The “Choline Vegan Crisis”: A Pseudo-Event Ignited By The Media and an Author With Meat and Dairy Support
There are dozens of headlines in the media this week that are scary! The “Choline Crisis “ may be upon us and we are unaware, at least in the UK. Prior to the publication this week of an opinion piece by Emma Derbyshire, Ph.D. in the British Medical Journal (BMJ) Nutrition, Prevention and Health, there was no impending choline crisis recognized. Derbyshire did not publish any original research on choline and health. The publication was a hypothesis about the role of choline in health and the potential risk of the trend towards more plant-based diets. The headlines did not point out that her work was her opinion and lacked any new data. Yet the headlines read:
1) Vegan diets ‘risk insufficient intake’ of nutrient critical for brain health
2) Meat-free diet ‘lacks vital nutrient for healthy brain’
3) Plant-based diets risk ‘dumbing down’ the next generation, nutritionist warns
4) Could we be overlooking a potential choline crisis in the United Kingdom?
Even the British Medical Journal joined in the hype with a newsroom headline that read:
5) Suggested move to plant-based diets risks worsening brain health nutrient deficiency
What Were Dr. Derbyshire’s Summary Points?
· Choline is a critical nutrient needed for neurocognition, lipid metabolism, liver function and homocysteine regulation.
· The majority of Europeans, American, Canadian and Australian populations are not meeting choline AI recommendations.
· Eggs, milk and meat appear to be major dietary providers and further movements away from the consumption of these could have unintended consequences for choline intake/status.
· Ongoing nutrition research must study ‘long-term’ intakes of choline e.g. using food frequency questionnaires rather than 24-hour recalls, which will give a more reliable picture of choline intakes.
· More needs to be done to educate health care professionals and consumers about the importance of a choline-rich diet and how to achieve this.
· If choline is not obtained in the levels needed from dietary sources per se then supplementation strategies will be required, especially in relation to key stages of the life-cycle such as pregnancy, when choline intakes are critical to infant development.
What Are Some Facts to Consider Before You Rush to the Butcher Shop?
1) Easily searchable is the fact that Dr. Derbyshire serves on the expert panel for the Meat Advisory Board, whose purpose is to provide information on meat in a healthy, balanced diet. Her prior work includes funding by the Agriculture and Horticulture Development Board, representing the interests of beef, lamb, pork, and dairy producers. This does not prove a bias, but it does not exclude it either. Clearly, the opinion piece suggested eating meat was healthy.
2) There was no mention of trimethyl-N-amine oxide (TMAO) and choline. TMAO was described in 2011 as a metabolite formed by the ingestion of red meat, egg yolk, and supplements with choline and L-carnitine that promote platelet clumping and atherosclerosis. Elevated levels of TMAO have been associated with higher mortality rates in certain patient groups. Even a brief review of recent original research would have revealed that choline supplements may increase platelet aggregation as has been shown. Derbyshire chose to ignore over 1,000 citations regarding TMAO in the National Library of Medicine.
3) Ignored were Comments by the Academy of Nutrition and Dietetics who published a guideline regarding vegetarian and vegan diets without commenting on a choline crisis.
4) Ignored were Comments by the National Institutes of Health on the rarity of choline deficiency syndromes. This comprehensive document indicated there was insufficient data to establish estimated average requirements for choline.
5) Ignored were data associating a higher dietary choline level and all-cause mortality.
6) The association of choline levels and certain cancers, and their malignant behavior, was not mentioned.
7) Omitted was the fact that of the top 12 dietary sources of choline listed by the National Institutes of Health, 6 are whole plant foods including roasted soybeans, shitake mushrooms, red potatoes, wheat germ, kidney beans, and quinoa with Brussels sprouts, broccoli, and peanuts close behind on the list.
What Has Happened Since the Publication of Crisis Piece?
The Vegan Society published a response to the article by saying “These reports have misrepresented the evidence base and suggested that vegan nutrition is unhealthy due to a lack of choline, particularly for children-this is NOT true”.
The British Dietetic Association spokesperson Bahee Van de Bor said that “You absolutely can meet the requirements with a vegan or plant-based diet. “But you have to have a plan. Foods can be vegan but not provide the necessary nutrients.” A spokesman for the British Nutrition Foundation added: “It’s likely that a healthy and varied vegetarian or vegan diet would provide some dietary choline”.
What to Do?
It is worth studying the table for the content of choline in food types. If you eat a plant-based diet, focusing on a variety of foods, some of which are rich in choline, is a good plan. Choline blood levels are not routine assessments. One would hope that the increase in whole plant foods will lead to an impending crisis of another kind in the UK and across the world: empty hospitals, clinics and pharmacies.