Bipolar disorder is a complex mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood swings can affect sleep, energy levels, behavior, judgment, and the ability to think clearly, often disrupting daily life.
Definition and Symptoms
Mania and Hypomania:
- Mania: Periods of extremely elevated mood, energy, and activity levels. Symptoms include inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed activity, and engaging in risky behaviors.
- Hypomania: Similar to mania but less severe. It doesn’t cause significant problems in social or work settings and doesn’t include psychotic symptoms.
Depressive Episodes:
- Depression: Periods of overwhelming sadness, hopelessness, and loss of interest in most activities. Symptoms include fatigue, changes in appetite and sleep patterns, difficulty concentrating, feelings of worthlessness, and suicidal thoughts or behavior.
Types of Bipolar Disorder
- Bipolar I Disorder: Characterized by at least one manic episode lasting at least seven days or by manic symptoms severe enough to require immediate hospital care. Depressive episodes often occur as well, typically lasting at least two weeks.
- Bipolar II Disorder: Defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
- Cyclothymic Disorder (Cyclothymia): Periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least two years (one year in children and adolescents); however, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- Other Specified and Unspecified Bipolar and Related Disorders: Bipolar symptoms that do not match the three categories listed above.
Research Insights on Lithium Carbonate
Lithium Carbonate: Lithium carbonate is a mood stabilizer commonly used in the treatment of bipolar disorder. Research by Maurer, Shippel, and Volz (2009) highlights lithium’s multifaceted role, particularly in extending the circadian rhythm and enhancing mitochondrial energy production. These functions are crucial because both circadian rhythm disruptions and mitochondrial dysfunctions are often observed in individuals with bipolar disorder.
Circadian Rhythm and Bipolar Disorder: The circadian rhythm, which regulates the sleep-wake cycle, is often dysregulated in people with bipolar disorder. Lithium has been shown to lengthen the circadian rhythm, which can help stabilize mood swings by promoting more regular sleep patterns and reducing the severity of manic and depressive episodes.
Mitochondrial Energy Production: Mitochondria are the energy powerhouses of cells. In bipolar disorder, mitochondrial dysfunction can lead to impaired energy production, contributing to the physical and mental fatigue experienced during depressive episodes. Lithium’s ability to improve mitochondrial energy production can enhance overall cellular function, potentially alleviating some symptoms of bipolar disorder.
High Homocysteine Levels and Methylation Issues
Research has identified elevated homocysteine levels in individuals with bipolar disorder, suggesting an impaired ability to convert folate to its active form, methylfolate, due to genetic variants like MTHFR. This methylation issue can lead to various problems, including mood instability and increased risk for depressive episodes.
The begins with folate coming into the one-carbon metabolism pathway where a methyl group is added, then the MTHFR enzyme breaks the methyl group off and hands it over to B12 and into the Methionine pathway where the methyl group is once again handed off to Homocysteine to make Methionine and thereby clearing Homocysteine. High homocysteine levels are indicative of insufficiencies in folate and/or B12 as well as getting the wrong forms of these vitamins (folic acid, methyl-B12, etc. For this reason, I use higher doses of Methyl Folate with a small amount of methyl-B12 and large amount of unmethylated B12 so that unmethylated-B12 is ready to ‘catch” the methyl-group and hand it off to Homocysteine. When too much methyl-B12 is present, there isn’t anywhere for the methyl group to go and it becomes trapped, which can impact neurotransmitter pathways, increasing anxiety. Ideal homocysteine levels are below 8.0 and above 14.0 there is an increased risk of developing Alzheimer’s Disease.
MTHFR and Methylation: MTHFR (methylenetetrahydrofolate reductase) is an enzyme crucial for the conversion of folate to methylfolate, a form that the body can use efficiently. Methylfolate is vital for producing neurotransmitters that regulate mood. Variants in the MTHFR gene can reduce the enzyme’s activity, leading to decreased methylfolate levels and potentially contributing to the development of mood disorders. However, there may be variability between races on the impact of MTHFR on development of Bipolar Disorder.
Food Sources are often inadequate in circumstances of MTHFR, MTRR, MTR and other methylation genetic snps, but here are some food sources:
Folate
- Fortified Cereals
- Beef Liver
- Cowpeas
- Spinach
- Great Northern Beans
- Asparagus
- Rice
- Baked Beans
- Green peas
- Broccoli
- Avocado
- Peanuts
- Lettuce
Vitamin B12
- Beef Liver
- Clams
- Fortified Cereals
- Trout
- Salmon
- Haddock
- Yogurt
- Beef
- Tuna
- Milk
- Cheese
- Egg
- Chicken
Fatty Acid Deficits and Phospholipid Metabolism:
Research by Stork and Renshaw (2005) indicates that individuals with bipolar disorder often have deficits in essential fatty acids and impaired phospholipid metabolism. These nutritional deficits can exacerbate symptoms and complicate treatment.
Phospholipids: Phospholipids are a class of lipids that are a major component of all cell membranes. They play a crucial role in cell structure and function, particularly in the brain. Phospholipids help maintain the integrity of cell membranes, facilitate cell signaling, and are involved in the formation of myelin, the protective sheath around nerve fibers.
Importance of Phospholipids:
- Cell Membrane Integrity: Essential for the proper functioning of neurons and other cells.
- Signal Transduction: Critical for the transmission of signals between neurons.
- Myelin Formation: Important for the efficient transmission of nerve impulses.
Dietary Sources and Supplementation: Ensuring adequate intake of essential fatty acids, such as omega-3, through diet or supplementation can help support phospholipid metabolism and improve overall brain health.
Fatty Acids
- Flaxseed
- Walnuts
- Chinook Salmon
- Scallops
- Soybeans
- Halibut
- Shrimp
- Tofu
- Winter Squash
- Cod
- Kidney Beans
Reactivity to Artificial Sweeteners
Artificial sweeteners like aspartame have been linked to mood instability and negative alterations in the gut microbiome, which can further affect mental health. Research suggests that individuals with bipolar disorder may be particularly sensitive to these effects.
Aspartame and Mood Lability: Studies have shown that aspartame can increase mood lability (the rapid and unpredictable changes in mood) in susceptible individuals. This is particularly concerning for those with bipolar disorder, as mood stability is a primary treatment goal.
Gut Microbiome: Artificial sweeteners can disrupt the balance of the gut microbiome, the community of microorganisms living in the digestive tract. A healthy microbiome is essential for overall health, including mental health, as it influences the production of neurotransmitters and the immune system.
Hypoglycemia and Mood Lability
Hypoglycemia, or low blood sugar levels, can aggravate mood lability in individuals with bipolar disorder. Maintaining stable blood sugar levels through a balanced diet is crucial for mood stability.
Research on Hypoglycemia and Mood: Studies have shown that fluctuations in blood sugar levels can lead to irritability, anxiety, and mood swings. For individuals with bipolar disorder, avoiding hypoglycemia is essential to prevent exacerbation of mood symptoms.
Dietary Recommendations:
- Frequent, Balanced Meals from a whole foods diet: Eating small, balanced meals throughout the day can help maintain stable blood sugar levels.
- Complex Carbohydrates: Incorporating complex carbohydrates, which break down slowly and provide a steady source of energy, can be beneficial.
- Protein and Healthy Fats: Including protein and healthy fats in meals can help sustain energy levels and prevent blood sugar spikes and crashes.
Bipolar disorder is a multifaceted condition that requires a comprehensive understanding of its various aspects, from symptoms and types to the underlying biological mechanisms. Research highlights the importance of lithium carbonate in regulating circadian rhythms and mitochondrial function, both of which are often disrupted in bipolar disorder. Additionally, high homocysteine levels and genetic methylation issues, nutritional deficits in essential fatty acids and phospholipids, and sensitivity to artificial sweeteners and hypoglycemia all play a role in the condition’s complexity.
A holistic approach to managing bipolar disorder should consider these factors, emphasizing the importance of diet, supplementation, and lifestyle modifications to support overall mental health and well-being.
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References
El-Hadidy, M. A., Abdeen, H. M., Abd El-Aziz, S. M., & Al-Harrass, M. (2014). MTHFR gene polymorphism and age of onset of schizophrenia and bipolar disorder. BioMed research international, 2014, 318483. https://doi.org/10.1155/2014/318483
Hu, C. Y., Qian, Z. Z., Gong, F. F., Lu, S. S., Feng, F., Wu, Y. L., Yang, H. Y., & Sun, Y. H. (2015). Methylenetetrahydrofolate reductase (MTHFR) polymorphism susceptibility to schizophrenia and bipolar disorder: an updated meta-analysis. Journal of neural transmission (Vienna, Austria : 1996), 122(2), 307–320. https://doi.org/10.1007/s00702-014-1261-8
Maurer, I. C., Schippel, P., & Volz, H. P. (2009). Lithium-induced enhancement of mitochondrial oxidative phosphorylation in human brain tissue. Bipolar disorders, 11(5), 515–522. https://doi.org/10.1111/j.1399-5618.2009.00729.x
Seshadri, S., Beiser, A., Selhub, J., Jacques, P. F., Rosenberg, I. H., D’Agostino, R. B., Wilson, P. W. F., & Wolf, P. A. (2002). Plasma homocysteine as a risk factor for dementia and alzheimer’s disease. New England Journal of Medicine, 346(7), 476–483. https://doi.org/10.1056/nejmoa011613
Stork, C., & Renshaw, P. F. (2005). Mitochondrial dysfunction in bipolar disorder: evidence from magnetic resonance spectroscopy research. Molecular psychiatry, 10(10), 900–919. https://doi.org/10.1038/sj.mp.4001711
