#443: Kevin Klatt, PhD, RD – Can Choline Help Improve DHA Status?

Detailed Study Notes: Episode 443
Kevin Klatt, PhD, RD – Choline

Episode Key Points

• Adequate intake of the omega-3 fatty acid DHA is advised during pregnancy, due to its role in brain and retinal development of the child, as well as decreased risk of preterm birth.
• Ingested DHA gets incorporated into different physiological pools, including the phosphatidylcholine-DHA pool.
• Additionally, pregnancy puts an increased stress on choline metabolism.
• Based on this, it has been hypothesized that choline demands may increase at this time, and that additional choline intake may increase DHA status.
• In a recently published RCT (1), researchers looked at the impact on DHA status in two groups:
  • Intervention
    • Choline 550 mg/d (500 mg + 50 mg tracer)
    • DHA 200 mg/d (algae)
    • Prenatal supplement
  • Control
    • Choline 25 mg/d (0 mg + 25 mg tracer)
    • DHA 200 mg/d (algae)
    • Prenatal supplement
• Results suggest that by supplementing choline alongside DHA (versus DHA alone), DHA bioavailability, and thus status, can be increased.
• This indicates that choline supplementation supports cellular metabolism to more efficiently handle and release DHA from a pregnant individual’s liver, and ultimately be delivered into all tissues, including the placenta.

Introduction to this Episode

A recently published study by Klatt and colleagues (1) examined the impact of choline supplementation alongside DHA supplementation, versus DHA supplementation alone, on DHA status in pregnancy.

It is known that DHA is a critical nutrient at this time for healthy development of the child. And through a number of mechanisms discussed later, it has been hypothesized that choline could lead to greater DHA status.

Terminology/Glossary

• Methyl group: A one-carbon (1C) unit.
• One-carbon metabolism: “One-carbon (1C) metabolism comprises a series of interlinking metabolic pathways that include the methionine and folate cycles that are central to cellular function, providing 1C units (methyl groups) for the synthesis of DNA, polyamines, amino acids, creatine, and phospholipids.” (2)
• Methyl donor: Methyl donors are nutrients that will readily donate a methyl group to another substance. This occurs through the process known as the methylation cycle.
• SAMe: S-Adenosyl-L-Methionine is a chemical in the body made from methionine, an amino acid found in foods. It is a methyl donor (see above).
• PEMT pathway: phosphatidylethanolamine N-methyltransferase (PEMT) pathway
• Isotope tracer: An isotopic tracer is a radioactive atom that can be detected and therefore used to mark the compound we’re examining, so that we can follow what happens to it. Tracer used in the discussed study was deuterium labeled-choline [d9-choline]. Tracers are explained more in the notes below.
• RBC-DHA: DHA found in the red blood cells.
• PC-DHA: DHA found in the membrane of phosphatidylcholine (PC).
• TMAO: Trimethylamine N-oxide (TMAO) is a choline metabolite that has been associated with a range of negative outcomes, mainly in relation to cardiovascular disease (you’ll often hear it discussed in relation to debates about red meat for example). So theoretically there could be an issue with high cholines dosages, however this hasn’t been shown to be problematic.

Episode 418

• Danny and Alan discussed the debate around whether a direct source of the long-chain omega-3 fatty acid DHA should be recommended.
• Based on the current state of the evidence, and the potential risks of DHA inadequacy, it was concluded that taking the ‘precautionary principle’ and getting a direct source of DHA in the peri-pregnancy period was important.
• For those who do not consume food sources of DHA (i.e. oily fish), then supplementation is advised.
• For those consuming a plant-exclusive diet, then this can be achieved with an algae-based supplement.

Episode 432

• Omega-3 fatty acid expert, Dr. Bill Harris was the guest in this episode.
• The role of DHA in brain development (as well as cognition in later life) was discussed at the 41:15 mark.
• Similar to episode 418, Dr. Harris’ conclusion was that, while there are benefits to ALA (the omega-3 fatty acid in plants, that can be converted to EPA & DHA in the body), it is still better to get a direct source of preformed DHA (and EPA).

Episode 441

• Dietitian and maternal nutrition research Dr. Julie Abayomi was on the podcast discussing diet during pregnancy.
• The importance of DHA during pregnancy was discussed at the 25.50 mark.
• DHA is really important for brain and neurological development in the fetus.
• It’s important to ensure adequate intake in early pregnancy
• There are studies that show that women who are deficient in omega-3 fatty acids in pregnancy have an increased risk of miscarriage and gestational diabetes.