~ 020808 Reduced Choline And Betaine Levels Correlate With Higher Levels Of Inflammation

The February, 2008 issue of the American Journal of Clinical Nutrition published the finding of Greek researchers that having reduced levels of the B vitamin choline, as well as betaine (trimethylglycine, a derivative of choline), is linked with a higher blood concentration of markers of inflammation. Inflammation is involved in the pathogenesis of atherosclerosis among other conditions, and inflammatory markers, including C-reactive protein, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-a), have been associated with cardiovascular event risk.

The current research evaluated data from 3,042 participants in the ATTICA epidemiologic study which included men and women in the Attica province of Greece who were free of cardiovascular disease, infections, dental problems or recent surgical history upon enrollment. Dietary questionnaire responses were analyzed for choline and betaine intake levels, and fasting blood samples were tested for levels of interleukin-6, C-reactive protein, TNF-a, homocysteine, glucose and total cholesterol.

Compared with subjects whose choline levels were in the lowest one-third of participants, those whose intake fell in the top third at over 310 milligrams per day had an average level of C-reactive protein that was 22 percent lower, an interleukin-6 level that was 26 percent lower, and a TNF-a level that was 6 percent lower. For those whose betaine levels were in the top third at over 360 milligrams per day, homocysteine levels were 10 percent lower, C-reactive protein concentrations were 19 percent lower, and TNF-a levels were 12 percent lower than participants whose levels were in the bottom third.

To the author's knowledge, the study is the first to show that a choline and betaine rich diet can influence inflammation. The various interrelations examined in the study suggest that although an effect on homocysteine may be involved in the findings, it may not be the only mechanism by which betaine and choline help reduce inflammation. (Homocysteine, a metabolic byproduct, has been shown to be related to inflammation when elevated.)

The authors remark that the reduction in inflammatory indexes observed in this study is similar to that which occurs among people who follow a Mediterranean diet or who consume increased amounts of omega-3 fatty acids. In an accompanying editorial, Steven H. Ziesel of the University of North Carolina at Chapel Hill suggests that the relatively higher betaine content of the Greek diet studied in the current investigation may be a newly revealed anti-inflammatory component of the Mediterranean diet. "There are multiple potential mechanisms whereby diets lower in choline and betaine might result in increases in biomarkers of inflammation in healthy humans," he writes. "If the association between choline and betaine and inflammation can be confirmed in studies of other populations, an interesting new dietary approach may be available for reducing chronic diseases associated with inflammation."

Related Health Concern: Chronic Inflammation

The New England Journal of Medicine published several studies in the year 2000 showing that the blood indicators of inflammation are strong predictive factors for determining who will suffer a heart attack (Lindahl et al. 2000; Packard et al. 2000; Rader 2000). The January 2001 issue of Life Extension magazine described these studies and explained how individuals could protect themselves against these inflammatory markers (such as C-reactive protein, homocysteine, and fibrinogen).

Scientists have identified dietary supplements and prescription drugs that can reduce levels of the pro-inflammatory cytokines. The docosahexaenoic acid (DHA) fraction of fish oil is the best documented supplement to suppress TNF-a, IL-6, IL-1(b), and IL-8 (Jeyarajah et al. 1999; James et al. 2000; Watanabe et al. 2000; Yano et al. 2000).

In addition to toxic cytokines, there are other inflammatory pathways that can be mediated via diet modification. A common problem involves overproduction of pro - inflammatory hormone-like "messengers" (such as prostaglandin E2) and underproduction of anti-inflammatory "messengers" (such as prostaglandin E1 and E3).

The good news is that omega-3 fatty acids found in fish oil help to suppress the formation of undesirable prostaglandin E2 and promote synthesis of beneficial prostaglandin E3 (Kelley et al. 1985; Watanabe et al. 2000). Gamma - linolenic acid (GLA) induces production of the anti-inflammatory prostaglandin E1 (Das et al. 1989; Fan et al. 1997). What you eat can significantly affect whether you have more of the beneficial prostaglandins (E1 and E3) as opposed to the pro-inflammatory prostaglandin E2.

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