Inside Bipolar Podcast: Using Supplements For Treatment

Meet Your Inside Bipolar Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: Today, we’re going to talk about supplements. A little while back, we did an episode on cannabis. Cannabis, marijuana edibles, because they’re really, really popular right now. And we started to get some emails that came in and said, hey, you talked about that. What about other supplements? What about things like Saint John’s wort, 5-HTP? Are supplements good? Now, I don’t want to rehash all of the stuff that we talked about in the cannabis episode, but what happens, Dr. Nicole, when somebody says, hey, I don’t want to take the medicine that has all the science behind it because I found some medicine at the mall that I’ve been told on the Internet works better. How does that make you as a medical practitioner, as a doctor feel? When you’re told that the thing at the gas station works just as well as your robust science?

Dr. Nicole: Oh, not gonna lie. A little. A little bit of me dies on the inside. A little. A little piece. It’s tough. And I, I want everybody to hear me when I say I do my absolute best to be as non-judgmental as possible when it comes to this area and my patients. And we talk through it. I love that people come in and they’ve been researching, so it lets me know that they care about their disorder and they want to feel better. I love that part. It also gives me the opportunity to have some discussions about why supplements versus FDA approved meds and we can have some really great conversations surrounding people’s fears and concerns about taking psych meds because that’s everybody’s fear. I don’t want to take psych meds. That’s an episode for a different day, but that is where we are. It’s very, very difficult because it does sometimes feel like people just don’t want to listen to anything that is based in evidence. And they just are so mistrustful of the system. It sometimes makes you think, well, why? Why do we keep doing this dance? If you’re just going to go get supplements from GNC, like why? Why pay a co-pay? Why do all this stuff? If GNC is who you revere as the expert?

Gabe: Let’s go ahead and hit some hard numbers before we get into the nitty gritty. First off, the stats are all over the place when it comes to how big the supplement industry is. There are some studies that put it at 38.9 billion. There’s other studies that put it at 149 billion. Again, these are these are with a B. So, I wanted to dispel this idea that that people on a big rolling farm, you know, sitting outside, growing this beautiful, luscious and from the earth carrying stuff and then, you know, making it in their own homes, Ma and Paul’s farm in the heartland giving you good things for, I don’t know, kindness and love.

Dr. Nicole: Packing things out of the ground into little capsules and closing them each one hand by hand, yeah.

Gabe: With her little arthritic hands.

Dr. Nicole: [Laughter] No, that’s not what’s happening.

Gabe: They try to create this idea. But it’s important to know that their own association, the North American Dietary Supplements Manufacturing Association, puts the level of supplements that are sold at 56.7 billion, again, with a B billion dollars. Some people, as you said, they’re mistrusting. They’re mistrusting of big corporations, of government agencies. And like, no, we can trust the supplement because it’s of the earth and it’s not being pushed on us by billion-dollar corporations. Now, the first thing that I want to say is, you know, GNC, Walmart, grocery stores, these are in fact billion-dollar corporations. So, if your reason for trusting these is oh well, I get this good feeling, that good feeling has been 100% created by marketing. It’s 100% created by unregulated marketing. There’s no FDA approval. Nobody’s watching over this. You don’t know what they’re going to get. And they can say almost anything that they want and they do not have to prove it so they can say, hey, ground up shark’s tooth will provide a help. Right? They never say cure. Right. Because that that’s that could be proven. They can say helps with fill in the blank and that’s where it gets dangerous.

Dr. Nicole: One of the first things I do usually tell people is that the supplement companies can put things out without the FDA even knowing. For a drug to be approved, I mean, my gosh, like it takes it takes a lot of stages and planning and studies and data review. There’s a there’s a lot more that goes into that than supplements. So, I always remind people, even though I know for you it’s anxiety provoking and scary to think about taking these pills because we have this weird connotation about psych meds and people. That’s what people say. Like I Psych meds make you look like a zombie. I don’t want that. I’d rather take a supplement. And so, it sounds better. And I get that. And I’m very sensitive to that. But the FDA and supplements have nothing to do with each other. There is nothing stopping Gabe and I from going out into my backyard and putting some grass in a capsule and saying it has the ability to help with concentration and focus. And all I have to put on there are some of the active ingredients, but then you’ll see proprietary blend on a lot of supplements and you’re like, I don’t even know what that means. What is this proprietary blend stuff that you don’t tell me? Don’t have to tell me. Don’t want to tell me. But I do start with that because I think that’s something that people don’t always understand is the regulation piece. And sometimes that in and of itself gets people to think, oh, well, maybe, maybe I have been a little misguided.

Gabe: Before we continue, I want everybody to know that if you want the Gabe and Dr. Nicole grass blend, if you use code INSIDE, you can save 20%. And we’ll mail those pills right to your house. And

Dr. Nicole: Yeah.

Gabe: We promise they will help with focus, concentration, virality. I mean, just don’t even think I said that word right, Because

Dr. Nicole: Uh.

Gabe: It means that you will be awesome. It helps you lose weight, be stronger, be better, run faster, movies that you didn’t like, you will now like, and you think to yourself, this sounds ridiculous. Yeah, it sounds ridiculous because I’ve made it sound ridiculous. But I think that you could also stop for a second and think, Huh? You know, Gabe and Dr. Nicole have a podcast. It’s associated with the big company. I bet we could do it. And that’s what scares me. I think there are people that would buy our proprietary helps with bipolar blend. And if we could get enough marketing behind it, we could literally sell sugar pills with literally any random combination of stuff and claim that it did X and we would have absolutely nothing to back it up. And here’s the most important thing that I want people to hear. We’re not required to. That. That’s by design. That that’s not a failing on our part, not proving what we’re saying. It’s by design. And I think that that’s scary for people who are in a vulnerable place and who are desperate to get well.

Dr. Nicole: Mhm. And people are looking for answers. People are scared. I want to make sure everybody hears me when I say I am fully aware that the psychiatric medications that we prescribe. When you look at that list that comes from the pharmacy with all those potential side effects, it’s as long as your arm and that can be very scary. I think where the issue comes in is that people just equate supplements with not having side effects or supplements as being cleaner than medication. And that’s just not always the case, especially if you’re treating bipolar disorder.

Gabe: I think we really have to pay attention to the idea that if something has no side effects, what’s it doing? Unfortunately, every positive produces a negative. Let’s take cars, for example. Cars are wonderful. Cars allow us to travel across the country, but cars have downsides. Pollution. They’re expensive. You can crash and get hurt or even die. Cars take up a lot of space. Our tax dollars go to roads. So, there’s positives and there’s negatives. So, there’s a side effect to cars. Pollutions, costs, space, but there’s a positive to cars getting where you’re going faster, being able to work farther from home, seeing people in other states, that is that is a robust look at cars. But what if somebody invented something like, no, it has absolutely nothing negative. It’s 100% positive. That’s not based in reality and it’s not factual. Anything that has the power to do something to your body that’s positive is absolutely, unequivocally going to have the same power to do something negative. And that’s where medical studies come in, because we want to maximize the positive and minimize the negative. And that is where a Dr. Nicole comes in because she knows what to look for. So, when those negatives start coming in, she says, hey, this is not for you and can pull you off with supplements. You’re making the decision. There’s a phrase that’s out there that says if you represent yourself in court as your own lawyer, you have a fool for a client. I would argue that if you’re prescribing your own medication, you have a fool for a doctor. And I think that we really, really, really, really need to look introspectively and decide, are we capable of treating this illness by ourselves with medication that sold over the counter at the local store? And I, I cannot help but think that the answer is always going to unequivocally be no. This is bigger than me and I need outside help.

Dr. Nicole: I’m not going to say that across the board, every supplement is a scam and a hustle and is not going to be effective. They could be. The problem I run into one is there’s often some inconsistency. People will take supplements versus FDA approved medications because of safety concerns. But yet the FDA approved drugs have gone through so much more testing and research than the supplements. So, I usually try to use that as an education piece, like, hey, let’s talk about this. Like, let’s be real about this thing. Also, people who don’t want to take meds because it’s not safe and they prefer more natural things, often have horrible diets. I’ll ask them, you know, kind of stuff. Do you eat? You ever eat Twinkies? What kind of processed you eat hot dogs, you eat, you know, you’re eating burgers from fast food restaurants like clearly natural. I don’t have a lot of vegans telling me, oh, I only want to do. So, I usually use that in a little like teasing way to break the ice so that we can have the conversation about safety. It’s just tease them a little bit. Um,

Gabe: I like that you framed it as teasing a little bit, but you’re right. The same people that want to take the supplement because it’s natural and it’s better and it’s safer, etc., are eating garbage and, you know, garbage foods, processed foods, bagged foods, a lot of potato chips, pizza, etc. And here’s the here’s the rub here, though. If you want to improve your health, both physical and mental health, changing your diet dramatically, lean meats, vegetables, getting exercise 20 minutes a day, sleep hygiene, things like that, things that have nothing to do with the supplement industry and nothing to do with the pharmaceutical industry are absolutely, unequivocally proven to help you manage bipolar disorder. And we’re skipping over that one.

Dr. Nicole: Yes, we are. And some of the supplements that people take are things that your body naturally makes or gets from certain foods. So, you could, by changing your diet, in some cases, increase your levels of those omega three fatty acids that you’re trying to get into your body by supplement or the 5-HTP that you’re trying to get into your body that absolutely you can get from a change in diet.

Gabe: Dr. Nicole, I have a question for you, but before we move on, I want to say that I like I like that our listeners look at the pharmaceutical industry through skeptical eyes. I like this. You should be proactive in your own care. What I’m really saying is that I want you to look at the supplement industry through the same lens, be just as skeptical of them as you are of the pharmaceutical industry. And I think that will move forward. And this is the genesis of my question. You mentioned that people mention these supplements to you. Now, a lot of people believe that doctors will never talk about supplements. Their psychiatrist doesn’t want to deal with it. They don’t want to hear about it. And I have been saying for years, everything that you take, whether over-the-counter prescribed, wherever you get it, your doctor needs to know about it. And I say this both with supplements and drug and alcohol use. If you are using an illegal substance, tell your psychiatrist because it could be impacting your care. Is that true? Do you want people to talk to you about their supplement use?

Dr. Nicole: 100%. I want to know. So, when I do an initial evaluation and I ask people, do you take any medication on a regular basis? People will say no. And then I will follow up with, well, do you take any supplements or vitamins or anything like that? And then that’s when I get the list. Typically, on the front end, I think people don’t equate supplements as being medicine. They don’t think of it that way. And I do. And so that’s one of those things that I actually have to work on being more clear when I ask that question. A lot of my patients are very good about saying, hey, I found this on the Internet and I’ve been taking this and it makes me feel great once I look it up and see what it is. If there are interactions, we’ll talk about it. But if not, I’m not going to tell somebody don’t take something that they say makes them feel good. Just because the supplements aren’t FDA approved doesn’t mean that there can’t be some benefit in them. So, I’m open to that for sure. I just need to make sure that we’re doing it in a safe way. So, I need you to tell me and your doctor needs you to tell them so that they can do the interaction check. We can check interactions; we can look and see what’s in it. We can tell you, oh, you might want to back off on this or that. We can do that, but not if you don’t tell us.

Sponsor Break

Dr. Nicole: And we’re back discussing supplements and bipolar disorder.

Gabe: There are, as far as I can tell, hundreds of thousands of supplements, natural remedies, natural treatments. I tried to Google it. Doctor. My, my, my, me. My head almost exploded. And I work on the internet for a living. There just seems to be every other site had had some, like you said, proprietary blend, special blend. This treats this, just pro this anti that fixes that solves that corrects it. It was it was absolutely amazing. So, we boiled this down to a few that you hear about a lot and one of them that you mentioned straight off the bat that’s been around for a long time was fish oils, omega-3. Hell, we’re given that to my dog now, that’s how popular fish oil has become.

Dr. Nicole: Yeah, there are a lot of positive effects. Official I think we in the medical community, we have wrapped our hands around the cardiovascular benefits of taking a gram a day. It’s just important to know one, you know, these are also things that you could get from your diet. You can get the omega-3s in in your in the foods that you eat. So, if you really want to be natural and go for it, you know, figuring out what a diet would look like that gave you these things would be really cool because I think it would, you know, give you a little more power and control and just be healthier overall. But yeah, the omega-3s, if you take one, make sure it has both the EPA and DHA in it and a gram of day is what most people will recommend. We think it has a positive effect for depression or can have a positive effect.

Dr. Nicole: I say can because really the data is inconclusive. Depression is the state that we tend to think of it as being effective for not mania. It also depends on the severity of your depression. You know, is this a very mild depression? Is this. A person who has a moderate or severe mood disorder? Fish oil is likely not to be not to be your jam. It’s not going to be the thing that pulls you out of that depression. But there’s literally nothing wrong with you taking a gram a day of omega-3. The cardiovascular benefits alone will outweigh anything.

Gabe: Sometimes I think that a little bit of history is a good thing. And let’s talk about where fish oil came from. A long, long time ago, a couple of researchers noticed that Alzheimer’s and dementia was not as prevalent in countries that had a lot of fish in their diet. So, they said, hey, maybe this is a protective factor for brain health. So that’s the first thing. They had a hypothesis. So, the second thing that they did is tested it. And as it turns out, no, the reason that there was less reporting of Alzheimer’s and dementia is because in those cultures, the older generation was taking care of at home. And while they were definitely having symptoms of dementia and Alzheimer’s, they were less likely to be diagnosed with it. So, it turns out that it wasn’t a protective factor for dementia and Alzheimer’s, and we learned that.

Gabe: But serendipitously, we did find out that it had other benefits. But as you pointed out, we already knew that it had those benefits and you could get that from eating fish. Your diet could provide some of these things. It’s interesting to understand that that’s where science comes from, because what the media reported is that fish oil may stop dementia. Fish oil may help with brain health, Fish oil may stop. And that was the headline. And because people weren’t reading the study, seeing the outcome of the study, they were just responding to the headlines. And then, of course, the supplement industry was like, hey, these are great headlines based on a hypothesis that is yet to be proven and would ultimately not be proven. Everybody jumped behind this and everybody is still jumping behind this. Now, as you pointed out, Dr. Nicole, there are benefits and there doesn’t seem to be a lot of downside. And again, it’s all in moderation. It’s what you eat. And of course, remember, supplements don’t have to be regulated. So, what you’re buying, we don’t know how pure it is, how good it is. We’ve there’s definitely a big difference between the $80 bottle of fish oil and the $10 bottle of fish oil. For one thing, there’s a $70 difference. But you’ve got to figure the quality is going to differ as well.

Gabe: I also want to take this opportunity to point out that manufacturers can do whatever they want with their product without telling anybody, really. I mean, they have to put it on the label. I’m not saying that there’s no consumer protection laws, but when you come to the drugs that are prescribed, there’s standards. I trust prescribed medications to be more regulated and regimented than I do a private consumer company that can do whatever they want. Even if I stick with the same brand of fish oil, they can change it without telling me. And you think, well, is that true, Gabe? Listen, anybody who grew up in the 90’s eating Lucky Charms has noticed a marked difference in the amount of marshmallows in Lucky Charms in 2023. They are giving us less marshmallows because they changed the recipe. Right. And they’re allowed to change the recipe and they don’t even have to tell you. And now they have special editions with double marshmallows. Back in my day, double marshmallows was the regular.

Dr. Nicole: [Laughter]

Gabe: We have to start looking at supplements like we look at Lucky Charms. They didn’t have to tell anybody. There’s no regulation. They can do whatever they want. It can be a different potency. It can be a different sourcing of the product. It can have a different they can just make changes and they really don’t have to give you any warning at all. These are big differences between supplements and prescriptions that you need to be aware of.

Dr. Nicole: I think that makes absolute sense. It is all about safety, consistency. I think we should strive for consistency. We just don’t have that in the supplement world. And I think that is more scary to me than anything. We put a lot of blind faith into these supplement companies and like I said earlier, I think supplements can be effective, but we have to have realistic expectations of what we think a supplement can do for us.

Gabe: What are some other popular supplements that folks are taking?

Dr. Nicole: Oh, let’s go ahead and get my good friend Saint John’s wort out the way.

Gabe: Very popular. I’ve heard about that one for years.

Dr. Nicole: [Laughter] I will tell you, of all the supplements that people tell me they take. I know we started the episode with me saying a piece of me dies on the inside, but really, I only die when they mentioned Saint John’s wort. That’s really the only one that when people say, oh, I’ve been taking Saint John’s wort, my stomach drops and I’ll tell you why. Saint John’s wort has the ability to work well, we have studies that show that it can be effective for depression. The problem is, I have seen in the hospital setting people admitted with mania from taking Saint John’s wort. People admitted with psychosis from taking Saint John’s wort because it affects serotonin levels. It can act almost like an SSRI. And because you wouldn’t take an SSRI with your bipolar illness without talking to your doctor, because we know that it has the ability, the SSRIs, to switch you to a manic episode. We also don’t want you to just randomly start Saint John’s wort without talking to us either. But I’ve seen that happen where people go into a depression and some loved one says, oh, you should take Saint John’s wort. I take Saint John’s wort when I’m depressed and it works great. It may work great for that person, but they don’t have bipolar disorder and so they give it to you and you take it and then you’re in the hospital. And let’s face it, we live in a world where if a little bit is good, a lot more might be better. So, people will take extra supplements because they think they’re harmless. They’re like, oh, it’s just a, it’s just a supplement. It’s just an herb. It’s just Saint John’s wort. Like, it’s not that serious. It’s not like I’m over here doubling up on Prozac, but you might as well be because if the outcome is the same, you might as well be.

Gabe: I’m always fascinated by this concept that the supplement is so powerful it is going to provide me relief from bipolar disorder, from a serious and persistent mental illness with a 15% death rate. Bipolar disorder is so, so serious. And this supplement is going to provide relief from that. And it’s equally harmless. It just it can’t be both. If it can absolutely impact the disease process, the illness process of bipolar disorder, then it absolutely, if taken incorrectly, can provide great harm. And since you are deciding how to prescribe your own medication in this case because you don’t have a doctor Nicole, and you’re just you’re standing at the grocery store or the local drugstore or the local supplement store and you’re determining it. You got to ask yourself, do I have the ability to know what to prescribe myself? And at the same number of people that would never try to fix their own car because that’s complicated, are literally trying to treat their own disease process and their own body with over-the-counter supplements and thinking, Oh, well, it’s harmless. It can’t possibly be both.

Dr. Nicole: And it can also interact with other medications that you take for other reasons. So, if let’s say you do have depression and you say, my antidepressant isn’t quite doing it all the way, I’m going to add a little Saint John’s wort. Saint John’s wort can interact with antidepressants. It can interact with the statins. So, if you’re on a statin for cholesterol, it can interact with that. If you have migraines and you take one of the triptans, it can interact with that. It can interact with your birth control pills. How about that, ladies? It can interact with your birth control pill. It can interact with some blood thinners and medications we take for heartburn. So, I think it’s important to talk to your physician, your primary care, your psychiatrist. They need to know because. We don’t need bad juju happening when we’re talking about blood clotting and cholesterol treatment and birth control. Like we don’t need that kind of smoke and to have to deal with that. So, I think it’s very, very important. Well, I don’t think I know it is extremely important that you make sure your doctors know that you’re taking it if you are. And I actually wouldn’t even start it without talking to your doctor.

Gabe: Another really popular treatment for bipolar disorder supplement wise that I hear about a lot is 5-HTP. I know very little about this. I don’t know if it’s newer or if it just became in vogue recently. What is 5-HTP and why do people think that it works for bipolar disorder and does it work for bipolar disorder?

Dr. Nicole: Yeah, well, it’s not new because your body makes it so. Your body produces this 5-HTP, this 5-hydroxytryptophan. Your body produces it from l-tryptophan and amino acids. So, we all hear about tryptophan in turkey and Thanksgiving, right? We all hear people talk about, oh, that’s why you go to sleep when you eat turkey, because the tryptophan and the turkey, whatever. I don’t know. I’m pretty sure it’s all the carbs that you go eat with the turkey that add to your slumber after you eat Thanksgiving meal. But it’s 5-HTP is naturally produced by your body and it is a precursor to serotonin production. So, I think people feel more comfortable with it because they think, oh, SSRI is bad. But the supplement that my body already makes, I could just go ahead and add a little bit more and maybe it’ll boost my serotonin production. Yeah, you know, is that true? Is that not, um, the it can help some people with mood. But again, you have to remember, when you’re dealing with bipolar illness, you’re not just worried about a mild depression. You have to keep mania under consideration. If you have more moderate to severe depression, you have to keep that under consideration. It’s an it’s a bit more of a balancing act with bipolar disorder. And honestly, if you want to get more 5-HTP, get it from your diet, figure out how to eat foods that can increase that in your body. But also 5-HTP interacts with things just like Saint John’s wort. So, it will interact with your antidepressants. It will interact with some like cough syrup, cold medicine preparations. If you’re somebody who deals with pain and you take tramadol, it could interfere with that. Those triptans, again, that migraine medication, it can interfere with that. So, it’s not benign. And just because your body produces it doesn’t mean that you shouldn’t tell your doctor about it, because it can also interact with some of the things that you’re already taking.

Gabe: I’ve noticed a theme throughout this podcast where people think that because your body produces something naturally, that it is safe. And it’s a little bit curious to me because at first blush I’m like, well, yeah, my body produces it. How could it be dangerous? But then I think about water. Water can absolutely be dangerous, but it also is necessary for our bodies to live. But there’s even water toxicity where if you drink too much water, you can become sick. And of course, everybody knows you can drown in water. So just because our body produces water and we need water to survive doesn’t mean that water can’t reach the level of danger. We need to think about our supplements in the exact same way. We’re not telling you to run screaming from them. We’re just telling you that supplements have two problems. One, they may or may not work. And two, if they can work, they need to be taken correctly and in the right doses with the right manufacturing. And all of those things are very sketchy over in supplement world. So, it’s really hard to do a show like this because I know somebody’s going to write me and say, look, but you just said that all of those things work and then you trashed them. But it and I and I feel that I don’t want to be a hypocrite. I really, really don’t. I’ve taken fish oil. When I first got sick, I took Saint John’s wort, but I did not get what I wanted out of it because I didn’t know anything about it.

Gabe: I don’t want to trash this stuff because as you’ve pointed out, some of this stuff, if used correctly, can work. It’s just like, hey, list off the supplements. Do they have some benefit? Saint John’s wort? It could have benefits if you’re right for it. Fish oil could have benefits if you’re right for it. 5-HTP, it could have benefits if your right to it. I guess that’s true of everything. I think anything

Dr. Nicole: Mhm.

Gabe: Can have some benefits if used correctly. So, it’s not a yes or no question. What scares me and what has always scared me about supplements is that they’re asking people who are sick and vulnerable and, in many cases, desperate to make medical decisions all by themselves and hope for the best outcome. And I think that that’s very, very scary and very, very dangerous. I know that we don’t have a lot of time left, but I have to ask because everybody I know, pretty much every person with bipolar disorder. I know. But everybody I know takes vitamin D; it is just touted everywhere as the wonder drug. We all need more vitamin D, and if I’m not mistaken, our foods are fortified with vitamin D. That’s how important vitamin D is. What’s the risk in just grabbing that off the off the shelf and taking it? I mean, isn’t that the wonder vitamin?

Dr. Nicole: It can be for a lot of people. I discourage you from overtaking any vitamin because some of them you can, I guess, overdose on like you. There are some supplements, some vitamins you can take too much of. So, before you go and load your basket up with all the alphabet of vitamins, make sure you talk to your primary care doctor. And if you don’t have one, you need one. Because if you’re taking all these supplements, you’re obviously trying to prevent something. So, the best way to know if it’s working is for an annual physical exam. Routine labs. Let’s see what that cholesterol looks like. Let’s check that blood pressure. Let’s get this stuff going. But make sure you talk to somebody professionally because you can’t overtake vitamins. Some you can’t, but some you can. Vitamin D is tricky. We know that a lot of people are walking around vitamin D deficient. Your body gets most of your vitamin D from the sun and from your diet. If you don’t spend a lot of time out in the sun, it’s going to make it difficult to get that production going. If you’re if you’re not out there taking advantage of the primary source and if you’re a darker skinned person, that ability is going to be decreased anyway. And in some communities, there is less access to foods that contain vitamin D, so then they’re not getting it as much from the food and from the diet.

Dr. Nicole: So, supplementation might be necessary. There is data out there that in general you might see low vitamin D across a variety of mental health diagnoses, but nothing specific to bipolar disorder. But in general, there is some research to support that. There are lower vitamin D levels across the board. What does that mean? We have no idea. But vitamin D, if you are deficient, can affect your mood balance. You can feel fatigue, you can feel down. You’re not you don’t have as much energy. So, you may come to me and say, Oh, I’m depressed. Like my energy is low. I’m just really down. I don’t have a lot of motivation to get up and get going and we’re treating your depression. So, I may order a vitamin D level. Your primary care doctor may order a vitamin D level, and we’ll see if you’re deficient and we’ll replace it. But a lot of people were walking around with low vitamin D, and you have to remember, we’re exiting the pandemic when people were inside and not going out as much. And so, all those things play a role.

Gabe: I really think it’s fair to say that if you’re deficient in anything that your body needs, you’re not going to feel your best. I don’t think that has anything to do with bipolar disorder. I think that’s for everybody. And obviously people who live with bipolar disorder, we have bodies, we have physical health. Is that true? If you’re deficient in anything, you’re not going to feel well. And perhaps people think that, oh, it’s my bipolar disorder, when in fact, it could be, for example, a vitamin deficiency or high blood pressure or high cholesterol or any number of things. And this is yet another reason why it’s so important to follow up with a medical provider to make sure that you’re not accidentally trying to solve a physical health problem with bipolar disorder supplements.

Dr. Nicole: Yeah, I think it’s important to talk to someone because you don’t know. And that whole not feeling well. Sometimes, that not feeling well is something that you can 100% put your finger on. Like we talked about vitamin D deficiency causing fatigue and you feel like your motivation is low. Sometimes it’s that simple. But being deficient in certain vitamins can also lead to other physical health things that you just aren’t even aware are happening within your body. So that’s why it’s important that you do have an annual physical exam.

Gabe: I loved doing this episode because I learned so much. And one of the things that I did learn, if I’m being honest, is that it’s not cut and dry. I wanted to start this episode by saying, don’t take supplements. They’re all a scam. Quit it. And it is much more nuanced and I do want to give space for that. The biggest thing that I learned, and maybe the only takeaway I want our listeners to have is you should absolutely, unequivocally disclose your supplement use to your psychiatrist, your general practitioner. Hiding it back and not telling them is just as dangerous as being prescribed a medication, not taking it and not telling your doctor. So, if you learned nothing else, if you’ve arrived at no other conclusions, and if you’ve just been like, why did I listen to this thing? If you only take this away, if you are taking any supplement, no matter how insignificant you feel that it is or how safe you think that it is, absolutely Share it with your medical provider because that will help them, right?

Dr. Nicole: Yeah. And be as discerning, we’ll say discerning, not skeptical. Be as discerning of supplements as you are of the medications that your doctors are prescribing. Give it the same side-eye. Bring the same energy. Do your same research and just have that same kind of healthy skepticism of a new thing. And if you’re going to take a supplement, make sure you’re taking something that has a good reputation behind it. The manufacturer has a good reputation behind it and take something of value.

Gabe: Dr. Nicole, it is always great learning from you. Thank you so much for the education about supplements. I really, really did learn a lot. Thank you, everybody, so much for being here. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also a national public speaker who could be available for your next event. You can grab my book on Amazon or wherever fine books are sold, or you can get a signed copy with free swag just by heading over to gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all those social media platforms @DrNicolePsych to see all the fun things I have my hand in at any given moment.

Gabe: If you can do us a favor, wherever you downloaded this episode, please follow or subscribe. It is absolutely free and tell people about the show. Share it on social media, share it in a support group. Send somebody an email, mention it around the water cooler. Hell, send a text because sharing the show is how we grow. We will see everybody next time on Inside Bipolar.

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