Managing Bipolar Disorder with Nutrition and Supplements

Bipolar Disorder (BD) is a chronic and recurrent mental disease that was once referred to as manic depressive illness. BD has a lifetime prevalence of 3-5% of the population. BD is also often associated with impaired functioning in various life areas (occupational, personal, family, social). [1-4]

BD is a somatic symptom disorder, which means that it is a mental disorder that manifests as physical symptoms that cause disease, illness, or injury. BD is associated with a high incidence of obesity, type 2 diabetes, heart disease, and stroke [5-8]. And these health conditions also negatively impact the course of mental illness. 

BD reduces life expectancy by as much as 10–20 years compared to the general population. [9] BD is a major disability to most who suffer from it.

BD varies in severity and episodes of extreme highs and extreme lows. The person suffering from the condition may feel hopelessly depressed at one moment and then overly elated the next moment.

While medications are currently the principal treatment for bipolar disorder and can help stabilize extreme mood shifts and unpredictable activity levels, they can have adverse side effects that can frequently increase the risk of heart disease. [10-12]

Fortunately, natural remedies involving better food choices and dietary supplements can play a role in managing bipolar disorder symptoms. For the brain to function correctly, it must have sufficient energy and specific nutrients. Therefore, a person’s nutrition and eating habits are closely related to the development and progression of many mental disorders, including BD.

For example, it is well documented that patients with BD and type 2 diabetes or glucose intolerance show a greater risk of suffering from chronic BD than people with BD but without glycemic control disorders. [13]

Also, dieting and other reasons for weight loss or weight gain are associated with the incidence of manic and depressive phases [14].

Studies show that dietary habits may cause and sustain conditions associated with BD, such as inflammation, oxidative stress, mitochondrial activity, reduced neuroplasticity, and neurogenesis [15-17]. 

One in three people with bipolar disorder also meets the criteria for binge eating disorder, bulimia nervosa, or variants of these eating disorders [18-19].

Here are some foods, nutrients, and lifestyle changes to consider to support you if you are suffering from BD: 

Reduce food intake, especially sugar and simple carbohydrates

Individuals with bipolar disorder showed a significantly higher intake of total energy, simple carbohydrates, protein, sugar, and total and saturated fat. [20] 

These foods increase inflammation which is a marker of many diseases, including mental health disorders.

Therefore, although you do want to consume carbohydrates, you want to ensure that the carbohydrates you are consuming are always whole, such as whole grains, fruits, and not fruit juices, potatoes, or other root vegetables that are baked and not fried, and avoiding added refined sugars found in candies, cakes, and other processed foods and unwhole baked goods. 

Consume rich sources of zinc

Zinc improves enzyme function and cell division. In a study led by Jessica Wang of the University of Pennsylvania School of Nursing, Philadelphia, researchers reviewed the evidence supporting the role of zinc deficiency in increasing depression symptoms and manic episodes. [21]

Zinc shows robust antidepressant properties. Zinc deficiency increases the risk of depression, while supplementation with zinc is an effective treatment. Consistently, zinc deficiencies were observed in 41.0% of psychogeriatric patients, including depressive disorders, compared to 14.4% of the control group demonstrating this deficiency [22-24].

It has also been reported that there is decreased cell survival in hippocampal regions of the brain in zinc deficiency. 

In addition, zinc also downregulates brain-derived neurotrophic factor (BDNF) activity [44]

There is evidence that shows a connection between BDNF and depressive disorders. BDNF helps to regulate brain function. [25]. 

BDNF also contributes to the regulation of both synaptic plasticity and energy metabolism, including feeding behavior. BDNF has been recognized as a critical target to explain the relationship between metabolic and psychiatric disease, and all of these studies suggest that the possibility that zinc balance is associated with mood status and BDNF-related neuronal function. [26-29]

You can see my article on BDNF to see how you can increase the activity of this growth factor.

15–30 mg of zinc can be taken daily as an antidepressant in supplement form. The National Institute of Health recommends no more than 40mg of zinc a day. Excellent food sources of zinc include legumes especially baked beans and chickpeas, nuts, especially cashews and almonds), seeds, and whole grains. Vegetables that are high in zinc are spinach, mushrooms, kale, and broccoli. 

And if I am mentioning BDNF, a high-fat Western World diet has been shown to lead to a decrease in BDNF expression in the brain and a deterioration in the quality of new hippocampal neurons. [30-33]

Consume omega-3 fatty acids

Omega 3 fatty acids are essential for brain development and function. Omega-3 fatty acids are long-chain, polyunsaturated fatty acids. Unlike saturated fats, which have been shown to have negative health consequences, omega-3 fatty acids have been associated with many health benefits, including mental health benefits.

Mood disorders have been associated with abnormalities in fatty acid composition and diminished omega-3 fatty acid levels. [34]

Omega 3 fatty acid-rich foods are low in the Western World Diet.

Consuming foods high in omega-3, such as chia seeds, green leafy sea vegetables, walnuts, lettuce, and broccoli, increases levels of fatty acids in the blood and travels across the blood-brain barrier into the brain. [35]

Due to its anti-inflammatory properties, it has been shown to help relieve depression and manic episodes.

According to research on the effects of omega-3 supplementation on bipolar patients, consuming omega-3 may help prevent recurring mood disorders. This conclusion came after observing omega-3 deficiencies in the blood and brain tissues of patients with bipolar disorder. [36]

Several epidemiological and intervention studies have shown the relationship between the consumption of foods rich in omega 3 fatty acids in diet or supplementation with these fatty acids and the occurrence or severity of depression. There are also studies showing that it is advisable to increase the content of this ingredient in the diet of BD patients. In the treatment of depression, doses of 1–2 g eicosapentaenoic acid daily have been used to reduce the symptoms of depression, including bipolar disorder. Omega 3 fatty acids also have no side effects, and their consumption is beneficial to general health. [37-41]

Vitamin D

Systematic reviews with meta-analysis have confirmed the association of low vitamin D levels with depression. They have demonstrated the efficacy of vitamin D supplementation in reducing the symptoms of depression in patients with clinically more severe depression. There are very few studies on the role of vitamin D in patients with BD. However, it has been established that vitamin D deficiency in the outpatient group of patients with BD is 4.7 times higher than in the general population [42-46].

Since most of the population is deficient in vitamin D during winter months, I recommend taking 1000 IU vitamin D3 daily.

Monitor salt intake

Lithium has been used for decades and continues to be the standard for treating bipolar disorder. [47] However, if you’re taking lithium for your condition, you should be careful about your salt intake. You have to maintain a healthy balance as a sudden spike or decrease in sodium consumption may negatively impact lithium levels in your blood. Avoid a low-sodium diet as it may lead to lithium toxicity and increase fluid intake to prevent dehydration. 

Reduce caffeine consumption

A person who has bipolar disorder may rely on a boost of caffeine to re-energize them when they’re feeling depressed. Foods and drinks high in caffeine include coffee, tea, sodas, sports drinks, energy drinks, and chocolate. However, excessive caffeine intake may lead to heart palpitations, blood pressure fluctuations, and headaches. Restlessness may result in sleep disturbances and insomnia, which can trigger a manic episode.

In a case report following a bipolar patient, consuming caffeine pills led to the acute exacerbation of a manic episode. After taking the medications and, soon after being admitted to the hospital, the patient experienced palpitations and exhibited manic and psychotic symptoms. [48] Caffeine is absorbed by the gastrointestinal tract rapidly; it quickly passes through the blood-brain barrier and increases serotonin levels. And when serotonin levels climb, depression and other behaviors linked to anxiety decline; however, this only happens while you drink the coffee. Between coffee cups, the brain enters a withdrawal state, and the neurotransmitters decline. Hence, it is wise to avoid coffee consumption. Although it may seem that it makes you feel good, the feeling is temporary and transient. After 10-14 days of no caffeine, your body will return to baseline levels, and good feelings without coffee will return. 

You can also increase serotonin levels with omega 3 fatty acid supplementation, bergamot, lavender, and lemon essential oils spread around the house, and regular daily exercise of 30 minutes endurance exercise of your liking such as walking, swimming, biking, or running.

Lifestyle

Obesity and inactivity are associated with depression and a worse course of illness, treatment noncompliance, and more significant deeply depressed states for patients with bipolar disorder [49].

Exercise can enhance the mood of individuals with bipolar disorder. It is essential to state that exercise doesn’t need to be sustained for long periods, nor does it need extreme physical effort or concentration and motivation. It can be more casual and last for a relatively short period of time, and still, be beneficial.

I advise exercising five days a week, for 30 minutes each day [50-51].

Mindfulness and/or Cognitive behavioral therapy (CBT) are very supportive in changing thought patterns, changing strategies for problem-solving, and supporting making better decisions such as food choices, exercise, reduction of substance use/caffeine, smoking, and better sleep) [52].

Support

Unfortunately, a holistic approach is necessary but most difficult for individuals with BD to comply due to their unique needs, including a lack of motivation, higher rates of substance use, less stable incomes, and sometimes cognitive impairment. Therefore, there is a need for the ongoing support of a caretaker or family member to support them in overcoming these difficulties to help them improve their situation. [53]

Takeaway 

People with bipolar disorder should be supported in considering alternative treatment methods to help manage symptoms, such as eating a healthy diet and monitoring sodium and caffeine consumption, exercising, taking dietary supplements, financial, behavioral, and habit-changing support. 

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Dr. Galit Goldfarb

References:

  1. Cerimele JM, Chwastiak LA, Dodson S, Katon WJ. The prevalence of bipolar disorder in general primary care samples: a systematic review.Gen Hosp Psychiatry. 2014 Jan-Feb; 36(1):19-25.
  2. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication.Arch Gen Psychiatry. 2007 May; 64(5):543-52
  3. Miller SB, Dell’Osso B, Ketter TA. The prevalence and burden of bipolar depression. J. Affect. Disord. 2014; 169(Suppl. 1): 3–11.
  4. McLaren KD, Marangell LB. Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities. Ann. Gen. Hosp. Psychiatry. 2004; 3(1): 7
  5. Galvez JF, Bauer IE, Sanches M, Wu HE, Hamilton JE, Mwangi B, Kapczinski FP, Zunta-Soares G, Soares JC. Shared clinical associations between obesity and impulsivity in rapid cycling bipolar disorder: a systematic review. J Affect Disord. 2014 Oct; 168():306-13.
  6. McIntyre RS, Konarski JZ, Misener VL, Kennedy SH. Bipolar disorder and diabetes mellitus: epidemiology, etiology, and treatment implications. Ann Clin Psychiatry. 2005 Apr-Jun; 17(2):83-93.
  7. Prieto ML, Cuéllar-Barboza AB, Bobo WV, Roger VL, Bellivier F, Leboyer M, West CP, Frye MA. Risk of myocardial infarction and stroke in bipolar disorder: a systematic review and exploratory meta-analysis. Acta Psychiatr Scand. 2014 Nov; 130(5):342-53.
  8. Sylvia LG, Shelton RC, Kemp DE, Bernstein EE, Friedman ES, Brody BD, McElroy SL, Singh V, Tohen M, Bowden CL, Ketter TA, Deckersbach T, Thase ME, Reilly-Harrington NA, Nierenberg AA, Rabideau DJ, Kinrys G, Kocsis JH, Bobo WV, Kamali M, McInnis MG, Calabrese JR. Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE).Bipolar Disord. 2015 Mar; 17(2):212-23.
  9. Miller C, Bauer MS. Excess mortality in bipolar disorders. Curr. Psychiatry Rep. 2014; 16(11): 499
  10. de Almeida KM, Moreira CL, Lafer B. Metabolic syndrome and bipolar disorder: what should psychiatrists know?CNS Neurosci Ther. 2012 Feb; 18(2):160-6
  11. Ketter TA. Strategies for monitoring outcomes in patients with bipolar disorder.Prim Care Companion J Clin Psychiatry. 2010; 12(Suppl 1):10-6.
  12. Serretti A, Chiesa A, Calati R, Fabbri C, Sentissi O, De Ronchi D, Mendlewicz J, Souery D. Side effects associated with psychotropic medications in patients with bipolar disorder: evidence from two independent samples.J Psychopharmacol. 2013 Jul; 27(7):616-28
  13. Calkin CV, Ruzickova M, Uher R, Hajek T, Slaney CM, Garnham JS et al. Insulin resistance and outcome in bipolar disorder. Br. J. Psychiatry. 2015; 206(1): 52–57.
  14. Reininghaus EZ, Lackner N, Fellendorf FT, Bengesser S, Birner A, Reininghaus B et al. Weight cycling in bipolar disorder. J. Affect. Disord. 2015; 171: 33–38.
  15. MaleticvV, Raison C. Integrated neurobiology of bipolar disorder. Front. Psychiatry. 2014; 5:98. Doi: 10.3389/fpsyt.2014.00098.
  16. Berk M, Kapczinski F, Andreazza AC, Dean OM, Giorlando F, Maes M et al. Pathways un- derlying neuroprogression in bipolar disorder: Focus on inflammation, oxidative stress and neurotrophic factors. Neurosci. Biobehav. Rev. 2011; 35(3): 804–817. 
  17. Lopresti AL, Jacka FN. Diet and bipolar disorder: A review of its relationship and potential therapeutic mechanisms of action. J. Altern. Complement. Med. 2015; 21(12): 733–739.
  18. McElroy SL, Crow S, Blom TJ, Biernacka JM, Winham SJ, Geske J, et al. Prevalence and correlates of DSM-5 eating disorders in patients with bipolar disorder. J Affect Disord. 2016;191:216–221. doi: 10.1016/j.jad.2015.11.010.
  19. Álvarez Ruiz EM, Gutiérrez-Rojas L. Comorbidity of bipolar disorder and eating disorders. Revista de Psiquiatría y Salud Mental (English Edition) 2015;8(4):232–241. doi: 10.1016/j.rpsmen.2015.05.001. 
  20. Firth J, Stubbs B, Teasdale SB, et al. Diet as a hot topic in psychiatry: a population-scale study of nutritional intake and inflammatory potential in severe mental illness. World Psychiatry. 2018;17(3):365-367. doi:10.1002/wps.20571
  21. Wang J, Um P, Dickerman BA, Liu J. Zinc, Magnesium, Selenium and Depression: A Review of the Evidence, Potential Mechanisms and Implications. Nutrients. 2018;10(5):584. Published 2018 May 9. doi:10.3390/nu10050584
  22. Swardfager W, Herrmann N, McIntyre RS, Mazereeuw G, Goldberger K, Cha DS, et al. Potential roles of zinc in the pathophysiology and treatment of major depressive disorder. Neurosci Biobehav Rev (2013) 37:911–2910.1016/j.neubiorev.2013.03.018 [PubMed] [CrossRef] [Google Scholar]
  23. Szewczyk B. Zinc homeostasis and neurodegenerative disorders. Front Aging Neurosci (2013) 5:33.10.3389/fnagi.2013.00033 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
  24. Grønli O, Kvamme JM, Friborg O, Wynn R. Zinc deficiency is common in several psychiatric disorders. PLoS One (2013) 8:e82793.10.1371/journal.pone.0082793
  25. M?yniec K, Doboszewska U, Szewczyk B, Sowa-Kucma M, Misztak P, Piekoszewski W, et al. The involvement of the GPR39-Zn(2+)-sensing receptor in the pathophysiology of depression. Studies in rodent models and suicide victims. Neuropharmacology (2014) 79:290–710.1016/j.neuropharm.2013.12.001
  26. Numakawa T, Adachi N, Richards M, Chiba S, Kunugi H. Brain-derived neurotrophic factor and glucocorticoids: reciprocal influence on the central nervous system. Neuroscience (2013) 239:157–7210.1016/j.neuroscience.2012.09.073 
  27. Noble EE, Billington CJ, Kotz CM, Wang C. The lighter side of BDNF. Am J Physiol Regul Integr Comp Physiol (2011) 300:R1053–6910.1152/ajpregu.00776.2010
  28. Lai J, Moxey A, Nowak G, Vashum K, Bailey K, McEvoy M. The efficacy of zinc supplementation in depression: Systematic review of randomised controlled trials. J. Affect. Disord. 2012; 136(1–2): 31–39.
  29. Stycze? K, Sowa-Ku?ma M, Siwek M, Dudek D, Reczy?ski W, Szewczyk B et al. The serum zinc concentration as a potential biological marker in patients with major depressive disorder. Metab. Brain Dis. 2017; 32(1): 97–103.
  30. Kishi T, Hirooka Y, Nagayama T, Isegawa K, Katsuki M, Takesue K et al. Calorie restriction improves cognitive decline via up-regulation of brain-derived neurotrophic factor: Tropomyosin- related kinase B in hippocampus of obesity-induced hypertensive rats. Int. Heart J. 2015; 56(1): 110–115.
  31. Liu X, Zhu Z, Kalyani M, Janik JM, Shi H. Effects of energy status and diet on Bdnf expression in the ventromedial hypothalamus of male and female rats. Physiol. Behav. 2014; 130: 99–107.
  32. Jacka FN, Cherbuin N, Anstey KJ, Sachdev P, Butterworth P. Western diet is associated with a smaller hippocampus: A longitudinal investigation. BMC Med. 2015; 13: 215. Doi: 10.1186/ s12916-015-0461-x.
  33. Zainuddin MS, Thuret N. Nutrition, adult hippocampal neurogenesis and mental health. Br. Med. Bull. 2012; 103(1): 89–114.
  34. Freeman MP. Omega-3 fatty acids in psychiatry: a review. Ann Clin Psychiatry. 2000 Sep;12(3):159-65. doi: 10.1023/a:1009069002816. PMID: 10984006
  35. Freund Levi Y, Vedin I, Cederholm T, Basun H, Faxén Irving G, Eriksdotter M, Hjorth E, Schultzberg M, Vessby B, Wahlund LO, Salem N Jr, Palmblad J. Transfer of omega-3 fatty acids across the blood-brain barrier after dietary supplementation with a docosahexaenoic acid-rich omega-3 fatty acid preparation in patients with Alzheimer’s disease: the OmegAD study. J Intern Med. 2014 Apr;275(4):428-36. doi: 10.1111/joim.12166. Epub 2014 Jan 11. PMID: 24410954.
  36. Shakeri J, Khanegi M, Golshani S, et al. Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder. Int J Prev Med. 2016;7:77. Published 2016 May 19. doi:10.4103/2008-7802.182734
  37. Beyer JL, Payne ME. Nutrition and bipolar depression. Psychiatr. Clin. North. Am. 2016; 39(1): 75–86.
  38. Pawe?czyk A, Rabe-Jab?o?ska J. Egzogenne wielonienasycone kwasy t?uszczowe mog? poprawia? sprawno?? wybranych funkcji poznawczych. Psychiatr. Psychol. Klin. 2008; 8: 178–191.
  39. Wilczynska A. Fatty acids in treatment and prevention of depression. Psychiatr. Pol. 2013; 47(4): 657–666.
  40. Sarris J. Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders. Australas. Psychiatry. 2017; 25(4): 369–372.
  41. Mischoulon D, Freeman MP. Omega-3 fatty acids in psychiatry. Psychiatr. Clin. North. Am. 2013: 36(1): 15–23
  42. Eyles DW, Burne TH, McGrath JJ. Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendo- crinol. 2013; 34(1): 47–64.
  43. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. Br. J. Psychiatry. 2013. 202: 100–107.
  44. Shaffer JA, Edmondson D, Wasson LT, Falzon L, Homma K, Ezeokoli N et al. Vitamin D sup- plementation for depressive symptoms: A systematic review and meta-analysis of randomized controlled trials. Psychosom. Med. 2014; 76(3): 190–196.
  45. Gowda U, Mutowo MP, Smith BJ, Wluka AE, Renzaho AM. Vitamin D supplementation to reduce depression in adults: Meta-analysis of randomized controlled trials. Nutrition. 2015; 31(3): 421–429.
  46. Boerman R, Cohen D, Schulte PF, Nugter A. Prevalence of vitamin D deficiency in adult outpatients with bipolar disorder or schizophrenia. J. Clin. Psychopharmacol. 2016; 36(6): 588–592.
  47. Tondo L, Alda M, Bauer M, et al. Clinical use of lithium salts: guide for users and prescribers. Int J Bipolar Disord. 2019;7(1):16. Published 2019 Jul 22. doi:10.1186/s40345-019-0151-2
  48. Kiselev BM, Shebak SS, Milam TR. Manic Episode Following Ingestion of Caffeine Pills: A Case Report. Prim Care Companion CNS Disord. 2015;17(3):10.4088/PCC.14l01764. Published 2015 Jun 25. doi:10.4088/PCC.14l01764
  49. Fagiolini A, Kupfer DJ, Houck PR, Novick DM, Frank E. Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry. 2003;160(1):112–7. doi: 10.1176/appi.ajp.160.1.112.
  50. Heath EH. ACSM’s guidelines for exercise testing and prescription. Med Sci Sports Exerc. 2005;37(11):2018. doi: 10.1249/01.mss.0000189073.33400.04.
  51. Malone M, Alger-Mayer SA, Anderson DA. The lifestyle challenge program: a multidisciplinary approach to weight management.Ann Pharmacother. 2005 Dec; 39(12):2015-20.
  52. Sylvia LG, Nierenberg AA, Stange JP, Peckham AD, Deckersbach T. Development of an integrated psychosocial treatment to address the medical burden associated with bipolar disorder. J Psychiatr Pract. 2011 May; 17(3):224-32.
  53. Casagrande SS, Jerome GJ, Dalcin AT, Dickerson FB, Anderson CA, Appel LJ, Appel LJ, Charleston J, Crum RM, Young DR, Guallar E, Frick KD, Goldberg RW, Oefinger M, Finkelstein J, Gennusa JV, Fred-Omojole O, Campbell LM, Wang N-Y, Daumi GL. Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial. BMC Psychiatry. 2010;10:108. doi: 10.1186/1471-244X-10-108.

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