Are Choline and Inositol Helpful for Fatty Liver Disease?


What are choline and inositol? Choline and inositol are naturally occurring compounds that have been receiving attention for their role in certain conditions like fatty liver disease. There has been an increasing level of concern about potentially widespread choline deficiencies. Here we answer your questions about choline and inositol, their roles in the body, and their impact on fatty liver disease.

What Is Choline?

Choline is a compound that can be produced in the body but must also be obtained from dietary sources. As a result, choline is described as an essential nutrient. Choline plays an important role in supporting brain health, brain development, nervous system development, and fortifying the membrane of every cell throughout the body.

Choline is used to make phosphatidylcholine, a phospholipid that makes up the critical structural component of cell membranes. Choline is also required to make neurotransmitters like acetylcholine, which is vital to transmitting important messages through the nervous system. Acetylcholine regulates the signals that are sent between the brain and muscle cells, helping to control movement.

Choline may have significant implications for treating panic attacks and anxiety disorders. A study conducted by researchers at the Haukeland University Hospital in Norway and published in the American Journal of Clinical Nutrition examined 5,918 subjects for choline intake and symptoms of anxiety and depression. (1) Results found that the lowest levels of choline intake were significantly correlated with anxiety. (1)

Choline is also vital for energy production and regulates metabolic functions in the liver and throughout the body since it supplies many of the required methyl groups needed for these processes to take place.

The daily average requirement for choline intake each day, as established by the National Institutes of Health Office of Dietary Supplements with the U.S. Department of Health and Human Services, ranges from about 450 milligrams for women to 550 milligrams for men. (2)

Requirements may vary depending on a person’s intake of other nutrients, individual biochemistry, as well as other factors like age, pregnancy, and the presence of health conditions.

Choline is naturally found in many food sources, including salmon, chicken breast, eggs, beans, broccoli, and peas.

Choline And Inositol for Fatty Liver Disease

Choline for Fatty Liver Disease?

Recently, a lot of hype has surrounded choline for its possible role in preventing fatty liver disease. Because of the role that choline plays in fat metabolism, connections have also been drawn between choline and weight loss.

Research shows that deficiency in choline leads to abnormalities in fat metabolism in the liver, which may contribute to patterns of lipid accumulation that are characteristic of fatty liver disease. Research has also determined that choline deficiency causes inefficient functioning of cellular mitochondria, the components of cells that are responsible for producing energy. Moreover, choline deficiency results in stress in the endoplasmic reticulum (ER), the component of the cell that is responsible for processing proteins. Abnormalities in mitochondrial function and ER contribute to inflammation that fuels nonalcoholic fatty liver disease. (3)

However, the argument for choline supplementation to reverse fatty liver disease is not so clear cut. Researchers in Australia concluded that choline requirements are highly dependent on an individual’s genetic makeup, hormone production, gut microbiome, and nutrient intake. (4) The researchers further explained that too much choline could contribute to heart disease. (4)

What Is Inositol?

Choline and inositol are often combined in supplement form. Inositol, also called Myo-inositol, is a carbohydrate compound that is produced naturally in the body and is also found in many plant foods like fruit and nuts. Inositol is important for many biological processes, including neurotransmitter synthesis and metabolic functions. Inositol was historically considered to be part of the B-vitamin family and was referred to as vitamin B8. However, unlike choline, inositol is not regarded as an essential nutrient that must be obtained from dietary sources. The human body is able to synthesize plenty of inositol on its own.

Inositol for Fatty Liver Disease?

Research shows that inositol and choline may play a role in decreasing fat accumulation in the liver. A study conducted by researchers at Eastern Washington University examined the impact of inositol and choline administration on the liver fat content of 19 animal models. (5) Results showed that rats who had received the choline inositol supplementation had significantly less liver fat than the control group. (5)

However, because inositol is produced through natural biological functions and is also abundantly found in food sources, supplementation is likely not necessary.

Promoting Healthy Inositol and Choline Levels in the Body

Aside from eating foods high in inositol and choline, there are numerous ways in which you can support healthy choline and inositol levels in the body without having to add dietary supplements that risk raising inositol and choline levels above the healthy range.

1. Eat Foods with Betaine

Choline is used to produce betaine, a compound that protects cells from external stressors such as high temperature or high salinity. (6)

By getting betaine through your diet, it reduces your body’s demand for choline to convert to betaine. Food sources of betaine include wheat germ, beets, spinach, and wheat bran. (6)

2. Get Enough Folate and Methionine

Folate is a B vitamin that like choline, is able to donate methyl groups to be used in important metabolic processes. Having adequate folate intake decreases the metabolic demand of choline since both compounds can share the duty of supplying methyl groups for metabolic processes. Folate can be found in a wide variety of foods, including spinach, asparagus, brussels sprouts, black-eyed peas, avocado, kidney beans, wheat germ, peanuts, papaya, and banana. Bread and breakfast cereals are often fortified with folate.

Methionine is an essential amino acid that is critical to the endogenous production of choline. Getting optimal ratios of essential amino acids in your diet, including methionine, are important for making sure your body produces enough choline. Methionine can be found in sesame seeds, brazil nuts, and meat. (7)

3. Lecithin

Both inositol and choline can be derived from lecithin, which can be found in many food products. For example, lecithin can be found in fish, cooked broccoli, soybeans, and black beans.

Should You Be Supplementing with Choline and Inositol?

Choline inositol is commonly combined in supplement form. Do you need to be taking this supplement? Most likely not, unless determined by your health care provider. A varied diet will likely meet your daily value of choline. Unless you have a strong genetic tendency that interferes with endogenous choline production and the normal utilization of choline in the body, you likely don’t need to supplement with choline and inositol.

If you do decide to supplement with choline and inositol with advice from your health care provider, make sure to seek out high-quality supplements. It’s important to keep in mind that dietary supplements are not assessed by the Food and Drug Administration for their ability to treat and manage health conditions. Always read supplement facts and do your research on specific brands. In dietary supplements, choline is often available in the form of choline bitartrate or CDP-choline. Many choline supplements are packaged in vegetarian capsules, with magnesium stearate as an additive. However, research shows that in small dietary amounts, magnesium stearate doesn’t pose health risks. (8)

B-complex vitamins contain essential vitamins like niacin, B12, and folate that help stabilize choline levels. Some B-complex vitamins even contain added choline. L-Alpha glycerylphosphorylcholine (Alpha GPC) is another supplement form that provides a form of choline that has been shown to have nootropic effects.

Meat vs Plant-Based Sources of Choline

In recent years, some have questioned the suitability of a plant-based diet based on choline intake, since animal products are more concentrated sources of choline than plant products.

However, there are many sources of plant-based choline that on the whole are healthier than meat sources, simply because they are also bundled with health-promoting compounds like fiber, vitamins, minerals, and antioxidants.

It’s also important to point out that individuals following a plant-based diet likely get much less dietary choline than omnivores and people who eat a diet high in meat. But in the research, science shows us repeatedly that following a healthy plant-based diet is curative and preventative for conditions like type 2 diabetes, insulin resistance, high blood pressure, and fatty liver disease. If choline deficiency was a significant cause of fatty liver disease, then everyone following a vegan diet or plant-based Mediterranean diet would have fatty liver disease.

Choline for Fatty Liver Disease: The Verdict

More research is needed to clarify the role of choline in fatty liver disease. The choline-fatty liver connection is likely influenced by numerous confounding factors. There simply is not enough research and information to suggest that most cases of fatty liver disease are fueled by choline deficiency. The endogenous production of choline and the consumption of adequate levels of folate, methionine, and betaine seem to be protective factors against choline deficiency. Plus, the standard American diet is rich in eggs, chicken, and steak, suggesting that the majority of the population is not at risk for a choline deficiency that’s serious enough to result in fatty liver disease.

Although choline deficiency is a very rare medical condition, a severe choline deficiency does cause fatty liver disease. If you suspect you may have a choline deficiency, consult your physician and a registered dietitian to discuss testing options and evaluate whether your choline intake matches your needs. A doctor and dietitian can help determine whether you should add a choline supplement to your diet.


The spotlight has recently been put on choline as a potential mediator in the development of fatty liver disease. However, not enough evidence exists to suggest that choline deficiency is a widespread issue. Choline, though considered an essential nutrient, is produced endogenously. Its production is also influenced by nutrients found in a variety of foods. Inositol is also unlikely to play a determining role in the development of fatty liver disease. Leading an active lifestyle and eating a balanced diet based on plant foods and rich in healthy fats, essential amino acids, and antioxidants are more influential factors in nonalcoholic fatty liver disease.










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