It’s no secret that eating unhealthy foods can lead to a host of ailments. But a lesser-known effect of a poor diet, according to research, is that it can contribute to bipolar mood episodes. And while there is no specific diet recommended for bipolar disorder, certain food choices may help manage manic episodes.
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 investigator at University of Michigan Medicine 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 small study from 2015 found an association between certain fatty acids and the severity of self-reported symptoms in those with bipolar disorder. And a review published in 2016 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.
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.
“Stimulants can trigger mania and should be avoided,” says Jess Fiedorowicz, MD, PhD, the head of the mental health department at Ottawa Hospital and a professor at the University of Ottawa in Canada. 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 2021 noted that caffeine’s stimulant effect may be responsible for triggering mania symptoms in some people, and it may also change the way certain medications used to treat bipolar disorder are metabolized in the body.
The Sleep Foundation points out that caffeine can increase irritability and anxiety in addition to affecting sleep, and recommends avoiding caffeine as you approach bedtime. Dr. Fiedorowicz adds that some over-the-counter medications, such as pseudoephedrine (Sudafed) — found in some cough and cold medicines — have stimulant properties similar to caffeine and can also trigger bipolar mood swings.
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 2015 that analyzed data on more than 11,000 people with bipolar disorder.
Eating a diet high in refined 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 from 2016. If you need to satisfy your sweet tooth, reach for fruit.
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. Saturated 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.
The Role of Omega-6 and Omega-3 Fatty Acids
There is also some evidence that an imbalance in the ratio of omega-6 to omega-3 fatty acid intake is problematic in bipolar disorder, says Melvin McInnis, MD, the director of the bipolar research program at University of Michigan Medicine in Ann Arbor.
According to a 2016 study, having a high omega-6 to omega-3 ratio increases the body’s inflammatory response, which is harmful for overall brain function. (One example from above: Avoiding fried foods — which are typically cooked in oils that are high in omega-6 fatty acids — may be an especially strong consideration if you have bipolar disorder.)
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 a study published in 2019. The authors noted that nutrition is now recognized as an important factor in the prevention and treatment of neuropsychiatric disorders like 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 4 to 1 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 in general. 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.”
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