Why I don’t recommend supplementing choline
I was reading Aaron Bergman’s Stuff I Buy and Use a few days ago and saw that he recommends supplementing choline. I’d heard about this previously but hadn’t looked into it yet, and the tl;dr for this post is that I don’t think it’s particularly well-supported by the evidence unless you’re pregnant or a very young child (<3 years old). I do want to give a shoutout to Elicit for building a very cool product that lets me quickly browse through literature for fields I don’t understand well. It’s not a mature tool, but I think it’ll be incredible in a couple of years.
There seems to be a fair bit of evidence suggesting that choline supplementation is helpful for young children. This was observed in rats at least as early as 1988. A 2021 meta-analysis suggests possible mechanisms for this.
In humans, a 2015 meta-analysis finds small to no effects of choline supplementation on a variety of health and performance factors. They find that it might improve cognition, but point out that high-quality interventional studies aren’t available. One RCT was published earlier the same year, showing that choline supplementation seemed to improve cognition in people who performed poorly on a test and worsen cognition in people who performed well. However, this RCT had a sample size of just 24 people and I suspect what they measured was regression to the mean.
On the other hand, choline does seem to correlate with depressive symptoms according to this meta-analysis. I’ve had issues with depression and don’t want more, so this would be enough to make me very cautious even though correlation doesn’t, as we all know, imply causation.
This is already sort of enough for me to not take a supplement. Evidence for benefits is sparse and the risks seem pretty significant, relatively speaking. But as a final check, I got on the Nootropics subreddit and searched for choline. And results seem… pretty underwhelming. Most people say they didn’t really feel anything, a couple of people said they did a little better on some of the supplements, and a couple people said they had significant depression. A skip for me. For what it’s worth, creatine seems to have much better evidence for improving cognition, and it improves physical recovery, and it has no side effects that I know of. I’m not sure why choline made Aaron’s list and creatine didn’t.