Think of it this way. You really love peanut butter. Jelly’s really great too. But together? You’ve got an epic sandwich. And what about the genius who discovered that surrounding peanut butter with chocolate quite simply created the perfect pairing?
As it turns out, scientists may have discovered a similar situation with these two nutrients: choline and docosahexaenoic acid (DHA). Although this time it’s not a taste-bud bonanza we’re talking about. Instead, what research is now exploring is whether the human body can benefit by taking choline and DHA together. And the results are promising. In today’s blog, we’ll explore some of the science that suggests, especially when it comes to brain health, that choline and DHA may be the next must-have coupling of nutrients.
Choline and DHA—What They Are
If you’re a regular reader of this blog, for sure you have a pretty good idea of what DHA is. You may not be as familiar with choline, although we have blogged about it at least once or twice before. And, if you’ve been pregnant in recent years, it’s likely that both nutrients have been part of your doctor’s recommended prenatal supplementation regimen as both are key for fetal brain growth and development.
Let’s start with choline. Known as an essential nutrient, choline is an organic, water-soluble compound. Some consider it part of the B-complex vitamins, specifically the long-lost B4 (referenced as long-lost, along with its cousins B8, B10 and B11, because they are no longer categorized as vitamins as they don’t meet the technical definition—but we digress); as this article explains, technically choline is not a vitamin nor is it a mineral.
Although your body makes a little choline, in order to get enough of the nutrient, you need to turn to external sources, food and/or supplements. Found in a variety of food, some of the richest sources include beef and beef liver, egg yolks, chicken breast and fish. You can also get choline from potatoes, legumes, milk, yogurt and some vegetables, such as shiitake mushrooms, broccoli, cauliflower and Brussels sprouts).
There are also numerous brands of choline dietary supplements and more companies appear to be adding choline to multivitamins. If you’re having trouble finding a DHA & Choline supplement, expect more of this combination in the future as the science for this nutrient partnership builds. Especially if you’re pregnant, ask your doctor about a prenatal vitamin containing both nutrients.
DHA is a type of omega-3 fatty acid, more specifically it’s a PUFA, which stands for polyunsaturated fatty acid. This means it’s one of the “good fats.”
The best food sources to obtain DHA are fatty fish like salmon and sardines and other shellfish such as mussels or shrimp. You can get some DHA from other foods including eggs, olive oil and some red meats. For vegans or vegetarians, algae (particularly nori, spirulina and seaweed), or algal oil, present a source of DHA.
Adding DHA supplements to your health routine can help increase your body’s level of this nutrient and offer a host of benefits. There are supplements available with only omega-3 DHA; however, most often DHA is paired with another omega-3 PUFA, eicosapentaenoic acid (EPA).
DHA and EPA have been studied separately and together—and consuming each by itself offers benefits. Taken together expands those benefits with even more possibilities. For example, one study of around 20,000 adults in Norway found that those taking 300-600 mg each of DHA and EPA were 30% less likely to have depression symptoms compared to those who didn’t, according to this piece. That’s because DHA and EPA are anti-inflammatory agents acting on nerve cells and also support serotonin, known to help with mood.
DHA & Choline
The benefits of DHA are wide and deep. In fact, this article discusses a dozen science-supported health benefits of the fatty acid and also points out that DHA is a strong player on its own, especially when it comes to brain function benefits and eye health support. DHA is especially important for pregnant moms and while breastfeeding in order to help ensure proper brain and eye development for the baby. During pregnancy, DHA benefits not only the mom-to-be, but also the fetus as, maternal DHA intake helps prevent pre-term labor, increases birth weight and supports postpartum mood in new mothers. As for the fetus, DHA is necessary to support development of the baby’s brain, eyes and nervous system. During pregnancy, DHA is transferred through the placenta to the fetus’ brain.
As for choline, among the many reasons to get adequate choline is that your brain and nervous system count on the nutrient to help regulate memory, mood, muscle control and more. This is particularly important, and the recommended amounts increase, for pregnant and lactating women. Why? Because choline is important for fetal brain development and placental function.
Earlier this year, in this blog, we shared a few studies that reported that inadequate maternal choline intake may lead to congenital disabilities and impaired postnatal cognitive ability. Moreover, low choline intakes may also have significant implications for maternal health, such as the increased risk of acute fatty liver during pregnancy.
This article pointed out that both the American Medical Association and the American Academy of Pediatrics have both reaffirmed the importance of choline during pregnancy and lactation. The article further noted that new and emerging evidence suggests that maternal choline intake during pregnancy, and possibly lactation, has lasting beneficial neurocognitive effects on the offspring.
Investing the Effects of Choline and DHA Intake
All of this leads us to where we started this blog. Are choline and DHA better together? If so, it wouldn’t be surprising. Scientists often talk about the synergistic role of nutrients.
In fact, this article says about this topic that nutrient synergy refers to the concept that the interaction between various nutrients in the body is significant and can have a greater impact on overall health than the sum of their individual effects. Essentially, this means that the combination of two or more nutrients working together can have a more significant impact on the body than each nutrient working alone.
This literature review published in Nutrients in 2019 says that choline and DHA play a significant role in infant brain and eye development, with inadequate intakes resulting in deficits in visual and neurocognitive function. What’s particularly concerning about this is that the authors noted that adequate choline and DHA intakes aren’t being met by the majority of American adults, especially among women of child-bearing age.
The authors also suggest that emerging findings illustrate synergistic interactions between choline and DHA, warning that insufficient intakes of one or both could be problematic, with deleterious impacts on both the mother’s and infant’s health throughout life.
The evidence, says the study, which includes cell culture, animal model and human clinical trials, provide compelling support for choline and DHA in maternal and infant nutrition. They add that the interactions between choline and DHA support roles in brain and eye health, and the findings that supplementation with one augments the other points to synergy between the two nutrients.
Results from this animal study in dams (pregnant rats or mothers) showed benefit individually from choline or DHA but demonstrated the combined efficiency of supplementation with choline and DHA on hippocampal neurodevelopment. Said the study authors, the study also emphasizes the requirements of both choline and DHA for better enhancement of fetal brain development, rather than individual supplementation with any one of the nutrients.
Another animal study, this one in mice, showed that the combined intake of fish oil and choline played a significant role in improving the learning and memory ability of mice in certain situations. The authors believe that this study provides a theoretical basis for helping improve memory for middle-aged and elderly people.
As the research for the combination of choline and DHA on brain health continues to emerge, what’s also interesting is how scientists are explaining why using these two ingredients together may be more beneficial in combination than alone.
For instance, take this study from researchers at Cornell University that looked at the effect of prenatal choline supplementation, taken during the second and third trimesters of pregnancy, on biomarkers of DHA status among pregnant participants consuming supplemental DHA.
In the study, 30 pregnant women were randomly assigned to receive either 550 mg/d choline + 200 mg/d DHA (intervention) or 25 mg/d choline + 200 mg/d DHA (control). Blood samples were taken at baseline, gestational weeks 20-24, gestational weeks 28-31, and maternal/cord blood at delivery.
Despite similar DHA intakes, the researchers observed a nearly 75% relative increase in maternal DHA status in the intervention arm compared to the control arm. These results indicate a significant nutrient-nutrient interaction where prenatal choline supplementation significantly improves biomarkers of maternal DHA status among free-living participants consuming supplemental DHA.
This is not dissimilar to other studies with other nutrients (think vitamin D and calcium, as an example) where one nutrient helps absorption or bioavailability of the other. In the case of choline and DHA, the relationship appears to be a two-way street. Not only does choline support DHA utilization, but DHA supplementation increases cellular choline uptake.
Testing for DHA and Choline
Even as the benefits of DHA and choline on brain health and other areas continue to drop into the scientific literature, one thing we already know for sure is that most people are falling short in these nutrients.
Here in the U.S., the majority of adults fail to consume enough seafood, thereby not meeting the recommendations of the American Heart Association for two servings, preferably of fatty fish, of three ounces cooked per week. (Fatty fish are the best source of DHA.) Even by adding supplements, still more people than you’d think are not reaching optimal (or even sufficient) levels of DHA/EPA omega-3 fatty acids. Although, if you are not reaching recommended goals, consistent use of supplements should help.
The only real way to know if you’re getting enough DHA in your diet is through testing. Here at OmegaQuant we offer five simple and convenient at-home tests for omega-3s, including three that test the combination of DHA and EPA, and two specifically related to prenatal DHA and lactating moms. Your doctor’s office can also provide an order to test your omega-3s. (We also offer a test of your dog’s omega-3 status, but that’s for another blog.)
As for choline, the National Institutes of Health Office of Dietary Supplements advises that most people in the U.S. fall short of recommended amounts of choline in their diets. Even looking at choline intake from both food and dietary supplements, the government advised that most people are still below recommended amounts.
This fact sheet is a primer for how much choline is recommended based on life stage, beginning at birth with 125 mg/daily. It’s recommended that pregnant teens and pregnant women get 450 mg/daily, while those breastfeeding need 550 mg/daily.
Choline status is not typically part of a typical lab test in healthy populations, but your doctor can order a medical blood test if requested.
Bottom line: Expect to hear more in the coming years about the benefits for the combination of choline and DHA for brain health as research is ongoing in this area. In the meantime, both these nutrients can have positive impacts on your health in a number of areas, and insufficiencies can be harmful for your health.