Many things can influence bipolar disorder, such as imbalances in blood sugar and thyroid hormones, or lifestyle. Orthomolecular practitioners believe that lifestyle changes should only be attempted after chemical imbalances have been corrected (or at least lessened). Trying to do everything at once can be overwhelming, resulting in a tendency to give up.
* Food allergies. These can devastate both the gastrointestinal tract and brain function, and are thought to be common among bipolar sufferers. Allergies include gluten (the protein in grains like wheat, rye, oats and barley), aspartame, chocolate, caffeine and casein (a protein found in dairy). A number of food-allergy tests are available, but none is 100-per-cent accurate. The best test remains the 'caveman' elimination diet, which avoids grains, dairy, eggs, legumes, sugar, citrus, caffeine, certain vegetables such as the nightshade family, and processed meat products. This can be carried out at home under the supervision of a qualified nutritionist.
* Candida overgrowth is extremely common among those with psychiatric disorders. Every bipolar sufferer should be investigated for this condition, and learn how to treat it through dietary changes and other yeast-killing and/or controlling methods.
* Hypoglycaemia (abnormally low blood sugar) can be due to consuming large amounts of sugar and refined carbohydrates. The body's response to hypoglycaemia is to release epinephrine (adrenaline), which can cause sweating, nervousness, hunger, faintness, palpitations, hypothermia and headaches. More severe low blood sugar can lead to a reduced glucose supply to the brain, resulting in irritability, confusion, dizziness, fatigue, weakness, visual abnormalities and coma. Dietary adjustment and adequate amounts of chromium, zinc, magnesium and other nutrients are required to maintain blood-sugar balance.
* Thyroid problems are a common cause of depression and should always be checked for by your GP. An overactive thyroid gland, or hyperthyroidism, can trigger restlessness, hyperactivity, insomnia and irritability - symptoms that could be mistaken for mania. A sluggish thyroid (hypothyroidism) may result in feelings of coldness, depression and low energy (Acta Psychiatr Scand, 2001; 104: 72-5).
* Digestive enzymes help the body absorb nutrients from food. These may be lacking in some bipolar individuals, resulting in a lack of B vitamins, which protect the nervous system. Digestive enzymes such as pepsin, betaine and papain aid in digesting fats and proteins, and are available at healthfood shops, though some may not be potent enough to be adequately therapeutic. If in doubt, consult your practitioner.
* Low stomach acid. Adequate stomach-acid production is necessary for an adequate supply of minerals and amino acids to be delivered to the body. A hydrochloric acid (HCI) test is worth considering as it can immediately reveal whether low stomach acid is a problem.
* Parasites are far more common in all of us than is often thought, and these 'nutrient robbers' and 'toxic releasers' often go undiagnosed for decades. They should be cleared out.
* Alcohol and recreational drugs. About 60 per cent of people with bipolar disorder have drug and/or alcohol abuse or dependence problems, the highest rate among patients with major psychiatric illnesses (JAMA, 1990; 264: 2511-8). One review revealed several factors that increase the risk for multiple substance use among bipolars, including early age of illness onset and the presence of mixed symptoms (Harvard Rev Psychiatry, 1998; 6: 133-41).
* Psychotherapy can help sufferers manage their symptoms better. Emphasis is placed on recognising early signs of relapse so that patients can seek medical care before a full-blown illness develops as well as learn how to modify the detrimental or inappropriate thought patterns and behaviours associated with bipolar disorder.