Acetylcholine Deficiency: Symptoms & Causes of Low Levels

Acetylcholine is crucial for learning, memory, sleep, and overall brain health, but low amounts can be detrimental.

Acetylcholine Deficiency: Symptoms & Causes of Low Levels

Producing the vital neurotransmitter acetylcholine is necessary for life and well-being, but having too little can cause some distressing problems.

In fact, low acetylcholine is associated with several cognitive diseases and other issues. But just knowing the importance of acetylcholine doesn’t help much.

Instead, it is better to know what causes acetylcholine deficiency, the signs and symptoms, and things that help with low levels.

What is Acetylcholine Deficiency?

Many deficiencies occur when you do not have enough essential vitamins, minerals, or in this case, neurotransmitter acetylcholine.

While it can be difficult to precisely measure levels of acetylcholine, there is evidence that suggests that there is a correlation between low acetylcholine levels and conditions including Alzheimer’s disease and other forms of dementia (1).

Since acetylcholine is the chief neurotransmitter of the parasympathetic nervous system, part of the peripheral nervous system within the autonomic nervous system, acetylcholine is essential for many bodily processes.

For example, it is necessary for muscle contraction, heart rate, blood vessel dilation, and many functions within the central nervous system responsible for breath regulation and for sending other unconscious signals.

Furthermore, acetylcholine function also impacts cholinergic neurons in the cholinergic system that directly influence cognitive function, including memory, learning, and information processing.

While researchers are still working on determining the exact problems that occur with too little acetylcholine levels, there is research on specific cognitive symptoms and physical signs.

What Are the Symptoms of Low Acetylcholine?

Since acetylcholine is vital for the body and mind function, low acetylcholine levels can cause symptoms that can be pretty unpleasant.

Psychological Symptoms

The psychological effects of low acetylcholine levels can range from subtle to severe. Typically, the primary symptoms will be related to mental fatigue and exhaustion.

You may get super stressed faster because you do not have enough energy to process information adequately. This can make it even harder to get through long workdays.

You may also find that you have an even harder time with the formation of thoughts. As a result, your problem-solving skills may suffer, and you may combat with brain fog.

Your brain function may seem slow and sluggish, and it may even be hard to focus for a prolonged period. This may even correspond with slurred speech or blurred vision.

Acetylcholine is also a critical neurotransmitter for cognition, including learning and memory (2).

Suppose you have lower than normal levels of acetylcholine. In that case, you may find that it becomes harder to remember details of short-term memories, and you may struggle to vocalize your thoughts because it’s harder to think of the right words.

In severe cases, it may even lead to memory loss.

Finally, there are also symptoms related to mental health. For example, insufficient acetylcholine can make it harder to manage stress and anxiety.

You may find that you are anxious more often when you do not have optimal amounts present. You may even become irritable and begin to show signs of mood swings, depression, rage, or confusion.

Physical Symptoms

Some physical symptoms may not seem very severe, but they can be bothersome and are not likely to get any better as you age.

For example, you may feel tired and begin to suffer from chronic fatigue. Some people will feel sleepy and not want to get out of bed in the morning or have difficulty staying awake.

You may even feel like your skeletal muscles are weak and only getting worse. Some people even have pain in their skeletal muscle system.

Also, the vagus nerve uses acetylcholine to act in digestion by influencing digestive enzymes. Without enough acetylcholine, it may be harder to poop regularly, and it can even lead to severe constipation.

The problems with the vagus nerve can vary and could cause gas buildup, poor digestion, diarrhea, stomach ache and nausea, vomiting, and other noticeable symptoms. Unfortunately, these signs are often the first to appear.

Below normal acetylcholine levels and problems with the vagus nerve can also cause low blood pressure, weakness, and dizziness (3).

In addition, it can lead to problems with inflammation that can cause pain. In some circumstances, this can cause blood clotting and rapid aging. ACh also helps maintain heart rate via cardiac muscle, and when the body doesn’t have enough, the heart can beat harder or faster.

Finally, the eyes can be checked for diagnosis because acetylcholine plays an important role in pupil dilation. When the eyes dilate, it can be harder to see clearly.

This is because insufficient amounts can result in an imbalance in the sympathetic nervous system that allows more light into larger pupils and the parasympathetic nervous system that does the opposite.

As a result, the eyes may even dry up without treatment or eye drops.

What Causes Low Acetylcholine Levels?

There is no single common cause of low levels of acetylcholine. Still, there are definitely things that tend to contribute to insufficient amounts of the brain chemical and develop a deficiency.

Medication and Drug Abuse

As with other neurotransmitters, medications and drugs can lower brain acetylcholine.

The primary category for medications and drugs that reduce the amount of acetylcholine in your body are anticholinergic drugs.

Anticholinergic medications are used to treat several conditions, including allergies, insomnia, constipation, asthma, and delirium.

In addition, other medicine, including some antidepressants and anticonvulsants, can also affect it and reduce the concentration of the neurotransmitter in the brain or work by blocking the ability to communicate within neurons.


As we age, the acetylcholine that keeps our brain cells healthy is limited. There is a vast difference between messengers and cognition in the brain of a 30-year-old and the brain of a 60-year-old.

As we get older, our brain does not produce acetylcholine like it used to, and this can contribute to many of the factors we associate with age, like muscle weakness, brain fog, and normal cognitive decline (4).

Genetics plays a significant role as well.

Mental Disorders

There are a few mental disorders and neurodegenerative diseases that correlate with lower-than-normal levels.

Alzheimer’s disease is the most studied, but schizophrenia and Parkinson’s disease are neurological disorders also associated with low amounts.

Research has also shown abnormal acetylcholine with other mental conditions and brain disorders.

Health Conditions

In addition to mental disorders, other health conditions can contribute to low acetylcholine.

Research shows a strong connection between low acetylcholine levels and myasthenia gravis, an autoimmune disease.

While more study is needed, some scientists believe that low acetylcholine also can play a role in heart disease (5).

How Is Acetylcholine Deficiency Diagnosed?

While there are definitely issues with less than adequate levels of acetylcholine, it isn’t very easy to measure the exact amount in humans.

In addition, more studies need to be completed to show the actual relationship between acetylcholine and symptoms. There is also no known cure or widely accepted treatments for the problem.

Because of this, poor amounts of acetylcholine are not a legitimate diagnosis. This is especially true when you consider the likelihood of there being other mechanisms and factors involved.

However, some things can be done in a medical setting that you may find to be beneficial.

A doctor would likely want to track your symptoms before diagnosing the issue and may run some tests to see how your brain and body operate, including the amount of ACh you can produce.

Being tested and evaluated ensures that they can provide medical advice for your situation.

How To Treat Acetylcholine Deficiency?

Both synthetic and natural methods can raise acetylcholine levels in the brain that may be beneficial for you.


Doctors can treat the symptoms, which is the most likely scenario. This means they may offer compounds that can help with the symptoms that you are experiencing.

For some, this means treating muscle pain and weakness. For others, it means giving something that can balance natural energy levels or reduce brain fog.

In some cases, they may even prescribe medicine types that can potentially increase acetylcholine, like acetylcholinesterase inhibitors.

These work to improve the acetyl coenzyme called choline acetyltransferase in the brain responsible for synthesizing acetylcholine.

By increasing acetylcholine levels, you may find that your symptoms wane and that you are able to think clearly and live more normally.

This type of medicine is usually only prescribed for severe neurodegeneration or decline like dementia or to treat Alzheimer’s disease.


There are also effective nootropic and dietary supplements that can increase acetylcholine levels in your brain.

For example, the most popular supplements are Citicoline (CDP-Choline), Alpha-GPC (L-Alpha glycerylphosphorylcholine), choline bitartrate, or synthetic centrophenoxine, which help provide adequate choline, the precursor to acetylcholine.

Choline deficiency can be a catalyst for acetylcholine problems. This is because precursors are building blocks that convert into new compounds.

So even though very little choline becomes acetylcholine, these types of choline supplements can still help with raising acetylcholine levels.

Other natural supplements, like bacopa monnieri, ginkgo biloba, or huperzine A, work directly to increase the release or duration of acetylcholine within the autonomic nervous system.

Many nootropics and acetylcholine supplements combine a choline source with other compounds to increase activity at the acetylcholine receptors and offer synergetic effects to make the supplement work better.


Diet is essential to increase acetylcholine naturally in our bodies. The foods we choose to eat can also have effects related to action at acetylcholine receptors.

Since choline is an essential nutrient, it makes sense that healthy nutrition could be a great benefit.

Unfortunately, most people do not get enough choline in their diet and food alone, and making different choices could help you do just that.

Choline is found in meat and fish as well as eggs and dairy, particularly the beef liver.

It is also found in other non-animal food, including beans, cruciferous vegetables, whole grains, nuts, and seeds. Choosing to eat foods like this can make a difference.

One problem some people face is that many of these foods don’t fit with low-fat diets.


Another natural way to influence ACh is through exercise (7). Not only that, but the impact is both significant and fast. Adding a couple of days of working out to a sedentary lifestyle can do a lot for the chemical messenger.

Also, getting enough physical activity can be good for the symptoms that you may be facing. It can give more energy, help to reduce fatigue and regulate heart rate.

Plus, it offers many other benefits to overall health and can reduce the side effects of other conditions.


Having an optimal amount of acetylcholine in the nervous system is vital for many mechanisms and critical to achieving proper body functioning. However, since many adults do not create enough from the things they eat, problems can arise.

There are several aspects of low acetylcholine leading to negative side effects that include physical and mental problems.

This often occurs when there is not an acetylcholine balance in the complex synapses.

If you are deficient, you may want to supplement with choline or change your lifestyle to improve the difficulties. This can help you specifically break down or increase the amount of acetylcholine absorbed.