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You have a small window of opportunity to switch a critical neurotransmitter (GABA) for long-term mental health cutting-edge molecular psychiatry research is showing³

Your baby's intelligence, mood and future mental health are all forged in the womb!

By Dr Rodney Lopez MBBS (Sydney University) GradCertNutriMed (RMIT)

What is Choline?

Choline is a vitamin-like essential nutrient and acts as a methyl donor, a process important to epigenetic expression.

Choline is just as important as any other vitamin or mineral you can name but very few would mention choline as a critical micronutrient for health or indeed for the optimal development of a baby's brain during pregnancy. 

Choline should be mentioned in the same breath as folate for your baby's health in the preconception and antenatal period.

Choline - Emerging molecular evidence for Choline supplemented in pregnancy preventing mood Disorders and Schizophrenia?

An essential understanding in molecular psychiatry and the molecular mechanisms of intelligence is unfolding. We now understand the critical role of Choline with regards to neurodevelopment and the prevention of subsequent mood disorders and even Schizophrenia developing later in the baby's life. Choline is a requirement for the creation of phospholipids (phosphatidylcholine, lysophosphatidylcholine, choline plasmalogen, sphingomyelin) and all of these are essential components of cell membranes¹. Plasmalogens are protective antioxidants in cell membrane that protect membrane lipids from oxidative stress. 

Cell membranes are of tremendous importance for cell-to-cell communications, for diffusion of molecules, as a protective barrier for the cell, as a 'pacemaker' for cell metabolism, for receptors to function and hormonal signals to generate cellular effects and growth along with a huge range of other metabolic and signalling functions to enable us as humans to function normally and for the foetus to develop normally. So you can see that choline is at the heart of cell membrane health and functionality.

Alpha-7 Nicotinic Receptors 

The switch from GABA being excitatory to inhibitory involves the Alpha-7 Nicotinic Receptors activating the membrane chloride transporter KCC2³, and this involves Acetylcholine activating the Alpha-7 Nicotinic Receptors (a7nAchR) in the first place. Choline as discussed above, is vital for Acetylcholine synthesis and thus this molecular neurodevelopmental change that converts the nature of the neurotransmitter GABA is choline dependent. Thus any insufficiency of Choline in the mother may have a profound effect on this crucial point in time in foetal brain development at the molecular level.

The foetal brain has 10x (ten times) the number of Alpha-7 Nicotinic Receptors in the foetal hippocampus than adults³, and it is interesting that animals with hippocampal damage exhibit hyperactivity. The hippocampus is involved in the consolidation of learning into short-term and long-term memory and emotional learning⁴.

Research has shown that both the long-chain Omega-3, DHA and Choline used in combination has a far more significant impact on foetal neurodevelopment than either component alone⁴.

As crucial as DHA and Choline are, you require a vast number of other vitamins, minerals and trace elements including iodine which is also critical for brain development. A well-designed multivitamin and mineral formulation that meets the needs of both mother and baby is undeniably vital for both mother and baby to thrive. Discuss this with an Activ8Health Specialist Dietitian. Nothing less than a highly specialised and safe multivitamin and mineral supplement will suffice in pregnancy! 

Why do you need to have supplemental choline?

The liver can produce choline but not enough for your needs or that of your developing baby. Egg yolks are one of the richest sources of choline but an adult will need to consume 2 - 3 per day to get enough choline to meet daily requirements and egg yolks are rich in the inflammatory producing Omega-6 fatty acids and thus not advised as a dietary source of choline to meet your daily needs.

In fact, Dr Artemis Simopoulos an Omega-3 expert from the National Institutes of Health (NIH) in the USA published a study comparing eggs from Greece and those from a typical supermarket in the Western world. In the Mediterranean eggs the ratio of Omega-6 to Omega-3 was around 1.3 so almost evenly matched and the supermarket eggs showed a whopping Omega-6 to Omega-3 ratio of 19.4 to 1 - in other words 19.4 time more Omega-6 than Omega-3 (Simopoulos & Sidossis 2000). Supermarket hens are fed Omega-6-rich grains predominantly.

Choline is a water-soluble compound and a component of two forms of phospholipid: 1) Phosphatidylcholine found in cell membranes and 2) Sphingomyelin a compound that makes up a significant component of the myelin sheath that insulates neurons (nerve cells).

Any deficiency in pregnancy will result in the mother's nutrient resources being raided by the developing baby

What is not taken into consideration is the fact that a developing baby depends on the mother to acquire all the nutrient resources it needs to develop and survive. This is not a symbiotic relationship but a parasitic one and if you are not consuming an optimal amount of vital micronutrients then the baby will draw upon your reserves. Your brain, nerves, organs and tissues are all available for your baby to plunder to meet its nutrient needs. This is probably the single most important cause for 'pregnancy brain' and mood disorders in the perinatal period. Micronutrients are not negotiable. Without these cells simply do not function. These disorders do not occur due to a pharmaceutical deficiency waiting for a registered drug to come out and fix. The Western diet is riddled with deficiencies and most mothers will go into pregnancy deficient in many micronutrients such as Omega-3's, Choline, Iodine, Magnesium, Zinc, B12, Fe, Folate etc. This is why a Multivitamin-Mineral product is vital leading up to pregnancy in BOTH the man and the woman as the man's sperm is also subject to poor nutrition. 

It is also important to note that Choline is a methyl (CH3) donor and Choline's metabolite Betaine, helps modulate epigenetic expression througth the Methionine-Homocysteine pathway. Epigenetics you may be aware is the switching mechanism for genetic expression i.e. epigenetics turns on or off the expression of certain genes. The whole process of cell differentiation in the embryo to foetal stage is the result of stem cell orchestration by epigenetics that tells a particular cell that you will become a liver cell or you will become a brain cell. So Choline is an important part of this epigenome.

Why would Choline and Acetylcholine affect mood disorders or Schizophrenia?

As a full-time medical practitioner at the coalface of general practice, I am stunned at how common mental health disorders are. From ADHD to mood disorders, manic depression, depression, anxiety, panic attacks, behavioural problems such as oppositional defiant disorder (ODD) and a range of other aberrant behaviours out there in the community.

It would have to be extremely unlikely that dietary factors are not at the heart of a vast majority of mental health disorders that have their beginnings in the neonatal period when the brain architecture and brain connections form. For those who think that this cannot be the case and that somehow these mental health disorders are just hardwired in us and that there is no cause, may need to understand the molecular basis of psychiatric illness and indeed molecular psychiatry that is now coming of age due to the enormous strides made in medical science.

It is interesting that GABA in adults is an inhibitory neurotransmitter, but this is not so in early foetal brain development when GABA is excitatory³.

The potential of preventing mental health disorders with such an inexpensive supplement - so why isn't this a public health issue?

It took folic acid to be applied population-wide for this to show definitive effects on neural tube defects in the perinatal period⁵. Neural tube defects are some of the most common severe congenital malformations seen and Folic Acid supplementation can prevent a staggering 72% of these⁵. Imagine if 72% of mental health disorders were prevented by the population-wide use of Choline supplementation. We won't know unless this is suggested and applied in the whole population as everyone needs an optimal intake of choline.

Choline was officially recognised by the Institute of Medicine (IOM) as an essential nutrient in 1998 in other words; humans cannot synthesise this compound in amounts necessary for health and Choline can become deficient in pregnancy and breastfeeding. In addition to this is that fact that 75% of people have a mutation in the PEMT(phosphatidylethanolamine N-methyltransferase) gene that impairs synthesis of Choline in the body making adequate dietary intake even more vital. Remember, around 60% of people are overweight or obese and by definition are not having an optimal diet. Rarely will anyone say on any given day 'I need to ensure I am getting an adequate supply of Choline today'

A lack of Choline in the diet can lead to significant organ damage that includes fatty accumulation in the liver (Fatty Liver or Non-Alchlolic Fatty Liver Disease or NALFD), liver damage and muscle damage. Fatty Liver is now an epidemic in society and this can lead to cirrhosis of the liver. Thus Choline is no plaything. It is a vital component of the diet which may be inadequate for our health.

It is bizarre when so much research is available and the fact that Choline is an essential nutrient whose intake is not negotiable if you want to maintain health and where deficiency states are common for various reasons that we do not see this important compound in prenatal supplements. Even if it is present in prenatal formulations, it is not at a therapeutic dose and may not be taken with the Omega-3, DHA. Choline does need to be taken in conjunction with a high-quality Omega-3 DHA supplement as DHA and Choline have synergistic effects as described above.

Choline is not only safe in pregnancy, it is necessary!

DHA plus Choline supplments exist on the market 

Preterm birth (less than 34 weeks gestation) is the leading cause of death in children globally and is the direct cause of more than 85% of perinatal deaths². A Cochrane Collaboration review found that a significant reduction in the risk of premature birth can occur if pregnant did one simple thing and that is to take Omega-3 supplements rich in DHA. This led to a call by Professor Julie Quinlivan as senior specialist in Obstetrics and Gynaecology to write an article in the Medical Observer magazine for Omega-3 supplements to be put on the PBS. In this article Prof Quinlivan stated with regard to prevention of premature births:  "However, there is a simple and easy intervention in the form of omega 3 supplements,with an updated Cochrane Review of 70 randomised trials, involving almost 20,000 pregnant women, showing they can reduce early preterm birth by 42% and an 11% reduction in preterm birth overall."

With such simple and extremely safe supplements out there why is this not public health practice. All supplements and medications need to be put into clinical context and medications are provided by doctors including myself with a huge potential for disastrous side-effects but these medications are not given without thought and consideration of a range of factors. It is for this reason, practitioner-only products exist so that a discussion can occur with the practitioner.to see if this is appropriate in their circumstance. This bias against clinical nutrition in favour of pharmaceutical interventions that can benefit humanity greatly is simply not acceptable. It is your right as a democratically-free person to review the scientific literature and make a decision.