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Mild choline deficiency can cause fatigue, insomnia, poor ability of your kidneys to concentrate urine, problems with memory, and nerve-muscle imbalances. Choline deficiency can also cause deficiency of another B vitamin, folate. Extreme choline deficiency can cause liver dysfunction, cardiovascular disease, impaired growth, abnormalities in bone formation, lack of red blood cell formation, infertility, respiratory distress and failure to thrive in newborns, kidney failure, anemia, and high blood pressure. Because your body can't make the neurotransmitter acetyl choline without choline, deficiency may lead to high blood pressure and respiratory distress. Because your body can't easily make a cell membrane component, phosphatidylcholine, without choline, deficiency may lead to kidney failure and lack of red blood cell formation. Choline deficiency particularly affects your liver, because a lack of choline prevents your liver from packaging and transporting fat in a natural pattern. The primary symptom of this change in fat-packaging is a decrease in your blood level of very low-density lipoprotein (VLDL), a complex fat-containing molecule that your liver uses to transport fat. As part of this same pattern, levels of triglycerides in your blood can also become greatly increased as a result of choline deficiency.

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