Bipolar disorder is one of several mental and physical health conditions associated with an increased risk of developing atherosclerosis (hardening of the arteries) and cardiovascular heart disease. And according to the American Heart Association, that increased risk may be evident early in life. Studies have found that young people with bipolar disorder have above-average rates of elevated triglycerides (blood fats), cholesterol, and blood pressure. Other risk factors for heart disease, such as overweight, obesity, diabetes, metabolic syndrome, smoking tobacco and other substance use, are more common in those with bipolar disorder than the general population.1

People with the most severe mental illnesses, including bipolar disorder, also carry a higher than average risk of early death from physical disease, with life expectancy shortened by 10 to 25 years, and cardiovascular disease recognized as the top cause. There are several reasons for this higher risk, including unhealthy lifestyle choices, access to and use of appropriate health care, side effects attributed to the use of medications such as antidepressants, antipsychotic drugs, and mood stabilizers, and biological factors related to mental illness that can compromise physical health.2

Working It Out

Over the past decade, physical exercise and other lifestyle interventions have become the focus of much research into keeping symptoms of bipolar disorder at bay and improving the day-to-day lives and future health outcomes for those who live with this debilitating condition. Overall, people with bipolar disorder reportedly lead sedentary lives and, perhaps predictably, those who do engage in physical activity get less exercise during periods of depression and more exercise during periods of mania.3

As with any other group, however, the solution is not as simple as advising people to get more exercise or to make any other lifestyle changes, for that matter. There is no “one-size-fits-all” intervention that will work for everyone with bipolar disorder.

For instance, a nation-wide study of bipolar patients found that those who exercised less than once a week, if at all, spent more time feeling depressed, exhibited more symptoms of depression, were less functional in their day-to-day lives and felt they had an overall lower quality of life than those who regularly exercised. On the other hand, those patients who exercised more often also reported experiencing more periods of mania during the previous year and more manic symptoms at the time of the study. The researchers suggest that an intervention aimed not only at encouraging regular physical activity but also more evenly distributed periods of exercise, could be beneficial to some people with bipolar disorder.3

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Food Matters

One small lifestyle intervention program developed by researchers at Harvard Medical School and the Psychiatry Department at Massachusetts General Hospital included nutrition modules that emphasized choosing healthy foods, eating balanced meals, limiting portion sizes, learning strategies to control cravings and understanding the role of various nutrients in good health. The program was well received by patients with bipolar disorder and, in combination with exercise and wellness programs, resulted in overall better eating habits, weight loss, and reduced blood fat, cholesterol and sugars levels over the course of the study. Medical research from Duke University also suggests that following healthier eating patterns, such as those found in a Mediterranean-style diet, may be especially beneficial to the physical and mental health of those with bipolar disorder.4,5

As a group, however, people with bipolar disorder, particularly young females, also have a higher-than-average rate of eating disorders, most commonly binge eating disorder and bulimia nervosa. Both of these conditions involve overeating and could help explain overall higher rates of overweight, obesity and other factors that contribute to the development of heart disease. Eating disorders are also linked to higher rates of mood instability and other issues that affect general health.6 Learning what a healthy diet looks like is just one component of any program or therapy that successfully treats eating disorders.

Personal Choices

In addition to understanding the type of broad lifestyle interventions that may help manage bipolar disorder and related mental health issues, while improving lifestyle habits that contribute to the development of heart disease and other chronic health problems, researchers still need to look into individual factors such as motivation, accessibility, readiness to change, co-existing conditions, and individual beliefs and attitudes toward diet, exercise, and other lifestyle habits, all of which play a large role in the success of any health improvement program. A review of all studies to date, looking at the benefits of lifestyle interventions designed to improve both mental and physical outcomes for people with bipolar disorder, found that these programs can indeed be successful but must take into account a patient’s individual needs and priorities in order for real change to occur.7

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