"I am a former student of Tina Williams and Warren Meck at Duke University and Steve Zeisel [University of North Carolina] was on my dissertation committee.  I ran across your website while looking for choline dosage recommendations during pregnancy.

When my wife was pregnant with our first child, I recommended lots of eggs and peanut butter. I also had my wife supplement with lecithin initially until we switched to choline bitartate. In the end she was getting 1.5 grams of choline a day, give or take. She kept this up (minus the peanut butter) through 1 year of breast feeding.

After 1 year, I did not supplement our son's diet with choline but a lot of our personal experience matches up with you describe: Full-term (he was induced against my better judgement); more alert; fast to become a good sleeper; low stress/anxiety response; fast to learn to walk (10 months); very good long-term memory (he can spontaneously remember things from 2 years ago at 4 years old).

We are now expecting our second child and the new research from Karen Stevens inspired me to see what was out there, and hence your blog.  Thanks for the good compilation of information. I think I will try for a much higher level of choline this time as well as more post-natal choline."

In this study he said his IRB would only allow the 750 mg dosing - so I guess he was hoping for it to be successful even at that lower level. Ultimately he didn't have a choice - since he couldn't proceed without his IRB's approval.

Unfortunately it was too low to see the beneficial impact on the brain.  Now that another study (see study identified in posting below) has come out with a dosing of over 5 grams per day I hope that his IRB allows a higher dosing level.

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Taking approximately 800 mg a day of choline during pregnancy does not improve babies' language and memory skills, according to a new study.

The results contrast with earlier studies in animals showing that a choline boost in utero improves rodents' performance on memory tasks. 

Earlier studies have found that pregnant women with very low levels of choline in their diet have a higher chance of delivering a baby with a birth defect. And adults who eat a choline-rich diet perform better on memory tests 

To see if adding extra choline during pregnancy can offer any benefits to babies, Zeisel and his colleagues asked 99 pregnant women to take six pills every day, beginning when they were 18 weeks pregnant and continuing until three months after the baby was born.

Fifty of the moms received fake pills containing corn oil, while 49 received pills with 833 milligrams (mg) of phosphatidylcholine, a form of choline.

The phosphatidylcholine pills added up to 750 mg of choline each day, the equivalent of 170 percent of the recommended level for pregnant women and 140 percent of the recommended daily amount for breastfeeding moms.

When the children were 10 and 12 months old, Zeisel's team gave them a battery of tests to measure short and long term memory, language skills and general development.

There were no differences between the two groups on any of the tests, the team reports in The American Journal of Clinical Nutrition.

Marie Caudill, a professor at Cornell University in Ithaca, New York, who was not involved in the current research, said the study was well conducted, but she offered a number of reasons that might explain the discrepancy between the animal studies and the current findings.

One possibility is that the babies were not tracked long enough to see any differences in their abilities.

"The animal studies demonstrated (that) supplementing the maternal diet with extra choline during pregnancy resulted in lasting beneficial effects on cognitive functioning in the adult offspring and prevented age-related cognitive decline," Caudill told Reuters Health by email.

Additionally, the type of choline used - phosphatidylcholine - might be less effective than choline itself. (Zeisel's group chose not to use choline because it can result in a fishy body odor.)

In addition, the tests may not be "sufficiently challenging," Caudill added.

Zeisel agreed that perhaps as children age and start to perform more complex mental processing, it might be easier to measure if a child has a deficit or a strength.

Notice also the dosing in this study below - 3.6 grams in the morning, and 2.7 grams in the evening. Now that this study has come out, I would take supplements at this level.

University of Colorado researchers study choline in infants

AURORA, Colo. (Jan. 15, 2013) -- Choline, an essential nutrient similar to the B vitamin and found in foods such as liver, muscle meats, fish, nuts and eggs, when given as a dietary supplement in the last two trimesters of pregnancy and in early infancy, is showing a lower rate of physiological schizophrenic risk factors in infants 33 days old. The study breaks new ground both in its potentially therapeutic findings and in its strategy to target markers of schizophrenia long before the illness itself actually appears. Choline is also being studied for potential benefits in liver disease, including chronic hepatitis and cirrhosis, depression, memory loss, Alzheimer's disease and dementia, and certain types of seizures.

Robert Freedman, MD, professor and chairman of the Department of Psychiatry, University of Colorado School of Medicine and one of the study's authors and Editor of The American Journal of Psychiatry, points out, "Genes associated with schizophrenia are common, so prevention has to be applied to the entire population, and it has to be safe. Basic research indicates that choline supplementation during pregnancy facilitates cognitive functioning in offspring. Our finding that it ameliorates some of the pathophysiology associated with risk for schizophrenia now requires longer-term follow-up to assess whether it decreases risk for the later development of illness as well."

Normally, the brain responds fully to an initial clicking sound but inhibits its response to a second click that follows immediately. In schizophrenia patients, deficient inhibition is common and is related to poor sensory filtering and familial transmission of schizophrenia risk. Since schizophrenia does not usually appear until adolescence, this trait--measurable in infancy--was chosen to represent the illness.

Half the healthy pregnant women in this study took 3,600 milligrams of phosphatidylcholine each morning and 2,700 milligrams each evening; the other half took placebo. After delivery, their infants received 100 milligrams of phosphatidylcholine per day or placebo. Eighty-six percent of infants exposed to pre- and postnatal choline supplementation, compared to 43% of unexposed infants, inhibited the response to repeated sounds, as measured with EEG sensors placed on the baby's head during sleep.

The study will be published online by The American Journal of Psychiatry (AJP) at AJP in Advance, its online-ahead-of-print website. The research was funded by the Institute for Children's Mental Disorders, the Anschutz Family Foundation, and the National Institute of Mental Health.

" There are rock-star nutrients in the pregnancy world that tend to receive all the attention. Folic acid, iron, and calcium are covered extensively in pregnancy magazines, and they're easily part of the mom-to-be vernacular. Choline--a water-soluble nutrient in the B vitamin family--on the other hand, remains largely unknown for many pregnant moms. But based on recent research, it deserves to be elevated to rock-star nutrient status.

One reason choline is difficult to study is that it's related to brain development, and linking low choline in pregnancy to a lower IQ or a higher rate of depression later in life is tough to measure. How do you measure IQ potential? How do you know if depression could have been avoided, had the child received more of a particular nutrient during early brain development?"

The problem is that they are still getting the story wrong in the details.  In this particular story the writer warns:

"As with anything in life, too much of a good thing is no longer a good thing--it is possible to get too much choline, mainly from overdoing it with supplements. Choline toxicity can lead to a fishy body odor, vomiting, and decreased blood pressure."

This woman has done a little research - but misses out important details and on the big point.  The tolerable upper intake level recommended for pregnant women from 10 years ago was 3.5 grams of choline per day  - and there are no identified side effects for that level for either Lecithin-based choline or choline bitartrate. New studies are using 6 grams per day so that level is obviously also safe.   The "fishy odor" is specific to choline chloride - which nobody in their right mind is going to take, because it tastes terrible (I tried it). 

Here is a good reference if you're concerned about the side effects or safety of higher levels of choline during pregnancy:

http://lpi.oregonstate.edu/infocenter/othernuts/choline/index.html#safety

Anyway - the full article is here, but its still far from conveying the real benefits of choline at the higher levels of 3.5 to 6 grams per day.

Pregnant? Get Your Choline!

http://health.usnews.com/health-news/blogs/eat-run/2012/08/31/pregnant-get-your-choline

"I'm about to start choline diet since we'd like to try for a second child but I'd like to ask you a few questions.

I've read pretty much all the articles on your website and came up with the below questions:

1.Is obtaining lecithin from SOY better than non-soy sources? If I supplement with sunflower lecithin for example, would I get the same result based on your research? There are some sunflower lecithin products on the market and I'd really like to try it over soy-lecithin if it works the same."

2.Does the choline intake of 3.5 gr for pregnant women and 1 gr for kids needs to be ON A DAILY basis or can we just take a few times a week?

3. I was reading your answer to one of the readers question and u were saying that Choline bitrate hasn't been studied much and thus doesnt show the same result from Lecithin or it is not same as other type of choline. But on the other hand, u also mentioned that u did take 50% of choline bitrate and 50% of lecithin during ur 2. pregnancy.I just dont understing why would follow this protocol if u think choline bitrate does not work same as Lecithin. I would appreciate if you clarify that part for me.

New research suggests that choline supplementation in pregnant women lowers cortisol in the baby by changing epigenetic expression of genes involved in cortisol production.

If you're sick from stress, a new research report appearing in the August 2012 issue of The FASEB Journal suggests that what your mother ate -- or didn't eat -- may be part of the cause. The report shows that choline intake that is higher than what is generally recommended during pregnancy may improve how a child responds to stress. These improvements are the result of epigenetic changes that ultimately lead to lower cortisol levels. Epigenetic changes affect how a gene functions, even if the gene itself is not changed. Lowering cortisol is important as high levels of cortisol are linked to a wide range of problems ranging from mental health to metabolic and cardiovascular disorders.

"We hope that our data will inform the development of choline intake recommendations for pregnant women that ensure optimal fetal development and reduce the risk of stress-related diseases throughout the life of the child," said Marie A. Caudill, Ph.D., a researcher involved in the work from the Division of Nutritional Sciences and Genomics at Cornell University in Ithaca, New York.

To make this discovery, Caudill and colleagues conducted a 12-week study involving pregnant women in their third trimester who consumed either the control diet providing 480 mg choline per day, a level that approximates current dietary recommendations, or the treatment diet which provided 930 mg choline per day. Maternal blood, cord blood and placenta tissue were collected to measure the blood levels of cortisol, the expression levels of genes that regulate cortisol, and the number of methyl groups attached to the DNA of the cortisol regulating genes (the epigenetic changes). Those from mothers who consumed the higher levels of choline showed reduced levels of cortisol.

"Depending on the relationship, one's mother can either produce stress or relieve it," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "This report shows that her effect on stress begins even before birth. The importance of choline cannot be overstated as we continue to unravel the role it plays in human health and development."

1.       Possibly a Higher Probability of Full Term Babies - our kids were both 41 weeks at birth (and so were virtually all our friends who also used choline) - and while there are many possible factors that might result in preterm birth - I suspect that good nutrition,  and low stress (or low stress /low cortisol) experienced by the fetus is going to result in a higher probability of being full term.  I've see research that if a mother-to-be takes folate / folic acid a year prior to conception - the rate of preterm birth is lower by 69% - and this suggests that Vitamin B like substances (like Choline) may have a roll in reducing risk of pre-term birth.  Since its now known that less than full term babies have a much higher rate of a large number of neurodevelopmental and other issues - I think that high choline kids might be benefiting from the choline in many different ways. 

2.    More alert and awake - this is especially noticeable during the first 3 months when many children have a tendency to be less alert.

3.    Fast to become full-night sleepers / Good Sleepers.  Our children started sleeping through the night (i.e. 6 to 8 hours sleep) at around 10 weeks or so.  I think that higher choline kids may (because the are less stressed) sleep better and sleep longer, earlier than regular kids who may be more sensitive and therefore wake up more frequently.

4.    Faster learning - of languages, etc. - At our first child's 2 year checkup the pediatrician said (unprompted by us) that she was amazed at the verbal and cognitive development, and as our child chatted in full sentences during the exam. She sees hundreds of kids, and has been a pediatrician in one of the best parts of our city for over 15 years, and said it was rare to see a child so advanced at that age.  Additionally, the 3 to 4 year old high choline kids I know speak two languages fluently, with vocabularies of several thousand words in each language. The children are also beginning to read at this age.

5.   Low Stress Response to Higher Stress Situations - In talking with other parents - I think that one common feature our children share is that some common higher-stress situations are not perceived as higher stress by our children.  The frequent vaccination shots when your child is very young are not so big a deal with high choline kids.  Our kids hardly cry at all, or perhaps at most for 5 or 10 seconds of light crying after a vaccination shot.  As you wait in the pediatrician's waiting room - you hear many kids screaming very loudly and persistently for a long time.  Our kids seem to view these experiences with much less concern.

6.   Faster Motor Skill Acquisition - most of our kids seem to start walking around age 9 months. (and by walking I mean able to walk across a 12 foot room without falling down).  Here is a video of our first child walking at about 9 and 1/2 months:  http://www.youtube.com/watch?v=7Hp6dheEgvo

7.       Very good long term memory (kids recall stories from when they were much younger unprompted, and in great detail).

8.       Naturally Low anxiety (our children never have really shown any stranger anxiety), and low fear (our children -- both boys and girls -- love handling snakes, bugs and crabs and other new things) but fear can be learned very quickly if exposed to a fearful situation. For example, one of the children's grandparents showed our daughter the Disney movie "Dumbo" and our daughter became afraid of the dark so we had to start leaving the hallway light on for about a 10 months.  I've discovered that older Disney movies have many terrifying scenes for young children  (think Dumbo's mother being taken away from her children, Bambi's mother's death, etc.) so we avoid them now.

9.       Choline-Induced reduction in sleep requirements  (for children between the ages of 4 months to about 2 years) - in a dose-dependent manner.  At age 4 months  our first child began eating egg yolks (from boiled eggs) crushed and mixed with yogurt - and we found pretty consistent results. One egg yolk generally resulted in a skipped nap (when two naps was typical) - and two egg yolks resulted in all the naps being skipped that day - and the child would be alert and full of energy until late in the evening (meanwhile all the other kids would be melting down and headed off to bed).