March 10, 2025 • 54 mins
Dr. Sheri Johnson shares groundbreaking research on how circadian rhythms and reward sensitivity affect bipolar symptoms, offering practical approaches to wellness through lifestyle interventions. Her work at UC Berkeley's CALM program explores how time-restricted eating and Mediterranean diet patterns can strengthen body rhythms and improve mood stability.
• Bipolar symptoms affect circadian rhythms, with genetic factors influencing clock genes throughout the body
• Time-restricted eating (consuming food within a consistent 10-hour window) helps reset disrupted body clocks
• The Mediterranean diet provides essential nutrients for brain health without rigid restrictions
• Blue light from screens suppresses melatonin production, making sleep difficulties worse
• Small, incremental habit changes are more sustainable than overwhelming lifestyle overhauls
• People with bipolar symptoms often have heightened reward sensitivity that can be both a gift (creativity, drive) and challenge
• Including people with lived experience in research design improves treatment approaches
• Mindfulness, journaling, and relaxation techniques can help manage nighttime awakening
Visit calm.Berkeley.edu/participate to learn about participating in current studies on time-restricted eating, Mediterranean diet, or the upcoming study on reward sensitivity and circadian rhythms.
Instagram: @ucbcalmprogram
Facebook: The CALM Program at UC Berkeley
X: @calmprogram
Bluesky: @ucbcalmprogram
Tiktok: @ucbcalmprogram
Bio:
Dr. Johnson is the Director of the Cal Mania (CALM) Program at the University of California Berkeley. She has received funding from NARSAD, NIMH, NSF, and NCI. She has published six books and over 300 manuscripts. She is a fellow of the American Association for the Advancement of Science, Association for Behavioral Medicine Research, and the Association for Psychological Science, and the Center for Advanced Study in the Behavioral Sciences (2013-2014).
Her work focuses on circadian rhythms, impulsivity and reward sensitivity in bipolar disorder. She has used a broad range of techniques, from neuroimaging to cognitive and behavioral testing and personality tests, to understand these mechanisms. Drawing on basic science, she has conducted treatment development research to target these dimensions.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Having bipolar disorder in the family and in
the genes is related to whetheryou're going to become a
military general.
You're going to create acompany.
Your company's going to make alot of money.
Kay Jamison has written abouthow many unbelievable artists
have had this, how many authors.
So that big dream thing is agift, but it's a curse.
Speaker 2 (00:25):
It's a gift but it's a curse.
Hey, welcome to the Upside ofBipolar conversations on the
road to wellness.
I am so excited that youdecided to join me today.
We're a community learning howto live well with bipolar
disorder and we reject that.
The best we can expect islearning how to suffer well with
it.
I'm your host, michelleReitinger of MyUpsideOfDowncom,
(00:47):
where I help people with bipolardisorder use the map to
wellness to live healthy,balanced, productive lives.
Welcome to the conversation.
Hey, welcome to the Upside ofBipolar.
I am your host, michelleReitinger, and I have a
(01:07):
fantastic guest today for you.
Dr Sherry Johnson is thedirector of Calmania, or CALM,
program at the University ofCalifornia, berkeley.
She has received funding fromNARSAD, nimh, nsf and NCI.
She has published six books andover 300 manuscripts.
She is a fellow of the AmericanAssociation for the Advancement
(01:30):
of Science, association forBehavioral Medicine and the
Association for PsychologicalScience and the Center for
Advanced Study in the BehavioralSciences.
Her work focuses on circadianrhythms, impulsivity and reward
sensitivities in bipolardisorder.
She has used a broad range oftechniques, from neuroimaging to
cognitive and behavioraltesting and personality tests,
(01:52):
to understand these mechanisms.
Drawing on basic science, shehas conducted treatment
development research to targetthese dimensions.
I am so excited to interviewyou today.
Thank you so much for joiningus.
Speaker 1 (02:04):
So thrilled to have the chance to meet with you.
I'm such a fan of the work youdo and the information you bring
forward, and I'm thrilled tohave this conversation.
Thank you.
Speaker 2 (02:16):
Wonderful.
Well, let's start with yourstory.
We always start witheverybody's story.
Speaker 1 (02:21):
I come from a family where a lot of the women have
struggled with their moods.
Nobody in those days wasgetting a lot of diagnoses, but
it was always familiar for meand so I was drawn into
psychology.
I thought I was going to studydepression.
I went through my PhD programand went off to an inpatient
mood disorder center where theystarted assigning me to work
(02:44):
with people who had bipolar.
And I loved the people.
There's a little extra sparkle,there's a little extra energy,
a little extra drive.
But also this profound sense ofhow does somebody navigate when
the differences in their beingare so profound during a mania
versus their regular self justhooked me.
(03:08):
So I started working with peopleclinically and then I was
working with somebody I reallydeeply admired who had bipolar
disorder and he said wait, Idon't get it.
You keep planning to studydepression.
And is there anything moreprofound than trying to figure
out why people move into maniaswhen they do?
(03:30):
When we don't have thoseanswers, how could you not
choose that as your science goal?
And it was one of thoselife-changing moments where I
just kind of looked across theroom and thought he's right and
did a pivot and started, youknow, trying to figure out how
(03:50):
do I get funding and how do Iget expertise to kind of focus
on that.
That conversation, and a coupleothers like that, shaped
decades of my life.
Speaker 2 (04:01):
That's incredible.
And it's so interesting becausefor all the years that I was
struggling with my symptoms,initially I didn't have any idea
what was causing anything.
It just felt like thisunpredictable experience that I
was getting yanked onto a rollercoaster I was holding on for
dear life until it was over, andthen I would survey the damage
afterwards and then rinse andrepeat.
(04:23):
You know, it was just and ityou feel like for me.
I was constantly questioningmyself, constantly questioning
is this, is this normal, is thismania, is this like?
What's going on with me?
And it made me.
I got to a point where I wasvery insecure.
I constantly insecure aboutdecision making, about, you know
(04:43):
, ideas that I had.
You know I would get these bigideas and start huge projects
and then cause a lot of damageto my family and to myself.
And and I got to the pointwhere I was like afraid, afraid,
I was scared.
It caused a lot of fear andanxiety for me.
Speaker 1 (04:57):
Yeah, yeah, no.
And so, michelle, I think youknow what you've done listening
to your narrative is you've goneso deep into thinking about
what are the triggers, what arethe things I need to do to
protect my life if I'm feeling,you know, out of sorts, what are
the ways I need to recoverafter going through that.
(05:19):
And there's a real brillianceabout that that I just I find
very profound.
And there's a real brillianceabout that that I just I find
very profound.
And part of me has always sortof felt like why are we not
listening to what people sayabout these triggers and how
they got through those episodesand how they protected their
life and then distributing that?
Why are we counting on so manypeople to reinvent that?
Which is why I'm such a fan ofyour podcast, because you're so
(05:42):
beautiful in the way youdescribe that process for people
, but I also think theclinicians.
You describe that process forpeople, but I also think the
clinicians need to take this toheart and the researchers need
to listen and kind of do theresearch to put that on the map.
So the first study I planned inbipolar disorder I was going to
look at like negative lifeevents, right, and people who
had bipolar disorder keptsigning up but then crossing out
(06:05):
what I said were the studygoals and saying to me you're
studying the wrong thing.
You need to study the timeswhen we get super excited and
goal-driven and reward-orientedand can kind of see this amazing
thing that's gonna happen andit gets too big for us.
And so I was like, okay, yeah,I better listen when 10 people
like take your study and sayI'll help you, but you're doing
(06:30):
the wrong thing.
Speaker 2 (06:30):
Let's x that out and get you on track, and that also
was a game changer for me.
So, yeah, and that's incredible.
I think one of the things thathas been was very discouraging
and I've heard this repeatedlyfrom I don't know how many
people is when people won'tlisten to us.
I think there is, you know,especially during
hospitalizations.
I had severe trauma fromhospitalizations where I was
where I knew better Meaning.
(06:52):
I know myself, I know whatyou're telling me to do is is
going to cause problems, and Iwas told you know, no, I'm the,
I'm the doctor, I know better.
You need to listen to me andyou know, for example, when at
the end of one of my longhospitalization, they were
insisting on putting me on amedication that had triggered
psychosis in me and I and I kepttelling him like this is not
(07:14):
good for me and I had nobodyelse there to advocate for me.
It was me by myself and I was solonely for my family.
I missed my children, I missedmy husband, I wanted to go home
and I was being told you can'tleave unless you accept this.
And it caught, it triggered amajor episode, it caused all
kinds of problems and that's oneof the things that is very
discouraging a lot of times isthat I think we feel discounted
(07:36):
and dismissed and, like people,don't you know, we're less than
in some ways, we're a patient tobe worked on rather than a
person to be listened to, andthat's one of the reasons why I
love what you're saying.
You know that you listen to andaltered what you were doing
because you realize that thepeople that you were trying to
study and help had someperspective that maybe you
didn't.
You didn't understand yourself.
Speaker 1 (07:59):
Totally I.
So one of the things I findmost exciting that's changing, I
think, rapidly in our field notrapidly enough, but it is
changing is bringing livedexperience into the research,
into the university, into thetraining, and I see that as a
really really healthy, importantpart of this.
(08:19):
When I started thinking aboutdoing my current study, I
reached out to somebody I knewwho had bipolar disorder and I
said I kind of want you to bepart of this from the ground up
this time.
And so we now we have a boardof people with lived experience,
we have people who are in everyweekly meeting, who are doing
coaching with us, and havingtheir voices has helped me not
(08:43):
make mistakes a lot of times andit really, you know, from the
ground up we thought, okay, whatI want to do.
I want to help people kind offollow a healthy diet, follow a
healthy lifestyle, give themcoaching around that and see if
it helps their whole well-being,see if it helps their bipolar
symptoms.
And I thought, okay, we can dothis.
(09:04):
And it was my lived experienceboard who was like, well, what
resources are you going to buildin from the get-go about if I'm
too tired to get out of bed?
What's healthy eating look like?
If I have lost motivation andfaith, what are you building in
about?
How do I get back on track thenext week?
So they were really justamazing in kind of coming
(09:28):
forward with.
What are the strategies we needto give people?
What are the supports we needto give people Knowing like it's
pretty darn hard to makebehavioral change?
Everybody in the universe knowslike have a healthy lifestyle,
that's great for you, and lookat how many people in the world
cannot pull that off right.
It's not just people withbipolar disorder that find it
(09:51):
really hard to follow abeautifully healthy lifestyle.
It's just it's hard.
So in so many ways, the livedexperience core has been just
amazing to me to work closelywith and I hope that we'll see
that in more and more researchteams.
Speaker 2 (10:04):
Yeah, absolutely, and I, you know, see that in more
and more research teams.
Yeah, absolutely, and I, youknow what I love about what
you're saying.
I've listened to doctors who Ithink they identify as holistic
psychiatrists who are usingalternative treatment methods,
which I fully support.
However, one of the challengesis a lot of times they don't
listen to people.
So, for one example inparticular is ketogenic diets,
(10:26):
and ketogenic diets are reallyhard for anybody to put into
place, let alone somebody who isstruggling with mood symptoms,
and I tried to do ketogenicyears ago and my family was
lucky to get any food.
You know we were.
We went through periods of timewhere I was struggling to get
out of bed.
I wasn't taking showers.
I would you showers.
I was going through severedepressive episodes, and then I
(10:46):
would get into this mode of likeokay, we've got to change our
diet, and it would trigger ahypomanic episode and I would
get all this stuff.
I would get hyper-focused onmeal prepping and all this stuff
, and then it's like revvingyour engine for an extended
period of time.
I would rev the engine to thepoint of crashing and then it
would.
It would.
It's like revving your enginefor an extended period of time,
I would rev the engine to thepoint of crashing, and then it
(11:07):
would crash.
I would feel like a failure.
Nobody was eating anything andagain, I wasn't shopping, you
know, and so I've recognized alot of times you present these
really complicated scenarios forpeople who need something
really super basic and and alsonot to feel like a failure when
when you struggle with it.
And so I loved that about whatyou're doing with your study
(11:28):
when I was introduced to thestudy.
That you're doing is that youprovide coaches that understand
what the people are goingthrough.
You provide people thatunderstand.
You have people working on, I'massuming, on the way that the
study is set up in the firstplace, helping you get insight
into what kind of challengespeople might run into in that
scenario.
So I mean that is brilliant andI want to see more of that,
(11:49):
because that's how you actuallyget to success.
We're not lab rats.
We are people who arestruggling with pretty serious
symptoms and we want to get well, but a lot of times, some of
that is outside of our likepower the idea of doing these
big things, making these hugechanges that require a lot of
consistency and and effort.
(12:11):
If we start getting.
That could actually be atrigger for hypomania.
Speaker 1 (12:14):
I love that you also touched on this other part of it
, which is that one of thethings I think a lot about with
mania is that kind of gettingcaptured by something exciting
and goal oriented and thatgetting too big and too
uncontrollable and there's arisk for lifestyle change, that
it's too big, right.
(12:34):
So one of the things we builtin really early on was well, how
do you think about one feasiblechange every week, practice
that, see how it goes.
Then you do your next changeLike and if all your goal is to
make sure that when you go tothe grocery store this week you
get some extra fruits to add tothe diet this week, that's
(12:56):
fabulous.
That's great and it'sinteresting.
You know I'm supervising allthese coaching sessions and you
know you can just hear thisdrive.
You can hear how much peoplewant to take it on full force,
go hard at this, do everythingthey can for their health,
everything for the research, forthe science, and so my coaches
(13:17):
are often the ones who aresaying, okay, that's great, but
what's the most important parthere and what do we need to
focus on first and what's goingto be hard about this?
Let's go ahead and dwell on.
Where's that going to gettricky with, you know, big
dreams, big hopes, big goals.
Um, how do we?
How do we pace it?
Speaker 2 (13:35):
yeah, so let's talk a little bit.
I want to talk.
Probably we got a little bitahead.
I want to go back just a littlebit and talk about your
studying of like triggers, for Ibelieve that you studied like
the triggers for hypomania andmania, and is that what led to
this, or are those?
I'm assuming those things haveto be related somehow.
Speaker 1 (13:56):
They are.
So I think about two kinds oftriggers and things that can
kind of weave into kind of manicvulnerability.
One is this kind of what wecall reward, this sense of
getting too enticed by the goalsand all of a sudden you're up
and going and it's two in themorning and everybody else has
(14:17):
piped down and you're stillalive with where this could go
and how this is going to unfoldand what it's going to mean and
people getting too excited aboutthat.
So we've done a lot of work onthat over the years.
But part of that, and the partthat we've gotten really
interested in too, is there's athing called the circadian
rhythm, your day-night rhythm,and it's biologically wired.
(14:39):
So we know a lot about yourbody, has a lot of internal
clocks.
You have an internal clock inyour body, has a lot of internal
clocks.
You have an internal clock inyour brain, but you have
internal clocks in almost everycell of your body and every
organ of your body and it'sgenetically driven and then it's
influenced by lifestyle factors.
Good health means having areally strong circadian rhythm
(15:01):
so that when it's daytime youare on and full of your energy
and you're concentrating andeverything feels good, and when
it's daytime, you are on andfull of your energy and you're
concentrating and everythingfeels good.
And when it's time to go tosleep, you go to sleep, you
drift off to sleep, you sleepdeeply, you sleep through the
night.
Everything's good.
For many people with bipolardisorder, there's genes for
clock, genes that are not aspowerful.
(15:21):
There's signs before theillness that that rhythm isn't
as strong, and when that rhythmgets out of whack it's sometimes
a little tell that mania is.
They're at higher risk formania.
So we've been fascinated aboutwhat happens when those two
processes collide.
(15:41):
So now imagine that I'm not theperson who gets great clues
from my body that it's time topower down and go to sleep, and
I just moved into a phase whereI am on fire about conquering
things and there's nothing in mybrain that goes that's all
great, pick it up tomorrow.
I'm going to stay through thenight and make this happen.
(16:01):
And now I'm missing all thosebeautiful things that happened
during sleep.
To reset my dopamine, give me abreather, give me back my
perspective.
So by six in the morning, whenother people start waking up,
I've been up all night.
Go and go and go and the wholething begins to take off.
So those are two things.
(16:22):
That was a handful.
Do you want?
Speaker 2 (16:24):
me to talk?
Yeah, I do want to.
I want to talk a little bitmore about circadian rhythm
because I think I think there'sa.
Often people understand thatsleep is important, but I don't
think that people fullyunderstand why, and I've.
You know, I had one young womanon my show a long while back.
She was one of my earlierguests whose first manic episode
was brought on by sleeplessness.
(16:44):
She went several days withoutany sleep and started having a
psychotic episode.
You know she, she ended up infull blown psychosis, ended up
hospitalized, and this, thislack of sleep, seemed to be the
trigger for you know, so it's.
It feels a little bit likechicken and an egg, the chicken
and the egg kind of thing where,like, did this, did the
(17:06):
sleeplessness cause that?
You know, you know what I mean.
Like it starts to feel likeyou're chasing your tail a
little bit with it.
But, but I also, as I've gonethrough the healing process,
found myself settling into amore natural circadian rhythm.
I recognized that thatsleeplessness was a big issue,
and so if I started havingissues with sleep, I would
immediately go to the thingsthat I know help me relax my
(17:28):
mind, relax my body.
You know the micronutrients,that the you know, mindfulness,
meditation, the things like thatthat would help settle things
down, because I knew if I, if Iallowed that to persist, I was
headed for trouble.
But but it wasn't something thatI ever really studied.
So I'd like to actually talkabout that a little bit, if
you're, if you're okay, if wecan explore that a little bit
more.
Because, because I know that alot of people in my audience are
(17:51):
going to be able to relate tobargaining with God for sleep.
You know, laying awake at nightwith your man, your mind, just
right, rolling and rolling androlling over, and you can't get
it to shut off.
And you know, as a mom withyoung children, when this was
happening I was like in tears.
You know just begging, likeplease just let me sleep, please
just let me sleep.
Like, if you let me sleep, I'lldo this.
Like I was like trying to offersomething because I couldn't
(18:12):
get my brain to shut off and andit would, like I said it's like
revving the engine and I knewif this persisted that after a
little while I was going to endup in a severe depressive
episode.
Speaker 1 (18:22):
So it's exhausting, yeah, so then also, how do you
put the brakes on finding calm,which is my research program for
a reason?
So a couple of things.
One, your words on this are sobeautiful and really capture.
It does work both ways, and so,but we do know that a night
(18:43):
without sleep is not a goodthing.
So there's an Italian group Idon't know how they got the
ethics on this, the ethics boarddo agree to this.
They brought in people who hadbipolar depression, were in a
depression state, kept them upall night and by the next
morning showed that about 12% ofthem had shifted from
depression straight intohypomania.
Experimental evidence, right.
(19:06):
We also repeated the study,which I'm like how did your
ethics board let you do that?
But anyway, we haveexperimental evidence and we
have longitudinal evidence thata night without sleep is not a
good thing.
So I love that.
You were like okay, how do Icalm this?
And certainly you know deepbreathing and meditation and
anything that relaxes the body,relaxes the mind, is good.
(19:29):
I'm not a psychiatrist, but alot of doctors will say look,
I'm going to give you a pill youcan take that'll zonk you out
if you're having that experience.
So that's something people cantalk to a doctor about a PRN.
But then the other thing we'vebeen fascinated by is how do you
just strengthen that day nightrhythm?
And you know there's a lot ofpeople who look at light therapy
(19:50):
.
And that's important becauseyou actually have a different
receptor in your eye that'ssensitive only to the light
frequency at dawn and dusk.
It fires off, it shootsstraight back into a brain
region called thesuprachiasmatic nucleus.
It feels like super fragile,you know thing.
But you have a brain region welike to say SCN because we can
(20:13):
pronounce it that then sends aclock through the whole brain
and it is sort of tuned by thelight at dawn and dusk.
So many people are fascinatedby that.
I was working with a circadianperson named Lance Kriegsfield,
a scientist who I adore, and hecame to me and he said are you
(20:33):
watching what's happening downat Salk Institute?
And I said what do you mean?
And he said have you beenhearing about time-restricted
eating?
I said no, I have no idea whatyou're talking about.
People at Salk who were doingmouse studies started to realize
that when they fed their micewas as powerful for the mouse's
day-night rhythm as the lightexposure at dawn and dusk or for
(20:58):
mice.
It's a different clock, butfood timing was as powerful as
light and part of that has to dowith it.
Beyond this beautiful clock youhave in your brain, the SCN, you
have clocks in every cell ofyour body and every organ of
your body and your stomach andyour liver and your kidneys and
all of those peripheral clocksare going to get shaped
(21:21):
profoundly by very carefultiming of your eating.
So they started to kind of lookat it's a version of
intermittent fasting.
But some forms of intermittentfasting are very harsh.
Some are like you don't eat fortwo days.
This is much more about eat atthe same darn time every morning
.
So your body has a little wakeup cue, gets the hormones going
(21:43):
your appetite is actually reallypredictive and then knock off
your eating a couple hoursbefore you're going to go to
sleep.
Because if you're still eating,melatonin comes along.
Melatonin and your kind ofinsulin are a little bit in
collision and melatonin is yoursleep agent, your sleep hormone,
so you don't want differenthormone systems fighting in
(22:04):
those last couple hours beforeyou go to sleep.
So basically it comes down toeat the same 10 hours every day,
eat by the clock and you'regoing to give your body a very
powerful signal of like hey,this is your morning, this is
your night, this is your morning, this is your night.
And if we can make that systema little better, the hope is
(22:25):
that then people can sleep moredeeply and also have a little
bit more of a cue of like youknow, time to power down.
Speaker 2 (22:32):
One of the things that happens a lot of times with
people who are struggling withthese symptoms is they've been
sleep disrupted for so long thatit's almost like they can't
figure out how to resetthemselves.
You know what I mean.
So what are the things thatpeople can do that will help
kind of reset that clock forthemselves?
So you're talking about thesethings like if somebody did this
, and I want to make sure Ihighlight for my audience you're
(22:55):
currently doing a study thathas to do with this, and can you
talk a little bit about thatstudy?
How long, in general, do peoplesee that it takes for them to
kind of reset that clock?
I don't know if you've foundthat yet or if you can share
that, so let's start there.
I don't want to give you toomany questions.
Speaker 1 (23:13):
Okay.
So our study is actually tocompare two forms of healthy
eating.
We're really fascinated by thiseat by the clock time,
restricted eating but the otherpiece we're really fascinated by
is the Mediterranean diet.
We're very invested in the ideathat there are these signs that
bipolar disorder is a wholebody phenomenon.
(23:35):
People with bipolar disorderoften also have metabolic
symptoms, cardiovascular thingsgoing on.
Energy is profoundly involved.
So how do we support wholehealth?
And so this study is to takefolks who are already on
medications mood stabilizers andsay what happens if we add one
(23:58):
or the other of these healthylifestyles and track can we make
a difference in symptoms andquality of life?
And if we could hand this outfor free to people, could we
promote better stability forpeople around the world who have
bipolar symptoms and wantsomething else to add in.
(24:19):
So Welcome.
Trust gave us money to do thelargest study that I've ever
heard of of healthy eating andbipolar disorder and whether it
makes a difference.
We're recruiting people.
We've said we'll find 450people to follow each person's
experience very carefully ofwhat worked, what didn't, who
(24:40):
does well, who can do it, whocan't.
What supports do they need sowe can take it forward?
Boards do they need so we cantake it forward.
We don't have data yet, butwe're actually really excited to
have 70 people enrolled,helping us by logging their
experience, logging their diet.
One thing I can tell you forsure is it's a process, so we
log for two weeks before we evenstart to set the timing of
(25:04):
eating, because we're trying tofigure out, well, what is your
midpoint.
And for people with bipolardisorder, sometimes there isn't
a set bedtime, wake up time.
So what's the middle of that?
We make a guess.
We set our timing window.
Sometimes we say let's startwith a 12 hour eating window and
do that for a week or two, thenbring it back to 10.
(25:25):
And maybe we're going toshuffle it, but we're going to
titrate it really carefully soit doesn't mess up their
lifestyle.
Like the last thing we want issome person with bipolar
disorder not getting to havedinner with their family because
they think, like I have to stopeating.
Like how do we, how do we thinkabout the most important social
pieces for you, lifestylepieces, and then build a rhythm
that's going to work for you.
And so we'll work with peopleacross 10 weeks, see if we can
(25:50):
get that rhythm in place andthen we'll follow them across
time to see is it making adifference?
Is it making a difference atthe end of those 10 weeks?
But what does it look likemonths later too?
Speaker 2 (26:01):
And it's really interesting that you mentioned
the Mediterranean diet, thatthat's the diet that you chose,
because, I mean, there are a lotof different diets out there
and a lot of claims about thediets, but I've actually seen
solid research on theMediterranean diet Drs Bonnie
Kaplan and Dr Julia Rucklage,who've done a ton of research in
the field of micronutrition andmicronutrient support.
That's where they have peoplestart, you know they, that's
(26:22):
what they they encourage intheir book.
They even have, you know, asection with recipes and
guidelines for how to you knowhow to eat healthy eating using
the Mediterranean diet.
They're not huge fans of likemajor changes as well, like you
were talking about, you know,helping support, actual.
I think that there's a tendency.
You have to be really carefulwith people who are, you know,
(26:44):
struggling with this, because wehave a tendency to go like full
bore into it and then burn outand crash, you know, and then
feel discouraged and give up,right and so more more so, I
think, than than somebody in thegeneral population who isn't
struggling with these symptoms.
And the thing I love about theMediterranean diet specifically
(27:05):
is that the brain support thatcomes from the nutrients that
you're putting, that you'reputting into your body.
You know I don't think that weunderstand enough about
nutrition.
I know for certain.
You know like in my personalexperience and most of the
people that I work with, theynever had never once had a
doctor talk to them aboutnutrition.
Not one time.
Speaker 1 (27:23):
Right?
Well, because it's not.
If there's not enough sciencefor the doctors to feel
confident, we have got to takeon, build the knowledge base.
But yeah, the Mediterraneandiet outside of bipolar disorder
, I mean, there are now studiesof thousands of people that say
this is great for your heart,it's great for your immune
system, it's great for yourbrain, it's great for your
(27:46):
cognition.
Your body needs these healthynutrients.
Another thing I really likeabout it is it's very focused on
how do you bulk up a little bitof the healthy stuff in your
diet and let's not punish you Ifyou want to have an ice cream,
think about that as an extra.
That's okay.
We don't ban anything, but wejust keep the focus on each week
(28:06):
, how do we add another littlebit of a healthy habit?
What's the thing you're goingto give your body?
What's the ritual you're goingto put in place to just give
yourself a little bit of healthystuff for your body vegetables,
fruit, whole grains and you'reright, there's like a million
resources.
I'm glad their book really goesinto this on like how do you
(28:26):
find recipes?
How do you do this?
A lot of people think it'sgoing to be super expensive, but
it's actually very affordablefoods like whole grains and
lentils and beans are like thestuff of grad school.
That's how you survive.
Grad school is you eat a wholelot of those very healthy
proteins that are very, verycheap.
The other thing is you canadapt it for every spice kit in
(28:50):
the world.
So if you love Mexican food,put your Mexican spices on top
of those beans.
If you like Japanese and Asianfood, put your Asian spices on
top of those whole grains.
So it's very adaptable andthere's a lot of good tips out
there about how to make it work.
Speaker 2 (29:08):
Yeah, and one of the things that I love about what
you said you've said a few timesnow and I this is something I
advocate as well is you're, youare developing habits for
healing, that the point is todevelop a habit, and so we, you
need to start with somethingsmall and achievable.
And you know, especially comingfrom a, you know, a bipolar
symptom background, I knew if Itried to make a whole bunch of
(29:30):
changes at one time, it was notsustainable, and so I and I'm a
big advocate of alarms, I usealarms for everything.
Anytime I'm trying a new habit,I will set alarms throughout
the day.
Don't turn the alarm off untilyou've done the thing, but it
needs to be something simple andreally easy to do so that my
brain doesn't get in the way of,like, building it up and
thinking, oh, this is such a bigthing to do, you know, and so
(29:51):
make you know.
If somebody is trying to changetheir diet, pick something that
you do, like you know,especially if you're introducing
a bunch of things that are newto you.
You know, maybe somebody hasnever eaten any lentils before
in their life, so don't try andchange your whole diet and put a
whole bunch of lentils andyou're not going to like it.
Your body's going to craveother things.
You know you got to changelittle things at a time, but but
the thing that's beautifulabout it is, in my experience,
(30:12):
is as you develop these habitsfor healing, you have
incremental wins and you startto feel better, which then gives
you the more motivation tocontinue moving forward with
that.
And I'm wondering if you'veseen that in your study so far,
if that's something that you'veseen play out.
Speaker 1 (30:25):
Yeah, I want to have you come talk to all the people
in our study because you're justsuch a voice for kind of how to
make this happen, and it fitsso well with the science.
Yeah, the hardest thing we'rehearing in coaching is people
having really high expectationsfor changing everything and then
being so deeply worried aboutletting themselves down, letting
(30:46):
us down, and so we're reallytrying to empower people to just
say one change at a time.
And then the science of this islog it and nobody likes logging
.
It feels geeky and kind ofscience world.
But actually those small stepsof just monitoring how did it go
and what got in the way eachday are kind of how you do
(31:09):
develop a ritual and a habit.
And what I'm hoping is thatpeople can take this not as a
scorecard for did I make amistake today, but more a way to
give themselves credit for youknow what today I fed my body, I
fed myself, I did somethinggood, thank you.
(31:29):
Like those small rituals to feelgood about.
And we're always sort of sayingof course you're going to have
your Saturday night where theMediterranean diet's out the
window right and of courseyou're going to have your
Saturday night where you atelater than you wanted to, or you
were out with your friends andyou weren't going to, or you
weren't going to tell yourgrandma you weren't going to
have a late night dinner.
Right, like all those things.
(31:50):
Right Like, give yourselfpermission and just work on.
How much can you create aritual?
How much can you create a habitthat feels comfortable, cause
that's what's going to stick.
Speaker 2 (32:01):
Yeah, and one of our mantras in my group is curiosity
, not judgment, so that we areyeah, because it's because
they're.
I think one of the things thatwe I believe is very common in
our community is we're veryjudgmental of ourselves.
People often judge us.
You know, the behaviors thatcome out of these symptoms are
(32:22):
not socially acceptable.
Often, you know, they areembarrassing, they're
discouraging and we are veryhard on ourselves.
We're very judgmental ofourselves and it needs to.
There needs to be a shift thatoccurs.
You know, one of the it startedfor me the first time that this
came into play was I have acoping mechanism which is
excessive television watchingand and I I was viewing it as an
(32:45):
addiction and I went toaddiction recovery programs.
I was like putting locks on mytelevision, I was doing all
these things to try and stop thebehavior, not understanding
that it was a coping mechanism.
And I finally had a therapistasked me the question what are,
what need are you trying to meet?
And I I was so caught off guardby the question.
I was like what are you talkingabout?
And she said what need are youtrying to meet with this?
And I had to think about it fora while because I didn't even I
(33:08):
had never considered there wasa need being met by this coping
mechanism, and so I think thatthat's one of the things that is
so important.
As people are trying to, webecome detectives in our own
lives.
You know what?
What is that?
What's behind?
What's motivating this behavior?
You know, I've got this symptom.
Something is motivating thebehavior that is attached to the
symptom, and get curious aboutit rather than judging ourselves
(33:31):
.
It doesn't mean that we.
It doesn't mean that we aregoing to accept the behavior I
don't like.
I don't like spending hours andhours on end watching
television programs that aremindless and uplifting.
You know, that's not somethingI want to continue in my.
I wanted to continue in my life.
However, it didn't do me anygood to beat myself up about it.
I needed to get curious aboutwhat was underpinning that
(33:52):
behavior and then, once I couldfigure out what was causing the
behavior, how can I meet thatneed in a better way, in a
healthier way, that that is moreproductive in my life?
And so I think the same thingwould be true for any you know,
as you're trying to develop newhabits.
If you're struggling with it,ask the question why, instead of
judging yourself and beatingyourself up.
Why am I struggling with this?
(34:14):
What's what's going on.
Is there a way that I can dothis differently?
That would be easier, you know,more conducive to success for
me, and maybe not even lookingat success or failure, because
those are judgment words as well.
But in order to accomplish whatI'm trying to accomplish, how
can I tweak things?
What can I do differently?
How can I find a way to meetthose needs and be curious about
(34:34):
the struggle rather thanjudgmental about it?
Speaker 1 (34:37):
That's beautiful.
I always sort of think, likewhat we want to be able to do is
hold the goal out here, reflecton it, think about what makes
this hard, what makes it easy,what makes it fit, and then go
from there.
And I think there's a lot ofthings that make that harder in
bipolar disorder.
One is the whole topic offeeling out of control is just
(34:58):
scarier, right.
And there's also thatself-critical.
You know, picking back up aftereverything that's happened,
it's easy to feel demoralized,scared, self-critical, and I
love that you're such a voicefor like you can get through
this.
You know, like let's take acurious, one goal at a time kind
(35:20):
of thing.
The other thing that we'vewritten about, we've tried to
understand, is that I thinkpeople with bipolar disorder
often set very high goals forthemselves.
They want to make a difference.
They've set bigger lifeambitions, bigger life dreams,
bigger goals, and they have moreof a worry about what happens
if that doesn't happen.
(35:41):
We call that the double-edgedsword, because the good side of
it is sometimes people withbipolar disorder make profound
difference.
You know, I mean we have more.
It's related Having bipolardisorder in the family and in
the genes is related to whetheryou're going to become a
military general.
You're going to create a company.
Your company is going to make alot of money.
(36:02):
Kay Jamison has written abouthow many unbelievable artists
have had this, how many authors.
So that big dream thing is agift, but it's a curse, you know
, because sometimes it's easierto take a small step than a big
(36:24):
step, and if you're holdingyourself to this standard of I'm
going to do this huge thing,then it's easy to fall short.
It's easy to feel self-critical, it's easy to get into a cycle
of well, that's not so big, butmeanwhile some of life is you
put one small foot forward, kindof thing.
(36:45):
So I'm really fascinated by howpeople juggle what they expect
of themselves and hold to kindof having a big dream.
But not let it overwhelm, we'reall just trying to get through
the day too.
Speaker 2 (37:01):
Yeah, absolutely, and I love the thing I love about
this study and I'd like to knowmore about if you've done
anything related to circadianrhythm outside of this.
I would like to talk about thata little bit more.
That's such an important topicand as I was preparing for this,
I had the thought like I don'tthink I've had anybody on to
talk about circadian rhythm.
(37:21):
How is that possible?
Like it's such an importanttopic and so critical to well
being.
But I would love to hear moreabout you know what what other
things that you have learned andwhat studies you've done
perhaps related to circadianrhythm and improving that,
because I think that that's whata lot of people who are
struggling with these thingswant to know.
So I love the study.
(37:42):
I want to make sure at the endwe'll talk about if somebody is
interested in participating inthis study, how they can reach
out to you.
But what other resources orstudies have you done that are
related to that, because it'ssuch an important resource for
people who are trying to recover, who are trying to heal, who
are trying to live healthierlives with their symptoms.
Speaker 1 (38:03):
Yeah.
So our biggest study on thisfront is about to launch.
We're going to do a worldwidestudy for people in
English-speaking countrieslooking at circadian rhythms and
reward and how they movetogether.
So we're going to be askingpeople to kind of take quick
games on their cell phones threeor four times a day to look at
(38:25):
how excited they are aboutrewards and games and winning
and how that changes withday-night rhythms.
We're going to be logging theirsleep.
We're going to be followingpeople across time.
Some of them will do brainscans in the evening to see if
pathways in the brain that areabout goals and going after
things are powering down in theway we would expect as it gets
(38:47):
into the evening.
So stay tuned.
We will be putting up stuff onour website about what people
who are interested to kind offollow their own reward and
circadian rhythms using thesecell phone apps and seeing what
we can figure out.
I've been less in the circadianrhythm space.
I've been more of a fan of that, but one of the things that I'm
(39:07):
proud of that we did is we havea lot of work out there on what
this looks like in adults andwe have a study under review
where we said okay, but how muchof that is the aftermath of
years of mania and depression,and does that just scramble this
system?
So we were able to work with agroup of adolescents who were
(39:29):
sort of very new to having theillness and we were able to show
that their circadian rhythmsalso look blunted.
They don't show the samestrength of day-night rhythm.
So what does that mean?
They look less energetic by day.
They look too energetic andless sleepy at night, but we can
see it very early on as peoplemove into having these symptoms.
(39:53):
So that's under review.
Wish us luck with reviewers.
I'm proud of it.
I think it'll get its way intothe world, but we'll see.
Speaker 2 (40:01):
Yeah, and it's you know, it always begins with
identifying the issue in thefirst place.
You know, once we can identifythe issue, then we can start
figuring out like, what do we doabout it now?
And I know that I, you know, Idon't know if you've had much
experience with blue light.
You know, yeah, yeah, becausethat's one of the things.
I've seen some articles aboutthe disruption in the circadian
rhythm that occurs because ofour exposure to blue light, and
(40:23):
it's definitely a menace.
Speaker 1 (40:24):
It's definitely a menace to your melatonin.
Speaker 2 (40:27):
Yeah, and is that?
So I was going to ask you ifyou knew much about.
You know what I don't want tospeak to.
I don't have the articles toquote, so I don't.
I'm not going to try and speakany kind of with any authority,
but what have you seen aboutthat?
How does blue light, which weknow for anybody in the audience
who doesn't understand what I'mtalking about this is exposure
to screens.
So our cell phones, ourtelevisions, our computers emit
(40:50):
blue light that affects ourbrain, it has an effect and it
has an impact on melatonin.
So can you talk a little bitabout that, Because I know that
that for me, that was a hugedisruptor.
Speaker 1 (41:02):
Yeah.
So let's back up for a minuteand talk about melatonin for
people who aren't familiar withwhat melatonin is, melatonin is
a hormone or a chemical that hasa strong day night rhythm.
It tends to come on at nightand it promotes, it helps people
go to sleep.
So as the melatonin comes on,that's part of why it's easier
(41:24):
for people to kind of drift offto sleep.
So the degree of melatoninrelease, or how well that
melatonin is working, is shapedby how powerful your circadian
rhythm is, or your day-nightbiological rhythm.
And so if you have a weakcircadian system, one of the
ways that may show up is themelatonin system not working as
well to give you these cues foryour body that it's time to
(41:47):
power down and go to sleep.
So melatonin is a reallycritical part of this whole
system, and what we know is thateven small amounts of light, as
melatonin is starting to kindof be released and do its work,
suppress more release ofmelatonin, and blue light is an
(42:08):
important part of that.
So people will think well, it'sokay that I'm just quietly
looking at my cell phone in bedor just watching TV to power
down, but that light is enoughto suppress melatonin.
And now you've lost one of thesignals, one of the really
important signals for your bodythat it's time to go to sleep.
(42:28):
So there's more than oneinfluence on whether you can go
to sleep.
One is how long you've beenawake, for you accumulate
something called the sleep debt.
Sleep One is how long you'vebeen awake, for you accumulate
something called the sleep debt,and so that's just building up
and building up, building up,and then when you go to sleep,
(42:53):
it disappears very, very quickly.
So you have sleep debt and youhave melatonin.
So there's still ways peoplecan sometimes fall asleep, even
if their melatonin is crushed.
But you're taking out half ofthe story there.
But you're taking out half ofthe story there.
You're taking out half of theinfluence that helps us just go.
Speaker 2 (43:04):
Okay, it's time drifting off, yeah, and it's so
interesting, one of the thingsthat I learned as I was trying
to figure out a way to keepmyself asleep.
So a lot of times people withbipolar will struggle with
staying asleep.
Maybe you can fall off to sleepreally quickly and then a
couple hours later you're wideawake again in the middle of the
night.
That's the circadian systemright there, and one of the
(43:28):
things I figured out.
And I think I must have read anarticle.
It's usually triggered likethese discoveries are often
triggered by reading somethingabout it.
But I realized when I'm wideawake at night, don't watch
television and don't get on myphone and I have a micronutrient
that I will.
I don't know if it's amicronutrient, I think it's
(43:50):
considered micronutrient.
Anyway, I have a supplementthat I take at night if I'm, if
my brain is racing and my bodyis kind of alert, that helps
kind of calm down thosereactions in my body.
And I will read.
Those are the two things thatI'll and I'll read something
that's not super engaging, likeI'm not going to read a fantasy
novel.
That's really exciting, that Iwant to keep reading.
You know, I'll read, I'll readsomething that's interesting but
(44:11):
not like super engaging, thatmy brain is like, yeah, I've had
enough of that and those twothings.
Or writing you know I'll likejournal or something to get
whatever's in my head thatthinks it needs attention out
onto a piece of paper andusually within about half an
hour I can fall back asleep andhave a good night, you know,
finish through the rest of thenight.
But I used to watch shows, likeyou know I would or or scroll
(44:32):
through my phone and I didn'trealize that I was working
against myself.
You know I was thinking I justcan't fall asleep and I didn't
realize.
Well, the reason you can't fallasleep is you're working
against yourself with this bluelight.
You know that's that iscombating your body's natural
system for trying to calm itselfback down and go back to sleep
Totally.
Speaker 1 (44:51):
You know, the other thing I think people don't talk
about enough is that moodstabilizers and antidepressants
also strengthen circadianrhythms and there's all kinds of
really interesting cellularlevel, molecular level,
biological level work going onto understand that and to try
(45:11):
and think about how that worksso you could kind of bulk it up.
So I think we have there'sactually really great lifestyle
work around how to help peoplesleep.
So there's a program calledCognitive Behavioral Therapy for
Insomnia which you can takeonline.
There's online apps to supportCBTI that's the cute little CBTI
(45:35):
that's out there and thenthere's lifestyle things to kind
of get rid of the stuff thatwould mess with your sleep, and
then there's medicationapproaches.
So this is one place where Ithink there's a lot of tools
that people can choose from.
But so vital to kind of thinkabout it.
I also want to sort of say forpeople who are hearing this and
(45:58):
then there's almost a kind ofterror that happens if you're up
at two in the morning andyou've heard like didn't Dr J
just say that that can triggermania, and now how am I supposed
to sleep right, to just helpyour body and mind relax and
deep breathing and reading andkind of focusing on your
(46:30):
favorite spot in the universe.
All of those things are alsogoing to help your body and your
mind relax, and making aconcerted effort to give that to
yourself in those moments isgoing to achieve some of the
important goals of sleep.
So I don't want people lyingawake at two in the morning
going, oh no, what happens ifshift gears and do your deep
breathing and count your sheepor visualize your last beautiful
(46:52):
place you were in?
Speaker 2 (46:53):
Yeah, and one of the things, one of the things you
learn in mindfulness, whenyou're, when you're practicing
mindfulness, is focusing on this, you know, on the deficit of
where you are to where you wantto be, sometimes widens that
space.
And so, rather than thinking,oh, I just want to fall asleep,
rather than focusing on whereyou want to be, just focus on
being present, calming yourselfdown and utilizing.
(47:16):
I encourage people to explorethe different resources you know
.
Try mindfulness, meditation,which I think is a big one.
There are relaxation, you know,recovery kind of things that
you can do with yoga.
That will help kind of relaxyour body, kind of bring you
back, tell your bodyeverything's okay, you're safe,
everything's fine.
You know, writing out the stuffthat's in your head.
(47:37):
A lot of times your brain justis trying to get your attention
for something, and that's why Ifound journaling so productive,
because give it a place to go.
Tell your brain, yes, I'mpaying attention to you and I
want to do it right now, but I'mgoing to put it down and then I
will remember to work on ittomorrow, you know, but but I
think, practicing thosedifferent things and try not to
focus on the deficit between youknow I'm wide awake and I want
(47:58):
to be asleep right now and justfocus on.
What can I do in this moment tocalm down?
How can I, how can I bringmyself into a calm state?
How can I relax my body?
Interested in in, you know,looking into this and
(48:21):
participating in this study.
The two, the two differentthings you're studying are
restricted eating and thenMediterranean diet.
Is that correct?
Speaker 1 (48:31):
Yeah, so people can come to our website it's called
calmberkeleyedu and learn moreabout our studies.
They can sign up online.
They can read more of thedetail.
They can send us an email withquestions.
We welcome questions, but thestudy we're enrolling folks in
right now is comparingtime-restricted eating or eating
(48:51):
10 hours a day at set timesagainst the Mediterranean diet
and trying to figure out whatsupport people need to follow
that.
And then in a couple monthswe'll launch our new study,
which is not about treatment,it's not about change.
It's about just understandingthis kind of how we call it
(49:12):
rhythm and rewards.
How does your day-night rhythminfluence what happens with the
way you go after rewards atnight?
Speaker 2 (49:22):
That's so interesting .
Can we talk just a little bitabout that?
Sorry, so you've mentioned afew times Sorry, that was a
question that I had earlier andI forgot about it.
So you've talked about rewards,studying like rewards and mania
and their connection to eachother.
Can you talk a little bit aboutwhat that is and what you mean
by that and what you've seenthat has made you think?
(49:42):
Let's do a study on this.
Speaker 1 (49:44):
Yeah, so I probably spent 20 years on this topic of
rewards and mania, and I wasn'tthe first.
There's a guy in the fieldnamed Depew who said okay, so,
first backing up, you have abrain system that helps you when
there's an exciting, positivereward out there.
It propels you into a state ofenergy, it helps you focus on it
, it gets your brain thinkingabout it, it gives you the joy
(50:08):
about like, okay, we're goingthere right, and we all have
that system.
It's called your reward system.
It's neurobiological, we knowwhere it is in the brain, it's
dopamine, and it's a good thing,right?
We all need a way that if Isaid, hey, there's a million
dollars on the opposite side ofcampus, you would mobilize and
you would run fast to go get it.
So we all have it and it'sadaptive and it's beautiful and
(50:32):
it does all these things thatDepew, a long time ago, said.
Boy, all those signs of maniasound an awful lot like what you
expect of a reward system infull tilt.
And what if, at the heart ofmania, what we have is a reward
system that is somehowdysregulated so that once it
goes into full tilt, it's harderto bring it back down, harder
(51:03):
to bring it back down.
So we've liked to think of itas a kind of extra sensitivity
to going after rewards.
They're more exciting, they'remore alluring, they're harder to
let go of and we haveself-report scales we can give
that are about this.
We all know people who like itdoesn't take much out there for
them to go into sheer joy, juicefull tilt.
I'm going there.
We all know people who arecloser to Eeyore.
(51:23):
Where you go there's a milliondollars on the other side of
campus and go, somebody else isprobably going to get it Right.
So we all, we are all titrated.
I think for bipolar disorderit's not just that it moves into
highs, it's also that it'sdysregulated.
It's hard to bring it back downinto check.
(51:47):
During the lows it goes way toolow.
So that opens up a lot of doorsfor us.
One is some prediction, becauseit turns out that that system
is designed to respond whenyou're in the middle of exciting
, stimulating possibilities.
You're in the middle ofexciting, stimulating
possibilities, so that's.
The bad news of this is thatsome of the moments that are so
(52:10):
exciting in life are alsovulnerable for kicking this off.
But if you know that, then youcan work closely with your
doctor when you're going throughthose periods and you can work
to kind of give yourself backcalm, even in the middle of
life's best moments.
You can go in the bathroom andtake three deep breaths.
You can make sure that youretreat, go to sleep, think
(52:33):
about it the next day.
You can learn to do yoga.
You can learn to doself-calming things.
You can learn to work with yourdoctor to titrate medications,
but that those are criticalmoments to make sure that you
and somebody who loves you orsomebody who watches you is
keeping tabs on.
Did this just get too high?
And how do we help you re?
Speaker 2 (52:52):
regulate.
I could talk to you all day.
This is fantastic.
I'm so excited for the thingsthat you're studying, and if
somebody wants to connect withyou, what's the best way to go
about that?
Speaker 1 (53:05):
Go straight to our website, columnberkeleyedu
Berkeley, by the way, is hard tospell, it's B-E-R-K-E-L-E-Yedu
and they can email, they cansign up for studies, they can
see what's coming next and Iwill say you know, getting this
(53:30):
right and figuring it outdepends on hearing from as many
people from as many differentbackgrounds as we can, and also
hearing from them when we didn'tget it right, or they want us
to tweak things, or they wantour study to get better in some
way.
So, yes, we'd love foreverybody in the universe to
sign up, but we also want tohear if there's ways that this
doesn't fit for people.
Speaker 2 (53:51):
Fantastic and I'll make sure all of your contact
information, the website,everything is linked in the in
the show notes so that peoplecan reach you easily.
Thank you so much for all thework you're doing and thank you
again for being a guest today.
Speaker 1 (54:04):
Thank you for everything you're doing.
It's really just beautiful toconnect to you and to watch what
you're doing, so best of luckwith this, thank you.
Speaker 2 (54:14):
All right, Until next time, Upsiders.
Hey, thanks for joining ustoday.
If you're ready to start onyour path to wellness with
bipolar, go to myupsideofdowncomand get your free mood cycle
(54:34):
survival guide four steps tosuccessfully navigate bipolar
mood swings.
If you're ready for more, checkout the Map to Wellness.
Until next time, Upsiders.
Having bipolar disorder in the family and in
the genes is related to whetheryou're going to become a
military general.
You're going to create acompany.
Your company's going to make alot of money.
Kay Jamison has written abouthow many unbelievable artists
have had this, how many authors.
So that big dream thing is agift, but it's a curse.
Speaker 2 (00:25):
It's a gift but it's a curse.
Hey, welcome to the Upside ofBipolar conversations on the
road to wellness.
I am so excited that youdecided to join me today.
We're a community learning howto live well with bipolar
disorder and we reject that.
The best we can expect islearning how to suffer well with
it.
I'm your host, michelleReitinger of MyUpsideOfDowncom,
(00:47):
where I help people with bipolardisorder use the map to
wellness to live healthy,balanced, productive lives.
Welcome to the conversation.
Hey, welcome to the Upside ofBipolar.
I am your host, michelleReitinger, and I have a
(01:07):
fantastic guest today for you.
Dr Sherry Johnson is thedirector of Calmania, or CALM,
program at the University ofCalifornia, berkeley.
She has received funding fromNARSAD, nimh, nsf and NCI.
She has published six books andover 300 manuscripts.
She is a fellow of the AmericanAssociation for the Advancement
(01:30):
of Science, association forBehavioral Medicine and the
Association for PsychologicalScience and the Center for
Advanced Study in the BehavioralSciences.
Her work focuses on circadianrhythms, impulsivity and reward
sensitivities in bipolardisorder.
She has used a broad range oftechniques, from neuroimaging to
cognitive and behavioraltesting and personality tests,
(01:52):
to understand these mechanisms.
Drawing on basic science, shehas conducted treatment
development research to targetthese dimensions.
I am so excited to interviewyou today.
Thank you so much for joiningus.
Speaker 1 (02:04):
So thrilled to have the chance to meet with you.
I'm such a fan of the work youdo and the information you bring
forward, and I'm thrilled tohave this conversation.
Thank you.
Speaker 2 (02:16):
Wonderful.
Well, let's start with yourstory.
We always start witheverybody's story.
Speaker 1 (02:21):
I come from a family where a lot of the women have
struggled with their moods.
Nobody in those days wasgetting a lot of diagnoses, but
it was always familiar for meand so I was drawn into
psychology.
I thought I was going to studydepression.
I went through my PhD programand went off to an inpatient
mood disorder center where theystarted assigning me to work
(02:44):
with people who had bipolar.
And I loved the people.
There's a little extra sparkle,there's a little extra energy,
a little extra drive.
But also this profound sense ofhow does somebody navigate when
the differences in their beingare so profound during a mania
versus their regular self justhooked me.
(03:08):
So I started working with peopleclinically and then I was
working with somebody I reallydeeply admired who had bipolar
disorder and he said wait, Idon't get it.
You keep planning to studydepression.
And is there anything moreprofound than trying to figure
out why people move into maniaswhen they do?
(03:30):
When we don't have thoseanswers, how could you not
choose that as your science goal?
And it was one of thoselife-changing moments where I
just kind of looked across theroom and thought he's right and
did a pivot and started, youknow, trying to figure out how
(03:50):
do I get funding and how do Iget expertise to kind of focus
on that.
That conversation, and a coupleothers like that, shaped
decades of my life.
Speaker 2 (04:01):
That's incredible.
And it's so interesting becausefor all the years that I was
struggling with my symptoms,initially I didn't have any idea
what was causing anything.
It just felt like thisunpredictable experience that I
was getting yanked onto a rollercoaster I was holding on for
dear life until it was over, andthen I would survey the damage
afterwards and then rinse andrepeat.
(04:23):
You know, it was just and ityou feel like for me.
I was constantly questioningmyself, constantly questioning
is this, is this normal, is thismania, is this like?
What's going on with me?
And it made me.
I got to a point where I wasvery insecure.
I constantly insecure aboutdecision making, about, you know
(04:43):
, ideas that I had.
You know I would get these bigideas and start huge projects
and then cause a lot of damageto my family and to myself.
And and I got to the pointwhere I was like afraid, afraid,
I was scared.
It caused a lot of fear andanxiety for me.
Speaker 1 (04:57):
Yeah, yeah, no.
And so, michelle, I think youknow what you've done listening
to your narrative is you've goneso deep into thinking about
what are the triggers, what arethe things I need to do to
protect my life if I'm feeling,you know, out of sorts, what are
the ways I need to recoverafter going through that.
(05:19):
And there's a real brillianceabout that that I just I find
very profound.
And there's a real brillianceabout that that I just I find
very profound.
And part of me has always sortof felt like why are we not
listening to what people sayabout these triggers and how
they got through those episodesand how they protected their
life and then distributing that?
Why are we counting on so manypeople to reinvent that?
Which is why I'm such a fan ofyour podcast, because you're so
(05:42):
beautiful in the way youdescribe that process for people
, but I also think theclinicians.
You describe that process forpeople, but I also think the
clinicians need to take this toheart and the researchers need
to listen and kind of do theresearch to put that on the map.
So the first study I planned inbipolar disorder I was going to
look at like negative lifeevents, right, and people who
had bipolar disorder keptsigning up but then crossing out
(06:05):
what I said were the studygoals and saying to me you're
studying the wrong thing.
You need to study the timeswhen we get super excited and
goal-driven and reward-orientedand can kind of see this amazing
thing that's gonna happen andit gets too big for us.
And so I was like, okay, yeah,I better listen when 10 people
like take your study and sayI'll help you, but you're doing
(06:30):
the wrong thing.
Speaker 2 (06:30):
Let's x that out and get you on track, and that also
was a game changer for me.
So, yeah, and that's incredible.
I think one of the things thathas been was very discouraging
and I've heard this repeatedlyfrom I don't know how many
people is when people won'tlisten to us.
I think there is, you know,especially during
hospitalizations.
I had severe trauma fromhospitalizations where I was
where I knew better Meaning.
(06:52):
I know myself, I know whatyou're telling me to do is is
going to cause problems, and Iwas told you know, no, I'm the,
I'm the doctor, I know better.
You need to listen to me andyou know, for example, when at
the end of one of my longhospitalization, they were
insisting on putting me on amedication that had triggered
psychosis in me and I and I kepttelling him like this is not
(07:14):
good for me and I had nobodyelse there to advocate for me.
It was me by myself and I was solonely for my family.
I missed my children, I missedmy husband, I wanted to go home
and I was being told you can'tleave unless you accept this.
And it caught, it triggered amajor episode, it caused all
kinds of problems and that's oneof the things that is very
discouraging a lot of times isthat I think we feel discounted
(07:36):
and dismissed and, like people,don't you know, we're less than
in some ways, we're a patient tobe worked on rather than a
person to be listened to, andthat's one of the reasons why I
love what you're saying.
You know that you listen to andaltered what you were doing
because you realize that thepeople that you were trying to
study and help had someperspective that maybe you
didn't.
You didn't understand yourself.
Speaker 1 (07:59):
Totally I.
So one of the things I findmost exciting that's changing, I
think, rapidly in our field notrapidly enough, but it is
changing is bringing livedexperience into the research,
into the university, into thetraining, and I see that as a
really really healthy, importantpart of this.
(08:19):
When I started thinking aboutdoing my current study, I
reached out to somebody I knewwho had bipolar disorder and I
said I kind of want you to bepart of this from the ground up
this time.
And so we now we have a boardof people with lived experience,
we have people who are in everyweekly meeting, who are doing
coaching with us, and havingtheir voices has helped me not
(08:43):
make mistakes a lot of times andit really, you know, from the
ground up we thought, okay, whatI want to do.
I want to help people kind offollow a healthy diet, follow a
healthy lifestyle, give themcoaching around that and see if
it helps their whole well-being,see if it helps their bipolar
symptoms.
And I thought, okay, we can dothis.
(09:04):
And it was my lived experienceboard who was like, well, what
resources are you going to buildin from the get-go about if I'm
too tired to get out of bed?
What's healthy eating look like?
If I have lost motivation andfaith, what are you building in
about?
How do I get back on track thenext week?
So they were really justamazing in kind of coming
(09:28):
forward with.
What are the strategies we needto give people?
What are the supports we needto give people Knowing like it's
pretty darn hard to makebehavioral change?
Everybody in the universe knowslike have a healthy lifestyle,
that's great for you, and lookat how many people in the world
cannot pull that off right.
It's not just people withbipolar disorder that find it
(09:51):
really hard to follow abeautifully healthy lifestyle.
It's just it's hard.
So in so many ways, the livedexperience core has been just
amazing to me to work closelywith and I hope that we'll see
that in more and more researchteams.
Speaker 2 (10:04):
Yeah, absolutely, and I, you know, see that in more
and more research teams.
Yeah, absolutely, and I, youknow what I love about what
you're saying.
I've listened to doctors who Ithink they identify as holistic
psychiatrists who are usingalternative treatment methods,
which I fully support.
However, one of the challengesis a lot of times they don't
listen to people.
So, for one example inparticular is ketogenic diets,
(10:26):
and ketogenic diets are reallyhard for anybody to put into
place, let alone somebody who isstruggling with mood symptoms,
and I tried to do ketogenicyears ago and my family was
lucky to get any food.
You know we were.
We went through periods of timewhere I was struggling to get
out of bed.
I wasn't taking showers.
I would you showers.
I was going through severedepressive episodes, and then I
(10:46):
would get into this mode of likeokay, we've got to change our
diet, and it would trigger ahypomanic episode and I would
get all this stuff.
I would get hyper-focused onmeal prepping and all this stuff
, and then it's like revvingyour engine for an extended
period of time.
I would rev the engine to thepoint of crashing and then it
would.
It would.
It's like revving your enginefor an extended period of time,
I would rev the engine to thepoint of crashing, and then it
(11:07):
would crash.
I would feel like a failure.
Nobody was eating anything andagain, I wasn't shopping, you
know, and so I've recognized alot of times you present these
really complicated scenarios forpeople who need something
really super basic and and alsonot to feel like a failure when
when you struggle with it.
And so I loved that about whatyou're doing with your study
(11:28):
when I was introduced to thestudy.
That you're doing is that youprovide coaches that understand
what the people are goingthrough.
You provide people thatunderstand.
You have people working on, I'massuming, on the way that the
study is set up in the firstplace, helping you get insight
into what kind of challengespeople might run into in that
scenario.
So I mean that is brilliant andI want to see more of that,
(11:49):
because that's how you actuallyget to success.
We're not lab rats.
We are people who arestruggling with pretty serious
symptoms and we want to get well, but a lot of times, some of
that is outside of our likepower the idea of doing these
big things, making these hugechanges that require a lot of
consistency and and effort.
(12:11):
If we start getting.
That could actually be atrigger for hypomania.
Speaker 1 (12:14):
I love that you also touched on this other part of it
, which is that one of thethings I think a lot about with
mania is that kind of gettingcaptured by something exciting
and goal oriented and thatgetting too big and too
uncontrollable and there's arisk for lifestyle change, that
it's too big, right.
(12:34):
So one of the things we builtin really early on was well, how
do you think about one feasiblechange every week, practice
that, see how it goes.
Then you do your next changeLike and if all your goal is to
make sure that when you go tothe grocery store this week you
get some extra fruits to add tothe diet this week, that's
(12:56):
fabulous.
That's great and it'sinteresting.
You know I'm supervising allthese coaching sessions and you
know you can just hear thisdrive.
You can hear how much peoplewant to take it on full force,
go hard at this, do everythingthey can for their health,
everything for the research, forthe science, and so my coaches
(13:17):
are often the ones who aresaying, okay, that's great, but
what's the most important parthere and what do we need to
focus on first and what's goingto be hard about this?
Let's go ahead and dwell on.
Where's that going to gettricky with, you know, big
dreams, big hopes, big goals.
Um, how do we?
How do we pace it?
Speaker 2 (13:35):
yeah, so let's talk a little bit.
I want to talk.
Probably we got a little bitahead.
I want to go back just a littlebit and talk about your
studying of like triggers, for Ibelieve that you studied like
the triggers for hypomania andmania, and is that what led to
this, or are those?
I'm assuming those things haveto be related somehow.
Speaker 1 (13:56):
They are.
So I think about two kinds oftriggers and things that can
kind of weave into kind of manicvulnerability.
One is this kind of what wecall reward, this sense of
getting too enticed by the goalsand all of a sudden you're up
and going and it's two in themorning and everybody else has
(14:17):
piped down and you're stillalive with where this could go
and how this is going to unfoldand what it's going to mean and
people getting too excited aboutthat.
So we've done a lot of work onthat over the years.
But part of that, and the partthat we've gotten really
interested in too, is there's athing called the circadian
rhythm, your day-night rhythm,and it's biologically wired.
(14:39):
So we know a lot about yourbody, has a lot of internal
clocks.
You have an internal clock inyour body, has a lot of internal
clocks.
You have an internal clock inyour brain, but you have
internal clocks in almost everycell of your body and every
organ of your body and it'sgenetically driven and then it's
influenced by lifestyle factors.
Good health means having areally strong circadian rhythm
(15:01):
so that when it's daytime youare on and full of your energy
and you're concentrating andeverything feels good, and when
it's daytime, you are on andfull of your energy and you're
concentrating and everythingfeels good.
And when it's time to go tosleep, you go to sleep, you
drift off to sleep, you sleepdeeply, you sleep through the
night.
Everything's good.
For many people with bipolardisorder, there's genes for
clock, genes that are not aspowerful.
(15:21):
There's signs before theillness that that rhythm isn't
as strong, and when that rhythmgets out of whack it's sometimes
a little tell that mania is.
They're at higher risk formania.
So we've been fascinated aboutwhat happens when those two
processes collide.
(15:41):
So now imagine that I'm not theperson who gets great clues
from my body that it's time topower down and go to sleep, and
I just moved into a phase whereI am on fire about conquering
things and there's nothing in mybrain that goes that's all
great, pick it up tomorrow.
I'm going to stay through thenight and make this happen.
(16:01):
And now I'm missing all thosebeautiful things that happened
during sleep.
To reset my dopamine, give me abreather, give me back my
perspective.
So by six in the morning, whenother people start waking up,
I've been up all night.
Go and go and go and the wholething begins to take off.
So those are two things.
(16:22):
That was a handful.
Do you want?
Speaker 2 (16:24):
me to talk?
Yeah, I do want to.
I want to talk a little bitmore about circadian rhythm
because I think I think there'sa.
Often people understand thatsleep is important, but I don't
think that people fullyunderstand why, and I've.
You know, I had one young womanon my show a long while back.
She was one of my earlierguests whose first manic episode
was brought on by sleeplessness.
(16:44):
She went several days withoutany sleep and started having a
psychotic episode.
You know she, she ended up infull blown psychosis, ended up
hospitalized, and this, thislack of sleep, seemed to be the
trigger for you know, so it's.
It feels a little bit likechicken and an egg, the chicken
and the egg kind of thing where,like, did this, did the
(17:06):
sleeplessness cause that?
You know, you know what I mean.
Like it starts to feel likeyou're chasing your tail a
little bit with it.
But, but I also, as I've gonethrough the healing process,
found myself settling into amore natural circadian rhythm.
I recognized that thatsleeplessness was a big issue,
and so if I started havingissues with sleep, I would
immediately go to the thingsthat I know help me relax my
(17:28):
mind, relax my body.
You know the micronutrients,that the you know, mindfulness,
meditation, the things like thatthat would help settle things
down, because I knew if I, if Iallowed that to persist, I was
headed for trouble.
But but it wasn't something thatI ever really studied.
So I'd like to actually talkabout that a little bit, if
you're, if you're okay, if wecan explore that a little bit
more.
Because, because I know that alot of people in my audience are
(17:51):
going to be able to relate tobargaining with God for sleep.
You know, laying awake at nightwith your man, your mind, just
right, rolling and rolling androlling over, and you can't get
it to shut off.
And you know, as a mom withyoung children, when this was
happening I was like in tears.
You know just begging, likeplease just let me sleep, please
just let me sleep.
Like, if you let me sleep, I'lldo this.
Like I was like trying to offersomething because I couldn't
(18:12):
get my brain to shut off and andit would, like I said it's like
revving the engine and I knewif this persisted that after a
little while I was going to endup in a severe depressive
episode.
Speaker 1 (18:22):
So it's exhausting, yeah, so then also, how do you
put the brakes on finding calm,which is my research program for
a reason?
So a couple of things.
One, your words on this are sobeautiful and really capture.
It does work both ways, and so,but we do know that a night
(18:43):
without sleep is not a goodthing.
So there's an Italian group Idon't know how they got the
ethics on this, the ethics boarddo agree to this.
They brought in people who hadbipolar depression, were in a
depression state, kept them upall night and by the next
morning showed that about 12% ofthem had shifted from
depression straight intohypomania.
Experimental evidence, right.
(19:06):
We also repeated the study,which I'm like how did your
ethics board let you do that?
But anyway, we haveexperimental evidence and we
have longitudinal evidence thata night without sleep is not a
good thing.
So I love that.
You were like okay, how do Icalm this?
And certainly you know deepbreathing and meditation and
anything that relaxes the body,relaxes the mind, is good.
(19:29):
I'm not a psychiatrist, but alot of doctors will say look,
I'm going to give you a pill youcan take that'll zonk you out
if you're having that experience.
So that's something people cantalk to a doctor about a PRN.
But then the other thing we'vebeen fascinated by is how do you
just strengthen that day nightrhythm?
And you know there's a lot ofpeople who look at light therapy
(19:50):
.
And that's important becauseyou actually have a different
receptor in your eye that'ssensitive only to the light
frequency at dawn and dusk.
It fires off, it shootsstraight back into a brain
region called thesuprachiasmatic nucleus.
It feels like super fragile,you know thing.
But you have a brain region welike to say SCN because we can
(20:13):
pronounce it that then sends aclock through the whole brain
and it is sort of tuned by thelight at dawn and dusk.
So many people are fascinatedby that.
I was working with a circadianperson named Lance Kriegsfield,
a scientist who I adore, and hecame to me and he said are you
(20:33):
watching what's happening downat Salk Institute?
And I said what do you mean?
And he said have you beenhearing about time-restricted
eating?
I said no, I have no idea whatyou're talking about.
People at Salk who were doingmouse studies started to realize
that when they fed their micewas as powerful for the mouse's
day-night rhythm as the lightexposure at dawn and dusk or for
(20:58):
mice.
It's a different clock, butfood timing was as powerful as
light and part of that has to dowith it.
Beyond this beautiful clock youhave in your brain, the SCN, you
have clocks in every cell ofyour body and every organ of
your body and your stomach andyour liver and your kidneys and
all of those peripheral clocksare going to get shaped
(21:21):
profoundly by very carefultiming of your eating.
So they started to kind of lookat it's a version of
intermittent fasting.
But some forms of intermittentfasting are very harsh.
Some are like you don't eat fortwo days.
This is much more about eat atthe same darn time every morning
.
So your body has a little wakeup cue, gets the hormones going
(21:43):
your appetite is actually reallypredictive and then knock off
your eating a couple hoursbefore you're going to go to
sleep.
Because if you're still eating,melatonin comes along.
Melatonin and your kind ofinsulin are a little bit in
collision and melatonin is yoursleep agent, your sleep hormone,
so you don't want differenthormone systems fighting in
(22:04):
those last couple hours beforeyou go to sleep.
So basically it comes down toeat the same 10 hours every day,
eat by the clock and you'regoing to give your body a very
powerful signal of like hey,this is your morning, this is
your night, this is your morning, this is your night.
And if we can make that systema little better, the hope is
(22:25):
that then people can sleep moredeeply and also have a little
bit more of a cue of like youknow, time to power down.
Speaker 2 (22:32):
One of the things that happens a lot of times with
people who are struggling withthese symptoms is they've been
sleep disrupted for so long thatit's almost like they can't
figure out how to resetthemselves.
You know what I mean.
So what are the things thatpeople can do that will help
kind of reset that clock forthemselves?
So you're talking about thesethings like if somebody did this
, and I want to make sure Ihighlight for my audience you're
(22:55):
currently doing a study thathas to do with this, and can you
talk a little bit about thatstudy?
How long, in general, do peoplesee that it takes for them to
kind of reset that clock?
I don't know if you've foundthat yet or if you can share
that, so let's start there.
I don't want to give you toomany questions.
Speaker 1 (23:13):
Okay.
So our study is actually tocompare two forms of healthy
eating.
We're really fascinated by thiseat by the clock time,
restricted eating but the otherpiece we're really fascinated by
is the Mediterranean diet.
We're very invested in the ideathat there are these signs that
bipolar disorder is a wholebody phenomenon.
(23:35):
People with bipolar disorderoften also have metabolic
symptoms, cardiovascular thingsgoing on.
Energy is profoundly involved.
So how do we support wholehealth?
And so this study is to takefolks who are already on
medications mood stabilizers andsay what happens if we add one
(23:58):
or the other of these healthylifestyles and track can we make
a difference in symptoms andquality of life?
And if we could hand this outfor free to people, could we
promote better stability forpeople around the world who have
bipolar symptoms and wantsomething else to add in.
(24:19):
So Welcome.
Trust gave us money to do thelargest study that I've ever
heard of of healthy eating andbipolar disorder and whether it
makes a difference.
We're recruiting people.
We've said we'll find 450people to follow each person's
experience very carefully ofwhat worked, what didn't, who
(24:40):
does well, who can do it, whocan't.
What supports do they need sowe can take it forward?
Boards do they need so we cantake it forward.
We don't have data yet, butwe're actually really excited to
have 70 people enrolled,helping us by logging their
experience, logging their diet.
One thing I can tell you forsure is it's a process, so we
log for two weeks before we evenstart to set the timing of
(25:04):
eating, because we're trying tofigure out, well, what is your
midpoint.
And for people with bipolardisorder, sometimes there isn't
a set bedtime, wake up time.
So what's the middle of that?
We make a guess.
We set our timing window.
Sometimes we say let's startwith a 12 hour eating window and
do that for a week or two, thenbring it back to 10.
(25:25):
And maybe we're going toshuffle it, but we're going to
titrate it really carefully soit doesn't mess up their
lifestyle.
Like the last thing we want issome person with bipolar
disorder not getting to havedinner with their family because
they think, like I have to stopeating.
Like how do we, how do we thinkabout the most important social
pieces for you, lifestylepieces, and then build a rhythm
that's going to work for you.
And so we'll work with peopleacross 10 weeks, see if we can
(25:50):
get that rhythm in place andthen we'll follow them across
time to see is it making adifference?
Is it making a difference atthe end of those 10 weeks?
But what does it look likemonths later too?
Speaker 2 (26:01):
And it's really interesting that you mentioned
the Mediterranean diet, thatthat's the diet that you chose,
because, I mean, there are a lotof different diets out there
and a lot of claims about thediets, but I've actually seen
solid research on theMediterranean diet Drs Bonnie
Kaplan and Dr Julia Rucklage,who've done a ton of research in
the field of micronutrition andmicronutrient support.
That's where they have peoplestart, you know they, that's
(26:22):
what they they encourage intheir book.
They even have, you know, asection with recipes and
guidelines for how to you knowhow to eat healthy eating using
the Mediterranean diet.
They're not huge fans of likemajor changes as well, like you
were talking about, you know,helping support, actual.
I think that there's a tendency.
You have to be really carefulwith people who are, you know,
(26:44):
struggling with this, because wehave a tendency to go like full
bore into it and then burn outand crash, you know, and then
feel discouraged and give up,right and so more more so, I
think, than than somebody in thegeneral population who isn't
struggling with these symptoms.
And the thing I love about theMediterranean diet specifically
(27:05):
is that the brain support thatcomes from the nutrients that
you're putting, that you'reputting into your body.
You know I don't think that weunderstand enough about
nutrition.
I know for certain.
You know like in my personalexperience and most of the
people that I work with, theynever had never once had a
doctor talk to them aboutnutrition.
Not one time.
Speaker 1 (27:23):
Right?
Well, because it's not.
If there's not enough sciencefor the doctors to feel
confident, we have got to takeon, build the knowledge base.
But yeah, the Mediterraneandiet outside of bipolar disorder
, I mean, there are now studiesof thousands of people that say
this is great for your heart,it's great for your immune
system, it's great for yourbrain, it's great for your
(27:46):
cognition.
Your body needs these healthynutrients.
Another thing I really likeabout it is it's very focused on
how do you bulk up a little bitof the healthy stuff in your
diet and let's not punish you Ifyou want to have an ice cream,
think about that as an extra.
That's okay.
We don't ban anything, but wejust keep the focus on each week
(28:06):
, how do we add another littlebit of a healthy habit?
What's the thing you're goingto give your body?
What's the ritual you're goingto put in place to just give
yourself a little bit of healthystuff for your body vegetables,
fruit, whole grains and you'reright, there's like a million
resources.
I'm glad their book really goesinto this on like how do you
(28:26):
find recipes?
How do you do this?
A lot of people think it'sgoing to be super expensive, but
it's actually very affordablefoods like whole grains and
lentils and beans are like thestuff of grad school.
That's how you survive.
Grad school is you eat a wholelot of those very healthy
proteins that are very, verycheap.
The other thing is you canadapt it for every spice kit in
(28:50):
the world.
So if you love Mexican food,put your Mexican spices on top
of those beans.
If you like Japanese and Asianfood, put your Asian spices on
top of those whole grains.
So it's very adaptable andthere's a lot of good tips out
there about how to make it work.
Speaker 2 (29:08):
Yeah, and one of the things that I love about what
you said you've said a few timesnow and I this is something I
advocate as well is you're, youare developing habits for
healing, that the point is todevelop a habit, and so we, you
need to start with somethingsmall and achievable.
And you know, especially comingfrom a, you know, a bipolar
symptom background, I knew if Itried to make a whole bunch of
(29:30):
changes at one time, it was notsustainable, and so I and I'm a
big advocate of alarms, I usealarms for everything.
Anytime I'm trying a new habit,I will set alarms throughout
the day.
Don't turn the alarm off untilyou've done the thing, but it
needs to be something simple andreally easy to do so that my
brain doesn't get in the way of,like, building it up and
thinking, oh, this is such a bigthing to do, you know, and so
(29:51):
make you know.
If somebody is trying to changetheir diet, pick something that
you do, like you know,especially if you're introducing
a bunch of things that are newto you.
You know, maybe somebody hasnever eaten any lentils before
in their life, so don't try andchange your whole diet and put a
whole bunch of lentils andyou're not going to like it.
Your body's going to craveother things.
You know you got to changelittle things at a time, but but
the thing that's beautifulabout it is, in my experience,
(30:12):
is as you develop these habitsfor healing, you have
incremental wins and you startto feel better, which then gives
you the more motivation tocontinue moving forward with
that.
And I'm wondering if you'veseen that in your study so far,
if that's something that you'veseen play out.
Speaker 1 (30:25):
Yeah, I want to have you come talk to all the people
in our study because you're justsuch a voice for kind of how to
make this happen, and it fitsso well with the science.
Yeah, the hardest thing we'rehearing in coaching is people
having really high expectationsfor changing everything and then
being so deeply worried aboutletting themselves down, letting
(30:46):
us down, and so we're reallytrying to empower people to just
say one change at a time.
And then the science of this islog it and nobody likes logging
.
It feels geeky and kind ofscience world.
But actually those small stepsof just monitoring how did it go
and what got in the way eachday are kind of how you do
(31:09):
develop a ritual and a habit.
And what I'm hoping is thatpeople can take this not as a
scorecard for did I make amistake today, but more a way to
give themselves credit for youknow what today I fed my body, I
fed myself, I did somethinggood, thank you.
(31:29):
Like those small rituals to feelgood about.
And we're always sort of sayingof course you're going to have
your Saturday night where theMediterranean diet's out the
window right and of courseyou're going to have your
Saturday night where you atelater than you wanted to, or you
were out with your friends andyou weren't going to, or you
weren't going to tell yourgrandma you weren't going to
have a late night dinner.
Right, like all those things.
(31:50):
Right Like, give yourselfpermission and just work on.
How much can you create aritual?
How much can you create a habitthat feels comfortable, cause
that's what's going to stick.
Speaker 2 (32:01):
Yeah, and one of our mantras in my group is curiosity
, not judgment, so that we areyeah, because it's because
they're.
I think one of the things thatwe I believe is very common in
our community is we're veryjudgmental of ourselves.
People often judge us.
You know, the behaviors thatcome out of these symptoms are
(32:22):
not socially acceptable.
Often, you know, they areembarrassing, they're
discouraging and we are veryhard on ourselves.
We're very judgmental ofourselves and it needs to.
There needs to be a shift thatoccurs.
You know, one of the it startedfor me the first time that this
came into play was I have acoping mechanism which is
excessive television watchingand and I I was viewing it as an
(32:45):
addiction and I went toaddiction recovery programs.
I was like putting locks on mytelevision, I was doing all
these things to try and stop thebehavior, not understanding
that it was a coping mechanism.
And I finally had a therapistasked me the question what are,
what need are you trying to meet?
And I I was so caught off guardby the question.
I was like what are you talkingabout?
And she said what need are youtrying to meet with this?
And I had to think about it fora while because I didn't even I
(33:08):
had never considered there wasa need being met by this coping
mechanism, and so I think thatthat's one of the things that is
so important.
As people are trying to, webecome detectives in our own
lives.
You know what?
What is that?
What's behind?
What's motivating this behavior?
You know, I've got this symptom.
Something is motivating thebehavior that is attached to the
symptom, and get curious aboutit rather than judging ourselves
(33:31):
.
It doesn't mean that we.
It doesn't mean that we aregoing to accept the behavior I
don't like.
I don't like spending hours andhours on end watching
television programs that aremindless and uplifting.
You know, that's not somethingI want to continue in my.
I wanted to continue in my life.
However, it didn't do me anygood to beat myself up about it.
I needed to get curious aboutwhat was underpinning that
(33:52):
behavior and then, once I couldfigure out what was causing the
behavior, how can I meet thatneed in a better way, in a
healthier way, that that is moreproductive in my life?
And so I think the same thingwould be true for any you know,
as you're trying to develop newhabits.
If you're struggling with it,ask the question why, instead of
judging yourself and beatingyourself up.
Why am I struggling with this?
(34:14):
What's what's going on.
Is there a way that I can dothis differently?
That would be easier, you know,more conducive to success for
me, and maybe not even lookingat success or failure, because
those are judgment words as well.
But in order to accomplish whatI'm trying to accomplish, how
can I tweak things?
What can I do differently?
How can I find a way to meetthose needs and be curious about
(34:34):
the struggle rather thanjudgmental about it?
Speaker 1 (34:37):
That's beautiful.
I always sort of think, likewhat we want to be able to do is
hold the goal out here, reflecton it, think about what makes
this hard, what makes it easy,what makes it fit, and then go
from there.
And I think there's a lot ofthings that make that harder in
bipolar disorder.
One is the whole topic offeeling out of control is just
(34:58):
scarier, right.
And there's also thatself-critical.
You know, picking back up aftereverything that's happened,
it's easy to feel demoralized,scared, self-critical, and I
love that you're such a voicefor like you can get through
this.
You know, like let's take acurious, one goal at a time kind
(35:20):
of thing.
The other thing that we'vewritten about, we've tried to
understand, is that I thinkpeople with bipolar disorder
often set very high goals forthemselves.
They want to make a difference.
They've set bigger lifeambitions, bigger life dreams,
bigger goals, and they have moreof a worry about what happens
if that doesn't happen.
(35:41):
We call that the double-edgedsword, because the good side of
it is sometimes people withbipolar disorder make profound
difference.
You know, I mean we have more.
It's related Having bipolardisorder in the family and in
the genes is related to whetheryou're going to become a
military general.
You're going to create a company.
Your company is going to make alot of money.
(36:02):
Kay Jamison has written abouthow many unbelievable artists
have had this, how many authors.
So that big dream thing is agift, but it's a curse, you know
, because sometimes it's easierto take a small step than a big
(36:24):
step, and if you're holdingyourself to this standard of I'm
going to do this huge thing,then it's easy to fall short.
It's easy to feel self-critical, it's easy to get into a cycle
of well, that's not so big, butmeanwhile some of life is you
put one small foot forward, kindof thing.
(36:45):
So I'm really fascinated by howpeople juggle what they expect
of themselves and hold to kindof having a big dream.
But not let it overwhelm, we'reall just trying to get through
the day too.
Speaker 2 (37:01):
Yeah, absolutely, and I love the thing I love about
this study and I'd like to knowmore about if you've done
anything related to circadianrhythm outside of this.
I would like to talk about thata little bit more.
That's such an important topicand as I was preparing for this,
I had the thought like I don'tthink I've had anybody on to
talk about circadian rhythm.
(37:21):
How is that possible?
Like it's such an importanttopic and so critical to well
being.
But I would love to hear moreabout you know what what other
things that you have learned andwhat studies you've done
perhaps related to circadianrhythm and improving that,
because I think that that's whata lot of people who are
struggling with these thingswant to know.
So I love the study.
(37:42):
I want to make sure at the endwe'll talk about if somebody is
interested in participating inthis study, how they can reach
out to you.
But what other resources orstudies have you done that are
related to that, because it'ssuch an important resource for
people who are trying to recover, who are trying to heal, who
are trying to live healthierlives with their symptoms.
Speaker 1 (38:03):
Yeah.
So our biggest study on thisfront is about to launch.
We're going to do a worldwidestudy for people in
English-speaking countrieslooking at circadian rhythms and
reward and how they movetogether.
So we're going to be askingpeople to kind of take quick
games on their cell phones threeor four times a day to look at
(38:25):
how excited they are aboutrewards and games and winning
and how that changes withday-night rhythms.
We're going to be logging theirsleep.
We're going to be followingpeople across time.
Some of them will do brainscans in the evening to see if
pathways in the brain that areabout goals and going after
things are powering down in theway we would expect as it gets
(38:47):
into the evening.
So stay tuned.
We will be putting up stuff onour website about what people
who are interested to kind offollow their own reward and
circadian rhythms using thesecell phone apps and seeing what
we can figure out.
I've been less in the circadianrhythm space.
I've been more of a fan of that, but one of the things that I'm
(39:07):
proud of that we did is we havea lot of work out there on what
this looks like in adults andwe have a study under review
where we said okay, but how muchof that is the aftermath of
years of mania and depression,and does that just scramble this
system?
So we were able to work with agroup of adolescents who were
(39:29):
sort of very new to having theillness and we were able to show
that their circadian rhythmsalso look blunted.
They don't show the samestrength of day-night rhythm.
So what does that mean?
They look less energetic by day.
They look too energetic andless sleepy at night, but we can
see it very early on as peoplemove into having these symptoms.
(39:53):
So that's under review.
Wish us luck with reviewers.
I'm proud of it.
I think it'll get its way intothe world, but we'll see.
Speaker 2 (40:01):
Yeah, and it's you know, it always begins with
identifying the issue in thefirst place.
You know, once we can identifythe issue, then we can start
figuring out like, what do we doabout it now?
And I know that I, you know, Idon't know if you've had much
experience with blue light.
You know, yeah, yeah, becausethat's one of the things.
I've seen some articles aboutthe disruption in the circadian
rhythm that occurs because ofour exposure to blue light, and
(40:23):
it's definitely a menace.
Speaker 1 (40:24):
It's definitely a menace to your melatonin.
Speaker 2 (40:27):
Yeah, and is that?
So I was going to ask you ifyou knew much about.
You know what I don't want tospeak to.
I don't have the articles toquote, so I don't.
I'm not going to try and speakany kind of with any authority,
but what have you seen aboutthat?
How does blue light, which weknow for anybody in the audience
who doesn't understand what I'mtalking about this is exposure
to screens.
So our cell phones, ourtelevisions, our computers emit
(40:50):
blue light that affects ourbrain, it has an effect and it
has an impact on melatonin.
So can you talk a little bitabout that, Because I know that
that for me, that was a hugedisruptor.
Speaker 1 (41:02):
Yeah.
So let's back up for a minuteand talk about melatonin for
people who aren't familiar withwhat melatonin is, melatonin is
a hormone or a chemical that hasa strong day night rhythm.
It tends to come on at nightand it promotes, it helps people
go to sleep.
So as the melatonin comes on,that's part of why it's easier
(41:24):
for people to kind of drift offto sleep.
So the degree of melatoninrelease, or how well that
melatonin is working, is shapedby how powerful your circadian
rhythm is, or your day-nightbiological rhythm.
And so if you have a weakcircadian system, one of the
ways that may show up is themelatonin system not working as
well to give you these cues foryour body that it's time to
(41:47):
power down and go to sleep.
So melatonin is a reallycritical part of this whole
system, and what we know is thateven small amounts of light, as
melatonin is starting to kindof be released and do its work,
suppress more release ofmelatonin, and blue light is an
(42:08):
important part of that.
So people will think well, it'sokay that I'm just quietly
looking at my cell phone in bedor just watching TV to power
down, but that light is enoughto suppress melatonin.
And now you've lost one of thesignals, one of the really
important signals for your bodythat it's time to go to sleep.
(42:28):
So there's more than oneinfluence on whether you can go
to sleep.
One is how long you've beenawake, for you accumulate
something called the sleep debt.
Sleep One is how long you'vebeen awake, for you accumulate
something called the sleep debt,and so that's just building up
and building up, building up,and then when you go to sleep,
(42:53):
it disappears very, very quickly.
So you have sleep debt and youhave melatonin.
So there's still ways peoplecan sometimes fall asleep, even
if their melatonin is crushed.
But you're taking out half ofthe story there.
But you're taking out half ofthe story there.
You're taking out half of theinfluence that helps us just go.
Speaker 2 (43:04):
Okay, it's time drifting off, yeah, and it's so
interesting, one of the thingsthat I learned as I was trying
to figure out a way to keepmyself asleep.
So a lot of times people withbipolar will struggle with
staying asleep.
Maybe you can fall off to sleepreally quickly and then a
couple hours later you're wideawake again in the middle of the
night.
That's the circadian systemright there, and one of the
(43:28):
things I figured out.
And I think I must have read anarticle.
It's usually triggered likethese discoveries are often
triggered by reading somethingabout it.
But I realized when I'm wideawake at night, don't watch
television and don't get on myphone and I have a micronutrient
that I will.
I don't know if it's amicronutrient, I think it's
(43:50):
considered micronutrient.
Anyway, I have a supplementthat I take at night if I'm, if
my brain is racing and my bodyis kind of alert, that helps
kind of calm down thosereactions in my body.
And I will read.
Those are the two things thatI'll and I'll read something
that's not super engaging, likeI'm not going to read a fantasy
novel.
That's really exciting, that Iwant to keep reading.
You know, I'll read, I'll readsomething that's interesting but
(44:11):
not like super engaging, thatmy brain is like, yeah, I've had
enough of that and those twothings.
Or writing you know I'll likejournal or something to get
whatever's in my head thatthinks it needs attention out
onto a piece of paper andusually within about half an
hour I can fall back asleep andhave a good night, you know,
finish through the rest of thenight.
But I used to watch shows, likeyou know I would or or scroll
(44:32):
through my phone and I didn'trealize that I was working
against myself.
You know I was thinking I justcan't fall asleep and I didn't
realize.
Well, the reason you can't fallasleep is you're working
against yourself with this bluelight.
You know that's that iscombating your body's natural
system for trying to calm itselfback down and go back to sleep
Totally.
Speaker 1 (44:51):
You know, the other thing I think people don't talk
about enough is that moodstabilizers and antidepressants
also strengthen circadianrhythms and there's all kinds of
really interesting cellularlevel, molecular level,
biological level work going onto understand that and to try
(45:11):
and think about how that worksso you could kind of bulk it up.
So I think we have there'sactually really great lifestyle
work around how to help peoplesleep.
So there's a program calledCognitive Behavioral Therapy for
Insomnia which you can takeonline.
There's online apps to supportCBTI that's the cute little CBTI
(45:35):
that's out there and thenthere's lifestyle things to kind
of get rid of the stuff thatwould mess with your sleep, and
then there's medicationapproaches.
So this is one place where Ithink there's a lot of tools
that people can choose from.
But so vital to kind of thinkabout it.
I also want to sort of say forpeople who are hearing this and
(45:58):
then there's almost a kind ofterror that happens if you're up
at two in the morning andyou've heard like didn't Dr J
just say that that can triggermania, and now how am I supposed
to sleep right, to just helpyour body and mind relax and
deep breathing and reading andkind of focusing on your
(46:30):
favorite spot in the universe.
All of those things are alsogoing to help your body and your
mind relax, and making aconcerted effort to give that to
yourself in those moments isgoing to achieve some of the
important goals of sleep.
So I don't want people lyingawake at two in the morning
going, oh no, what happens ifshift gears and do your deep
breathing and count your sheepor visualize your last beautiful
(46:52):
place you were in?
Speaker 2 (46:53):
Yeah, and one of the things, one of the things you
learn in mindfulness, whenyou're, when you're practicing
mindfulness, is focusing on this, you know, on the deficit of
where you are to where you wantto be, sometimes widens that
space.
And so, rather than thinking,oh, I just want to fall asleep,
rather than focusing on whereyou want to be, just focus on
being present, calming yourselfdown and utilizing.
(47:16):
I encourage people to explorethe different resources you know
.
Try mindfulness, meditation,which I think is a big one.
There are relaxation, you know,recovery kind of things that
you can do with yoga.
That will help kind of relaxyour body, kind of bring you
back, tell your bodyeverything's okay, you're safe,
everything's fine.
You know, writing out the stuffthat's in your head.
(47:37):
A lot of times your brain justis trying to get your attention
for something, and that's why Ifound journaling so productive,
because give it a place to go.
Tell your brain, yes, I'mpaying attention to you and I
want to do it right now, but I'mgoing to put it down and then I
will remember to work on ittomorrow, you know, but but I
think, practicing thosedifferent things and try not to
focus on the deficit between youknow I'm wide awake and I want
(47:58):
to be asleep right now and justfocus on.
What can I do in this moment tocalm down?
How can I, how can I bringmyself into a calm state?
How can I relax my body?
Interested in in, you know,looking into this and
(48:21):
participating in this study.
The two, the two differentthings you're studying are
restricted eating and thenMediterranean diet.
Is that correct?
Speaker 1 (48:31):
Yeah, so people can come to our website it's called
calmberkeleyedu and learn moreabout our studies.
They can sign up online.
They can read more of thedetail.
They can send us an email withquestions.
We welcome questions, but thestudy we're enrolling folks in
right now is comparingtime-restricted eating or eating
(48:51):
10 hours a day at set timesagainst the Mediterranean diet
and trying to figure out whatsupport people need to follow
that.
And then in a couple monthswe'll launch our new study,
which is not about treatment,it's not about change.
It's about just understandingthis kind of how we call it
(49:12):
rhythm and rewards.
How does your day-night rhythminfluence what happens with the
way you go after rewards atnight?
Speaker 2 (49:22):
That's so interesting .
Can we talk just a little bitabout that?
Sorry, so you've mentioned afew times Sorry, that was a
question that I had earlier andI forgot about it.
So you've talked about rewards,studying like rewards and mania
and their connection to eachother.
Can you talk a little bit aboutwhat that is and what you mean
by that and what you've seenthat has made you think?
(49:42):
Let's do a study on this.
Speaker 1 (49:44):
Yeah, so I probably spent 20 years on this topic of
rewards and mania, and I wasn'tthe first.
There's a guy in the fieldnamed Depew who said okay, so,
first backing up, you have abrain system that helps you when
there's an exciting, positivereward out there.
It propels you into a state ofenergy, it helps you focus on it
, it gets your brain thinkingabout it, it gives you the joy
(50:08):
about like, okay, we're goingthere right, and we all have
that system.
It's called your reward system.
It's neurobiological, we knowwhere it is in the brain, it's
dopamine, and it's a good thing,right?
We all need a way that if Isaid, hey, there's a million
dollars on the opposite side ofcampus, you would mobilize and
you would run fast to go get it.
So we all have it and it'sadaptive and it's beautiful and
(50:32):
it does all these things thatDepew, a long time ago, said.
Boy, all those signs of maniasound an awful lot like what you
expect of a reward system infull tilt.
And what if, at the heart ofmania, what we have is a reward
system that is somehowdysregulated so that once it
goes into full tilt, it's harderto bring it back down, harder
(51:03):
to bring it back down.
So we've liked to think of itas a kind of extra sensitivity
to going after rewards.
They're more exciting, they'remore alluring, they're harder to
let go of and we haveself-report scales we can give
that are about this.
We all know people who like itdoesn't take much out there for
them to go into sheer joy, juicefull tilt.
I'm going there.
We all know people who arecloser to Eeyore.
(51:23):
Where you go there's a milliondollars on the other side of
campus and go, somebody else isprobably going to get it Right.
So we all, we are all titrated.
I think for bipolar disorderit's not just that it moves into
highs, it's also that it'sdysregulated.
It's hard to bring it back downinto check.
(51:47):
During the lows it goes way toolow.
So that opens up a lot of doorsfor us.
One is some prediction, becauseit turns out that that system
is designed to respond whenyou're in the middle of exciting
, stimulating possibilities.
You're in the middle ofexciting, stimulating
possibilities, so that's.
The bad news of this is thatsome of the moments that are so
(52:10):
exciting in life are alsovulnerable for kicking this off.
But if you know that, then youcan work closely with your
doctor when you're going throughthose periods and you can work
to kind of give yourself backcalm, even in the middle of
life's best moments.
You can go in the bathroom andtake three deep breaths.
You can make sure that youretreat, go to sleep, think
(52:33):
about it the next day.
You can learn to do yoga.
You can learn to doself-calming things.
You can learn to work with yourdoctor to titrate medications,
but that those are criticalmoments to make sure that you
and somebody who loves you orsomebody who watches you is
keeping tabs on.
Did this just get too high?
And how do we help you re?
Speaker 2 (52:52):
regulate.
I could talk to you all day.
This is fantastic.
I'm so excited for the thingsthat you're studying, and if
somebody wants to connect withyou, what's the best way to go
about that?
Speaker 1 (53:05):
Go straight to our website, columnberkeleyedu
Berkeley, by the way, is hard tospell, it's B-E-R-K-E-L-E-Yedu
and they can email, they cansign up for studies, they can
see what's coming next and Iwill say you know, getting this
(53:30):
right and figuring it outdepends on hearing from as many
people from as many differentbackgrounds as we can, and also
hearing from them when we didn'tget it right, or they want us
to tweak things, or they wantour study to get better in some
way.
So, yes, we'd love foreverybody in the universe to
sign up, but we also want tohear if there's ways that this
doesn't fit for people.
Speaker 2 (53:51):
Fantastic and I'll make sure all of your contact
information, the website,everything is linked in the in
the show notes so that peoplecan reach you easily.
Thank you so much for all thework you're doing and thank you
again for being a guest today.
Speaker 1 (54:04):
Thank you for everything you're doing.
It's really just beautiful toconnect to you and to watch what
you're doing, so best of luckwith this, thank you.
Speaker 2 (54:14):
All right, Until next time, Upsiders.
Hey, thanks for joining ustoday.
If you're ready to start onyour path to wellness with
bipolar, go to myupsideofdowncomand get your free mood cycle
(54:34):
survival guide four steps tosuccessfully navigate bipolar
mood swings.
If you're ready for more, checkout the Map to Wellness.
Until next time, Upsiders.
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