Frequently Asked Questions

F.A.Q. – Frequently Asked Questions

Here I answer questions that I am asked on a regular basis. The following information is not medical advice. Please discuss your individual needs with your trusted physician. You are welcome to take my articles with you as educational material so that your doctor can find out the appropriate dosages.

— Last Update: Jan 09 2023

In General

In short, I cannot help you in such cases. I try to help as many people as possible by compiling and publishing relevant information. In doing so, I make sure that I always make the sources of my research available to my medical colleagues so that they can draw the appropriate conclusions for their treatment. Please understand that I do not run a practice or perform treatments as part of my work. Physicians and alternative practitioners who wish to offer therapies according to my guidelines can contact me and will receive extensive material and I will also name these colleagues on my Alzheimer Therapy according to Nehls list. I ask for your understanding if I have to refer to the linked lists and this FAQ.


In my article “Lithium, the Essential Trace Element“, I provide arguments as to why lithium in microdoses of around 1 mg of pure lithium (around 25.7 mg lithium orotate monohydrate, which is the common chemical form of lithium orotate, which mathematically reduces the proportion of lithium somewhat compared to lithium orotate) per day could represent a sensible basic supply or, in my opinion, cover an essential requirement.

A low dose of 5 mg pure lithium (approximately 128.5 mg lithium orotate monohydrate) per day, on the other hand, could be useful to treat existing neuroinflammation; it could therefore help with long-COVID and post-Vac (spikeopathy), chronic fatigue, chronic fatigue syndrome, burn-out and neurodegenerative diseases such as depression, Alzheimer’s and Parkinson’s disease.

Since the half-life is over 24 hours, it doesn’t really matter whether you take it in the morning or evening.
I personally take it in the morning on an empty stomach.

These products contain only homeopathic doses of lithium, which is often too low to have a relevant neuroinflammatory effect (e.g. via GSK3).

I receive a high amount of emails on a daily basis with questions about such products: But  I cannot take the place of recognized quality control agencies and therefore cannot say anything about the purity or quality of the ingredients and packaging materials of these products.

This is also true for other products I recommend to remedy deficiencies, such as vitamin D3 or algae oil. For liability reasons, I cannot make product-specific recommendations.

No, algae oil does not contain lithium.

Lithium is certainly not harmful in low, most likely essential doses and is not a cause for autism, quite the contrary. But how does this false claim come about, and where exactly does the mistake lie?

According to a Danish study from 2023, which was widely disseminated in the media, there is supposed to be a connection between the regional lithium concentration in drinking water or the possible consumption of this water during pregnancy and the risk of autism in the child.[1]

We are talking about lithium concentrations in drinking water of 0.6 to 30.7 µg/L (micrograms per liter). Dividing this range into four concentration ranges (so-called quartiles), an approximately 23% increased rate of autism was observed in the second, third, and fourth quartiles compared to the respective lower quartile.

It is not known whether and in what quantities the pregnant women actually consumed drinking water. But let’s assume a liter per day, then it becomes clear that there can be no causality. Comparing the lithium intake observed here of 0.6 to 30.7 µg per day with the lithium intake of 100,000 µg and more per day in connection with the treatment of bipolar disorders, it is clear how small the amounts are. In a Dutch study from 2012, even at high dosages for the treatment of bipolar disorders, no neuropathological abnormalities were observed in the children of the patients: “Continuing lithium therapy during pregnancy did not cause adverse effects on growth, neurological, cognitive and behavioral development of exposed children.”[2] A larger follow-up study from 2022, which also examined the consequences of lithium treatment during pregnancy, came to the same conclusion: “In this study, we found no evidence for significantly altered neuropsychological functioning of lithium-exposed children at the age of 6-14 years, when compared to non-lithium-exposed controls.”[3]

Therefore, there must necessarily be another explanation if an intake of lithium thousands of times higher, as was the case in the drinking water study, does not cause autism. Moreover, correlation is not proof of causality.

But whether there is even a correlation, as claimed, must first be ensured. Statistical distortions very easily lead to seeing connections where there are none; similar criticism is also expressed by other scientists. Brian Lee, Associate Professor at Drexel University in Philadelphia, provides a detailed critique of the data collection and statistical analysis of the mentioned study in a comprehensive article[4], which also refers to other critical voices. Here are a few excerpts from the criticisms (the actual list is much longer):

  1. In a case-control study like this, the main question is whether the sampling strategy leads to distortions. The new study included all eligible autistic children in Denmark, while controls were randomly selected from the Danish population. If cases and controls come from different geographical populations, the results could simply reflect geographical differences in the prevalence of autism or confounding factors and not geographical differences in lithium concentration in drinking water.

  2. Another problem is the accuracy of quantifying lithium intake since there is no data on the dose administered to participants. Thus, the “estimated nature” of the possibly administered lithium amount here poses another statistical challenge. However, according to Brian Lee’s analysis, the authors of the study did not use any statistical method to account for the great uncertainty associated with the estimated dosage – hence the point estimates are probably biased (in which direction is only a guess) and the so-called confidence intervals (supposed accuracy) are an artifact.

  3. Although the authors found that a single unmeasured confounder cannot explain the results, it is plausible that several factors interact. The mother’s mental health and the socioeconomic status at the individual level are likely both related to lithium intake and autism in children, but neither of these two factors was considered.

Another objection arises, even if one assumes, despite the many statistical problems, that there is indeed a connection between low lithium intake (via drinking water) and autism. Since it cannot be the lithium (as above), one would have to take a closer look at the water itself. For example, the lithium concentration in freshwater from volcanic regions or sources is usually higher. However, volcanic rock also contains many other minerals, and thus the water contains constituents that are typically also unusually high. But this was not investigated. For instance, children with an autism spectrum disorder according to a twin study had increased concentrations of lead in their milk teeth, which are formed in a perinatal developmental phase.[5] But thallium, cadmium, mercury, tin, and tungsten are also discussed alongside lead and some other heavy metals as causal factors in autism.

Conclusion: Lithium in low and very likely essential dosage is with utmost certainty not harmful and not a cause of autism; quite the contrary. In an animal model of autism, for example, the effect of low doses of lithium on clinical symptoms was examined. The authors conclude:

“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.”[6]


[1] Ketzel M, Raaschou-Nielsen O, Ritz BR. Association Between Estimated Geocoded Residential Maternal Exposure to Lithium in Drinking Water and Risk for Autism Spectrum Disorder in Offspring in Denmark. JAMA Pediatr. 2023 Jun 1;177(6):617-624. doi: 10.1001/jamapediatrics.2023.0346. PMID: 37010840; PMCID: PMC10071398.

[2] van der Lugt NM, van de Maat JS, van Kamp IL, Knoppert-van der Klein EA, Hovens JG, Walther FJ. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev. 2012 Jun;88(6):375-8. doi: 10.1016/j.earlhumdev.2011.09.013. Epub 2011 Oct 14. PMID: 22000820.

[3] Poels EMP, Schrijver L, White TJH, Roza SJ, Zarchev MG, Bijma H, Honig A, van Kamp IL, Hoogendijk WJG, Kamperman AM, Bergink V. The effect of prenatal lithium exposure on the neuropsychological development of the child. Bipolar Disord. 2022 May;24(3):310-319. doi: 10.1111/bdi.13133. Epub 2021 Oct 5. PMID: 34585812; PMCID: PMC9293321.

[4] https://doi.org/10.53053/SCBZ3308

[5] Arora M, Reichenberg A, Willfors C, Austin C, Gennings C, Berggren S, Lichtenstein P, Anckarsäter H, Tammimies K, Bölte S. Fetal and postnatal metal dysregulation in autism. Nat Commun. 2017 Jun 1;8:15493. doi: 10.1038/ncomms15493. PMID: 28569757; PMCID: PMC5461492.

[6] Wang J, Xu C, Liu C, Zhou Q, Chao G, Jin Y. Effects of different doses of lithium on the central nervous system in the rat valproic acid model of autism. Chem Biol Interact. 2023 Jan 25;370:110314. doi: 10.1016/j.cbi.2022.110314. Epub 2022 Dec 16. PMID: 36535311.

Omega-3 Fatty Acids

The “terrestrial” omega-3 fatty acid (ALA) in flaxseed oil is very inefficiently converted to the “aquatic” omega-3 fatty acids (EPA and DHA), which must be considered the true essential fatty acids.

As a matter of principle, I do not make product-specific recommendations, if only for liability reasons.

This allegation appears in a so-called “Rote-Hand-Brief” dated 11/16/2023 (German). The “Rote-Hand-Brief” is a type of information letter commonly used in Germany by pharmaceutical companies to inform healthcare professionals about newly identified drug risks, to recall defective batches of drugs, or to provide other important information. This letter is not about an essential nutrient, but about drugs, i.e. chemical products containing omega-3 fatty acids, which are used, for example, for the medical treatment of lipid metabolism disorders. This letter does not discuss conventional, natural omega-3 fatty acid products, such as those derived from fish and algae. However, no reference is made to this important distinction. This, of course, creates a great deal of uncertainty among people who take aquatic omega-3 fatty acids – and who are demonstrably doing themselves and their health a great service by doing so. A comprehensive explanation of the relationships can be found here (German):

I leave it to you, as an enlightened reader, to find an answer to the question of why, for example, the “Deutsche Apotheker Zeitung” (German Pharmacist’s Newspaper) does not provide information in this sense, but continues to fuel uncertainty with statements such as “the dose makes the poison”. Anyone who has read The Indoctrinated Brain knows my frightening answer to this question: discouraging people from leading a brain-healthy lifestyle is an essential part of the indoctrination process.

Foods rich in omega-6 are generally also rich in histamine.

However, this does not apply to omega-3-rich sources.

Due to the poor fat solubility of histamine, properly produced fish or algae oil is harmless with regard to histamine and therefore has no side effects for people with a histamine intolerance.

Vitamin D

As a matter of principle, I do not make product-specific recommendations, if only for liability reasons.

A well-balanced diet naturally contains vitamin K2. It is also produced by a healthy microbiome. Therefore, I only recommend it in the case of a proven K2 deficiency that cannot be compensated for naturally. An additional daily intake of 100-200 mg of K2 in combination with vitamin D3 cannot do any harm, but makes the supplement unnecessarily expensive.

The short answer is basically no, and always when vitamin D deficiency is prevented by supplementation at the usual frequency and dose.The reasons are easy to understand: The vitamin D3 prohormone (or 25(OH)-vitamin D3) is produced in the liver in a first biochemical conversion step from vitamin D3, which can either be formed in the skin in the summer or supplied by the diet. This metabolic product is measured to determine vitamin D levels. In a second biochemical step, the gene-regulating vitamin D hormone (or 1,25(OH)2 vitamin D3) is formed in the cells, e.g. of the immune system, as needed. This hormone is essential for the natural defense function of the immune system, which is why a regular supply of vitamin D – whether from the summer sun or supplements – is essential. A vitamin D3 deficiency or an insufficient vitamin D3 prohormone level is associated not only with impaired viral defense or immune surveillance, but also with the risk of an excessive inflammatory response, the so-called cytokine storm. This is the main cause of severe to fatal disease progression in influenza or SARS-CoV-2 infections, for example.

A well-functioning immune system protects us not only from invading viruses or bacteria, but also from cancer cells. As millions of new cells are created in our bodies every second, copying errors in the duplication of genetic material lead to mutations, some of which can be the starting point for the development of cancer. Vitamin D deficiency also interferes with the immune system’s ability to detect and eliminate cancer cells before they can cause damage. It follows that a deficiency of this vitamin is a serious problem. This biological logic has been confirmed in numerous studies: Correcting vitamin D deficiency reduces the likelihood of developing cancer and increases the chances of beating cancer once it has developed.

Supplementation in case of illness & during pregnancy

There are indeed indications that lithium can reduce the function of the thyroid gland. To my knowledge, however, this is only the case with high macro-dosing for the treatment of bipolar disorder.

The microdosing, which I consider to be the essential dosage, or the low dosage that I suggest for spikeopathy, is over 100 or over 40 times lower, so I do not expect any such side effect here or consider it very unlikely.

However, your doctor can easily check this with laboratory tests.

MS is a neuroinflammatory disease in which relapses are caused by a cytokine storm. It is therefore not surprising that there is some evidence of possible benefits, and certainly no documented side effects, with low-dose lithium.

See: Rinker JR 2nd et al: Randomized feasibility study to assess tolerability and clinical effects of lithium in progressive multiple sclerosis. Heliyon 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393418/

Parkinson’s disease is a neuroinflammatory disease, so adjunctive therapy with low-dose lithium may be useful. In a review, the two authors conclude:
“The use of low-dose lithium in combination with other potential or existing therapeutic agents may be a promising approach to reduce symptoms and disease progression in neurodegenerative diseases.

See: Lazzara CA & Kim YH: Potential application of lithium in Parkinson’s disease and other neurodegenerative disorders. Front Neurosci 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621308/pdf/fnins-09-00403.pdf

By inhibiting GSK3 (glycogen synthase kinase), lithium may contribute to an increase in glycogen synthesis, which can lead to a reduction in blood glucose levels. (Glycogen is the storage form of glucose, mainly in the liver.) This is good news, but could mean a significant reduction in insulin requirements. If you are an insulin-treated diabetic, be sure to talk to your doctor before you start taking this medicine. If your doctor recognizes the importance of suppressing chronic inflammation in relation to late damage in diabetes mellitus (for detailed information on lithium’s regulation of inflammation, see https://michael-nehls.de/infos/lithium/), he or she will hopefully help you adjust your natural need for lithium and reduce your insulin administration accordingly. However, this is a process that must be done under direct medical supervision.

In this study*, the authors “developed a lithium therapy regimen to maximize the concentration of lithium in the mother’s brain while keeping fetal concentrations low enough to reduce the risk of birth defects. This maximum dose suggested by the model was 400 mg of lithium three times a day.” This is a huge amount when you consider that 1 mg once a day is about the amount of lithium you get from sea fish or 1.5 liters of Fachinger Spring mineral water. Therefore, an appropriate microdose (maximum 1 mg of pure lithium, i.e. 25.7 mg of lithium orotate monohydrate) should not cause any problems for either the mother or the child. However, this should be discussed with the treating physician before starting the drug.

* Horton S et al: Maximum recommended dose of lithium for pregnant women based on a PBPK model of lithium absorption. Adv Bioinformatics 2012, https://www.hindawi.com/journals/abi/2012/352729/

Yes, this also applies to the fat-soluble vitamins A, E, and K, but possibly also to the essential aquatic omega-3 fatty acids (so measure the omega-3 index and adjust the algae oil dosage if necessary). Higher daily doses may be required. You should therefore have your levels checked and possibly adjust the dosage. For example, in a study of women only, people were more likely to develop osteoporosis* after gallbladder removal. Considering that bone health requires much lower vitamin prohormone levels (50 nmol/l) than mental, psychological and immunological health (125 nmol/l), it is extremely important to monitor levels and ensure healthy levels through supplementation.

* Polat HB & Beyazal MS. The effect of cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in postmenopausal women. Arch Osteoporos 2018, https://pubmed.ncbi.nlm.nih.gov/29790021/

Submit a new question:

If you have not found an answer to your question here, you are welcome to submit a new question. Please note that we will not be able to answer your question personally, but will make the answers to the most frequently asked questions publicly available to all readers here in due course. If you have any questions about your health or therapy, please contact your therapist in confidence. I can only provide general information and do not run a practice myself.
FAQ new question

In my latest book “The Indoctrinated Brain”, I have summarized most of the issues mentioned here in detail for you: