People with Parkinson’s disease are known to have tremor, stiffness, and slowed movement. But they sometimes also have “non-movement disorders.” Among these are anxiety and panic disorders.
Anxiety is a condition that causes fear, worrying, and/or nervousness; the fears may or may not be based on reality. Anxiety can have severe effects, causing a feeling of being drained, tired, or worn out. It may affect sleep, work, and even relationships. Some people with Parkinson’s fear social engagements, for example, for fear of being criticized or negatively judged by others.
Panic disorder is another kind of anxiety, in which a person has a sudden attack of uncontrollable terror. It can cause shaking, panting or trouble breathing – all of which are also Parkinson symptoms. And panic attacks can make Parkinson symptoms much worse; they can even stop Parkinson medications from working.
What causes anxiety and panic disorders?
For some people, low blood levels of the nutrients iron, vitamin D, and vitamin B6 are related to anxiety and panic disorders. And, for reasons not entirely clear, many people with Parkinson’s have been found to have low levels of these nutrients.
Iron is involved in the production of some neurotransmitters, including dopamine (1). In a review of clinical studies, researchers found that, among other nutrients, low iron levels were involved in persons experiencing anxiety.(2) In another study, iron-deficient patients were given iron supplements, and found a reduction in their anxiety.(3)
In a study related to vitamin D deficiency, researchers studied over 7,000 individuals regarding depression, anxiety, panic, and phobia, and found that vitamin D deficiency was associated with depression and panic. (4) Other researchers have found widespread deficiency of vitamin D among people with Parkinson’s; deficiency is also associated with depression, falls, and bone fractures.
Some people who have panic attacks have a low level of serotonin, a neurotransmitter found in the nervous system and in blood platelets. Serotonin is produced by vitamin B6 and iron from the amino acid tryptophan. Researchers studied individuals who were having panic attacks and found they had lower levels of both B6 and iron than patients in a control group who did not have panic attacks. (5) This suggests that B6 and iron levels in the blood may be factors in panic attacks.
How do you know if you have nutrient deficiencies?
If you experience anxiety or panic attacks, your doctor can test your blood for levels of iron (blood levels of ferritin, hemoglobin, and hemocrit), vitamin B6 (pyridoxine) and vitamin D (25[OH]D). If levels are very low, the doctor may prescribe supplements or even injections, to bring your blood levels back to normal.
It will also be important for you to be sure to get enough of these nutrients in your daily meals. Supplements are helpful, but foods have supporting nutrients that work together to provide much greater benefit than a supplement. Also, iron is found in abnormal amounts in the brain of those with Parkinson’s; and it is a pro-oxidant which can be inflammatory in the large amounts found in supplements, so foods are a better choice. Let’s look at some foods that contain these, and many other valuable nutrients.
Animal foods with a high iron value include beef, beef liver, pork, poultry, and seafood such as halibut, haddock, perch, salmon, tuna, clams, and oysters. These contain heme iron, which is readily absorbed. Because too much iron can interfere with levodopa absorption, and because these foods are also high in protein, they can block levodopa. If you use levodopa, be sure to take it at least 30 minutes before eating these foods. Fish and seafood are especially good choices for those with Parkinson’s because they also contain brain-supportive omega-3 fatty acids.
Plant foods high in iron include soybeans, tofu, lentils, spinach, chard, garbanzo beans. These have the non-heme form of iron, which is less well absorbed than heme iron. Acidity helps boost iron absorption, so having lemon juice or vinegar in a salad dressing, or an orange, in the same meal with beans and leafy greens will help you get the most iron absorption from the plant food.
According to the Food and Nutrition Information Center of the USDA, the Recommended Dietary Allowance (RDA) for iron is 8 mg per day for males ages 19 and older, 18 mg per day for women between the ages of 19 to 50, and 8 mg per day for women ages 51 and older.
Foods high in vitamin B-6
Tuna, turkey, beef, chicken, salmon, sweet potato, potatoes, sunflower seeds, spinach and other dark leafy greens, and bananas are all good sources of vitamin B-6. Tuna, beef, poultry, salmon, and spinach are good iron sources also, so you have the benefit of both nutrients in these foods.
The RDA for B-6 is 1.3 milligrams for males ages 14 to 50 and females ages 19 to 50. Males over age 50 require 1.7 milligrams, while females of the same age require 1.5 milligrams.
Foods rich in vitamin D
There are few foods that contain vitamin D, and of these, salmon is by far the best. Four ounces of salmon have 128% of the recommended amount per day. Sardines, fortified cow’s milk, tuna, egg yolks, and shiitake mushrooms have smaller but still important amounts. Salmon, again, is a good source of vitamin D, as well as vitamin B6 and iron. It’s a good food to eat 2-3 times a week. Sunlight is a very good source of vitamin D. When sunlight is available, exposing your face and arms for about 10 minutes a day will provide sufficient vitamin D.
The recommended daily allowance (RDA) for vitamin D for all adults ages 19 to 70 years is 600 IU/day. For those over age 71 the RDA is 800 IU/day. If taking supplements choose the vitamin D3 form, which is better absorbed than the D2 form.
There are medications your doctor can prescribe to treat anxiety and panic disorders. However, not everyone responds equally well to them, and for some, the side effects can be a problem as well. Further, if the anxiety is due to nutrient deficiency, medications may not help.
If you experience anxiety and/or panic attacks, first ask your doctor to rule out deficiency of iron and vitamins B6 and D. If you are deficient in one or more of these, your doctor can decide whether you need supplements, injections, or simply an improved diet. When your blood levels return to normal, you may find the anxiety and panic attacks have stopped; but if not, then your doctor can determine whether an anti-anxiety medication is the answer.
(1) Beard, J. Iron Deficiency Alters Brain Development and Functioning. J. Nutr. May 1, 2003 vol. 133 no. 5 1468S-1472S
(2) Młyniec K1, Davies CL2, de Agüero Sánchez IG3, Pytka K4, Budziszewska B5, Nowak G6. Essential elements in depression and anxiety. Part I. Pharmacol Rep. 2014 Aug;66(4):534-44.
(3) Encephale. 2017 Feb;43(1):85-89. doi: 10.1016/j.encep.2016.08.002. Epub 2016 Sep 16.
[Iron deficiency: A diagnostic and therapeutic perspective in psychiatry].
[Article in French]
(4) Maddock J1, Berry DJ, Geoffroy MC, Power C, Hyppönen E. Vitamin D and common mental disorders in mid-life: cross-sectional and prospective findings. Clin Nutr. 2013 Oct;32(5):758-64.
(5) Mikawa Y1, Mizobuchi S, Egi M, Morita K. Low serum concentrations of vitamin B6 and iron are related to panic attack and hyperventilation attack. Acta Med Okayama. 2013;67(2):99-104.