Moreover, individuals with bipolar disorder have a high prevalence for multiple chronic conditions, such as being overweight or obese, says Rachel Bergmans, PhD, MPH, a research fellow in the department of psychiatry at the University of Michigan Medical School in Ann Arbor. So choosing healthy options is particularly important if you have this condition. “Maintaining a healthy diet has the potential to not only benefit the symptoms of bipolar disorder but reduce the burden of these co-occurring illnesses,” explains Dr. Bergmans. There is increasing evidence that nutrition affects mental health, including the mood states in bipolar disorder. For example, a study published in September 2015 in the Journal of Psychiatric Research found that certain fatty foods could contribute to poor mental health and overall dysfunction in people with bipolar disorder. A review published in March 2016 in the same journal concluded that an overall healthy lifestyle, including exercise and diet, can be useful in managing bipolar disorder long term (though the authors note that changing certain unhealthy habits can be a challenge). To help you follow and stick to healthy diet guidelines, which include eating more fruit and vegetables and paying attention to the fat content in your diet, it may be helpful to work with a registered dietitian to come up with a plan that works for you. Research has also uncovered a link between low levels of omega-3s and the development of bipolar disorder; conversely, an adequate intake of fatty fish is associated with a lower risk of developing the disorder, according to an article published in June 2019 in the journal Therapeutic Advances in Psychopharmacology. According to the authors, nutrition is now recognized as an important factor in the prevention and treatment of neuropsychiatric disorders such as depression, bipolar disorder, and schizophrenia. Dr. McInnis explains that people with bipolar disorder should rebalance the types of fat in their diet to include more omega-3 fats and fewer omega-6 fats. “The ideal ratio of omega-6 fatty acids to omega-3 fatty acids is around four to one or even less,” adds Bergmans. “In Western diets, this ratio can be as high as 16 to 1, due to consuming too many foods high in omega-6 fatty acids and not enough foods that are good sources of omega-3 fatty acids.” Since omega-6 fatty acids compete with omega-3s in the body, you should try to avoid foods with a high omega-6 to omega-3 ratio, including oils such as corn, soybean, and cottonseed, advises Bergmans. Better oil options include canola, flaxseed, and olive, which are also low in saturated fat. It’s a good idea, too, to add more omega-3-rich foods to your diet. Walnuts, almonds, flaxseed, wild-caught salmon, sardines, anchovies, spinach, collard greens, and winter squash are some options. If you eliminate bipolar-incompatible foods from your diet, you will improve not only your psychological well-being but also your physical health, including your heart health. That’s particularly important for people with bipolar, because the disorder can increase your risk of obesity and heart and vascular disease, according to the National Institute of Mental Health. “People with bipolar disorder have, in general, poor diets and are not good at planning healthy diets with appropriate foods,” McInnis explains. One particular problem is fast food, which is a primary food source for a number of people with bipolar disorder, he says. “It’s convenient, cheap, and provides satisfaction — albeit short term.”
What Foods and Drinks Should People With Bipolar Disorder Avoid?
If you have bipolar disorder, the fundamentals of a healthy diet include not just what you should eat but also what you shouldn’t eat. Consider cutting back on or cutting out these items that could worsen your bipolar symptoms.
1. Caffeine
“Stimulants can trigger mania and should be avoided,” says Jess G. Fiedorowicz, MD, PhD, an associate professor in the departments of psychiatry and internal medicine at the University of Iowa Carver College of Medicine in Iowa City. Caffeine is an underappreciated bipolar trigger and can also impair sleep, he says, which can be particularly problematic because sleep deprivation is a notorious trigger for bipolar mood swings and mania. While the evidence isn’t conclusive, a systematic review published in September 2020 in the journal Bipolar Disorders points out that caffeine’s stimulant effect may be responsible for triggering mania symptoms, and it may also change the way certain medications used to treat bipolar disorder are metabolized in the body. The National Sleep Foundation points out that caffeine can increase irritability and anxiety in addition to affecting sleep and recommends avoiding caffeine as you approach bedtime. Fiedorowicz adds that some over-the-counter medications, such as pseudoephedrine — found in some cough and cold medicines — have stimulant properties similar to caffeine and can also trigger bipolar mood swings.
2. Alcohol
Alcohol and bipolar disorder are a bad combination. Alcohol can affect bipolar mood swings and may also interact negatively with medication such as lithium, according to the National Alliance on Mental Illness (NAMI). People with bipolar disorder are also more likely to die prematurely if they use alcohol or other substances, according to a study published in the September 2015 in the journal The Lancet Psychiatry that analyzed data on more than 11,000 people with bipolar disorder.
3. Sugar
Eating a diet high in sugar can make it harder to control weight and obesity — and related belly fat — and make some bipolar disorder drug treatments less effective, according to the results of a multicenter study published in June 2015 in the journal Acta Psychiatrica Scandinavica. If you need to satisfy your sweet tooth, reach for fruit.
4. Salt
If you’re taking lithium for your bipolar disorder, you’ll need to carefully monitor your salt intake, because any sudden increase or decrease in the amount of sodium you ingest can affect lithium levels. According to NAMI, people who take lithium should avoid low-sodium diets and dehydration, because they can increase the risk of lithium toxicity. Talk with your doctor about how to safely manage the salt in your diet to stay within a healthy range. Equally important when taking lithium is to make sure you drink enough fluids since dehydration can cause dangerous side effects, Fiedorowicz cautions.
5. Fat
Fiedorowicz suggests following the heart-healthy recommendations from the American Heart Association to limit the amount of saturated fat and trans fat in your diet. That means opting for lean protein and low-fat dairy products and eating plenty of fruits, vegetables, and healthy grains. You might have heard that the fat in foods could alter the way your body uses medication: Generally, your medication will still be effective, but eating a lot of fried, fatty foods just isn’t good for your heart. And remember that the oils used for frying are high in the omega-6 fatty acids you want to avoid.
Healthy Foods to Swap in for Less Healthy Options
Planning a healthier diet doesn’t have to be a chore. McInnis advises going to your local farmers markets, exploring the options, and talking with the farmers themselves about how to best use their produce. And for quick stops at the store, he recommends sticking to the periphery, where whole foods, such as produce and fish, are usually found. For more ways to make your diet healthier, McInnis advises:
Munch on fresh vegetables with a savory dip, such as hummus, instead of potato chips or fries.Skip the sweet pastry and instead top a slice of whole-grain bread or a few crackers with fruit preserves.Choose a decaf latte or herbal tea instead of a fourth or fifth cup of coffee.Avoid the burgers and fries at fast food places and order a fresh salad instead.Swap a fried entrée for steamed or broiled fish.
Building the best diet often takes a group effort, including help from your bipolar treatment medical team. If your diet and lifestyle need a complete makeover, reach out to your doctor or a dietitian for help. Additional reporting by Barbara Kean and Jessica Migala
