Q. I have recently received web site information about supplements such as human growth hormone and lithium that are now available without prescription. These are thought to improve memory, increase concentration, relieve depression, help with better metabolism, relieve pain, etc. As a sufferer of fibromyalgia, I find the idea of these medications appealing, but have some questions.

Where does human growth hormone come from? How is it "harvested"? Is it possible that it could be gotten unethically? Is it safe for adults? Does it heal and prevent aging as the claims state? The amount of lithium described is apparently very small, and travels to the brain directly, without having to saturate the blood stream, which per the company, makes it safer regarding adverse side effects. How much is too much? Do you recognize any studies that confirm this?

A. You are raising several separate questions, but from my standpoint, the bottom line is this:

1. There are no convincing research studies, to my knowledge, demonstrating the safety and effectiveness of growth hormone or over-the-counter (non-prescription) lithium for any emotional, psychiatric, or pain-related problem, including fibromyalgia.
2. There may be serious risks or side effects associated with impure samples of growth hormone, or with non-standardized formulations of lithium.

Now a few specifics: Human growth hormone (HGH) as such is no longer prescribed in this country. For more than 20 years, cadaver-derived human growth hormone (HGH) was used to enhance linear growth in short children. In 1985 the US Food and Drug Administration (FDA) stopped use of the hormone in response to reported deaths due to Creutzfeldt-Jakob disease (CJD) in 3 former HGH recipients. (CJD is a severe and deadly neurological disease). To date, a total of 9 patients have been identified who both received HGH and became infected with CJD agent (7 in the United States, 1 in Britain, and 1 in New Zealand).

Circumstances make it likely that HGH contaminated with a slow growing, viral-like particle may have been responsible for these fatalities (see Zekauskas et al, J Okla State Med Assoc 1990 Sep;83(9):447-8). Modern formulations of HGH (somatropin) are derived from a strain of bacterium that has been modified by the addition of the gene for HGH, and do not present the risk of CJD. The use of somatropin is mainly in children with growth failure due to under-production of the natural hormone.

Aging is associated with a significant decline in secretion of growth hormone. Understandably, there is a great deal of interest in somatropin as a potential treatment for certain age-related diseases and disabilities; however, "…studies with growth hormone therapy in the elderly have been somewhat disappointing with minimal changes in lean body mass, musculoskeletal function, and overall quality of life…" (see CJ Rosen, Endocrine 2000 Apr;12(2):197-201).

Another recent review concluded that, "there are currently no data supporting the hypothesis that growth-hormone [use] in non-deficient persons prolongs life span or reduces morbidity [organ or tissue damage]" (T. Munzer, Ther Umsch 2002 Jul;59(7):371-6).

Regarding lithium, I have seen some of the over-the-counter preparations as advertised on the Internet. I have no idea how pure these are, or what the actual lithium content of these preparations may be. However, it is of note that even one of the sites that advertises such a product states, "Lithium is a trace element that may be useful in treating addictions such as alcoholism; manic depression; and mental instability. We do not recommend our lithium mineral water for common or everyday use. Unlike our other mineral waters, lithium could have serious side effects."

I am not aware of any well-designed, controlled studies using such preparations for specific emotional or psychological problems. It may be true, however, that trace amounts of lithium, which may be found in some grains, vegetables, and drinking water (GN Schrauzer, J Am Coll Nutr 2002 Feb;21(1):14-21) are necessary for normal fetal development. But this is quite a different matter than using a supplement to boost lithium levels, even by small amounts. We simply don't have the data to support this practice for any medical condition, and certainly not for fibromyalgia!

With respect to the latter, the most recent reviews (see Sim & Adams, Clin J Pain 2002 Sep-Oct;18(5):324-36; Williams et al, J Rheumatol 2002 Jun;29(6):1280-6) suggest that a multi-modal approach is most useful. This may combine relaxation programs, physical therapies, cognitive behavioral therapy and analgesic medication. I would encourage you to pursue such treatments via a specialty clinic (e.g., a Chronic Pain Treatment Center), rather than falling into the seductive trap of internet hype!

October 2003

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