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Diet and Bipolar Disorder

Q. Is there a correlation between eating habits through one's first twenty years of life and bipolar disorder? By eating habits, I mean intake of very little protein or fat, yet large concentration of refined carbohydrates. Do people with bipolar disorder have eating disorders as well, like bulimia, anorexia, etc.?

I have two nieces (one on each side of family) who fit this profile and have been diagnosed with bipolar disorder. Is a connection between the diet habits and diagnosis?

A. I am not aware of any research showing that the specific dietary pattern you describe is correlated with bipolar disorder; however, I doubt very much that this has been investigated in any systematic fashion. That said, there are some intriguing connections between both diet and eating disorders, and the diagnosis of bipolar disorder.

First of all, there is great interest in the role of certain omega-3-fatty acids in both the origin and treatment of bipolar disorder. These so-called marine fats are found in tuna and other fish, as well as in certain nuts. Some evidence suggests that a deficiency of such omega-3-fatty acids may be associated with the development of bipolar disorder (see LF Saugstad, Med Hypotheses 2001 Dec;57(6):679-92). Furthermore, there is preliminary evidence that omega-3-fatty acids may be of benefit in the treatment of bipolar disorder (see Stoll et al, Arch Gen Psychiatry 56:407-12, 1999).

The other question you raise may also be answered with a qualified "yes". Susan McElroy and colleagues (Am J Psychiatry 2001 Mar;158(3):420-26) investigated 288 outpatients with bipolar I or II disorder, using structured diagnostic interviews and clinician-administered and self-rated questionnaires. They found that patients with bipolar disorder often have comorbid (co-occurring) anxiety, substance use, and, to a lesser extent, eating disorders. But what this means with respect to eating disorders and bipolar disorder isn't clear.

It may be that some genetic factor predisposes to both conditions--or, that some element of learned behavior is involved. For example, might an adolescent with a cyclical mood disorder learn to eat more at certain times of his or her mood cycles than at others? It is clinically recognized, for example, that during the depressed phase of bipolar disorder, patients often gain considerable amounts of weight. Do they then try to get rid of this when their mood returns to normal, or when they become manic? Might this prompt some to engage in self-induced vomiting, laxative abuse, etc? Over many years, could this pattern become ingrained, such that the person actually develops an eating disorder? I don't have good answers to these questions, but further research may help provide them.

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March 2003

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