Here is an email I received about a month ago - and my response:

While I was looking through some of your posts in your website I was hoping to ask you a few questions about your personal experience with choline supplementation.  Firstly, why did you decide to go almost exclusively with a salt such as choline bitartrate for your first child vs phosphatidylcholine or choline from lecithin.  It looks as though you decided at some point to change this with your second child and go about half with a salt and half with a phospholipid.  I was perhaps wondering if you still feel one vs the other is better in terms of potential benefits during pregnancy and specifically for the child.  I understand the different bioavailability of the two, but was hoping for your thoughts on other specific mechanisms, (side effects on pregnant female, potency, cost, bioavailability, etc).  Also, you must forgive me it has been a while since I took my college biology courses and biochemistry, but were you concerned with a possibility of over-methylation during gestation?  I most definitely feel there is a huge advantage to choline, folic acid, and other methyl donors but always want to be vigilant in determining risk vs benefit of a particular amount of supplement.  Accordingly did you supplement with 3500 mg of choline bitartrate, yielding approximately, 1400 mg of choline, or was the total amount of choline 3500 mg? 

And also I am assuming this amount is based on a daily regimen of 3 times a normal daily intake of approximately 400-500 mg.  Also if you don't mind my asking what type and/or brand of prenatal vitamin did your wife use pre, peri and post gestation?  And lastly, given the same circumstances would you do anything different specifically (and non-specifically) with the choline supplementation for your children?

My email reply:

Regarding this "why did you decide to go almost exclusively with a salt such as choline bitartrate for your first child vs phosphatidylcholine or choline from lecithin.  It looks as though you decided at some point to change this with your second child and go about half with a salt and half with a phospholipid.  I was perhaps wondering if you still feel one vs the other is better in terms of potential benefits during pregnancy and specifically for the child"

There is some research on high levels of lecithin being bad for child development - you can find it in http://pubmed.org - it was done back in the 80s - and at high levels - like 15 grams/day.  That scared me off the high Lecithin diet - but then with the second pregnancy I decided to try a balanced approach - 50% each.   There is no real research data to validate either strategy.  Our first child seems to be developing at a faster rate than the second - but that could be due to other factors like a close pregnancy (18 months between births) or stress of having the second child while taking care of the first, and/or my wife getting the flu at the end of the first trimester on the second child.  So - its hard to say. We experienced no problems of any kind during the pregnancy or after with the 3.5 Grams/day. Both children started walking at 9 months, both children are advanced for their age - but the first child is much, much more advanced for his age.

In all my calculations I'm calculating the actual amount of choline in the supplement (e.g. in this tablet we used

http://www.iherb.com/Nature-s-Way-Choline-500-mg-Bitartrate-100-Tablets/1877?at=0

I calculated 500mg for each tablet - so we might take 7 of these, and this Lecithin (triple strength) at

http://www.iherb.com/Now-Foods-Lecithin-1200-mg-200-Softgels/658?at=0

at 1.14 grams per three capsules - so around 9 or 10 capsules to reach 3.5 grams.

During age 6 months to 3 years - I've tried to average about 300 to 400 mg for the children - primiarly via egg yolks (egg yolk omletes, egg yolks mixed with yogurt when they are age 6 months to 1 year), and then egg yolk French toast, etc. mixed with Lecithin ). 

admin (at) cholinebaby.com

I received this email a few weeks ago:

Hi,

I'm a little confused by when the choline is required. I know entirely throughout pregnancy would be optimal, however I have also come across some information that says only in the third trimester. What is your experience/knowledge with this? I am currently 24 weeks pregnant and have been able to have eggs on and off.

Thanks,
Lisa

My Response was:

Hi Lisa,

The most important time for prenatal choline supplementation seems to be the last 20 weeks of pregnancy - and this is when it seems to have the largest impact on intelligence.  But its also important to have it for the year following - during breast feeding. 

"Nuances in choline action are showing up. By narrowing the window of prenatal supplementation, Williams and others have identified only two small periods during which extra choline boosts a rat's intelligence. The first is from days 12 to 17 in gestation. This correlates roughly with the second half of a human pregnancy. The other window runs from 2 to 4 weeks after birth - a period that corresponds loosely with human infancy and toddlerhood."  source: Science News Online, Week of Nov. 3, 2001; Vol. 160, No. 18

We supplemented with 1 grams of choline per day during the first half of the pregnancy (and on average 2 to 4 egg yolks per day), and then around 3 grams (it's a lot of choline) during the last 20 weeks.  We supplemented with both Choline Bitartrate and triple strength lecithin. In one child we used more Lecithin (perhaps 75% lecithin, and the other child we split it 50%/50% Soy Lecithin-based choline, and Choline Bitartrate.

Hope that helps,

admin (at) cholinebaby.com

A group of Canadian nutrition researchers are seeking to raise people's awareness of their needs for the essential nutrient Choline - especially in women who are planning a pregnancy, who are pregnant, or breastfeeding (though research also suggests that high choline levels during the first 3 years of life may have significant benefits on the brain health of a child - see earlier posts on this topic). 

"Despite its apparent health benefits, few Albertans seem to be getting enough choline in their diets, the researchers have found.

"Our preliminary dietary studies clearly show an insufficient choline intake compared to the recommended levels," said Curtis, an analytical chemist and project leader for ongoing choline research at the university.

According to the Institute of Medicine, women should consume 425 milligrams of choline per day--the equivalent of almost four whole eggs. This value is higher for men and pregnant women.

In an ongoing study looking at the nutrition of pregnant women in Edmonton and Calgary, few study participants are meeting the adequate intake for choline and only one of the first 600 women surveyed reported taking a supplement that contained the nutrient.

This statistic is surprising, says Field, given that 97 per cent of women reported consuming at least one supplement.

"Nobody's taking it," Field said. "If there was information out there on choline, we'd see a lot more of it in this group we had."

In a continuing animal study, Field and her team are looking at the effects of choline during lactation--a nutiritionally critical period, but one not well studied.

"It's the most nutritionally stressful period for a woman," Field said. "Her nutritional needs are far greater than during pregnancy because she has to produce milk, an important source of choline, for this growing infant."

New mother rats were fed diets with varying amounts of choline. The amount they consumed appeared to influence the health of their pups.

"The pups that were fed from the moms who didn't have the choline in the diet survived didn't grow as well," Field said. "If there's a decrease in growth, or not a normal rate of growth, that has large implications for later health."

You can read the full press release from the University of Alberta research group here:

U of A researchers strive to increase awareness about Choline during Pregnancy (August 8, 2011)

Here are the results of a new study that relates to prenatal choline (choline taken during pregnancy) and increased health of the baby long term.

Research links diet during pregnancy to breast cancer risk reduction in female offspring

Era of Hope conference to feature compelling research examining benefits to daughters based on mother's diet

ORLANDO, Fla. -- August 3, 2011 -- During pregnancy, women are counseled to refrain from consuming certain types of foods, beverages and medications in order to avoid jeopardizing the health and development of the fetus. In fact, the American Pregnancy Association has a list of a dozen items they recommend expectant mothers omit from their diets. However, there are some additions, such as folic acid, that, when taken before and/or during pregnancy, can actually reduce the risk of birth defects and other disorders.¹ Research presented today at the Era of Hope conference, a scientific meeting hosted by the Department of Defense Breast Cancer Research Program (BCRP), reveals findings suggesting that if an expectant mother increases her consumption of foods high in certain fatty acids or nutrients during her pregnancy, she can potentially reduce the risk of breast cancer in her female offspring.

The research delves into breast cancer risk reductions attributed to the fetus when the mother, while pregnant, increases omega 3 fatty acids within her diet or consumes dietary methyl nutrients (methionine, choline, folate and vitamin B12). Some findings hypothesize that these diet augmentations may even prevent breast cancer from ever developing in the offspring.

"This is exciting and intriguing research," said Captain Melissa Kaime, M.D., Director of the Congressionally Directed Medical Research Programs (CDMRP), under which the BCRP is managed. "To be able to reduce the risk and possibly prevent this devastating disease before birth is an incredible notion; the BCRP is proud to support research with such potential."

Maternal Consumption of Omega 3 Fatty Acids to Reduce Breast Cancer Risk in Offspring
Principal Investigator: Philippe T. Georgel, PhD, Marshall University

Maternal dietary alterations, including increasing the consumption of omega 3 fatty acids, may reduce the risk of breast cancer to the fetus by causing epigenetic changes in utero and later through nursing. These changes may alter gene expression permanently, a change referred to as imprinting. Researchers at Marshall University conducted a study to investigate whether having a diet rich in omega 3s while pregnant would result in changes to fetal mammary gland gene expression, thereby reducing the chance that female offspring would later develop breast cancer.

In this study, there was a reduced incidence of mammary gland cancer observed for the offspring of mice that, while pregnant and nursing, consumed a diet containing canola oil, rich in omega 3, compared with the offspring of mice that, while pregnant and nursing, consumed a diet containing corn oil rich in omega 6 fatty acids. Reviewing the gene expression profiles of both groups showed that many genes related to cancer development differed between the two groups. Significant differences in the patterns of two important epigenetic markers were also observed.

"Pregnant women should be mindful of what they consume since their diet may incite epigenetic changes that could impact the development of their offspring, not just in utero but also for time to come," said Dr. Philippe Georgel, Marshall University. "Additional research continues, as we seek to elucidate the effect of diet on breast cancer-specific gene expression."

In Utero Exposure to Dietary Methyl Nutrients and Breast Cancer Risk in Offspring
Principal Investigator: Chung S. Park PhD, North Dakota State University

Links are being drawn to complete mammary gland development of the mother during pregnancy and reduction in breast cancer risk in her daughters. Supplementing the mother's diet with lipotropic nutrients (methionine, choline, folate and vitamin B12) is thought to increase methyl metabolism which stimulates the full development of the mammary gland, thereby inducing an epigenetic imprint in the mammary gland of the fetus and decreasing its breast cancer risk. Investigators at North Dakota State University are researching this link with the overall objective of determining the extent to which supplementing diets with methyl nutrients during pregnancy reduces the offspring's overall breast cancer susceptibility.

The study looked at 45 pregnant rats and randomized them into two groups: one to receive a control and the other to be fed a methyl-supplemented diet. Once the pups were born, they were separated into three additional groups depending on the feeding regime of their mother. When the female pups reached a specific age, they were exposed to a chemical that induced breast cancer and researchers charted when the first tumor appeared and measured all tumor sizes and volumes. Results demonstrated that the offspring from the methyl-supplemented diet group showed a decrease in tumor incidence and growth when compared to the control group. Also, they had fewer tumors and fewer tumors that multiplied.

"The conclusions of this study suggest that we may be able to prevent the development of breast cancer in daughters of women at risk for breast cancer by supplementing the mother's diet during pregnancy," said Dr. Chung Park, North Dakota State University. "We look forward to exploring this study further to strengthen the implications of these initial findings."

###

About the Era of Hope

The Era of Hope (EOH) conference joins scientists, clinicians and breast cancer advocates committed to advancing research on the prevention, detection, diagnosis and treatment of breast cancer. From August 2-5, 2011 in Orlando, Florida, the EOH will feature prominent scientists and clinicians with presentations of recent remarkable advances in breast cancer research funded by the Department of Defense Breast Cancer Research Program (BCRP). This research challenges paradigms and pushes boundaries to identify innovative, high-impact approaches for future breast cancer research and discoveries.

Our "high choline" children (3.5 grams of Choline per day during the last 20 weeks of pregnancy, and about 300mg per day of choline thereafter) seem to be developing well. Of course, with all the typical challenges -- of a 2 year old with their constant testing of the boundaries of good behavior, and a 13 month old who is constantly on the run exploring the world. 

Our first child is now 2 years and 8 months old - and began preschool about a month and a half ago (for only two days a week) - at a Chinese language immersion school.  We're one of the few parents where the child is entirely Caucasian (with no Chinese language ability in my wife and I) - but the teachers have been quite amazed at our child's Chinese language proficiency.  They said that she is far better than most children, and probably the most proficient Chinese speaker in her class - with only one other Chinese child close. 

Of course - I suspect this might sound better than it actually is - because if you're truly a Chinese family that speaks Chinese at home - you're probably not going to be sending your kid to a Chinese immersion preschool - because the kids will already know Chinese - and they'd be sending them to an English immersion school so that they learn English.  At the same time - it might be more surprising than that because our older child is also the best English speaker (vocabulary, pronunciation, understanding) among her peers, among exclusively English speaking kids.  Normally children who are learning two languages are delayed in both languages and only catch up much later in school, I've read - so it seems like it might be unusual that a child is ahead of all the other kids both in their native language (English in our case) and the second language also.  While I have no proof - I suspect that this might be the choline effect.

Our younger child seems to be progressing well too and is now 13 months old.  She started walking early and has continued to become a very strong walker - and when my wife's brother was in town the other week he noted that she was a stronger and more adept walker than his daughter who is 4 or 5 months older.  She is also quite a climber - she climbed up on our kitchen chair - and was going to then climb up on the kitchen table - before I stopped her.  Not a lot of fear with this kid either - as with the first child. Although, generally, the second child is a little more tentative around new things than the first child - who isn't frightened by much.

Language skills with our second child seems to be developing slightly more slowly than in our first child.  She has the typical "Momma, Dada", and Nana (her grandmother's preferred name from the children) and "Baba" (Chinese for father).  And she also has developed perhaps half a dozen quasi-words that she uses on a regular basis.  By "Quasi-words" what I mean are incompletely formed words - for the word "Duck" she just says "Du" (appearing not to be able to form the ending of the word).  "Fish" is "ish",   Book is "Boo.." but no "k" sound.  She knows the words - but doesn't seem to have the ability to say all the sounds. 

Our Chinese nanny continues to practice complete immersion with our second child, as we did with the first child - but given that the amount of time you have available when you have two child is significantly less than when you have only one.  This could be a factor in our second child learning language less quickly - an I have read that the second child generally is a few points (on average) lower IQ because of just this factor - you as parents or caretakers you just have a lot less time to dedicate to the second child compared to the first.

As a general note on the ongoing Choline intake of our children - I still feed our older child about 4 egg yolks (somes fortified with Lecithin at the level of 1 gram or so) in the form of an "egg yolk french toast" special that I mix up and give to her every few days.  Given that each egg has about 125 mg of Choline (I've read) - that means that our older child is probably averaging about 250mg to 400mg of choline a day.

We've also started giving one or two egg yolks a day to our younger child - in the form of egg yolk mixed up with organic plain yogurt - or about 175mg or so average per day. 

One thing I've noticed is that the Choline sleeplessness effect seems to be much less for our second child.  When we gave eggs with yogurt to our first child - it seemed to turbo charge him in a dose dependent way. If we gave him one egg yolk - he'd miss one nap, two egg yolks and he'd not need sleep all day, and with three egg yolks, he would stay up active and alert until 10pm at night.  It was a very dramatic difference.  It was actually kind of nice - because when we knew that we were going out to an event during the day and we wouldn't be able to accommodate the afternoon nap - we'd give our son some extra choline in the morning (an extra egg or two) and the day's activities would be uninterrupted and our son would enjoy the entire day without getting tired.