Move Over Folic Acid, Choline is Here!
If you live in the United States, you were taught that folic acid, also known as B9 or folate, is a necessary and important vitamin for pregnant women. You were probably told that studies show taking it during pregnancy reduces the risk of Neural Tube Defects (NTD).
Over time, we've since learned that synthetic, unconverted folic acid is detrimental for all people. It increases the risk of cancer, and it is harder for the body to absorb and utilize, resulting in what researchers call a pseudo deficiency. This is where the body is receiving tons and tons of folic acid, but cannot convert it or use it in the methylation cycle, so it remains deficient. This tends to cause high serum levels of folic acid on blood tests, so doctors reassure their clients that they are not deficient.
This caused educated people to begin avoiding folic acid, and all unconverted B vitamins. They moved to methylated vitamins, which are bioavailable and easier to use in the body. This is also important for all the mothers who might have MTHFR or related genetic polymorphisms, to make sure they get enough B vitamins even though their bodies find it harder to absorb and use them.
With all that being said, as the constant drum roll to take tons of folic acid continues and as the fight for methylated B vitamins marches on, what we all need to do is take a look at another nutrient called Choline.
What is Choline?
Choline is typically not considered a vitamin or mineral, but a water-soluble nutrient grouped in with B vitamins. And it's a huge piece of the puzzle that all pregnant and breastfeeding women need to know about right now.
Choline is an important part of the methylation process. So, just like folate, it's necessary to make hundreds of functions work properly in the body. Without choline, homocysteine cannot properly convert to methionine for mental health. Without choline, the liver cannot detox the body properly. Without choline, the brain cannot function or grow properly.
What evidence do we have about Choline's importance?
The importance of choline for pregnant and breastfeeding women is shown in the available medical literature. For example, this study
(https://www.ncbi.nlm.nih.gov/pubmed/25956258) found that MTHFR defects, folate deficiency, or choline deficiency caused organized cell death in the brain and short term memory deficits in offspring.
Another study (https://www.ncbi.nlm.nih.gov/pubmed/26700730) found that not only does a low choline diet for the mother increase the risk of NTDs, it also alters the way the cerebral cortex grows. Even worse, the lead researcher noted that there appeared to be a "sensitive window of time" during neurological development and that even if exposed to adequate choline later down the road, the original damage does not change.
Researchers are also learning through this study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319504/) that choline deficiency is connected to the mechanism of cancer development. These researchers observed that choline deficiency seems to alter the repair of DNA and increase the rate of genetic mutations, which is considered a pathway to cancers.
The evidence is piled up when it comes to this nutrient. But, the most important points for childbearing women include:
Choline is part of homocysteine conversion. High homocysteine levels are associated with increased risk of miscarriage and heart defects.
Choline is necessary to build neurological connections and to balance brain growth for the baby during pregnancy, and after birth in the breastfeeding infant. Choline deficiency is associated with memory problems, lower test scores, depression, and more. It is needed throughout the entire brain, so the problems that can happen here are staggering.
Choline is necessary to build a healthy midline through the brain and spinal cord. Choline deficiency is associated with increased risk of NTDs and midline defects.
Choline is necessary for neurochemical balance in the brain. Altered metabolism of this nutrient is implicated in things such as anxiety and depression. A study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687891/) found that altered levels of it in certain parts of the brain are associated with pediatric depression, even when age and sex matched.
Choline is absolutely vital for healthy liver function, so a deficiency during pregnancy could be associated with several common complications such as pre-eclampsia, HELLP syndrome, and cholestasis.
Choline is excreted in the milk after birth, and continues to support healthy brain growth and methylation during childhood.
With all the focus on folic acid, our society forgot that nutrition is multi-faceted. What's worse is that researchers didn't show much interest in choline, and since it is present in a variety of foods, many health officials still believe that a regular diet is good enough to get ample choline during pregnancy and while breastfeeding.
What they didn't realize is that just like the MTHFR genetic mutation, a large portion of women also have choline mutations. Surzenko, the lead researcher in the study short term memory problems from choline deficiency, laid out this problem succinctly when she said,
“Around 45 percent of women carry a polymorphism in the gene required to produce choline during pregnancy as a response to estrogen, which makes them vulnerable to choline deficiency. Without enough dietary choline, the developing fetuses in these mothers are at a risk for hindered brain development.”
These PEMT mutations could be in a majority of the population, meaning even if women are eating ample amounts of healthy, varied foods, they might not be absorbing enough choline. And for those women who avoid certain foods such as eggs and animal livers, their overall intake might already be severely restricted.
What could be worse?
So, this nutrient is necessary during pregnancy to protect the child from NTDs and to grow the child's brain adequately. It helps to run the methylation cycle, so it's connected to every major system in the body including the immune system, excretion (detox) system, and neurological health. It's vital for liver health and a deficiency can increase the risk of things such as nonalcoholic fatty liver disease and glucose imbalance (PCOS, diabetes, hypoglycemia, etc). A lot of women might have polymorphisms that make it harder for them to obtain this nutrient from food. What could be worse?
Choline is connected to gallbladder health!
How many women are feeling some puzzle pieces slamming together right now? Gallbladder attacks, stones, and pain are so common during pregnancy that it's almost considered a normal pregnancy scenario. Many women are constantly watching their diet to avoid painful attacks, and many more go on to surgically remove their gallbladder for relief. Why? Why would pregnancy seem to trigger a gallbladder to go insane? Choline deficiency starts to create a working picture here. As estrogen creation and usage is increased through things such as pregnancy, it increases the need for methylation to break down this hormone and excrete it from the body.
So conceiving, birthing, and breastfeeding can represent large burdens on the gallbladder and liver through the methylation system. As methylation is disrupted and the body begins to run out of necessary methyl donors such as folate and choline, it switches to a glucose system called glucoronidation. Sugar cravings and hormone swings, a liver that's dying and a finicky gallbladder...is anything sounding familiar yet?
This sticky, substitute bile can't be excreted thoroughly, so it starts to stagnate inside the gallbladder. It basically reduces down until it crystallizes into gallbladder stones.
So, pregnant women who develop gallbladder stones are literally looking at a red flag that they are choline deficient, B vitamin deficient, and have a disrupted methylation cycle. This should be considered somewhat of an urgent crisis and a call for careful, bioavailable supplementation! Instead, women are told to restrict their diet and wait it out!
Choline does not have a well established RDA, as it's been fairly neglected in the medical world until recently. It does not have a very potent toxicity. Massive dosages such as 16,000mg daily are associated with vomiting, odor, and sweating. Various converted forms such as acetylcholine and phosphatidylcholine are now easily available online. It used to be that most companies only offered the precursor and only derived from soy, but these days people can purchase lecithin supplements derived from sunflower seeds.
It's time to spread the word on choline, how it functions in the body, and how it's absolutely vital during the childbearing years. When you hear women complain about joint pain during pregnancy, tell them about choline. When women are worried about pre-e, HELLP, and liver conditions, share a choline link. If you hear of a woman suffering from gallbladder issues, make sure she hears about choline. The doctors likely won't tell anyone about this, so it's up to us to use our tribe to share the information and to empower each other to restore our own health.
Friday, June 23, 2017
Wednesday, February 8, 2017
Are you familiar with the way to determine what is poisonous and what is venomous? The ole rule of thumb goes:
If it attacks you, it's venomous
If you touch it/eat it, it's poisonous
Moved to human relationships, the difference between a venomous person and a poisonous person is that one person attacks you and one person is poisonous simply by being around them. (And both forms of toxicity are important to pay attention to and to protect yourself from regardless.)
Sometimes, it's difficult to discern when a person is struggling versus being passively poisonous, versus being aggressively venomous. I like to use the MIDAS system to help clarify the situation. You can apply the MIDAS system to any relationship or interaction in your life. It does not have to be hetero-romantic. Coworkers, friends, relatives, neighbors...any of them are applicable here.
MIDAS stands for:
Mistake: A rare event, often out of character and related to stress, sickness, loss, etc
Imperfection: A personality flaw, bad habit, or other ingrained deficit that isn't dangerous or violent
Dysfunction: Scripts and worldviews often related to childhood modeling, trauma, and miseducation
Abuse: Activated dysfunctional scripts
Sociopathy/Narcopathy: Sadism, torture, abuse simply for the sake of abusing others
The touch of MIDAS is all about determining how your life on every metaphysical plane (physically, mentally, emotionally, psychologically, spiritually, financially, etc etc) is touched by other people. Whether passively poisoned, or actively injected with venom, how other people act in your relationships does leave an impression on you. Recognizing how and why can help you to build healthy boundaries and make choices that either repair the relationship to a functional level, or help you to escape the relationship.
You know you've been touched by MIDAS when you feel:
Cycles of hope and disappointment
A sensation of being used
Anger coming out in odd or misdirected ways
A lack of purpose or direction in life
Impatience and irritability when others need you (touched out)
Going off a previous conversation I had with SAHMs (Stay At Home Moms) I will use the example of a hetero-romantic relationship where the male partner tosses his dirty laundry on the ground next to the hamper. Notice that this is a fairly minor, non-violent incident. Toxicity doesn't have to be outrageous to still represent dysfunction, abuse, or sociopathy. That's why it's important to look at all the pieces of a relationship instead of trying to gauge health by seriousness alone.
Is it a Mistake? Perhaps he was late for work, not feeling well, distracted by the dog?
Is it an Imperfection? Perhaps he just isn't a good housekeeper, is easily distracted, has choline mutations, ADHD and despite being a great guy, will just never be good at laundry?
Is it Dysfunction? Was he raised to believe the other partner is supposed to do it? Does he think that's lowly work and he's above it?
Is it Abuse? Will he come home angry if you didn't clean up after him? If you complain, will he verbally lash out, give you the cold shoulder, punch the wall?
Is it Sociopathy? Is he playing mindgames, gaslighting you in sneaky ways that others can't see, denying it, making you doubt reality? Do you feel as if you're trapped, drowning, lost, but if you mention anything to others, they think you're unstable or complaining?
In each scenario, the issue was the same, but the toxicity was incredibly different. Recognizing these differences is important to avoid codependency, enmeshment, or other harmful issues from long term exposure to toxicity. Using the same laundry example, how might a person respond differently in each scenario? You're still trying to maintain a long term, loving relationship with mercy and forgiveness, but you don't want to fall into being a doormat or ignoring consistent boundary issues.
If it's a Mistake, it might be a great opportunity to practice love as a verb. To pick up that laundry, to let complaints slide. To text an extra I love you and make sure he's okay. We all have bad days. Now's the chance to show that support to a loved one.
Maybe it's a noted Imperfection, a constant struggle in the household, and even an annoying habit that quietly eats away at relationship balance. In that case, it's time to clarify boundaries and voice frustrations. In such a situation, maybe both people will agree that it's ok to just chill about laundry on the floor, provided he is the one who takes responsibility and cleans it up on designated laundry day. Notice how it involves two people compromising, but still sticking to boundaries. It's his responsibility to clean up after himself just as it's her responsibility to release expectations that might not matter overall. An imperfection tends to be resolved when both people clarify boundaries and grow as individuals.
When it comes to Dysfunction, the most charitable thing to do is to call it out. Being loving in the face of dysfunction is refusing to accept those unhealthy scripts. A case of dysfunction means it's time to involve third parties for mediation and monitoring (such as doctors and therapists.) It's possible for people to carry dysfunctional scripts but not act directly abusive, and that is exactly the right time to begin counseling to see if the relationship can be salvaged.
In cases of Abuse, the most common pitfall is wrongly identifying abuse as an imperfection. This is especially easy to do when comorbid issues are involved, such as substance abuse and mental illness. It can be tempting to dismiss abuse as the person having a hard time, or suffering. If you're aware of your partner's background, you might feel sympathy. "He was raised by an abusive mom, of course this is triggering for him." "He's battling depression and lost his job, his temper is just on edge right now." Imperfection is passive and not related to dysfunction. Violence, including non-physical violence such as emotional and verbal attacks, are Abuse, not imperfection. Working individually with a therapist can help you to discern this clearly so that you can leave the relationship.
Sociopathy seems to be the easiest of all of them, yet it can often be the most difficult to recognize and the hardest by far to resolve. Narcissists, psychopaths, and sociopaths are often quite clever and very obsessed, weaving webs for their victims that can take years to untangle. Always involve third parties (therapists and doctors) individually, for you. Beware of the sociopath's ability to triangulate (use therapists, family members, and doctors against you). Building a personal community away from the sociopath is important to escape.
Keep in mind that even when it comes to Mistakes and Imperfections, they can passively poison you. Depending on the situation and seriousness, these incidents might require healing and counseling. A one time Mistake might be entirely innocent, but can still cause a lot of hurt. In healthy, functioning relationships, Mistakes and Imperfections aren't excused, but resolved openly with both sides working together. If you notice a consistent history of one person constantly having a mistake, or attributing things to imperfection, along with a lack of apology and change, you've moved into sneaky Abuse.
I hope to add more to this concept with later writings. Thanks for reading!