Should you supplement with choline for anxiety? New neuroscience research suggests that people with anxiety disorders have lower levels of choline in the brain compared to those without anxiety. In this post I explain what choline is, how it supports acetylcholine and the nervous system, and what this study does—and does not—mean with regards to choline for anxiety.
What Can We Learn about Choline for Anxiety?
In this post, you’ll learn about choline for anxiety. Here’s some fascinating research that just came out. People with anxiety have less choline in the brain than those without anxiety disorders. Anxiety disorders are a complex condition that are fueled by many contributing factors. But up to 30% of the population has one, this includes general anxiety disorder, social anxiety, panic disorder and phobias. And I often experience more anxiety than I’d prefer. I work hard to manage it.
Anxiety is not just a mindset problem.
It’s a whole-body nervous system state. Our brain is a physical organ that needs physical nutrients to function properly.
And research is increasingly showing that nutrients—like choline—may play a role in how calm, flexible, and resilient your brain can be under stress.
There’s a lot of garbage on the internet about magical supplements that will cure anxiety or depression. Most of the supplements just don’t show results when rigorously researched. But what if supplementing with choline gave your brain the nutrient it’s missing? Let’s take a look at this study and see what we can learn.
Quick disclaimer: I am not a doctor nor a researcher. I’m a therapist who boils down information to make it accessible. So here are my questions and what I learned.
New Research on Choline for Anxiety: Is the Study Trustworthy?
This recent study was published in the Nature Journal Molecular Psychiatry, which is very trustworthy and peer reviewed. It’s a high-quality journal.
This study was a meta-analysis. It analyzed data from 25 studies that included 370 people with anxiety disorders and 342 people without. (This is not a huge number of participants, but it’s not tiny either.)
What they found: people with anxiety had 8% less choline on average than people without anxiety.
“This is the first meta-analysis to show a chemical pattern in the brain in anxiety disorders” says Jason Smucny, co-author and assistant professor. (You might remember that in 2023 a huge UCL meta-analysis came out showing that there was no evidence for low serotonin being associated with depression, yeah, youtube shut down my video on that).
How did they study it? (It’s hard to get into the brain w/o damaging it)
They used an MRI machine to do a ¹H-MRS which is a chemistry report that tells you what molecules are present and how much. (I have no idea how it works). They also checked for a bunch of other chemicals and did not find other differences.
What Is Choline? The Link Between Nutrients and Anxiety Brain Chemistry
Choline is “a cation with a chemical formula [(CH3)3NCH2CH2OH]”. I don’t know what that means. But here’s what I learned: It’s an essential nutrient that’s often grouped with B vitamins (even though it isn’t a B vitamin). It plays a key role in metabolism and maintaining cell membranes. This is all vital for memory, mood and muscle movement. The body only produces a small amount of choline so most must come from dietary sources.
Choline is also essential to making acetylcholine, a neurotransmitter involved in attention, memory, and nervous system regulation
Acetylcholine is a key chemical used by the parasympathetic nervous system—the “rest and digest” system.
It helps:
- Slow your heart rate
- Lower physical anxiety
- Shift you out of fight-or-flight
- Support relaxation and recovery
If acetylcholine signaling is weak, your nervous system may get in flight or flight, even when you know you’re safe. When anxiety is high, acetylcholine tends to drop—making it harder to learn new coping skills while you’re anxious.
Acetylcholine is also associated with attention, concentration and mental clarity. That’s why you’ll often see acetylcholine mentioned in ADHD or cognitive research, like Alzheimer’s research.
Now, the reason I’m going through these questions is when you hear about a supplement for anxiety or depression, it’s really important that you ask good questions. So this is how I’m going through this. I’m checking to see if it’s a real study. I’m trying to understand what they found, and what they’re researching. And I think a lot of information around supplements is just overblown.
So here’s the next really important question about this study: is it cause or effect?
If choline is low, your system may struggle to downshift from Fight or Flight, or to think clearly to solve stressful situations.
That doesn’t cause anxiety on its own—but it can make anxiety harder to regulate.
We know that choline isn’t the only factor in the brain. The amygdala can be overactive, the pre-frontal cortex can be underactive, and there can be too much norepinephrine. (I had to look that one up. I thought, is this the brain chemical that is like adrenaline, but in the brain? So I looked it up, and yes, it is.) Norepinephrine triggers the FFF response. Plus, experiences, like trauma, and habitual responses, like avoidance, can wire the brain to increase your anxiety. There’s a lot going on here. So…
Choline for Anxiety: Is Low Choline a Cause or Effect?
Is this lower choline that we’re seeing in the brain a cause of anxiety, or an effect of anxiety?
Just because it’s lower doesn’t mean that choline deficiency causes anxiety
It’s totally possible that the constant fight-flight-freeze response leads to a depletion in choline, rather than a depletion in choline leading to a constant fight-flight-freeze response. We just don’t know.
This does suggest something important: anxiety may be associated with differences in brain chemistry and nutrient availability—not just thought patterns or coping skills.
That matters because it moves us away from shame and toward systems thinking. We can take a holistic approach to support various parts of our brain and body ecosystem to experience more wellness.
Do Anxiety Supplements Help? What the Science Says
And here’s the really big question: do supplements—such as choline for anxiety—help?
Jason Smucny, who was one of the researchers, said “It suggests that nutritional approaches, like appropriate choline supplementation, may help restore brain chemistry and improve outcomes for patients.”
Some large observational studies show that higher plasma choline is associated with lower anxiety symptoms, though not necessarily lower depressive symptoms in adults. Anxiety and depression are closely linked, which is why I bring up the depression studies.
And there’s one active trial on choline supplementation with adults with depression but the results aren’t out yet. There are a few limited studies showing some benefit for choline supplementation for kids with ADHD, but they are small sample sizes and limited studies.
One of the things we see with studies around supplements is that they use a different type of supplement. There are some studies and clinical trials that touch on citicholine supplementation in relation to anxiety, depression, and ADHD or attention-related symptoms, but the evidence is limited and mixed. Most research so far isn’t definitive enough to say choline treats anxiety, depression, or ADHD, but it does show patterns and possibilities worth understanding and researching with large sample sizes. And that’s what almost any research paper says: we should study this more.
Here’s what we do know.
The body only produces a small amount of choline so most of it must come from dietary sources. And many US kids don’t get the recommended daily amount.
While we wait for more research, perhaps consider adding more foods with choline– omega 3 fatty acids, salmon, beef liver, egg yolks, beef, chicken, fish, soybeans, and milk. Also beans and legumes, and cruciferous vegetables. (That’s another one I had to look up, and basically it’s broccoli and Brussels sprouts.)
My Verdict on Choline for Anxiety: Supplements vs. Proven Solutions
Let me be very clear here:
- This research is early.
- It’s correlational, not causal.
- And choline is not a magic fix.
You don’t need to rush out and buy supplements. Talk with your doctor.
And always remember with supplements, more is not always better—especially with supplements we haven’t studied enough. Too much Choline can make you smell like a fish and can harm your liver in addition to other side-effects.
What do we know that does help restore our wellness ecosystem?
Here’s a bunch of stuff that has a lot more decades of research showing it is effective for anxiety:
- Sleep
- Exercise
- Nutrition – sticking to the Mediterranean diet can decrease risk by 30%
- Skills learned in therapy, including CBT and exposure therapy
- Meditation
- Nature time
- Social support
So what am I going to do about this information? I’m going to go make some deviled eggs, mostly because they’re delicious. I’m going to try to eat healthier in general.
Break the Anxiety Cycle in 30 Days
If you’d like to learn the skills to retrain your brain to be less anxious from a cognitive behavioral approach, you could check out my online course Break the Anxiety Cycle in 30 Days. It’s part of my membership. You’ll learn the hidden thing that’s keeping your brain anxious, how to actually stop worrying (or at least decrease it by 90%), how to gradually face your fears, and more about the mind-body connection with anxiety and the nervous system.
