Bipolar Disorder and Diet Part I: Omega-3 fatty acids

two polar bearsTrue (type I) Bipolar Disorder (which used to be called manic-depression) affects about 1% of the population, but milder forms exist that affect an additional 5% of Americans. These include Bipolar Disorder type II, as well as more subtle bipolar spectrum mood disorders. These are very serious conditions that can cause significant distress and impairment for individuals and their families. People are often told that bipolar disorders are the result of a “chemical imbalance” that must be corrected with medications…but what causes this chemical imbalance?

 

The truth is we do not know. What we do know is that the tendency to develop bipolar disorder (and its moody cousins along the bipolar spectrum) is partly genetic and partly environmental (lifestyle). We can’t do anything right now about the genetic vulnerability, but if we understood which lifestyle factors increased our risk for these mood disorders, we could potentially reduce the incidence and/or the severity of these conditions.

Mood stabilizing medications are incredibly important tools in the treatment of bipolar disorders, but they are imperfect tools—they do not work for everyone, and come with risk of side effects. What if there were dietary changes that could reduce the need for medication in some people? After all, the chemicals in our brains come from food, so it stands to reason that what we eat could have a powerful impact on our brain chemistry, and therefore influence our mood and behavior.

Omega 3 fatty acid supplements improve bipolar depression.

Omega-3 fatty acids (ALA, EPA, and DHA) and the omega-6 fatty acid LA are considered essential because they are critical components of all cells, and they are the only fats our bodies can’t make from scratch. Put simply, omega-6’s promote inflammation and omega-3’s reduce inflammation. We need both omega-3 and omega-6 in our diets, but we need them to be in proper balance. For example, if we get an infection, we need both forces available—first, inflammatory forces to fight off the invading bacteria, then anti-inflammatory forces to clean up the scene and begin the process of healing. The delicate balance between these two forces is vital to the health of our immune system.

Unfortunately, the typical “Western” diet is seriously lopsided, and the shift in our diets from animal-based fats to plant-based fats is the biggest reason why we are off-kilter. The two most important omega-3 fatty acids, EPA and DHA, do not exist in plant foods, and modern animal foods contain less of them than they used to due to the way they are produced. In addition, we have been told for decades that plant fats are healthier for us than animal fats, so there has been a huge increase in the amount of vegetable oil in our diets, and these are very high in omega-6 fatty acids.

Scientists estimate that our hunter-gatherer ancestors ate a diet that contained roughly equal amounts of omega-3 and omega-6 fatty acids, but that most of us civilized folk currently take in at least 15 times more omega-6 than omega-3. This imbalance is unhealthy, especially for the brain, which requires high concentrations of omega-3’s:

  • Omega-3’s give brain cell membranes the flexibility they need in order to function properly. Brain cells communicate with each other by exchanging chemical neurotransmitters (such as serotonin and dopamine), and in order to do this, their membranes need to be soft and pliable.
  • Omega-3’s reduce the activity of brain cell signaling chemicals, such as protein kinase C (manic symptoms have been associated with hyperactivity of this compound).
  • Omega-3’s provide anti-inflammatory protection to brain cells. Mood disorders are strongly associated with inflammation in the brain (on a microscopic level).

There have been lots of studies of omega-3 fatty acids in mood disorders. A recent review of the best available clinical studies found that adding daily omega-3 fatty acid supplements to mood stabilizing medications for 12 to 16 weeks significantly improved symptoms of depression in people with bipolar disorder (evidence for improvement in manic symptoms was insufficient). Among the omega-3’s, EPA was found to be superior to DHA, and ALA (flax oil) was ineffective. Therefore, the current science supports the use of 1000 mg per day of an omega-3 supplement that is as high in EPA as possible.

You can also improve your omega-3/omega-6 balance by:

  1. Minimizing your use of vegetable oils, which are all high in omega-6. Those that are especially high include: safflower, grapeseed, sunflower, cottonseed, corn, walnut, and soybean oils. Choices that are lower in omega-6 include coconut oil, olive oil, cocoa butter, and palm oil.
  2. Increasing your use of healthy animal fats, which contain omega-3’s and are lower in omega-6. The best sources are wild fish and naturally-raised animals (grass or pasture-fed), if available and affordable. However, even most commercially-produced animal meats contain much less omega-6 than vegetable oils do.

For more information about omega-3 and omega-6 fatty acids and the foods that contain them, please see the fats page.

Word to the wise:  studies of omega-3 supplements in bipolar disorder were conducted in people who were also taking mood stabilizing medications.  We do not know if simply taking omega-3 fatty acids without medications would be helpful enough, or would work quickly enough, especially in severe cases of bipolar depression, therefore this would not be a smart strategy in an emergency.

Read my post about Bipolar Disorder and Low-Carbohydrate Diets.

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REFERENCES

Balanzá-Martínez V et al.  Therapeutic use of omega-3 fatty acids in bipolar disorder. Expert Rev Neurother. 2011;11(7):1029-47.

Deckelbaum RJ and Torrejons C. The omega-3 fatty acid nutritional landscape: health benefits and sources. Journal of Nutrition 2012; 142: 587S–591S.

Hegarty BD and Parker GB.  Marine omega-3 fatty acids and mood disorders–linking the sea and the soul.  “Food for Thought” I.  Acta Psychiatr Scand 2011;124(1):42-51.

Kouba M and Mourot J. A review of nutritional effects on fat composition of animal products with special emphasis on n-3 polyunsaturated fatty acids. Biochimie 2011; 93: 13-17.

Kris-Etherton PM et al. Polyunsaturated fatty acids in the food chain in the United States. Am J Clin Nutr 2000; 71(suppl): 179S-88S.

Layé, S.  Polyunsaturated fatty acids, neuroinflammation and well being. Prostaglandins, leukotrienes and essential fatty acids 2010; 82: 295-303.

Martins JG.  EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression:  evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr 2009;28(5):525-42.

Montgomery P and Richardson AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database of Systematic Reviews 2008, Issue 2. Art No.:CD005169.

Sarris J et al.  Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression.  J Clin Psychiatry 2012; 73(1):81-6.

Please note that after 30 days, Dr. Ede may not personally respond to comments, however comments shall remain open to encourage community discussion.
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  • Elaine

    I laughed out loud at the picture! 🙂 Thanks for the clearly written article. So when choosing an Omega 3 supplement, would it be best to look for any particular amount of EPA, or just the highest? One brand I have in mind says “1000mg Fish Oil, 380mg EPA, 190mg DHA.”

  • Hi Elaine–so glad you liked the photo! I
    had a lot of fun picking it out.

    A review published just a few
    months ago suggests that supplements containing more than 60% EPA were most
    effective. The supplement you are considering contains 67% EPA, so that sounds
    like a good choice. The jury is still out about the optimum dose of EPA, but
    scientists are currently recommending 1000 mg of omega-3’s, and most studies
    used supplements that contained 1000 mg or more of EPA. In order for you to get
    that much EPA you’d need to take 3 pills per day of the supplement you mentioned.

    REFERENCE: Martins JG et al.
    Eicosapentaenoic acid appears to be the key omega-3 fatty acid component
    associated with efficacy in major depressive disorder: a critique of Bloch and
    Hannestad and updated meta-analysis. Molecular Psychiatry (2012), 1 – 6

    • Elaine

      Thank you!

      • Hi Dr. Ede, I have found that when I take 1000mg of EPA I break out. And I typically have dry skin, so it is very rare for me to have acne. Also my scalp is more oily and for the first time in my life, I MUST wash my hair every day or else it looks extremely greasy. When I back off the dose, it goes away, but then my eczema comes back! I am currently taking a brand that comes in a 500mg dose of EPA, 200 DHA. I really don’t think I can stomach taking the oil in non-capsule form, so do you think I should just be searching for a brand that comes in a slightly higher dose, like 600 or 700mg? Do my symptoms just mean that I don’t need as much as other people might? I do eat fish a lot…

        • Hi Elaine

          This is very interesting, and a great example of how different we each are, as well as how difficult it is to turn blanket theories into advice that will work for everyone…yes, of course it would make sense to reduce the dose to that which does not cause acne. There is the possibility that it has to do with something else about the formulation (some filler or additive), or perhaps even a mild fish intolerance, but regardless, common sense about the dosing should always trump the science:)

          • Oh thank you that’s a good point. Just saw that is has Vitamin E as an additive derived from Soy! Gross…not sure how I missed that before.

    • Dan

      Elaine wrote:
      One brand I have in mind says “1000mg Fish Oil, 380mg EPA, 190mg DHA”

      That’s 38% EPA, not 67%.

  • Des

    Hi Georgia, love this post. What do you think about Extra Virgin Red Palm oil (not to be confused with palm kernel oil), extra virgin olive oil and virgin coconut oil? All these oils except olive oil are considered to be quite saturated, which is a good thing, but if I’m looking to decrease my systemic inflammation for the purpose of reducing acne, are these oils a safe bet? I don’t always want to cook with beef tallow, lard and bacon fat. Thanks!

    • Hi Des

      Inflammation-wise, it is the omega-6 content that is probably most important when comparing these oils. Coconut oil has the lowest amount of omega-6 because it is lowest in PUFA’s and highest in saturated fat compared to the other two. Coconut oil contains about 2% omega-6. palm fruit oil approximately 9% omega-6 and olive oil approximately 10% omega-6. All of these oils are a far better choice than most seed oils, which are very high in omega-6’s.

  • Greg Marlow

    I found that adding calcium in addition to omega 3 cured my bipolar disorder. The omega 3 allows higher blood levels of calcium and calcium lowers neuron excitability.