Choline is an essential nutrient that plays a foundational role in brain health, liver function, methylation, and neurotransmitter synthesis. It serves as both a structural building block for cell membranes and a biochemical precursor for several key molecules, including acetylcholine (a neurotransmitter critical for memory, focus, and muscle control) and betaine (trimethylglycine), a major methyl donor in the body.

On the Neurotransmitter XL panel, choline reflects the body’s capacity to maintain membrane integrity, neurotransmitter balance, and methylation efficiency. Adequate choline ensures optimal communication between neurons, healthy liver metabolism, and efficient detoxification through the methionine cycle, which depends on methyl donors for proper function.

Because the brain and liver are among the most metabolically active organs, choline status is often a key indicator of both cognitive performance and cellular energy balance.

Physiological Function:

Choline is metabolized within cellular mitochondria resulting in production of trimethylglycine; TMG plays a role in supporting methyl donation processes either directly (methylating homocysteine) or indirectly through supporting production of S-adenosyl methionine (SAMe). Choline is converted into acetylcholine (ACh).

Common food sources:

Beef liver, eggs, soybeans, scallops, chicken breast

Serum cholinesterase is a blood test that looks at levels of 2 substances that help the nervous system work properly. They are called acetylcholinesterase and pseudocholinesterase. Your nerves need these substances to send signals.

Acetylcholinesterase is found in nerve tissue and red blood cells. Pseudocholinesterase is found primarily in the liver.

Serum cholinesterase, also known as pseudocholinesterase (PCHE), is a type of cholinesterase found in the blood that plays a crucial role in the breakdown of certain chemicals, including acetylcholine. It is distinct from acetylcholinesterase, found at nerve endings, and it has a different substrate specificity.

Serum cholinesterase is often measured through blood tests and is utilized as a biomarker for various health conditions, particularly those related to the liver's synthetic function.

Abnormal levels of serum cholinesterase can be indicative of liver dysfunction and can be monitored for acute poisoning detection. Its measurements are valuable in assessing liver function and overall health.

Typically, normal pseudocholinesterase values range between 8 and 18 units per milliliter (U/mL) or 8 and 18 kilounits per liter (kU/L).

Note: Normal value ranges may vary slightly among different laboratories. Talk to your provider about the meaning of your specific test results.

Help to diagnose drug-induced lupus (DIL) and systemic lupus erythematosus (SLE). Antibodies to both chromatin and histones have been found in patients with procainamide-induced lupus; however, patients with lupus induced by drugs such as quinidine, penicillamine, methyldopa, and acebutolol have antibodies to chromatin but not antihistone. Antichromatin antibodies are found in 50% to 90% of SLE patients and have been linked with proteinuria in SLE patients.

Antichromatin antibodies are more sensitive than anti-dsDNA antibodies in detecting active SLE.

A high hair chromium (Cr) level is likely to indicate excess exposure to Cr. Hair Cr levels do not appear to be affected by permanent solutions, dyes, or bleaches, but external contamination is possible. Trivalent Cr is considered to be an essential trace element with a low order of toxicity. Cr toxicity via oral ingestion is not likely. However, it is noteworthy that excessive self-supplementation has been reported to be associated with insomnia and increased unpleasant dream activity in some individuals (J. Nutr. Med.; 3(43), 1992).

Phytates decrease oral assimilation of Cr+3, whereas nicotinic acid and vitamin C increase absorption of Cr+3, zinc, vanadium and iron compete with Cr for absorption. In contrast, hexavalent Cr compounds are considerably more toxic and are primarily absorbed via inhalation as a result of industrial exposure. Industrial exposure to high amounts of Cr has been reported to be associated with allergic dermatitis, skin ulcers, bronchitis, and lung and nasal carcinoma. Elevated hair Cr levels have also been observed in patients with cerebral thrombosis and cerebral hemorrhage.

Chromium is ubiquitous in foods at low low concentrations. Derived from processing of food with stainless steel equipment. Also present in tobacco smoke, chrome, plating, dyes and pigments, leather tanning, and wood preserving and is deposited into air, water, and soil.

Blood distribution of chromium appears to be equally divided between plasma and RBCs, whole blood chromium the sample type for total chromium measurement. Chromium (VI) is more concentrated in the RBCs, while chromium (III) does not enter the RBCs. Therefore, it is possible to distinguish sources and types of exposure to indicate toxic (Cr VI) exposure versus benign (Cr III) by measuring RBC chromium. Chromium rapidly clears from the blood and measurements relate to recent exposure. Urinary chromium excretion reflects absorption of the previous one to two days.

Chromium is an essential trace mineral crucial for carbohydrate metabolism and insulin sensitivity. It plays a role in stabilizing blood sugar levels and is involved in lipid and protein metabolism. Hair analysis offers a long-term view of chromium status, reflecting dietary intake, environmental exposure, and overall mineral balance.

Chromium, when measured in whole blood as part of a Toxic and Essential Elements panel, provides valuable insights into the body's chromium status, which is pivotal for various physiological functions. Chromium is a trace element essential for human health, primarily recognized for its role in enhancing the action of insulin, a hormone critical to the metabolism and storage of carbohydrate, fat, and protein. Its presence in whole blood reflects both recent dietary intake and the body's stores of the mineral. Chromium exists in several forms, but the trivalent chromium (Cr3+) is the biologically active form, considered safe and necessary for human health, while hexavalent chromium (Cr6+) is toxic and carcinogenic. The measurement of chromium in whole blood can be crucial for evaluating nutritional status, particularly in populations at risk of chromium deficiency, such as those with unbalanced diets, the elderly, and individuals with impaired glucose tolerance.

A high hair chromium (Cr) level is likely to indicate excess exposure to Cr. Hair Cr levels do not appear to be affected by permanent solutions, dyes, or bleaches, but external contamination is possible. Trivalent Cr is considered to be an essential trace element with a low order of toxicity. Cr toxicity via oral ingestion is not likely. However, it is noteworthy that excessive self-supplementation has been reported to be associated with insomnia and increased unpleasant dream activity in some individuals (J. Nutr. Med.; 3(43), 1992).

Phytates decrease oral assimilation of Cr+3, whereas nicotinic acid and vitamin C increase absorption of Cr+3, zinc, vanadium and iron compete with Cr for absorption. In contrast, hexavalent Cr compounds are considerably more toxic and are primarily absorbed via inhalation as a result of industrial exposure. Industrial exposure to high amounts of Cr has been reported to be associated with allergic dermatitis, skin ulcers, bronchitis, and lung and nasal carcinoma. Elevated hair Cr levels have also been observed in patients with cerebral thrombosis and cerebral hemorrhage.

Chromium (Cr) is essential for proper metabolism of glucose in humans. It potentiates the action of insulin via glucose tolerance factor (GTF) which is Cr+3 bound in a dinicotinic acid-glutathione complex. Other functions of Cr include aiding in lipid metabolism and assisting with HDL/LDL cholesterol balance.

Chromium is an essential trace mineral that plays an important role in optimizing insulin function and the regulation of blood glucose levels. Chromium may also be anti-atherogenic and assist in lowering cholesterol.

Chromium is ubiquitous in foods at low low concentrations. Derived from processing of food with stainless steel equipment. Also present in tobacco smoke, chrome, plating, dyes and pigments, leather tanning, and wood preserving and is deposited into air, water, and soil.

Blood distribution of chromium appears to be equally divided between plasma and RBCs, whole blood chromium the sample type for total chromium measurement. Chromium (VI) is more concentrated in the RBCs, while chromium (III) does not enter the RBCs. Therefore, it is possible to distinguish sources and types of exposure to indicate toxic  (Cr VI) exposure versus benign (Cr III) by measuring RBC chromium. Chromium rapidly clears from the blood and measurements relate to recent exposure. Urinary chromium excretion reflects absorption of the previous one to two days.

Chromium enhances utilization of insulin, resulting in improved burning of glucose. Chromium is involved in maintaining blood sugar levels and energy levels. It is also associated with cholesterol regulation.

Hair Chromium is a good indicator of tissue levels and may provide a better indication of status than do urine or blood/serum.

Chromium is generally accepted as an essential trace element that is required for maintenance of normal glucose and cholesterol levels; it potentiates insulin fucnction. 

Deficiency conditions may include hyperglycemia, transient hyper/hypoglycemia, fatigue, accelerated atherosclerogenesis, elevated LDL cholesterol, increased need for insulin and diabetes-like symptoms, and impaired stress responses. 

A high hair chromium (Cr) level is likely to indicate excess exposure to Cr. Hair Cr levels do not appear to be affected by permanent solutions, dyes, or bleaches, but external contamination is possible. Trivalent Cr is considered to be an essential trace element with a low order of toxicity. Cr toxicity via oral ingestion is not likely. However, it is noteworthy that excessive self-supplementation has been reported to be associated with insomnia and increased unpleasant dream activity in some individuals (J. Nutr. Med.; 3(43), 1992).

Phytates decrease oral assimilation of Cr+3, whereas nicotinic acid and vitamin C increase absorption of Cr+3, zinc, vanadium and iron compete with Cr for absorption. In contrast, hexavalent Cr compounds are considerably more toxic and are primarily absorbed via inhalation as a result of industrial exposure. Industrial exposure to high amounts of Cr has been reported to be associated with allergic dermatitis, skin ulcers, bronchitis, and lung and nasal carcinoma. Elevated hair Cr levels have also been observed in patients with cerebral thrombosis and cerebral hemorrhage.

Chromium occurs in primarily two states, trivalent chromium (chromium 3) typically found in foods and hexavalent chromium (chromium 6) typically found in industrial sources and pollutants. Chromium 3 is much less toxic than chromium 6. The body can detoxify some amount of chromium 6 to chromium 3 using glutathione, hydrogen peroxide, glutathione reductase, and ascorbic acid. Few serious adverse effects have been linked to high intakes of chromium 3, so no UL (= upper limit) has been established for chromium 3. Overexposure to chromium 6 can occur in welders and other workers in the metallurgical industry, use of chromium-containing paints and primers, individuals with metallic surgical implants, individuals who ingest chromium salts. Chromium toxicity can occur via oral, inhaled, or dermal absorption. Chromium toxicity, depending upon route of exposure, can cause nausea, vomiting, diarrhea, muscle cramps, skin lesions, sinus, nasal and lung cancer, renal failure, liver damage, circulatory collapse, coma and death.