At this point I feel that keeping an eye on lithium levels, particularly for anyone adding any form of B12 is critical. At this time no one else is talking about the critical role of lithium with respect to B12. We all recognize the importance of B12 but we also need to be aware that if you are adding B12 you really want to pay attention to lithium levels and to be sure you are not depleting your system of lithium.

I believe that the role of lithium and the importance of lithium with regard to the Methylation Cycle has been under recognized and overlooked for a very long time. This is true with respect to both the adults on this program as well as individuals with autism.

As I have cited in the past, lithium is reported to play a role in the transport of B12. This would fit with the data I have accumulated which indicates that until lithium is in balance on a HMT (hair metal test) that the cobalt (a measure of B12) generally will not increase on a UEE (urine essential element test). In cases where blood B12 is high, yet urine cobalt is low we again see confirmation of the role of lithium, as in these cases the HMT lithium as well as blood lithium tends to be low. Once lithium is supported the B12 levels will also reach a better balance. The positive role of lithium is not limited to its impact on B12 transport.

Lithium is not only a factor in B12 transport, it has a range of other roles in the body. Lithium is well known to play a role in mood, and limiting aggression. It also helps in controlling excess glutamate in the system as well as its involvement in B12 transport. Lithium has been reported to increase human gray matter in the brain (Moore, The Lancet). “Defined human lithium deficiency diseases have not been observed. However, inverse associations of tap water lithium contents in areas of Texas with the rates of mental hospital admissions, suicides, homicides and certain other crimes suggest that low lithium intakes cause behavioral defects” (Schrauzer, J Am Coll Nutr ). This is supported by animal studies illustrating that lithium deficient rats showed behavioral abnormalities. In these studies lithium has also been shown to impact fetal growth and development, with significant effects on birth rate, litter size and higher incidences of spontaneous miscarriages. Lithium reaches a maximum level during the first trimester, aiding in the expansion of the stem cell pool and impacting embryonic development. In addition, data indicates that those with Lyme disease are also low in lithium and that the use of lithium may be a help for this condition (Top Ten Lyme Disease Treatments, Rossner). In addition to its positive impact on gray matter, lithium also “selectively increases neuronal differentiation of hippocampal neural progenitor cells both in vitro and in vivo” (Kim, Journal of Neurochemistry).

Data from the American College of Nutrition suggests that 83% of our population is lithium deficient and recommend a minimum daily intake of at least 1mg/day (Journal of the American College of Nutrition). My personal opinion in terms of dosing, as with other supplements for this program, is that I rely strongly on biochemical data. I believe in regular testing, especially for those who have shown low in lithium or those who have a particular SNP in the MTR (methionine synthase) gene. In general for those where lithium is a significant issue I would run a HMT every three to four months. In addition, blood lithium tests can also be run to supplement hair data. Estimates of the ideal average intake and recommended dose for lithium range from 650 to 3100 micrograms for a 70 kg adult (Schrauzer, J Am Coll Nutr) to therapeutic doses that are approximately ten times higher. “Since Lithium is minimally protein bound and has an apparent volume of distribution of 0.6 L/kg. The therapeutic dose is 300–2700 mg/d” (Mohandas Indian J Psychiatry). Daily increases of only 0.4 milligrams of dietary lithium have been sufficient in some cases to demonstrate improvements in cognitive function as well as mood (Schrauzer, Biological Trace Element Research). As always, with any supplementation, work with and defer to your own doctor in terms of use and dosage.

The goal is to be certain lithium is in balance without levels becoming too high. The best way to ensure balance in my personal opinion is to run frequent HMT, blood tests if needed and as always work with and defer to your doctor. In my experience there is no perfect dose of lithium. Those who are on thyroid medication or taking iodine in higher doses may require more lithium as iodine will compete with lithium. Those who are using massive doses of B12 injections may require more lithium to keep it in balance (again as judged by biochemical testing). Those who have specific types of MTR mutations tend to have intrinsically lower lithium levels. I have a great deal of data supporting the fact that specific MTR (methionine synthase) SNPs correlate with low HMT lithium. As to why, I can hypothesize but this is an area where there is very little direct research on the interaction between B12 and lithium. Presumably this relationship is due to over activity of the MTR enzyme secondary to particular SNPs. Since MTR uses B12 and lithium plays a role in B12 transport you can see why it fits with the data that those who have particular MTR mutations that cause excess MTR activity would tend to require more lithium.

Again, to reiterate on lithium dosing…run tests on a regular basis! The goal is to keep lithium in balance without having it climb too high or be way too low. If you are supplementing with lithium and are seeing high level excretion in urine and hair then run a blood lithium test to determine if much of what you are supplementing with is simply being excreted. If you are supporting with lithium and your HMT gets into balance then run regular HMT to be sure that lithium at that dose stays in balance. I have noted that individuals with particular SNPs in the Methylation Cycle, such as a particular MTR mutation, tend to be very low in lithium as judged by hair metal analysis (HMT). For those with these specific MTR SNPs, the more B12 you add the more lithium may be needed, so again, run tests and as always work with your doctor. I have seen some unique cases where individuals were unable to keep lithium in balance using nutritional supplement sources of lithium. In these instances the use of prescription lithium was needed through consultation with their doctors.

Again, to reiterate one more time, it is my personal opinion and based on the data I have been generating, that lithium support is a critical missing piece of many supplement programs particularly for those using high dose B12. In order to be sure that lithium stays in balance, run frequent HMT and if needed blood lithium levels. As always work with and defer to your own doctor. Supporting with higher levels of B12 before having ascertained that lithium is in balance may lead to further depletion of lithium levels. For this reason I highly suggest running a hair metal test (HMT), and/or blood lithium test along with a urine essential element test (UEE) to assess the lithium level in the system BEFORE looking to add long route support. If lithium levels are low in hair and blood or urine, or if very high level lithium excretion is observed (in the absence of support) consider additional lithium supplementation with your doctor before moving on to B12 support.

Finally, there is a close relationship between lithium levels in hair and potassium levels. Potassium is critical for muscle function, and lack of potassium can also play a role in aggressive behavior (along with low lithium). It is my personal opinion that potassium support should always be considered when supporting with lithium. Again, as always work with and defer to your own doctor in terms of any supplementation program.

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