February 8, 2023

The Promise of Lithium: Thomas Guttuso, Jr., MD

For most patients, a diagnosis of Alzheimer’s, or Parkinson’s creates a future without any proven treatment to stop the inevitable progression of symptoms. My next guest’s new book dives deep and how lithium is a valuable answer, from years of research and experience working in the field.

Welcome to the Author Hour Podcast, I’m your host, Hussein Al-Baiaty. I’m joined by author Tom Guttuso, who’s here to talk about his new book called The Promise of Lithium. Let’s flip through it.

Hello, and welcome back to Author Hour. I’m Hussein. Today, I’m super excited to have a friend of mine come on the show. His name is Tom. Tom, thank you for coming on the show today. I really appreciate you. I want to mention why you’re a friend. It’s because we met at the Guided Author Workshop. Here we are now celebrating your launch of your book. How incredible is that? Welcome to the show, my friend.

Thomas Guttuso, Jr: Thanks, Hussein. It is very good to be here. Amazing that in one year, I have a book.

Hussein Al-Baiaty: Yes, yes. It’s like, the process worked itself out. I know, it wasn’t easy and we’ll get into that for sure. The book is called The Promise of Lithium. I remember you sitting there, sharing with the group about your book. Being very passionate about the topic of your book, which is just remarkable. I remember going around to tables, and a lot of people were sharing like, why they wanted to write books. Yours was profound. I remember it, it was this really unique urge to want to help people. I’m really excited that you’re here and to get in this topic a little bit.

Thomas Guttuso, Jr: Great. Excited to talk about it.

Hussein Al-Baiaty: Yeah. All right, so before we get into the book, I want to tell our listeners a little bit about who you are, your personal background, where you grew up, high school, college, whatever. If you want to share about a person that helped direct you in a way, that changed your life in the positive direction and who would that be?

Thomas Guttuso, Jr: Yeah. I mean, first part is I grew up in a suburb of Buffalo, New York. Did high school here. I went to college at Cornell University. Spent a year out in California trying to learn how to surf. That was a bit unsuccessful at the time. Although, I’m definitely a more accomplished surfer at this point. I came back to Buffalo, received a master’s in psychology and then went to medical school at University of Buffalo. Residency in neurology and a sub-specialization in movement disorders, which is mostly the study of Parkinson’s disease. Did a lot of research in Rochester and came back and joined the faculty in Buffalo at University of Buffalo in the medical school. That was in 2003, and I’ve been here since 2003.

In terms of who inspired me, which you just asked me before we started this, the first person that popped in my head was my oldest sister. It must have been some time in middle school, she bought me a book for Christmas that was called The Brain. I just devoured the thing. I was so interested in it. I think that’s what got me started. I just found the book fascinating, thinking about what our brain does, how it is responsible for all of our emotions and everything we feel and how it works, these chemicals and this electricity and these pathways. That just, I think, kindled my interest in neuroscience and then neurology and research. She’s been quite an inspiration ever since. I bounce everything off of her. Of course, she read the book and had many critical comments for me, prior to getting sent to the editor.

Lithium and the Brain

Hussein Al-Baiaty: Of course. Of course. Oh, I love that so much. Well, thank you, sister, for helping Tom realize his full potential and make this incredible journey throughout the understanding of the brain, which I mean, let’s be honest, it is hands down the most valuable real estate in the world, is that right? At least that’s how I was taught about it. It’s so valuable. I feel like, I know so little about it, even though I’ve read as much as I could. But not in a medical journey, if you will, but really try to understand myself and my trauma.

I love your approach. Your book is, again, so easy to navigate and get into, because it’s very story-driven. I really want to get into, if you can give us an overview briefing, how does this idea of lithium play a role in the functioning of the brain? Obviously, we know why you chose to focus on it, because seems like you were just channeled by it and fascinated. I’d like to know, where does lithium play in all of this?

Thomas Guttuso, Jr: Very little is written about the necessity of lithium for brain function. Lithium is just one of the elements on the periodic table of elements. It’s an ion. It sits very closely to some other elements that are critical for brain functioning; sodium, potassium, calcium. These things have been studied tremendously, and how important they are for function, physiology and disease process.

Lithium, really, not much. Lithium has been mostly relegated to basic science world, in petri dishes, cell cultures, animal models. But it’s certainly not considered an essential element for brain functioning. I wonder if that belief in the neuroscience world should be challenged, just based on everything that I have read and learned and researched myself with lithium. That’s something, I think that’s going to be far into the future. It is a fascinating and extremely old element. When you think about lithium, what’s the first thing you think of, when you think of lithium?

Hussein Al-Baiaty: Oh, man. Batteries, instantly. Tesla. Literally. Yeah, exactly. I mean, but my science is not very far beyond my understanding, but I have no idea.

Thomas Guttuso, Jr: Oh, but it’s true. I think that most people would say exactly what you just said. Lithium-ion battery.

Hussein Al-Baiaty: They last longer, it’s true.

Thomas Guttuso, Jr: They last longer, yeah. They’re a lot more expensive. Lithium predates the origin of the Earth. It is one of the first three elements formed at the Big Bang, the genesis of the universe over 13 billion years ago. Lithium is still part of our environment. It’s in the food we eat and the water we drink. It is with us. We all have some lithium circulating in our blood streams.

Hussein Al-Baiaty: When did this correlation start to happen? When you started to busily try to figure out some things in studies, what led you to what your book is really focused around, which is Alzheimer’s and Parkinson’s disease? Why that area of the brain that you decided, I guess, it’s a portion of where these things happen in the brain? How did you then make the connection that it’s a deficiency in lithium, or is it too much lithium? Where did that part of the story really come into play that you decided that, “Oh, there’s something to be researched here”?

Thomas Guttuso, Jr: I wish I could say that I made some discovery in a laboratory, or had some eureka moment. But it was completely by accident. It’s described in the book. I learned so much from just listening to my patients. They shocked me sometimes with the things that they report. When I look at it, it’s not surprising. I can read about these diseases, and I can study them. The patients who are living with them, they have a wealth of information on what the diseases do, how they affect somebody’s life. In this case, what they experience when a new therapy is started.

For this lithium journey and the origin of this book, it started about eight years ago, when one of my patients with Parkinson’s, who was having a lot of trouble with a particular kind of Parkinson’s symptom came in and told me that those symptoms had pretty much resolved, just out of the blue. I was completely shocked. He and his wife said that all they could attribute to why the symptoms improved so much was because his psychiatrist put him on a very low dose of lithium. That was the start of it.

I just listened to this patient and his wife, and was fascinated that could this actually be something that could help other patients as well? I just started taking a deep dive into it. I just hit, did a literature search, started reading more and more and more about it. The more I read, I felt like Alice in Wonderland, just going down these rabbit holes, and one hole led to another. Before I knew it, I saw that that was a pretty compelling story supporting very low doses of lithium. Lithium that you can purchase over the counter as a dietary supplement, evidence supporting that it may prevent and slow both Alzheimer’s and Parkinson’s disease. That’s how it started, really. It was completely by accident.

Hussein Al-Baiaty: Well, and I would say, yes, it is an accident, but also your attentiveness to be aware. Your urge to want to help others spawned from listening in that way. I think that’s an attribute to you and your characteristics. I applaud you because, yes, again, it comes up and this may be something that you haven’t thought about, and how to really think about that. You made the connection happen and I think that’s really powerful. To me, how I define an artist is a person that is aware and is interested and is seeking not only a solution, but ways to come up with the solution. To come up with solutions, sometimes, you don’t need to come up with them. Sometimes, like you said, your customers, or your clients, or your patients are actually talking about them, but are you listening to them? That’s such a powerful way to just think about our world in general.

I commend you for that, man, because had you not been aware and listening, I don’t know that you picked up on it and moved along with it. Your interest in how the brain works is obviously fascinating, because it’s healthy, keeps going, keeps growing and changing and evolving. I appreciate that. The most surprising, perhaps, or intriguing things that you uncovered during your time researching how lithium impacts the brain and what were the benefits, besides maybe healing, or curing Alzheimer’s and Parkinson’s, was there any other benefits that came up?

Lithium, Smoking, and Parkinson’s

Thomas Guttuso, Jr: I think one of the most surprising things that I learned as I was reading more and more, and that I do describe in the book is this connection between lithium, tobacco and Parkinson’s disease. There’s been studies suggesting that lithium could be a very valuable treatment for patients with Alzheimer’s and Parkinson’s since the 90s. It’s nothing that’s new. Many hundreds and hundreds of different scientists have written articles on this. Their conclusions have been, this is something we need to look into. This is very promising. We need to do clinical trials. This is over and over and over again. It just hasn’t gotten traction, in terms of really generating a lot of clinical research studies in humans to investigate in patients with Alzheimer’s, in patients with Parkinson’s, can low doses of lithium slow down the progression of the disease and preserve patients’ futures?

When I find connections in humans, different things that humans are exposed to, and those associations bearing out fruit in terms of a decreased chance of developing an illness, I definitely take notice of that. One of the things that like I said, I’m a Parkinson’s disease specialist. Ever since I started doing research on Parkinson’s, I came across these studies that everybody in the world of Parkinson’s knows about, is that there is this huge inverse relationship between smoking and the chance of developing Parkinson’s disease. It’s just the strangest thing. Study after study shows the exact same thing.

It’s somewhere between a 50% to 80% reduced risk of developing Parkinson’s. The best studies show about a 77% reduced risk, which is a huge risk reduction in something that’s clearly very dangerous. It’s like, one of the worst things that you can do for your body is smoke. Yet, how in the world could smoking decrease your risk for Parkinson’s? It’s been a puzzle in the whole Parkinson’s scientific community for a very long time.

When I came across this article that was published in 1980, showing very, very high levels of lithium in tobacco, it was like, my heart stopped. I’m like, “Oh, my God. Could this be, it?” I got so into it that I collaborated with a scientist here at UB, who had a lab that had the capacity of measuring lithium levels in tobacco, and went to the 7-Eleven right around the corner from my house and I bought five packs of cigarettes and brought them over to the lab and we measured the lithium, just to confirm what this old study from 1980 showed. We confirmed that and we published it.

It’s like, okay, in humans, this exposure to low amounts of lithium from smoking, that may be what is leading to this huge risk reduction. I mean, if that actually translates to a 77% reduced rate of progression in patients with Parkinson’s, I’m sure you know and listeners know that these diseases, Alzheimer’s and Parkinson’s, they don’t stay still. That patients continue to get worse over time. That’s the problem with these diseases. If we could figure out a way to slow them down, or stop them completely, these diseases would be no big deal. We diagnose them and we’d stop them in their tracks. That would be a huge benefit. A 50%, or 75% reduced rate of progression would be a tremendous value for patients.

That was really something that shocked me. The other thing that really shocked me was to find that there were actually two well-designed studies in patients with Alzheimer’s disease, and a pre-Alzheimer’s condition that already showed that lithium, low doses of lithium significantly slow the disease progression over time.

As I started reading this and I started putting all this together, and especially when I started writing grant applications and trying to get funding to move this forward, I just felt like there was an urgency. I needed to get this information out there to patients. Honestly, my primary audience—patients are a big target of this book. I’m hoping is that the people who are reviewing grant applications, through hopefully, a conversation that this book can start will really start to feel like these lithium studies and these lithium grant applications, we need to take these more seriously. We really need to push the pedal.

Even though lithium, it’s not some exciting, sexy, new compound that is patented and under the control of a big pharmaceutical company, it’s a generic, very inexpensive compound. We’ve got some really good evidence to move this forward.

Hussein Al-Baiaty: Yeah. It sounds to me like, you already pointed to the fact that it’s like, if this works so well, why isn’t it out there in the world? Well, it’s not one of those compounds that can be – it sounds like they can be very controlled by a specific big pharma situation, where – there’s huge profits behind it and all these things. It’s one of those things, it’s like, eat this vegetable and you’ll feel this. It’s one of those like, just drink water. It’s almost too easy to believe, it sounds like. You know what I mean? But it sounds like, there’s not only just so much research pointing to it, but you’ve also experienced it in your own patients. That’s really what makes this powerful, and this book really powerful was that you are involved, you’re in the work every day. This is how you’ve been able to help people.

Can you share a story, perhaps, on a patient that just came to you and having Parkinson’s, perhaps, or Alzheimer’s and having this way to treat them and say, “Hey can you get on this many, I guess, tablets of lithium?” Did you witnessed the trend going down? Can you tell us a little bit about a story, something like that, that it’s happened with you?

Thomas Guttuso, Jr: Well, it’s two different things. The way I got interested in lithium, that story I told about the patient that came in to see me years ago, he experienced symptomatic improvement. Soon after his psychiatrist put him on lithium, he noticed his symptoms were much better, and so did his wife. It was a very short-term improvement. What the book is addressing is a different application of lithium. It’s trying to slow down the disease and improve the patient’s future. It’s what we call the disease modifying therapy. That’s that potential, much greater benefit of lithium than a symptomatic improvement in person, symptoms just immediately as trying to preserve their future.

I describe it to patients as when your doctor prescribes you a blood pressure medication, or a cholesterol medication, it’s not to make you feel better right now. It’s to try and prevent something in the future, like a heart attack, or a stroke. The main application, potential application of lithium is just that. It’s to use lithium as a daily supplement to potentially slow the progression and preserve a patient’s future.

These low doses of over-the-counter lithium wouldn’t make patients feel better immediately. That wouldn’t be designed like that. Just like taking a blood pressure medication, or cholesterol medication is not going to make you feel better immediately. It’s a difficult question for me to answer, but I did. Initially, when I first got interested in lithium, I started prescribing it to other Parkinson’s patients who had that similar Parkinson’s motor symptoms, are called motor fluctuations. I was surprised and patients were very, very surprised in how well it was improving their motor fluctuations.

When you hear something from one patient, when I hear something from one patient, it really piques my curiosity. It makes me want to delve into it. When I started hearing it over and over again, that gets me pumped. That just gets me so excited to try and bring that information to the world. That is what happened when I first started using lithium off-label. Lithium, it’s not FDA-approved for treating Parkinson’s, or Alzheimer’s. It’s only FDA-approved for treating a condition called bipolar disorder.

Another really interesting part of the story is dosing. One of the biggest factors in bringing a therapy to a patient, trying to figure out what the right dose is. If you use too high of a dose of anything, it’s going to have toxicity. It’s going to have side effects. Too low of a dose runs the risk of it not being effective. There’s that Goldilocks dose. That was a really simple and fascinating part of this story initially, was that there was low doses of lithium appeared to be providing benefit for my Parkinson’s patients without side effects.

Previous researchers had looked at higher doses of lithium, the doses that are used in patients with bipolar disorder. Parkinson’s patients did not do well. They had a lot of side effects from it. That was back in the early 80s. After they published those results, showing that higher dose of lithium was very poorly tolerated, that was it. There was no more research on lithium in Parkinson’s for this particular problem in Parkinson’s patients, until I started doing work on it about eight years ago.

Dose — there’s a quote that I have in the book. A doctor and an alchemist, which I think is the old name for pharmacist. Alchemist. Paracelsus says that the dose makes the poison. Everything is a poison. If you take too much of it, even water. You drink too much water, it can kill you. Something as safe and simple as water. The dose is extremely important.

Hussein Al-Baiaty: Wow, that’s very powerful. I love that you added that piece of knowledge to the whole idea in reducing that dose and making it to where the side effects are non-existent, and the person is getting the help that they need. That’s so powerful, and you’re changing lives with that. What I want to know now is a little bit about, let’s put it from this perspective. I mean, there’s the patient that’s going through said situation, right? Parkinson’s, or Alzheimer’s. But then there’s the people around them that have to take care of them and be alongside them. Obviously, some of these diseases are very limiting, or they create limitations to where the people around them are impacted. How would you say it improves the wellness of the people around them?

Thomas Guttuso, Jr: First of all, something that I just wanted to be very clear on and I really tried to be clear about this in the book, is that there is much more research that needs to be done. All the studies that I’ve reviewed in the book and all the data that I’ve presented, it presents a very promising, encouraging picture for the potential of lithium to prevent and slow these diseases. We do need more studies to be completed, to try and confirm what the earlier studies have shown. Nonetheless, I felt like it was important to get this information to patients and to caregivers.

For precisely, I think, what you’re getting at is that I believe that this information in this book will provide a lot of hope for patients. It has been really difficult. I’m mostly taking care of people with Parkinson’s and also for patients with Alzheimer’s disease to get excited about study after study that they see coming through the pipeline from major pharmaceutical companies. There’s a lot of buzz. These patients enroll in clinical trials, hoping that they will be able to be part of the discovery of a truly effective way to slow down diseases, or patients are so excited about potentially being involved with something that leads to a cure for Alzheimer’s, or Parkinson’s.

I’ve just seen the disappointment in patients’ faces after every single study has been negative, negative, negative. In the world of Parkinson’s, there is, we have no approved ways to slow down the disease, or to prevent the disease. Alzheimer’s just recently, just within the past year, there’s been two new treatments that have received approval to slow down Alzheimer’s disease. There’s a lot of controversy, especially with the first one and even the second one that just got approved. At least from the data that’s been shown so far, they’re not making a huge difference in slowing the progression of the disease. Some experts aren’t quite sure that patients will even fully appreciate the improvement.

Patients and caregivers, they’re in desperate need of hope. They understand. We don’t have anything at all proven to stop the progression of these diseases, but I believe this book will provide a lot of hope for patients and for caregivers, at least to understand what’s going on, what causes these diseases, and what’s involved, what we should be thinking about for ways to slow down these diseases. Then especially, the book focuses quite a bit, why lithium makes such good sense for those specific purposes to prevent and slow the diseases. Clearly, a lot more research needs to be done. You shouldn’t discount hope. Hope itself has tremendous qualities and improves patient’s quality of life.

Hussein Al-Baiaty: That’s so powerful, man. I can’t agree with you more. I think, again, back to that whole sitting down at the tables, and you’re just starting your book journey, you’re just one of those people that really had this intention to help and get the word out about this. I mean, it’s not a miracle drug, or anything like that. Like you said, it doesn’t sound fancy, it’s just this low dose of X pill. Obviously, you’re someone to reach out to, talk to about, listen to, read this book, most definitely, if you or your family members are struggling with Alzheimer’s or Parkinson’s.

Tom, I want to say thank you for sharing your stories and your experiences with me and the audience today. The book is called The Promise of Lithium: How an Over-the-Counter Supplement may Prevent and Slow Alzheimer’s and Parkinson’s Disease. Very powerful. Besides checking out the book, where can people find you, Tom?

Thomas Guttuso, Jr: On Facebook, there is a site on the book. If you search, Promise of Lithium on Facebook, you’ll find our Facebook page. I am blogging on there. That’s one place to find me. You can contact me.

Hussein Al-Baiaty: How about LinkedIn?

Thomas Guttuso, Jr: Oh, yeah. That’s right. I’m on LinkedIn, too. They can find me on LinkedIn.

Hussein Al-Baiaty: Well, thanks again, Tom. I appreciate you coming on the show today. Love the knowledge. Love the wisdom. Thank you for imparting and working so hard, creating such a powerful book that I know for a fact will help so many. Thanks again, brother.

Thomas Guttuso, Jr: Yeah. Thanks, Hussein.