{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:13:02Z","timestamp":1778735582515,"version":"3.51.4"},"reference-count":65,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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 \u00b5g Li\/L) and a second group with Li concentrations higher than 100 \u00b5g\/L. The highest Li concentrations (&gt;1500 \u00b5g Li\/L) were observed in the highly mineralized Na-HCO3 type waters that are naturally carbonated (&gt;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\u2212 contents. The consumption of as little as 0.25 L\/day of Vidago natural mineral water (2220 \u00b5g 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.<\/jats:p>","DOI":"10.3390\/ijerph17228369","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T10:00:32Z","timestamp":1605175232000},"page":"8369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Lithium in Portuguese Bottled Natural Mineral Waters\u2014Potential for Health Benefits?"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7164-5525","authenticated-orcid":false,"given":"Maria Orqu\u00eddia","family":"Neves","sequence":"first","affiliation":[{"name":"Department of Civil Engineering, Architecture and Georesources, CERENA (Centro de Recursos Naturais e Ambiente), Instituto Superior T\u00e9cnico, University of Lisbon, 1049-001 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1644-7195","authenticated-orcid":false,"given":"Jos\u00e9","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Civil Engineering, Architecture and Georesources, CERENA (Centro de Recursos Naturais e Ambiente), Instituto Superior T\u00e9cnico, University of Lisbon, 1049-001 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5874-0157","authenticated-orcid":false,"given":"Hans G.M.","family":"Eggenkamp","sequence":"additional","affiliation":[{"name":"Department of Petrology and Mineral Resources, Eberhard-Karls University of T\u00fcbingen, Schnarrenbergstra\u00dfe 94-96, 72076 T\u00fcbingen, Germany"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"ref_1","unstructured":"(2020, May 12). World Health Statistics 2016: Monitoring Health for the SDGs. Available online: https:\/\/www.who.int\/gho\/publications\/world_health_statistics\/2016\/en\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.5694\/j.1326-5377.1949.tb36912.x","article-title":"Lithium salts in the treatment of psychotic excitement","volume":"2","author":"Cade","year":"1949","journal-title":"Med. J. Aust."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"951","DOI":"10.3727\/096368909X471251","article-title":"Review of lithium effects on brain and blood","volume":"18","author":"Young","year":"2009","journal-title":"Cell Trans."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.ejphar.2014.06.042","article-title":"Lithium: A review of pharmacology, clinical uses, and toxicity","volume":"740","author":"Oruch","year":"2014","journal-title":"Eur. J. Pharmacol."},{"key":"ref_5","unstructured":"Emsley, J. (1991). The Elements, Clarendon Press. [2nd ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1080\/07315724.2002.10719188","article-title":"Lithium: Occurrence, dietary intakes, nutritional essentiality","volume":"21","author":"Schrauzer","year":"2002","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_7","first-page":"153","article-title":"Daily dietary lithium intake in Belgium using duplicate portion sampling","volume":"208","author":"Cauwenbergh","year":"1991","journal-title":"Eur. Food Res. Technol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1080\/026520399283876","article-title":"Dietary exposure estimates of 30 elements from the UK Total Diet Study","volume":"16","author":"Ysart","year":"1999","journal-title":"Food Addit. Contam."},{"key":"ref_9","unstructured":"ANSES (2020, May 12). Second French Total Diet Study (FTDS2) Report 1. Inorganic Contaminants, Minerals, Persistent Organic Pollutants, Mycotoxins and Phytoestrogens. Available online: https:\/\/www.anses.fr\/en\/system\/files\/PASER2006sa0361Ra1EN.pdf."},{"key":"ref_10","first-page":"300","article-title":"Dietary exposure to essential and potentially toxic elements for the population of Hanoi, Vietnam","volume":"22","author":"Marcussen","year":"2013","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1080\/19440049.2019.1704445","article-title":"Risk assessment of antimony, barium, beryllium, boron, bromine, lithium, nickel, strontium, thallium and uranium concentrations in the New Zealand diet","volume":"37","author":"Pearson","year":"2020","journal-title":"Food Addit. Contam. Part A"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.fct.2013.10.026","article-title":"Dietary intake of barium, bismuth, chromium, lithium, and strontium in a Spanish population (Canary Islands, Spain)","volume":"62","author":"Rubio","year":"2013","journal-title":"Food Chem. Toxicol."},{"key":"ref_13","unstructured":"Schrauzer, G.N., and Klippel, K.F. (1991). Overview of lithium toxicity. Lithium in Biology and Medicine, VCH Verlag."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.mehy.2016.02.002","article-title":"Is violence in part a lithium deficiency?","volume":"89","author":"Goldstein","year":"2016","journal-title":"Med. Hypotheses"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s00217-016-2823-9","article-title":"Cultivation of mushrooms for production of food biofortified with lithium","volume":"243","author":"Mleczek","year":"2017","journal-title":"Eur. Food Res. Technol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Seidel, U., Jans, K., Hommen, N., Ipharraguerre, I.R., L\u00fcersen, K., Birringer, M., and Rimbach, G. (2020). Lithium Content of 160 Beverages and Its Impact on Lithium Status in Drosophila melanogaster. Foods, 9.","DOI":"10.3390\/foods9060795"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1176\/appi.ajp.2007.07081255","article-title":"Lithiated Lemon-Lime Sodas","volume":"164","author":"Roberts","year":"2007","journal-title":"Am. J. Psychiatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/BF02990271","article-title":"Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions","volume":"25","author":"Schrauzer","year":"1990","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1192\/bjp.bp.108.055798","article-title":"Lithium levels in drinking water and risk of suicide","volume":"194","author":"Ohgami","year":"2009","journal-title":"Br. J. Psychiatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1192\/bjp.bp.110.091041","article-title":"Lithium in drinking water and suicide mortality","volume":"198","author":"Kapusta","year":"2011","journal-title":"Br. J. Psychiatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s12011-013-9815-4","article-title":"Lithium in the public water supply and suicide mortality in Greece","volume":"156","author":"Giotakos","year":"2013","journal-title":"Biol. Trace Elem. Res. Biolog."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jtemb.2017.03.009","article-title":"Lithium levels in the public drinking water supply and risk of suicide: A pilot study","volume":"43","author":"Liaugaudaite","year":"2017","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1192\/bjp.bp.110.088617","article-title":"Lithium in drinking water and suicide rates across the East of England","volume":"198","author":"Kabacs","year":"2011","journal-title":"Br. J. Psychiatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"567","DOI":"10.3109\/15622975.2015.1062551","article-title":"Relationships of local lithium concentrations in drinking water to regional suicide rates in Italy","volume":"16","author":"Pompili","year":"2015","journal-title":"World J. Biol. Psychiatr."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Knudsen, N.N., Schullehner, J., Hansen, B., J\u00f8rgensen, L.F., Kristiansen, S.M., Voutchkova, D.D., Gerds, T.A., Andersen, P.K., Bihrmann, K., and Gr\u00f8nb\u00e6k, M. (2017). Lithium in Drinking Water and Incidence of Suicide: A Nationwide Individual-Level Cohort Study with 22 Years of Follow-Up. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14060627"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"47","DOI":"10.20344\/amp.10744","article-title":"Lithium in Public Drinking Water and Suicide Mortality in Portugal: Initial Approach","volume":"32","author":"Oliveira","year":"2019","journal-title":"Acta Med. Port."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.pnpbp.2008.08.012","article-title":"Lithium: Bipolar disorder and neurodegenerative diseases. Possible cellular mechanisms of the therapeutic effects of lithium","volume":"32","author":"Marmol","year":"2008","journal-title":"Prog. NeuroPsychopharmacol. Biol. Psychiatry"},{"key":"ref_28","first-page":"104","article-title":"Microdose lithium treatment stabilized cognitive impairment in patients with Alzheimer\u2019s disease","volume":"10","author":"Viel","year":"2013","journal-title":"Curr. Alzheimer Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00198-018-4745-9","article-title":"Lithium Use and Risk of Fracture: A Systematic Review and Meta-Analysis of Observational Studies","volume":"30","author":"Liu","year":"2018","journal-title":"Osteoporos. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"365","DOI":"10.3177\/jnsv.63.365","article-title":"Effect of Lithium on the Mechanism of Glucose Transport in Skeletal Muscles","volume":"63","author":"Jung","year":"2017","journal-title":"J. Nutr. Sci. Vitaminol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1093\/phe\/phz002","article-title":"Adding Lithium to Drinking Water for Suicide Prevention\u2014The Ethics","volume":"12","author":"Ng","year":"2019","journal-title":"Public Health Ethics"},{"key":"ref_32","unstructured":"Reimann, C., and Birke, M. (2010). Geochemistry of European Bottled Water, Borntraeger Science Publishers."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"91","DOI":"10.5414\/TEX01222","article-title":"Evaluation of beneficial and adverse effects on plants and animals following lithium deficiency and supplementation, and on humans following lithium treatment of mood disorders","volume":"29","author":"Schafer","year":"2012","journal-title":"Trace Elem. Electrolytes"},{"key":"ref_34","unstructured":"STATISTA (2020, May 15). Per Capita Consumption of Bottled Water in Europe in 2017, by Country. Available online: https:\/\/www.statista.com\/statistics\/455422\/bottled-water-consumption-in-europe-per-capita\/."},{"key":"ref_35","unstructured":"EFBW (2020, May 15). Natural Waters: The Natural Choice for Hydration. Available online: https:\/\/www.efbw.org\/."},{"key":"ref_36","unstructured":"(2009). Council Directive 2009\/54\/EC\/18-6-2009 on the exploitation and marketing of natural mineral waters. Off. J. EU, L164, 45\u201358."},{"key":"ref_37","unstructured":"ANZ Guidelines (2020, May 20). ANZECC-ARMCANZ-2000-Guidelines-Vol1, Available online: https:\/\/www.waterquality.gov.au\/media\/57."},{"key":"ref_38","unstructured":"Publications Office of the EU (2020, May 15). List of Natural Mineral Waters Recognized by Member States. Available online: https:\/\/op.europa.eu\/en\/publication-detail\/-\/publication\/b9453284-4083-11e3-b4f5-01aa75ed71a1\/language-en\/format-PDF\/source-140676132."},{"key":"ref_39","unstructured":"Lei 54\/2015 (2015). Bases do regime jur\u00eddico da revela\u00e7\u00e3o e do aproveitamento dos recursos geol\u00f3gicos existentes no territ\u00f3rio nacional, incluindo os localizados no espa\u00e7o mar\u00edtimo nacional. DRE, 54, 4296\u20134308."},{"key":"ref_40","unstructured":"Super Bock Group (2020, May 15). \u00c1guas. \u00c1gua das Pedras. Ficha T\u00e9cnica., Available online: https:\/\/www.superbockgroup.com\/produto\/aguas\/."},{"key":"ref_41","first-page":"39","article-title":"O Estudo Metagen\u00f3mico das \u00c1guas Minerais Naturais tendo em vista o Reconhecimento Cient\u00edfico das Voca\u00e7\u00f5es Terap\u00eauticas","volume":"53","author":"Pascoal","year":"2018\u20132019","journal-title":"Bol. Minas (Ed. Espec. Term.)"},{"key":"ref_42","unstructured":"Greenberg, A., Clesceri, L.S., Andrew, D., and Eaton, A.D. (1992). Standard Methods for the Examination of Water and Wastewater, American Public Health Association, American Water Works association, Water Environment Federations. [18th ed.]."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s40899-018-0218-8","article-title":"Revision of the hydrogeological conceptual models of two Portuguese thermomineral water systems: Similarities and differences","volume":"5","author":"Marques","year":"2019","journal-title":"Sustain. Water Resour. Manag."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1379093","DOI":"10.1155\/2019\/1379093","article-title":"Assessment of Chaves Low-Temperature CO2-Rich Geothermal System (N-Portugal) Using an Interdisciplinary Geosciences Approach","volume":"2019","author":"Marques","year":"2019","journal-title":"Geofluids"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.gexplo.2010.08.001","article-title":"Classification of natural mineral and spring bottled waters of Portugal using Principal Component Analysis","volume":"107","author":"Ribeiro","year":"2010","journal-title":"J. Geoch. Explor."},{"key":"ref_46","first-page":"103","article-title":"L\u00edtio em \u00e1guas engarrafadas e de abastecimento p\u00fablico portuguesas","volume":"102","author":"Neves","year":"2015","journal-title":"Com. Geol."},{"key":"ref_47","first-page":"627","article-title":"The effect of long-term lithium treatment on kidney function","volume":"246","author":"Rybakowski","year":"2012","journal-title":"Psychiatr. Pol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s12011-018-1455-2","article-title":"Is Lithium a Micronutrient? From Biological Activity and Epidemiological Observation to Food Fortification","volume":"189","author":"Szklarska","year":"2019","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1161\/HYPERTENSIONAHA.107.089862","article-title":"Context dependency of serum and urinary lithium: Implications for measurement of proximal sodium reabsorption","volume":"49","author":"Bochud","year":"2007","journal-title":"Hypertension"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e1900039","DOI":"10.1002\/mnfr.201900039","article-title":"Lithium-Rich Mineral Water is a Highly Bioavailable Lithium Source for Human Consumption","volume":"63","author":"Seidel","year":"2019","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.phrs.2014.06.012","article-title":"Sodium-Phosphate Cotransporter Mediates Reabsorption of Lithium in Rat Kidney","volume":"87","author":"Uwai","year":"2014","journal-title":"Pharmacol. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1146\/annurev.pharmtox.011008.145557","article-title":"Lithium\u2019s Antisuicidal Efficacy: Elucidation of Neurobiological Targets Using Endophenotype Strategies","volume":"49","author":"Kovacsics","year":"2009","journal-title":"Annu. Rev. Pharmacol. Toxicol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1007\/s12665-013-2671-x","article-title":"Carbon isotopes and geochemical processes in CO2-rich cold mineral water, N-Portugal","volume":"71","author":"Carreira","year":"2014","journal-title":"Environ. Earth Sci."},{"key":"ref_54","unstructured":"Louren\u00e7o, M.C. (2000). Modela\u00e7\u00e3o Estat\u00edstica das \u00c1guas Gasocarb\u00f3nicas de Vidago e Pedras Salgadas. [Master\u2019s Thesis, Instituto Superior T\u00e9cnico]."},{"key":"ref_55","unstructured":"APIAM (2020, May 18). \u00c1guas Minerais Naturais e \u00c1guas de Nascente\u2014Livro Branco. Available online: http:\/\/www.apiam.pt\/publicacoes\/Livro-Branco-APIAM\/-\/47\/23\/175."},{"key":"ref_56","first-page":"319","article-title":"Geoqu\u00edmica do Fl\u00faor em \u00c1guas Minerais da Zona Centro Ib\u00e9rica","volume":"3","author":"Calado","year":"1993","journal-title":"Mem\u00f3rias"},{"key":"ref_57","unstructured":"(2003). Council Directive 2003\/40\/EC\/16-5-2003\/ establishing the list, concentration limits and labelling requirements for the constituents of natural mineral waters and the conditions for using ozone-enriched air for the treatment of natural mineral waters and spring waters. Off. J EU, L126, 34\u201339."},{"key":"ref_58","unstructured":"(1998). Council Directive 98\/83\/EC\/3-11-1998\/on the quality of water intended for human consumption. Off. J EU, L330, 32\u201354."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/00004583-199504000-00011","article-title":"Lithium in hospitalized aggressive children with conduct disorder: A double-blind and placebo-controlled study","volume":"34","author":"Campbell","year":"1995","journal-title":"J. Am. Acad. Child Adolesc. Psychiatr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1176\/appi.ajp.162.10.1805","article-title":"Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: A systematic review of randomized trials","volume":"162","author":"Cipriani","year":"2005","journal-title":"Am. J. Psychiatr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1192\/bjp.bp.110.083030","article-title":"Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: Systematic review and meta-analysis","volume":"198","author":"Jones","year":"2011","journal-title":"Br. J. Psychiatr."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1161\/HYPERTENSIONAHA.110.168054","article-title":"Association of sodium and potassium intake with left ventricular mass: Coronary artery risk development in young adults","volume":"58","author":"Rodriguez","year":"2011","journal-title":"Hypertension"},{"key":"ref_63","unstructured":"U.S. Food & Drug Administration (2020, September 18). Sodium in Your Diet\u2014Use the Nutrition Facts Label and Reduce Your Intake, Available online: https:\/\/www.fda.gov\/food\/nutrition-education-resources-materials\/sodium-your-diet."},{"key":"ref_64","first-page":"159","article-title":"Ingest\u00e3o de \u00e1gua mineral natural gasocarb\u00f3nica hipersalina e press\u00e3o arterial","volume":"29","author":"Santos","year":"2010","journal-title":"Rev. Port. Cardiol."},{"key":"ref_65","first-page":"131","article-title":"Effect of sodium chloride and sodium bicarbonate-rich mineral water on blood pressure and metabolic parameters in elderly normotensive individuals: A randomized double-blind crossover trial","volume":"14","author":"Schorr","year":"1996","journal-title":"J. Hypertens."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/22\/8369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:32:29Z","timestamp":1760178749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/22\/8369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,12]]},"references-count":65,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17228369"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17228369","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,12]]}}}