Managing Bipolar Disorder with Nutrition and Supplements

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October 3, 2021

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. 

Feel free to comment below and let me know what you liked best about this article.

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Dr. Galit Goldfarb

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