1. Bipolar Disorder and Diet Kristin Schefcik

2. What is bipolar disorder? Mania Euphoric mood Increased energy Decreased need for sleep Rapid thinking and speech Depression Low energy Loss of usual interests Sleep and appetite disturbance Difficulty concentrating

3. Current treatments Lithium toxic Valproate weight gain polycystic ovary disease Lamotrigine skin rash fatal dermatological reaction Patients are unable to tolerate adverse effects of current medications

4. Diet: an alternative treatment Omega-3 fatty acids Vitamins Minerals Zinc Selenium Copper

5. Essential Omega-3 fatty acids Docosahexaehoic acid (DHA) DHA is concentrated in synaptic membranes and has mood stabilizing effects Ecosapentaenhoic acid (EPA) Studies reveal that high dose therapy leads to incorporation of DHA and EPA into Phospholipid membranes which is crucial for cell signaling.

6. Phospholipid membranes in bipolar patients (Chiu et al. 2003) Hypothesis there is a depletion of omega-3 fatty acids in erythrocyte membranes of bipolar patients. Method 20 healthy controls and 20 bipolar patients Results No significant difference in the overall PUFA composition between the control and the bipolar groups A significant decrease of DHA in the bipolar group

7. Omega-3 fatty acids and neurotransmitter signaling Receptor G-protein Phospholipas e C Membrane Phospholipid Inositol Triphosphate Ca++ Diacylglycerol PKC Omega-3 fatty acids Omega-3 fatty acids Lithium Valproate Lithium

8. Proposed mechanism of omega-3 fatty acids Inhibits G proteins Blocks L-type calcium channels Inhibits PKC activity Reduces proinflammatory cytokines This mechanism prevents over signaling and promotes mood stabilization by reducing the amount of free inositol that can pass the blood-brain barrier.

9. Dietary sources of omega-3 fatty acids Seafood is an important source of omega-3 fatty acids especially DHA and EPA

10. Comparison of seafood consumption and rates of bipolar disorder (Noaghiul and Hibbeln 2003) Hypothesis Increased rates of seafood consumption corresponds with decreased rates of bipolar disorder Method Data on prevalence of bipolar disorder in 10 countries was compared with seafood consumption documents obtained from the National Marine Fisheries. Results A strong correlation between the rate of seafood consumption and prevalence of bipolar disorder. Conclude Insufficient intake of Omega-3 fatty acids increases the risk of bipolar disorder

11. Vitamin and mineral supplementation Essential for normal brain function Play key roles in neurotransmitter signaling NMDA receptors have zinc binding sites There may be similar receptors with copper and magnesium binding sites

12. Zinc and violent behavior (Walsh et al. 1997) Evaluated the zinc levels of 135 men incarcerated for assault. Found and inverse relationship between zinc levels and the seriousness of the behavior. Low levels of zinc were associated with increased levels of violence.

13. Mood stabilization with mineral supplements (Kaplan et al. 2001) 14 bipolar patients were treated with mineral supplements. Overall the study showed a 55% to 66% reduction in bipolar symptoms. Some patients no longer required psychotropic medications following the mineral treatment.

14. Mineral supplement: E.M. Power+ Based on a treatment used for stress and mood problems in cattle. Contains a wide range of vitamins and minerals at doses that far exceed the recommended daily values.

15. Other research on single mineral supplements Selenium No significant improvement in mood of bipolar patients with increased levels on selenium alone. Tryptophan only temporary improvement of bipolar symptoms with increased levels of tryptophan alone.

16. Synergistic effects of vitamins and minerals Research focusing on the effects of individual supplements showed no significant improvement in bipolar symptoms. Research with a cocktail of vitamins and minerals showed significant results and improvement of bipolar symptoms. Therefore, the vitamins and minerals must be working in concert to produce positive results.

17. Criticism Some may object to clinical trials with a mixture of ingredients. It is unscientific when the active ingredient is unknown. The amount of dietary mineral intake that is sufficient for most of the population may be adequate, deficient, or even toxic for the minority. More research is needed to determine accurate dosage and active ingredients.

18. Mechanisms of action Bipolar Genes or Environment? Inborn error of metabolism where metabolic errors lead to altered brain function Depletion of vitamins and minerals in the soil. Studies show significant decrease in soil samples with little effort to re- mineralize the soil

19. Conclusion Kaplan study with a cocktail of vitamins and minerals shows significant results for bipolar patients. Increased omega-3 fatty acid intake also shows significant results for bipolar patients. More studies are needed to determine exact mechanisms of fatty acids, vitamins, and minerals within the human body. Also investigation of synergistic effects and studies combining omega-3, vitamins, and minerals.