Anxiety often feels intensely personal. When worry shows up without warning, when your chest feels tight or your thoughts loop endlessly, it can seem as if your own brain is working against you. Many people with anxiety are told that the problem lives only in their thoughts or that it is something they should be able to control with enough willpower. Over time, this way of thinking can lead to shame or frustration, especially when anxiety persists despite sincere efforts to manage it through mindset changes alone.
Emerging research is challenging that narrow view by showing that anxiety is also connected to measurable changes inside the brain. Scientists are finding that prolonged stress leaves chemical and metabolic traces that affect how the brain functions day to day. New findings from researchers at UC Davis Health suggest that people with anxiety disorders tend to have lower levels of choline, an essential nutrient that supports brain cell structure, communication, and energy use. This discovery does not mean anxiety can be fixed with a single nutrient or dietary change, but it does add an important biological layer to understanding why anxiety can feel so persistent and exhausting.
What the Research Revealed About Anxiety and Choline
The researchers conducted a large analysis that combined data from 25 previously published brain imaging studies. Together, these studies compared 370 people diagnosed with anxiety disorders to 342 people without anxiety. Using a noninvasive MRI-based technique called proton magnetic resonance spectroscopy, scientists were able to measure neurometabolites, which are chemicals involved in brain metabolism rather than brain structure alone. One of those chemicals was choline.
Across the combined data, people with anxiety disorders showed about an eight percent reduction in choline levels in specific regions of the brain. The most consistent findings appeared in the prefrontal cortex, the area responsible for emotional regulation, impulse control, and decision making. Senior author Dr. Richard Maddock emphasized the importance of this difference by stating, “An 8 percent lower amount doesn’t sound like that much, but in the brain, it’s significant.” Even relatively small changes can matter when they affect regions that are constantly working to manage stress and emotions.
The study was published in Molecular Psychiatry and is the first meta-analysis to identify a consistent chemical pattern in the brains of people withn anxiety disorders. Co-author Jason Smucny described the importance of the findings by saying, “This is the first meta-analysis to show a chemical pattern in the brain in anxiety disorders.” While the data does not prove that low choline causes anxiety, it does show that anxiety is associated with altered brain chemistry across multiple independent studies.
Why Choline Is So Important for Brain Function
Choline is a foundational nutrient for the brain. It is required to build and maintain cell membranes, which allow brain cells to stay flexible and communicate efficiently. Choline is also necessary for producing acetylcholine, a neurotransmitter involved in memory, focus, mood regulation, and muscle control. Because brain cells are constantly sending and receiving signals, they rely on a steady supply of choline to function normally.
Unlike some nutrients, the body can only produce a small amount of choline on its own. Most of what the brain uses must come from food. When the brain is under chronic stress, as it often is in anxiety disorders, its demand for choline may increase. Over time, this increased demand may outpace supply, contributing to the lower levels observed in people with anxiety.
Researchers involved in the study believe this reduction reflects metabolic strain rather than a simple dietary shortfall. Anxiety disorders are associated with prolonged stress responses that increase the brain’s workload. In this state, the brain may be using more resources just to manage ongoing threat signals and emotional regulation, leaving fewer reserves to maintain optimal chemical balance.
Anxiety, Stress, and the Brain’s Alarm System
Anxiety disorders are closely tied to how the brain processes potential threats. The amygdala plays a central role in detecting danger, while the prefrontal cortex helps assess whether a situation is manageable or requires action. In healthy functioning, these systems work together to keep responses proportional. In anxiety disorders, this balance is disrupted, making everyday situations feel overwhelming or unsafe.
Stress-related neurotransmitters such as norepinephrine are often elevated in anxiety disorders. Norepinephrine is a key part of the body’s fight or flight response and prepares the brain and body for action. When this system remains active for long periods, it increases metabolic demand in brain regions responsible for emotional control and decision making, which may help explain the observed changes in choline levels.
Dr. Nona Kocher, a psychiatrist who was not involved in the research, described the reduction in choline as “not trivial,” while viewing it as a sign of metabolic strain rather than direct proof of causation. This perspective reinforces the idea that anxiety reflects a brain under sustained pressure, not a lack of effort or emotional strength on the part of the person experiencing it.
Which Anxiety Disorders Were Included
The analysis included people diagnosed with generalized anxiety disorder, panic disorder, and social anxiety disorder. Despite differences in symptoms and triggers, these conditions shared a similar pattern of lower choline levels in key brain regions. This consistency suggests that different anxiety disorders may share underlying biological features, even when they look different on the surface.
Anxiety disorders affect roughly 30 percent of adults in the United States. Maddock highlighted the scale of the issue by stating, “Anxiety disorders are the most common mental illness in the United States, affecting about 30 percent of adults.” He also noted that many people do not receive adequate treatment, which makes understanding the biological side of anxiety especially important for improving care and reducing stigma.
By identifying shared chemical patterns across multiple anxiety diagnoses, the research supports a more unified view of anxiety as a condition rooted in both brain function and lived experience.
Most People Do Not Get Enough Choline
One striking aspect of this research is that low choline intake is already common in the general population. Data from the National Institutes of Health shows that most Americans do not meet the recommended daily intake for choline, including children. This means many people may already be operating with limited reserves, even before chronic stress enters the picture.
Choline is found in foods such as eggs, fish, chicken, beef, soybeans, milk, and certain vegetables. While animal-based foods tend to be richer sources, plant-based foods also contribute meaningful amounts. Some forms of omega three fatty acids, particularly those found in salmon, may help supply choline to the brain more efficiently.
Maddock cautioned against self-medicating with high-dose choline supplements. He emphasized uncertainty around treatment effects by stating, “We don’t know yet if increasing choline in the diet will help reduce anxiety. More research will be needed.” Excessive choline intake can cause side effects, reinforcing the importance of moderation and professional guidance.
What This Means for Supporting Mental Health
This research does not offer a cure or a simple dietary solution for anxiety. Instead, it expands understanding by showing that long-term stress can alter brain chemistry in measurable ways. For many people, this perspective can ease self-blame and encourage a more compassionate view of mental health challenges.
Supporting brain health involves more than nutrients alone. Adequate sleep, regular movement, emotional connection, therapy, and medical care all help reduce the metabolic burden on the brain. Nutrition may support this process, but it works best alongside other forms of care rather than as a standalone solution.
Choline now joins a growing list of biological clues linked to anxiety. While it does not provide a direct answer, it adds depth to how anxiety is understood and reminds us that caring for mental health also means caring for the physical brain that carries it every day.
