Nutrients that May Help to Manage Bipolar

Photo by Jordan Whitt on Unsplash

This is the second part of my three-part series focusing on nutrition with particular mental illnesses. You can read my post from last week about nutrition and anxiety here.  Next week I will cover depression and nutrition. If there is a mental illness you would like to see covered please let me know in the comments or by sending me a message!

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This information is provided for educational purposes only. It should not be seen as an attempt to diagnose or treat. Do not stop taking any medication without talking to your doctor first.

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About 5.7 million adults in America are diagnosed with bipolar disorder. This disorder has not been super well studied, and the literature on the impact of nutrition on symptoms of bipolar disorder is few and far between, though with a healthy (unhealthy?) dose of speculation, snake oil, and conspiracy theories.

But I have compiled the information that I think can be helpful.  Remember supplementation is not necessary for most people.  If you think you may be deficient in a specific nutrient you can get a blood test done at your doctor's office to see if you are.  Most of these nutrients can be supplied by a varied diet of fruits, vegetables, proteins and whole grains. More general recommendations will follow after the break down of specific nutrients.

The B-Vitamins Folate (B9) & Cobalamin (B12)

The B-vitamins are a range of similar (same, same but different) nutrients that generally help with cell metabolism. Many of them also have a part in nerve function. They are all water soluble (meaning your body removes excess amounts as urine), and are generally considered safe (toxicity chances are low). It has been generally suggested that people with bipolar disorder do not absorb B-complex vitamins easily and may often have deficiencies in these vitamins (1). 

Vitamin B9 (folate/folic acid) has been shown to be low in some people with bipolar disorder who are taking lithium or experiencing a manic episode. Supplementing with this vitamin seems to show that it enhances the effect of lithium.   

Low levels of vitamin B12 (cobalamin) may have a role in triggering manic states. B12 is important for the creation of many mood-regulating brain chemicals such as GABA, serotonin, and dopamine.

A study carried out in 2009 of 90 people in the manic phase of bipolar disorder, half of which were given folic acid supplements along with their normal maintenance routine, and the other half were not given the folic acid supplement.  For those taking the folic acid their symptoms of mania decreased significantly more than the people that did not take the supplement.

The B-vitamins are also an important part of the homocysteine metabolism in the body. Homocysteine is a non-protein alpha-amino acid. With the aid of certain B-vitamins, it can be recycled into methionine or converted into cysteine. High levels of homocysteine can make a person more prone to inflammation of the blood vessels, which makes high homocysteine levels a possible risk factor for coronary artery disease. It has also been associated with blood clots, heart attacks, and strokes. Abnormally high levels of homocysteine have been claimed to be a significant risk factor for the development of a wide range of diseases including neuropsychiatric illnesses.

Folate and cobalamin (both B-vitamins!) deficiencies are associated with high levels of homocysteine. The literature strongly suggests that homocysteine has neurotoxic properties that can lead to neuronal cell death and can be toxic to dopaminergic systems, and dysfunction of dopamine neurons which has been associated with bipolar disorder.

Interestingly high homocysteine levels are typically found in people with cardiovascular disease or metabolic syndrome, but high homocysteine levels have also been found in people with bipolar disorder even if they did not have cardiovascular disease or metabolic syndrome.  The mechanism behind this is not well understood and seem to depend on nutritional intake, age, reduced glomerular filtration rate, the type of mood stabilizing medication used and can even be influenced by genetic makeup.

What does this have to do with B-vitamins?

B-vitamins can help to reduce homocysteine levels which can theoretically help to improve brain function. Folate specifically is a cofactor involved in both homocysteine metabolism and monoamine synthesis. This is what helps to suggest that folate supplementation could normalize monoamine synthesis and correct mood stabilizer-associated folate deficiency.

As always, if you are a vegan, or vegetarian most of the natural B-12 sources will not be for you, thus it would be recommended to either take a B12 supplement or make sure to consume fortified B12 sources (cereals, tofu, etc).

Omega-3 Fatty Acids

Omega-3 fatty acids are an essential fatty acid that we have to consume in our diet because our body cannot produce it on its own. They are responsible for keeping synaptic connections in our brain running smoothly which can potentially impact mood, and it has been suggested that Omega-3 fatty acids can help to level out mood swings (1).  Often, omega-3 fatty acids are present at lower levels in most Americans with bipolar disorder.

Also, Omega-3 fatty acids act as competitive inhibitors of omega-6 fatty acids. This means that when omega-3 fatty acids are present in the system the body is more "take-in" the omega-3 fatty acids first instead of the omega-6. While omega-6 is part of a healthy diet, an imbalance in omega-3 and omega-6 can cause more inflammatory causing mediators to be floating around in your system. The inflammation can cause issues with mood.  Thus, consuming more omega-3 fatty acids can help to reduce this inflammation.

In two studies they found that supplementation with omega-3 fatty acids helped to improved scores for depression in patients with well-managed Bipolar disorder in conjunction with their normal medication routine. But no significant improvement was seen with scores regarding their mania.

While the studies do not show significant improvement in mania symptoms, most of the studies do show a positive impact with depression and omega-3 consumption/supplementation.

Why Wild Caught Salmon? 
Often when you see recommendations for omega-3 fatty acids you will see salmon listed, but it always seems to have the caveat of "wild caught".  Why is that? Well, some research has shown that wild caught salmon has higher levels of healthy fats than farmed salmon. This is because wild salmon lives in colder water than their farmed counterparts. Animals that live in colder climates have to have higher fat stores to help insulate them against the cold and to help them survive during long swims, or when food is scarce. If you cannot afford wild caught, or if wild caught is not available near you, don't worry! Plenty of other research shows that farmed salmon doesn't short-change your health in the omega-3 department! Farmed salmon will still give you a good dose of omega-3s so just buy what you can!

Amino Acids

The study of amino acids and their impact on physical health has been widely studied. But only recently have we begun to study the impact that they can have on our mental health. Emerging evidence is suggesting that some people with bipolar disorder may be genetically susceptible to mood swings when select amino acids are not present in the diet. 

Two (small) placebo-controlled trials suggest that certain branched-chain amino acids (BCAAs), in particular, leucine, isoleucine, and valine, may provide rapid improvement in patients with acute mania by possible interrupting the synthesis of norepinephrine and dopamine (some of the chemicals responsible for that "OMG I can do ANYTHING" feeling during mania). 

Other early findings suggest that restricting or excluding l-tryptophan from the diet may increase the susceptibility to depressive mood swings in those with bipolar disorder. Since tryptophan is used by the body to produce serotonin (feel good chemical) this may explain why a lack of tryptophan in the diet may lead to depressive moods. 

Another amino acid of interest is taurine, which is known to help produce a calming effect in the brain. Some studies have shown that taurine deficiency is more common in patients with bipolar disorder than patients without. Due to its calming effect, deficiency in taurine may play a part in increased occurrence of manic episodes. 

Amino acids are typically found in protein-containing foods (because amino acids are the building blocks of protein).  Tryptophan is an easy one, because when you hear "tryptophan" I want you to think "Thanksgiving". The "turkey nap" that everyone seems to take after Thanksgiving dinner has been attributed to tryptophans presence in turkey meat. 

General Recommendations

Eating a balanced diet with fruits, veggies, whole grains, and protein can benefit you regardless of your mental illnesses, or medications. The specific nutrients listed above are a guideline. If you feel that maybe you are lacking in the B-vitamin department, or aren't consuming enough omega-3's use the lists above as a way to help you start fitting this foods into your diet. 

Reducing or avoiding alcohol can help manage symtpoms of bipolar disorder, and alcohol may adversely affect medications that you may be taking to help manage your bipolar disorder. If you feel that you may have a problem with alcohol please check out these resources. 

General resources for bipolar disorder can be found here.

If you are suffering from suicidal thoughts or feelings please call: 1-800-273-8255

If you enjoyed this post or learned something new, please let me know in the comments! You can also share this post with others!

1) Prescription for Nutritional Healing, Fifth Edition: A Practical A-to-Z Reference to Drug-Free Remedies Using Vitamins, Minerals, Herbs & Food ... A-To-Z Reference to Drug-Free Remedies)