Citicoline: Better Than Dietary Choline?
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Citicoline: Better Than Dietary Choline?
Citicoline, also known as cytidine diphosphate-choline (or CDP-Choline, to its friends, or cytidine 5′-diphosphocholine if it wants to get fancy) is a dietary supplement that the stomach can metabolize easily for all the brain’s choline needs. What are those needs?
Choline is an essential nutrient. We technically can synthesize it, but only in minute amounts, far less than we need. Choline is a key part of the neurotransmitter acetylcholine, as well as having other functions in other parts of the body.
As for citicoline specifically… it appears to do the job better than dietary sources of choline:
❝Intriguing data, showing that on a molar mass basis citicoline is significantly less toxic than choline, are also analyzed.
It is hypothesized that, compared to choline moiety in other dietary sources such as phosphatidylcholine, choline in citicoline is less prone to conversion to trimethylamine (TMA) and its putative atherogenic N-oxide (TMAO).
Epidemiological studies have suggested that choline supplementation may improve cognitive performance, and for this application citicoline may be safer and more efficacious.❞
Source: Citicoline: A Superior Form of Choline?
Great! What does it do?
What doesn’t it do? When it comes to cognitive function, anyway, citicoline covers a lot of bases.
Short version: it improves just about every way a brain’s healthy functions can be clinically measured. From cognitive improvements in all manner of tests (far beyond just “improves memory” etc; also focus, alertness, verbal fluency, logic, computation, and more), to purely neurological things like curing tinnitus (!), alleviating mobility disorders, and undoing alcohol-related damage.
One of the reasons it’s so wide in its applications, is that it has a knock-on effect to other systems in the brain, including the dopaminergic system.
Long version: Citicoline: pharmacological and clinical review, 2022 update
(if you don’t want to sit down for a long read, we recommend skimming to the charts and figures, which are very elucidating even alone)
Spotlight study in memory
For a quick-reading example of how it helps memory specifically:
Keeping dementia at bay
For many older people looking to improve memory, it’s less a matter of wanting to perform impressive feats of memory, and more a matter of wanting to keep a sharp memory throughout our later years.
Dr. Maria Bonvicini et al. looked into this:
❝We selected seven studies including patients with mild cognitive impairment, Alzheimer’s disease or post-stroke dementia
All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis.
Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses❞
The researchers concluded “yes”, and yet, called for more studies, and of higher quality. In many such studies, the heterogeneity of the subjects (often, residents of nursing homes) can be as much a problem (unclear whether the results will be applicable to other people in different situations) as it is a strength (fewer confounding variables).
Another team looked at 47 pre-existing reviews, and concluded:
❝The review found that citicoline has been proven to be a useful compound in preventing dementia progression.
Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases.
Its positive impact on learning and cognitive functions among the healthy population is also worth noting.❞
Source: Application of Citicoline in Neurological Disorders: A Systematic Review
The dopamine bonus
Remember how we said that citicoline has a knock-on effect on other systems, including the dopaminergic system? This means that it’s been studied (and found meritorious) for alleviating symptoms of Parkinson’s disease:
❝Patients with Parkinson’s disease who were taking citicoline had significant improvement in rigidity, akinesia, tremor, handwriting, and speech.
Citicoline allowed effective reduction of levodopa by up to 50%.
Significant improvement in cognitive status evaluation was also noted with citicoline adjunctive therapy.❞
Source: Citicoline as Adjuvant Therapy in Parkinson’s Disease: A Systematic Review
Where to get it?
We don’t sell it, but here’s an example product on Amazon, for your convenience
Enjoy!
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What Matters Most For Your Heart?
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Eat More (Of This) For Lower Blood Pressure
Heart disease remains the world’s #1 killer. We’d say “and in the US, it’s no different”, but in fact, the US is #1 country for heart disease. So, it’s worse and perhaps some extra care is in order.
But how?
What matters the most
Is it salt? Salt plays a part, but it’s not even close to the top problem:
Hypertension: Factors Far More Relevant Than Salt
Is it saturated fat? Saturated fat from certain sources plays more of a role than salt, but other sources may not be so much of an issue:
Can Saturated Fats Be Heart-Healthy?
Is it red meat? Red meat is not great for the heart (or for almost anything else, except perhaps anemia):
The Whys and Hows of Cutting Meats Out Of Your Diet
…but it’s still not the top dietary factor.
The thing many don’t eat
All the above are foodstuffs that a person wanting a healthier heart and cardiovascular system in general might (reasonably and usually correctly) want to cut down, but there’s one thing that most people need more of:
Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
And this is especially true for heart health:
❝Dietary fiber has emerged as a crucial yet underappreciated part of hypertension management.
Our comprehensive analysis emphasizes the evidence supporting the effectiveness of dietary fiber in lowering blood pressure and reducing the risk of cardiovascular events.❞
Specifically, she and her team found:
- Each additional 5g of fiber per day reduces blood pressure by 2.8/2.1 (systolic/diastolic, in mmHG)
- Dietary fiber works in several ways to improve cardiovascular health, including via gut bacteria, improved lipids profiles, and anti-inflammatory effects
- Most people are still only getting a small fraction (¼ to ⅓) of the recommended daily amount of fiber. To realize how bad that is, imagine if you consumed only ¼ of the recommended daily amount of calories every day!
You can read more about it here:
Dietary fiber critical in managing hypertension, international study finds
That’s a pop-science article, but it’s still very informative. If you prefer to read the scientific paper itself (or perhaps as well), you can find it below
Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control
Want more from your fiber?
Here’s yet another way fiber improves cardiometabolic health, hot off the academic press (the study was published just a couple of weeks ago):
How might fiber lower diabetes risk? Your gut could hold the clues
this pop-science article was based on this scientific paper
Gut Microbiota and Blood Metabolites Related to Fiber Intake and Type 2 Diabetes
Take care!
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The Insider’s Guide To Making Hospital As Comfortable As Possible
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Nobody Likes Surgery, But Here’s How To Make It Much Less Bad
This is Dr. Chris Bonney. He’s an anesthesiologist. If you have a surgery, he wants you to go in feeling calm, and make a quick recovery afterwards, with minimal suffering in between.
Being a patient in a hospital is a bit like being a passenger in an airplane:
- Almost nobody enjoys the thing itself, but we very much want to get to the other side of the experience.
- We have limited freedoms and comforts, and small things can make a big difference between misery and tolerability.
- There are professionals present to look after us, but they are busy and have a lot of other people to tend to too.
So why is it that there are so many resources available full of “tips for travelers” and so few “tips for hospital patients”?
Especially given the relative risks of each, and likelihood, or even near-certainty of coming to at least some harm… One would think “tips for patients” would be more in demand!
Tips for surgery patients, from an insider expert
First, he advises us: empower yourself.
Empowering yourself in this context means:
- Relax—doctors really want you to feel better, quickly. They’re on your side.
- Research—knowledge is power, so research the procedure (and its risks!). Dr. Bonney, himself an anesthesiologist, particularly recommends you learn what specific anesthetic will be used (there are many, and they’re all a bit different!), and what effects (and/or after-effects) that may have.
- Reframe—you’re not just a patient; you’re a customer/client. Many people suffer from MDeity syndrome, and view doctors as authority figures, rather than what they are: service providers.
- Request—if something would make you feel better, ask for it. If it’s information, they will be not only obliged, but also enthusiastic, to give it. If it’s something else, they’ll oblige if they can, and the worst case scenario is something won’t be possible, but you won’t know if you don’t ask.
Next up, help them to help you
There are various ways you can be a useful member of your own care team:
- Go into surgery as healthy as you can. If there’s ever a time to get a little fitter, eat a little healthier, prioritize good quality sleep more, the time approaching your surgery is the time to do this.
- This will help to minimize complications and maximize recovery.
- Take with you any meds you’re taking, or at least have an up-to-date list of what you’re taking. Dr. Bonney has very many times had patients tell him such things as “Well, let me see. I have two little pink ones and a little white one…” and when asked what they’re for they tell him “I have no idea, you’d need to ask my doctor”.
- Help them to help you; have your meds with you, or at least a comprehensive list (including: medication name, dosage, frequency, any special instructions)
- Don’t stop taking your meds unless told to do so. Many people have heard that one should stop taking meds before a surgery, and sometimes that’s true, but often it isn’t. Keep taking them, unless told otherwise.
- If unsure, ask your surgical team in advance (not your own doctor, who will not be as familiar with what will or won’t interfere with a surgery).
Do any preparatory organization well in advance
Consider the following:
- What do you need to take with you? Medications, clothes, toiletries, phone charger, entertainment, headphones, paperwork, cash for the vending machine?
- Will the surgeons need to shave anywhere, and if so, might you prefer doing some other form of depilation (e.g. waxing etc) yourself in advance?
- Is your list of medications ready?
- Who will take you to the hospital and who will bring you back?
- Who will stay with you for the first 24 hours after you’re sent home?
- Is someone available to look after your kids/pets/plants etc?
Be aware of how you do (and don’t) need to fast before surgery
The American Society of Anesthesiologists gives the following fasting guidelines:
- Non-food liquids: fast for at least 2 hours before surgery
- Food liquids or light snacks: fast for at least 6 hours before surgery
- Fried foods, fatty foods, meat: fast for at least 8 hours before surgery
(see the above link for more details)
Dr. Bonney notes that many times he’s had patients who’ve had the worst thirst, or caffeine headache, because of abstaining unnecessarily for the day of the surgery.
Unless told otherwise by your surgical team, you can have black coffee/tea up until two hours before your surgery, and you can and should have water up until two hours before surgery.
Hydration is good for you and you will feel the difference!
Want to know more?
Dr. Bonney has his own website and blog, where he offers lots of advice, including for specific conditions and specific surgeries, with advice for before/during/after your hospital stay.
He also has a book with many more tips like those we shared today:
Calm For Surgery: Supertips For A Smooth Recovery
Take good care of yourself!
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Vit D + Calcium: Too Much Of A Good Thing?
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Vit D + Calcium: Too Much Of A Good Thing?
- Myth: you can’t get too much calcium!
- Myth: you must get as much vitamin D as possible!
Let’s tackle calcium first:
❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞
Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.
But what about too much?
Hypercalcemia
Having too much calcium—or “hypercalcemia”— can lead to problems with…
- Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
- Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
- Stones: kidney stones causing pain.
- Moans: refers to fatigue and malaise.
- Thrones: polyuria, polydipsia, and constipation
- Psychic overtones: lethargy, confusion, depression, and memory loss.
(mnemonic courtesy of Sadiq et al, 2022)
What causes this, and how do we avoid it? Is it just dietary?
It’s mostly not dietary!
Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…
Too much vitamin D
Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.
This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.
Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.
See for yourself:
- Hypercalcemia of Malignancy: An Update on Pathogenesis and Management
- Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment
How much is too much?
The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.
See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too
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Study Tips for Exam Season?
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You’ve Got Questions? We’ve Got Answers!
Q: Any study tips as we approach exam season? A lot of the productivity stuff is based on working life, but I can’t be the only student!
A: We’ve got you covered:
- Be passionate about your subject! We know of no greater study tip than that.
- Find a willing person and lecture them on your subject. When one teaches, two learn!
- Your mileage may vary depending on your subject, but, find a way of studying that’s fun to you!
- If you can get past papers, get as many as you can, and use those as your “last minute” studying in the week before your exam(s). This will prime you for answering exam-style questions (and leverage state-dependent memory). As a bonus, it’ll also help ease any anxiety, because by the time of your exam it’ll be “same old, same old”!
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Cottage Cheese vs Ricotta – Which is Healthier?
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Our Verdict
When comparing cottage cheese to ricotta, we picked the ricotta.
Why?
Cottage cheese is a famous health food, mostly for being a low-fat, low-carb, source of protein. And yet, ricotta beats it in most respects.
Looking at the macros first, cottage cheese has more carbs, while ricotta has more protein and fat. The fat profile is pretty much the same, and in both cases it’s two thirds saturated fat, which isn’t good in either case, but cottage cheese has less overall fat which means less saturated fat in total even if the percentage is the same. Because the difference in carbs and protein is not large, while ricotta has considerably more fat, we’ll call this category a win for cottage cheese.
In terms of vitamins, cottage cheese has more of vitamins B1, B5, and B12, while ricotta has more of vitamins A, B2, B3, B9, D, E, and K, so this one’s a win for ricotta.
In the category of minerals, cottage cheese has slightly more copper, while ricotta has much more calcium, iron, magnesium, manganese, potassium, selenium, and zinc. In particular, 2.5x more calcium, and 5x more iron! An easy and clear win for ricotta here.
Taking everything into account: yes, cottage cheese has less fat (and thus, in total, less saturated fat, although the percentage is the same), but that doesn’t make up for ricotta winning in pretty much every other respect. Still, enjoy either or both (in moderation!) if you be so inclined.
Want to learn more?
You might like to read:
Take care!
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Wholesome Threesome Protein Soup
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This soup has two protein– and fiber-rich pseudo-grains, one real wholegrain, and nutrient-dense cashews for yet even more protein, and all of the above are full of many great vitamins and minerals. All in all, a well-balanced and highly-nutritious light meal!
You will need
- ⅓ cup quinoa
- ⅓ cup green lentils
- ⅓ cup wholegrain rice
- 5 cups low-sodium vegetable stock (ideally you made this yourself from offcuts of vegetables, but failing that, low-sodium stock cubes can be bought in most large supermarkets)
- ¼ cup cashews
- 1 tbsp dried thyme
- 1 tbsp black pepper, coarse ground
- ½ tsp MSG or 1 tsp low-sodium salt
Optional topping:
- ⅓ cup pine nuts
- ⅓ cup finely chopped fresh mint leaves
- 2 tbsp coconut oil
Method
(we suggest you read everything at least once before doing anything)
1) Rinse the quinoa, lentils, and rice.
2) Boil 4 cups of the stock and add the grains and seasonings (MSG/salt, pepper, thyme); simmer for about 25 minutes.
3) Blend the cashews with the other cup of vegetable stock, until smooth. Add the cashew mixture to the soup, stirring it in, and allow to simmer for another 5 minutes.
4) Heat the coconut oil in a skillet and add the pine nuts, stirring until they are golden brown.
5) Serve the soup into bowls, adding the mint and pine nuts to each.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Give Us This Day Our Daily Dozen
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Why You Should Diversify Your Nuts!
Take care!
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