I first became fascinated with lithium in 2005, during my fourth year in pharmacy school while I was on a clinical rotation at Dr. William Walsh’s clinic The Pfeiffer Treatment Center, outside of Chicago. This rotation was my first insight into using nutrition (more specifically, ortho-molecular medicine) for health conditions that were deemed either incurable, or only treatable with heavy duty pharmaceuticals.
Why was I so interested in lithium? As a pharmacy student, I had learned that lithium was one of only two drugs that had been shown to reduce suicidality, but there’s a lot more to my passion on this subject. The unfortunate reason for becoming interested in suicide came as a result of losing someone I loved, to suicide in 2004, while still in pharmacy school.
Pharmaceutical lithium has a lot of supportive evidence for reducing suicidality and leveling out the extreme mood swings in bipolar disorder. However, lithium is a widely known thyroid-toxic drug — in fact, I always recommended screening for new-onset thyroid issues for anyone taking lithium, when I was working as a clinical pharmacist.
My curiosity took me down a rabbit hole when I found that small doses of lithium, even the amounts found in some water supplies, seem to help with suicidality. A study in Texas found that counties with higher levels of lithium in the water, had significantly lower levels of suicide, homicide, drug use, and violent crimes. And this was at daily levels hundreds of times lower than prescription lithium — this is known as “nutritional lithium.”
Additionally, nutritional lithium has been shown to slow dementia, improve cognition by optimizing levels of neurotransmitters such as serotonin and dopamine, help heal the brain from injury and stroke, reduce inflammation, help bipolar disorder and depression, support methylation, help healthy cells survive, protect against harmful free radicals by acting as an antioxidant, help with inflammatory bowel disease, help with addiction and substance abuse (irritability is a key indicator it could help), reduce aggressive behavior in children, and even promote longevity.
And so I remember thinking years ago, why can’t we just put lithium in everyone’s water like we do fluoride? Then of course I started to learn more about the causes of thyroid issues as a result of my own health journey, and I realized that fluoride, even in small amounts added to water for benefiting teeth, was actually toxic to the thyroid.
And so I wondered, is nutritional lithium safe and/or beneficial for the thyroid, or could it be toxic, even in small doses? This is a question I’m often asked by colleagues and my very well-researched clients, so I wanted to do some digging around… and I was surprised by what I found.
Keep reading to learn:
- How lithium works as a nutrient in the body
- What are the benefits and risks of lithium?
- What does nutritional lithium do, and what’s a good dose?
- How much lithium is too much, when you have a thyroid disorder?
- How to tell if you have lithium toxicity
What is Lithium?
Lithium is a naturally occurring mineral that exists as a salt, and can be found in water. In fact, the most common source of lithium today is tap water. As rocks erode, the lithium gets into the water, then plants absorb it, and small amounts enter the food chain. Lithium can be concentrated in hot springs, which were often important sites to Native Americans and thought to have healing benefits.
In 2002, lithium was deemed “essential,” meaning that humans need to ingest it for health. It was suggested that the RDA, or Recommended Daily Allowance, be accepted at 1 milligram per day for adults (150 pounds). The World Health Organization also recommends 1 mg per day.
Every organ and tissue in the human body contains the mineral lithium, which is especially important for brain health. However, many people may be deficient in this essential nutrient, particularly if they live in areas where the lithium content in the drinking supply is low, or if they use a water filtration system that removes lithium, such as reverse osmosis.
Symptoms of lithium deficiency can include increased impulsivity, aggression, suicidality, cognitive impairment (including learning and memory impairment), decreased immune response, and an effect on gene expression that can lead to a higher risk of developing Alzheimer’s and bipolar disorder.
Furthermore, tests to determine lithium levels in the hair of children with autism, have shown significantly lower levels of this nutrient (in the 1 percentile) as compared to the rest of the population.
This finding indicates the possibility that reduced lithium intake in pregnant mothers may be correlated to a risk of autism in children.
Today, we think about lithium as a powerful psychiatric medication — but while lithium is certainly a powerful pharmaceutical, it is important to make the distinction between pharmaceutical lithium and nutritional lithium.
History of Lithium
Through the 1800s and early to mid-1900s, lithium was used as a treatment for various health issues, including gout, bladder problems, and cardiovascular health. It was also found to improve mood by the early 1900s. Interestingly, lithium citrate was the original “up” in 7-Up. In 1948, some spas known for their mood-boosting benefits in the Czech Republic were analyzed and found to have a high lithium content.
In the early 1900s, spas, hot springs, and mineral baths across North America became popular destinations for “healing,” and some of these places would also bottle and sell their mineral water. Mudlavia’s “mud bath and lithia water spring” is just one of many reports of these types of places claiming to “cure” arthritis as well as offer innumerable health benefits, including improvements in mood. When people realized that this could be attributed to lithium salts, then came the idea of concentrating lithium in tablets.
In Europe, lithium had already been used to treat depression around this time period. However, its use was not formalized or well-documented.
Australian psychiatrist John Cade is credited for critical experiments in the 1940s that put lithium on the map as a legitimate treatment for mania, research that was influenced by his time in a Japanese internment camp in WWII. At this time, Cade noted a connection between nutritional deficiencies and diseases as he was treating prisoners. When he got back to Melbourne, he collected urine from people with depression, “mania” (bipolar disorder), and schizophrenia. He started injecting urine into guinea pigs at varying doses, and found that the urine from those with mania was more lethal to the guinea pigs than the urine from non-depressed individuals. (Poor guinea pigs!)
He then started experimenting with giving lithium carbonate to guinea pigs, and found that it reduced urine toxicity and induced calm. In 1949, he reported his research findings (on research with humans) in the Medical Journal of Australia, and this was the first significant published study on the use of lithium for mania.
Through the 1960s, lithium was being used in American psychiatric hospitals. Clinical studies at this time continued to show successful results for the treatment of mania and depression. Significantly, it was showing enough promise to be used instead of electroshock therapy.
Lithium was approved by the F.D.A. in 1970, but only for the treatment of mania, and not as a prophylactic (a maintenance or preventative dose given over a longer period) even though there was promising evidence that it was effective as a prophylactic, and it had been approved for this use in the EU for some time.
Lithium carbonate and lithium citrate have since been considered the “gold standard” for the treatment of mood disorders, although their use has declined with the introduction of other types of antidepressants and antipsychotics into the pharmaceutical market.
Today, lithium is prescribed in the U.S. as a generic drug or under the brand names Lithobid, Eskalith, and Lithate.
Pharmaceutical lithium is what we most often think of when we hear the word lithium. It is one of the oldest and most effective psychiatric medications that is mainly used to treat bipolar disorder and the incapacitating swings between mania and depression.
As a mood stabilizer, pharmaceutical lithium is also used to treat major depression, when antidepressant medications don’t work. It greatly reduces the risk of suicide for patients suffering from mental illness.
Pharmaceutical lithium, in the form of lithium citrate or lithium carbonate, has been used for over 60 years at very high doses, often 800-1200 mg per day. This prescription has the ability to promote immediate improvements in people with bipolar disorder.
Pharmaceutical Lithium and Side Effects
Part of why lithium carbonate requires large doses is to force the lithium across the blood-brain barrier, but the problem with these large doses is the potential for toxicity and side effects, which specifically can also affect the thyroid and kidneys.
Short-term side effects can include drowsiness or “fogginess,” polydipsia (thirst and dry mouth), polyuria (excessive urination), nausea, diarrhea, and tremors. In the longer term, it can lead to irreversible kidney damage, kidney failure (this is rare but possible), neurological issues, cardiac symptoms, hypothyroidism, and hyperparathyroidism. Overdose can cause seizures and even death.
Physiologically, side effects from pharmaceutical lithium may be intense, and may even signal lithium toxicity. This prompts people who are already struggling with mental health issues such as bipolar disorder, to stop their medications suddenly, which can further exacerbate symptoms such as mania.
Pharmaceutical Lithium and Thyroid Disease
It is a well-established fact that high-dose pharmaceutical lithium is toxic to the thyroid. I wrote an article on the nine most thyroid toxic medications, and lithium was at the top of that list!
The high doses of lithium in prescription medications can interfere with thyroid function and increase thyroid autoimmunity. This is well-documented, and I have unfortunately seen this clinically as a pharmacist.
Here’s how lithium can affect the thyroid:
- It has a suppressive effect on the thyroid gland.
- It can inhibit the synthesis and release of thyroid hormones.
- It can increase TSH while lowering free thyroid hormones.
- It may lead to increased destruction of thyroid cells.
- It can lead to hypothyroidism and goiters.
- It can lead to hyperthyroidism, which is less common than hypothyroidism but can occur with long-term use of lithium, due to prolonged inflammation of the thyroid gland.
- It can increase the production of parathyroid hormones.
Lithium can also affect the conversion of T4 hormones into the (more biologically active) thyroid hormone T3. When T4 and T3 levels are low, TSH levels can increase dramatically, as TSH production signals the thyroid gland to make more thyroid hormone.
“Lithium-induced hypothyroidism” is the term for hypothyroidism that occurs as a consequence of taking pharmaceutical lithium. Goiter development (enlargement of the thyroid gland) is the most common thyroid-related side effect seen with people who take prescription lithium as a mood stabilizer.
Hypothyroidism and the development of goiters can occur in up to 52 percent of those on lithium therapy, and can develop in just a few months. Just like the general population, these effects on the thyroid are more common in women.
While lithium does not seem to increase thyroid antibodies, it can lead to an increased risk of thyroid autoimmunity in susceptible individuals, and accelerate the progression of Hashimoto’s.
Thyroid monitoring is also important to discuss here. Anyone taking pharmaceutical lithium should have their thyroid frequently monitored, including before and during therapy. The monitoring should include thyroid antibodies (TPO and TG), as well as TSH, free T3, and free T4.
In summary, pharmaceutical (high dose) lithium, which is often prescribed for bipolar disorder, can seriously affect the thyroid. Lithium has a long-known suppressive effect on the thyroid gland and can increase TSH while lowering free thyroid hormones.
Lithium, Mental Health and Hashimoto’s
Even though I am an advocate of the functional medicine approach, which promotes the use of non-pharmaceutical therapies where appropriate, I want to stress that I don’t take the use of lithium for mental health reasons lightly, as my life has been touched by a loved one’s suicide.
I could probably write an entire book on the tragedy of losing a beautiful loved one to suicide, and maybe one day I will. For now, I want to share that I lost confidence in myself as a healer after this person’s death. Here I was, studying to become a pharmacist, and yet I couldn’t even help a person I loved get better.
The worst part was, I had planned on either specializing in psychiatric pharmacy or pursuing another degree to become a psychiatrist. Yet I couldn’t stop someone I cared about, from losing a battle against the mental health issues I was training to treat.
I began to research the mechanisms behind suicidality, and participated in a fundraiser for the American Foundation of Suicide Prevention, which involved completing a 20-mile walk overnight in downtown Chicago with thousands of others who had lost a loved one.
I remember that this person reported feeling “dulled” and “deadened” by mood-stabilizing medications and refused to take them. I later heard those same words often in my career as a pharmacist. People with bipolar disorder would often refuse to take their medications because they no longer felt joy and excitement, and suffered from a loss of libido and brain fog.
Of course, I think that being alive and medicated is better than being unmedicated and dead. Fortunately, there are many additional options to help us feel better, as not everyone can tolerate the side effects of the medications used to treat bipolar disorder.
As we can see, this “miracle drug” is not without consequences and can cause serious side effects. That said, the side effects do seem to correlate with dosage and accumulation in the body, which opens the door for a new option… low-dose lithium, also known as nutritional lithium.
I love the quote: “The dose separates the poison and the remedy,” because it perfectly illustrates the difference between pharmacological and nutritional lithium.
Nutritional lithium refers to very small levels of lithium, and how it affects our health. (Here, we are talking about lithium as a nutrient, not as a drug.) In contrast to using the high, pharmaceutical doses of lithium carbonate or citrate, nutritional lithium supplements are usually taken in the form of lithium orotate, which is a more stable and well-tolerated form of lithium than the carbonate version used in prescriptions.
Doses typically range from 400 micrograms to 40 milligrams.
Let’s go back to the 2005 study in Texas, that looked at lithium in drinking water. People who lived in the studied counties with “high” lithium levels in the water were getting about 2 mg of lithium per day, which is hundreds of times less than what can be found in a pharmaceutical drug.
Similar results were found in other studies, where these small amounts present in the water (compared to none) showed a lower risk for suicide for the general population. In fact, suicide rates are 60-80 percent less in these communities.
We know from these correlation studies that communities with lithium in their water supply have lower rates of crime, suicide, homicide, rape, and drug dependency. Even trace doses have been found to be antidepressant and mood-stabilizing.
Why is that?
Research conducted in the 1970s found that lithium orotate ended up in larger concentrations in the brain than the equivalent dose of lithium carbonate, suggesting that this compound could offer similar effects at lower doses. (This happens because it can move through cell membranes/the blood-brain barrier more efficiently.)
Moreover, studies have found that lithium orotate allows more lithium into the brain than lithium carbonate, and remains there longer. In pharmacology, this is an excellent situation, where the compound goes where it’s supposed to, and the rest of the body is spared from excess.
I was excited to be introduced to the work of Dr. James Greenblatt, a psychiatrist who has been in practice for 30 years and is an expert on nutritional lithium, through our work as key opinion leaders for Pure Encapsulations. Dr. Greenblatt wrote Nutritional Lithium: A Cinderella Story, which I was excited to dive into to deepen my own understanding of this topic.
Beyond mood and suicide, nutritional lithium may offer other benefits, including slowing dementia and improving cognition.
- Lithium could potentially slow dementia and Parkinson’s by moderating dopamine. One study with patients with Parkinson’s showed that low doses of lithium boosted the production of an enzyme that helps dopamine synthesis.
- Lithium can improve mitochondrial function. Mitochondrial defects are common in brain diseases, aging, and cancer.
- Lithium may improve cognition by optimizing levels of neurotransmitters such as serotonin and dopamine.
- Lithium can inhibit an essential enzyme, GSK3β, which is related to inflammation and GI disorders, including Inflammatory Bowel Disease (IBD). It may thus reduce damage to the colon in those with IBD.
- Lithium may offer a potential healing role in traumatic brain injury, stroke, and neurological disease.
- Lithium reduces inflammation, protects cells against free radicals, and helps healthy cells survive.
- Lithium supports methylation (more on that in a minute).
- Lithium may help with behavioral problems, reduce irritability, reduce aggressive behavior, and be helpful in managing addictions.
It is even possible that nutritional lithium could be beneficial for other diseases, including fibromyalgia, Lyme disease, headaches, and glaucoma.
Per Dr. Greenblatt:
Lithium is a powerful epigenetic factor that can be used to dim the expression of genes that lead to aggression and mental illness while stimulating the expression of health-enhancing genes.
Lithium May Reduce Inflammation/Neuroinflammation
Low-dose lithium has been shown to decrease inflammatory proteins by suppressing pro-inflammatory molecules called cytokines, while increasing anti-inflammatory proteins in the body. Lithium also inhibits the release of arachidonic acid — this acid is typically released following injury and trauma, and promotes an inflammatory response within the body. While this response is helpful in acute (or sudden) cases of injury, it can be harmful if the inflammatory response is sustained for long periods of time. By suppressing arachidonic acid, lithium decreases harmful inflammation.
One study in mice showed that lithium appeared to have neuroprotective effects against nervous system autoimmunity, suggesting that lithium may be especially beneficial for reducing neuroinflammation.
How Lithium Can Enhance Cognitive Function
Evidence suggests that lithium may increase brain-derived neurotrophic factor (BDNF), which promotes the survival and growth of neurons, ultimately enhancing cognitive function. It also appears to inhibit glycogen synthase kinase-3 activity, which plays an important role in determining cell death.
There is a growing body of research suggesting that lithium may provide significant benefits in the treatment and prevention of Alzheimer’s. Lithium has been shown to disrupt the key enzyme responsible for the development of amyloid plaques and neurofibrillary tangles associated with Alzheimer’s disease. Additionally, lithium has been shown to repair existing damages brought on by the disease. Patients on lithium have been found to have significantly higher gray matter volumes in their brains.
In a recent trial published in Current Alzheimer’s Research, a nutritional dose of 300 µg of lithium was given to Alzheimer’s patients for 15 months. When compared with the control, those on low-dose lithium showed significant improvements in cognitive markers after just three months of treatment. These benefits appeared to strengthen as the study proceeded, with many of the lithium-treated individuals showing notable cognitive improvements by the end of the trial. These results suggest that lithium, used at low doses over a long period of time, could be a viable treatment for Alzheimer’s disease.
How Lithium Supports Methylation
Lithium orotate has been found to be helpful for individuals that have a MTHFR variation of the gene C677T, as well as the COMT gene. Lithium increases the transport of vitamin B12 and folate, which are critical components in the production of methyl groups. (This function is often impaired in those with these particular gene variations, and can lead to anxiety and mood disorders.)
Interestingly, the MTHFR gene mutation, which also affects B12 and folate metabolism, is higher in those with both mental health issues and Hashimoto’s.
Nutritional lithium has certainly piqued my interest, and perhaps supplementation can be a way to achieve benefits for those that don’t have detectable levels of lithium in their drinking water.
Lithium and the Brain
Lithium is able to get through the blood-brain barrier (a very selective barrier designed for protection) to get into the brain, where it has some interesting actions. Research suggests that lithium orotate is able to penetrate the blood-brain barrier more effectively than lithium carbonate.
Lithium’s benefits for the brain come from its ability to optimize levels of key neurotransmitters such as serotonin, dopamine, and glutamine (all of which are important in neuron signaling), promote the growth and survival of neurons, reduce brain-damaging enzymes, inhibit the growth of “plaques” and “tangles” that are observed in dementia, and increase grey matter (a type of beneficial brain tissue).
Lithium increases BDNF (brain-derived neurotrophic factor) that allows for increased growth of the neurons (brain cells). BDNF can also help to protect existing neurons and slow their decline or loss, giving lithium “neuroprotective” benefits.
Along the same lines, lithium is also associated with stem cell production, which may account for lithium’s anti-aging functions. The growth of nerve cells, creation of new cells, and improved signaling between cells, may improve overall brain function.
Lithium also regulates neurotransmitters. According to Dr. James Greenblatt, lithium helps the body to balance neurotransmitters and serves more of a regulatory role. Often, this can mean an increase in serotonin and dopamine — our “feel good” neurotransmitters. These changes in neurotransmitters may account for the decrease in aggression seen in the studies of lithium in various water supplies.
Lithium and Children
Supplementing with nutritional lithium can prevent deficiency and possibly even serious problems related to mood and behavior, and is safe enough to be used with children.
A study conducted in 2018 found that low-dose lithium improved cognitive function in children with intellectual disabilities. The children’s IQ scores were significantly increased following the use of low-dose lithium over three months. Additionally, the authors found that the low dose of lithium had only reversible, and mild effects.
It may also offer a potential healing role in traumatic brain injury, stroke, and neurological disease. Higher lithium levels in drinking water correlate to a reduced mortality rate from all causes, giving it attention in longevity and anti-aging circles.
It may also have benefits related to autism. Tests to determine lithium levels in the hair of children with autism, have shown significantly lower levels of this nutrient (in the 1 percentile) as compared to the rest of the population. This finding indicates the possibility that reduced lithium intake in pregnant mothers may be correlated to a risk of autism in children.
Furthermore, nutritional lithium may help children with neuromuscular irritability symptoms such as:
- Early waking
- Waking up screaming
- Having meltdowns
- Waking up at night
- Jumping when pleased
- Climbing to high places
- Having hands/body in strange poses
- Difficulty falling asleep
- Jerking during sleep
- Destructive behavior
- Falling and getting hurt while running
- Inconsolable crying
- Being fearful of harmless objects
- Constant movement
- Flapping hands
- Slapping books
- Biting/chewing fingers
- Chewing on things
How Does Lithium Work?
Lithium seems to have many interesting and beneficial effects on the body. Some of the mechanisms are not fully understood, but here is what we do know.
As mentioned earlier, lithium is able to get through the blood-brain barrier (a very selective barrier designed for protection) to get into the brain, where it increases BDNF (brain-derived neurotrophic factor) that allows for increased growth of the neurons (brain cells). Lithium is also associated with stem cell production. The growth of nerve cells, creation of new cells, and improved signaling between cells, may improve overall brain function.
Secondly, lithium regulates neurotransmitters, which can mean an increase in serotonin and dopamine.
Thirdly, lithium has anti-inflammatory and antioxidant actions. It does this by decreasing protein messengers called cytokines that signal inflammation; and by increasing levels of DHA, one of the anti-inflammatory fats and brain-protective fats that are found in cold water fish.
And finally, lithium plays a role in the transport of vitamin B12 and folate (vitamin B9) into our cells, where they can be used for various processes, including neurotransmitter production. More B12 and folate in the cells can mean more serotonin and dopamine. (Deficiencies in these B vitamins are related to mood swings, depression, irritability, dementia, and mania.) Interestingly, the MTHFR gene mutation, which also affects B12 and folate metabolism, is higher in those with both mental health issues and Hashimoto’s.
What About Nutritional Lithium and the Thyroid?
Now that we’ve covered all of the benefits of lithium, as well as the risks to the thyroid from pharmaceutical lithium, the question remains: what about low-dose nutritional lithium? Could it cause thyroid issues and toxicity?
A South American study looking at high levels of lithium in the water supply did find that lithium in drinking water affected TSH and T4 levels, but without clinical significance. In this study, 202 women from four Andean villages in northern Argentina, an area in which there is a high concentration of lithium in drinking water, were assessed for lithium exposure through urine testing. Their thyroid function was evaluated by measuring plasma free thyroxine (T4) and pituitary gland thyroid-stimulating hormone (TSH) levels. The authors found that higher levels of lithium in urine were associated with lower T4 levels and higher TSH levels, which is consistent with previous reports of hypothyroidism.
Since there haven’t been any studies specifically at low doses (5-20 mg) of lithium orotate on thyroid function, I asked Dr. Greenblatt to share his experience with nutritional lithium and those with thyroid issues.
Dr. Greenblatt shared that he has been prescribing nutritional lithium for 30 years and has compared notes with Dr. Jonathan Wright of the Tahoma Clinic, who has been prescribing nutritional lithium for almost 40 years.
While Dr. Greenblatt notes that prescription lithium carbonate clearly has an effect on thyroid function, he says: “We cannot predict those who develop side effects. Some patients who have taken 1200 mg for many years have seen no effects on thyroid; and yet some may take 600 mg and in a year, develop hypothyroidism”… in his experience with nutritional lithium orotate (in dosages from 1 mg to 20 mg), he has never seen significant effects on thyroid function.
He does use nutritional lithium in those with thyroid issues who have a history of depression, and has noted that he has seen the most dramatic response to lithium orotate in those individuals with a family history of depression, suicide, or any substance abuse. Additionally, lithium orotate seems to work really well when people have irritability. Furthermore, he will test the person to determine if they have a lithium deficiency. If lithium levels are undetectable, this could mean that the person has lithium deficiency and may benefit from a nutritional dose.
That said, Dr. Greenblatt always recommends practicing caution with the use of lithium with someone with known thyroid disease.
His clinical recommendations include:
- Determine if the patient was struggling with mood symptoms prior to thyroid dysfunction.
- Explore the family history of substance abuse, suicide, or mood disorder. I have seen the most dramatic response to lithium orotate in those individuals with a family history of depression, suicide, any substance abuse.
- Perform trace mineral hair testing: several labs will look for low levels of lithium in hair that are otherwise undetectable.
Using these three clinical guidelines, Dr. Greenblatt says that it may be appropriate for someone with thyroid disease to take lithium orotate, as long as they are monitoring thyroid function.
Of note, in his book, Dr. Greenblatt discusses the importance of zinc for protecting thyroid function for someone who is taking nutritional lithium. Zinc is necessary for producing TRH (thyroid releasing hormone) in the brain, which signals the release of TSH (thyroid-stimulating hormone), and maintaining optimal levels of zinc is incredibly beneficial for those with Hashimoto’s. Dr. Greenblatt recommends 30-60 mg per day of zinc while taking nutritional lithium, for its thyroid protective benefits.
Testing Lithium Levels
If you are considering the use of nutritional lithium for its various benefits, be sure to test your lithium levels, which can be tested via a blood draw, urine sample, or via a hair mineral analysis test.
- Blood levels are usually monitored when someone is taking pharmaceutical lithium, in order to avoid toxicity. The standard blood ranges are 0.6-1.5 mEq/L, and the optimal range is considered to be 0.6-1.2 MEq/L. Toxicity can occur at levels higher than 1.5 mEq/L.
- Nutritional lithium levels can be assessed via a urine sample kit that can be self-ordered through ZRT Laboratory and some other labs, like Great Plains.
- Lithium levels can also be assessed using a hair mineral analysis test, which you can order from a functional medicine practitioner. When lithium levels are undetectable, this may indicate some benefit from supplementing trace doses, even as low as the recommended 1 mg per day.
Water Supply Testing
I highly recommend finding out what is present in your local water supply if possible — it can be eye-opening!
Some cities publish their tap water quality information, but if you can’t find this info, or if you are curious about your home’s tap water quality, you can get your own testing kit from Tap Score.
I do recommend using water filtration systems to filter possibly harmful substances such as fluoride from your tap water, however, which means that nutrients such as lithium could be filtered out.
Dietary Sources of Lithium
If you are looking into upping your intake of lithium, one way to do so is by getting more lithium through diet. After all, I truly believe that food can be medicine, and eating whole foods doesn’t present the risks that might come along with medications or supplements.
Adding lithium-rich foods to your diet might be the easiest way to increase your lithium intake.
Here’s an approximate amount of lithium found in various foods (μg/g dry weight):
- Cereals: 4.4
- Fish: 3.1
- Mushrooms: 0.19
- Vegetables: 2.3
- Meat: 0.012
- Dairy products: 0.5
- Nuts: 8.8
Quantities in foods can vary, of course. Furthermore, many people with Hashimoto’s are sensitive to cereals, dairy products, and nuts.
Here are some suggestions for those who may be following specific dietary protocols for Hashimoto’s:
- Oats (only if you tolerate grains and have a certified gluten-free source; soak or sprout oats to increase their digestibility and nutritional value)
- Egg yolks
- Goji berries (Fun fact: Goji berries are members of the nightshade family, so caution to those who may be sensitive to nightshades.)
- Pistachios (if you can tolerate nuts)
- Fruits and vegetables like potatoes, tomatoes, and cabbage
- Some mineral water (such as San Pellegrino)
Most of us get our lithium from vegetables and mineral/tap water, but the level of lithium naturally occurring in any given region can vary greatly. It is estimated that we ingest anywhere from a few hundred micrograms to several thousand micrograms each, in a given day.
You may also benefit from removing high-sodium processed foods and caffeine. Both excess sodium and caffeine can increase the excretion of lithium from the body, which increases the need for nutritional lithium. Right after I learned about this, I recalled a client many moons ago who had a manic episode after drinking lots of Red Bulls.
Lithium from Tap Water, Mineral Waters, and Spas
Both tap and mineral water can contain trace amounts of lithium, but the level of lithium in any water depends essentially on how much lithium is naturally found in that location. One study which analyzed the lithium content of various brands of bottled natural mineral waters that are available on the Portuguese market, found the potential for water in that area to be therapeutically useful. This suggested the possibility that there are fewer suicides in areas with higher levels of lithium.
However, there is also the potential for high levels of other minerals, such as fluoride, which should not be consumed in high amounts, especially for people with Hashimoto’s. As such, looking for lithium-rich tap water is not one of my go-to strategies.
What about lithium-rich spa water? I don’t think that we need a study to tell us that spending time in a spa makes us feel better. 🙂 That said, is it the lithium in spa waters that actually improves our mood, or is it the mere fact that we are in a spa, practicing self-care? Nonetheless, I see mineral spas as therapeutic, and there is certainly a possibility that bathing in mineral-rich waters offers health benefits. From my own experience, my patients’ experiences, and reports dating back hundreds of years, I would contend that the use of heat therapy through spas and saunas is an effective way to help lower stress, improve mood, and support healing.
Supplementing with Nutritional Lithium
You can also increase your lithium intake with low-dose nutritional lithium supplements.
Lithium supplements are usually taken in the form of lithium orotate. Recommended doses range from 400 micrograms to 40 milligrams.
Although taking the dose suggested above is safe, it may be helpful to take essential fatty acids as well, to minimize the possibility of side effects (3 to 5 grams a day may reverse some symptoms of prescription lithium toxicity). Specifically, supplementing with safflower oil (a rich source of vitamin E) at a dose of 3 to 5 grams per day, can reduce the chance of developing lithium-related tremors and ataxia (a disorder that affects balance and coordination of speech as well as movement). This is relevant for all types of lithium.
Additionally, supplementing with zinc when taking nutritional lithium can help protect the thyroid. A dose of 30-60 grams of zinc per day has been shown to normalize thyroid function following four months of nutritional lithium consumption.
Side effects from lithium orotate are rare, but here are some notes and precautions:
- Not to be taken in conjunction with antidepressants (SSRIs or MAOIs) unless advised by a health professional.
- Medications such as calcium channel blockers or ACE inhibitors may alter the metabolism of lithium.
- Your doctor should check serum lithium levels after three months.
- Your doctor should monitor renal, parathyroid, and thyroid function.
- Discuss with your doctor if you are planning on becoming pregnant.
- Some people feel “too” relaxed or subdued when taking lithium.
- Possible side effects (published in one report) include hand tremors, nausea, vomiting, excessive thirst, and frequent urination.
- Do not take this supplement if you are pregnant or breastfeeding.
Supplementing with lithium orotate can offer many benefits and is generally safe, especially if you know or believe you have a lithium deficiency — however, check with your doctor about possible medication interactions, and be sure to follow all guidelines.
People who have a thyroid condition such as Hashimoto’s and are taking lithium (in any form) should also be monitoring thyroid function to ensure their levels are within the normal range throughout supplementation.
As always, please work with your healthcare provider to determine if nutritional lithium is right for you.
A Note About Mental Health
If you are thinking about taking your life, please, please, please don’t do it! There are answers and solutions to help you feel happy and full of life. I promise. Depression is like a cloud over our brain that impairs our judgment. We can lift the cloud and show you how beautiful you are, and how beautiful life can be.
If you do already take pharmaceutical lithium and are interested in taking low-dose lithium orotate instead, this could be a possibility; however, I would not recommend stopping your prescription, nor adding lithium orotate to the mix if you are already taking psychotropic medications, without consulting your practitioner. Please don’t just stop your meds suddenly, as they can cause withdrawal symptoms and, in some cases, serious relapses.
Interestingly, there have been many cases of people being misdiagnosed as having bipolar disorder when they actually had thyroid problems — I discussed this in an earlier article, Are You Going Crazy or is it Just Your Thyroid?.
While pharmaceutical or nutritional lithium can be options, I do want you to be aware that there are a host of other strategies that can be helpful in addressing mood disorders, whether used in conjunction with antidepressants and/or lithium, or on their own. These might include bright light therapy, T3-containing medications, meditation, and counseling.
Though we think of a powerful antidepressant when we hear the word “lithium,” this natural mineral has some pretty profound benefits for neurological health (when taken in low doses). In fact, a 2011 study concluded that low-dose lithium actually promotes longevity — an increase of lithium in the water supply was correlated with a profound effect on anti-aging.
Though some people with Hashimoto’s will need to proceed with caution and consult with their own practitioners, the potential benefits of low-dose lithium are worth looking into for those with mood disorders (bipolar disorder and depression), neurological issues (Alzheimer’s and memory disorders), chronic inflammation, or MTHFR gene variations.
There are also dietary and lifestyle interventions that may help with mood disorders, as well as Hashimoto’s. Whichever methods you choose to look into, I highly encourage you to work with a practitioner who will support you on your health journey!
I’m curious, have you tried low-dose lithium? What effects have you experienced?
As always, I wish you all the best!
P.S. Be sure to sign up for my weekly newsletter to get a free book chapter, recipes, Thyroid Diet Starter Guide, and notifications about upcoming events and my latest research. For future updates, be sure to follow us on Facebook and Instagram too!
- Pacholko AG, Bekar LK. Lithium orotate: A superior option for lithium therapy?. Brain Behav. 2021;11(8):e2262. doi:10.1002/brb3.2262
- Schrauzer GN, Shrestha KP. Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions. Biological Trace Elements Research. 1990;25(2):105-13.
- Cochrane, Sharlene Voogd. “Letters from Mudlavia: ‘… It Is Just Very Hard to Get Well.’” Indiana Magazine of History. 2001; 97(4): 296–314. Indiana University Department of History. https://www.jstor.org/stable/27792341. Accessed November 2021.
- Greenblatt JM, Grossman K. Nutritional Lithium: A Cinderella Story: The Untold Tale Of The Mineral That Transforms Lives And Heals The Brain. North Charleston: Create Space Independent Publishing Platform, 2016.
- Shorter E. The history of lithium therapy. Bipolar Disord. 2009;11 Suppl 2(Suppl 2):4-9. doi:10.1111/j.1399-5618.2009.00706.x
- Draaisma, Douwe. Lithium: the gripping history of a psychiatric success story. Nature. 26 August 2019. https://www.nature.com/articles/d41586-019-02480-0. Accessed November 2021.
- Martone G. Nutritional Lithium. Journal of Clinical Psychiatry Neuroscience. 2018;1(1):3-4.
- Machado-Vieira R, Manji HK, Zarate CA. The role of lithium in the treatment of bipolar disorder: convergent evidence for neurotrophic effects as a unifying hypothesis. Bipolar Disorder. 2009;11(2):92-109.
- Ohgami H, Terao T, Shiotsuki I, Ishii N, Iwata N. Lithium levels in drinking water and risk of suicide. British Journal of Psychiatry. 2009;194(5):464-5. doi: 10.1192/bjp.bp.108.055798.
- Vita A, De Peri L, Sacchetti E. Lithium in drinking water and suicide prevention: a review of the evidence. International Clinical Psychopharmacology. 2015;30(1):1-5. doi: 10.1097/YIC.0000000000000048
- Schrauzer GN. Lithium: occurrence, dietary intakes, nutritional essentiality. Journal of the American College of Nutrition. 2002;21(1):14-21.
- Marshall, TM. Lithium as a nutrient. Journal of American Physicians and Surgeons. 2015;20(4):104-109.
- Kibirige D, Luzinda K, Ssekitoleko R. Spectrum of lithium induced thyroid abnormalities: a current perspective. Thyroid Research. 2013;6(3).
- Hu L-Y, Shen C-C, Hu Y-W, Chen M-H, Tsai C-F, Chiang H-L, Yeh C-M, Wang W-S, Chen P-M, Hu T-M, Chen T-J, Su T-P, Lui C-J. Hyperthyroidism and risk for bipolar disorders: a nationwide population-based study. PLoS One. 2013;8(8): e73057. doi: 10.1371/journal.pone.0073057
- Chakrabarti S. Thyroid functions and bipolar affective disorder. Journal of Thyroid Research. 2011;2011:306367. doi: 10.4061/2011/306367
- Rowse AL, Naves R, Cashman KS, et al. Lithium controls central nervous system autoimmunity through modulation of IFN-γ signaling. PLoS One. 2012;7(12):e52658. doi:10.1371/journal.pone.0052658
- Chiu CT, Chuang DM. Neuroprotective action of lithium in disorders of the central nervous system. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011;36(6):461–476. doi:10.3969/j.issn.1672-7347.2011.06.001
- Shaw W. Lithium Deficiency: Common In Mental Illness And Social Ills. The Great Plains Laboratory Inc. website. https://www.greatplainslaboratory.com/articles-1/2015/11/13/lithium-deficiency-common-in-mental-illness-and-social-ills. Published November 16, 2015. Accessed February 4, 2020.
- Giotakos O. Is Impulsivity in Part a Lithium Deficiency State? Psychiatriki. doi:10.22365/jpsych.2018.293.264.
- Greenblatt J. Nutritional Lithium: Organizing Our Genes & Optimizing Our Moods. The ZRT Laboratory Blog. https://www.zrtlab.com/blog/archive/nutritional-lithium-deficiency-genes-mental-health/. Published September 8, 2017. Accessed February 4, 2020.
- Greenblatt J. Lithium’s Billion Year Journey: A Cinderella Story for Brain Health. The ZRT Laboratory Blog. https://www.zrtlab.com/blog/archive/nutritional-lithium-brain-health-cinderella-story/. Published August 24, 2017. Accessed February 4, 2020.
- Broberg K, Concha G, Engström K, Lindvall M, Grandér M, Vahter M. Lithium in drinking water and thyroid function. Environ Health Perspect. 2011;119(6):827–830. doi:10.1289/ehp.1002678
- Gabriel DeSouza, Halford G Warlick IV, and Vincent S Gallicchio. The Dual Effect of Lithium on Inflammatory Bowel Disease and Bipolar Disorder: A Review. Madridge Journal of Clinical Research. December 2019. DOI:10.18689/mjcr-1000111
- Alevizos B, Alevizos E, Leonardou A, Zervas I. Low dosage lithium augmentation in venlafaxine resistant depression: an open-label study. Psychiatriki. 2012;23(2):143-148.
- Seidel U, Jans K, Hommen N, et al. Lithium Content of 160 Beverages and Its Impact on Lithium Status in Drosophila melanogaster. Foods. 2020;9(6):795. Published 2020 Jun 17. doi:10.3390/foods9060795
- Szklarska D, Rzymski P. Is Lithium a Micronutrient? From Biological Activity and Epidemiological Observation to Food Fortification. Biol Trace Elem Res. 2019;189(1):18-27. doi:10.1007/s12011-018-1455-2
- Greenblatt, James. Nutritional Lithium: Orchestrating Our Genes & Optimizing Our Moods. The ZRT Laboratory Blog. https://www.zrtlab.com/blog/archive/nutritional-lithium-deficiency-genes-mental-health. Published, Friday, September 08, 2017. Accessed November 2021.
- Baker S, Shaw W. Case Study: Rapid Complete Recovery From An Autism Spectrum Disorder After Treatment of Aspergillus With The Antifungal Drugs Itraconazole And Sporanox. Integr Med (Encinitas). 2020;19(4):20-27.