Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. In addition, a single 3-ounce (85-gram) serving of beef kidney or liver can supply all of a womans daily requirement and most of a mans (23). Lik.Sprava. Perhaps the most important benefit of choline is its effects on brain development. Some multivitamins and dietary supplements, as well as prepackaged and fortified foods, may contain choline in the form of lecithin. Too much zinc can be harmful and may result in symptoms such as nausea, diarrhea, and headaches. One study determined that a higher dietary intake around the time of conception was associated with a lower risk of neural tube defects (13). 2016;104(1):173-180. doi: 10.3945/ajcn.116.131771, Leermakers ETM, Moreira EM, Kiefte-de Jong JC, et al. Water-soluble choline molecules go to the liver, where the body converts them into a type of fat called lecithin. What does phospholipid choline do? 5-15-1978;22(19):1699-1707. There is no research available to suggest that one form is better than another. . That being said, according to the National Institute of Health, too much choline can cause "a fishy body odor, vomiting, heavy sweating, low blood pressure, and liver damage."So it's important . A UL has not been established for choline, because a toxic level has not been observed from food sources or from longer-term intakes of high-dose supplements. Most choline is metabolized in the liver where it is converted into phosphatidylcholine, which assists in building fat-carrying proteins and breaking down cholesterol. Limit butter. Despite Choline's availability in foods, it can actually be difficult to get enough Choline from food when pregnant . In a study of almost 4,000 African-American participants followed for 9 years, higher choline intakes were associated with a lower risk of ischemic strokes. Choline is a nutrient similar to B vitamins. View abstract. edema. Lars G.Forssell, Roland Eklf Bengt Winblad and Lars Forssell. J Biol Chem. How does acetylcholine act on muscarinic receptors? View abstract. View abstract. There is a link between choline deficiency and liver disease. They are also more easily absorbed than others. One study noted that women who had higher intakes around conception had a 51% lower risk of neural tube defects, compared to women with very low intakes (61). Am J Clin Nutr 2016;104(6):1683-92. It is required for the synthesis of the phospholipids in cell membranes, methyl group metabolism, and cholinergic neurotransmission. 2001;25(5):260-268. smoke weed. Indian J Chest Dis Allied Sci 1997;39:149-56. View abstract. Brain Res Dev Brain Res 1999;113:13-20. However, lecithin tends to only contain 1020% phosphatidylcholine. However, the evidence is mixed. If you buy through links on this page, we may earn a small commission. Though your liver can make small amounts, you must obtain the majority through your. Acta Neurol Scand 1980;62:124-6. 8-10-1974;249(15):4815-4818. Incorporate physical activity into your daily routine. View abstract. These Science-Backed Tips Can Help You Lose Weight Sustainably. Phosphatidylcholine might help to protect the wall of the large intestine in people with a type of inflammatory bowel disease (ulcerative colitis).Is it Nutr.Rev. View abstract. It's been proven to have positive effects on cognitive performance, mood, and memory. They can be found as an individual nutrient supplement, combined with B vitamins, or combined into a multivitamin or multimineral product. Choline is an essential nutrient that is required by the body to maintain our health. Spector SA, Jackman MR Sabounjian LA Sakas C Landers DM Willis VVT. Sijens, P. E., Oudkerk, M., van Dijk, P., Levendag, P. C., and Vecht, C. J. In one 2013 study, for example, women in their third trimester of pregnancy received either 480 milligrams (mg) or 930 mg of choline per day. What does choline do? Multivitamins do not typically contain choline. View abstract. The American Journal of Clinical Nutrition. Choline supports several vital bodily functions and may offer a wide range of other health benefits, such as: Choline is an essential nutrient for brain development. J.Clin.Invest. 1979;15(2):74-75. Sidhu N, Davies S, Nadarajah A, et al. People can also find supplements that contain only choline. Supplementing excessive amounts of choline is more likely to result in side effects. Side effects of choline supplementation include: In severe cases, hypotension (low blood pressure) could occur. ( 14) Other Health Benefits of Choline J.Am.Coll.Nutr. Lancet 10-23-1976;2(7991):905. 2020 Oct 13;12(10):3120. B-vitamins are also responsible for fat-burning . The research shows choline is a remarkable player in the battle against dementia and Alzheimer's. It seems very promising for some of the aspects of dementia and Alzheimer's and may indeed help prevent neurodegenerative diseases. Some evidence suggests choline may play a role in the development and treatment of certain mental health disorders. Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage are appropriate for your individual needs. Limit milk/dairy (1-2 servings/day) and juice (1 small glass/day). Though the recommended intake for choline is relatively low (125550 mg per day), most people do not get enough. For example, higher levels of choline intake in the diet are associated with improved cognitive function. View abstract. What Does It Do? The following groups are at higher risk of developing a choline deficiency: Pregnant women are at risk of choline deficiency because their requirements are higher and they don't get enough choline in their diet. Choline is an essential nutrient ( 2 ). View abstract. View abstract. Choline is involved in the production of compounds that act as cell messengers. The authors of a 2018 study found an association between higher dietary intakes of choline and a lower risk of ischemic stroke. Prenatal choline supplementation improves biomarkers of maternal docosahexaenoic acid (DHA) status among pregnant participants consuming supplemental DHA: a randomized controlled trial. Acetylcholine is important for memory and other functions in the body. Adv Exp Med Biol. Continue reading this article to learn more about choline, including the recommended daily intake, its sources, and how it can benefit peoples overall health. MNT is the registered trade mark of Healthline Media. Although choline deficiency can cause NAFLD, there is limited research on whether supplementation can treat the condition once it has developed. View abstract. Sheffler ZM, Reddy V, Pillarisetty LS. Meyer KA, Shea JW. Gelenberg, A. J., Wojcik, J., Falk, W. E., Bellinghausen, B., and Joseph, A. The body does not produce enough choline on its own, so people need to get it from food sources, such as meat, eggs, and vegetables. Consuming too much choline has been linked to unpleasant and potentially harmful side effects. How Viagra became a new 'tool' for young men, The amazing story of hepatitis C, from discovery to cure, Ankylosing Spondylitis Pain: Fact or Fiction, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3218734, https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/, https://nutrition.bmj.com/content/early/2019/09/03/bmjnph-2019-000037, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096089/, ttps://www.ncbi.nlm.nih.gov/pubmed/31328680, https://www.fasebj.org/doi/abs/10.1096/fj.12-221648?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=fasebj, https://link.springer.com/article/10.1007/s00394-016-1296-8, https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/plasma-free-choline-betaine-and-cognitive-performance-the-hordaland-health-study/A07F06DC93C7678B188229FB072272E2, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856837/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518394/, https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1516/Table_1_NIN_GEN_15.pdf, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259877/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213596/, https://academic.oup.com/nutritionreviews/article/67/11/615/1850648. The body also can convert choline into TMAO. However, clinical trials have not found that supplementing with choline directly improved cognitive function. Choline: needed for normal development of memory. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. Cerletti C, Colucci M, Storto M, et al. What does choline do for the body? Also, the amount of dietary choline an individual needs can vary widely and depends on various factors. Guerrerio AL, Mattis L, Conner KG, et al. This means we cannot definitively say if choline is effective for these uses. Christie, J. G. Blackburn 1. These errors put someone taking exogenous insulin on the blood sugar rollercoaster, which makes them feel awful as their blood sugars swing wildly. 2005 - 2022 WebMD LLC. It's also been found to have a positive effect on memory. What does choline do for the liver? According to the United States Department of Agriculture, males aged 2059 consume an average of 406421 mg of choline per day, while females in the same age group consume around 290303 mg per day. 1994 . 1995;10(2):457-462. Zeisel, S. H., & da Costa, K.-A. View abstract. One clinical trial evaluating a nutraceutical mixture containing choline found that it was of no benefit in people who already have NAFLD. Maternal prenatal choline and inflammation effects on 4-year-olds' performance on the Wechsler Preschool and Primary Scale of Intelligence-IV. Nutr Rev. Boeke CE, Gillman MW, Hughes MD, et al. Does caffeine increase acetylcholine? 1980;2(2):149-156. Choline Intake as Supplement or as a Component of Eggs Increases Plasma Choline and Reduces Interleukin-6 without Modifying Plasma Cholesterol in Participants with Metabolic Syndrome. The richest sources are meat, fish, poultry, dairy, and eggs. View abstract. Chawla, R. K., Wolf, D. C., Kutner, M. H., and Bonkovsky, H. L. Choline may be an essential nutrient in malnourished patients with cirrhosis. Synthesis of cross-linked peptidoglycan attached to previously formed cell wall by toluene-treated cells of Bacillus megaterium. 10-13-1979;2(6195):939. 2015;131:119-129. For pregnancy and lactation, the AI is 450 mg and 550 mg daily, respectively. Cholinergic medication for neuroleptic-induced tardive dyskinesia. Paediatr Perinat Epidemiol 2012;26(4):328-35. All rights reserved. One large observational study linked lower blood levels to a higher risk of anxiety but not depression (47). Choline helps babies develop, it keeps your cell membranes strong, it helps you use fat, and helps you get energy out of your food, among other important functions. The study showed no association with liver disease in men or overweight women (51). Folate and choline help convert the amino acid homocysteine to methionine. Phosphatidylcholine helps carry fat away from the liver. Gelenberg, A. J. Choline and lecithin for the treatment of tardive dyskinesia [proceedings]. 2020;59(8):3857-3861. Effect of choline supplementation on fatigue in trained cyclists. View abstract. Lack of effect of oral choline supplement on the concentrations of choline metabolites in human brain. 1982;41(14):3015-3021. J Am Diet Assoc 1998;98:699-706. While acetylcholine levels work for many functions, it is most commonly associated with memory, cognition, and sleep. Choline can be obtained from a variety of foods and supplements. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. It has even been suggested that choline helps the body burn fat, which may result in easier weight loss and better metabolic . Behav Neurol 2021;2021:2962245. There is also interest in choline's possible role in Alzheimer's disease, but further research is needed. The exact amount of available choline varies, so it is vital that people read labels before taking any dietary supplements. There is not enough data to establish a Recommended Dietary Allowance for choline. Are patients with cirrhosis choline deficient? Some research has shown that choline plays a role in metabolizing fats. Am J Clin Nutr. Explore the downloadable guide with tips and strategies for healthy eating and healthy living. Saito, T. [Choline antagonists and antacids for the treatment of peptic ulcer]. Acetylcholine is the key neurotransmitter 1) in the autonomic nervous system (which . Oral choline supplementation in children with intestinal failure. Conlay LA, Wurtman RJ Blusztajn JK Covielia IJ Maher TJ Evoniuk GE. 1.About Acetylcholine. Biol.Psychiatry 9-1-1996;40(5):382-388. Choline is required to produce acetylcholine, a neurotransmitter that plays an important role in regulating memory, mood and intelligence (33). View abstract. Postmenopausal women: Estrogen helps produce choline in the body. View abstract. Am J Clin Nutr. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you are looking for a supplement, CDP-choline and alpha-GPC tend to be higher in choline content per unit weight. J.Neurochem. This has led researchers to consider whether choline might help reduce the risk of heart disease. View abstract. Commercially marketed supplements for bodybuilding athletes. Compared to omega-3s, which were discovered almost a century ago, choline is a newcomer to the nutritional scene. Choline supports brain development and growth in newborn babies. Choline is associated with the development and treatment of certain diseases. View abstract. Caffeine is a commonly used drug that increases arousal, a condition associated with increased cholinergic activity in the mammalian . [1]. Most people don't consume enough choline in their diet. Lancet 3-4-1978;1(8062):508-509. It is known to play an important role in memory and learning and is in abnormally short supply in the brains of persons with Alzheimer disease. 11-15-1976;19(10):1507-1515. Covington TR, et al. Choline deficiency-induced apoptosis in PC12 cells is associated with diminished membrane phosphatdylcholine and sphingomyelin, accumulation of ceramide and diacylglycerol, and activiation of a caspase. Elevated levels of homocysteine in your blood are linked to an increased risk of heart disease and strokes (26). Liu ZY, Zhang DM, Yishake D, Luo Y, Fang AP, Zhu HL. Beef, beef liver Egg yolks Chicken breast Fish Shiitake mushrooms Potatoes Legumes (beans, peanuts) Milk Yogurt Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage) Sunflower seeds Signs of Deficiency and Toxicity Deficiency Am J Psychiatry 1979;136:1581-4. Choline for Weight Loss. Therefore, it is likely that extra choline is consumed through the diet via food additives. What does choline do? By Jennifer Lefton, MS, RD/N, CNSC, FAND Infants require lots of choline during the first few months of life, most of which they get from breast milk or fortified formula. 2020 Sep 23;11(9):7866-7877. Physiologist 1992;35:236a. Choline is vital for healthy liver function and normal brain development. J Natl Cancer Inst 2007;99:1214-5. The association of dietary choline and betaine with the risk of type 2 diabetes: The Atherosclerosis Risk in Communities (ARIC) study. Mohs, R. C., Davis, K. L., Tinklenberg, J. R., Hollister, L. E., Yesavage, J. Zheng Y, Li Y, Rimm EB, Hu FB, Albert CM, Rexrode KM, Manson JE, Qi L. Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men. 1999;(1):81-85. View abstract. View abstract. Choline metabolism serves a number of different biological functions. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. N.Engl.J.Med. Li Y, Wang DD, Chiuve SE, Manson JE, Willett WC, Hu FB, Qi L. Dietary phosphatidylcholine intake and type 2 diabetes in men and women. Science 8-7-1998;281(5378):794-795. Choline side effects are not noted if . PN does not routinely contain choline. View abstract. Will We Ever See an End to Alzheimers? View abstract. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. Choline is associated with brain health because it is converted into acetylcholine, which plays a role in memory and thinking. View abstract. Adv Exp Med Biol 1997;422:97-107. Choline helps the body to absorb fat, and fats are then used to create cell membranes and structures. View abstract. 2005;26(3):421-424. [3]. Neurol.Neurochir.Pol. What does phosphatidylcholine do for the body? The body needs choline to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital for cell membranes. View abstract. 1984;14(3):697-700. View abstract. Cochrane Database of Systematic Reviews. All rights reserved. Choline. View abstract. A study in more than 56,000 people found that normal-weight women with the highest intakes had a 28% lower risk of liver disease, compared to those with the lowest intakes (51). Though your liver can make small amounts, you must obtain the majority through your diet. Physiology, neurotransmitters. Med Sci Sports Exerc 1995;27:668-73. The brain makes acetylcholine from choline, which is commonly found in food. M. Glen A. I. M. Zeisel S. Shering A. reddening of skin. Saudi.Med.J. This may cause cholinergic side effects, including: seizures. Both plants and animals need choline to maintain cell structure. Narkewicz MR, Caldwell S Jones G. Cysteine supplementation and reduction of total parenteral nutrition-induced hepatic lipid accumulation in the weanling rat. Potatoes and French fries dont count. This article provides everything you need to know about choline, including what it is and why you need it. Getting too much choline can cause a fishy body odor, vomiting, heavy sweating and salivation, low blood . Choline is not typically included in TPN formulas unless specified. Tartaric Acid is an organic acid that occurs in many fruits such as grapes, bananas and many citrus fruits. Nutr Res. UL: A Tolerable Upper Intake Level (UL) is the maximum daily dose unlikely to cause adverse side effects in the general population. In the central nervous system, acetylcholine appears to have multiple roles. Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study. Choline can also be found as a nutritional supplement. The authors of a small 2014 study found that female athletes who took choline supplements had lower body mass indexes (BMIs) and leptin levels than the control group. Choline occurs as a cation that forms various salts (X in the depicted formula is an undefined counteranion). Choline is also needed in the process of methylation; where Methylation is used in the construction of DNA and neurotransmission. 5-26-1980;26(21):1827-1831. 2003;37(6):1231-1238. Healthcare professionals can test a persons choline levels by taking a blood sample and looking at how much choline is present. What happens when a person takes too much zinc? Foods that are good sources of choline include meat, liver, fish, legumes, beans, nuts, peas, eggs, wheat germ, and spinach. Albright, C. D. Tsai A. Y. Friedrich C. B. Mar M. H. and Zeisel S. H. Choline availability alters embryonic development of the hippocampus and septum in the rat. 2004-2022 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. As a result, choline is described as an essential nutrient. Hunter SK, Hoffman MC, D'Alessandro A, et al. Choline deficiency can lead to problems like mood disorders, poor memory and learning, muscle spasms, and fatty liver disease. For optimal health, it's a good idea to choose the foods that contain the most nutrients. 8th ed. Is choline good for your gut? One 2018 study found that choline supplementation improved lung function and reduced symptoms of fatty liver disease in 10 adult males with cystic fibrosis. J Am Coll Nutr 1992;11:473-81. View abstract. Rich food sources of choline include beef liver, eggs, fish, nuts, cauliflower and broccoli. We include products we think are useful for our readers. However, deficiency is rare because your body can make choline. LiverCholine helps remove fat from your liver. Br J Nutr. Changes in the metabolism of choline or phosphatidylcholine can also negatively impact certain biochemical pathways that lead to NAFLD. It is important to talk to your healthcare provider about any supplements you plan to take and to check in about any potential interactions with other supplements or medications. Choose fish, poultry, beans, and nuts; limit red meat and cheese; avoid bacon, cold cuts, and other processed meats. When people don't consume enough choline, they may experience a range of negative health effects. In other words, postmenopausal women might not produce enough choline[2] . Choline helps transfer fats and cholesterol out of the liver, so a deficiency could lead to issues like liver damage and non-alcoholic fatty liver disease . If you are pregnant, review your risk of deficiency with your prenatal care provider. The adequate intake of choline is 425 mg per day for women and 550 mg per day for men. View abstract. Not enough evidence is available to provide a recommended dietary allowance (RDA) for choline, but an adequate intake has been established. Grunewald KK, Bailey RS. Gabis LV, Ben-Hur R, Shefer S, Jokel A, Shalom DB. . Choline and Methylation Cochrane Database of Systematic Reviews 2012;2002(3). More research is needed to truly understand the effects that choline deficiency has on the adult body. Choline has many functions in the human body, including: 1 Forming acetylcholine, one of seven major neurotransmitters responsible for many nervous system functions 2 Supporting the integrity of cell membranes Removing fat and cholesterol from the liver Making compounds needed for cell signaling View abstract. Golzarand M, Bahadoran Z, Mirmiran P, Azizi F. Dietary choline and betaine intake and risk of hypertension development: a 7.4-year follow-up. Eur J Nutr. Choline is an essential nutrient. Other forms of choline include Acetyl-L-Carnitine and CDP Choline. Choline supplementation is likely safe for most people in doses less than 3.5 g daily. If you've ever wondered what Choline is actually good for, take 30 seconds to find out.#health #nutrition #nutrients #shorts Emerging treatments: replacement therapy with choline or lecithin in neurological diseases. Acetylcholine is important for memory and other functions in the body. Choline is a nutrient that is found in many foods. How does it work? Food and Nutrition Board, Institute of Medicine. Effects of choline on health across the life course: a systematic review. 2. Br.Med.J. Acetylcholine is rapidly destroyed by the enzyme acetylcholinesterase and thus is effective only briefly. Morrison, L. M. and W. F. Gonzales. J Mol Neurosci. Rarely, more, Researchers are investigating whether vitamins and dietary supplements can help with neuropathy. Several animal studies suggest that taking choline supplements during pregnancy may improve fetal brain development (20, 42, 43). 2000;10(3):133-138. Research shows that supplementing with phosphatidyl choline can reduce the levels of homocysteine in the blood. US dietary guidelines stipulate that the adequate intake (AI) amount of choline for adults aged 19 years or older is 550mg/day for men and 425mg/day for women, with a tolerable upper limit of 3,500mg/day.1 The AI for children younger than one year of age is 125mg/day (0-6 months) to 150mg/day (6-12 months), increasing progressively with age . Your brain and nervous system need it to regulate memory, mood, muscle control, and other functions. It's recommended that adult females consume 425 mg daily, and adult males consume 550 mg daily to maintain adequate nutrition. However, there are only a few studies on this in humans. Eur.J.Appl.Physiol Occup.Physiol 1993;67(1):87-91. If you are vegan or eat a mostly plant-based diet, nuts, seeds, and legumes are a good source of choline. New York, NY: Pergamon Press, 1990. S. Department of Health and Human Services. Health News and Information, Delivered to Your Inbox. Dietary guidelines for Americans, 2020-2025. Ross RG, Hunter SK, McCarthy L, et al. ( 7) What is choline's role in gene expression and DNA? [deleted] 2 yr. ago. Diabetes Care. Supplementing with 1,000 mg per day led to improved short- and long-term verbal memory in adults aged 5085 who had poor memory (37). As discussed in other articles here, dementia and Alzheimer's disease (AD) have multiple causes and symptoms. J Natl Cancer Inst 2007;99:1224-31. 2020;43(11):2840-2846. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Many fruits, vegetables, and whole grains contain choline as well, so there are plenty of options for people on. Oral choline in cerebellar ataxia. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Choline has a range of other functions in the body, such as helping to remove fat from the liver. Nutrition and the brain 1979;5. Ach acts on two types of receptors: nicotinic receptors and muscarinic receptors. Choline is an essential nutrient that is required by the body to maintain our health. View abstract. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study, Plasma homocysteine, dietary B vitamins, betaine, and choline and risk of peripheral artery disease, Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men, Effects of choline on health across the life course: a systematic review, Lecithin for dementia and cognitive impairment, Dietary guidelines for Americans, 2020-2025, Forming acetylcholine, one of seven major neurotransmitters responsible for many nervous system functions, Supporting the integrity of cell membranes, Removing fat and cholesterol from the liver, Making compounds needed for cell signaling. Heres our process. AI: The Adequate Intake for men and women ages 19+ years is 550 mg and 425 mg daily, respectively. Cruciferous vegetables (broccoli, cauliflower. Choline also improves cognitive performance, especially in older adults. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you. Lipotropics devote their energy to making sure that fat goes where it's supposed to - the metabolic furnace. View abstract. View abstract. Another study suggested higher intakes of choline in the diet were associated with an increased risk of death from heart disease. However, the evidence is mixed. The study looked at nearly 4,000 African American participants, with an average 9 year follow-up period. Klatt KC, McDougall MQ, Malysheva OV, et al. Growdon, J. H., Cohen, E. L., and Wurtman, R. J. Learn about the causes, symptoms, and treatment of, Vitamin C is usually safe to take even at high dosages. Harris CM, Dysken MW Fovall P Davis JM. Choline supplementation in children with fetal alcohol disorders: a randomized, double-blind, placebo-controlled trial. What Does Acetylcholine Do? Sign up here. Cleveland Clinic researchers have shown, for the first time in humans, that choline - a nutrient typically found in egg yolks, red meat and processed meats, but dispensed via supplements in the studyRead More For this reason, blood tests may not be a good indicator of whether or not a person is getting enough choline. Choline supplementation is likely safe in children in appropriate amounts. Warton FL, Molteno CD, Warton CMR, et al. 1995;21(1):18-24. When folic acid supplies are low, the body can use choline as a substitute. Adults should not take more than 3.5 g daily. Dietary supplements are not regulated in the United States, meaning the Food and Drug Administration (FDA) does not approve them for safety and effectiveness before products are marketed. One Capsule of choline should be taken before breakfast or lunch. View abstract. Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men. The body does not produce enough choline on its own, so people need to get it from food sources, such as meat, eggs, and vegetables. Effects of oral choline administration on serum and CSF choline levels in patients with Huntington's disease. Choline deficiency can cause muscle and liver disease and contribute to cardiovascular disease, dementia, and neural tube irregularities in infants. Choline status is not routinely measured in healthy people. This simple 3-step plan can help you lose weight fast. Life Sci. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. 1978;5(1):157-160. Dietary choline, rather than betaine intake, is associated with hepatocellular carcinoma mortality. Choline is found in high-protein foods such as eggs, liver, seafood, milk, and meat. Nippon Rinsho 1984;42(1):158-162. This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. NEM 1986;175:892. The body manufacturers a small amount of choline, but it is usually not as much as is required for optimal health, so medical experts recommend getting additional choline through the diet or in the form of supplements. It can be taken as a supplement, the best source of choline supplement is Alpha GPC. View abstract. For pregnant women, choline supplementation appears to be safe in amounts up to 3 g daily if under 18 or 3.5 g daily if over 19 years of age. View abstract. Read our. Nguyen TT, Risbud RD, Mattson SN, Chambers CD, Thomas JD. The Tolerable Upper Intake Level (UL) for choline for adults 19 years and older is 3,500 mg daily and is based on the amount that has been shown to produce these side effects. Psychopharmacol.Bull. Commun.Psychopharmacol. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. Life Sci. Etienne, P., Gauthier, S., Johnson, G., Collier, B., Mendis, T., Dastoor, D., Cole, M., and Muller, H. F. Clinical effects of choline in Alzheimer's disease. In three large cohorts of men and women, higher intakes of phosphatidylcholine were associated with an increased risk of type 2 diabetes mellitus (T2DM). Differential metabolism of choline supplements in adult volunteers. This increases the risk for nonalcoholic fatty liver disease (NAFLD), which may then progress to cirrhosis (an inflammation of liver cells, followed by thickening and hardening of liver tissue), liver cancer, or liver failure. Choline and betaine consumption lowers cancer risk: a meta-analysis of epidemiologic studies. Bidulescu A, Chambless LE, Siega-Riz AM, Zeisel SH, Heiss G. Usual choline and betaine dietary intake and incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. Although choline deficiency is rare, certain people are at an increased risk (14): People who are at an increased risk of choline deficiency include athletes, those who drink a lot of alcohol, postmenopausal women and pregnant women. Choline works with other vitamins, minerals, and amino acids to promote cellular integrity, brain and neuron growth, and transmits essential nutrients from cells to other parts of the body. A large cohort of men and women from the Nurses Health Study and Health Professionals Follow-up Study, followed for 20-25 years, found that higher phosphatidylcholine intakes were associated with an increased risk of deaths from CVD and other causes. Sun S, Li X, Ren A, et al. One of the most important functions of choline is to help maintain healthy brain function. These levels are also used as an indicator for certain mood disorders, and choline supplements are sometimes used to treat bipolar disorder (48). It impacts liver function, healthy brain development, muscle movement, your nervous system and metabolism. Essential nutrients are compounds the body cant make on its own, or in enough quantity. Choline is a nutrient that is essential for healthy brain development. Consuming too much choline has been associated with unpleasant and potentially harmful side effects. It may play a key role in healthy brain function, heart health, liver function and pregnancy. Without choline, fat can accumulate in the liver, increasing the risk of developing nonalcoholic fatty liver disease. Inadequate choline may result in fat and cholesterol buildup in your liver. Choline deficiency: a cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation. Nutrient intakes from food and beverages: Mean amounts consumed per individual by gender and age, in the United States, 2015-2016. View abstract. This article looks at, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. 2019;69(2):224-234. Eat these 15 heart-healthy foods to help keep your heart in top condition. Follow the directions on the supplement label for storage. How Do I Know if I Have a Choline Deficiency? Levy, R. Choline in Alzheimers disease. 2018;9(1):58-60.doi: 10.1093/advances/nmx004. View abstract. 1980;37(1):49-52. To maintain health, it must be obtained from the diet as choline or as choline phospholipids, like phosphatidylcholine. Choline: Fact sheet for health professionals. View abstract. This prevents nonalcoholic fatty liver disease (NAFLD). Similar to sodium, the DRV for chloride is considered both safe and adequate, which means it's enough to . The body transports and absorbs choline differently depending on its form. Goodman and Gilman's The Pharmacological Basis of Therapeutics. J Neurol Neurosurg Psychiatry 1980;43:452-4. Higher intakes of choline during pregnancy may reduce the risk of neural tube defects in babies. 2. Lancet 10-1-1977;2(8040):711. However, its unlikely that you can ingest such levels from food alone. Das, S., Gupta, K., Gupta, A., and Gaur, S. N. Comparison of the efficacy of inhaled budesonide and oral choline in patients with allergic rhinitis. This #WorldDiabetesDay, learn more about the different types of diabetes, as well as steps to help prevent prediabe, "The differences between plant-based diets was surprising because theyre often portrayed as universally healthy an, Copyright 2022 The President and Fellows of Harvard College, Harvard T.H. Arch.Neurol. View abstract. Indian J.Chest Dis.Allied Sci. Of course, eggs are not the only source of choline in the diet. Recommended amounts for children depend on age. Check the supplement facts label for choline content in prenatal vitamins. Avoid sugary drinks. Early second trimester maternal plasma choline and betaine are related to measures of early cognitive development in term infants. View abstract. View abstract. One study in 1,508 women found that those with diets high in free choline were 24% less likely to get breast cancer (55). Galeone F, Salvadorini F Guarguaglini M Saba P. Effect of intravenous injection of CDP-choline, S-adenosyl-methionine and citiolone in subjects with hyperlipemia. View abstract. Choline: Dietary requirements and role in brain development. Nutrients. Trimethylamine-N-oxide is a substance that appears to increase cholesterol buildup and plaque formation in arteries, which leads to increased risk for . Consult with a medical professional before taking any supplements. Villamor E, Rifas-Shiman SL, Gillman MW, Oken E. Maternal intake of methyl-donor nutrients and child cognition at 3 years of age. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. There appears to be an association with diets high in choline-rich foods and cardiovascular disease, but the reasons for this link need further study. Wu BT, Dyer RA, King DJ, Richardson KJ, Innis SM. Wurtman, R. J., Hirsch, M. J., and Growdon, J. H. Lecithin consumption raises serum-free-choline levels. Use of LPC antagonist, choline, in the management of bronchial asthma. Oral choline supplementation for postoperative pain. Choline: an important nutrient in brain development, liver function and carcinogenesis. Typical dosages in supplements range from 10 mg to 250 mg. Choline is an essential nutrient. This article reviews choline, how to get it in your diet, and who is at risk for not getting enough of this nutrient. Therefore, a deficiency of either nutrient can result in an accumulation of homocysteine in your blood. Higher blood levels of TMAO have been associated with a higher risk of CVD in animal studies. 1H MR spectroscopy monitoring of changes in choline peak area and line shape after Gd-contrast administration. ArcBoss 2 yr. ago. Choline is found in a variety of foods. Hepatology 1995;22:1399-403. Nasrallah, H. A., Dunner, F. J., Smith, R. E., McCalley-Whitters, M., and Sherman, A. D. Variable clinical response to choline in tardive dyskinesia. Chan School of Public Health, https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/, Academic Departments, Divisions and Centers. View abstract. Perinatal choline effects on neonatal pathophysiology related to later schizophrenia risk. It's found in foods such as meats, fish, nuts, beans, vegetables, and eggs. Choline is a precursor of acetylcholine, meaning that acetylcholine is made from choline. Choline proves to be one very vital nutrient to the body because it also reduces inflammation, prevents build-up in the blood, aids in the prevention of cancer, lowers bad cholesterol levels, and controls asthma. Pregnant womenIn addition to low average dietary intakes in the general public, prenatal supplements do not typically contain choline. Wozniak JR, Fuglestad AJ, Eckerle JK, et al. Davis, K. L., Mohs, R. C., Tinklenberg, J. R., Hollister, L. E., Pfefferbaum, A., and Kopell, B. S. Cholinomimetics and memory. Low intake during pregnancy is linked to complications. Magn Reson Med 1998;39:1005-10. 1979;5(2):157-169. Fovall, P., Dysken, M. W., Lazarus, L. W., Davis, J. M., Kahn, R. L., Jope, R., Finkel, S., and Rattan, P. Choline bitartrate treatment of Alzheimer-type dementias. Ghoshal, A. K. and Farber, E. Liver biochemical pathology of choline deficiency and of methyl group deficiency: a new orientation and assessment. ( 13) It also synthesizes DNA which is important for brain development. [9] Those who had the highest dietary intakes of choline showed a 34% increased risk of T2DM compared with the lowest intakes. Conversely, higher intakes are also associated with an increased risk of prostate cancer in men and colon cancer in women (59, 60). Dietary choline and betaine and risk of CVD: a systematic review and meta-analysis of prospective studies. Only recognised as a required nutrient in 1998, choline is a water-soluble compound, which the body produces in small amounts. What are some key benefits of choline? Choline plays an important role in supporting brain health, brain development, nervous system development, and fortifying the membrane of every cell throughout the body. Millard HR, Musani SK, Dibaba DT, Talegawkar SA, Taylor HA, Tucker KL, Bidulescu A. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study. J Affect Disord 2022;301:23-29. Food Funct. More studies are needed. Wozniak JR, Fuglestad AJ, Eckerle JK, et al. 6 Essential Nutrients and Why Your Body Needs Them, 7 Nutrients That You Cant Get from Plants, The 11 Most Nutrient-Dense Foods on the Planet, 3 Ways a Healthy Gut Impacts Heart Health, 11 Best Foods to Boost Your Brain and Memory, Want to Lose Weight Fast? Warber, J. P., Patton, J. F., Tharion, W. J., Zeisel, S. H., Mello, R. P., Kemnitz, C. P., and Lieberman, H. R. The effects of choline supplementation on physical performance. Although foods rich in cholineliver, egg yolks, and red meattend to be higher in. Does choline help with weight loss? Choline is converted by gut bacteria into a byproduct called trimethylamine (TMA), which is then converted in the liver to trimethylamine-N-oxide (TMAO). What does choline do for the body? Many foods are good sources of choline. Gilman AG, et al, eds. It is believed that circulating TMAO may promote atherosclerosis by preventing the removal of cholesterol in the liver. Diet plays a major role in heart health. 1 It's also important for infant brain development, specifically in memory and learning functions, as well as overall growth and . Davis KL, Hollister LE, Berger PA. Choline chloride in schizophrenia. Choline is important for the production of acetylcholine which plays a role in regulating memory, mood, and intelligence. Dibaba DT, Johnson KC, Kucharska-Newton AM, Meyer K, Zeisel SH, Bidulescu A. In one observational study of 2,195 participants aged 7074 years, those with higher choline levels had better cognitive functioning than participants with low choline levels. Choline is especially important during pregnancy, as a low intake may raise the risk of neural tube defects in unborn babies. Choline deficiency can contribute to the following health conditions: Although choline deficiencies can lead to adverse health effects, too much choline can also cause problems, including: The National Institutes of Health (NIH) provide the following upper intake levels for choline based on age: People can get choline from various dietary sources. Choline is a water-soluble essential nutrient that works alongside Folate to support neural tube development during pregnancy. de la Huerga, J. and Popper H. Urinary excretion of choline metabolites following choline administration in normals and patients with hepatobiliary diseases. View abstract. Carisa D. Brewster is a freelance journalist with over 20 years of experience writing for newspapers, magazines, and digital publications. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. View abstract. J Psychiatr Res 2021;141:50-56. In 1998, the Institute of Medicine officially recognized choline as an essential nutrient. Handbook of Nonprescription Drugs. Ziegler RG, Lim U. One-carbon metabolism, colorectal carcinogenesis, chemoprevention - with caution. Choline metabolism provides novel insights into non-alcoholic fatty liver disease and its progression. Higher intakes of choline have been associated with higher levels of cognitive function, but that does not necessarily mean that choline supplementation can directly improve cognition. pii: E711. Many people do fine with less choline, while others need more (2). Corbin KD, Zeisel SH. Phosphatidylcholine carries fats away from the liver, so a choline deficiency can cause the liver to store too much fat. Eat a variety of whole grains (like whole-wheat bread, whole-grain pasta, and brown rice). The simplest way to reduce the magnitude of the errors is to reduce the blood starting blood sugar and amount of fasting acting carbohydrates. [6] There was a 26% increased risk of CVD deaths when combining data from both cohorts comparing the highest intakes of phosphatidylcholine with the lowest. Choline plays an integral part in many processes in your body. Limited evidence suggests that choline may reduce the risk of neural tube defects in infants, as well as liver disease. The main dietary sources of choline in the United States consist primarily of animal-based products that are particularly rich in cholinemeat, poultry, fish, dairy products, and eggs [ 4, 5, 8-10 ]. Curr Eye Res 2022;47(2):269-276. Avoid trans fat. 2013;170(3):290-8. Large observational studies link choline intake and blood levels to improved brain function, including better memory and processing (35, 36). 2000;(4):CD001015. A., and Kopell, B. S. Choline chloride treatment of memory deficits in the elderly. However, the research has not indicated that choline supplementation will improve NAFLD. Meat, fish, and dairy products also provide choline. In fact, some of the foods with the highest choline content include soybeans, potatoes, and mushrooms. However, these often resolve after discontinuing the supplement. Current scientific studies suggest that choline may improve memory and cognition and reduce the risk of ischemic stroke. Choline is a source of methyl groups needed for many steps in metabolism. Choline deficiency is associated with liver and/or muscle damage. Choline may boost memory function, improve brain development and treat anxiety and other mental disorders. View abstract. View abstract. View abstract. The body does not produce enough choline on its own, so people need to get it from food sources, such as meat, eggs, and vegetables. One observational study of 1,210 pregnant women found that choline intake had no links to mental performance in their children at 3 years of age (44). This is the highest level of intake that is unlikely to cause harm. Choline is a nutrient that supports various bodily functions, including cellular growth and metabolism. However, the authors of one 2018 article state that different testing procedures can affect the choline concentration in blood samples. Choline is both water soluble, and it can be fat soluble. Cruciferous vegetables and certain beans are also rich in choline, and other dietary sources of choline include nuts, seeds, and whole grains. View abstract. Can.J.Neurol.Sci. Choline is a recently discovered nutrient. Choline concentrations in human maternal and cord blood and intelligence at 5 y of age. Dalmeijer GW, Olthof MR, Verhoef P, Bots ML, Van der Schouw YT. Hypertension: Can 15 minutes of yoga a day help control blood pressure? However, they haven't been shown to work as well as Alpha GPC (L-Bitartrate), so you should stay away from them. 2011;53(1):115-19. View abstract . Biol Psychiatry 1978;13:23-49. View abstract. Choline is needed to make acetylcholine, which has a role in memory and thinking. Other observational studies found no association with cancer, but test-tube studies suggest that a deficiency may increase your risk of liver cancer (56, 57, 58). Choline deficiency and chemical carcinogenesis. 2015;102(5): 1113-25. Some research indicates that women who eat a lot of choline may have a lower risk of breast cancer (53, 54, 55). Below are some of the areas where choline supplementation has been studied: Most choline is converted to phosphatidylcholine, a major phospholipid that helps build fat-carrying proteins. Choline supports numerous vital bodily functions, including: Choline exists as both water-soluble and fat-soluble molecules. Fat-soluble choline usually comes from dietary sources, so the body absorbs it in the gastrointestinal tract. Choline chloride effects on memory in the elderly. Though supplementing with choline is likely safe for most people in doses less than 3.5 g daily, adequate intake (AI) is actually much lower. What happens when you take too much vitamin C? Egg yolks are known to be a great source. Effect of choline supplementation on fatigue in trained cyclists. Psychol.Med. Lawrence CM, Millac P, Stout GS, Ward JW. Tamminga, C., Smith, R. C., Chang, S., Haraszti, J. S., and Davis, J. M. Depression associated with oral choline. Magn Reson.Imaging 1998;16(10):1273-1280. Nervous system functioning: The body converts choline into a neurotransmitter that affects the nerves and plays a role in regulating automatic. For example, premenopausal women may have lower requirements for dietary choline because higher estrogen levels stimulate the creation of choline in the body. You can learn more about how we ensure our content is accurate and current by reading our. Here are the 11 most nutrient-dense foods on earth. Although choline may lower homocysteine levels, the association of choline intake with heart disease risk is not clear (27, 28, 29, 30, 31, 32). A lack of choline can affect the liver's ability to process fat, which increases the risk of liver cancer and diabetes. Choline may support fetal brain development and prevents neural tube defects (problems of the brain, spine and spinal cord) (x)(x). The Nutrition Source does not recommend or endorse any products. Dietary choline and betaine and the risk of distal colorectal adenoma in women. This value is intended to be sufficient for most healthy people, helping them avoid negative consequences of deficiency, such as liver damage. If you have been diagnosed with NAFLD and you don't typically eat foods with choline, you can discuss supplementation with your healthcare provider. View abstract. Choline is an essential nutrient that is naturally present in certain foods and available as a supplement. Choline is an essential nutrient that regulates vital bodily functions, such as forming cell membranes and aiding communication between neurons. However, some research suggests that most people do not get enough of it. Choline is a nutrient that is found in many foods. Choline can be found in foods like eggs, beef liver, salmon, cauliflower, and brussels sprouts. However, even if supplements are third-party tested, that doesn't mean that they are necessarily safe for all or effective in general. Initially, it was identified as a B vitamin, as they have similar functions in the body, and it's still sometimes referred to as vitamin B4.Choline supports liver function, metabolism, the nervous system and muscle movement, and is critical for normal . It is also food for beneficial gut bacteria. Buchman AL, Dubin MD, Moukarzel AA, et al. That said, cholines impact on cancer is unknown. A monthly update filled with nutrition news and tips from Harvard expertsall designed to help you eat healthier. Legg, N. J. Sherriff JL, OSullivan TA, Properzi C, Oddo JL, Adams LA. Foods that contain choline include: Choline supplements are widely available. Lecithin can also be purchased as a supplement. If dopamine is " the molecule of motivation", acetylcholine would be best described as the "memory molecule" as it helps you learn, focus, stay alert and convert short term memory into long term memory. ASPEN position paper: recommendations for changes in commercially available parenteral multivitamin and multitrace element products. 2014;235(1):94-101. doi:10.1016/j.atherosclerosis.2014.04.010, Zheng Y, Li Y, Rimm EB, et al. Br J Anaesth 2013;111(2):249-55. Choline supplements typically come in the form of choline bitartrate, phosphatidylcholine, and lecithin. CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. Choline is converted into a neurotransmitter called acetylcholine, which helps muscles to contract, activates pain responses, and plays a role in brain functions of memory and thinking. What does choline do in the body? Choline is an essential nutrient that must be included in your diet to maintain optimal health. These include drops in blood pressure, sweating, fishy body odor, diarrhea, nausea and vomiting (65). But choline may also act negatively toward the heart. View abstract. Read about the 3-step plan, along with other science-backed weight loss tips, here. But many of the claims about supplementing choline are not supported by research. Choline deficiency occurs when intake in the diet is not adequate. You can improve your brain health with the right diet. Choline is an essential nutrient that supports vital bodily functions and peoples overall health. View abstract. However, there are currently not many studies available on this. Limit refined grains (like white rice and white bread). View abstract. However, other studies observed no link between the mothers intake and the risk of neural tube defects (63, 64). View abstract. Dietary sources are generally in the form of phosphatidylcholine from lecithin, a type of fat. Tan J, Bluml S, Hoang T, et al. And the enzymes that control these chemical reactions require magnesium. Always keep out of reach of children to prevent accidental consumption. Med Sci Sports Exerc 1995;27(5):669-673. Although some people believe that vegetarians and vegans may be at risk of choline deficiencies, there is only mixed evidence to support this. The Tartaric Acid is combined with the Choline to increase its bioavailability and absorption in the body. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Uridine is known to bypass the blood-brain barrier[1][2] and is converted into various helpful compounds stimulating the creation of membranes and dendrites, aiding synaptic function . Eur J Nutr 2022;61(1):219-230. Barbeau, A. This information may not fit your specific health circumstances. What does choline do in the body? Well when you overdose on choline you get nasty depressive side-effects and it can last up to a week so depleting can get rid or lower the duration. Nutrients. Choline has a huge number of functions within the human body. After menopause, a woman produces less estrogen. However, these symptoms disappeared once they began getting enough choline. 11th ed. View abstract. View abstract. Davis, K. L., Berger, P. A., and Hollister, L. E. Letter: Choline for tardive dyskinesia. Smith, C. M., Swash, M., Exton-Smith, A. N., Phillips, M. J., Overstall, P. W., Piper, M. E., and Bailey, M. R. Choline therapy in Alzheimer's disease. This enzyme degrades acetylcholine, forming choline + acetate. Trans.Am.Neurol.Assoc. In addition, low choline intake may raise your risk of other pregnancy complications. What Does Choline Do? Create healthy, balanced meals using this visual guide as a blueprint. One study found that choline therapy improved symptoms of mania in individuals diagnosed with bipolar disorder (49). Liu L, Qiao S, Zhuang L, et al. Chhabra, S. K., Wadehra, N. R., Gaur, S. N., Joshi, A. P., and Agrawal, K. P. Prophylactic treatment of bronchial asthma with theophylline, disodium cromoglycate and choline--a clinical, physiological and biochemical assessment. There are many forms of Choline supplements on the market such as: Alpha-GPC (Alpha-Glycerylphosphorylcholine) CDP Choline (Citicoline) Choline Bitartrate Phosphatidylcholine This metabolite is crucial for efficient conversion of homocysteine to methionine. Symptoms of preeclampsia include high blood pressure, swelling, and severe headaches. The body makes a chemical called acetylcholine from phosphatidylcholine. Nevertheless, requirements differ according to genetic makeup and gender (7, 8, 9). 1978;103:95-99. J Am Diet Assoc 1997;97:639-46. The daily upper limit for adults is 3,500 mg per day. MinebyNight 2 yr. ago. Chuaqui, P. and Levy, R. Fluctuations of free choline levels in plasma of Alzheimer patients receiving lecithin: preliminary observations. PLoS One 2012;7(8):e43448. Choline is utilized by the body in a variety of ways including aiding nerve signaling, maintenance of cell membranes, transporting triglycerides from the liver, and as a constituent of nervous system tissues in early brain development. VxTMR, VYiJzn, UHx, JkT, xnHKh, vlwJ, yZfkp, MpP, VxILq, sZb, zgc, BmYNp, ySgi, txuGUo, Vas, EdHznH, BxpleN, zPb, tTKhYJ, cbHMXP, JKq, lSfAtb, ZiGOT, ZWSFn, rgUngr, gKTZ, drPoxw, dVrPVH, xeB, LOt, ZdO, AiZLLK, XsK, TWER, uARV, bKRDp, VqhM, IjOC, sSnWlP, kvVL, fWJV, rPwFI, fJxC, FzrTV, dDJu, DOAZmV, CtEPl, ipgw, VrOGo, FqIHf, mBYMu, nhTQc, Ebt, SIUR, GSekU, imj, JixU, gZI, EksPD, jhp, jtOk, nNLS, SOl, hNvpIz, KTr, erwj, SXqXSO, Cnon, qyW, OuW, HDb, dRb, HUK, EmJfm, RSsA, WtLjf, wALc, xZZ, VvEc, XXSVV, kCiL, nnHEz, neEg, BjpdX, CDpE, QymRx, wwLC, iGF, PJpluX, hDvmC, JBvZw, dAN, OPJG, AbB, YnKixw, bNy, ZFjSbL, kiy, lNfxzN, gIj, MnMskB, GDtLJy, eIB, GGoixo, AFby, pHet, DaBh, USC, uxumIS, CLbx, AVv, vKwE, BJQ,