Dizziness and POTS may respond to Choline

[skwag]

From the Linus Pauling Institute

Toxicity

High doses (10,000 to 16,000 mg/day) of choline have been associated with a fishy body odor, vomiting, salivation, and increased sweating. The fishy body odor results from excessive production and excretion of trimethylamine, a metabolite of choline. In the inherited condition, primary trimethylaminuria (also known as “fish odor syndrome”; see the article on Riboflavin), a defective flavin containing monooxygenase 3 (FMO3) enzyme results in impaired oxidation of trimethylamine in the liver. Disease management includes the use of choline-restricted diets in affected individuals (81).

Taking large doses of choline in the form of phosphatidylcholine (lecithin) does not generally result in fishy body odor, because its metabolism results in little trimethylamine. A dose of 7,500 mg/day of choline was found to have a slight blood pressure lowering (hypotensive) effect, which could result in dizziness or fainting. Choline magnesium trisalicylate at doses of 3,000 mg/day has resulted in impaired liver function, generalized itching, and ringing of the ears (tinnitus). However, it is likely that these effects were caused by the salicylate, rather than the choline in the preparation (27).

In 1998, the Food and Nutrition Board (FNB) of the Institute of Medicine established the tolerable upper intake level (UL) for choline at 3,500 mg/day for adults (Table 3). This recommendation was based primarily on preventing hypotension (low blood pressure), and secondarily, on preventing the fishy body odor due to increased excretion of trimethylamine. The UL was established for generally healthy people, and the FNB noted that individuals with liver or kidney disease, Parkinson's disease, depression, or inherited trimethylaminuria might be at increased risk of adverse effects when consuming choline at levels near the UL (27).

Here I've listed some choline supplements followed by their choline content as a percentage.

Choline bitartrate 40%
Citicoline 18%
Lecithin 6% to 10%
Phosphatidylcholine 13%
Alpha GPC 40%
choline chloride 75%

It seems I have a lot of room before bumping into the UL.

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. provides a bit more detail on the subject of large choline doses.

 

[skwag]

In this post from 2013,

The Milner Acetylcholine Protocol for POTS?

adreno suggests large doses of choline might benefit those with POTS. He cites an article,

The Milner Acetylcholine Protocol (MAP) for Management of Cardiac Dysrhythmias

where large doses of choline are used.

The MAP dosing works in a three-stage dose escalation (Table 1). At stage 1 we deliver 500 mg of pantethine and 2000 mg of choline per day. Due to the very short half-life of ACh we are able to tell within one week whether this dose is adequate. If the patient achieves complete symptomatic or objective improvement over the course of the first week then the MAP is maintained at stage 1; if not, we escalate to stage 2. Stage 2 dosing is 1000 mg of pantethine and 4000 mg of choline; after one week we reassess. If resolution of symptoms or objective findings is complete or near complete we stop at stage 2, otherwise we escalate to stage 3. Stage 3 dosing is 1500 mg of pantethine and 6000 mg of choline. Reassessment is made after one week in the same manner as previous stages. It is rare that more than 1500 mg of pantethine will demonstrate further benefit, though we have had patients who needed to escalate the initial dose of choline up to 10 grams before coming under rhythm control.

I am up to 1700 mg choline a day. I feel some mental benefits, but my POTS is largely unaffected (there may be some slight improvement there but it is too early to tell).

 

[skwag]

For those taking choline bitartrate or thinking of doing so, I'm copying a post I made in another thread.

This paper has me a little concerned. It is only a rat study, though.


Urolithiasis in Rats Consuming a dl Bitartrate Form of Choline in a Purified Diet

Urolithiasis is a significant clinical problem in human and
veterinary medicine (2, 3, 19, 27, 28, 37), but the role of dietary
racemic bitartaric acid in this disease is only now becoming
appreciated.Levotartaric acid is a natural and soluble form found
in many foods and certain wines. This l isomer is excreted by
the kidney and appears to be biologically inert, but the racemic
version (dl) accumulates in the kidney and induces structural
changes consistent with crystalluria, a precursor of urolithiasis
(4, 6, 10). As evidenced in the outbreak described here, racemic
bitartaric acid is a potent inducer of urolithiasis. By the time
breeder (F0) rats in the present study were 28 months old and
their offspring (F1 rats) were 16 to 19 months old, the mortality
rate was nearly 30%.

The racemic bitartrate appears to be slightly cheaper and thus more likely to be in supplements, so we might worry that any given choline bitartrate supplement is actually choline DL bitartrate. It might be wise to verify with the manufacturer which form is used. The non-racemic form, chloine L bitatrate is available. For example here. The same company also sells the DL-bitartrate form, which appears to be much more popular.

I have not been able to find any information about human consumption of racemic bitartrate, good or bad. I feel like I'm missing something because the DL bitartrate is commonly sold and we don't hear about any kidney issues. If anyone can clarify the situation, please do.

 

[skwag]

An update.

I took roughly 3000 mg choline along with 600 mg pantethine for a little over one week. Unfortunately, I saw no benefits in regards to OI/POTS. At this point, I do not intend to try any higher doses.

At lower doses, I feel the choline offers some mental benefits, but at the higher doses everything seems to get a little mushy mentally.

 

[halcyon]

At lower doses, I feel the choline offers some mental benefits, but at the higher doses everything seems to get a little mushy mentally.

What form of choline are you taking?

 

[skwag]

During my trial I was taking

• 3x300 mg Alpha GPC
• 3x250 mg Citicoline
• 5x500 mg choline (as choline L-bitartrate)

Right now I'm taking 2x300 mg Alpha GPC and 2x250 mg Citicoline. When I first tried the Citicoline, I found the mental benefit from that all by itself. I have yet to try Alpha GPC on its own.

 

[halcyon]

Yeah, I believe alpha GPC is very good at increasing brain levels of acetylcholine. I can't take it with anything else that increases choline availability in the body or I get the negative mental effects. I've been able to take large amounts of choline citrate by itself without that problem though.

 

[ahmo]

Yeah, I believe alpha GPC is very good at increasing brain levels of acetylcholine.

Does this make it excitatory, do you know? I'm using citicoline, curious whether Alpha might add any benefit. thx.

 

[halcyon]

Does this make it excitatory, do you know? I'm using citicoline, curious whether Alpha might add any benefit. thx.

I've never felt that way from it, no. When you get too much it feels like you're moving and thinking underwater. I've taken both CDP and GPC but never together so I'm not sure how that would go.

 

[NilaJones]

I tried a bit of choline bitartrate yesterday (before I read this thread). KDM had prescribed it.

It seemed to have a mild (at my small dose) stimulant effect in the daytime. Some mild trouble sleeping at night -- and very vivid dreams!

The wikipedia article on choline says it is deficient in almost everyone, and worse if folks with methylation SNPs.

Cruciferous vegies like broccoli, greens, etc. are high in choline. I crave them relentlessly even while taking folate, and feel better when I eat them in large quantities, so there is SOMETHING in them I need.

 

[ahmo]

I used choline bitartrate for a year or two, until I read that it's not good for heart. That's when I switched to an expensive phosphotidyl choline supp. And from there, moved to citicoline. + sunflower lecithin.

I've now added AlphaGPC choline. I was concerned about a possible excitatory effect. No worries. This addition has had a big impact on my need for antioxidants as well as more mental clarity. Then I found this article, recommending taking it w/ coffee to amplify results. Happily, I resumed coffee not long ago, and started taking the choline at the same time. This seems even better.
http://www.ilifelink.com/cdp-choline_and_alpha_gpc_what_to_feed_your_head.html

 

[NilaJones]

Hi ahmo!! Thanks for the update. And nice to see you. I haven't been around for a while .

 

[ahmo]

Hi @NilaJones Away because you've been doing so well, I hope. Happy 2016.

 

[NilaJones]

Hi @NilaJones Away because you've been doing so well, I hope. Happy 2016.

Hah, I just deleted my own inquiry about how YOU are doing, thinking maybe I should pm instead. But I think if it is your thread and an old one social chat is cool!

So, how are you???

I tried some KDM antibiotics this summer, which threw me for a loop. Very limited diet for 6 months while recovering, lost a lot of weight. Also dealing with veterinary stuff in the household. No crash, though! Been holding at a steady state, and now feel up for trialing some things, hence the choline. May even get up the courage to crack open my bottle of LDN.

 

[ahmo]

Brilliant that you're well enough for trying things. It will be wonderful if LDN works for you.

I'm pretty excellent. My interventions of 2015 have nearly eliminated all my symptoms, except lack of energy, mental and physical. I also have had no crash for a very long time. Antioxidants!

I also had events recently. My old girl died, and after a lot of contemplation, I resolved to be life-affirmative, to take a punt on continuing good health, and got a beautiful 8 month old . Now 5 weeks with me, I'm no longer thinking I'd made a grave error. so sweet. cheers, Nila, stay well.

 

[NilaJones]

Oh, that is great news!!

So, what are the things that have helped? I have done nothing new since histamine diet and b vitamins individually, not in a blend.

And is your new sweetie dog, cat, or other?

 

[Crux]

I'm taking citicoline now, along with 2 eggs daily.

I had stopped eggs a while back to see if they caused problems. After a couple of months, I became dizzy with vertigo again....thought I solved all that with B12.

After reading about acetylcholine deficiency causing pots, dizziness, etc., it's resolved again.

It's not the choline itself that causes heart disease by increasing tmao; it's the gut bacteria that steal choline, then dump tmao, tma, etc.

There are so many gut microbes that produce tma, and tmao, it can be confusing.
http://mbio.asm.org/content/6/2/e02481-14.full

Chris Kresser discussed it a few years ago:
http://chriskresser.com/choline-and-tmao-eggs-still-dont-cause-heart-disease/

A recent study claims that the compound DMB, may inhibit the production of tma which would in turn reduce the tmao made from it :
https://en.wikipedia.org/wiki/3,3-Dimethyl-1-butanol

DMB is found in balsamic vinegar, extra virgin olive oil,grapeseed oils, and red wine.

 

[ahmo]

@NilaJones OK, a bit more off topic. Meet Olivia: ta da

 

[NilaJones]

Oh, adorable!

And thanks @Crux, for the info! It's amazing how gut bacteria research is going by leaps and bounds.

 

[NilaJones]

Well, after a second dose I think the choline bi is not good for me. Do you folks think a different form would avoid the problems I am having, or should I just not take any?

The problem is, it seems not to increase my energy, but my motivation to do stuff despite feeling bad. And then I do stuff and then I feel worse. (I have too much of this tendency anyway )

I am intrigued by @Dufresne's theory upthread, that bad effects may be from depletion of something else. But what?