Benefits
Liver fat on FibroScan in a placebo-controlled trial
In a double-blind trial in 193 adults with fatty liver plus type 2 diabetes, high cholesterol or obesity, 1.8 g a day of essential phospholipids added to lifestyle advice for 6 months lowered liver fat (CAP score) more than placebo, with the difference seen by 3 months and still present 3 months after stopping. HbA1c also improved. Several authors worked for the maker.
Liver enzymes in a large real-world study
In an observational study of 2,843 Russian adults newly diagnosed with fatty liver and metabolic conditions, 1.8 g a day of polyenylphosphatidylcholine for 24 weeks was followed by lower ALT, AST and GGT, with no control group. A pooled analysis of four small randomized trials found larger ALT drops when it was added to diabetes treatment. Both analyses involved maker employees.
Colon mucus layer: larger trials found no benefit
Low PC in colonic mucus was proposed as a factor in ulcerative colitis. A 60-person phase 2 trial of delayed-release PC helped patients come off steroids, but the phase 3 program was negative: the 466-person induction trial was stopped early for futility and the maintenance trial showed no significant difference from placebo.
Memory and thinking: the choline pathway
PC supplies choline, which the body uses to make acetylcholine. In a 29-person study of people with cognitive problems after COVID-19 or vaccination, PC did not outperform the comparison groups and the authors called the result inconclusive, and a Cochrane review found no clear benefit of lecithin in dementia. A study in Chinese older adults linked lecithin to better memory, with mechanisms tested in mice.
Choline needs in pregnancy
The Adequate Intake for choline rises to 450 mg a day in pregnancy and 550 mg during breastfeeding, and prenatal supplements typically contain little if any. In a 26-woman controlled feeding trial, infants of mothers eating 930 mg versus 480 mg of choline a day in the third trimester had faster information-processing speed. That trial did not test PC specifically.
Mechanism of action
Cell membrane building block
PC and phosphatidylethanolamine are the most abundant phospholipids in mammalian cell membranes, and the balance between them affects lipid droplets and energy metabolism.
Choline source for acetylcholine
PC releases choline, which the body uses to make the neurotransmitter acetylcholine and to build cell membranes. About half of dietary choline in the US comes as PC, and lecithin, a PC-rich ingredient, is a common food additive.
Fat export from the liver
The liver needs PC to assemble and secrete very low density lipoproteins (VLDL), its main route for exporting fat. When liver PC synthesis is blocked or choline is lacking, fat builds up in the liver.
Colonic mucus barrier
PC is part of the mucus layer lining the colon, and low mucus PC was proposed as a factor in ulcerative colitis. That was the rationale for the PC colitis trials, whose phase 3 results were negative.
Clinical trials
Multicenter, double-blind, randomized, placebo-controlled phase 4 trial of essential phospholipids (Essentiale) 1,800 mg/day plus lifestyle advice for 6 months at 15 centers in Germany and Poland (Stefan et al. 2026, Liver Int).
193 adults with fatty liver (MASLD) plus type 2 diabetes, high cholesterol or obesity; 165 in the main analysis; more than three quarters were obese.
Liver fat measured as CAP score fell more than with placebo at 6 months (p=0.0269), with the effect seen at 3 months (p=0.0049) and still present 3 months after stopping (p=0.0234). HbA1c (p=0.0069) and the fatigue subscore of quality of life improved; the total quality-of-life score improved only numerically. No safety concerns arose. Several authors were employees of Opella, which supported the study.
Prospective 24-week observational study at 174 sites in Russia of polyenylphosphatidylcholine added to standard care, with no control group (Maev et al. 2020, BMJ Open Gastroenterol).
2,843 adults with newly diagnosed fatty liver and at least one of overweight or obesity, high blood pressure, type 2 diabetes or high cholesterol; almost all were prescribed 1.8 g/day.
Liver echogenicity on ultrasound improved in 68.3% and liver structure in 42.7% of patients at 24 weeks. A companion analysis of the same cohort reported falls in ALT of about 20 U/L, with smaller falls in AST and GGT. Without a control group the changes cannot be attributed to PC alone; one author was a Sanofi employee.
Randomized, double-blind, placebo-controlled trial of retarded-release phosphatidylcholine 2 g/day for 12 weeks (Stremmel et al. 2007, Ann Intern Med).
60 adults with chronic steroid-refractory ulcerative colitis.
The primary endpoint (steroid withdrawal with low or improved disease activity) was met by 50% on PC versus 10% on placebo, and 80% versus 10% stopped steroids without a flare. Mild bloating was common. The authors noted the small size and short duration.
Two multicenter, double-blind, randomized, placebo-controlled trials of modified-release PC (LT-02): a 12-week induction trial and a 48-week maintenance trial, alongside mesalamine (Dignass et al. 2024, Clin Gastroenterol Hepatol).
466 patients with mild to moderate ulcerative colitis and an inadequate response to mesalamine in the induction trial; 150 in the maintenance trial.
The induction trial was stopped early for futility: deep remission at week 12 was 13.5% on placebo versus 14.2% and 9.7% on the two LT-02 doses. In maintenance, remission at 48 weeks did not differ significantly (49.3% LT-02, 43.2% placebo). LT-02 was safe and well tolerated.
Randomized, double-blind, controlled feeding study of maternal choline intake in the third trimester (Caudill et al. 2018, FASEB J).
26 pregnant women randomized to 480 or 930 mg choline a day; 24 infants tested.
Infants of mothers on 930 mg had faster information-processing speed (reaction time) averaged across 4, 7, 10 and 13 months. This tested total choline intake, not PC supplements. Funded in part by the Egg Nutrition Center and the Beef Checkoff.