The Importance of Nutrition in Patients With Bipolar Disorder

Roger Rivera, DNP, PMHNP, a psychiatric nurse practitioner specializing in complex mood disorders, emphasized the underrecognized role of nutrition in bipolar disorder management. He noted that patients with bipolar disorder already experience neurochemical instability, which can then be exacerbated by certain dietary choices.¹ Rivera highlighted that nutrition, hydration, and moderation are foundational to stabilizing mood.

He cautioned against indiscriminate use of supplements, citing a patient with excessive vitamin B12 levels due to overlapping injections and oral preparations. Instead, Rivera advocated for individualized assessment, including laboratory work and, when appropriate, genetic testing, to guide nutritional interventions. Nutrient deficiencies (like magnesium, zinc, probiotics) may warrant supplementation, but only for patients with specific needs.

Rivera also warned about food and drug interactions, particularly in patients taking older pharmacologic agents that are more susceptible to food interactions.² Tyramine-rich foods like aged cheeses, cured meats, and fermented products may present risks, while high sugar intake can precipitate mood fluctuations. Caffeine, often overused by patients with bipolar disorder and comorbid anxiety or insomnia, may worsen agitation and interfere with medication absorption.

Importantly, Rivera stressed the need for effective patient communication. Education should frame dietary choices as part of long-term health and quality of life, not as rigid restrictions. Practical counseling, including moderation, hydration, and culturally relevant examples, helps patients integrate changes sustainably. Rivera concluded that communicating nutrition in bipolar disorder is both a science and an art, requiring collaboration across expertise to optimize outcomes.

Mr Rivera is board-certified as a family nurse practitioner and psychiatric mental health nurse practitioner. His areas of expertise include psychiatry, family medicine, critical care, emergency medicine, and trauma surgery. Mr Rivera also holds a Doctorate of Nurse Practice, as well as Nurse Educator from the University of Florida.

References

1. Gabriel FC, Oliveira M, Bruna De M Martella, et al. Nutrition and bipolar disorder: a systematic review. Nutr Neurosci. 2023;26(7):637-651.

2. Van den Eynde V, Gillman PK, et al. The prescriber's guide to the MAOI diet-thinking through tyramine troubles. Psychopharmacol Bull. 2022;52(2):73-116.