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Could we be overlooking a potential choline crisis in the United Kingdom?
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  • Published on:
    Individual Variation in Choline Requirements
    • Steven Zeisel, Professor of Nutrition and Pediatrics; Director, UNC Nutrition Research Institute. University of North Carolina at Chapel Hill

    The article by Emma Derbyshire on choline presented an excellent overview of what scientists and practitioners need to know about this essential nutrient. I would like to add two additional areas for your readers consideration.
    Individual Variation in Choline Requirements: Dietary choline requirements are governed by person’s ability to make choline moiety de novo (mediated by the gene PEMT; phosphatidylethanolamine methyltransferase), and by pathways (genes) that transport, use and excrete choline (including genes of folate metabolism that are intertwined in the metabolism of choline). Several very common single nucleotide polymorphisms (SNPs) in these genes have a profound impact on choline needs (1, 2). When eating a low choline diet, 77% of men and 80% of postmenopausal women, develop fatty liver, liver damage or muscle damage, while only 44% of premenopausal women develop such signs of organ dysfunction (1-3). The promoter for the PEMT gene is estrogen responsive (1, 4), and this likely explains why premenopausal women are more resistant to developing organ dysfunction when fed a low choline diet (4). Several SNPs in PEMT abrogate estrogen-induction of the gene’s expression and have a significant effect on choline requirements in premenopausal women, increasing the risk of developing organ dysfunction when fed a low choline diet by up to 25-fold (1-3). Premenopausal women who are carriers of a common SNP in MTHFD1 (5,10-methylenetetrahydrofolate dehydrogenase)...

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    Conflict of Interest:
    Potential conflicts of interest: Dr. Zeisel is the founder of a company using gene-guided medical foods to treat health problems (SNP Therapeutics). Also, he receives grant funding from the US National Institutes of Health, the US Department of Agriculture, and the Balchem company. He serves on scientific advisory boards for Metabolon, Proctor and Gamble, Abbott, Ingenuity Foods, ByHeart, Baxter, and Artara,
  • Published on:
    Author receives funding from the meat industry

    Dear Editor

    We find it very concerning that you have chosen to publish an opinion piece on the health effects of veganism that does not disclose that the author is an advisor to the Meat Advisory Panel, which “is supported by an unrestricted educational grant from the red meat industry’’, in their own words. This is clearly an unacceptable conflict of interest to not be disclosed. We assume this was accidentally overlooked by your publishing team? Now that it is has been brought to your attention can we ask what you will do to address this, given that this opinion piece has created multiple negative headlines about veganism in the media?

    There is no evidence that vegans are deficient in this nutrient or that they suffer from any subsequent negative health effects. This is clearly a very biased opinion piece, that does not mention the negative effects of choline in the diet, such as increased risk of heart disease secondary to TMAO activation (Wang et al). Eating excessive amounts of choline is clearly not advisable or the panacea that the author purports, but her motivations are clear.

    Yours faithfully

    Dr Cullimore
    GP in Brighton

    Dr Shireen Kassam, Consultant Haematologist
    Dr Rebecca Jones, GP
    Tina Gawthorpe
    Katherine Garmonsway
    Dr Hannah Short, GP and menopause specialist
    Dr Bina Vekaria, radiology registrar
    Hayley Tait
    David Brian
    Dr Nitu Bajeka


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    Conflict of Interest:
    None declared.
  • Published on:
    Funded by the Meat Advisory Panel

    "Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors." is incorrect. The author receives "an unrestricted educational grant from the red meat industry". See the MAP website for details.

    Conflict of Interest:
    None declared.