Lithium is essential, also for children

Should children receive lithium and if so, how much?

I am often asked: "Should children be given lithium, and if so, how much? In this article I try to give an answer that is understandable to both doctors and lay people. Although I cannot give a general recommendation for the use of lithium because of the legal situation, which is not only dubious but also dangerous to health, I can use my personal approach to lithium supplementation in children as an example of what makes sense from my point of view.

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The case for lithium

From a purely scientific point of view, lithium actually fulfills all the criteria of an essential trace element (see my Article on Lithium, the Essential Trace Element), so the only question that remains for me is how much of this vital substance the human organism needs each day to naturally regulate its vital functions. Accordingly, a deficiency has serious implications for human health, as summarized in a 1996 World Health Organization (WHO) report on "Trace elements in human nutrition and health"[1]: "Epidemiological studies in the USA have shown negative correlations between lithium in drinking-water and mortality, especially from heart disease [...] and admission rates to mental hospitals ". These and many other effects of chronic lithium deficiency, especially on the human psyche, have since been documented in a large and growing number of studies. For example, if you are lucky enough to live in a region where the local drinking water happens to have a slightly higher concentration of lithium, you are significantly less likely to become depressed, commit suicide or develop Alzheimer's disease. (see here)

As early as 2011, an Austrian study provided conclusive evidence that "overall suicide rate […] as well as the suicide mortality ratio […] were inversely associated with lithium levels in drinking water."[2] According to this study, "an increase of lithium concentration in drinking water by 0.01 mg/l [milligrams per litre] was associated with a decrease in the suicide rate of 1.4 per 100 000 or a 7.2% reduction in the SMR [standardised mortality ratio; the ratio of observed deaths in the study group to expected deaths in the general population] for suicide". To make suicide completely unlikely in purely mathematical terms, it would therefore be necessary to increase the dose by a factor of about 15, i.e. about 0.3 mg per day more than in regions with a relatively high suicide rate. This small amount of just 0.0003 grams of additionally administered lithium also corresponds approximately to the amount that, according to the results of a clinical trial from 2013, was able to completely halt the mental deterioration of Alzheimer's patients in the early stages of the disease over the entire study period of 15 months.[3]

I want to emphasize at this point: Lithium is not a drug in this case. Rather, it is a deficiency of these micro amounts of lithium that has a significant impact on the human psyche and brain function and is one of the causes of the disease. Supplementation corrects the deficiency and its effects. A number of researchers are therefore calling for serious consideration to be given to adding lithium to tap water.[4]

However, this 0.3 mg in addition to an average low intake of about 0.1 mg per day (see here) is only the result of a rough calculation; a safer intake would be at least one milligram of lithium per day, i.e. about three times the amount. Other researchers consider this to be the essential daily requirement for an average person weighing 70 kg.[5] This amount would correspond to about 100 to 200 grams of seafood, since seawater has a lithium concentration almost 100 times higher than fresh water, and is even more enriched in shellfish (up to 6 mg per kilogram).[6] For a detailed discussion of the evolution of the human mind during our existence as "fishers and gatherers" (forced by an ice age that lasted many tens of thousands of years), see my book "The Algae Oil Revolution" (to be published in English soon).

Past and Present Lithium Supply

Lithium played a crucial role in the evolution of single-celled prehistoric creatures and the first multicellular organisms about half a billion years before humans, when the trace element surprisingly influenced the same signaling molecules. In fact, it is essential in the above mentioned micro quantities in all animals (worms, fruit flies, rats and goats) that have been studied so far. Accordingly, the WHO report quoted at the beginning states that "there is evidence from experimental animal studies that it [lithium] has an essential functional role". But then the WHO concludes: "Lithium may have essential functions in experimental animals but it is not known whether there is a human requirement.” This unsubstantiated claim cannot be reconstructed using scientific logic. Why all life on earth should need lithium (this even applies to plants, which grow better at low lithium concentrations) [7] and this need does not exist in humans of all people has far-reaching consequences (apart from increased suicide, depression and Alzheimer's rates and many other physical and mental illnesses, including in lithium-deficient children): To date (as of June 2024), lithium is not classified as essential for humans, not even as probably essential. In addition, this completely unscientific formulation contributes to the fact that lithium supplements are even banned in many countries worldwide and in Europe, or are only available with a doctor's prescription.

Since at least German soils are poor in lithium, only a few German mineral waters, such as “Hirschquelle” (1.3 mg lithium/l), reach relevant levels. However, according to official measurements, the highly mineralized German Tainach spring also contains significant traces of other elements in concentrations that could be of concern - such as 8.58 micrograms of uranium per liter (μg/l).[8] This is no small amount, as can be seen from the fact that, according to the Bavarian State Office for Health and Food Safety, values above 2 μg/l of uranium ensure that corresponding foods are not classified as suitable for baby food.[9]

According to some studies, normal lithium intake can be as high as 3.4 mg per day, depending on soil and drinking water concentrations. In places like Chile, where lithium-rich salt flats can contain up to 1,500 mg of lithium per liter, total lithium intake can be as high as 10 mg per day, with no evidence of adverse effects in the local population. This is also in line with statements made by practitioners in the USA, where lithium has been used for decades in doses of 5 mg per day (net amount in the form of lithium orotate) without any reports of side effects. The problem is exactly the opposite, namely chronic deficiency in people living in areas with low lithium levels, as is the case in Germany. Without adequate lithium supplementation in these areas, the above-mentioned essential daily dose of 1 mg for adults cannot be achieved.[10] For comparison: This is 100 to even more than 200 times less than the dose used to treat psychiatric illnesses such as major depression or bipolar disorder; at the same time, it is 10 times the amount that people in Germany consume on average through their normal diet (0.1 mg lithium, see here).

Common dosages in the treatment of neuropsychiatric disorders in children

My thoughts on essential lithium intake are about microdosing. However, it is good to know what macrodoses are used in children and adolescents, e.g. in the USA, e.g. for neuropsychiatric disorders such as bipolar disorder. For example, the Mayo Clinic recommends lithium carbonate, which is more common than lithium orotate, but in my opinion less suitable, because higher amounts are needed to achieve the same effect (no active transport into the brain), which in turn is associated with a higher rate of side effects.[11] The following dosages are recommended[12]:

• Children older than 7 years and weighing more than 30 kg: 600 to 1800 mg of lithium carbonate (i.e., about 120 to 360 mg of lithium) daily.

• Over 7 years of age and between 20 and 30 kg: 600 to 1200 mg of lithium carbonate (i.e., about 120 to 240 mg of lithium) daily.

• Over 7 years of age and under 20 kg: According to the Mayo Clinic, a doctor should determine the dosage.

Nevertheless, the authors of a meta-analysis of the use of high-dose lithium in children and adolescents with the above disorders concluded: "No severe adverse events directly related to lithium were reported in BD and CD [treatment]; common side effects were similar to adults."[13]

Effects, side effects, and optimal blood levels

It is well known that children are not small adults, but have a higher metabolism and, in particular, a higher renal excretory function, which explains the relatively high doses. If children with a body weight of 20 to 30 kg can be given 120 to 240 mg per day therapeutically, no side effects are to be expected with an essential dose of 1 mg of lithium, which is more than 100 to 200 times lower - after all, one is far from the toxic range in which one has long since found oneself with the therapeutically high dose. In fact, the opposite is the case, i.e., otherwise serious negative effects of chronic deficiency on the mental development and mental health of children (and adults, of course) are remedied, such as an increased likelihood of developing mental disorders such as AD(H)D, anxiety symptoms, and depressive behavior.

In fact, initial case reports show that some mentally abnormal children with emotional disorders such as anxiety reactions, depression, and associated sleep disturbances have lithium levels as low as 0.2 μg/l (pediatrician Dr. Christian Schellenberg, personal communication). For comparison: The normal value in the population of 1 μg/l, which is based on an estimated intake of only 0.1 mg lithium per day, is five times higher and thus still at least 10-20 times below the natural value, which in my opinion should be achieved with an essential dosage (see here). Measurements have shown that in these children, by administering 1 to 2.5 mg of lithium (in the form of lithium orotate) daily, the value rose to the natural (essential, in my opinion) value of up to about 20 μg/l lithium. In these cases, symptoms improved significantly. To be clear: this is not a drug therapy, but merely the elimination of an unnatural deficiency of an essential trace element that leads to psychological problems (sleep and attention disorders, anxiety symptoms, etc.). These symptoms can therefore also be treated causally by eliminating the deficiency.

I assume that even children who are classified as healthy could be mentally more efficient and mentally more resilient due to the regulating function of the trace element lithium.

Dosages to achieve essential lithium levels

In the 10 to 20 kg body weight range, I think half a mg of lithium (which is about 13 mg of lithium orotate) daily would be a reasonable amount. For lower weights, correspondingly less, e.g., 0.25 mg of lithium (equivalent to about 6.5 mg of lithium orotate) daily after breast-feeding - at least that is what I would consider good for my children with the knowledge I have today. During lactation, the mother can supplement the essential amount of 1 mg (a measurement of lithium blood levels can be done for interest, but the amounts supplied are so small and so far from any toxicity that this investigation should be purely academic).

Ultimately, the pediatrician has to help decide on these suggestions, as I would for my family due to current legislation (the German prescription requirement also contributes). If you need help as a parent, I suggest that your doctor read the relevant articles on my Substack page.

Disclaimer

All of the considerations presented here are based on publicly accessible documents and studies, most of which are also linked. Nevertheless, the author accepts no liability for the content and any errors. This also applies to quantities. Deviations in dosage may result from lifestyle, gender, age, body size, any pre-existing conditions and, in particular, existing medications. Supplementation should therefore, not only because of the existing prescription requirement, only be taken after consultation with a trusted doctor - the author accepts no liability for unauthorized intake.

Sources

[1] https://www.who.int/publications/i/item/9241561734 (p. 224)

[2] Kapusta ND, Mossaheb N, Etzersdorfer E, Hlavin G, Thau K, Willeit M, Praschak-Rieder N, Sonneck G, Leithner-Dziubas K. Lithium in drinking water and suicide mortality. Br J Psychiatry. 2011 May;198(5):346-50. doi: 10.1192/bjp.bp.110.091041. PMID: 21525518

[3] Nunes MA et al: Microdose lithium treatment stabilized cognitive impairment in patients with Alzheimer's disease. Curr Alzheimer Res 2013, 10:104-107, www.ncbi.nlm.nih.gov/pubmed/22746245

[4] Araya P, Martínez C, Barros J. Lithium in Drinking Water as a Public Policy for Suicide Prevention: Relevance and Considerations. Front Public Health. 2022 Feb 17;10:805774. doi: 10.3389/fpubh.2022.805774. PMID: 35252091; PMCID: PMC8891154.

[5] Schrauzer GN. Lithium: occurrence, dietary intakes, nutritional essentiality. J Am Coll Nutr. 2002 Feb;21(1):14-21. doi: 10.1080/07315724.2002.10719188. PMID: 11838882.

[6] Barbosa H et al: Lithium: A review on concentrations and impacts in marine and coastal systems. Sci Total Environ 2023, https://www.sciencedirect.com/science/article/pii/S0048969722064737

[7] Hawrylak-Nowak B, Kalinowska M, Szymańska M: A study on selected physiological parameters of plants grown under lithium supplementation. Biol Trace Elem Res. 2012 Dec;149(3):425-30. doi: 10.1007/s12011-012-9435-4. Epub 2012 May 11. PMID: 22576984; PMCID: PMC3501157; alinowska M, Hawrylak-Nowak B, Szymańska M. The influence of two lithium forms on the growth, L-ascorbic acid content and lithium accumulation in lettuce plants. Biol Trace Elem Res. 2013 May;152(2):251-7. doi: 10.1007/s12011-013-9606-y. Epub 2013 Jan 25. PMID: 23354541; PMCID: PMC3624008.

[8] https://leopard.tu-braunschweig.de/receive/dbbs_mods_00027200

[9] https://www.lgl.bayern.de/lebensmittel/warengruppen/wc_59_trinkwasser/ue_2006_trinkwasser_uran.htm

[10] Schrauzer GN. Lithium: occurrence, dietary intakes, nutritional essentiality. J Am Coll Nutr. 2002 Feb;21(1):14-21. doi: 10.1080/07315724.2002.10719188. PMID: 11838882.

[11] Pacholko AG, Bekar LK. Lithium orotate: A superior option for lithium therapy? Brain Behav. 2021 Aug;11(8):e2262. doi: 10.1002/brb3.2262. Epub 2021 Jul 1. PMID: 34196467; PMCID: PMC8413749.

[12] https://www.mayoclinic.org/drugs-supplements/lithium-oral-route/proper-use/drg-20064603

[13] Janiri D, Moccia L, Montanari S, Zani V, Prinari C, Monti L, Chieffo D, Mazza M, Simonetti A, Kotzalidis GD, Janiri L. Use of Lithium in Pediatric Bipolar Disorders and Externalizing Childhood- related Disorders: A Systematic Review of Randomized Controlled Trials. Curr Neuropharmacol. 2023;21(6):1329-1342. doi: 10.2174/1570159X21666230126153105. PMID: 36703581; PMCID: PMC10324336.