CDP-Choline

What is CDP-Choline?

Formally named cytidine-5-diphosphocholine, but also commonly called citicoline in the medical literature, CDP-choline (as it is most often abbreviated) is a naturally occurring compound in the body. It occurs as an intermediate in the synthesis of the well-known membrane constituent, phosphatidylcholine. As shown below, CDP-choline is a nucleotide composed of cytosine, choline, ribose, and pyrophosphate¹.

Where Does CDP-Choline Come From?

As shown in the diagram below, CDP-choline is produced in the body from choline during the synthesis of phosphatidylcholine; the most common component of membrane phospholipids which surround most cells in the body. CDP-choline happens to be marketed as a prescription drug (under the name of Citicoline) in Japan, Spain, France and Italy, while it is sold an as over-the-counter dietary supplement in USA².

CDP-Choline Benefits

CDP-Choline has a long history of therapeutic use; dating back to the early 80’s³. At this time, it was used largely for its ability to enhance integrity and function of neuronal membranes³. This has recently culminated in it being used in pre workouts to boost mental function, but its traditional usage centred on treating a variety of neurological disorders and injury (including those resulting from stroke). Of the >11,000 volunteers and patients that have been studied with CDP-choline, benefits have been seen for a variety of disorders including cerebral ischemia, traumatic brain injury, hypoxia, Alzheimer’s and Parkinson’s diseases, learning and memory disorder, alcoholism, during addiction and glaucoma³. CDP-choline exerts its action by increasing neurotransmitter levels such as dopamine and norepinephrine. CDP-choline has also been shown to increase serotonin in the brain as well as acetylcholine levels¹.

In the context of pre workouts, CDP-choline is included to enhance focus and mental energy, which naturally helps one train better. Because it has never been studied as an ergogenic, it’s hard to say what definite benefits it will provide when taken as a pre workout, but it’s perfectly reasonable to expect performance advantages.

CDP-Choline Negatives and Side Effects

Numerous studies have shown the side effect profile for CDP-choline to be very favorable. For example, a Cochrane review (one of the most prestigious reviews in science) concluded that CDP-choline tended to be associated with fewer adverse effects than placebo in elderly patients with cerebral disorders⁵. What’s more, in a large drug surveillance study using CDP-choline⁴ with 2817 cases, no potential side effects were observed in 95% of patients. Of the remaining patients, 4% experienced digestive symptoms (nausea, stomach pain, and diarrhea), and <1% experienced cardiovascular symptoms (low blood pressure or slow or tachycardia). Safety has also been demonstrated in studies of CDP-choline in neurological conditions such as chronic cerebral disorder⁵, acute ischemic stroke⁶, and traumatic brain injury⁷.

CDP-Choline Recommended Dosages

Studies with oral CDP-choline have typically used dosages between 500mg and 2,000mg, with the most common being 1,000mg to 2,000mg. Even studies that have used very large oral doses of up to 4,000mg have shown good tolerability with minimal side effects⁸.

CDP-Choline Supplements

There are only a select number of pre workouts available in Australia that contain CDP-choline. However, as yet it is not possible to buy stand-alone CDP-choline. The biggest questions with the pre workouts that contain CDP-choline is whether they have a high enough dose for it to be effective. With many pre workouts having considerable caffeine content, most of the time it’s not possible to simply double the dosage so as to get a good hit of CDP-choline.

Stacking CDP-Choline Supplements

Because it’s still a relatively new ingredient to sports nutrition, there’s no key recommendations when it comes to stacking CDP-choline with other nutrients/supplements. But because it works largely on a neurological level, it should go well with most popular pre workout nutrients, which are not known to impact brain function.

CDP-Choline Safety

CDP-choline has a very good safety profile. Studies as far back as 1983 have documented its safety in terms of ECG and EEG abnormalities, neurological tests, tendon reflexes, blood pressure and heart rate. As far as side effects go, they are very rare and never severe and consisted mainly of digestive intolerance, gastrointestinal discomfort and restlessness. In no case was it necessary to interrupt the treatment for side effects attributed to CDP-choline use⁴.

References

1. Wignall ND, Brown ES. Citicoline in addictive disorders: a review of the literature. Am J Drug Alcohol Abuse. 2014;40(4): 262–268.
2. Alexandrov, AV. Citicoline: Ferrer Internacional. Curr Opin Invest Drugs. 2001;2:1757–1762.
3. Cytidine 5’-diphosphocholine (CDP-Choline) in stroke and other CNS disorders. Neurochemical Research. 2005;30(1):15–23.
4. Fernandez LR. Efficacy and safety of oral CDP-choline. Drug surveillance study in 2817 cases. Arzneimittelforschung. 1983;33(7A):1073-80.
5. Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. The Cochrane database of systematic reviews. 2005; (2):CD000269.
6. Davalos A, et al. International Citicoline Trial on acUte Stroke trial. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet. 2012; 380 (9839):349–357.
7. Zafonte RD, et al. Effect of citicoline on functional and cognitive status among patients with traumatic brain injury: Citicoline Brain Injury Treatment Trial (COBRIT). JAMA : the Journal of the American Medical Association. 2012;308(19):1993–2000.
8. Cho HJ, Kim YJ. Efficacy and safety of oral citicoline in acute ischemic stroke: drug surveillance study in 4,191 cases. Methods and findings in experimental and clinical pharmacology. 2009;31(3):171–176.