Lithium's Role in Chronic Fatigue Syndrome
The trace metal lithum is oft overlooked in terms of nutritional support. Although not abundant compared to other metals like iron and zinc, lithium plays a key role in several biochemical mechanisms pertinent to chronic illnesses such as fibromyalgia and chronic fatigue syndrome. Lithium is highly concentrated in the diet in eggs, dairy products, beets, and thyme. It has been suggested that as much as 83% of the population is deficient in this metal (1).
Most are familiar with prescribable lithium utilized for the treatment of psychological and major depressive disorders. While potentially effective for mood stabilization in these conditions, doses this large may be highly toxic over the long-term. Several studies have instead looked at smaller, micro doses and neurocognitive benefits.
Possible mechanisms surrounding lithium’s cognitive support include its ability to maintain BDNF levels—the crucial neurotropic product recently found severely depleted in CFS. A cohort of Alzheimer’s patients were given lithium over a 10-week period. At the end of the study, participants had significant increases in BDNF in serum and in the brain (2). Yet another study gave only 300 micrograms of lithium to Alzheimer’s patients over the course of a year which stabilized these patient’s cognitive decline (3).
An additional mechanism of neurocognitive support arise in lithium’s role in the metabolism of the omega-3 fatty acid DHA (4). This fat is crucial for brain health, especially the myelin sheaths of neurons, and reduces neuroinflammation through the induction of cytokines. Finally, lithium provides antioxidant protection via its ability to enhance glutathione-S-transferase enzyme expression in the brain (5).
Lithium’s Role in Methylation
Lithium is a key cofactor in the methylation cycle. Not only does it help transport B12, it also is required for function of the MTR (methionine synthase) enzyme, which recycles homocysteine to methionine. Dr. Yasko believes that in order to maintain healthy B12 levels, lithium levels must also be considered. With increasing loads of B12 such as via intramuscular injection, lithium may become further depleted (6).
Lithium and Glutamate
Lithium also plays a role in maintaining levels of glutamate in the body (6). Excessive glutamate worsens many neurocognitive conditions due to its ability to stimulate the NMDA receptor (more on this key receptor in a later post). Excessive glutamate can promote hyperexcitability, anxiety, and sleep disturbances. Few studies have measured glutamate levels in CFS, but indirect measures suggest this is a common abnormality in CFS (7). In my practice, high levels are common in CFS patients.
How to Test Lithium Levels
One reliable method to assess lithium status is through hair mineral analysis. This type of testing is very accurate at measuring minerals over the long term. Urine mineral testing or red blood cell lithium may be another alternative for patients who do not have access to hair testing or who have dyed or chemical treated hairstyles.
The commonly prescribed high-dose lithium used for psychiatric conditions is in the form of lithium carbonate. Supplemental forms however are in the better tolerable orotate or citrate forms. Tablets and liquid formulations are available in the dispensary to cater to tolerance.
Words of Caution
Even microdose lithium may be contraindicated in some individuals taking certain antidepressants or those with kidney conditions. As always, work with a knowledgeable physician before beginning a new supplement protocol.
1 Schrauzer, GN. (2002) Lithium: Occurrence, Dietary Intakes, Nutritional Essentiality. J Am Coll Nutr. 21(1):14-21. http://www.ncbi.nlm.nih.gov/pubmed/11838882
2 Leyhe, T., et al (2009) Increase of BDNF serum concentration in lithium treated patients with early Alzheimer's disease. J Alzheimers Dis. 16(3):649-56. http://www.ncbi.nlm.nih.gov/pubmed/19276559
3 Nunes MA, Viel TA, Buck HS. (2013) Microdose lithium treatment stabilized cognitive impairment in patients with Alzheimer's disease. Curr Alzheimer Res. 10(1):104-7. http://www.ncbi.nlm.nih.gov/pubmed/22746245
4 Basselin M., et al. (2010) Lithium modifies brain arachidonic and docosahexaenoic metabolism in rat lipopolysaccharide model of neuroinflammation. J Lipid Res. 51(5):1049-56. Epub 2009 Dec 29. http://www.ncbi.nlm.nih.gov/pubmed/20040630
5 Shao L, Cui J, Young LT, Wang JF. (2008) The effect of mood stabilizer lithium on expression and activity of glutathione s-transferase isoenzymes. Neuroscience. 151(2):518-24. Epub 2007 Nov 13. http://www.ncbi.nlm.nih.gov/pubmed/18082333
6 Yasko, Amy (2014) Feel Good Nutrigenomics: Your Roadmap to Health. NRI, LLC.
7 Maes, M & Morris, G. (2013) A neuro-immune model of Myalgic Encephalomyelitis/Chronic fatigue syndrome. Metab Brain Dis. 28(4):523-40. Epub 2012 Jun 21. http://www.ncbi.nlm.nih.gov/pubmed/22718491