Low-Dose Lithium Supplements Review
Choose the Best Low-Dose
Lithium Supplement. CL Tests Reveal Which Low-Dose Lithium Supplements Offer
the Best Quality and Value.
Medically reviewed and
edited by Tod Cooperman, M.D. 
Last Updated
: 05/26/2018 | Initially Posted:
08/05/2017
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Table of Contents
Summary
·
What is lithium? Lithium is a mineral used in large doses
(hundreds of milligrams) as prescription medicine to treat bipolar disease but
at much lower doses (fractions of a milligram to a few milligrams) as a dietary
supplement. The form in supplements is typically lithium orotate or lithium
aspartate, while prescription medicine is lithium carbonate or lithium citrate.
(See What It Is). Although all forms will provide
lithium, read labels carefully to understand how much lithium is being promised
because lithium is only a small portion of lithium-containing compounds, e.g.,
only about 4% of lithium orotate is elemental lithium (See Forms of Lithium). Use the Results table to
easily compare amounts of lithium in tested supplements.
·
Health benefits of lithium supplements: There is no
conclusive evidence that supplemental lithium helps. However, some
observational studies and small clinical studies suggest that low-dose lithium
may improve mood, reduce the risk of suicide and reduce the risk and/or
progression of dementia. (See What It Does).
·
How much lithium should I take? Suggested daily
doses of supplemental lithium range from about 0.3 mg to 5 mg — similar to, or
slightly above, the amounts of lithium obtained per day from what we normally
eat and drink (See Dosage).
·
Best lithium supplement? Many products passed our tests for
quality, in which products were tested for their amounts of lithium and
potential contaminants (lead, cadmium, and arsenic) (See What CL Found). Three supplements were
selected as Top Picks.
Be aware that many supplements on the market provide more lithium than you
want, but it is possible to use partial dosing (See Dosage).
·
Lithium safety and side effects: Too much lithium
can cause toxicity and affect thyroid function (See Concerns and Cautions).
What It Is:
Lithium
is a mineral, although not an "essential" mineral, i.e., it is not
required by the body. It is used as a prescription drug to treat bipolar
disorder (manic —depressive illness) most often at a dose of about 900 to 1,800
mg of lithium carbonate (of which about 18.8% is elemental
lithium, yielding 169 to 338 mg of elemental lithium) per day, typically in
divided doses. When prescribed as a liquid, lithium is typically given in the
form of lithium citrate syrup (Lithiuim Prescribing Information 2018).
Lithium is also available as a dietary supplement at very low doses, typically
ranging from a fraction of a milligram to 1 to 20 mg of elemental
lithium in the form of lithium orotate (of which 3.83% is elemental
lithium) or lithium aspartate (of which 4.8% is elemental lithium (see "Forms of Lithium" in the ConsumerTips™ section).
What It Does:
Low-dose lithium:
Some but not all studies suggest that higher natural levels of lithium in
drinking water may protect against suicide (Sugawara, Int J Environ Res Pub Health 2013).
The earliest of these studies found that the incidence rates of suicide,
homicide, and rape were significantly higher in counties in Texas where
drinking water supplies contained little or no lithium than in counties with
higher lithium levels in the water (ranging from 0.070 to 0.170 mg per liter) (Schrauzer, Biol Trace Elem Res 1990). The lead
researcher of this study subsequently recommended a daily intake of lithium for
adults of 1 milligram (1 mg), which is roughly the amount Americans get from
what they eat and drink each day (about 0.6 mg to 3.1 mg depending on location)
(Schrauzer, J Am Coll Nutr 2002).
A subsequent study in the
U.S. confirmed the association between low lithium in groundwater and higher
rates of mental illness (bipolar disorder, depression, and dementia) and other
medical conditions, but, after adjusting for healthcare resources and
demographics by geography, found no association. Regions of low
lithium tended to be areas with far more medical resources, likely resulting in
more diagnoses. For example, the rate of bipolar disorder was nearly double in
regions of low lithium (0.04 mg or less per liter) compared to those with high
lithium (over 0.04 mg per liter), but there were nearly triple the number of
psychiatrists, double the number of hospital beds, and nearly 50% more primary
care physicians in areas of low lithium than in areas of high lithium (Parker, JAMA Psychiatry 2018).
For lithium levels in groundwater
sampled in regions across the U.S., see the map at the top of page 28 of
the US Geological Survey 2011.
Levels are shown in micrograms per liter (1 microgram = 0.001 mg).
The belief that small amounts of lithium may benefit some people has led some
physicians to prescribe or recommend very low doses of lithium (just a few
milligrams daily), as can be obtained from lithium orotate supplements (which
often contain 131 mg of lithium orotate per capsule, providing 5 mg of
lithium). [Note: Due to the large mass of the "orotate" portion of
the molecule, only 3.83% of lithium orotate is lithium, as compared to 18.8% of
lithium carbonate]. One psychiatrist, for example, has anecdotally reported
benefits from giving 2 mg to 20 mg of lithium orotate daily to treat
patients with aggression, depression, and other conditions (Greenblatt, Townsend Letter 2015) [Note: This
amount of lithium orotate would yield only 0.08 to 0.8 mg of lithium]. A small
study among former drug users given 0.4 mg of lithium daily from naturally
lithium-rich brewer's yeast tablets suggested that this very low dose of
lithium improved mood, such as happiness (Schrauzer, Biol Trace
Elem Res 1994).
A small, placebo-controlled study in Brazil of elderly people with mild
cognitive impairment found that lithium given daily for one year was
associated with decreased levels of a marker for Alzheimer's disease known as
P-tau and better results on certain cognitive tests. Although this study used
"lower doses" of lithium than used in treating bipolar disease, the
amounts given were higher than the very low doses typically in supplements, and
the form used was prescription lithium carbonate. The dose ranged from 150 mg
to 600 mg of lithium carbonate (i.e., 28 mg to 113 mg of elemental lithium) (Forlenza, Br J Psych 2011). (It should be noted
that an extended follow-up analysis of this study showed an increase in certain
adverse effects of the lithium treatment -- see the Aprahamian
reference in the Concerns and Cautions section.)
A 15-month, placebo-controlled study using just 0.3 mg per
day of lithium (from a 1.5 mg dose of lithium carbonate) stabilized cognitive
impairment in people with Alzheimer's disease. Significant
differences between the lithium and placebo groups started three months into
treatment and increased over time (Nunes, Curr Alzheimer Res 2013).
(This amount of lithium is the same amount contained in a capsule of the LifeExtension Memory Protect product
tested in this Review).
A large, long-term study in Denmark found an association
between increased lithium levels in drinking water and a lower risk of
developing dementia. People living in areas with the highest levels
of lithium in the water (0.015 mg per liter) were 18% less likely to develop
dementia than those in areas with the lowest lithium levels (0.002 to 0.005 mg
per liter) (Kessing, JAMA Psychiatry 2017).
(Note: Lithium levels in Denmark and most of Europe tend to be significantly
lower than in other regions of the world: Consumption of 2 liters of water per
day in the area of Denmark with the highest concentration of lithium in
drinking water (0.03 mg per liter) provides only 0.06 mg of lithium — an
extremely low amount -- although approximately the same amount contained in a
capsule of the American Biologics Lithium product tested in
this Review).
Quality Concerns and
Tests Performed:
Neither
the FDA nor any other federal or state agency routinely tests lithium
supplements for quality prior to sale. ConsumerLab.com, as part of its mission
to independently evaluate products that affect health, wellness, and nutrition,
purchased several dietary supplements sold in the U.S. claiming to contain
various forms and amounts of lithium. These were tested for their amounts of
lithium and for potential contamination with heavy metals (lead, cadmium, and
arsenic). Standard tablets and caplets were also tested for their ability to
properly disintegrate ("break apart") as needed for absorption.
See How Product Were Evaluated for
more information about how products were evaluated.
What CL Found:
ConsumerLab.com found no problems with the quality of lithium
supplements. Each contained its listed amount of lithium, which ranged from
0.05 mg to 20 mg (see Dosage), and none was contaminated with the
heavy metals lead, cadmium, or arsenic. All tablets broke apart properly in
disintegration testing.
The lithium supplements tested in this Review fell into the following
categories based on the amount of elemental lithium in a suggested daily
serving:
Extremely low-dose (<0.1 mg): American Biologics® Lithium was
the only product tested in this category. It provides just 0.05 mg (or 50
micrograms) of lithium per capsule. This is an extremely small amount
of lithium. As noted earlier, Americans get more than 10 times this amount of
lithium each day just from what they eat and drink. However, it is similar to
the amount associated with reduced risk of dementia in a study in Denmark where
lithium levels in water are particularly low (see Kessler study, above). Although each
capsule is only 12 cents, based on the small amount of lithium provided, the
cost of getting lithium from this product is many times higher than from other
products.
Very low-dose (0.3 mg to 10 mg): Most products fell into this
category, providing 0.3 mg to 10 mg of lithium per capsule or tablet. These
could significantly increase intake of lithium to several times what one
normally gets from one's diet, but is still just a fraction of that from
prescription lithium. Among these, the least expensive in terms of obtaining
lithium were Solaray® Lithium
Aspartate 5 mg and Swanson Ultra® Lithium Orotate. Each
provided 5 mg of lithium per vegetarian capsule for 8 cents. Other products in
this category cost 25% to 150% more.
Low-dose (20 mg): Vital Nutrients Lithium (Orotate) 20 mg was
the only product tested in this category. It is a bit more expensive than the
lowest cost "Very Low Dose" products (above). You could, for example,
take four of Swanson 5 mg capsules and spend 32 cents to get
the same amount of lithium (from lithium orotate) as from one VitalNutrients capsule that
costs 53 cents.
Top Picks:
CL's Top Picks among the lithium supplements
are Swanson Ultra Lithium Orotate (5 mg) and Solaray Lithium Aspartate 5 mg, as well
as LifeExtension Memory Protect (0.3
mg).
Swanson and Solaray provide high-quality lithium at the
lowest cost. The amount of lithium in a capsule of each (5 mg) is about twice
the highest amount obtained in the diet in the U.S. Although these products
contain different forms of lithium (i.e., orotate and aspartate), there is not
enough information to suggest that one is preferable to the other. (Note: As
noted in "Forms of Lithium" in the ConsumerTips™ section, toxicity occurred in an animal study
involving large amounts of lithium orotate, but it is not known if this
toxicity would occur in people, particularly at the low dose in these
supplements.) Although these are Top Picks, be aware that you may
want to use a lower dose than 5 mg — such as 0.3 mg or 1 mg. This would be more
consistent with the recommendations of some researchers, and you can reduce the
dose in the capsules of these products as explained -- see "Dosage" in the ConsumerTips™
section.
Other options to get a somewhat lower doses of lithium are the Life
Extension Memory Protect (0.3 mg of lithium from lithium orotate per
capsule) or Good State Health Solutions Ionic Lithium (0.5 mg
of lithium chloride from a liquid). Although both passed our tests, our Top
Pick among these is LifeExtension
Memory Protect based on more clinical experience in recent years with
the orotate form than the chloride form and with the fact that 0.3 mg of
lithium was the dose shown in one study (see Nunes study, above) to stablize Alzheimer's disease. LifeExtension is
a more expensive product (44 cents per day). It is sold as a pack containing 24
capsules of lithium orotate and another 12 capsules containing the same amount
of lithium orotate combined with colostrinin
polypeptide complex (0.1 mg) -- which is derived from colostrum and was shown,
at the same dose in a 15-week placebo-controlled study in Poland, to help
stabilize (although not improve) symptoms of Alzheimer's disease (Bilikiewicz, J Alz Dis 2004).
Test Results by Product:
Listed
alphabetically below are the test results for ten lithium-containing
supplements. Nine were selected by ConsumerLab.com for testing and one
(indicated with a CL Flask) was included for having passed the same evaluation
through ConsumerLab.com's voluntary Quality Certification Program.
The full list of ingredients is available for each product by clicking on the
word "Ingredients" in the first column. Products listed as
"Approved" met their label claim and ConsumerLab.com's
standards for lithium supplements. Expected amounts of ingredient and lithium
are shown in the second column. Pricing information, cost comparisons,
additional ingredients, and special designations can be found in the last
column.
|
RESULTS OF CONSUMERLAB.COM TESTING OF LITHIUM SUPPLEMENTS |
||||||
|
Product Name, Amount
Listed of Elemental Lithium per Unit, Serving Size, and Suggested Daily
Serving on Label |
Claimed Amount of
Lithium Per Labeled Daily Serving |
--TEST RESULTS-- |
Cost For Daily
Suggested Serving On Label |
|||
|
OVERALL RESULTS: |
Contained Labeled
Amount of Lithium |
Did Not Exceed
Contamination Limit for Lead, Cadmium and Arsenic |
Disintegrated
Properly |
|||
|
|
0.05 mg |
APPROVED |
|
|
NA |
$0.12 |
|
|
9.2 mg |
APPROVED |
|
|
|
$0.30 |
|
|
0.5 mg |
APPROVED |
|
|
NA |
$0.20 |
|
|
5 mg |
APPROVED |
|
|
NA |
$0.10 |
|
|
0.3 mg |
APPROVED |
|
|
NA |
$0.44 |
|
|
5 mg |
APPROVED |
|
|
NA |
$0.20 |
|
|
5 mg |
APPROVED |
|
|
NA |
$0.08 |
|
|
5 mg |
APPROVED |
|
|
NA |
$0.08 |
|
|
10 mg |
APPROVED |
|
|
NA |
$0.32 |
|
|
20 mg |
APPROVED |
|
|
NA |
$0.53 |
|
|
||||||
|
Unless otherwise noted, information about the products
listed above is based on the samples purchased by ConsumerLab.com (CL) for
this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's
ingredients differ from what is listed above, it may not necessarily be of
the same quality as what was tested. |
||||||
|
Copyright ConsumerLab.com, LLC, 2017. All rights reserved.
Not to be reproduced, excerpted, or cited in any fashion without the express
written permission of ConsumerLab.com LLC. |
||||||
ConsumerTips™:
Forms of lithium:
A study published in 1978 suggested a possible advantage of lithium orotate
over lithium carbonate. When equal, large amounts of lithium from either form
were given by injection to rats, higher concentrations of lithium occurred in
the serum and brains of the animals given the orotate form (Kling, J Pharm Pharmacol 1978).
However, hopes were dashed a year later, when other researchers conducted a
similar experiment using large amounts of lithium and observed that kidney
function was reduced by the lithium orotate, which may have explained the
greater buildup of lithium in organs of the body. The researchers wrote
"It seems inadvisable to use lithium orotate for the treatment of
patients." (Smith, J Pharm Pharmacol
1979).
Perhaps as a result of this, lithium orotate has not been tested clinically for
the treatment of bipolar disease.
There are also liquid lithium citrate supplements on the market, providing
low-dose lithium (e.g., 2 mg of lithium per dropper). As noted earlier, the
citrate form of lithium is also sold as an FDA-approved drug (raising the
question of whether it can legally be sold as a supplement) and is used to
provide high doses of lithium but in liquid form, as it is more palatable than
lithium carbonate. The lithium citrate liquid (syrup) is absorbed slightly
faster than lithium carbonate from a pill but is otherwise bioequivalent, i.e.,
it does not raise lithium levels in the body more than lithium carbonate when
given as equal amounts of lithium (Guelen, Biopharm Drug Dispos 1992).
Lithium chloride (which is 16.4% lithium) was used in late 1940's in the U.S.
as a liquid salt substitute due to increasing emphasis on restriction of sodium
intake from sodium chloride (and the fact that lithium chloride has a similarly
salty taste). However, side effects, such as weakness, drowsiness, and
generalized tremors, were reported in people consuming several grams of lithium
chloride daily (Hanlon, JAMA 1949) and the FDA ordered lithium
salt substitutes be removed from the market (Johnson, The History of Lithium
Therapy 1984). These side effects do not seem surprising,
considering that each gram of lithium chloride contains 164 mg of lithium and
some people were consuming several times this amount daily. Lithium chloride
does not appear to be commonly used presently in supplements, although it is
found in the liquid product, Good State Liquid Ionic Lithium Ultra
Concentrate, a liquid providing 0.5 mg of lithium per 10 drops, which
passed testing in this Review.
Only a small portion of a lithium compound is elemental lithium, as noted
earlier (see What It Is). For example, lithium orotate is
3.83% lithium, lithium aspartate is 4.8% lithium, and the lithium carbonate in
prescription drugs 18.8% lithium. What can be confusing is that prescription
medication lists the dose in terms of the amount of lithium compound, such as
"900 mg of lithium carbonate" (which would be 169 mg of elemental
lithium), while labels on supplements normally take an opposite approach,
focusing on the amount of elemental lithium and then identifying the lithium
compound used -- and, sometimes, the amount of this compound, such as
"Lithium (as lithium orotate 131 mg) 5 mg." Keep this in mind when
you read labels, and be aware that published articles sometimes use the term
"lithium" when actually referring to a lithium compound.
Dosage:
Meaningful studies with low-dose lithium have not been published, so it is not
possible to determine an "effective dose." As noted above, 1 mg per
day was suggested by a researcher to boost lithium intake to a level equal to
that in areas with lower suicide risk, and 0.4 mg improved mood in a small
study. Other than LifeExtension Memory
Protect (0.3 mg of lithium) and Good Health Solutions Ionic
Lithium (0.5 mg of lithium), products in this dosage range are not
commonly sold, with most products providing 5 mg or more of lithium -- or an
extremely low dose of just 0.05 mg. Although an inexact procedure, if you want
to get a lower dose of lithium than 5 mg at low cost, it would not be difficult
to twist open a 5 mg capsule, pour out a portion of contents (such as half, if
you want a 2.5 mg dose) and re-close the capsule.
Concerns and Cautions:
Be
aware that taking too much of any form of lithium can cause toxicity. Most
toxicity is mild and includes lethargy, vomiting, difficulty with balance, and
muscle tremors. In 2007, an 18 year-old woman in
Pittsburgh intentionally misused a lithium orotate supplement, Find
Serenity Now (Urban Nutrition, LLC), taking 18 tablets each containing
120 mg of lithium orotate (providing 4.6 mg of lithium per tablet and a total
of 83 mg of lithium) and displayed these symptoms when admitted to an emergency
room. Even larger doses or chronic use of high doses can cause coma or seizures
(Pauze, J Med Toxicol 2007). Side effects can be exacerbated
if you are dehydrated (as this increases the concentration of lithium in your
body), so be sure to remain well hydrated when taking lithium — particularly at
higher doses (Gitlin, Int J Bipolar 2016).
Long-term exposure to high or even moderate amounts of lithium can also affect
thyroid function (causing hypothyroidism), as was shown in a study in the
Argentine Andes where the amount of lithium in drinking water was as high as 1
mg per liter and total daily lithium intake may be as high as 30 mg daily (Broberg, Environ Health Perspect
2011).
Long-term use of lithium at the high doses used in
bipolar disease has been associated with kidney disease, although a 4-year
study involving a somewhat lower daily dose (150 mg to 600 mg of lithium
carbonate, providing, 28 to 113 mg of elemental lithium) given to elderly
people in Brazil did not find any impairment of kidney function. However, those
receiving lithium there were significantly more likely to have developed
diabetes (20%), arrhythmia (20%), and weight gain (25% -- averaging 12 lbs), and, during the first two years of the study, there
was an effect on thyroid function as evidenced by increased TSH levels. (Aprahamian, J Clin Psych 2014).
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Latest Clinical Research Updates for Low-Dose Lithium
Supplements
Do We Really Need More Lithium?
5/26/2018
Studies have shown higher
rates of mental illness and dementia in areas with the lowest levels of lithium
in the water, suggesting that people supplement with lithium. However, a new
study raises doubts about this. For details, see the What It Does section
of the Low-Dose Lithium Supplements Review.
Does Lithium Prevent Dementia?
8/27/2017
A new study found the
risk of developing dementia to be significantly lower in areas with higher
levels of lithium in the drinking water. This finding is consistent with a
study that found low-dose lithium to stabilize patients with Alzheimer's
disease. Details about these studies are in the "What It Does" section
of the Low-Dose Supplements Review, which includes our Top Picks among low-dose lithium supplements.
Related CL Answers (1)