Nutritional Lithium: The Untold Story of the Mineral that Transforms Lives and Heals the Mind Written by James Greenblatt, reviewed here by Judith Ames Written for the Nutritional Therapist Fall 2017
While the CDC names Chronic Disease “The Leading Cause of Death and Disability in the United States”, Mental Health concerns are giving Chronic Disease some stiff competition for the title. The National Institute of Mental Health names Mental Illness the leading cause of disability in ages 15 to 44 in the US. Mental health disability has increased in children by 35% in the last two decades. [1] On a larger stage, The World Health Organization (WHO) cites depression as the greatest cause of disability on the world stage. The increasing importance of mental health emphasizes the importance of sharpening our skills, as Nutritional Therapy Practitioners, to address mental illness.
The fundamental nutritional balancing that Nutritional Therapy Practitioners encourage for general health recovery, also provides the foundation of support for brain health and mood disorders. This is not surprising: as seen from a holistic perspective, the health of the body is integral to the health of the brain. While balancing macronutrients is important for mental health recovery, there are a number of specific micronutrients, commonly deficient in the general population, which play a significant role. One particularly intriguing one, is lithium. Dr. James Greenblatt, a pioneer in the field of integrative medicine, recognized for his decades of work with complex mood, behavioral, and eating disorders, has found deficiencies of the trace mineral lithium so crucial in both the decline and restoration of mental health, that he has dedicated a book, and a number of articles to this one nutrient.
Dr. Greenblatt currently serves as the Chief Medical Officer at Walden Behavioral Care in Waltham, MA and serves as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. Although he still, on occasion, prescribes conventional medications, his first choice has shifted, over the years, to nutritional interventions. His treatments are based on the accumulating research on nutritional interventions for psychiatric illness, as well as an assessment of the individual genetics and biochemistry of each patient. Greenblatt points out the irony that, during his three decades of practice, the introduction and subsequent extraordinary increase in use of prescription medications to treat psychiatric and neurological disorders occurred concurrently with a marked increase in those same psychiatric and neurological disorders. In Dr. Greenblatt’s 2016 book, Nutritional Lithium: The Untold Story of the Mineral that Transforms Lives and Heals the Mind, and his 2015 article (Lithium The Untold Story of the Magic Mineral That Charges Cell Phones and Preserves Memory) for The Townsend Letters, he reviews the fascinating history of lithium’s use and cites extensive research and case studies from his practice, making a powerful case for the beneficial effects of this trace element for mental health as well as general neurological health. The book includes an impressive list of disorders responsive to lithium treatment: mood disorders, anger, irritability and aggression, addiction, ADHD, Dementia and Alzheimer’s, Parkinson’s, glaucoma[2], eating disorders and more.
Lithium is an element, the lightest mineral. It is found in the soil and water across the country in varying amounts. From ancient times and across the globe, lithium has been favored in mineral baths. There are several mineral springs in the US which were first known and frequented by Native Americans who, finding healing benefits from these waters, named them sacred. Later Europeans discovered and enjoyed the benefits of these lithium containing springs[3]. The original formulation of the drink Seven Up included lithium. Seven Up was advertised as being helpful for hangovers, with the sales slogan: “It takes the ouch out of the grouch.”
In the health arena, lithium is best known for its use in the treatment of bipolar disorder. Approved in 1974 by the FDA to prevent recurrent mania, lithium carbonate is the first choice of therapy for patients with bipolar disorder in the US. For this use, it is associated, in James Greenblatt ‘s words: “with pharmacies, doctor's offices, and backwards of psychiatric hospitals. Lithium is perceived as a dangerous drug used to treat severe mental illness with incapacitating side effects.” This perception of lithium as a dangerous “drug” interferes with the recognition and benefits of this natural substance. He mentions further impediment to its promotion: “It appears to be another case where the profound benefit of a nutrient fails to gain recognition in the healing community because of its very simplicity. As lithium is a natural element, and as such cannot be patented, to where an individual company can benefit from the proceeds, there is less incentive to secure funding for the scope of research that practitioners find reassuring as they make their decisions what to use, nor to promote its use.”
Natural indeed The World Health Organization added lithium to the list of nutritionally essential trace elements. Lithium is ubiquitous in the soils where we grow our food, the water we drink and in the human body (with high concentrations in the hippocampus). The intake of an average adult ranges dramatically throughout the US and the world. The U.S. Environmental Protection Agency estimates that the daily intake of lithium in the US ranges from about 0.65 mg to 3 mg. Sources of natural lithium are the water, grains, vegetables and meats that we consume.
Greenblatt’s statement: “The lithium in your water affects your mental health” is substantiated by epidemiological studies in Texas. The studies were inspired by anecdotic reports, in 1949 and prior, about the beneficial effects of lithium in drinking water on mental health. In some parts of Texas, the natural tap water lithium levels may reach 150 mcg/L. [5] A 1970 study comparing counties in Texas analyzed levels of organically derived lithium in the water of 27 Counties in Texas and compared them to various indicators of mental health. The study shows a significant trend: the higher the lithium content, the lower the level of psychiatric illness in the county. In the study’s author’s words: “In Texas, USA, lithium levels in drinking water were shown to be inversely associated with admissions and readmissions for psychoses, neuroses and personality disorders in state mental hospitals, as well as with homicide rates, suicide and crime rates.”[6] Lithium water studies have been conducted in Austria, England, Greece, and Japan revealing similar strong inverse correlation between mental health indices and the levels of lithium in the water supply.[7]
Side Effects of high dose Lithium Carbonate According to Greenblatt, although paper after paper is written about the benefits of lithium for bipolar and depression, its use has actually been declining due to unpleasant and potentially damaging side effects and the need to monitor it closely to manage these side effects. The most dangerous side effect is kidney damage. In an article in the New York Times titled "I Don't Believe in God, but I Believe in Lithium," author Jamie Lowe describes how kidney damage forced her to stop taking lithium and seek a kidney transplant. She described her fear of returning to life as she knew it before lithium: a life without sanity. Greenblatt reports having treated thousands of patients with backgrounds similar to Jamie's. He describes one patient, who had been taking a pharmacological dose of lithium carbonate, which is typically between 900 to 1800 mg. After experiencing strong side effects, he had been forbidden by his doctor to continue taking lithium in the high doses required for the lithium carbonate. This patient experimented, with Greenblatt’s help (and on his own without Greenblatt’s knowledge), to discover that he could maintain relief from symptoms at a dose of 10 milligrams per week. Monitoring indicated that the 10 mg dose was not a threat to his liver. Such lower doses, being comparable to what one might naturally absorb (if one were lucky enough to live in a part of the country with higher lithium levels) is referred to as a nutritional or physiological dose. He had previously been taking a pharmacological dose of lithium carbonate.
Determining need While in the different counties in Texas, the majority of the population was healthy regardless of the lithium supply, there was, evidently, a minority of people for whom greater amounts of lithium made a crucial difference for their mental wellbeing. Biochemical individuality plays a role here. How can one determine when lithium might be beneficial for an individual’s health? For Greenblatt, rather than following the standard protocol of assessing the correct dose by monitoring a patient's "therapeutic blood level," he determines the dosage by listening to his patient’s reports of the symptoms they are experiencing. Symptoms of anxiety, ADHD, depression, mania, a family history of addiction or suicide are, for him, indications of lithium deficiency. When a low level of lithium is suspected, he uses a hair mineral test to confirm the deficiency. He finds a high correlation between the symptoms listed and hair test results. [11]
Form and Dose In his 25 years of practice, Greenblatt has sought the lowest dose of lithium that would alleviate symptoms. There is some debate about the best form of lithium to use. In his earlier publications Greenblatt stated that the form of lithium has been less important than establishing with each patient the minimal effective dose, based on self-reported symptoms. He at first questioned the claims of greater bioavailability of lithium orotate, compared to the lithium carbonate (the form used in conventional prescriptions). In later publications he notes the superior bioavailability of the orotate chelate of lithium, citing a study in 1978 which indicated that the concentration of Lithium in rat brains was higher after a dose of lithium orotate than after similar dose of lithium carbonate[9].
Joan Mathews Larson PhD, another pioneer in nutritional support for mental health, shares Greenblatt’s experience that, in her words: “high lithium doses, which leave people toxic and trembling are not always necessary or appropriate”. She was involved in a study of patients with a bi-polar diagnosis where a mixed form of lithium derived from vegetable concentrates (Lithinase 50 mcg taken with meals) greatly improved all participants.[8] When they were taken off of the supplement they reverted to their former state, and then recovered again when the supplement was reintroduced. Her Health Recovery Center, with impressive addiction recovery rates, currently promotes lithium orotate, a low dose (5 mg) “bio-absorbable” form of lithium that has shown positive results in stabilizing bi-polar clients and improving sleep. Larson's and Greenblatt’s experiences suggest that the lower doses of lithium, found in lithium orotate and mixed chelates, alleviate the danger of the side effects associated with lithium carbonate.
Both Biotics and Progressive Laboratories offer mixed chelates of lithium derived from plants which draw the lithium into their structure from lithium rich soil and water. These natural chelates are arguably the most natural form of lithium: they are perhaps the closest approximation of how our body would encounter lithium, if we lived in a lithium rich geography. One wonders if variations in bioavailability are the reason for the variation in typical doses for each form of lithium:
Mechanism According to Greenblatt, Lithium optimizes serotonin, facilitates transport of B12 and Folate, and stabilizes levels of monoamine oxidase. Each of these contribute to balanced neurotransmitters and consequently mood.
Bipolar, Mood swings, Aggression, Anger Greenblatt notes studies showing that lithium, when used for bipolar patients, also treats their aggression and other studies where the use of lithium yielded dramatic results in patients with violent outbursts: adolescents with conduct disorders, prisoners with uncontrolled rage, patients with traumatic brain injury and patients with substance abuse problems.
Parkinson’s Dopamine dysregulation is a key factor in Parkinson’s. Levodopa, the primary medication used for Parkinson’s, works by being converted to dopamine in the brain. According to Greenblatt, lithium is commonly used to regulate dopamine activity in psychiatric conditions where the dopamine system is out of balance, such as Schizophrenia, ADHD, addiction and affective disorders. Prompted by recognizing the dopamine connection, there have been a number of small studies on the benefits of lithium on Parkinson’s. In 1983 six patients for whom medication had ceased working were treated with lithium carbonate in addition to their regular treatment. Five of the six experienced marked reductions in muscle rigidity and a decrease of painful dystonic cramps. A follow-up double blind placebo controlled study where patients had periods on and off of lithium “reported that painful Parkinsonian cramps were reduced or abolished in the majority of treatment periods with lithium”. [12] Greenblatt cites studies showing how lithium could benefit Parkinson’s recovery beyond just preventing the side effects of Levodopa. The studies indicate that lithium suppresses Glycogen Synthase Kinase (GSK) (which spurs the production of Lewy bodies); promotes cell survival, decreases oxidative stress and increases several key neurotropic factors including BDNF (bone density neurotropic factor). Julie K Anderson PhD, author of a 2015 rodent study reported that low doses of lithium boosted “the expression of tyrosine hydroxylase, an enzyme which increases dopamine synthesis.” This is her description of the effects: “We clearly saw a prevention of the motor difficulties we would have expected to see in the animals. The treatment also protected the area of the brain that is normally damaged by Parkinson’s.” The research, so far, is intriguing and promising, but limited in scale. Greenblatt suggests that lithium is a viable option for counter balancing the side effects of Levodopa, and he also suggests that it can be used as a stand-alone treatment.
Alzheimer’s Greenblatt notes two ways that lithium might benefit Alzheimer’s patients: “Lithium has been shown to disrupt the key enzyme responsible for the development of amyloid plaques and neurofibrillary tangles associated with Alzheimer's disease.” He states that “lithium ions encourage the synthesis and release of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3)” which play a role in the growth, and maintenance of nerve cells and could repair damages brought about by Alzheimer's disease.[13]
It is intriguing to consider the role of the hippocampus in regards to Alzheimer’s. Research has found that one of the first areas in the brain affected by Alzheimer's disease is the hippocampus.[14] The hippocampus is recognized to be crucial to short and long-term memory[15] and to contain the highest concentrated lithium in the body. Is the concentration of lithium crucial for its function? Could something as simple as depletion effect the functions the hippocampus performs?
Research lends credence to this line of thought. Greenblatt cites a study: “In a recent trial published in Current Alzheimer's Research, a nutritional dose of just 300 mcg of lithium was administered 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 3 months of treatment. Furthermore, these protective effects appeared to strengthen as the study proceeded, with many of the lithium-treated individuals showing marked cognitive improvements by the end of the trial. These results suggest that lithium could be a viable treatment for Alzheimer's disease when used at low doses over the long term.”[16]A study in Lancet, “to study pharmacologically-induced increases in grey matter volume with chronic lithium use in patients with bipolar mood disorder. [notes that] Grey-matter volume increased after 4 weeks of treatment.[17]
Dr. Nassir Ghaemi, whom Greenblatt considers “one of the more notable and respected advocates of lithium use in the medical community”, states, in his review of 24 clinical, epidemiological, and biological reports that assessed standard or low-dose lithium for dementia, that "lithium is, by far, the most proven drug to keep neurons alive, in animals and in humans, consistently and with many replicated studies."[18] For more on Alzheimer’s and lithium, see an article by Greenblatt on the website for the Walden Clinic where he works[19].
In regards to assessing need, Greenblatt mentions that those of us interested in long term cognition, i.e. remaining free from dementia and Alzheimer’s (and who is not?) might consider a prophylactic dose of lithium.
Conclusion The history of nutrition is littered with foods and nutrients coming into and falling out of favor. Saturated fats have moved from number one demon to friend. Dr. Greenblatt's book is an authoritative attempt to destigmatize lithium: a powerful, underused nutrient. From the standpoint of suicide prevention alone, with suicide the second leading cause of death in ages 10-24,[20] the need could not be more compelling. Greenblatt calls lithium “the most effective medication in psychiatry”, and believes that assessing lithium levels should be a critical component of any nutritional assessment. To close with Greenblatt’s words: “With low-dose lithium, we have a safe nutritional supplement that is effective in treating a wide range of disabling symptoms of mental illness. Perhaps in the future, patients like Jamie Lowe, the author of the New York Times article, will not be forced to make a decision between mental and physical health. The compelling and growing scientific literature on the benefits of low-dose lithium therapy combined with over 25 years of clinical practice have convinced me that with low-dose lithium, it is entirely possible to have both.”[21
[1] James Greenblatt Nutritional Lithium, The Untold Tale Of The Mineral That Transforms Lives And Heals The Brain.
[2] Greenblatt cites a study which observed reduced intraocular pressure by 22% in rats after a six week period.
[3] Two examples of lithium containing Springs are Lithia Springs Resort in Ashland Oregon and Orvis Hot Springs in Ridgeway Colorado
[4]Nutritional Risk Assessment of Eleven Minerals and Trace Elements: Prevalence of Inadequate and Excessive Intakes from the Second French Total Diet Study Journal of American Nutrition
[5]Journal of American Nutrition http://americancollegeofnutrition.org/content/the-journal/content/21/1/14.full
[6] The British Journal of Psychiatry (2011) 198, 346–350. doi: 10.1192/bjp.bp.110.091041
[7] Schrauzer GN, Shrestha KP. Lithium in drinking water and the incidences of crimes, suicides and arrests related to drug addictions. Biol Trace Elem Res. 1990;25:105–113
[8] Nutrition Perspectives, January 1988
[9] http://www.ncbi.nlm.nih.gov/pubmed/26768 J Pharm Pharmacol. 1978 Jun;30(6):368-70 and http://www.ncbi.nlm.nih.gov/pubmed/34690: "This data suggest the possibility that lower doses of lithium orotate than lithium carbonate may achieve therapeutic brain lithium concentrations."
[11] Another possible way to assess deficiencies of lithium would be a taste test. At a conference on ADHD, I spoke with Greenblatt about the zinc taste test, which we as NTPs are taught. The zinc taste test gives a simple, inexpensive, repeatable check for dose correction of zinc. He was not familiar with the test. I would love to see someone develop an aqueous lithium solution for a taste test which could be as used in the same way as the very effective, if not well documented, aqueous zinc taste test.
[12] Pages 93-4 in Greenblatts Nutrtional Lithium
[13] Greenblatt’s Townsend Letter article http://www.townsendletter.com/Oct2015/lithium1015_2.html
[14]Neural Regeneration Research v.8(5); 2013 Feb 15 PMC414613 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146132/.
[15] Research has found that one of the first areas in the brain affected by Alzheimer's disease is the hippocampus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146132/.
[16] From Greenblatt’s Townsend letter article: http://www.townsendletter.com/Oct2015/lithium1015_2.html
[17] Lancet. 2000 Oct 7;356(9237):1241-2. Lithium-induced increase in human brain grey matter. https://www.ncbi.nlm.nih.gov/pubmed/11072948
[18] From an article by Greenblatt on Great Plains Laboratory’s web site: https://www.greatplainslaboratory.com/articles-1/2017/1/23/lithium-the-untold-story-of-the-magic-mineral-that-charges-cell-phones-and-preserves-memory
[19] http://www.waldenpsychiatric.com/lithium-may-prevent-alzheimers-disease/
[20]https://msrc.fsu.edu/system/files/MullerOerlinghausen%20B%20et%20al%202010%20Lithium%20reduces%20pathological%20aggression%20and%20suicidality-%20a%20mini-review.pdf
[21] 2015 article (Lithium The Untold Story of the Magic Mineral That Charges Cell Phones and Preserves Memory) for The Townsend Letters
Nutritional Lithium: The Untold Story of the Mineral that Transforms Lives and Heals the Mind Written by James Greenblatt, reviewed here by Judith Ames Written for the Nutritional Therapist Fall 2017
While the CDC names Chronic Disease “The Leading Cause of Death and Disability in the United States”, Mental Health concerns are giving Chronic Disease some stiff competition for the title. The National Institute of Mental Health names Mental Illness the leading cause of disability in ages 15 to 44 in the US. Mental health disability has increased in children by 35% in the last two decades. [1] On a larger stage, The World Health Organization (WHO) cites depression as the greatest cause of disability on the world stage. The increasing importance of mental health emphasizes the importance of sharpening our skills, as Nutritional Therapy Practitioners, to address mental illness.
The fundamental nutritional balancing that Nutritional Therapy Practitioners encourage for general health recovery, also provides the foundation of support for brain health and mood disorders. This is not surprising: as seen from a holistic perspective, the health of the body is integral to the health of the brain. While balancing macronutrients is important for mental health recovery, there are a number of specific micronutrients, commonly deficient in the general population, which play a significant role. One particularly intriguing one, is lithium. Dr. James Greenblatt, a pioneer in the field of integrative medicine, recognized for his decades of work with complex mood, behavioral, and eating disorders, has found deficiencies of the trace mineral lithium so crucial in both the decline and restoration of mental health, that he has dedicated a book, and a number of articles to this one nutrient.
Dr. Greenblatt currently serves as the Chief Medical Officer at Walden Behavioral Care in Waltham, MA and serves as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. Although he still, on occasion, prescribes conventional medications, his first choice has shifted, over the years, to nutritional interventions. His treatments are based on the accumulating research on nutritional interventions for psychiatric illness, as well as an assessment of the individual genetics and biochemistry of each patient. Greenblatt points out the irony that, during his three decades of practice, the introduction and subsequent extraordinary increase in use of prescription medications to treat psychiatric and neurological disorders occurred concurrently with a marked increase in those same psychiatric and neurological disorders. In Dr. Greenblatt’s 2016 book, Nutritional Lithium: The Untold Story of the Mineral that Transforms Lives and Heals the Mind, and his 2015 article (Lithium The Untold Story of the Magic Mineral That Charges Cell Phones and Preserves Memory) for The Townsend Letters, he reviews the fascinating history of lithium’s use and cites extensive research and case studies from his practice, making a powerful case for the beneficial effects of this trace element for mental health as well as general neurological health. The book includes an impressive list of disorders responsive to lithium treatment: mood disorders, anger, irritability and aggression, addiction, ADHD, Dementia and Alzheimer’s, Parkinson’s, glaucoma[2], eating disorders and more.
Lithium is an element, the lightest mineral. It is found in the soil and water across the country in varying amounts. From ancient times and across the globe, lithium has been favored in mineral baths. There are several mineral springs in the US which were first known and frequented by Native Americans who, finding healing benefits from these waters, named them sacred. Later Europeans discovered and enjoyed the benefits of these lithium containing springs[3]. The original formulation of the drink Seven Up included lithium. Seven Up was advertised as being helpful for hangovers, with the sales slogan: “It takes the ouch out of the grouch.”
In the health arena, lithium is best known for its use in the treatment of bipolar disorder. Approved in 1974 by the FDA to prevent recurrent mania, lithium carbonate is the first choice of therapy for patients with bipolar disorder in the US. For this use, it is associated, in James Greenblatt ‘s words: “with pharmacies, doctor's offices, and backwards of psychiatric hospitals. Lithium is perceived as a dangerous drug used to treat severe mental illness with incapacitating side effects.” This perception of lithium as a dangerous “drug” interferes with the recognition and benefits of this natural substance. He mentions further impediment to its promotion: “It appears to be another case where the profound benefit of a nutrient fails to gain recognition in the healing community because of its very simplicity. As lithium is a natural element, and as such cannot be patented, to where an individual company can benefit from the proceeds, there is less incentive to secure funding for the scope of research that practitioners find reassuring as they make their decisions what to use, nor to promote its use.”
Natural indeed The World Health Organization added lithium to the list of nutritionally essential trace elements. Lithium is ubiquitous in the soils where we grow our food, the water we drink and in the human body (with high concentrations in the hippocampus). The intake of an average adult ranges dramatically throughout the US and the world. The U.S. Environmental Protection Agency estimates that the daily intake of lithium in the US ranges from about 0.65 mg to 3 mg. Sources of natural lithium are the water, grains, vegetables and meats that we consume.
Greenblatt’s statement: “The lithium in your water affects your mental health” is substantiated by epidemiological studies in Texas. The studies were inspired by anecdotic reports, in 1949 and prior, about the beneficial effects of lithium in drinking water on mental health. In some parts of Texas, the natural tap water lithium levels may reach 150 mcg/L. [5] A 1970 study comparing counties in Texas analyzed levels of organically derived lithium in the water of 27 Counties in Texas and compared them to various indicators of mental health. The study shows a significant trend: the higher the lithium content, the lower the level of psychiatric illness in the county. In the study’s author’s words: “In Texas, USA, lithium levels in drinking water were shown to be inversely associated with admissions and readmissions for psychoses, neuroses and personality disorders in state mental hospitals, as well as with homicide rates, suicide and crime rates.”[6] Lithium water studies have been conducted in Austria, England, Greece, and Japan revealing similar strong inverse correlation between mental health indices and the levels of lithium in the water supply.[7]
Side Effects of high dose Lithium Carbonate According to Greenblatt, although paper after paper is written about the benefits of lithium for bipolar and depression, its use has actually been declining due to unpleasant and potentially damaging side effects and the need to monitor it closely to manage these side effects. The most dangerous side effect is kidney damage. In an article in the New York Times titled "I Don't Believe in God, but I Believe in Lithium," author Jamie Lowe describes how kidney damage forced her to stop taking lithium and seek a kidney transplant. She described her fear of returning to life as she knew it before lithium: a life without sanity. Greenblatt reports having treated thousands of patients with backgrounds similar to Jamie's. He describes one patient, who had been taking a pharmacological dose of lithium carbonate, which is typically between 900 to 1800 mg. After experiencing strong side effects, he had been forbidden by his doctor to continue taking lithium in the high doses required for the lithium carbonate. This patient experimented, with Greenblatt’s help (and on his own without Greenblatt’s knowledge), to discover that he could maintain relief from symptoms at a dose of 10 milligrams per week. Monitoring indicated that the 10 mg dose was not a threat to his liver. Such lower doses, being comparable to what one might naturally absorb (if one were lucky enough to live in a part of the country with higher lithium levels) is referred to as a nutritional or physiological dose. He had previously been taking a pharmacological dose of lithium carbonate.
Determining need While in the different counties in Texas, the majority of the population was healthy regardless of the lithium supply, there was, evidently, a minority of people for whom greater amounts of lithium made a crucial difference for their mental wellbeing. Biochemical individuality plays a role here. How can one determine when lithium might be beneficial for an individual’s health? For Greenblatt, rather than following the standard protocol of assessing the correct dose by monitoring a patient's "therapeutic blood level," he determines the dosage by listening to his patient’s reports of the symptoms they are experiencing. Symptoms of anxiety, ADHD, depression, mania, a family history of addiction or suicide are, for him, indications of lithium deficiency. When a low level of lithium is suspected, he uses a hair mineral test to confirm the deficiency. He finds a high correlation between the symptoms listed and hair test results. [11]
Form and Dose In his 25 years of practice, Greenblatt has sought the lowest dose of lithium that would alleviate symptoms. There is some debate about the best form of lithium to use. In his earlier publications Greenblatt stated that the form of lithium has been less important than establishing with each patient the minimal effective dose, based on self-reported symptoms. He at first questioned the claims of greater bioavailability of lithium orotate, compared to the lithium carbonate (the form used in conventional prescriptions). In later publications he notes the superior bioavailability of the orotate chelate of lithium, citing a study in 1978 which indicated that the concentration of Lithium in rat brains was higher after a dose of lithium orotate than after similar dose of lithium carbonate[9].
Joan Mathews Larson PhD, another pioneer in nutritional support for mental health, shares Greenblatt’s experience that, in her words: “high lithium doses, which leave people toxic and trembling are not always necessary or appropriate”. She was involved in a study of patients with a bi-polar diagnosis where a mixed form of lithium derived from vegetable concentrates (Lithinase 50 mcg taken with meals) greatly improved all participants.[8] When they were taken off of the supplement they reverted to their former state, and then recovered again when the supplement was reintroduced. Her Health Recovery Center, with impressive addiction recovery rates, currently promotes lithium orotate, a low dose (5 mg) “bio-absorbable” form of lithium that has shown positive results in stabilizing bi-polar clients and improving sleep. Larson's and Greenblatt’s experiences suggest that the lower doses of lithium, found in lithium orotate and mixed chelates, alleviate the danger of the side effects associated with lithium carbonate.
Both Biotics and Progressive Laboratories offer mixed chelates of lithium derived from plants which draw the lithium into their structure from lithium rich soil and water. These natural chelates are arguably the most natural form of lithium: they are perhaps the closest approximation of how our body would encounter lithium, if we lived in a lithium rich geography. One wonders if variations in bioavailability are the reason for the variation in typical doses for each form of lithium:
- lithium carbonate, typically prescribed at between 900 to 1800 mg.
- lithium orotate prescribed at from 5-34 mg
- Lithinase: a tablet is 50 mcg
- LyZime Forte: a tablet is 150 mcg
Mechanism According to Greenblatt, Lithium optimizes serotonin, facilitates transport of B12 and Folate, and stabilizes levels of monoamine oxidase. Each of these contribute to balanced neurotransmitters and consequently mood.
Bipolar, Mood swings, Aggression, Anger Greenblatt notes studies showing that lithium, when used for bipolar patients, also treats their aggression and other studies where the use of lithium yielded dramatic results in patients with violent outbursts: adolescents with conduct disorders, prisoners with uncontrolled rage, patients with traumatic brain injury and patients with substance abuse problems.
Parkinson’s Dopamine dysregulation is a key factor in Parkinson’s. Levodopa, the primary medication used for Parkinson’s, works by being converted to dopamine in the brain. According to Greenblatt, lithium is commonly used to regulate dopamine activity in psychiatric conditions where the dopamine system is out of balance, such as Schizophrenia, ADHD, addiction and affective disorders. Prompted by recognizing the dopamine connection, there have been a number of small studies on the benefits of lithium on Parkinson’s. In 1983 six patients for whom medication had ceased working were treated with lithium carbonate in addition to their regular treatment. Five of the six experienced marked reductions in muscle rigidity and a decrease of painful dystonic cramps. A follow-up double blind placebo controlled study where patients had periods on and off of lithium “reported that painful Parkinsonian cramps were reduced or abolished in the majority of treatment periods with lithium”. [12] Greenblatt cites studies showing how lithium could benefit Parkinson’s recovery beyond just preventing the side effects of Levodopa. The studies indicate that lithium suppresses Glycogen Synthase Kinase (GSK) (which spurs the production of Lewy bodies); promotes cell survival, decreases oxidative stress and increases several key neurotropic factors including BDNF (bone density neurotropic factor). Julie K Anderson PhD, author of a 2015 rodent study reported that low doses of lithium boosted “the expression of tyrosine hydroxylase, an enzyme which increases dopamine synthesis.” This is her description of the effects: “We clearly saw a prevention of the motor difficulties we would have expected to see in the animals. The treatment also protected the area of the brain that is normally damaged by Parkinson’s.” The research, so far, is intriguing and promising, but limited in scale. Greenblatt suggests that lithium is a viable option for counter balancing the side effects of Levodopa, and he also suggests that it can be used as a stand-alone treatment.
Alzheimer’s Greenblatt notes two ways that lithium might benefit Alzheimer’s patients: “Lithium has been shown to disrupt the key enzyme responsible for the development of amyloid plaques and neurofibrillary tangles associated with Alzheimer's disease.” He states that “lithium ions encourage the synthesis and release of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3)” which play a role in the growth, and maintenance of nerve cells and could repair damages brought about by Alzheimer's disease.[13]
It is intriguing to consider the role of the hippocampus in regards to Alzheimer’s. Research has found that one of the first areas in the brain affected by Alzheimer's disease is the hippocampus.[14] The hippocampus is recognized to be crucial to short and long-term memory[15] and to contain the highest concentrated lithium in the body. Is the concentration of lithium crucial for its function? Could something as simple as depletion effect the functions the hippocampus performs?
Research lends credence to this line of thought. Greenblatt cites a study: “In a recent trial published in Current Alzheimer's Research, a nutritional dose of just 300 mcg of lithium was administered 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 3 months of treatment. Furthermore, these protective effects appeared to strengthen as the study proceeded, with many of the lithium-treated individuals showing marked cognitive improvements by the end of the trial. These results suggest that lithium could be a viable treatment for Alzheimer's disease when used at low doses over the long term.”[16]A study in Lancet, “to study pharmacologically-induced increases in grey matter volume with chronic lithium use in patients with bipolar mood disorder. [notes that] Grey-matter volume increased after 4 weeks of treatment.[17]
Dr. Nassir Ghaemi, whom Greenblatt considers “one of the more notable and respected advocates of lithium use in the medical community”, states, in his review of 24 clinical, epidemiological, and biological reports that assessed standard or low-dose lithium for dementia, that "lithium is, by far, the most proven drug to keep neurons alive, in animals and in humans, consistently and with many replicated studies."[18] For more on Alzheimer’s and lithium, see an article by Greenblatt on the website for the Walden Clinic where he works[19].
In regards to assessing need, Greenblatt mentions that those of us interested in long term cognition, i.e. remaining free from dementia and Alzheimer’s (and who is not?) might consider a prophylactic dose of lithium.
Conclusion The history of nutrition is littered with foods and nutrients coming into and falling out of favor. Saturated fats have moved from number one demon to friend. Dr. Greenblatt's book is an authoritative attempt to destigmatize lithium: a powerful, underused nutrient. From the standpoint of suicide prevention alone, with suicide the second leading cause of death in ages 10-24,[20] the need could not be more compelling. Greenblatt calls lithium “the most effective medication in psychiatry”, and believes that assessing lithium levels should be a critical component of any nutritional assessment. To close with Greenblatt’s words: “With low-dose lithium, we have a safe nutritional supplement that is effective in treating a wide range of disabling symptoms of mental illness. Perhaps in the future, patients like Jamie Lowe, the author of the New York Times article, will not be forced to make a decision between mental and physical health. The compelling and growing scientific literature on the benefits of low-dose lithium therapy combined with over 25 years of clinical practice have convinced me that with low-dose lithium, it is entirely possible to have both.”[21
[1] James Greenblatt Nutritional Lithium, The Untold Tale Of The Mineral That Transforms Lives And Heals The Brain.
[2] Greenblatt cites a study which observed reduced intraocular pressure by 22% in rats after a six week period.
[3] Two examples of lithium containing Springs are Lithia Springs Resort in Ashland Oregon and Orvis Hot Springs in Ridgeway Colorado
[4]Nutritional Risk Assessment of Eleven Minerals and Trace Elements: Prevalence of Inadequate and Excessive Intakes from the Second French Total Diet Study Journal of American Nutrition
[5]Journal of American Nutrition http://americancollegeofnutrition.org/content/the-journal/content/21/1/14.full
[6] The British Journal of Psychiatry (2011) 198, 346–350. doi: 10.1192/bjp.bp.110.091041
[7] Schrauzer GN, Shrestha KP. Lithium in drinking water and the incidences of crimes, suicides and arrests related to drug addictions. Biol Trace Elem Res. 1990;25:105–113
[8] Nutrition Perspectives, January 1988
[9] http://www.ncbi.nlm.nih.gov/pubmed/26768 J Pharm Pharmacol. 1978 Jun;30(6):368-70 and http://www.ncbi.nlm.nih.gov/pubmed/34690: "This data suggest the possibility that lower doses of lithium orotate than lithium carbonate may achieve therapeutic brain lithium concentrations."
[11] Another possible way to assess deficiencies of lithium would be a taste test. At a conference on ADHD, I spoke with Greenblatt about the zinc taste test, which we as NTPs are taught. The zinc taste test gives a simple, inexpensive, repeatable check for dose correction of zinc. He was not familiar with the test. I would love to see someone develop an aqueous lithium solution for a taste test which could be as used in the same way as the very effective, if not well documented, aqueous zinc taste test.
[12] Pages 93-4 in Greenblatts Nutrtional Lithium
[13] Greenblatt’s Townsend Letter article http://www.townsendletter.com/Oct2015/lithium1015_2.html
[14]Neural Regeneration Research v.8(5); 2013 Feb 15 PMC414613 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146132/.
[15] Research has found that one of the first areas in the brain affected by Alzheimer's disease is the hippocampus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146132/.
[16] From Greenblatt’s Townsend letter article: http://www.townsendletter.com/Oct2015/lithium1015_2.html
[17] Lancet. 2000 Oct 7;356(9237):1241-2. Lithium-induced increase in human brain grey matter. https://www.ncbi.nlm.nih.gov/pubmed/11072948
[18] From an article by Greenblatt on Great Plains Laboratory’s web site: https://www.greatplainslaboratory.com/articles-1/2017/1/23/lithium-the-untold-story-of-the-magic-mineral-that-charges-cell-phones-and-preserves-memory
[19] http://www.waldenpsychiatric.com/lithium-may-prevent-alzheimers-disease/
[20]https://msrc.fsu.edu/system/files/MullerOerlinghausen%20B%20et%20al%202010%20Lithium%20reduces%20pathological%20aggression%20and%20suicidality-%20a%20mini-review.pdf
[21] 2015 article (Lithium The Untold Story of the Magic Mineral That Charges Cell Phones and Preserves Memory) for The Townsend Letters