Can we prevent schizophrenia? It may be up to choline.

Choline forms healthy brain function in pregnancy.

Choline forms healthy brain function in pregnancy.

A key point about nutrition most often misunderstood is that each nutrient we eat performs a specific action. Nutrients are most often signaling molecules that direct the creation of hormones, tissues, fluids, electrical impulses and other important metabolic functions. New research has once again demonstrated the importance of these signaling molecules during pregnancy and this time it’s choline. Often considered one of the B vitamins, choline is an essential part of acetylcholine, which supports proper brain function. Similar to the way folic acid supplementation during pregnancy promotes proper neural tube development, choline supplementation appears to signal for the proper coding of specific parts of brain neurons.

Choline metabolism in humans varies greatly by stage of life, genetic polymorphisms and gender, with an increased demand for choline during pregnancy and lactation. Most dietary choline is found in meat and eggs, generally putting Paleo eaters in good choline status, while vegetarians and vegans get optimal choline by including good plant sources of choline like quinoa, broccoli, oats, green peas, edamame, bananas, and pinto beans. Pregnant and prospective pregnant women would do well to be thoughtful about choline intake. Studies have shown that one expectant mother out of five does not get adequate choline in her diet. The recommended intake of choline in pregnancy is 450 mg/day, yet the 2010 Nurse’s Health Study indicated that a whopping 95 percent of pregnant women consumed less that 411 mg of choline each day. While ad lib diets have been found to average 8.4 mg/kg for men and 6.7 mg/kg for women, a study of pregnant women in California found that 25% of women had an intake that provided less than half this amount. For a 140-pound (63 kg) woman, that calculates to be about 213 mg/day, well below the recommended intake. For women who weigh much less, this difference can be even greater. Considering the impact of choline on the developing fetal brain, choline nutrition is of significant importance.

Research funded by the Brain Behavior Research Foundation at the University of Colorado has found that mothers with better choline intake may be able to prevent schizophrenia in their children. Dr. Robert Freedman, Chair of Psychiatry at the University of Colorado, along with Dr. Camille Hoffman and Dr. Randal Ross of the University of Colorado, School of Medicine have now completed a 9-year pre and post natal study of women and their children. This gets a little technical but stick with me. Choline is needed during fetal development to properly develop neurons in the brain that transport and exchange information that form our thoughts and actions. A deficiency in choline during fetal brain development may prevent certain genes known as CHRNA7 genes, from encoding specialized alpha-7 receptors on neurons. Alpha-7 receptors are responsible for tempering or inhibiting our behavioral response to various stimuli. If the neurons lack the ability to inhibit responses, the neurons can overreact, making us more easily agitated, anxious, and even change our thoughts to be more reactive. In other words, healthy neurons have the ability to ‘turn down the volume’ on a situation or thought so that we can respond more appropriately. This is a key issue in schizophrenia.

Choline concentrations in-utero, vary at different times during pregnancy. They are higher in early pregnancy, while in later months the uterine environment changes and choline concentrations decline. This can affect how many of these alpha-7 receptors are encoded, especially in choline deficient mothers. Patients with schizophrenia have been found to have less optimal inhibitory activity in the brain near the time of birth and this may predispose them to schizophrenia later in life. Schizophrenia isn’t usually expressed until late teen hood or early twenties, and this study will continue to follow these children, but Dr. Freedman points out an interesting fact. Children, who go on to develop schizophrenia, have recognizable motor problems in the first year of life. While motor problems alone don’t diagnose future schizophrenia, often there are other signs in early childhood that can be traced to deficits in inhibition that may be associated with schizophrenia.

Here’s the University of Colorado study in a nutshell:

A double-blind trial to compare normal choline intake with choline supplementation, the study included 100 healthy women who received either:

  • Special dietary instructions on eating a choline rich diet AND 2x the normal dietary levels of choline in supplement form during pregnancy and then to mother and newborn through 3 months after birth


  • Only received special dietary instructions on eating a diet rich in choline

The results:

  • 76% of infants whose mothers received choline supplementation + dietary instruction showed normal inhibition of alpha 7 receptors
  • 43% of infants whose mothers received dietary instruction only, showed normal inhibition of alpha 7 receptors
  • Infants of mothers who carry special genetic risk factors for schizophrenia:
    • Had better alpha 7 inhibition with choline supplementation + dietary instruction
    • Had diminished alpha 7 inhibition receiving dietary instruction alone

One of the beauties of this study is that they compared diet and supplementation to diet alone. Food should be our first line of defense in health while supplements fill in the gaps in our diet. But even though variations in dietary practices from omnivore to vegan can greatly affect choline status, it may be too early to suggest specific choline supplementation in all pregnant women. As a nutritionist, I’d like to see pregnant and prospective parents have a detailed mental health history included by their health professionals, consider genetic evaluation if they have a family history of schizophrenia, and be referred for nutrition education including advise on supplementation that may be of benefit in each pregnancy. Thoughtfulness about preconception and pregnancy nutrition can only improve pregnancy outcomes and may even provide a life free of mental illness for a child.

Use these links to learn more about choline in food, to read more about the study here and also view presentations by Drs. Hoffman and Freedman from the Brain Behavior and Research Foundation’s 2015 New York Mental Health Research Symposium .


  • Choline: Critical Role During Fetal Development and Dietary Requirements in Adults, Steven H. Zeisel
  • Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am. J. Epidemiol. 2004;160:102–9.
  • Velzing-Aarts FV, Holm PI, Fokkema MR, van der Dijs FP, Ueland PM, Muskiet FA. Plasma choline and betaine and their relation to plasma homocysteine in normal pregnancy. Am. J. Clin. Nutr. 2005; 81:1383–89.
  • This link leads to a website provided by the Linus Pauling Institute at Oregon State University.  Linda Illingworth is not affiliated or endorsed by the Linus Pauling Institute or Oregon State University.

March Against Monsanto San Diego

Monsanto MarchThanks to Dan Osman and the Organic Consumers Association for planning the great rally at Balboa Park today. Here’s a quick recap of speakers, their websites (below) and a bit of my talk today.

Monsanto would like you to believe that the glyphosate residue on genetically modified food is safe and doesn’t cause cancer. But these statements are  based on studies that are too short to show cancer, and are not looking at the myriad of other health issues that have dramatically increased since the early 1970’s when GMO seeds and high nitrogen fertilizers hit the fields, and the use of herbicides and pesticides dramatically increased. Geneticists tell us that daily small pulses of noxious chemicals can be more harmful than a single large exposure. The subtle changes in nutrients and chemical compounds affect our DNA and our ability to defend our bodies from everything from cancer to autoimmune disorders, gastrointestinal problems, mental health issues, autism, and healthy pregnancies. Everything we ingest is a signalling molecule, especially the nutrients in food. Whether it’s chemicals in air pollution, vitamins, medications, food, herbicide or pesticide, it all signals a reaction in the body that affect how the body reacts. It makes a difference if your liver is compromised and can’t remove or detoxify harmful compounds efficiently or if you are so overloaded your liver and kidneys can’t keep up. Small children are particularly susceptible to growth and developmental issues due to exposure to harmful chemicals. We have the right to know how our food is grown and what’s in it. It’s time for Monsanto and other chemical companies to stand up for our health rather than their profits, protect our valuable resources and be good stewards of our food supply.

Remember it matters where you spend your food dollars. You may spend a little more for healthy food, but you won’t pay as much at the doctor’s office! Stay informed! The EU and Canada are considering revoking their approval for glyphosate. California is listing it as a probable carcinogen and the WHO found glyphosate to be a probable carcinogen as well before reversing its opinion. Those scientists who are responsible for reversal of their opinions are withholding their names, not willing to stand behind their own opinions. That should tell  us something.

Presenters at the event today in San Diego:

Peter Mathews — Political Science professor, internationally recognized pundit and author of “Dollar Democracy: With Liberty and Justice for Some; How to Reclaim the American Dream for All”

D’Marie Mulattieri — activist, speaker, writer. Organizer, Occupy Orange County, March Against Monsanto Laguna Beach, Expose the TPP – USA. Ran for Congress in 2012. California Clean Money Campaign and OC4BERNIE. Wrote the foreword for the book, “We’re Monsanto: Still Feeding the World, Lie After Lie.

Leslie Goldman, a grassroots food activist, recipient of a United Nations Peace Medal, writer and blogger

Carol Grieve, Certified Life Coach, Holistic Nutritionist, radio host of Food Integrity Now,


Functional foods: help lower blood pressure naturally


Functional food is a term to describe a specific food or food components that have specific effects in our bodies. It’s a bit of a misnomer since food IS the building block of our bodies, and so effects almost every aspect of our health. Blood pressure is one aspect of our health that responds quite favorably to changes in our dietary intake. This study published November 6, in the British Journal of Nutrition, illustrates how grape seed extract can lower blood pressure. Subjects were given a grape seed extract containing beverage to drink twice daily for 6 weeks. Test subjects with pre-hypertension (borderline high blood pressure), reduced their systolic and diastolic blood pressures by 5.6% and 4.7%,  respectively.  Interestingly, those with higher blood pressure experienced almost twice the blood pressure lowering benefit. The amount of grape seed extract used in the study was 150 mg, twice daily (300 mg/day), easily found in an over the counter supplement.

But you don’t have to take pills. Simply eating more vegetables, legumes, and fruit can significantly lower blood pressure, so much so that vegetarians and vegans have almost no risk of developing high blood pressure. How does this work? The compounds in plant foods help make nitric oxide in the blood vessels which relaxes the muscles that line the arteries. Yes, you have muscles in your arteries! These ‘smooth muscles’ as we call them, like nitric oxide and minerals, particularly magnesium. Legumes, whole grains, nuts and seeds are good sources of magnesium, so a diet high in plants naturally lowers blood pressure.

Researchers have described another functional food, flax seed, as having ‘one of the most potent antihypertensive effects achieved by a dietary intervention.’ In a study published in 2013 in Hypertension, just 30 g of flax seed daily for 6 months reduced systolic (the top number) pressure by 10 mm Hg, and diastolic (the bottom number) by 7 mm Hg. That’s enough to push a person with high blood pressure into the normal blood pressure range.  Thirty grams of flax seed is 4 Tbsp. which may be a lot for some to eat everyday. But remember, in the study, they didn’t encourage any other dietary changes. So a more practical daily routine might include 2 Tbsp. of flax seed, 1/2 cup beans or whole grain like quinoa, a cup of blueberries and some hibiscus tea. Yes, you can drink functional food blood pressure lowering compounds too. This study in Fitoterapia found hibiscus tea to be as effective as a common blood pressure medication, and published in the Journal of Nutrition, researchers Diana McKay, et al, found just 3 cups of hibiscus tea  to lower systolic pressure by 7 mm Hg.

Want more evidence? Just complete your own search on PubMed on functional foods and hypertension. And don’t forget to check your blood pressure…high blood pressure is a risky business!




Planning ahead for a healthy baby

pregnant nutrition

In 2013, I had a thiamin deficiency. Not my proudest moment as a functional nutritionist, but hey, I relearned something I didn’t think would affect me. At the height of my green juicing habit, I was consuming lots of blueberries and LOTS of kale. I love kale; in my smoothie at breakfast, a kale salad at lunch, and oh heck I’ll through some in my soup/stir fry/dinner tonight, too. Well, kale and blueberries contain an anti-nutrient called anti-thiaminase. As you can surmise, anti-nutrient means it interferes with the utilization or absorption of a particular nutrient and that’s how I ended up with a thiamin deficiency. So I sadly said adieu to kale for a while, saved some blueberries for the rest of the planet and stocked my fridge with other fruit and veggies.

Now with the recent addition of our precious new niece Anna, and counseling several new mommies and mommies to be, I can’t stop reading about how nutrition affects the growing fetus. This video by Dr. Michael Gregor at, illustrates the point that what we eat tells the body how to behave.  Nutrients not only become the structure of our bodies, they are also messengers that deliver instructions on how to put together the structures in our bodies. While I am, admittedly, a whole food zealot, I have concerns about optimizing intake while not flooding the body with ‘messages’ that might in fact be harmful. The possibility that Mother Nature’s closing of a specialized opening in the heart might be adversely affected by high doses of antioxidants gets my attention. As does the research on depression, cardiovascular health, and immunity, all affected by the signaling molecules called nutrients that speak to developing DNA in utero. This ‘programmed DNA’ then dictates the health of the new human into adulthood. I always advocate a plant based diet, including plenty of vegetables and fruit during pregnancy. However, guzzling  concentrated sources of polyphenols and other antioxidants via dehydrated powders and concentrated juices on a daily basis may not be the best advice we can give. In hopes of creating the best developmental environment possible for a developing fetus, 2-3 servings of fruit and veggies at each meal, in their whole unprocessed states seem more appropriate. And yes, paternal nutrition affects the health of the fetus, too. If you are pregnant or soon to be, I hope you watch the video and check out the links above. As the wise Michael Pollan reminds us: eat real food (not powdered, processed ‘health’ food), not too much (optimize, don’t flood the system), mostly plants (yep, plants heal).



Nutrition and the brain

the brain with hands and utensils in front of an empty plate

The more we know about the brain, our genetics and nutrition, the more nutrition becomes suspect in either the creation of or the worsening of cognitive decline. Research has some new theories about those pesky plaques in the brain called beta amyloid plaque. It appears that beta amyloid plaque may initially be a protective mechanism but when left unchecked, can lead to irreversible or, at least, damage that is difficult to reverse or slow down. This is similar to the formation of artery plaque. Plaque is laid down in an attempt to quench inflammation in the arterial wall. But over time, if the inflammation remains, this continuous building of plaque blocks off the artery from adequate blood flow, starving out the cells that depend on this blood flow to maintain their health. What causes this inflammation? A diet too high in carbohydrate that maintains higher blood sugar. This higher blood sugar may well be hovering at the upper end of the normal range, but over time sugar causes inflammation that creates a cascade of events that alert the immune system of danger, make blood cells sticky and hijack LDL cholesterol using it to form a plaque. In the brain, this creates beta amyloid plaque, which initially acts to help the cell by outsourcing energy production, keeping glucose out of the cell and reducing damage. But this shift has its cost. It limits available fuel within the cell and relies on valuable fat for fuel that would otherwise become part of the protective layer of neurons. This same inflammatory process can occur virtually anywhere in the body and can affect anyone. If you have diabetes, you are 2 to 5 times more likely to develop Alzheimer’s. Suffice it to say, you don’t want to go there!

Foods that rapidly digest to sugar: refined grains, sweets, soda, and alcohol all contribute to unhealthy blood sugar levels. Alcohol is particularly troublesome. Here’s what happens when we imbibe. Since we can’t store ethanol, it it’s the first fuel used before the other carbs, protein, and fat we consume. That means that some of the additional calories you consumed are more likely to become fat in your fat cells. This is because alcohol turns down the metabolic rate by limiting each cell’s ability to burn fuel. That’s like putting a speed limiter on your car’s engine. Your cells simply can’t burn fuel beyond a certain rate. A diet simply too high in carbohydrate can have the same effect. Not carbs from vegetables, whole fruit, dairy and modest amounts of whole grains, but those coming from sweets, soda, refined, processed foods and alcohol.

So what’s the best fuel for your brain? While experts like Dr. David Perlmutter recommend a grain free diet, and Dr. Michael Greger recommends a vegan diet, most experts agree that reducing the amount of sugar you eat is the first step. What do I tell my patients?

  • Limit grain products like bread, cereal, and crackers, choosing more beans, legumes, and root vegetables.
  • Plan your meals around vegetables and protein:
    • Sweet potato, spinach salad with walnuts, 1/2 an artichoke
    • Minestrone Soupmade with butternut squash and beans
    • Main dish salad with roasted root vegetables and salmon
    • Falafels wrapped in lettuce, kale or chard
  • Limit sweets to fresh fruit, or in moderation, dried fruit
  • Avoid soda completely: regular and artificially sweetened (those sweeteners affect your gut bacteria and disrupt the brain)
  • Include healthy fats every day: nuts, seeds, fatty fish, avocado, coconut oil (in moderation)

It doesn’t matter where you start, as long as you start soon. Your brain will thank you with better concentration, improved sleep and less risk of Alzheimer’s.