Some nutrition tips for bipolar disorder

In her weekly column, Nutritionist Nonie de Long shares some tips to help boost mood

Dear Readers, 

As promised the other week,  I’m going to tell you today about a past client who completely turned her life around by using my nutrition coaching services. Just to recap, here is the summary of her story. This week I am going to reveal the entire story and what on earth it has to do with bacon!

We’ll call her Sandy.

Sandy came to me about six years ago. She was horribly depressed, possibly even suicidally so. She was a parent and was in such a worn-down state she could barely function. She expressed that she no longer had any joy or pleasure in life. She was hiding this from her family and colleagues and felt utterly hopeless. She was in a leadership position at work, but that was hanging on by a thread with her current performance. She just didn’t have the energy or drive anymore. 

When I inquired about her diet I found that she was eating what many nutritionists advocate: chicken breast and fish, lots of salads, veggies all the time, low to no fats, and she was weighing everything and counting calories. She worked out intensely almost every day, as she had always been into fitness. But now, no matter what she did she couldn’t get rid of the belly and weight around the middle. And her energy had plummeted to an all-time low. She needed naps and chocolate just to function.

She confided in me that she had been diagnosed with a mood disorder years prior, and had been taking several powerful mind-altering medications for decades. It had taken years of trial and error to find ones that worked for her, but she didn’t feel they were working any longer. She felt “dead inside.” But at the same time, she dreaded changing them because the side effects were so bad she couldn’t cope. 

She also relayed that she was afraid to ask her doctor for change, because of the pressure she experienced in those conversations to “comply” with what she was told was best for her. The diagnosis had caused her physician to behave in a way that robbed her autonomy. She didn’t want to cause conflict, but she didn’t know how she could keep going like this. Her mood and mental state had gotten too low. She was at the end of her ability to suffer any longer. Six months later you wouldn’t recognize her. Sandy had stopped measuring food and exercising so much. She was off the meds (her choice) and no longer had the symptoms of a mood disorder. She was taking a handful of supplements every day and was eating red meat and fat regularly. She had started to lose the belly. 

One year later this very same woman radiated happiness. She was still not taking any mood-stabilizing pharmaceuticals (her choice), and she felt truly alive for the first time in decades. The weight around the middle was gone completely and she exercised less often, with far less intensity than before. She was loving her work and her life and was now able to be available for her beautiful family in a way she hadn’t been able to be before. 

What had we done that made such a difference? I’ll break it down into steps for you.

  1. Reduce the exercise

Say what? Sounds insane, right? But it’s essential to understand how intense exercise acts on a body that has been in a high-stress state for too long. Let me explain.

Stress, including intense workouts, can stimulate hormones like cortisol, DHEA, and adrenaline through HPA axis activation. Think of the HPA axis as a control hub for the nervous and endocrine (hormone) systems of the body. This control hub manages our reactions to stress and stress hormones, as well as regulating many body functions like mood and emotions, energy, sexuality, digestion, metabolic state, and immunity. Is this starting to make sense in Sandy’s case? 

When the stress is short lived – even on a regular basis – the body can rebalance itself later. That’s the normal situation. This is often tied to the feeling of a “high” just after a workout and a sense of “calm” later. However, if the stress is too severe and frequent these hormones are stimulated too much and can become chronically imbalanced. This in turn can cause an HPA axis imbalance. You now not only have a system problem, you have a problem with the control hub. 

In this state you can see things like insulin resistance even though the person is not really eating a lot of sugar, thyroid function imbalances, and troubles with circadian rhythm and night sleep. The body is on overdrive and becomes hyperreactive to almost all stimuli. Everything is perceived as a threat. The metabolism slows right down, sugar is continually circulating and triggering insulin – resulting in belly fat and greater mood swings – and the person has zero energy. 

The intensity of Sandy’s exercise was keeping her in this state – even if we changed her diet. It was, in essence, keeping her overweight and tired and wired all the time! So I insisted she take it down to 2-3x a week with cortisol reducing exercise like yoga, slow resistance training, swimming, or walking. She fought me, but in the end she started to see the difference and that gave her trust in further recommendations. 

  1. Replace carbs with meat

It may seem counterintuitive to reduce carbs for a person who has no energy and to eat red meat for weight loss, but that is exactly what we did. Sandy had all the signs of insulin resistance even though she wasn’t diabetic. Her stress hormones were exacerbating her reaction to carbs, so we needed to follow a very low carbohydrate, ketogenic diet. And this, dear readers, is where bacon comes in. 

Bacon is quick and easy to cook for a snack when you’re first getting into ketosis and you’re going to kill someone if you don’t eat something fast because your blood sugar is dysregulated. Additionally, it’s loaded with salt, which is essential to reduce the symptoms of keto flu. It has enough fat to help stimulate the body to burn fat for energy, facilitating the transition to ketosis. So bacon was a lifesaver in helping Sandy get into a keto state where she could stop reacting to every little thing that happened and start to relax a little bit. From that state we could make real gains in her health. She noticed the difference as soon as she hit ketosis. 

When I inquired about her diet I found that she was eating what many nutritionists advocate: chicken breast and fish, lots of salads, veggies all the time, low to no fats, and she was weighing everything and counting calories. She worked out intensely almost every day, as she had always been into fitness. But now, no matter what she did she couldn’t get rid of the belly and weight around the middle. And her energy had plummeted to an all-time low. She needed naps and chocolate just to function.

She confided in me that she had been diagnosed with a mood disorder years prior, and had been taking several powerful mind-altering medications for decades. It had taken years of trial and error to find ones that worked for her, but she didn’t feel they were working any longer. She felt “dead inside.” But at the same time, she dreaded changing them because the side effects were so bad she couldn’t cope. 

She also relayed that she was afraid to ask her doctor for change, because of the pressure she experienced in those conversations to “comply” with what she was told was best for her. The diagnosis had caused her physician to behave in a way that robbed her autonomy. She didn’t want to cause conflict, but she didn’t know how she could keep going like this. Her mood and mental state had gotten too low. She was at the end of her ability to suffer any longer.Six months later you wouldn’t recognize her. Sandy had stopped measuring food and exercising so much. She was off the meds (her choice) and no longer had the symptoms of a mood disorder. She was taking a handful of supplements every day and was eating red meat and fat regularly. She had started to lose the belly. 

One year later this very same woman radiated happiness. She was still not taking any mood-stabilizing pharmaceuticals (her choice), and she felt truly alive for the first time in decades. The weight around the middle was gone completely and she exercised less often, with far less intensity than before. She was loving her work and her life and was now able to be available for her beautiful family in a way she hadn’t been able to be before. 

  1. Supplement like crazy

In Sandy’s case the thyroid was struggling as well, although this was not caught on standard testing by her physician. She didn’t look like the common type for hypothyroidism. Her TSH was just fine. However, those who understand how the thyroid works know that there are other tests to determine if it’s not functioning optimally. I did some testing of my own and put her on supplements customized to her particular imbalances. This included magnesium, which is essential in most people, but especially those who crave chocolate. Changes from these were noticeable in about 6 weeks. 

  1. Work with the doctor on the meds

Sandy was adamant she wanted off her meds, which is her right. I explained, however, that this should be done with physician supervision. It’s outside my scope of practice to advise regarding medications. Readers: if you have consulted a nutritionist who has advised you discontinue or change or increase a medication, run, don’t walk away!  We are not licensed nor qualified to give advice that advice. And professionals respect the limits of their profession.

There are often severe withdrawal symptoms when coming off of mind-altering medications. I have observed that these withdrawal symptoms usually pass after 2 weeks, but during that time they can be hell. With benzos it’s much, much longer and more brutal. Ditto antipsychotics, which can cause rebound psychosis if they are discontinued. These withdrawal side effects can be seen as validation that the person needs the medication, even though they may not if they were able to make it past the withdrawal phase.  I’ve often wondered if drugs are intentionally made thus. But given this, I do not recommend discontinuing any medication without physician assistance to supervise a slow and safe taper. How slow depends on the drug and the person. Physicians are able to guide a client safely!

However, clients will often try to change their medication on their own without consulting their doctor because their doctor will challenge their wish to discontinue. This is sad because in Canada patients have the right to decide for themselves which medications they want to take for their health conditions. This is not currently the case with persons who are thought to be a risk to themselves or others without medications, and maybe another day we can explore that can of worms. In my practice, when patients feel doctors aren’t listening to them I suggest taking an advocate along for meetings or putting their request in writing in a letter to be put in their medical file.

These documents sound decision-making and thoughtful consideration. I am available for my clients to attend physician appointments if they need it. Sometimes just having someone there who understands your concerns can empower you to better advocate for yourself. 

In Sandy’s case, the meds were discontinued abruptly without physician oversight against my advice and it caused rebound symptoms that frightened her. I advised her to consult her doctor immediately and gave her the time frame she was looking at for withdrawal symptoms. She chose to go without medication for that time in consultation with her doctor and after two weeks to the day she felt so good she didn’t feel the need to take any medication any longer. She continues to feel that good today. She does not now meet the requirements for her previous bipolar diagnosis. 

The last time I heard from Sandy the weight around the middle was still gone. Her mood was fantastic and she was completely stable. She has advanced her career and her personal and family life is wonderful. She still works out regularly, although her style of working out has changed. She continues to follow a lower carb diet with keto cycling – something I teach my clients to do. She does not need the handfuls of supplements any longer. And she still loves her bacon! 

As I said last week, insulin resistance plays a huge role in many health issues, including mood disorders. I believe this is under-appreciated by most medical and nutrition clinicians because studies are few to date and dietary studies are notoriously difficult to conduct and extrapolate reliable data from. With this and any mental health concern, clients need a lot of hand-holding and encouragement. They need someone they can reach almost instantly during waking hours if they are afraid or overwhelmed. And they need someone who understands what they are experiencing. This is where 1:1 coaching is essential. And this is what I specialize in.  

I know this is a deviation from my normal Question and Answer format, but with the rise in mental health issues during the pandemic I thought it important to share the power of nutrition for mental wellness. There are powerful alternatives to medication for those who would like to explore that option. And who doesn’t love a redemptive story about bacon?

As always, if readers have their own health questions, I welcome them. Just send me an email at mail@askthenutritionist.ca. Readers can sign up for my free newsletter at hopenotdope.ca to stay on top of upcoming events like my kombucha class in the coming weeks through Barrie Public Library and for more great articles like this one. Have a blessed Easter week everyone!

Namaste! 

Nonie Nutritionista

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