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Is Lithium Deficiency Real? Health Effects of Low Lithium

Written by Mathew Eng, PharmD | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Mathew Eng, PharmD | Last updated:

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Lithium Deficiency
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Lots of people get trace amounts of lithium from food and water. Several studies have found a link between low lithium in drinking water and higher rates of crime, dementia, suicide, and mortality. But is lithium essential for health and wellbeing? And is there an amount of lithium people should be getting in their diet? Read on to learn more about this element and its potential effects on health.

Is Lithium Deficiency A Thing?

When it comes to nutrients, generally you will only experience deficiency if a certain nutrient is essential. That means that it should play an important role in the body, which is why a deficiency will lead to health problems.

Fact is, lithium is not officially considered to be a micronutrient, because studies still can’t agree on the subject. Micronutrients, also called trace elements, are dietary minerals that are needed in very small amounts for the proper growth, development, and function of our bodies [1, 2]

Several studies have shown that microdoses of lithium (e.g., lithium in drinking water) may have anti-aging, anti-dementia, and anti-suicidal effects, but the evidence is inconclusive [1].

Bottom line is that further studies are needed to establish beyond a doubt [1]:

  • whether lithium is a trace element and
  • what levels are required to maintain good health
Lithium is not officially a micronutrient. Studies disagree on whether it’s possible to be deficient in lithium, and the evidence so far is inconclusive. More studies are needed to clarify if lithium is essential for human health.

The Curious History of Lithium

Let’s take a step back and first talk about what lithium is. The story about lithium is anything but ordinary.

Lithium is a chemical element naturally found in minerals, rocks, and bodies of water. It is one of the three elements created in the Big Bang. We humans have adapted to getting some lithium from water and food. We weren’t really aware of this until recently, though [3].

“Crazy Waters”

Many mineral springs contain lithium. Some of them, such as Mineral Wells in Texas, have long-held reputations as “crazy waters.” Texas was well known for its mineral water resorts back in the 19th century. Thousands of “crazy” people and those with various chronic health problems used to gush to these springs to enjoy the healing benefits of lithium [4].

Medical Discoveries

The potential health benefits of lithium were first discovered in 1847. Back then, a London-based physician named Alfred Baring Garrod started using lithium to treat gout – including “brain gout.” By the 1930s, lithium became a widely-available drug [4].

Around that time, French physician Dr. Reyss-Brion remembers that a preparation called “Dr. Gustin’s Lithium” was popular in the south of France. “It’s quite simply for that reason that you don’t have a lot of manic-depressives in Marseilles,” he observed [4].

It wasn’t until the 1940s that doctors started using lithium for mania. At the time, lobotomies and electroshocks were pretty much the only other available therapies. This makes lithium the first psychiatric drug [4].

Lithium predates modern antidepressants by some 40 years. Some even argue that it unfairly fell out of favor precisely because newer, more expensive drugs (like DepakoteValproic Acid) were being marketed by companies [5, 4].

However, even to this day, lithium perseveres. It continues to be the preferred treatment for bipolar disorder. Some doctors consider lithium the single most effective treatment in psychiatry [4].

Lithium was first used in medicine over 100 years ago. It’s the first psychiatric drug, and it’s still considered one of the most effective treatments for bipolar disorder.

Where We Stand Today

Today, lithium salts are available as prescription medication and supplements. Many people get confused by these: is it the same if you take prescription lithium and supplements? And why is one form available only by prescription and the other is sold as a supplement?

In fact, these forms are different for two main reasons: first, prescription forms use high doses, whereas supplements are taken at much lower doses; secondly, the prescription version mostly contains lithium carbonate, while supplements usually have lithium orotate [6, 7].

Lithium aspartate and liquid formulations of lithium carbonate are used both as prescription medication and supplements, depending on the dosage [6].

Keep in mind that no supplemental forms of lithium are not approved by the FDA to treat any medical disorder, disease, or condition [6].

We’ll go into more detail on supplemental forms of lithium in the “supplements” section. You can also check out our lithium orotate article for a full breakdown of this supplement.

Supplemental forms of lithium, like lithium orotate, are widely available and used in much lower doses than the prescription forms.

Why Do Some Get Less Lithium Than Others?

Where you live can have a huge impact on the amount of lithium you are getting, since lithium concentrations in soil and water can vary wildly depending on location [8, 9].

Some scientists have found a link between little to no lithium (geographically) and negative effects on cognitive function and behavior [8, 9, 10, 11, 12].

Below are some factors that affect how much lithium a person gets.

1) Lithium Content in Food and Water

Most people get almost all of their lithium from the food and water they consume [13].

However, lithium levels in groundwater and soil can vary greatly [13].

Just in the U.S., lithium concentrations in groundwater range from almost zero to well over 170 micrograms/L [14, 15].

It can even come down to your specific city – neighboring cities or counties can have very different lithium levels in their water sources. For example, water supplies in Los Angeles County average around 0.5 micrograms/L while drinking water in nearby Orange County contains as much as 10 micrograms/L [14, 15, 9].

Generally speaking, dryer regions in the U.S. tend to have higher levels of lithium compared to more humid areas. This might explain the “crazy water” in Texas, which is famous for its high lithium content [16].

Lithium content in the water also depends on how the water is being purified. Some forms of purified water, like distilled water, will not provide any lithium. On the other hand, filtered water typically does contain lithium. This is because carbon filters, which most commercially available water filters use, are not great at removing trace metals [17, 18].

Fruits and vegetables grown in lithium-poor soil will have lower lithium levels [13].

The average person in the U.S. gets somewhere between 0.6 to 3.1 mg of lithium each day [13].

We get most of our lithium from food and water. The amount of lithium in the water varies geographically and depends on water purification methods. Produce grown in lithium-poor soil will have lower lithium levels.

2) Medications

Certain drugs can cause lithium levels in the body to drop, usually by increasing the amount of lithium that leaves the body through urine [19].

The bulk of research comes from people taking prescription lithium. But even if you’re not on prescription lithium, these drugs will likely have a similar effect [19].

Drugs that significantly reduce lithium in the blood include [19]:

There are reports of other drugs lowering lithium levels, including [20]:

3) Dialysis

Dialysis is a medical procedure that filters the blood, removing excess water and toxins. It’s usually performed in patients with impaired kidney function, such as in chronic kidney disease [21].

The procedure also removes lithium. In fact, lithium overdose is sometimes treated with dialysis [22].

What Does Lithium Do In The Body?

Studies suggest that lithium:

  • Modifies sodium transport in nerve and muscle cells [23]
  • Alters the metabolism of neurotransmitters, specifically dopamine, norepinephrine, and serotonin [23]
  • May activate neurogenesis and increase gray matter volume [23]

Potential Health Effects Associated With Low Lithium

1) Suicide Risk

Lithium stands out from other psychiatric drugs because of its ability to reduce suicidal behavior. Researchers found that prescription lithium does this much better than most antidepressant and antipsychotic medications [24, 25].

According to some estimates, prescription lithium may reduce the risk of attempted and completed suicides by 80% [26].

Some research suggests that even the trace amounts of lithium found in groundwater may lower suicide rates [8].

One study compared over 3.1k water samples to suicide rates in 226 counties in Texas. They found that lower lithium levels in public drinking water were linked to higher suicide rates [8].

A different study looking at water samples from 40 cities in Japan discovered the same link: low lithium was connected with increased suicide rates. However, this association was only seen in women [9].

In contrast, a Lithuanian study found that low lithium in drinking supply was linked to higher suicide rates in men, but not in women [27].

Lithium deficiency has also been linked to suicide in other countries, including Italy, Greece, and Austria [28, 29, 30].

However, a study in England failed to find a link [31].

Some scientists think that lithium may exert its antisuicidal effect via reinforcing “top-down brakes” of aggressive action in the brain [1].

Lower levels of lithium in public water supplies have been linked to higher suicide rates in several large-scale studies.

2) Criminal Behavior & Aggression

Does lithium make people more mellow and easygoing?

That may be the case, because some studies have found a link between low lithium levels and aggression and violence [10, 32].

One study analyzed data collected from 27 counties in Texas during a 9 year period. They found that areas with little to no lithium in the drinking water had higher rates of homicide, rape, and theft [15].

A study performed in Greece found similar results. Areas with low lithium levels in the drinking water had higher rates of homicide, rape, and drug abuse [33].

The connection between low lithium and criminal behavior is not totally understood, but some think that lithium’s ability to improve impulse control may play a role [10].

Some researchers also think that lithium may protect against neurotoxicity caused by lead exposure, however this is a hypothesis that needs verification [34].

Scientists have found that areas with little to no lithium in the drinking water tend to have higher rates of crime.

3) Dementia

A massive study performed in Denmark compared drinking water samples from over 800k people. They found that those drinking water with lower levels of lithium had higher rates of dementia [12].

There have been reports that bipolar patients on lithium may have a lower incidence of dementia. To verify this, scientists used a microdose of lithium administered once daily to people with Alzheimer’s for 15 months (around 100 people). Lithium seemed to prevent cognitive decline, with significant differences starting three months after the beginning of the treatment, and increasing progressively, compared to controls [35].

In a mouse model of Alzheimer’s disease, lithium in microdose prevented plaque buildup and memory loss [36].

Initial studies are promising, but additional well-designed research is needed to confirm that lithium indeed can help prevent dementia.

Scientists have found that areas with little to no lithium in the drinking water tend to have higher rates of dementia. Initial studies in humans and animals suggest lithium may help prevent cognitive decline, but further independent studies are needed for confirmation.

4) Lifespan

According to one study, lower levels of lithium in tap water were linked to higher rates of death by any cause (not just suicide). This was based on data collected from 234 Texas counties and over 6.1k water samples [37].

Similarly, another study found a link between lower lithium levels in drinking water and higher all-cause mortality in 18 neighboring Japanese municipalities with a total of over 1.2 million people [38].

Scientists have found that low doses of lithium extend the lifespan in worms (C. elegans) [38].

What could possibly explain the results? According to several studies, lithium’s increases the length of telomeres–small proteins that cap your DNA-protecting chromosomes. The longer telomeres are, the more leeway cells have to divide. The length of telomeres is something like the sand in the top part of your lifespan hourglass–the more you have, the better [39, 40, 41, 42].

Bottom line? Lithium may lengthen telomeres, potentially prolonging lifespan [39, 40].

However, further well-designed studies are needed to confirm this.

Two studies have found a link between lower lithium levels in drinking water and higher mortality rates. Some scientists think that lithium may lengthen telomeres. However, more studies are needed to confirm this.

5) Depression

We know that prescription lithium is used to treat several psychiatric conditions, including bipolar disorder, depression, and schizophrenia [43, 44, 45].

But what about the trace amounts of lithium? Do they have a similar effect?

In a study of over 3k students in Japan, low lithium levels in tap water correspond to worse symptoms of depression [46].

However, in a Danish study of over 150k people, lithium concentrations in drinking water did not appear to alter rates of bipolar disorder, despite being the main condition that prescription lithium is used for [47].

One study found a link between low lithium in drinking water and depression. However, a much larger study failed to find a link. Therefore, there is no conclusive evidence that trace amounts of lithium have an effect on depression.

6) Cellular Regeneration

Studies have found that lithium stimulates and regenerates several types of stem cells. Stem cells act as foundational units in the body. They’re full of potential and can transform into more specialized cells depending on what the body needs [48, 49].

Research has shown that lithium stimulates multiple types of stem cells, including ones found in the brain, blood, and bones [48, 50].

Lithium also increases the production of growth factors in the brain, like BDNF and NGF. In fact, people who take prescription lithium drugs often have increased brain cell density and gray matter [50, 51].

Some scientists think that people with lithium deficiencies may have a reduced ability to generate stem cells, which could slow down cellular growth and repair [48, 13].

However, currently, there is no solid evidence that supports this.

Some scientists think that lithium may stimulate cell growth and repair. However, the evidence for this is inconclusive.

How Much Is Enough?

Could it be that communities of more peaceful, less aggressive, less impulsive, and happier people simply have more lithium in their water? Could the rise in firearm violence, suicides, and homicides be – at least in part – due to declining lithium levels [10, 32]?

We still don’t have conclusive answers to these questions.

However, studies do seem to suggest that getting a bit more lithium naturally tends to be beneficial.

The minimum level of consumption necessary for maintaining health is unknown and has not officially been established.

But despite the fact that this element is not officially considered to be a micronutrient, some scientists have suggested provisional recommended intakes set at 1000 μg/day or 1 mg/day for a 70-kg adult (14.3 μg/kg body weight) [2, 13].

However, keep in mind that these levels are not officially recognized nor supported by large-scale, well-designed, independent studies.

How Much Is Too Much?

We can’t be sure.

The issue with lithium is that studies looking into its general safety are lacking.

We can surmise that lithium is relatively safe in small doses, based on the fact that much higher doses are used as lifelong treatments for psychiatric disorders.

However, lithium has the potential to impair the functioning of the thyroid gland and kidneys and to exacerbate symptoms of some diseases such as psoriasis [2].

There is no official RDA for lithium because it’s not officially recognized as an essential nutrient. Some have recommended intakes of 1mg/day. However, studies looking at the safety of low doses of lithium are lacking.

Ways to Increase Lithium

1) Food and Water Sources

Most people get all of their lithium from food and water. The average person in the U.S. gets roughly 0.6 to 3.1 mg of lithium each day [13].

Water

Drinking water can be a great source of lithium, but that heavily depends on where you live. In the United States, lithium levels in drinking water can range from close to zero to over 170 micrograms/L [14, 15].

Some other parts of the world have exceptionally high amounts of lithium in the water. For example, one study found that certain areas of Argentina have over 1000 mcg/L of lithium [52].

How much lithium is in the water where you live?

The United States Geological Survey (USGS) publishes information on trace elements in water samples taken from across the country [16].

Just be aware that lithium levels can vary greatly, even between nearby water sources. This means water lithium levels from a neighboring city may not reflect your own [16].

Water in Texas, especially from mineral springs, seems to be exceptionally high in lithium. Dr. Lynch, the man who bought the “crazy water” mineral springs in Texas back in the 19th century attributed improvements in his health to lithium. Allegedly, these springs also contain other beneficial minerals, such as calcium, magnesium, and sulfate [4].

Spring water spas in Texas are not as popular as they used to be, but they might be worth checking out.

Food

Many different foods can provide a good amount of lithium.

There are estimates that cereal grains and vegetables can cover from 66 to over 90% of the daily lithium consumed, while the rest comes from food of animal origin and from drinking water [2].

Some examples of lithium-rich foods include [2]:

  • Nuts (8.8 micrograms/g)
  • Cereals (4.4 micrograms/g)
  • Fish (3.1 micrograms/g)
  • Vegetables (2.3 micrograms/g)
  • Dairy products (0.5 micrograms/g)

This means that a cup of cereal will give you 0.4 mg of lithium, while half a cup of nuts or 200g of fish will have about 0.6 mg of lithium [53].

Certain types of tea may also be a good source of lithium. A quarter liter of black tea provides about 0.58-1.35 micrograms/g of lithium, while the same volume of red tea contains 0.72-1.70 micrograms/g [2].

2) Supplements

There are several supplements that contain low doses of lithium. One of the more popular ones is lithium orotate. Lithium aspartate and lithium citrate supplements are also available.

Lithium supplements are not approved by the FDA.

Lithium orotate contains about 4 mg of actual or elemental lithium per 100 mg dose. This is in contrast to lithium carbonate, which contains about 19 mg of lithium per 100 mg [54].

Have in mind the following dosage differences:

  • Lithium carbonate is typically prescribed at doses of 600-1800 mg/day. This would give you about 114-340 mg of elemental lithium.
  • Lithium orotate usually contains about 5 mg of elemental lithium per dose.

This difference in dosage means that lithium supplements are highly unlikely to cause the toxicities associated with prescription lithium.

Are there advantages to using lithium orotate?

A couple of old studies claim that lithium orotate may be better at penetrating the blood-brain barrier, allowing it to reach higher levels in the brain [55, 56].

However, other studies have refuted these results. In addition, research on lithium orotate in the past couple of decades has stalled due to safety concerns. Even less research has been done on the other available lithium supplements [57, 58].

If you would like to learn more lithium supplements, including safety and benefits, check out our article here.

We get most of the lithium from food and water. Lithium-rich foods include nuts, cereal grains, and vegetables.Supplements are also available.

Takeaway

Studies have found a link between lower levels of lithium in drinking water and higher rates of suicide, crime, dementia, and mortality. This suggests that lithium may improve human health and wellbeing, but conclusive evidence is still missing.

Lithium is not officially considered a micronutrient and therefore the minimum level of consumption necessary for maintaining health is unknown. Further studies are needed to establish beyond a doubt that lithium is a trace element and a potential RDA.

A safe way to increase lithium in the diet is to get more lithium-rich foods such as nuts, cereal grains, and vegetables. Lithium supplements are also available, but their safety and efficiency is debatable.

About the Author

Mathew Eng

Mathew Eng

PharmD
Mathew received his PharmD from the University of Hawaii and an undergraduate degree in Biology from the University of Washington.
Mathew is a licensed pharmacist with clinical experience in oncology, infectious disease, and diabetes management. He has a passion for personalized patient care and believes that education is essential to living a healthy life. His goal is to motivate individuals to find ways to manage their chronic conditions.

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