The impact of phosphatidylcholine deficiency  

The human body relies on a myriad of vitamins and minerals to function properly; when we are deficient in one or more areas, dysfunction and disease are the eventual result. Phosphatidylcholine is one of the most critical. Over time, a phosphatidylcholine deficiency can contribute to life-limiting illness, from liver and lung disease to Alzheimer’s. 

Read on to discover what recent research has shown about the importance of maintaining proper levels of this nutrient. 

Phosphatidylcholine: Lipid function

Phosphatidylcholine (PC) is a phospholipid attached to a choline particle. It is built around a glycerol molecule, which is a three-carbon molecule. Two of the carbons are attached to fatty acids and the third is attached to phosphorylcholine (which is also known as choline phosphate and is found in lecithin). Think of its structure as a choline head, a glycerol body and two fatty acid legs.    

There are different varieties of PC because of variations in the fatty acids in the “legs.” This is important because PC is taken to improve the quality of the cell membrane. Since the structure of the molecule contains fatty acids, the quality of the fatty acids consumed matters.^1,2 Hydrogenated and partially hydrogenated oils, and the dead vegetable oils commonly found on grocery store shelves, will be detrimental to the cell membrane, even when PC is taken as a supplement. When supplementing with PC, make sure the patient is consuming good fats in the diet; you may also consider giving a good fatty acid supplement. 

More than 95% of the body’s store of choline is found in PC. Methyl group availability is crucial for protein and nucleic acid synthesis and pH regulation. PC acts as a slow-release source for choline. Malnourished individuals with low choline frequently display fatty liver and related problems. These patients often respond favorably to PC supplementation.  

Lipids and the brain

The brain and nervous system have a high content of lipids and phospholipids. It was noticed that in Alzheimer’s disease and dementia patients that the neurotransmitter acetylcholine is produced by depleting PC from the brain. Publications from the late 1980s and 1990s suggested that decreased brain phospholipid levels and alterations in brain phospholipid metabolism could be connected with Alzheimer’s disease. The authors of one study stated, “It has been hypothesized that the selective vulnerability of certain brain cholinergic neurons in Alzheimer’s disease may reflect the unique way that choline is utilized by these neurons, i.e. not only as a component of major membrane phospholipids, e.g. phosphatidylcholine (PC), but also as a precursor of their neurotransmitter, acetylcholine (ACh). 

“Taken together these data demonstrate that cholinergic neurons utilize the choline stored in PC to synthesize ACh; that this process may lead to a depletion in membrane phospholipids (when choline supply is inadequate); and that the resulting changes in neuronal membrane composition might adversely affect cellular viability.”³ 

Because of observations like this, several studies looked at giving phosphatidylcholine, choline and acetylcholine precursors to patients with dementia and Alzheimer’s disease. Most of the studies showed supplementation in this manner did not improve cognition and memory; although giving PC as a “memory pill” to Alzheimer’s patients may not be a great way to design a study to test its value to the brain. 

PC may be valuable for long-term health of the brain and nervous system. It may be possible to slow the progression of dementia by replenishing the phospholipids in the brain. 

There are studies that show the benefits of PC supplementation to the nervous system. One double-blind study involving 80 college students found that a single dose of PC helped explicit memory.⁴ Animal studies have shown that PC supplementation protects the brain from dementia and even improves memory.^5,6 

PC is useful for the health of the brain tissue itself. One study looked at 72 cognitively intact adults between the ages of 65 and 75. They found that higher PC levels were associated with thicker grey matter in the prefrontal cortex and with cognitive flexibility.⁷ The authors stated, “These results suggest that particular nutrients may slow or prevent age-related cognitive decline by influencing specific structures within the brain. This report demonstrates a novel structural mediation between plasma phosphatidylcholine levels and cognitive flexibility.” 

PC provides the main structural component of the cell membrane. In addition to providing structural support and regulating membrane fluidity, PC also acts as a precursor for intracellular messenger molecules that are central to cell signaling and thereby influence cell function. 

Liver health

One of the best researched uses of PC is in ameliorating liver damage. There are many studies showing its benefit for patients with both alcoholic and non-alcoholic fatty liver.^9-12 

PC use in both hepatitis B and hepatitis C patients has been studied and found to have a positive effect.^13-16 The authors of one study stated, “In a prospective double-blind trial, polyunsaturated phosphatidyl choline therapy (3 g/day) was given in addition to normal maintenance immunosuppressive therapy to 15 patients with HBsAg negative chronic active hepatitis. Histological evidence of disease activity was significantly reduced in the phospholipid-treated group. The results indicate that polyunsaturated phosphatidyl choline is of value as additional treatment in the management of patients with HBsAg negative chronic active hepatitis whose disease is inadequately controlled with conventional doses of immunosuppressive therapy.”13 

Consider using PC as an adjunct in treating liver disease.^17,18 PC also enhances the effectiveness of silybin in protecting from liver damage.^19-20 

Digestive system optimization

When you think of PC, think of cellular repair. Inflammatory bowel disease is all about damage to the cells lining the intestine, and patients can benefit from PC supplementation. Studies have shown that PC supplementation is extremely helpful to patients with ulcerative colitis.^22-24 

One study, a double blind, randomized, placebo-controlled study, was performed in 60 patients with chronic active, non-steroid-dependent, ulcerative colitis. Clinical improvement was seen in 90% of the patients given PC, with 53% of them going into remission.²²  

PC is good to give to patients taking NSAIDs. Studies show PC can reduce the damage done to the GI tract by these drugs.^25-26 One study compared the use of ibuprofen to the use of ibuprofen fortified with PC in arthritis patients. The authors of the study concluded, “Ibuprofen-PC is an effective osteoarthritic agent with an improved GI safety profile compared with ibuprofen in older OA patients, who are most susceptible to NSAID-induced gastroduodenal injury.”²⁷ 

Lung function

The surfactant of premature babies is abnormally low in PC. Treatment with exogenous surfactant containing PC is the standard therapy for infants with, or at risk of having, respiratory distress syndrome. 

PC may also be beneficial to patients with asthma. Inhalation of nanoparticles of PC improved lung function tests in asthmatics, according to one study.²⁷ Another study found a combination of PC and iodine was also found to be effective in relieving the symptoms of patients with childhood asthma.²⁸ In general, this combination seems to benefit patients with allergies.^29-30 

Final thoughts

Phosphatidylcholine intake is critical to keeping your body functioning properly. Recommending the testing of these levels to all your patients can help you head off a variety of health issues before they become major problems, and supplementing (or changing the diet) to improve these levels can only help your patients with whatever issues they come to you with.  

PAUL VARNAS, DC, DACBN, is a graduate of the National College of Chiropractic and has had a functional medicine practice for 34 years. He is the author of several books and has taught nutrition at the National University of Health Sciences. For a free PDF of “Instantly Have a Functional Medicine Practice” or a patient handout on the anti-inflammatory diet, email him at paulgvarnas@gmail.com. 

References 

1. Hodson L, et. al. Effect of supplementation with flaxseed oil and different doses of fish oil for 2 weeks on plasma phosphatidylcholine fatty acids in young women. Eur J Clin Nutr. 2018;72(6):832-840. PubMed. https://pubmed.ncbi.nlm.nih.gov/29849178/. Accessed Dec. 19, 2023. 
2. Clore JN, et. al. Changes in phosphatidylcholine fatty acid composition are associated with altered skeletal muscle insulin responsiveness in normal man. Metabolism. 2000;49(2):232-238. PubMed. https://pubmed.ncbi.nlm.nih.gov/10690951/. Accessed Dec. 19, 2023. 
3. Blusztajn JK, et. al. Phosphatidylcholine as a precursor of choline for acetylcholine synthesis. J Neural Transm Suppl. 1987;24:247-259. PubMed. https://pubmed.ncbi.nlm.nih.gov/3316498/. Accessed Dec. 19, 2023. 
4. Ladd SL, et. al. Effect of phosphatidylcholine on explicit memory. Clin Neuropharmacol. 1993;16(6):540-549. PubMed. https://pubmed.ncbi.nlm.nih.gov/9377589/. Accessed Dec. 19, 2023. 
5. Ulus IH, et. al. Choline increases acetylcholine release and protects against the stimulation-induced decrease in phosphatide levels within membranes of rat corpus striatum. Brain Res. 1989;484(1-2):217-227. PubMed. https://pubmed.ncbi.nlm.nih.gov/2713682/. Accessed Dec. 19, 2023. 
6. Chung SY, et. al. Administration of phosphatidylcholine increases brain acetylcholine concentration and improves memory in mice with dementia. J Nutr. 1995;125(6):1484-1489. PubMed. https://pubmed.ncbi.nlm.nih.gov/7782901/.  Accessed Dec. 19, 2023. 
7. Zamroziewicz MK, et. al. Inferior Prefrontal Cortex Mediates the Relationship between Phosphatidylcholine and Executive Functions in Healthy, Older Adults. Front. Aging Neurosci. 2016;(8). Frontiers. https://www.frontiersin.org/articles/10.3389/fnagi.2016.00226/full. Accessed Dec. 19, 2023. 
8. Barbeau A. Lecithin in Parkinson’s disease. J Neural Transm Suppl. 1980;(16):187-193. Springer Link. https://link.springer.com/chapter/10.1007/978-3-7091-8582-7_21. Accessed Dec. 19, 2023. 
9. Kidd PM. PhosphatidylCholine [Monograph]. Alternative Medicine Review. 2002;7(2):150. Research Gate. https://www.researchgate.net/publication/316996993_PhosphatidylCholine_Monograph. Accessed Dec. 19, 2023.  
10. Horejsova M, Urban J. The effect of polyene phosphatidylcholine (Essentiale forte) in the treatment of liver steatosis and ultrasound findings–preliminary study. Cas Lek Cesk. 1994;133(12):366-369. PubMed. https://pubmed.ncbi.nlm.nih.gov/8069893/. Accessed Dec. 20, 2023. 
11. Tandy S, et. al. Hydrogenated phosphatidylcholine supplementation reduces hepatic lipid levels in mice fed a high-fat diet. Arteriosclerosis. 2010;1(213):142-147. PubMed. https://pubmed.ncbi.nlm.nih.gov/20832797/. Accessed Dec. 20, 2023. 
12. Lieber CS, et. al. Phosphatidyl-choline protects against fibrosis and cirrhosis in the baboon. Gastroenterology. 1994;106:152-159. PubMed. https://pubmed.ncbi.nlm.nih.gov/8276177/. Accessed Dec. 20, 2023. 
13. Use of polyunsaturated phosphatidyl choline in HBsAg negative chronic active hepatitis: results of prospective double-blind controlled trial. Liver. 1982;2(2):77-81. PubMed. https://pubmed.ncbi.nlm.nih.gov/6757621/. Accessed Dec. 20, 2023. 
14. Visco G. Polyunsaturated phosphatidylcholine (EPL) associated with vitamin B-complex in the treatment of acute viral hepatitis-B. LaClinica Terapeutica. 1985;114:183-188. PubMed. https://pubmed.ncbi.nlm.nih.gov/3902335/. Accessed Dec. 21, 2023. 
15. Ilic V, Begic Janev A. Therapy for HBsAg-positive chronically active hepatitis. Med Welt. 1991;42:523-525. EurekaMag. https://eurekamag.com/research/007/946/007946928.php. Accessed Dec. 20, 2023. 
16. Niederau C, et. al. Polyunsaturated phosphatidylcholine and interferon alpha for treatment of chronic hepatitis B and C: a multicenter, double-blind, placebo-controlled trial. Hepatogastroenterol. 1998;45:797-804. PubMed. https://pubmed.ncbi.nlm.nih.gov/9684137/. Accessed Dec. 20, 2023. 
17. Essential phospholipids in the treatment of alcohol-related liver disease: clinical and experimental study. Eksp Klin Gastroenterol. 2014;(10):28-32. PubMed. https://pubmed.ncbi.nlm.nih.gov/25911927/. Accessed Dec. 20, 2023. 
18. Hayashi H, et. al. Beneficial effect of salmon roe phosphatidylcholine in chronic liver disease. Curr Med Res Opin. 1999;15(3):177-184. PubMed. https://pubmed.ncbi.nlm.nih.gov/10621924/. Accessed Dec. 20, 2023. 
19. Loguercio C, et. al. Silybin combined with phosphatidylcholine and vitamin E in patients with nonalcoholic fatty liver disease: a randomized controlled trial. Free Radic Biol Med. 2012;52(9):1658-1665. PubMed. https://pubmed.ncbi.nlm.nih.gov/22343419/. Accessed Dec. 20, 2023. 
20. Buzzelli G, et. al. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol. 1993;31(9):456-460. PubMed. https://pubmed.ncbi.nlm.nih.gov/8225695/. Accessed Dec. 20, 2023. 
21. Stremmel W, et. al. Phosphatidylcholine for steroid-refractory chronic ulcerative colitis: a randomized trial. Ann Intern Med. 2007;147(9):603-610. PubMed. https://pubmed.ncbi.nlm.nih.gov/17975182/. Accessed De. 20, 2023. 
22. Retarded release phosphatidylcholine benefits patients with chronic active ulcerative colitis, Gut. 2005;54(7):966-971. PubMed. https://pubmed.ncbi.nlm.nih.gov/15951544/. Accessed Dec. 20, 2023. 
23. Stremmel W, et. al. Delayed Release Phosphatidylcholine is Effective for Treatment of Ulcerative Colitis: A Meta-Analysis. Dig Dis. 2021;39(5):508-515. Europe PMC. https://europepmc.org/article/MED/33440385. Accessed Dec. 20, 2023. 
24. Karner M, et. al. First multicenter study of modified release phosphatidylcholine “LT-02” in ulcerative colitis: a randomized, placebo-controlled trial in mesalazine-refractory courses. Am J Gastroenterol. 2014;109(7):1041-1051. PubMed. https://pubmed.ncbi.nlm.nih.gov/24796768/. Accessed Dec. 20, 2023. 
25. Cryer B, et. al. Low-dose aspirin-induced ulceration is attenuated by aspirin-phosphatidylcholine: a randomized clinical trial. Am J Gastroenterol. 2011;106(2):272-277. PubMed. https://pubmed.ncbi.nlm.nih.gov/21081908/. Accessed Dec. 20, 2023. 
26. Lanza FL, et. al. Clinical trial: comparison of ibuprofen-phosphatidylcholine and ibuprofen on the gastrointestinal safety and analgesic efficacy in osteoarthritic patients. Aliment Pharmacol Ther. 2008;28(4):431-442. PubMed. https://pubmed.ncbi.nlm.nih.gov/18549459/. Accessed Dec. 20, 2023. 
27. Lisitsa AV, et. al. Experience with the use of phospholipid preparations in the combined treatment of bronchial asthma. Klin Med (Mosk). 2012;90(12):16-21. PubMed. https://pubmed.ncbi.nlm.nih.gov/23516864/. Accessed Dec. 20, 2023. 
28. Kawano Y, et. al Effect of lecithin-bound iodine on the patients with bronchial asthma. Int Immunopharmacol. 2005;5(4):805-810. PubMed. https://pubmed.ncbi.nlm.nih.gov/15710348/. Accessed Dec. 20, 2023. 
29. Kawano Y, et. al. Analysis of immunosuppressive activity of lecithin-bound iodine (LBI) on antigen-induced IL2 responsiveness in peripheral blood lymphocytes from patients with allergic diseases. Arerugi. 1993;42(11):1707-1714. PubMed. https://pubmed.ncbi.nlm.nih.gov/8279971/. Accessed Dec. 20, 2023. 
30. Kawano Y and Noma T. Modulation of mite antigen-induced immune responses by lecithin-bound iodine in peripheral blood lymphocytes from patients with bronchial asthma. Br J Pharmacol. 1995;115(7):1141-1148. Europe PMC. https://europepmc.org/article/PMC/1908798. Accessed Dec. 20, 2023.