from outside like toxins and infections, but what is missing on the inside. While our bodies can produce a limited amount of choline on its own, this is not enough especially if B vitamins like B12, folate, and B2 are lacking. The missing nutrients may hinder or completely prevent full recovery after detox therapies or infection protocols. As society presses more and more into a plant-based nutrition emphasis, we either need to push back for adequate choline in animal products or supplement with nutraceuticals. Helping our patients achieve healthier more abundant lives requires keeping the big picture in mind in all dimensions of health.
Nikhil Dave, Jessica M. Judd, Annika Decker, Wendy Winslow, Patrick Sarette, Oscar Villarreal Espinosa, Savannah Tallino, Samantha K. Bartholomew, Alina Bilal, Jessica Sandler, Ian McDonough, Joanna K. Winstone, Erik A. Blackwood, Christopher Glembotski, Timothy Karr, Ramon Velazquez. Dietary choline intake is necessary to prevent systems‐wide organ pathology and reduce Alzheimer’s disease hallmarks. Aging Cell, 2023; DOI: 10.1111/acel.13775
Thanks to Science Daily:
Arizona State University. “Study explores effects of dietary choline deficiency on neurologic and system-wide health: Reaching adequate dietary choline intake is critical to offset organ pathologies and may help protect the brain against Alzheimer’s disease.” ScienceDaily. ScienceDaily, 17 January 2023. <www.sciencedaily.com/releases/2023/01/230117193006.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.