Diet and Nutrition
Why diet and nutrition are important to your quality of life
Healthy eating habits are important to staying physically healthy and well. Like everyone else, people with bipolar disorder can feel better if they eat a healthy, well-balanced diet–but research shows this is often a challenge when living with the condition1. Research has shown that some nutrients may work with regular medication treatment to produce better health in people with bipolar disorder. A few nutritional supplements (pills or liquids that you can take when you are not getting enough of a particular nutrient in your diet, like omega-3 fatty acids) may help the symptoms of bipolar disorder2 – but more research is needed before we can be sure3,4. For example, while many research studies show that omega-3 fatty acids are good for physical health, we are still learning how they may also boost how your brain develops and works5.
How you can take action
It’s important to eat well, although, in reality, it’s easier to plan a wide-ranging improvement of your diet than to actually do it. As with physical exercise, it’s best to begin with a modest goal and gradually raise it. Set goals that are specific and achievable. You should try to be clear about what you intend to do and aim for manageable changes. For example, if you are trying to eat healthier in general, try starting with reading the food guide, including the importance of serving sizes, eating a varied and balanced diet, and including a variety of healthy oils, vitamins and minerals. Tracking your daily food intake with a food diary (on paper or online) can also be helpful, although this may not be suitable if you also live with an eating disorder6.
Problem-solve around obstacles to maintaining a healthy diet. For example, you may find it useful to think of solutions to the possible problem of emotional eating (eating because of how you feel emotionally rather than when you feel hungry) and how some moods lead you to eat while others don’t.
There are specific challenges for those who live with bipolar disorder when it comes to eating well. Two important things that dieticians may note for people with bipolar disorder are:
- Not eating at all can make a mood episode more severe. You may want to buy special snacks that you can try to eat when you feel a mood episode is being triggered.
- Be very cautious about supplements and holistic treatments that suggest they may enable you to stop taking your medications for bipolar disorder. You should discuss any new diet or supplement with your health practitioner.
Another challenge to dietary change for people with bipolar disorder is that certain medications can sometimes trigger intense hunger or cravings that are difficult to control7. This can be a challenging problem with no easy solution. Discussing this possible side-effect with your healthcare provider to explore the benefits and risks of changing the type or amount of medication may be helpful. When changes to your medications are not acceptable, seeking help from a dietician to help you improve your diet plan can help to offset this increased risk of consuming more food than your body needs.
Bipolar disorder and eating disorders
Bipolar disorder, particularly bipolar II, is associated with a higher incidence of body dissatisfaction and eating disorder symptoms8,9,10, especially binge eating disorder8 and binge/purge symptomatology (as in bulimia9,10). Having an eating disorder in conjunction with bipolar disorder can be connected to a greater burden on your mental health. In addition to the added difficulty of eating disorder symptoms, one study showed that having both binge eating disorder and bipolar disorder is associated with greater rates of anxiety, substance use, psychosis and suicidality11. Additionally, while tracking your calories and nutrients is recommended for many people, it may do more harm than good for the mental health of those with eating disorders6.
Therefore, when considering how to approach a healthy diet with bipolar disorder, it’s important to take your overall wellbeing into account. For example, if tracking your nutrition or weight triggers symptoms of an eating disorder, it’s best to find an alternative approach.
Some tips for managing disordered eating or body image concerns when you have bipolar disorder are:
Focus on how your body feels, not how it looks.
Nutritious food is always good for you, regardless of how you look while you’re eating it. It’s important to attend to your overall physical health, but it’s possible to track your wellness without focusing on numbers. One way of doing this is to pay attention to how your body feels, or how your mood changes, after eating different foods. Mindfulness can be helpful towards this end!
Remember that your self-image and your diet are separate.
It is possible to feel good about yourself even when you are unhappy with how you look. You are a whole person, with your own unique outlook, experiences, relationships, and abilities. Just like your diagnosis, the way you look is just one aspect of yourself. Think about whether or not you’ve connected your body image with your overall sense of self, and consider how you might be able to separate them. Our section on Identity provides tips that can be applied here.
On social media, follow people who make you feel good about yourself.
A recent study of young women found that exposure to a wider variety of body types helps to improve compassion towards one’s own body12. Similarly, finding accounts of other people who live well with bipolar disorder may help you to accept and learn to live well with the condition too.
Challenge negative thoughts that arise about your diet or your appearance.
On the Mood page, we share some tips from cognitive behavioural therapy on how to challenge negative thoughts that arise. Just like with depressive thoughts, you can challenge negative thoughts about your body or diet. For example, believing that eating one dessert will offset your healthy eating habits for the rest of the week is an example of “All or nothing thinking.” Visit the Mood page to learn more.
Talk to a professional.
If you are experiencing issues with disordered eating, it is recommended to speak to a medical professional who is equipped to help you. When attending medical appointments, it can be helpful to make medical professionals aware that you are experiencing body image concerns in addition to bipolar disorder. For example, if you want to talk about your overall health, but would prefer not to see the number when you are weighed, you can mention this to the person working with you.
Finances and healthy eating
Financial problems can present a barrier to healthy eating for anyone. If you receive income or disability assistance, there may be local options to help you eat better – the resources available to you will differ depending on where you live. Or, you can try an online meal planner, which can help you stick to a budget, eat healthy meals, and reduce food waste. Three options you can look into in your own neighbourhood are buying clubs, community kitchens, and community gardens. Buying clubs are when groups of people who live in the same community organize to place bulk or wholesale orders with regional farmers – a cheaper option than buying organic produce from the grocery store. Community kitchens are groups of neighbours who organize to cook and share meals (e.g., monthly) to increase food knowledge and share expenses. Sometimes individuals contribute skills instead of money, for example, childcare for other members of the group. Lastly, you can grow some of your own produce in a community garden plot. More often than not, community garden plots are affordable and can supply you with a large amount of fresh vegetables, while increasing your and your family’s food security. All of these community-based options can also help you expand your cooking skills and build relationships.
Pay attention to your overall health
Finally, it’s important to see your doctor regularly for routine screening or monitoring of metabolic risk factors. Risk factors are things that may cause other things to happen (for example, smoking is a risk factor for getting lung cancer). You can still get lung cancer without smoking, but you have a higher chance if you smoke or have smoked in the past. It is especially important to regularly check your metabolic risk factors (such as fasting blood sugar, cholesterol, blood lipids, blood pressure and abdominal circumference (the distance around your stomach)), if you are on medications that may increase your risk, or if your age or lifestyle puts you at higher risk for, diabetes or cardiovascular disease13. Monitoring your own weight and blood pressure can also be very helpful.
- Lopresti, A. L., & Jacka, F. N. (2015). Diet and bipolar disorder: A review of its relationship and potential therapeutic mechanisms of action. Journal of Alternative and Complementary Medicine, 21(12), 733-739. doi: 10.1089/acm.2015.0125
- Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies—PubMed. (n.d.). Retrieved 29 June 2020, from https://pubmed.ncbi.nlm.nih.gov/27631140/
- Fusar-Poli L, Surace T, Vanella A, et al. The effect of adjunctive nutraceuticals in bipolar disorder: A systematic review of randomized placebo-controlled trials. J Affect Disord. 2019;252(March):334-349. doi:10.1016/j.jad.2019.04.039
- Arab A, Mehrabani S, Moradi S, Amani R. The association between diet and mood: A systematic review of current literature. Psychiatry Res. 2019;271:428-437. doi:10.1016/j.psychres.2018.12.014
- Sylvia L.G., Peters A.T., Deckersbach T., et al. (2013). Nutrient-based therapies for bipolar disorder: A systematic review. Psychotherapy and Psychosomatics, 82: 10-19.
- Levinson, C. A., Fewell, L., & Brosof, L. C. (2017). My Fitness Pal Calorie Tracker Usage in the Eating Disorders. Eating Behaviors, 27, 14–16. https://doi.org/10.1016/j.eatbeh.2017.08.003
- Bernstein, E. E., Nierenberg, A. A., Deckersbach, T., & Sylvia, L. G. (2015). Eating behavior and obesity in bipolar disorder. Australian & New Zealand Journal of Psychiatry, 49(6), 566–572. https://doi.org/10.1177/0004867414565479
- Wildes, J. E., Marcus, M. D., & Fagiolini, A. (2008). Prevalence and correlates of eating disorder co-morbidity in patients with bipolar disorder. Psychiatry Research, 161(1), 51–58. https://doi.org/10.1016/j.psychres.2007.09.003
- McDonald, C. E., Rossell, S. L., & Phillipou, A. (2019). The comorbidity of eating disorders in bipolar disorder and associated clinical correlates characterised by emotion dysregulation and impulsivity: A systematic review. Journal of Affective Disorders, 259, 228–243. https://doi.org/10.1016/j.jad.2019.08.070
- Lunde, A. V., Fasmer, O. B., Akiskal, K. K., Akiskal, H. S., & Oedegaard, K. J. (2009). The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations. Journal of Affective Disorders, 115(3), 309–314. https://doi.org/10.1016/j.jad.2008.10.012
- McElroy, S. L., Crow, S., Biernacka, J. M., Winham, S., Geske, J., Cuellar Barboza, A. B., Prieto, M. L., Chauhan, M., Seymour, L. R., Mori, N., & Frye, M. A. (2013). Clinical phenotype of bipolar disorder with comorbid binge eating disorder. Journal of Affective Disorders, 150(3), 981–986. https://doi.org/10.1016/j.jad.2013.05.024
- Ogden, J., Gosling, C., Hazelwood, M., & Atkins, E. (2020). Exposure to body diversity images as a buffer against the thin-ideal: An experimental study. Psychology, Health & Medicine, 1–14. https://doi.org/10.1080/13548506.2020.1734219
- De Almeida, K.M., Moreira, C.L., & Lafer, B. (2012). Metabolic syndrome and bipolar disorder: What should psychiatrists know? CNS Neuroscience and Therapeutics, 18: 160–166.