Anxiety can interfere with a person’s life, but what does it do to a person’s brain?
A recent meta-analysis of studies found choline — an essential nutrient — was 8% lower in the brains of people with social anxiety disorder, generalized anxiety disorder and panic disorder compared to people without those mental health conditions.
That might not sound like much, but it’s an unusually large deficit, says Dr. Richard Maddock, senior author of the study and a professor of psychiatry and behavioral sciences at UC Davis Health.
He has treated patients with anxiety and studies chemical abnormalities in people with psychiatric disorders.
“This is among the largest abnormalities I’ve seen,” Maddock tells TODAY.com.
“The brain runs a tight ship. It doesn’t usually let things get too out of balance. So that’s a sizable change.”
Maddock became intrigued by the phenomenon while using MRI scanners to measure the concentration of important molecules in the brain in living patients. He kept noticing choline levels tended to be low in the anxious patients.
The question is: Do low levels of choline actually promote anxiety, or are they a red flag that someone is experiencing it? The answer is unclear, Maddock says. One possibility is that people with anxiety disorders use up more choline, so their levels in the brain drop.
Previous studies also suggest not getting enough choline may make a person a little more prone to anxiety or perhaps less capable of regulating it, he notes.
Almost one-third of U.S. adults, 31%, will experience an anxiety disorder at some time in their lives, according to the National Institute of Mental Health.
It’s the most common mental illness in the U.S., marked by persistent anxiety that can interfere with daily life, the Anxiety & Depression Association of America notes.
What Is Choline?
Choline is an essential nutrient the body needs, but doesn’t make enough of on its own, so it needs to come from the diet, says Lisa Young, Ph.D., a registered dietitian and adjunct professor of nutrition at New York University.
Researchers have called it the “underconsumed and underappreciated” essential nutrient.
Most people in the U.S. don’t get an adequate amount of choline, according to the National Institutes of Health.
Choline and the Brain
The small molecule is an essential part of cell membranes. That’s important for the brain, which has an extensive system of cell membranes, Maddock says.
“All the neurons branch out extensively and communicate with each other, so there’s more of a requirement for choline in these complicated branching membranes in the brain than in pretty much any other tissue,” he notes.
Choline is also needed to produce acetylcholine, a neurotransmitter for brain and nervous system functions, the NIH notes.
“Because of choline’s role with…brain signaling as part of acetylcholine, the neurotransmitter, it does play a role in mood health and also mental health,” Young says.
Studies show animals deprived of choline don’t learn very well, Maddock adds. That could have consequences for psychotherapy — the treatment of choice for most people with anxiety disorders, he notes.
Therapy is all about learning new ways to regulate emotional reactions, so low choline might impede a person’s ability to learn their way out of stressful situations and manage their reactions, he says.
Which Foods Are High in Choline?
Foods rich in choline include:
Meat, especially beef liverPoultryFish, including canned tuna and salmonEggs, especially the yolkDairy products such as milk and yogurtLegumes, including kidney beans, navy beans and peasVegetables, particularly cruciferous options like Brussels sprouts, broccoli, kale, collards and bok choy. Other vegetable sources include soybeans, potatoes and shiitake mushrooms
Since choline is found predominantly in animal-derived foods, vegetarians and vegans may be at greater risk for not getting enough, researchers say.
Choline enters the brain most efficiently when there are also plenty of omega-3 fatty acids in the diet, Maddock says. He recommends people take an omega-3 fatty acid supplement along with foods rich in choline, such as eggs. Or choose foods such as salmon, which contain both omega-3 fatty acids and choline.
Should I Take a Choline Supplement?
Both Young and Maddock advise against taking a choline supplement.
“You should be able to get plenty of choline from your diet,” Maddock says.
“Food first, and if you have anxiety, talk to a therapist and see what they advise,” Young adds. “I would do food before I started taking the supplement for sure.”