Plant-based diet risks worsening brain health nutrient deficiency, warns nutritionist

Accelerating consumer trends towards plant-based and vegan diets risks lowering people’s intake of choline, according to a nutritionist.

Choline is a critical nutrient needed for neurocognition, lipid metabolism, liver function and homocysteine regulation and important for memory, mood and muscle control. The primary sources of dietary choline are found in beef, eggs, dairy products, fish, and chicken, with much lower levels found in nuts, beans, and cruciferous vegetables, such as broccoli.

It is likened to omega-3 fatty acids in that it is an ‘essential’ nutrient that cannot be produced by the body in amounts needed for human requirements. Choline deficiency is linked to liver disease, offspring cognitive function and potential neurological disorders.

In the UK, choline is not yet included in food composition databases, main nutrition surveys or official recommendations. In 1998, the US Institute of Medicine recommended minimum daily intakes. These range from 425 mg/day for women to 550 mg/day for men, and 450 mg/day and 550 mg/day for pregnant and breastfeeding women, respectively, because of the critical role the nutrient has in foetal development. In 2016, the European Food Safety Authority published similar daily requirements.

Most people are not meeting choline recommendations

However, most European, American, Canadian and Australian populations are not meeting choline AI recommendations, said Emma Derbyshire, Director and Lead Consultant at Nutritional Insight, a consultancy specialising in nutrition and biomedical science.

More needs to be done to educate health care professionals and consumers about the importance of a choline-rich diet and how to achieve this, she argued in the journal BMJ Nutrition, Prevention & Health. She warned that further movements away from the consumption of choline-rich foods could have unintended consequences for choline intake/status.

“The mounting evidence of choline’s importance makes it essential that it does not continue to be overlooked in the UK. This is now more important than ever given that accelerated food trends towards plant-based diets/veganism could have further ramifications on choline intake/status. Government bodies and organisations should look to extended datasets to include this essential nutrient.”

Choline should feature in UK dietary guidance

She commended the first report (EAT-Lancet) on compiling a healthy food plan based on promoting environmental sustainability, but suggested that the restricted intakes of whole milk, eggs and animal protein it recommends could affect choline intake.

She was at a loss to understand why choline does not feature in UK dietary guidance or national population monitoring data. “Given the important physiological roles of choline and authorisation of certain health claims, it is questionable why choline has been overlooked for so long in the UK. Choline is presently excluded from UK food composition databases, major dietary surveys, and dietary guidelines.”

It may be time for the UK government’s independent Scientific Advisory Committee on Nutrition to reverse this, she suggested, particularly given the mounting evidence on the importance of choline to human health and growing concerns about the sustainability of the planet’s food production.

“More needs to be done to educate healthcare professionals and consumers about the importance of a choline-rich diet, and how to achieve this. If choline is not obtained in the levels needed from dietary sources per se then supplementation strategies will be required, especially in relation to key stages of the life cycle, such as pregnancy, when choline intakes are critical to infant development.”

The EFSA advice on AI recommendations for choline:

400 mg for adults and adolescents aged 15-17 years.
140 to 340 mg for children aged 1-14 years.
160 mg for infants aged 7-11 months.
480 mg for pregnant women and 520 mg for lactating women.

Achieving the AI for choline is extremely difficult without the consumption of eggs or taking a dietary supplement, according to US National Health and Nutrition Examination Survey data. This revealed egg consumers had almost twice the usual choline intake compared with non-consumers.

The survey also showed that protein, meat and seafood consumption were associated with increased choline intakes compared with non-consumers.

Another Canadian study has suggested that the main dietary sources of choline are eggs, dairy products and meat. Women consuming at least one egg daily were eight times more likely to meet choline intake recommendations compared with pregnant non-consumers, it said.

Another study at Cornell University suggested that when expectant mothers consume sufficient amounts of the nutrient choline during pregnancy, their offspring gain enduring cognitive benefits.