Choline Supplementation Accelerates Fat Loss During Crash Diet in Female Athletes: 2g Choline Double the Rate of Fat Loss in the Last Week Before the Competition

Can you hit the fat hard with choline?
I want to be honest with you. I am a huge fan of choline and truly believe that it is hugely under-appreciated, but the prominent relative (not absolute) increase in body fat loss in study at hand must be interpreted with caution - no matter how statistically significant the "choline advantage" may be.

Before we can get to said "cautious interpretation", let's briefly take a look at what exactly Gehan Elsawy, Osama Abdelrahman, and Amr Hamza from the Zagazig University and the Mansoura University in Egypt did to produce a 100% increase in body fat loss in their 22 female study participants (15 taekwondo and 7 judo athletes).
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The idea was to clarify the magnitude of rapid body mass reduction among Egyptian judokas, in order to identify the scientific basis and justification for such practices. In that, the researchers were particularly interested in the effects of choline supplementation on bodymass reduction and leptin levels among their females taekwondo and judo athletes.

The athletes were divided into two groups, according to their body mass; the experimental group contained ten female athletes, and the control group twelve female athletes. At the time of enrollment, all the subjects were healthy, according to a medical information questionnaire, and none of the subjects had any specific dietary restrictions. Exclusion criteria included the use of any medication or supplement during the previous six months.

2.0g per day divided in two 1.0g doses of choline did the trick

For one week prior to a competition, the athletes in the experimental group took choline tablets (1.0 g) twice daily with a meal, equaling a total daily dose of 2.0 g (the scientists don't provide any information on the form of choline, they used, but their references suggest that it was PC, i.e. phosphatidylcholine). The control group received a placebo, and they participated in usual training (with 75% training intensity) at the same time as the choline group four times per week.
"According to Anni et al. (2011), choline supplementation appears to be safe and the authors recommend taking approximately 2.5 g one hour before a prolonged exercise session. The effective dose in sport studies is 0.2 g phosphatidylcholine 90% per kg of the body mass, which equals 2.1 g of choline for an 80-kg athlete. There is no requirement for a loading or maintenance phase and choline supplementation up to one hour before exercise has been shown to be effective in reducing fatigue." (Elsawy. 2014)
There was no standardized diet, there were no diet logs and there was no recording of training intensity and volume. Unfortunately, there was also no investigation of gastrointestinal and serum TMAO levels - TMAO is a substance that is formed when choline (or choline sources like l-carnitine) are metabolized by your gut bacteria. It has been linked to heart disease, but it is (a) not clear if it is causally involved in its development or whether its elevation in CHD is the results of another underlying factor (e.g. dysbiosis) that's the actual driver of inflammation and cardiovascular problems. In their 2015 review, Ufnal et al. describe this problem quite pointedly:
"Several experimental studies suggest a possible contribution of TMAO to the etiology of cardiovascular diseases by affecting lipid and hormonal homeostasis. On the other hand, TMAO-rich seafood, which is an important source of protein and vitamins in the Mediterranean diet, has been considered beneficial for the circulatory system. Although in humans TMAO is known mainly as a waste product of choline metabolism, a number of studies suggest an involvement of TMAO in important biological functions in numerous organisms, ranging from bacteria to mammals. For example, cells use TMAO to maintain cell volume under conditions of osmotic and hydrostatic pressure stresses" (Ufnal 2015).

Janeiro et al. (2018) have recently discussed the causation vs. correlation issue in a paper in Nutrients. They conclude that the question whether TMAO is the "mediator" or a "bystander" in the disease process can, as of now, not be answered conclusively. They do yet provide a list of TMAO lowering foods and supplements that contains prebiotics, probiotics, antibiotics, gynostemma pentaphylium, resveratrol, DMB, meldonium and other agents.
Body impedance a major source of error: The body fat analyses were conducted with Tanita Bioimpedance BC-418 devices. A technique that has only recently been shown to be highly sensitive to changes in body water (Slater. 2014) - changes as they occur regularly in female subjects and changes which could be influenced by the consumption of choline. I mean, generations of bodybuilders have popped choline tablets in an effort to reduce the subcutaneous water and get that cut dry look, judges want to see on stage (learn more).
But let's leave this unresolved issue behind and address the things that were assessed are body weight, body fat (see red box above), serum and urinary choline, as well as back and leg strength.
Figure 1: Changes in leptin, plasma choline, body fat (%), BMI, leg & back strength within the last week of precompetition dieting with or without the addition of 2g of choline (undisclosed form) in a recent study by Elsawy et al. (2014).
Statistically significant differences were observed for plasma choline (obviously), leptin and the change in body fat (-1% vs. -2% in the choline group). It would be nice if we also knew if this affected the food and/or water intake and/or if we had confirmation from DEXA and caliper data that the body fat difference was more than just body impedance b*s* - unfortunately, none of these data are available.
Choline could also boost fat loss by boosting carnitine levels | more
Bottom line: Now, if it was not for the difference in leptin, the study probably wouldn't have made it into the SuppVersity news - a 1% difference, in body fat (%), as statistically significant as it may be, is after all hardly worth mentioning, when it was measured by body impedance in a tranining phase where hypohydration often beomes an issue. In conjunction with the reduced MDA levels, a clear sign of significant anti-oxidant effects of choline, and the general role of choline in the metabolism of fat (Hanin. 1987), which has also been linked to a greater level of satiety (Wurtman. 1977), I am yet willing to say: Adding 2.0g of choline in form of cheap choline bitartrate is certainly worth a try - I mean, what to you have to lose aside from some of the money you would otherwise spend on other unproven fat burners? And yes, I am pretty sure that in case it does work, it will work for both: women, as in the study at hand, and men.
  • Elsawy et al. "Effect of Choline Supplementation on Rapid Weight Loss and Biochemical Variables Among Female Taekwondo and Judo Athletes." Journal of Human Kinetics volume 40/2014, 77-82.
  • Hanin I, Ansell GB. "Lecithin: Technological, Biological, and Therapeutic Aspects". Plenum Press, NY, 180-181; 1987.
  • Slater, Gary. "Assessing Body Composition of Athletes." Sports Nutrition for Paralympic Athletes (2014): 189.
  • Wurtman RJ, Hirsch MJ, Growdon JH. "Lecithin consumption raises serum-free-choline levels." Lancet, 1977; 2: 68-69
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