If you or a loved has bipolar disorder, you know how important it is to manage mood episodes with bipolar medications and healthy lifestyle habits. But did you also know that certain foods and dietary supplements might play a role in helping -- or hindering -- people with bipolar disorder?
What Is Bipolar Disorder?
Bipolar disorder is a complex disorder that's defined by dramatic or unusual mood episodes of highs and lows. The episodes of mania and depression can range from very mild to extreme in their intensity and severity. With bipolar disorder, mood episodes can come on gradually over many days or even weeks. Or they can come on suddenly, occurring over the course of just a few days. To count as episodes, symptoms must occur as a constellation of features that affects not only mood but also sleep, energy, thinking, and behavior and must last for at least several days, representing a change from your usual self.
With bipolar disorder, the person may experience episodes of major depression or instead, extreme elation and excessive energy. The elation is called mania. The mood episodes of bipolar disorder are accompanied by disturbances in thinking, distortions of perception, and impairment in social functioning.
Bipolar disorder was once thought to affect about 1% of the population. Some experts now believe it's higher, perhaps affecting 3% to 4% of the population. There are no laboratory tests to diagnose bipolar disorder, and its symptoms can overlap with other psychiatric disorders. As a result, it's often misdiagnosed and undertreated.
Is There a Diet for Bipolar Disorder?
- Avoiding the "Western" style diet that's rich in red meats, saturated fats and trans fats, and simple carbohydrates. This eating style is linked to a higher risk for obesity, type 2 diabetes, and heart disease. Eating less saturated fats and simple carbohydrates can help overall health but does not directly affect the symptoms of bipolar disorder.
- Eating a balance of protective, nutrient-dense foods. These foods include fresh fruits, vegetables, legumes, whole grains, lean meats, cold-water fish, eggs, low-fat dairy, soy products, and nuts and seeds. These foods provide the levels of nutrients necessary to maintain good health and prevent disease, in general.
- Watching caloric intake and exercising regularly to maintain a healthy weight. Some findings show that those with bipolar disorder may have a greater risk for being overweight or obese. Talk to your doctor about ways to avoid weight gain when taking bipolar medications.
Does Fish Oil Improve Mood With Bipolar Disorder?
The American Heart Association (AHA) recommends eating fatty fish at least two times a week. Good choices include:
- Albacore tuna
Fish oil can help keep your heart healthy. But some experts also believe that fish oil might play a role in brain function and behavior. While studies of omega-3 fatty acids for mood symptoms are not conclusive, some experts believe that they may be helpful in some people with bipolar disorder, particularly if they have a higher risk of cardiovascular disease or high triglycerides.
Some research suggests that getting more omega-3 fatty acids found in fish oil is linked to greater volume in areas of the brain. In particular, these areas are related to mood and behavior. In one study of 75 patients, one of the benefits of omega-3 fatty acids was decreasing depression in bipolar disorder.
Still, the overall evidence for benefit of fish oil in bipolar disorder is inconsistent. More studies are needed before fish oil can be recommended as a proven treatment for bipolar disorder.
If you're a vegetarian or vegan looking for possible benefits of fish oil, go with nuts. Walnuts, flaxseed, and canola oil contain alpha-linolenic acid (ALA), which is converted to omega-3 fatty acid in the body.
Which Foods Should I Avoid if I Have Bipolar Disorder?
Some general dietary recommendations for treating bipolar disorder include:
- Getting only moderate amounts of caffeine and not stopping caffeine use abruptly
- Avoiding high-fat meals to lower the risk for obesity
- Watching your salt if you have high blood pressure but not skimping on salt if you are being prescribed lithium (low salt intake can cause higher levels of lithium in the blood)
- Following your doctor's instructions to stay away from foods that may affect your specific bipolar medication, if any
In addition, you need to be wary of natural dietary supplements that can cause a drug-herb interaction.
Avoiding too much caffeine may be helpful for getting good sleep, which is especially important for people with bipolar disorder. When someone with bipolar disorder is feeling depressed, extra caffeine may temporarily cause a boost in energy, and possibly mood. The problem is that caffeine can disrupt sleep. Caffeine can also cause nervousness, heart palpitations, and headaches, worsen high blood pressure, or cause irritation in the stomach or esophagus in people that have acid reflux.
In addition to lowering caffeine, it's important to avoid high-fat meals with some bipolar medications. High-fat meals may delay the time it takes for some bipolar medications to be absorbed into your system. Talk to your doctor about your medications and necessary dietary changes.
If you take MAO inhibitors (a certain class of antidepressant that includes Emsam, Nardil, and Parnate), it's important to avoid tyramine-containing foods. These foods can cause severe hypertension in people taking MAO inhibitors. Some foods high in tyramine are:
- Overly ripe bananas and banana peels
- Tap beer
- Fermented cheese
- Aged meats
- Some wines, such as Chianti
- Soy sauce in high quantities
Your doctor can give you a list of foods to avoid if you take these drugs.
Also, avoid taking natural dietary supplements if you are taking bipolar medications. Supplements such as St. John's wort and SAM-e are touted to treat moderate depression. A few studies show benefit for some people with depression. But these natural therapies can interact with antidepressants and other bipolar medications. Discuss any natural dietary supplement with your doctor to make sure it is safe.
What About Alcohol and Bipolar Disorder?
Instructions for most psychiatric medications warn users not to drink alcohol, but people with bipolar disorder frequently abuse alcohol and other drugs. The abuse is possibly an attempt to self-medicate or to treat their disturbing mood symptoms, and they may also cause mood symptoms that can mimic those of bipolar disorder.
Alcohol is a depressant. That's why many people use it as a tranquilizer at the end of a hard day or as an assist for tense social situations. While some patients stop drinking when they are depressed, it is more common that someone with bipolar disorder drinks during low moods. According to the National Institute of Mental Health, people with bipolar disorder are five times more likely to develop alcohol misuse and dependence than the rest of the population.
The link between bipolar disorder and substance abuse is well established. Alcohol is a leading trigger of depressive episodes in many people who are vulnerable to depression or bipolar disorder. About 15% of all adults who have a psychiatric illness in any given year also experience a substance use disorder at the same time. Substance use disorders can seriously disrupt efforts to treat bipolar disorder and often may require their own forms of treatment.
Can I Drink Grapefruit Juice While on Bipolar Drugs?
Be careful. Talk to your doctor or pharmacist about eating grapefruit or drinking grapefruit juice with your bipolar medication. Grapefruit juice may increase the blood levels of many psychiatric medications that are used in bipolar disorder. These include some antidepressants (such as Zoloft or Luvox), the anti-anxiety drug Buspar, certain anticonvulsants (such as Tegretol), some antipsychotics (such as Latuda, Seroquel or Geodon), stimulants (such as Adderall, Adderall XR, or Dexedrine), and many sedative-hypnotics (benzodiazepines), such as Klonopin, Xanax, Valium, and Ativan, which could cause excessive drowsiness, mental impairment and even toxicity.
Should I Take Bipolar Medication With or Without Food?
Each bipolar medication is different. So talk with your doctor or pharmacist before taking the first dose. Some bipolar drugs can be taken with or without food. Others (such as Latuda or Geodon) are better absorbed into your system when taken with food or are less effective if taken with food (such as Saphris). Your doctor or pharmacist can pull the latest recommendations on taking the bipolar medication so you can safely take the medicine and get the full benefit of the drug.