It is not unusual to feel stressed – most of us succumb to it at various times - but there are a number of reasons why stress worsens Parkinson’s symptoms, such as tremor, slow movement, freezing, speech and swallowing difficulties.

A diagnosis of Parkinson’s can lead to stress as it brings with it worries and uncertainties about the future, both for you and your family.

Dopamine, which is deficient in the brains of people with Parkinson’s, is used by the body to produce adrenaline. Adrenaline needs to be produced in order for the body to cope with stress. It is therefore not surprising that people with the condition do not produce adequate adrenaline to cope with physical, mental or emotional stress under control.

Sources of stress can be emotional and/or physical, for example dealing with daily activities or life events such as job loss or bereavement, difficulty coping with work, other illness, medication side effects or fatigue and anxiety. Stress can also result from frustration about any adjustments or limitations that you find come from living with Parkinson’s. You may also feel that you have lost control over your life.

Analysing and addressing the reasons for stress and learning to relax is important in managing symptoms and maintaining a good quality of life. With the right attitude, careful planning and lifestyle adjustments many sources of stress can be eliminated or their impact reduced.

We all have different ways of dealing with stress - what works well for one person may not work for another, so you will need to experiment a little and see what is most effective for you.

Things that cause stress in someone with Parkinson’s may differ to triggers in people without the condition. Talking with a professional psychologist can help you to identify your own individual stressors and find ways to effectively manage your stress.

Remember that any stressor will affect your motor (movement) symptoms. You should therefore speak with your doctor promptly if something is causing you stress, for example a sexual problem, difficulties with speech, swallowing, bowel function or with specific movements, or other health concerns. If you ignore problems, they are likely to get worse and in turn cause you more and more stress.

Ask your GP to refer you to a psychotherapist who can provide support and training in stress management techniques. In some cases, it may be helpful for your family or carer to be referred for support too. It generally helps to share your concerns by talking with someone you know or trust.

Other suggestions for coping with stress are outlined below.

Keeping positive

A positive attitude is generally thought to be one of the major factors in successfully coping with Parkinson’s on a day-to-day basis, and this is certainly true of stress. How Parkinson’s affects you is greatly influenced by your attitude towards it. Try not to let the condition define who you are - focus on other aspects of your life that are positive and find things each day to be grateful for. And try to avoid self-criticism as this will almost certainly make things worse.

Accepting lifestyle adaptations, and focusing on what you can do, will help you continue to manage everyday activities and enhance your enjoyment and quality of life. 

Coping will, of course, be more difficult for some people, but many people lead fulfilling and active lives because they understand how Parkinson’s affects them and work around any limitations. They adopt, as American writer Sidney Dorros¹ said, a strategy of “Accommodation without Surrender”.

Keeping your situation in perspective and trying to laugh a little about it can also help to relieve stress. This can sometimes be hard but laughter really does help - it releases chemicals in the brain which help lift spirits. It may also diffuse difficult or awkward situations by putting people around you at ease, making communication easier and removing tension. ‘Laughter therapy’ groups may also be helpful.

Diet

Diet affects our ability to cope with stress. Stress upsets the regulation of blood sugar (glucose) into cells in the body, causing mood swings and fatigue. Managing your diet to optimise the regulation of blood sugar levels can therefore help with managing stress^2,3. To regulate blood sugar (glucose), it is important to eat a small snack every 2 to 3 hours.

Glucose, which is obtained mainly from fruit and vegetables, is made in the body to provide energy for our cells. However, it is now recognised that neurological conditions such as Parkinson’s compromise the ability of cells to absorb glucose from our blood. It is therefore advisable to ask your doctor to check your blood sugar regulation function. Producing energy for cells in the body and brain is an underlying problem in Parkinson’s.

It is also now recognised that a unique dietary fat in coconut oil (medium chain triglycerides or MCTs) can act as an energy source, quite apart from glucose.

Ideally you should be guided by a nutritional therapist or dietician who has been specifically trained in the biochemical challenges Parkinson’s poses and can consider your own personal biochemical make-up when advising on diet.

Medication

Your medications may in fact cause stress as an unwanted side effect. Ask your doctor for a review of the doses you take, the timing of the doses and for the minimum effective dose.  If that does not help, ask if there is an alternative medication to provide the same benefits. Some common drugs interfere with the way levodopa works so ask your doctor if you have any concerns.

Nutrition

People with Parkinson’s may have different needs and responses to nutrition to those without the condition. The ability to digest certain foods varies from one person to another. A nutritional therapist or dietician will be able to tailor an individual eating plan to suit you.

It is important to recognise that certain foods interact with some medications and this can affect how well levodopa works and is absorbed. The timing of meals, and therefore the consumption of protein, carbohydrate and fat, should be decided according to timing of any levodopa you take.

A healthy intake of protein, carbohydrates and essential fatty acids is essential over the day. 

The gut is now known as the Enteric Nervous System with much of the brain environment in it. This is also called ‘The Gut Brain Axis’. Therefore, the health of the intestinal tract is extremely important and any gut problems can be great stressors in Parkinson’s. If you have any bowel problems, you should ask your doctor to refer you to a bowel specialist.

Below are some suggestions for ‘healthy’ food but diet must be individualised!

• Carbohydrates – provide energy for cells in our body and brain. Metabolising carbohydrate can be problematic in Parkinson’s.

Good sources of carbohydrates include brown rice, sweet potatoes, vegetables (particularly dark green and orange colours), plantains and fruit. Gluten free grains are usually more suitable. 

People with other conditions such as diabetes, metabolic syndrome and cancer should seek advice from their dietician and doctor. 

• Fibre – helps to keep your bowels functioning well. As stress can result in cramps and constipation, eating foods high in fibre is very important. Fruit, vegetables and grains (preferably gluten free) are excellent sources of fibre.

However gliadin, a molecule found in gluten grains (wheat, rye, non gluten-free oats, barley and spelt) may act as a neurotoxic opiod in people with a neurological condition.  Wheat is now unhealthily genetically modified which poses a challenge to the immune system. Eating gluten-free grains such as rice, corn, buckwheat, millet and tapioca may therefore be a healthy alternative, especially if abdominal symptoms cause discomfort and stress. The flour from these grains can also be used in cooking and baking.

• Protein – fish including salmon, mackerel and sardines, poultry, eggs and avocado (which contrary to reputation does not contain cholesterol).

Caution! 
Soy is a whole protein but research has shown that lectins in this grain can negatively affect gut health. Peanuts also contain lectins which make them difficult to fully digest.

• Alcohol - alcohol can make you feel down or irritable and in Parkinson’s it can be difficult to eliminate from your system. It is also contraindicated with some medications so check with your doctor before consuming alcohol.

Foods to avoid:

• Heating or cooking in polyunsaturated oil. Only use olive oil, coconut oil and occasionally butter for heating (if you do not have a cholesterol problems).
• Caffeine – this may raise blood pressure and raise pulse rate and impact on stress control. You should therefore limit or reduce your intake of caffeine. Green tea does contain caffeine and a moderate intake can be healthy as it contains some healthy nutrients.
• Also avoid any sudden change in your diet as this may upset the ability of your liver to detoxify your body and can make you unwell.

For more information see Eating well.

Exercise, recreation and leisure

Exercise can be very beneficial in reducing stress and it can also increase mobility, reduce other Parkinson’s symptoms and improve overall quality of life. 

Pursuing suitable activities you enjoy, or finding new ones, can help you forget any limitations living with Parkinson’s might bring. The opportunities are wide ranging from energetic activities such as playing sports or going to a gym, to less energetic pastimes like going to the cinema or art galleries, walking, joining a book club or art class. The trick in reducing stress is finding something enjoyable that distracts you from your illness and helps you relax. Many people find creative therapies help them relax and forget their symptoms as well as enjoy the company of others.

Complementary therapies such as Tai Chi, light massage and meditation, to name just a few, can be very relaxing. Chi Qong can also help with relaxation and breathing techniques.

Maintaining relationships is vital. Social contact and interaction with friends and family can help you stay positive, and will provide opportunities to share any worries and allow you to continue to engage in everyday life.

See also Exercise.

Support groups

Support groups offer a safe place to discuss feelings, ask questions and obtain valuable information.

The Parkinson’s association in your country or members of your healthcare team should be able to provide details. You can also or enquire at a local library or look on the Internet. 

Counselling

If you find that stress is severe and interferes considerably in your daily life you should talk to your doctor as they may be able to refer you for counselling, either on an individual or family basis. This can help promote a more positive attitude to living with Parkinson’s which in turn can help you to cope with your individual stressors.

Talk with your doctor, or Parkinson’s nurse specialist if you have one, and request that he or she refers you to a therapist such as a psychotherapist, psychiatrist or a counsellor. There are also many specialists who can help you with practical difficulties that cause you stress, for example speech therapists, nutritional therapists or dieticians, physiotherapists, occupational therapists and sex therapists.

Other stress management techniques

There are a number of other techniques, such as autogenic training and hypnotherapy that may help you to manage stress effectively. The key to success is to find one or two techniques that work for you and to then practice and use them regularly. The following may help:

• deep breathing - take slow, gentle, deep breaths in through the nose and out through the mouth, counting to five as you breathe in and five as you breathe out. Then try breathing out a little longer than you breathe in. Repeat this over the day until you begin to feel more relaxed. If you feel dizzy, when doing this technique, then stop and ask a physiotherapist to guide your breathing technique.
• relaxation - sit or lie in a comfortable position with your eyes closed and slowly focus on relaxing the different parts of your body, one at a time. Many find this works best starting with the head and working down to the feet but this is up to you. There are many different CDs, DVDs, videos and books to guide you, many specifically created for people with Parkinson’s
• meditation - this technique concentrates on a particular thought or awareness and can be effective in managing stress but it does require some practice. Meditation classes are widely available and there are numerous CDs, DVDs, videos and books available, including many specifically created for people with Parkinson’s
• The Parkinson’s association in your country may be able to provide details of local groups or other sources of information, or you can ask your doctor or other healthcare professional. 

References:

1. Parkinson’s:A Patient’s View – Sidney Dorros - view details
2. Parkinson’s Disease Reducing Symptoms with Nutrition and Drugs - Dr. Geoffrey Leader and Lucille Leader - view details 
3. Parkinson’s Disease Top Tips to Optimize Function - view details.

Content last reviewed: September 2015

Articles from Parkinson's Life online magazine

• How stress and mindfulness could impact Parkinson’s disease symptoms
• 9 steps to a stress-free life with Parkinson’s