Lithium levels in the public drinking water supply and risk of suicide: A pilot study

Evaluation of potential human health risks associated with Li and their relationship with Na, K, Mg, and Ca in Romania's nationwide drinking water

Background

Increasing lithium (Li) demand worldwide due to its properties and role in renewable energy will raise water reservoir pollution and side effects on human health. Divergent results regarding Li concentration in water and affective disorders are found in the literature, which is why regional reports are expected.

Objective

The present study evaluated the occurrence and human health risks resulting from oral exposure, respectively, and the relationship between alkali metals (Li, Na, and K) and minerals (Mg, Ca) in balanced purified water (bottled) and spring water.

Methods

The ICP-MS technique was used to measure a national database with 53 bottled and 42 spring water samples randomly selected. One-way ANOVA, Pearson correlation, and HCA analysis were applied to assess the possible relationship between metals in water. The possible side effects of Li poisoning of water resources on human health have been evaluated using the Estimated Daily Intake Index (EDI) and Total Hazard Quotient (THQ).

Results

The toxic metals (As, Hg, and Pb) were measured, and the results indicate values above the detection limit of 22.3% of samples in the case of lead but not exceeding the safety limits. Depending on the water sources, such as bottled and spring water, the Li concentration varied between 0.06-1,557 and 0.09-984% μg/L. We found a strong positive correlation between Li and Na and Mg, varying between bottled and spring waters (p% <%0.001). Li exceeded the limit set by the Health-Based Screening Level (HBSL) in 41.37 and 19% of bottled and spring water samples. The oral reference doses (p-RfDs) for the noncancer assessment of daily oral exposure effects for a human lifetime exceeded threshold values. The THQ index shows potential adverse health effects, requiring further investigations and remedial actions in 27.58% of approved bottled waters and 2.38% of spring waters.

Conclusion

We can conclude that water is safe based on the Li concentration found in drinking water and supported by a gap in strict regulations regarding human Li ingestion. The present study can serve decision-makers and represent a starting database with metals of interest for further clinical studies. Decision-makers can also use it to find solutions for sustainable management of clean and safe drinking water.

Dietary lithium stimulates female fecundity in Drosophila melanogaster

The trace element lithium exerts a versatile bioactivity in humans, to some extend overlapping with in vivo findings in the model organism Drosophila melanogaster. A potentially essential function of lithium in reproduction has been suggested since the 1980s and multiple studies have since been published postulating a regulatory role of lithium in female gametogenesis. However, the impact of lithium on fruit fly egg production has not been at the center of attention to date. In the present study, we report that dietary lithium (0.1-5.0 mM LiCl) substantially improved life time egg production in D. melanogaster w1118 females, with a maximum increase of plus 45% when supplementing 1.0 mM LiCl. This phenomenon was not observed in the insulin receptor mutant InRE19, indicating a potential involvement of insulin-like signaling in the lithium-mediated fecundity boost. Analysis of the whole-body and ovarian transcriptome revealed that dietary lithium affects the mRNA levels of genes encoding proteins related to processes of follicular maturation. To the best of our knowledge, this is the first report on dietary lithium acting as an in vivo fecundity stimulant in D. melanogaster, further supporting the suggested benefit of the trace element in female reproduction.

Lithium Content and Its Nutritional Beneficence, Dietary Intake, and Impact on Human Health in Edibles from the Romanian Market

Lithium (Li) is present in human nutrition based on food intake, and several studies recommend it for treating mood disorders, even if the biological proprieties and biochemical mechanisms represent the basis for its use as an essential element. The Li content was evaluated using the inductively coupled plasma mass spectrometry technique (ICP-MS) in 1071 food and beverage samples from the Romanian market. The results show that Li had a decreasing mean concentration in the food samples as follows: vegetables leafy > bulbous > fructose > leguminous > egg whites > root vegetables > milk products > egg yolks > meats. Approximately a quarter of all data from each dataset category was extreme values (range between the third quartile and maximum value), with only 10% below the detection limit. Mean Li concentration indicated higher values in red wine, white wines, beers, and fruit juice and lower in ciders and bottled waters. A particular interest was addressed to plants for teas and coffee seeds, which showed narrow amounts of Li. For both food and beverages, two similar matrices, including egg whites and yolks and white and red wines, were found to have significant differences, which explains the high variability of Li uptake in various matrices. For 99.65% of the analyzed samples, the estimated daily intake of Li was below the provisional subchronic and chronic reference dose (2 µg/kgbw/day) for adverse effects in several organs and systems. Even so, a risk occurs in consuming bulbous vegetables (Li > 13.47 mg/kg) and fructose solano vegetables (Li > 11.33 mg/kg). The present study's findings indicate that ingesting most of the analyzed beverages and food samples could be considered safe, even if future studies regarding Li content, nutritional aspects, and human cohort diseases must be conducted.

SPIRAL MRI for in vivo lithium-7 imaging: a feasibility study in mice after oral lithium treatment

Lithium has been the frontline treatment for bipolar disorder for over 60 years. However, its mode of action and distribution in the brain is still incompletely understood. The primary isotope of lithium, lithium-7 (7Li), is a magnetic resonance (MR) active, spin-3/2 nucleus. However, its low MR sensitivity and the small brain size of mice make 7Li MR imaging (MRI) difficult in preclinical research. We tested four MRI sequences (FLASH, RARE, bSSFP, and SPIRAL) on lithium-containing phantoms, and bSSFP and SPIRAL on orally lithium-treated adult C57BL/6 mice. 7Li MR spectroscopy was acquired weekly at 9.4T to monitor the lithium uptake. The in vivo T1 relaxation time of 7Li was estimated in four mice. 4-h SPIRAL 7Li MRI was acquired in ten mice at a resolution of 2 × 2 × 3 mm3. SPIRAL MRI provided the highest signal-to-noise ratio (SNR) per unit acquisition time and the best image quality. We observed a non-homogeneous distribution of lithium in the mouse brain, with the highest concentrations in the cortex, ventricles, and basal brain regions. Almost no lithium signal was detected in the olfactory bulb and the cerebellum. We showed that in vivo 7Li MRI in mice is feasible, although with limited spatial resolution and SNR.

Lithium concentration in tap water, bottled mineral water, and Danube River water in Hungary

Due to increased manufacture and recycling of lithium batteries across the world, we may anticipate a rise in lithium pollution in the aquatic environment and drinking water reservoirs. In order to investigate the current status regarding the lithium content in Hungarian tap waters, samples were collected from the public drinking water supply systems of 19 county seats in Hungary during seasonally selected times. Depending on the water sources, such as bank-filtrated river water, surface water from open reservoirs, and groundwater, the lithium concentrations varied between 0.90-4.23, 2.12-11.7 and 1.11-31.4 µg/L, respectively, while the median values were 3.52, 5.02 and 8.55 µg/L, respectively. The lithium concentration in the bottled Hungarian mineral waters was also determined since the daily intake of lithium can be influenced by the consumption of mineral waters. The concentrations ranged from 4.2 to 209 µg/L, while the median value was only 17.8 µg/L. Additionally, a correlation was only found between lithium and potassium concentrations. The lithium concentration was also assessed at ten sampling locations in the Hungarian segment of the Danube River since the Danube water is also a water source for additional drinking water utilities using bank filtration technology. The mean and median lithium concentrations were 2.78 and 2.64 µg/L, respectively.

The concentration of Lithium in water resources: A systematic review, meta-analysis and health risk assessment

The presence of trace elements such as lithium (Li) in water resources in the long term can endanger consumers' health. Several studies have been conducted on Li concentration in water sources; hence, this study attempted to retrieve studies using a systematic search. The search was conducted in Web of Sciences, Embase, PubMed, and Scopus databases from 1 January 2010 to 15 January 2023. Li concentration was meta-analyzed based on the type of water resources and countries subgroups in the random effects model (REM) statistical analysis. In addition, health risk assessment in different age groups was calculated using the target hazard quotient (THQ). This study included 76 papers with 157 data reports in our meta-analysis. The overall pooled concentration of Li was 5.374 (95 % CI: 5.261-5.487 μg/L). The pooled concentration of Li in groundwater (40.407 μg/L) was 14.53 times surface water (2.785 μg/L). The highest water Li content was attributed to Mexico (2,209.05 μg/L), Bolivia (1,444.05 μg/L), Iraq (1,350 μg/L), and Argentina (516.39 μg/L). At the same time, the lowest water Li content was associated with Morocco (1.20 μg/L), Spain (0.46 μg/L), and India (0.13 μg/L). THQ due to Li in water resources in consumers of Iraq, Mexico, South Africa, Afghanistan, Bolivia, Portugal, Malawi, South Korea, Nepal, South Korea, Argentina, and the USA was higher than 1 value. Therefore, continuous monitoring of Li concentration in water sources and reducing Li concentration, especially in groundwater water, using new water treatment processes in these countries are recommended.

An investigation into the association between suicide mortality rate and lithium levels in potable water: a review study

This study aimed to investigate the association between lithium levels in potable water and suicide mortality rates in the total inhabitants. We systematically searched Embase, PubMed/MEDLINE, Scopus, PubMed Central (PMC), Google Scholar databases, as well as medRxiv using the following keywords: drinking water, lithium, standardized mortality ratio (SMR), tap water, suicide, and ground water. Pearson regression analysis was used to test an association between variables with 95% confidence interval (CI). A value of P < 0.05 was considered significant. A total of 16 eligible articles were identified. Lithium concentrations in drinking water range from 0.4 to 32.9 μg/l. Average rates of suicide mortality (per 100 000 capita) range between 0.790 (±0.198) and 123 (±50). About 16 original studies confirmed the inverse relationship between lithium concentrations in potable water and suicide mortality rates (R = -0.576; R2 = 0.3323; 95% CI, -0.820 to -0.325; β = -0.3.2; P = 0.019). High lithium concentrations in potable water were associated with decreased suicide rates. We concluded that lithium concentration in potable water was inversely associated with suicide mortality rates among a total population. However, further research is required to clarify the relationship between lithium concentrations in drinking water and suicide rate.

Effects of different doses of lithium on the central nervous system in the rat valproic acid model of autism

Epidemiological studies have shown that low doses of lithium in the environment can have beneficial effects on mental health. Autism spectrum disorder, a neurodevelopmental disorder in which patients exhibit abnormal behaviors, pharmacological interventions usually relied on a range of psychotropic medications. However, such medications often produce severe side effects or are ineffective in symptoms. Finding alternative ways to improve abnormal behaviors in individuals with autism are warranted, in which case lithium may be a relatively safe and effective medication. Lithium salt therapy is used to treat a variety of neuropsychiatric disorders and has neuroprotective effects. In this study, we investigated the effects of different doses of lithium on neurobehavioural disorders using the rat model of autism established by valproic acid (VPA) injection. Lithium was observed to have an ameliorative effect on the social cognitive, social memory and anxiety levels in the rat model of autism. Immunofluorescence staining showed that subchronic LiCl administration (1.0 mmol/kg) significantly reduced the number of Iba-1 positive cells in the CA1 region of the hippocampus in VPA group and brought it close to the levels of control group. Significantly lower levels of the pro-inflammatory marker IL-6 were observed in the hippocampus and serum after lithium treatment. In addition, the lithium treatment increased the levels of H3K9 acetylation in the hippocampus of VPA-exposed rats. The results showed a defensive effect of environment-related lithium exposure doses on neurobehavioural deficits in the rat valproic acid model of autism, suggesting that it may be a potential drug for the treatment of autism.

Lithium bioaccumulation in Lentinus crinitus mycelia grown in media with different lithium sources and pH values

Lentinus crinitus bioaccumulates lithium in mycelia, but bioaccumulation may be affected by pH of the culture medium. Lithium is used in clinical practice as a mood stabilizer and antidepressant. This study aimed to assess the effect of culture medium pH and lithium source (LiCl or Li₂CO₃) on lithium bioaccumulation in vegetative mycelia of L. crinitus grown in malt extract broth. Lentinus crinitus U9-1 was cultured in malt extract broth supplemented with Li₂CO₃ or LiCl (50 mg L^-1 lithium) in the pH range of 3.0 to 6.0. The pH was adjusted using HCl solution. The results showed that medium pH affected mycelial biomass production, lithium bioaccumulation in mycelial biomass, and lithium transfer from the culture medium to mycelial biomass. The effect of lithium source on the bioaccumulation capacity of mycelial biomass varied according to pH. At pH 4.0, both lithium sources stimulated mycelial biomass production compared to the control without the addition of lithium. At pH 5.5, Li₂CO₃ provided the highest lithium bioaccumulation in mycelial biomass. Lithium transfer from the culture medium to mycelia was highest in Li₂CO₃-supplemented cultures at pH 4.5. LiCl reduced hyphal width compared with Li₂CO₃ and the control. However, pH and lithium sources did not affect the formation of clamp connections in hyphae. For the first time, the influence of the pH of the culture medium on lithium bioaccumulation by Lentinus crinitus is reported. Finally, we conclude that the culture medium pH affected lithium transfer and bioaccumulation in mycelial biomass differently depending on the lithium source. Additionally, we report the presence of clamp connections in the hyphae of L. crinitus as an indicator of even growth.

Lithium Accumulation in Salvinia natans Free-Floating Aquatic Plant

The new context of the intensive use of lithium-based batteries led to increased production of Li and Li-containing wastes. All these activities are potential sources of environmental pollution with Li. However, the negative impact of Li on ecosystems, its specific role in the plants' development, uptake mechanism, and response to the induced stress are not fully understood. In this sense, the Li uptake and changes induced by Li exposure in the major and trace element contents, photosynthetic pigments, antioxidant activity, and elemental composition of Salvinia natans were also investigated. The results showed that Salvinia natans grown in Li-enriched nutrient solutions accumulated much higher Li contents than those grown in spring waters with a low Li content. However, the Li bioaccumulation factor in Salvinia natans grown in Li-enriched nutrient solutions was lower (13.3-29.5) than in spring waters (13.0-42.2). The plants exposed to high Li contents showed a decrease in their K and photosynthetic pigments content, while their total antioxidant activity did not change substantially.

Lithium in Drinking Water as a Public Policy for Suicide Prevention: Relevance and Considerations

Although suicide is considered a major preventable cause of mortality worldwide, we do not have effective strategies to prevent it. Lithium has been consistently associated with lowering risk of suicide. This effect could occur at very low concentrations, such as trace doses of lithium in tap water. Several ecological studies and recent meta-analysis have suggested an inverse association between lithium in water and suicide in the general population, with a lack of knowledge of clinically significant side effects. This paper is aimed as a proposal to discuss the addition of lithium to drinking water to decrease the suicide rate. For this, we review the evidence available, use previous experiences, such as water fluoridation to prevent dental caries, and discuss the complexity involved in such a public policy. Considering the limited data available and the controversies contained in this proposal, we suggest that a consensus on lithium concentration in water is needed, where the suicide rates start to reduce, as happened with water fluoridation. This measure will require to develop community-controlled trials with strict monitoring of any side effects, where democratic procedures would constitute one of the most appropriate ways to validate its implementation according to the reality of each community.

Association between lithium levels in drinking water and suicide rates: Role of affective disorders

OBJECTIVE

The study aimed to assess the association between lithium levels in drinking water from public supplies and suicide rates in different municipalities of Lithuania in relation with incidence of affective disorders.

METHODS

53 drinking water samples were analysed from the main public drinking water systems of the country's municipalities. Lithium levels were determined using the ion chromatography method. Information on all registered affective disorders across all age groups and gender within the 5-year period was obtained from the Department of Statistics, and was averaged across the investigation time period. For the statistical analysis, lithium levels were averaged per municipality and plotted against suicide standardized mortality rates per 100,000 populations, within the 5-year period.

RESULTS

We found that lithium levels in drinking water are positively associated with the incidence of affective disorders. Our findings suggest higher incidence rates of affective disorders in the municipalities with a lithium level in drinking water above median compared to those in the municipalities with a lithium level below median and with the same socio-demographic and psychiatric characteristics. Suicide mortality rates are inversely associated with lithium levels in drinking water only in municipalities with higher lithium levels (above median) and with a high rate of affective disorders.

CONCLUSION

Based on our study results and insights we generate the following hypothesis for the further research, that lithium level in drinking water might have an important protective effect against suicide rates in the population with affective disorders.

Lithium: Perspectives of nutritional beneficence, dietary intake, biogeochemistry, and biofortification of vegetables and mushrooms

Although lithium (Li) is not an essential nutrient for humans, low Li intakes are associated with increased suicide and homicide rates, aggressive behaviors, unipolar/bipolar disorders, acute mania, etc. On the other hand, Li is one of the most effective psychopharmacological agents used for the treatment of these psycho-behavioral disorders. The beneficial normothymic effect of Li could be achieved at lower doses, therefore, modern psychiatry has called to consider Li biofortification of foods to improve its dietary intake. The concept of agronomic biofortification of crops with Li is juvenile and there exist a limited number of studies, mainly focused on vegetables or mushrooms. This review, first of its kind, discusses the nutritional beneficence and dietary intake of Li, its biogeochemistry, and opportunities and challenges in the Li biofortification of food crops. Literature showed that dietary intake of Li in many countries of the world is insufficient, compared to the provisional recommended dietary allowance (RDA) of 1.0 mg day^-1 for a 70 kg adult. Lithium contents of soils are widely variable and the metal has high mobility in soils, making it more prone to leaching, and available for plant uptake. Biofortification studies reveal that plants can accumulate significant quantities of Li in their edible tissues without yield loss and quality associated negative effects. At lower application rates, Li tissue concentration could reach to the level that consuming 100-200 g of Li-biofortified fresh vegetables or mushrooms could support its RDA. It seems impossible to enrich the plants with Li to the levels that allow their application in psychiatric treatments, which requires the dosage of 600-1200 mg day^-1. However, there is need to refine the methods of Li biofortification strategies to obtains plant specific concentration of Li in edible parts so that consuming a specific amount could provide the proposed dietary intake requirement.

Biodegradable magnesium-based biomaterials: An overview of challenges and opportunities

As promising biodegradable materials with nontoxic degradation products, magnesium (Mg) and its alloys have received more and more attention in the biomedical field very recently. Having excellent biocompatibility and unique mechanical properties, magnesium-based alloys currently cover a broad range of applications in the biomedical field. The use of Mg-based biomedical devices eliminates the need for biomaterial removal surgery after the healing process and reduces adverse effects induced by the implantation of permanent biomaterials. However, the high corrosion rate of Mg-based implants leads to unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. To overcome these limitations, alloying Mg with suitable alloying elements and surface treatment come highly recommended. In this area, open questions remain on the behavior of Mg-based biomaterials in the human body and the effects of different factors that have resulted in these challenges. In addition to that, many techniques are yet to be verified to turn these challenges into opportunities. Accordingly, this article aims to review major challenges and opportunities for Mg-based biomaterials to minimize the challenges for the development of novel biomaterials made of Mg and its alloys.

Relationship between Lithium Levels in Drinking Water and Suicide Rates: A Nationwide Study in Lithuania

To investigate an association of lithium levels in the drinking water with suicide mortality rates in Lithuania. Methods: Samples from public drinking water systems were taken in all districts of Lithuania. Lithium levels were determined using the ion chromatography method. For the statistical calculations, lithium levels were averaged per district municipality and plotted against suicide standardized mortality rates (SMR) per 100,000 populations, within the 5-year period from 2012 to 2016. Results: We found that lithium concentrations in drinking water were significantly negatively associated with total suicide rates in a nonlinear way. Conclusion: Lithium intake with drinking water may affect suicide rates in some geographical areas.

The association between lithium in drinking water and neuropsychiatric outcomes: A systematic review and meta-analysis from across 2678 regions containing 113 million people

BACKGROUND

Lithium in drinking water may have significant mental health benefits. We investigated the evidence on the association between lithium concentrations in drinking water and their neuropsychiatric outcomes.

METHODS

We conducted a systematic review and meta-analysis and searched Pubmed, Embase, Web of Science, PsycINFO and CINAHL up to 19 January 2020, for peer-reviewed research examining the association between lithium concentrations in drinking water and neuropsychiatric outcomes. We used a pairwise analysis and a random effects model to meta-analyse suicide rates and psychiatric hospital admissions. We assessed for publication bias using Egger's test and Duval and Tweedie's Trim and Fill analysis.

RESULTS

Twenty-seven studies including 113 million subjects were included in this systematic review. Meta-analysis of 14 studies including 94 million people found higher lithium concentrations were associated with reduced suicide rates (r = -0.191, 95% confidence interval = [-0.287, -0.090], p < 0.001) and meta-analysis of two studies including 5 million people found higher lithium concentrations were associated with fewer hospital admissions (r = -0.413, 95% confidence interval = [-0.689, -0.031], p = 0.035). We found significant heterogeneity between studies (Q = 67.4, p < 0.001, I² = 80.7%) and the presence of publication bias (Egger's test; t value = 2.90, p = 0.013). Other included studies did not provide sufficient data to analyse other neuropsychiatric outcomes quantitatively.

CONCLUSION

Higher lithium concentrations in drinking water may be associated with reduced suicide rates and inpatient psychiatric admissions. The relationship with other neuropsychiatric outcomes and complications remains unclear. Further research is required before any public health recommendations can be made.Trial registration number: The study was registered with PROSPERO, number CRD42018090145.

Lithium in drinking water and suicide prevention: The largest nationwide epidemiological study from Japan

OBJECTIVES

The aims of the present study thus were (a) to further investigate the association between lithium levels in drinking water and suicide rates by adjusting relevant factors using the so far largest available dataset in Japan, (b) to confirm sex differences, (c) to estimate the effects of long-term exposure to trace lithium, (d) to investigate the effects of drinking bottled instead of tap water, and (e) to exploratorily investigate which lithium levels may be associated with lower suicide rates.

METHODS

Mean lithium levels in drinking water of all 808 cities and wards (ie, 785 cities of 46 prefectures and 23 wards of Tokyo) in Japan were examined in relation to mean suicide standardized mortality ratios (SMRs) during the 7 years from 2010 to 2016. Multiple regression analyses adjusted for the size of each population were used to investigate the association of lithium levels with suicide SMRs with adjustments for relevant factors.

RESULTS

The adjusted model showed significant inverse associations of lithium levels with total and male SMRs, but not with female SMRs. Neither the proportion of residents who continued to live in the same city nor the consumption of bottled water changed the association between lithium levels and suicide SMRs. Finally, it was 30 μg/L or more that was associated with lower suicide SMRs.

CONCLUSIONS

The present findings reconfirm the inverse association between lithium levels in drinking water and suicide rates particularly in the male population.

Large-scale survey of lithium concentrations in marine organisms

Trace metals such as Cu, Hg, and Zn have been widely investigated in marine ecotoxicological studies considering their bioaccumulation, transfer along trophic webs, and the risks they pose to ecosystems and human health. Comparatively, Li has received little attention, although this element is increasingly used in the high-tech, ceramics/glass, and medication industries. Here, we report Li concentrations in more than 400 samples, including whole organisms and different organs of bivalves, cephalopods, crustaceans, and fish. We investigated species from three contrasting biogeographic areas, i.e. temperate (Bay of Biscay, northeast Atlantic Ocean), tropical (New Caledonia, Pacific Ocean), and subpolar climates (Kerguelen Islands, southern Indian Ocean), among diverse trophic groups (filter-feeders to meso-predators) and habitats (benthic, demersal, and pelagic). Although Li is homogeneously distributed in the ocean (at 0.18 μg/mL), Li concentrations in soft tissues vary greatly, from 0.01 to 1.20 μg/g dry weight. Multiple correspondence analyses reveal two clusters of high and low Li concentrations. Li distributions in marine organisms appear to be mostly geographically independent, though our results highlight a temperature dependency in fish muscles. Li is consistently bio-reduced through the trophic webs, with filter-feeders showing the highest concentrations and predatory fish the lowest. Strong variations are observed among organs, consistent with the biochemical similarity between Na and Li during transport in the brain and in osmoregulatory organs. Fish gills and kidneys show relatively high Li concentrations (0.26 and 0.15 μg/g, respectively) and fish brains show a large range of Li contents (up to 0.34 μg/g), whereas fish liver and muscles are Li depleted (0.07 ± 0.03 and 0.06 ± 0.08 μg/g, respectively). Altogether, these results provide the first exhaustive baseline for future Li ecotoxicology studies in marine coastal environments.

Association between naturally occurring lithium in drinking water and suicide rates: systematic review and meta-analysis of ecological studies

BACKGROUND

The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population.

AIMS

To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates.

METHOD

The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375).

RESULTS

The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = -0.27, 95% CI -0.47 to -0.08; P = 0.006, I2 = 83.3%), male (pooled β = -0.26, 95% CI -0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = -0.13, 95% CI -0.24 to -0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration.

CONCLUSIONS

This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.

Lithium in Portuguese Bottled Natural Mineral Waters-Potential for Health Benefits?

There is increasing epidemiologic and experimental evidence that lithium (Li) exhibits significant health benefits, even at concentrations lower than the therapeutic oral doses prescribed as treatment for mental disorders. The aim of this study is to determine the content of Li in 18 brands of bottled natural mineral waters that are available on the Portuguese market and from which the sources are found within the Portuguese territory, to provide data for Li intake from drinking water. Analyses of Li were performed by inductively coupled plasma-mass spectrometry. The results indicate highly different Li concentrations in natural mineral waters: one group with low Li concentrations (up to 11 µg Li/L) and a second group with Li concentrations higher than 100 µg/L. The highest Li concentrations (>1500 µg Li/L) were observed in the highly mineralized Na-HCO₃ type waters that are naturally carbonated (>250 mg/L free CO₂). As a highly bioavailable source for Li dietary intake these natural mineral waters have potential for Li health benefits but should be consumed in a controlled manner due to its Na and F⁻ contents. The consumption of as little as 0.25 L/day of Vidago natural mineral water (2220 µg Li/L), can contribute up to 50% of the proposed daily requirement of 1 mg Li/day for an adult (70 kg body weight). In future, Li epidemiological studies that concern the potential Li effect or health benefits from Li in drinking water should consider not only the Li intake from tap water but also intake from natural mineral water that is consumed in order to adjust the Li intake of the subjects.

Association between lithium in tap water and suicide mortality rates in Miyazaki Prefecture

Background

Most studies have reported that suicide mortality rates are negatively associated with lithium levels in tap water; however, a few studies showed either no association or a positive association. Thus, the association between suicide mortality and lithium levels in tap water remains controversial. To clarify the association, our study evaluated the association between lithium levels in tap water and suicide mortality rates in Miyazaki Prefecture of Japan, after adjusting for confounding factors.

Methods

We measured lithium levels in tap water across the 26 municipalities of Miyazaki Prefecture in Japan. We examined the standardized mortality ratio (SMR) for suicide in each municipality and used the data as the average suicide SMRs over 5 years (2009–2013). Weighted least-squares regression analysis, adjusted for the size of each municipality’s population, was used to investigate the association between lithium levels in tap water and suicide SMRs. In addition to a crude model, in an adjusted model, potential confounding factors (proportion of elderly people, proportion of one-person households, annual marriage rate, annual mean income, unemployment rate, the density of medical doctors per 100,000 people, annual total rainfall, and proportion of people with a college education or higher) were added as covariates.

Results

We showed that male and female suicide SMRs were not associated with lithium levels in tap water in Miyazaki Prefecture. After adjusting for confounders, male suicide SMRs were significantly and positively associated with the proportion of elderly people in the population and annual total rainfall, and female suicide SMRs were associated with the proportion of elderly people in the population.

Conclusions

No association between lithium levels in tap water and suicide mortality rates was found in Miyazaki Prefecture.

Lithium in drinking water sources in rural and urban communities in Southeastern Nigeria

There is a dearth of data on lithium content of domestic water sources in Nigeria. This study reported the lithium concentration in ground and surface water sources used for drinking in Southeastern Nigeria. Thirteen (13) natural springs, 24 streams, 7 hand-dug wells and 80 boreholes, making a total of 124 water samples were collected from strategic locations and analysed by ICP-OES. The distribution of lithium according to water sources and lithostratigraphic units as well as dietary contribution of lithium through drinking water was investigated. Average lithium concentrations in water samples from all sources were between 0.09 and 1.54 μg/L (overall mean ± SEM: 1.0 ± 0.2 μg/L). Results according to the geological formations of the areas studied indicated that only water sources located within the Benin Formation and Bende-Ameki Formation contained lithium in the range of <0.21-7.24 and < 0.21-1.97 μg/L respectively, whereas lithium was not detected in samples located within the Nsukka and Mamu lithostratigraphic units. Total intakes of lithium from water consumption (0.64 L for children and 2 L for adults) for all water sources were 79 and 247 μg/day for children and adults respectively, while the average daily intake of lithium from the water sources ranged from 0.004 to 0.066 and 0.002-0.044 μg/kg body weight for children (15 kg) and adults (70 kg) respectively. Drinking water in the study areas contributes only about 0.02-0.47% of the U.S. EPA estimated daily intake (9.3-44.3 μg/kg) of Lithium.

Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis

BACKGROUND

Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium concentration in drinking water and suicide mortality in the general population.

METHODS

A systematic search was conducted in Web of Knowledge, PubMed, ScienceDirect, and Scopus to find papers reporting the crude relationship between drinking water lithium and suicide incidence in the general population until June 2019. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model.

RESULTS

We retrieved 308 English original articles, of which 13 ecologic studies with a total sample size of 939 regions and one cohort study with a sample size of 3,740,113 people were eligible for the meta-analysis. A significant relationship was found between the lithium concentration in drinking water and reduced suicide mortality (OR= 0.42; 95% CI: 0.27-0.67; p-value <0.01). Ten studies reported gender-specific responses to lithium, with the pooled estimates as follows: OR= 0.54; 95% CI: 0.35-0.84; p-value <0.01 for men, OR= 0.70; 95% CI: 0.48-1.01; p-value =0.057 for women, and OR= 0.63; 95% CI: 0.47-0.83; p-value <0.01 for total.

LIMITATIONS

The study was limited to the assessment of the crude relationship between lithium exposure and suicide rate without considering the role of confounders.

CONCLUSIONS

Lithium in drinking water is dose-dependently associated with reduced suicide mortality at least in ecological studies. However, we need well-designed clinical trials to confirm the protective effect of drinking water lithium intake against suicide.

The impact of anthropogenic inputs on lithium content in river and tap water

The use of lithium (Li) has dramatically increased during the last two decades due to the proliferation of mobile electronic devices and the diversification of electric-powered vehicles. Lithium is also prescribed as a medication against bipolar disorder. While Li can exert a toxic effect on living organisms, few studies have investigated the impact of anthropogenic inputs on Li levels in the environment. Here we report Li concentrations and Li isotope compositions of river, waste and tap water, and industrial products from the metropolitan city of Seoul. Results show that the large increase in population density in Seoul is accompanied by a large enrichment in aqueous Li. Lithium isotopes evidence a major release from Li-rich materials. Water treatment protocols are also shown to be inefficient for Li. Our study therefore highlights the need for a global Li survey and adequate solutions for minimizing their impact on ecosystems and city dwellers.

Lithium bioaccumulation in Lentinus crinitus mycelial biomass as a potential functional food

Lentinus crinitus is an important basidiomycete consumed by ethnic groups from the Amazon, commonly found in decomposing trees with high lignolytic and antioxidant activities. Lithium is a mood stabilizer, antiepileptic, antipsychotic, and antidepressant used in clinical practice. This study aimed to evaluate L. crinitus mycelial biomass bioaccumulated with lithium in liquid cultivation medium. The malt extract medium was added from zero to 100 mg L^-1 lithium from two lithium sources (Li₂CO₃ and LiCl). The maximum mycelial biomass production was 7218.89 mg L^-1 in the culture medium added with 5 mg L^-1 lithium from LiCl. The highest lithium concentration in the mycelial biomass was of 574.72 μg g^-1 produced in the culture medium with 25 mg L^-1 lithium from Li₂CO₃. Pearson's correlation showed that Li₂CO₃ reduces the mycelial biomass and increases lithium bioaccumulation. The maximum translocated lithium from cultivation medium to mycelial biomass was up to 19 or 28% with LiCl or Li₂CO₃, respectively. Therefore, although Li₂CO₃ presents greater inhibition on the mycelial biomass production, it promoted greater lithium bioaccumulation in L. crinitus mycelial biomass and resulted in greater yield of lithium translocation. The equivalent daily dose of lithium for psychiatric treatment, without bioavailability studies, could be reached with 97.4 g lithium-enriched mycelial biomass and, based in the literature, for reduction of violence and criminality rates the amount could be reached with 0.24-0.58 mg. Thus, the development of lithium-enriched mycelial biomass could be an alternative functional food.

Unraveling prevalence and public health risks of arsenic, uranium and co-occurring trace metals in groundwater along riverine ecosystem in Sindh and Punjab, Pakistan

The current study focuses on the understanding of contamination status, distribution, source apportionment and health perspectives of arsenic (As), uranium (U) and other co-occurring trace metals in the groundwater samples collected along the major rivers in Sindh and Punjab provinces, Pakistan. ICP-MS analysis revealed that the concentrations of As in the groundwater in Sindh and Punjab ranged from 0.2 to 81.1 µg/L (n = 38) and 1.1 to 501.1 µg/L (n = 110), respectively. Importantly, this study is the first evidence of U contamination in the groundwater samples in Pakistan, which revealed the concentrations of U at from 0.8 to 59.0 and 0.1 to 556.0 µg/L respectively, in Sindh and Punjab. Moreover, the concentrations of Sr and Mn exceeded the WHO limits in the current study area. Anthropogenic activities such as urbanization, direct dispose of industrial, agricultural waste into waterways and extensive use of pesticides and fertilizers might be the main sources of elevated levels of total dissolved solids and electrical conductivity, which increased the mobilization of As, U and Sr in the groundwater samples. Human health risk assessment parameters such as average daily dose, hazard quotient (HQ) and cancer risk indicated severe risks of As and U in the study area. The HQ values of As and U in Punjab were observed at 69.6 and 7.7, respectively, implying the severity of the health risks associated with consumption of contaminated groundwater for drinking purposes. In a nutshell, proactive control and rehabilitation measures are recommended to eradicate trace metals associated groundwater contamination in the targeted areas to avoid future worst scenarios.

The change of surface charge by lithium ion coating enhances protein adsorption on titanium

Surface charge is one of the essential physicochemical properties of titanium surfaces for extracellular protein adsorption. Titanium surfaces are generally electronegatively charged at physiological pH. Typical cellular adhesive proteins and cell membranes are also negatively charged. Therefore, there are no direct electric interactions between proteins and titanium surfaces at physiological pH. The objective of this study was to determine how different electrical charges on titanium surfaces affect protein adsorption. Commercially pure grade-2 titanium disks, 19 mm in diameter and 1.5 mm in thickness, having acid-etched micro-roughed surfaces, were prepared. Electropositive charge was supplied by soaking in LiOH solution at concentrations of 0.05, 0.1, 0.25, 0.5, and 1.0 M. After LiOH treatment, X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) were performed. The zeta potential, isoelectric point, and wettability of titanium surfaces were measured. The adsorption levels of proteins, including albumin, laminin, and fibronectin, were evaluated. Osteoblastic cell attachment level was also determined. Incorporation of Li was detected in the oxide layer of titanium without surface morphological modification. The zeta potential was shifted up and the isoelectric point was increased from 3.94 to 5.63 by LiOH treatment. Long-term super-hydrophilicity was also obtained on Li-treated surfaces. The adsorption of albumin and laminin increased with increasing concentration of LiOH treatment solution, whereas fibronectin adsorption was highest upon treatment with 0.25 M. The osteoblastic cell attachment level was shown to be dependent on the amount of fibronectin adsorbed. In conclusion, LiOH treatment enhances biological adhesion on titanium with an increase in surface charge and hydrophilicity. This study suggests that modifying the surface charge provides a direct protein-to-materials interaction and the optimal application of Li should be investigated further.

Quantification of Elemental Contaminants in Unregulated Water across Western Navajo Nation

The geologic profile of the western United States lends itself to naturally elevated levels of arsenic and uranium in groundwater and can be exacerbated by mining enterprises. The Navajo Nation, located in the American Southwest, is the largest contiguous Native American Nation and has over a 100-year legacy of hard rock mining. This study has two objectives, quantify the arsenic and uranium concentrations in water systems in the Arizona and Utah side of the Navajo Nation compared to the New Mexico side and to determine if there are other elements of concern. Between 2014 and 2017, 294 water samples were collected across the Arizona and Utah side of the Navajo Nation and analyzed for 21 elements. Of these, 14 elements had at least one instance of a concentration greater than a national regulatory limit, and six of these (V, Ca, As, Mn, Li, and U) had the highest incidence of exceedances and were of concern to various communities on the Navajo Nation. Our findings are similar to other studies conducted in Arizona and on the Navajo Nation and demonstrate that other elements may be a concern for public health beyond arsenic and uranium.

Lithium-Rich Mineral Water is a Highly Bioavailable Lithium Source for Human Consumption

SCOPE

Lithium is an important trace element in human nutrition and medicine. Mineral and medicinal waters may represent a significant source of dietary lithium intake.

METHODS AND RESULTS

The lithium concentration of 360 German mineral and 21 medicinal waters is determined. Based on a systematic screening, three different mineral waters exhibiting low (1.7 µg L^-1 ), medium (171 µg L^-1 ), and high lithium (1724 µg L^-1 ) concentrations are chosen for an acute bioavailability study in male healthy volunteers. In Germany, a north-east to south-west gradient of analyzed lithium concentrations is observed in the 381 tested waters. The lithium concentration in the water is significantly correlated with its sodium (r = 0. 810), potassium (r = 0.716), and magnesium (r = 0.361), but not with its calcium concentration. In a randomized cross-over trial, volunteers (n = 3×10 each) drink 1.5 L of the respective mineral waters, and lithium concentrations in serum and urine are monitored over 24 h. Consumption of the mineral waters with a medium and high lithium content results in a dose-dependent response in serum lithium concentrations and total urinary lithium excretion.

CONCLUSION

Lithium-rich mineral and medicinal waters may be an important and highly bioavailable lithium source for human consumption.

Is Lithium a Micronutrient? From Biological Activity and Epidemiological Observation to Food Fortification

Lithium compounds have been widely used in psychopharmacology, particularly in the treatment of bipolar disorder. Their normothymic and neuroprotective properties when used at high doses have been well established. However, a number of observations suggest that environmentally relevant lithium doses may also exert beneficial health effects, leading to a decrease in the rate of suicides and levels of violence. Despite the fact that this element is not officially considered to be a micronutrient, some authors have suggested provisional recommended intakes set at 1000 μg/day for a 70-kg adult (14.3 μg/kg body weight). The present paper reviews the biological action of lithium, its bioavailability and metabolism, and content in different foodstuffs and water. It also assesses epidemiological data on potential correlations between lithium intake and suicide rate as well as examines the concept of fortifying food with this element as a strategy in the primary prevention of mood disorders and pre-suicidal syndrome.

Human exposure to trace elements via consumption of mussels Mytilus galloprovincialis from Boka Kotorska Bay, Montenegro

In order to assess human health risks via consumption of potentially toxic mussels, the concentrations of Al, Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Ni, Pb, Sr, Zn and Hg were studied in Mytilus galloprovincialis collected from the coastal area of Montenegro. By two approaches for the human health risk assessment (HHRA), considering oral reference doses by the United States Environmental Protection Agency (US EPA) and provisional tolerable intakes by the Joint FAO/WHO Expert Committee on Food Additives (JECFA), it has been revealed that despite the fact that trace element levels do not exceed the defined limits for mussels, they can be limiting factors for the mussel consumption. Specifically, it was noticed that the levels of Co, Pb, Cd and Li could be the limiting factors for the consumption of mussels from this coastal area. Al and Li data obtained in this study are especially important since these two elements have not been previously studied in M. galloprovincialis. Furthermore, taking into account the significant differences in concentrations of elements in different seasons, the study confirmed the starting assumption that in the calculations for the HHRA the average concentrations of elements in samples taken in different seasons during a longer period should be used.

On the rubidium and lithium content and availability in the sub-arid south-eastern Mediterranean: potential health implications

Rubidium and lithium are rather rare elements in environmental research, despite their affiliation with a group of chemically active metals and the abundance of Rb in the environment. A growing body of evidence, although controversial, has indicated that both elements possess unique essential and neurophysiological characteristics in biota and humans. Both elements may concentrate in soil and vegetation of sub-arid environments. We investigated the content and (potential) availability of Rb and Li in the soils and natural waters of Galilee, the Coastal Plain, and the northern Negev of Israel. A newly developed chromatographic technique for the separation of truly dissolved Rb and Li compounds has been applied. High concentrations of Rb, together with high values of the potentially vital Rb-to-K ratio, were found in the soils, the soil solutions, rainwater, throughfall water, and the plant litter leachates, but not in the surface and spring waters. This may indicate a sequestration of Rb in the local soils and a semi-closed Rb turnover in the soil-plant system with a major input from sea aerosols. Low Li bulk and available concentrations were determined in all the natural compartments. Possible implications of such specific environmental features on the local population health were discussed.

Regional Distribution of Longevity Population and Elements in Drinking Water in Jiangjin District, Chongqing City, China

In order to determine the spatial variation of longevity population and elements contained in the drinking water of longevity region in Jiangjin and investigate the relationship between the elements in drinking water and longevity, population censuses on township level and 98 drinking water samples from Jiangjin District, Chongqing City in West China were collected and analyzed. Population statistics on township level showed that the number of centenarians per 100,000 inhabitants (OC), centenarity index (CI), and number of centenarians per 10,000 over 65-year-old subjects (UC) present obvious geographic distribution properties, generally Central region > Northern region > Southern region (Kruskal-Wallis test, p < 0.05). Moderate hard water (150 mg/L < total hardness (TH) = 156.17 mg/L < 300 mg/L) was mainly found in drinking water from longevity township (OC > 7.5) in Jiangjin District, whereas soft water (75 mg/L < TH = 111.23 mg/L < 150 mg/L) was mostly in non-longevity township (OC < 7.5). The mean concentration of strontium (Sr) (0.73 mg/L) in drinking water from the longevity township was apparently higher than that of non-longevity township (0.44 mg/L) (Mann-Whitney U test, p = 0.019 < 0.05). The concentrations of Ba, Li, Mn, Ni, and Se in drinking water from longevity township were also higher than those of non-longevity township (Mann-Whitney U test, p < 0.05). The research indicates that exercising strict control over the concentrations of TH, Sr, Ba, Li, Mn, Ni, and Se in drinking water might be good for the health and prolong people's life.

Psychiatric benefits of lithium in water supplies may be due to protection from the neurotoxicity of lead exposure

INTRODUCTION

Lithium is a medication used to treat bipolar disorder and may also prevent cognitive decline and suicide. Lithium is also found naturally, in levels well below clinical doses, in drinking water worldwide, and levels have been inversely associated with rates of psychiatric disorders. Lead (Pb) is another element in the environment but is a toxin of public health concern. Negative effects of chronic lead exposure and possible benefits of environmental lithium exposure appear complementary.

HYPOTHESIS

Exposure to environmental lithium has associated benefits, which may be due to the mitigation of lead toxicity by lithium.

METHODS

A series of reviews tested each element of the hypothesis. A systematic review clarified the psychiatric and medical correlates of lithium in drinking water. Non-systematic reviews clarified the harms of environmental lead, summarized experimental studies of lithium used to prevent lead toxicity, and explored overlapping biological mechanisms in lithium and lead exposure.

RESULTS

Higher levels of lithium in drinking water were associated with lower suicide rates in 13 of 15 identified studies. While fewer studies were available for other outcomes, lithium was associated with lower rates of homicide, crime, dementia, and mortality. Lead was reported to be ubiquitous in the environment, and chronic low-level exposure has been associated with adverse effects, including effects opposite to the outcomes associated with lithium. Animal studies demonstrated that lithium pre-treatment mitigates lead toxicity. Neurophysiological correlates of lead and lithium exposure overlap.

CONCLUSIONS

Microdose lithium is associated with better psychiatric and medical outcomes, which are complementary to harms of environmental lead exposure. Experimental animal evidence is supportive, and lead and lithium impact overlapping neurophysiologic pathways. Therefore, several lines of circumstantial evidence suggest that lithium protects against the neurotoxic effects of lead. Further studies are required to clarify the benefits and mechanisms of low-dose lithium. There are significant public health implications if this paper's hypothesis is true.

Serum lithium levels and suicide attempts: a case-controlled comparison in lithium therapy-naive individuals

BACKGROUND

Several epidemiological studies have shown the inverse association of lithium levels in drinking water and suicide rates; however, it is necessary to perform a clinical study dealing with individual patients.

METHODS

We analyzed 199 patients including 31 patients with suicide attempts, 21 patients with self-harm, and 147 control patients. All were transferred to a university emergency department suffering from intoxication or injury, were aged 20 or more years, and were alive at the start of the study. The exclusion criteria consisted of suffering from schizophrenia and a past or present history of lithium therapy. These exclusions were applied because it is difficult to determine whether their suicide attempt was induced by the intent to end their life or by psychotic symptoms such as auditory hallucinations, and if the patient had received lithium therapy, the association between the small amount of lithium taken from drinking water and food and serum lithium levels cannot be detected.

RESULTS

There was a significant difference (p = 0.043) between the three groups whereby patients with suicide attempts had significantly lower lithium levels than control patients (p = 0.012) in males but not females. Multivariate logistic regression analysis with adjustment for age and gender revealed that patients with suicide attempts had significantly lower lithium levels than control patients (p = 0.032, odds ratio 0.228, 95% CI 0.059-0.883).

LIMITATIONS

The limitations of the present study are the nature of observational research which cannot reveal a causal relationship and the relatively small number of subjects.

CONCLUSIONS

The present findings suggest that higher serum lithium levels may be protective against suicide attempts in lithium therapy-naive individuals.