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People with bipolar disorder tend to gain and lose weight precipitously. Individuals often gain weight when they are depressed and lose weight when they are manic. Both depression and weight gain tend to increase with age if nothing is done to stop them. During manic episodes, some are pleased with their lack of appetite and ability to lose weight, but trying to become manic as a method of weight control can be deadly.

Sometimes people with bipolar disorder develop eating habits that interfere with losing weight. The most common habits I have seen in bipolar disorder are eating late at night and eating breakfast food cereals. I have known several people who were so adamant about having their midnight bowl of cereal that they could never lose weight.

How does eating affect my bipolar disorder?
It is not completely understood how food and diet affect bipolar disorder. It is apparent that missing meals and starving yourself causes bodily stress, which is probably not good for bipolar disorder. Bipolar disorder also sends your body distorted signals that may cause you to crave certain foods. Furthermore, certain foods can affect the way you feel. For example, I have heard from many people with bipolar disorder that their mood can change radically for the better after eating chocolate, carbohydrates, or even a very large meal.

There is no special diet or nutritional scheme that can effectively treat bipolar disorder. However, my impression is that a diet high in protein and low in starch will not worsen bipolar disorder and may help it. I recommend high-quality proteins like beef and lamb and low-fat protein sources such as turkey, chicken, fish, nonfat cottage cheese, yogurt, and low-fat cheeses like ricotta, farmer's cheese, and Mexican cheese. Eggs are high in proteins and easy to fix.

The most important recommendation is that you eat a healthy, nutritionally balanced diet. If you are having problems adhering to healthy eating habits, ask your doctor to recommend a qualified nutritionalist.

Why do I crave chocolate? Does it have anything to do with bipolar disorder?
Chocolate contains compounds like theobromine, caffeine, and trigonelline, which artificially stimulate the body by increasing adrenaline. Another component, called phenylethylamine, is structurally similar to addictive drugs such as amphetamines.

Does sugar worsen bipolar symptoms?
Many patients have told me that they feel hyperactive or manicky after eating "sugar," but I have never found anyone who could get a "sugar high" from eating spoonfuls of table sugar. Therefore, I suspect something else is involved when people feel hyperactive after eating. In addition to sugar, most candies contain a stimulant in the form of chocolate. Health and power bars are similar, with a lot of starch added in the form of grains. Doughnuts, cake, and pie are heavy on starch and fat in addition to sugar. If these make you feel hyper, then stay away from them.

Why do I feel so hopeless about my weight loss?
It is common in bipolar disorder to be extra concerned about your outward appearance. Many with the disorder feel that they cannot go out of the house until they lose weight or that no one will want to associate with a fat person. The burden to lose weight then inhibits those with bipolar disorder from socializing, meeting people, making friends, or applying for a better job.

You will enjoy your life better if you start going out now, before you lose all your weight.

Will going on a diet affect my bipolar disorder? What do you think about the Atkins diet and the South Beach diet?
My bipolar patients are using high-protein diets and losing weight. So far, I have not seen these diets destabilize bipolar disorder. If you have bipolar disorder, you should always discuss your personal health concerns with a doctor before you start a diet, to make sure the plan you choose is right for you.

What else can I do about my weight?
Look into national associations for bipolar disorder, professional and personal websites, and online forums. Talk about your weight issues with other persons with bipolar disorder and find out what works and what does not.

What about diet pills? I heard that if I take them, I can eat all I want and still lose weight.
Sorry. There are no magic weight-loss schemes. The notion of eating everything you want and losing weight is nothing more than a fantasy made up to sell phony diet pills. So is the advertisement that claims you will lose weight without exercise. In fact, stimulant diet pills such as phentermine (Adipex and Ionamin), benzphetamine (Didrex), and methampheatmine (Desoxyn), as well as herbal stimulants, can worsen depression and trigger mania or psychosis in persons with bipolar disorder. Many people like the energy that diet pills give them, but stimulants in the pills can also cause insomnia and put a strain on the heart. It is important that you stay away from them. To get more energy and lose weight, the healthiest and most effective options are to watch your diet and exercise regularly.

My doctor said my weight is endangering my health. Is there a safe medication I can take that can help me regain my health?
There is a prescription medication called orlistat (Xemical) that reduces the amount of fat the body absorbs from food and can be given to those who are severely overweight. My patients who have taken this medication have had success losing weight but progress is slow. Patients in research studies were still losing weight six months after beginning the medication and had not gained it back. This is an important hurdle because it is generally believed that if you can keep weight off for six months, it is much less likely to come back. Patients taking orlistat have also been able to start programs of exercise and diet that had been impossible for them before.

Some people taking orlistat will get gas, cramping, and/or diarrhea and will be unable to take the medication. Consult a doctor who is familiar with orlistat and its use.