I am re-posting this major article, originally published in September 2017, to bring it attention to newer readers who may have missed it before. This is the central thesis and main breakthrough we had in understanding Parkinson’s Disease.
INTRODUCTION: THE NERVOUS SYSTEMS
In my pursuit of pragmatic solutions to Parkinson's Disease, I found myself increasingly researching the nature of stress in humans, and inevitably drawn towards studying the Nervous System (NS).
I have already shared much of what I've learned, together with the practical applications to lessening Parkinson's symptoms, via this website, but here is a summary of my current understanding. We consist of many Nervous Systems in one body - we could say there are, at least, five of "me" in each of us. These include the Central (brain), Sympathetic (fight-or-flight), Para-sympathetic (relaxed), Enteric (gut instinct), and Somatic (free movement) Nervous Systems (and probably several others too). We may consider each one of these as a semi-autonomous "program", which becomes more or less active in response to bio-rhythms and our internal/external environments. As each program is excited or inhibited, this can profoundly affect how we think, feel, move, act and re-act.
For example, our decisions and actions in times of great stress can be diametrically opposed to those we might have taken if we were in completely relaxed frame of mind. Our gut and brains can also often be in disagreement, with many factors influencing which one we decide to trust in a specific circumstance. When we are well and our entire system is functioning as it was designed to do, these various Nervous Systems work together in harmony, keeping us safe and optimizing our survival. The right programs become more active when the right circumstances call on them, while others become more passive. A well balanced NS then results in a sense of a single integrated "self".
However, when we are chronically ill or our internal environments are disrupted, the different Nervous System programs may start to give contradictory signals and even compete for food & brain power. The external environment which our NS also perceives through our senses may itself be considered as a "diseased state" if its far removed from that which our bodies and brains are designed to survive and thrive in. Humans are unique in that we have been able to self-create new environments in which to live. Unfortunately, our modern societies tend to create discord and confusion in our Nervous Systems, precisely because we weren't designed to live our modern lives.
These internal and external imbalances can create circumstances in which some of the NS programs may become over-active or under-active for prolonged periods. These confused NS states can then lead to chronic illness, especially if the body receives contradictory signals from multiple "programs" at once, leading to a breakdown of self-identity.
In this article I will cover how Parkinson's Disease can now be elegantly and simply explained from the perspective that one of our NS programs has become permanently inhibited, while another background process is inappropriately permanently switched on. I aim to show how all the major symptoms of PD simply come out in the wash of this explanation, and then begin to provide suggestions for pragmatic long term solutions to the condition based on these conclusions.
INTRODUCTION: THE POLYVAGAL THEORY
The different Nervous Systems can also have their own "sub-programs". For example, the Para-Sympathetic NS includes the Vagal Nerves and other Cranial Nerves. These sub-systems may themselves branch in multiple ways too, conveying different information and affecting different parts of the brain and body through their own instruction sets. The "Polyvagal Theory" of Dr Stephen Porges reveals how the Vagus Nerve has a multiplicity of branches (separate bunches of nerve fibers arising from different parts of the brain, which take different pathways through the body, with different roles). Application of this theory provides us the required framework of understanding, which for the first time, allows us to explain Parkinson's Disease completely and coherently. In this article, I would like to try to provide as clearly as possible the explanation, in order to help other people with PD ease their suffering.
Porges' original paper is very long and full of unfamiliar jargon, and the theory has evolved (become more complex) over time with the originator's own understanding, however our focus here is firmly on the pragmatic application of the theory to Parkinson's Disease, not on the intricacies of the theory itself. The aim is to:
break Porges' original work down in to a much more readily understandable form;
provide simple and elegant explanations for people with PD, which we can apply in real life;
avoid getting bogged down in technical details or exactitude;
cover only the original, basic version of the theory, as this is more than sufficient at this stage.
Key Points of the Polyvagal Nervous System
An Evolutionary Perspective
The Vagus Nerve contains two main branches which contribute to the regulation of the internal organs, including the heart and lungs. The two branches originate from different regions of the brain. The Polyvagal Theory is based on a perspective that the different branches arose during the reptilian (earlier) and mammalian (later) stages of evolution of life on Earth. Porges' refers to these two branches with a myriad of different names, but henceforth, and to avoid confusion, I will consistently use the terms "Vegetative VN" and "Smart VN". The Vegetative VN deals with subconscious, reflexive functions, involuntary muscle flexing and glandular secretions, while the Smart VN is involved in more conscious, voluntary and social activities.
While reptiles tend to freeze when threatened and don't communicate well with other members of the species, the development of the Smart VN in mammals and humans allowed us to actively pay attention after being startled, e.g. by listening to or observing the potential sources of threat, together with the ability to communicate information to others in a social grouping, via complex facial expressions and vocalizations.
The differences between the reptilian and mammalian cardiac systems provides insight into why mammals needed to have more complex Vagal Systems: the metabolic output and energy requirements of mammals can be four to five times higher than that of reptiles, requiring a more complex system for safe regulation. Reptiles tend to be passive, sit-and-wait feeders, slow moving and spend a lot of their time still when they are not being threatened, while mammals tend to be very active in hunting/searching for food, in order to supply their higher metabolic demands.
The response of reptiles when threatened is typically characterized by a freezing of gross motor activity and a further slowing down of heart beat: consider the familiar fear response in turtles withdrawing into their shell. In contrast, the initial response of mammals to threat is fight-or-flight, for which heart rate needs to rapidly quicken to prepare the body for action.
The Vagal System is responsible for the change in heart rate in both cases. The Vegetative VN in reptiles is inhibited under non-threatening conditions, but becomes activated when danger is perceived, causing a freeze response and bringing the heart rate down even lower. In contrast, however, the Smart VN of mammals is most active in safe situations, keeping a break on their heart rate, preventing metabolic rates becoming too high. It is most active during sleep or complete relaxation. When higher metabolic demands are needed, such as under stress, the Smart VN is withdrawn temporarily, allowing the heart rate to accelerate.
The reasons for this difference in the roles of the VN is evolutionary, because if mammals still adopted the reptilian strategy of freezing with the corresponding reductions in heart beat rate due to stress, the result would be catastrophic for the oxygen-hungry mammalian brain and heart. If prolonged, this strategy would rapidly produce heart attack, brain damage or even death.
While the Smart VN usually provides the main regulatory cardiac signals in mammals, the Vegetative VN still remains and has a role in mammalian neuro-anatomy. Mammals still exhibit freezing behaviors and can "Play Dead" when they are very scared.
The Role of Other Cranial Nerve
In humans, the Vagal NS is also inter-linked with other Cranial Nerves, including the trigeminal, facial, accessory and glossopharyngeal nerves. These nerves control muscles and sensation in the face, biting, chewing, the tongue, tilting and rotation of the head, shoulder movements, ear membranes, sucking in air, and muscles in the throat for vocalization and swallowing.
The Smart VN systems in humans therefore integrates functions such as head rotation to orient the senses toward the source of stimulation, mastication to ingest food, salivation to initiate digestive processes, facial expression and creating noises for purposes of social communication.
Furthermore, in evolutionary terms, the voluntary muscles supplied by these five Cranial Nerves evolved from regions in the body which were gills in early stages of life, and hence were, and remain, strongly associated with oxygen supply and chemically sensing oxygen and carbon dioxide levels in the body. They influence the rate of rhythmic movements such as heart beat, impacting on states of stress or relaxation, via the voluntary control of breathing, and are also responsible for voluntary control of the volume and tone of vocalizations (speech and making noises).
Hence the overall Smart VN System is also strongly associated with movement, emotion, and communication, contributing to the unique social and survival behaviors observed in mammals.
Vagus Nerve BRANCH Competition and Contradiction
The concept of competition between Sympathetic and Para-Sympathetic Nervous Systems is well known, as is the VN's ability to inhibit Sympathetic influences, allowing us to discharge from excited or stressed states.
However, there may also be a different type of competition, in which the two Vagal branches convey contradictory information to the target organs. Both branches of the VN are capable of regulating heart beat rate, for example, via signals they send to specialized muscle tissue in the heart.
This competition between the two branches readily explains many medical issues when the Smart VN becomes very weak (low Vagal Tone). Its regulation of the heart may then be easily inhibited, resulting in sudden loss of control. If there is a surge of Vegetative VN activity in response to this withdrawal of the Smart VN, the consequence is a rapid slowing of the heart rate, from which it might not be able to recover, and the heart and brain being starved of oxygen. Examples of this occurring include massive bradycardia in hypoxic babies and sudden death of athletes following exercise.
Similarly, the breathing rate in people with a weak Smart VN system may be overly prone to the influences of the Vegetative VN, and sudden changes from Smart to Vegetative VN control can cause asthma attacks.
THE COMPLETE EXPLANATION FOR PARKINSON'S DISEASE
Notwithstanding the types of sudden onset PD caused by blows to the head or acute chemical poisoning, we now have a complete, simple and elegant framework of understanding of "Ideopathic" Parkinson's Disease, which is readily explained as follows.
By the time of diagnosis, the Smart Vagal Tone in People with Parkinson's Disease (PwP) has become critically low: the Smart VN and the associated Para-Sympathetic Cranial Nerves have become almost permanently inhibited. The potential causes of the weakening of the Smart VN System are manifold, and each of us will have our own cumulative history of why our Smart VN has malfunctioned. Known contributing factors include: viral infection of the Smart VN itself; chronic stress, leading to under-use and hence atrophy through loss of neurons and neural connections; genetic weaknesses; nutritional regimes which don't support the Smart VN, causing deficits in the neurotransmitters which it operates by (acetylcholine in particular); chronic pain due to physical trauma and injury that cause other parts of the NS to be permanently excited, and hence the Smart VN inhibited; emotional trauma and mental health issues which cause deep negative emotional states, also leading to prolonged inhibition of the Smart VN; broken circadian rhythm/poor sleep patterns resulting in the shortening of time periods in which the Smart VN is supposed to be at its most active.
With the weakening of the Smart VN and associated Cranial Nerves, go all their functions outlined previously, leading, precisely, to all the well known major non-motor symptoms of Parkinson's Disease. Facial expressiveness is lost and the face becomes a blank mask. Use of the larynx and muscles in the throat are lost, causing the problems with speech and vocalizations, swallowing, chewing and saliva control. The ability to rotate and tilt the head is lost and the neck becomes extremely stiff and painful. The ability to raise the arms is lost and shoulders become painful and frozen. The sense of balance provided by the ear is lost, causing falls. The ability to experience positive emotional states, and to read these in the faces of others, is lost and anti-socialness increases, leading to feelings of isolation.
The sensory roles of those Paras-Sympathetic nerves involved with Smart VN activity are also inhibited and hence atrophy too, causing the major sensory symptoms of PD: loss of senses of smell and taste; severe problems with vision and movement of the eyes; malfunction of the internal sense of oxygen and carbon dioxide levels in the body leading to very shallow breathing; an inability to heed what other people are saying; aversion to music and noise; aversion to physical touch.
With the withdrawal of the Smart VN, other programs of the NS become over-activated in order to fill the void. In diseases like Autism, it is the Sympathetic Nervous System which becomes ascendant, leading to pathological fight or flight behaviors. In PD, however, it is the Vegetative VN, in particular in its role of activating Freeze/Playing Dead behaviors, which becomes dominant, resulting in the almost permanent shut down of motor functions, as well as very shallow breathing and a low heart rate, leading to blood pressure and anoxia issues. Typically, some triggering event - a severe physical or emotional trauma resulting in a near death or out-of-body experience - has occurred in the past, through which the NS "learns" how to Play Dead. The "Freeze" program of the NS then becomes increasingly ingrained and dominant as the Smart VN weakens and withdrawals, such that Playing Dead becomes the default response to being startled (stressed).
As the Freeze response of the Vegetative VN becomes more easily excited, its other role in regulating rest and digest function is inhibited, resulting in the appearance of the gastric problems associated with PD (constipation, malabsorption, digestive enzyme deficits), together with imbalances in the gut microbiome.
The body may begin to exhibit tremor in an attempt to stimulate the Smart VN, trying to release itself from the Playing Dead mode (this is an observable and natural mechanism by which mammals can release themselves from severe trauma, especially after a life-threatening event). Unfortunately, the Smart VN is too weakened for it to ever become excited enough to take back control, so the body perpetually tremors without release. In rigidity dominant (no tremor) forms of PD, the Freeze is so deep that the NS does not even attempt to release itself.
Thus begins a series of very vicious circles. Inflammation and toxicity soar as the NS is never in relaxed state, causing both pain and negative emotions to rapidly increase. The system starts to increasingly become a source of self-startlement and self-stress, feeling threatened due to the internal inflammation, pain and negative thought processes about the future, the fear and sense of falling, and an increasing perception that it is unsafe due to lack of social support/isolation. The pain and mental anguish cause further degradation in sleep. Digestive malabsorption causes further decrease in the nutritional support of the Smart VN. Past unhealed physical and emotional traumas recur and worsen due to the inflammation. This results in the Vegetative VN Freeze program rapidly becoming increasingly self-activated, while the Smart VN to continues to atrophy further.
Other parts of the NS then begin to atrophy too, due to prolonged under-use. Other programs weaken, and more unused neurons and neuronal connections are lost. For example, dopamine producing cells in the Substantia Nigra of the Central NS, responsible for initiating voluntary movements, become dormant as they are no longer being called upon. Awareness of the extremities (hands and feet) is also lost.
If these negative feedback cycles are not interrupted, these vicious circles lead to the apparently degenerative nature of Parkinson's Disease.
... AND HOW TO FIX IT
We have now explored a framework of understanding of PD based on the Polyvagal Nervous System, and seen how this provides, for the first time, a complete, coherent, simple and elegant explanation for Parkinson's Disease. This new understanding provides us the practical and pragmatic solutions to the condition.
Firstly, the bad news. Since we now know "Ideopathic" PD onset is due to a long term process of atrophication of the Smart Vagal System, usually over many years or even decades prior to diagnosis, we simply cannot expect any quick fixes. It will necessarily take significant time (probably also in years) to rebuild what has already been lost, but it should now be very clear that PwP can be pro-active to prevent further decay. We should definitely not sit and wait in the [according to our new understanding, false] hope that a chemical "cure" will one day be found.
Resolving Root Causes
To prevent further deterioration, we can take all possible steps to minimize those factors in our lives which are causing the inhibition our Smart VN and exciting our Vegetative VN to Freeze. So, first and foremost, we should attempt to identify and address all the root causes which caused our Smart VN to atrophy and the life-threatening traumas by which our Vegetative VN "learned" to Freeze/Play Dead. Indeed, if these underlying causes are not addressed, they will simply continue to feed the vicious circles of NS degradation, and thus even if a "cure" came tomorrow it would, at best, be a temporary fix only. Therefore, I believe we need to accept that our lifestyle choices matter, and face the somewhat hard truth that we cannot ever to return to our "old lives".
Steps we can take in this regard include:
Identify and address all sources of Stress in our lives, putting in place appropriate Stress Management tools, and giving up as many of our responsibilities as we can;
Make informed and appropriate anti-inflammatory nutritional choices; adjust our diet and take supporting supplements and probiotics accordingly;
Identify and adopt appropriate treatment for all unresolved physical traumas, injuries and sources of pain, not just relying on pain killers nor leaving injuries to fester;
Identify mental health issues and seek appropriate therapies, treatment and support; address unresolved emotional traumas, especially those connected with near death or out-of-body experiences;
Fix broken circadian rhythm and sleep patterns; learn and practice relaxation techniques often;
Ask to be tested for known viruses, infections and allergens associated with PD and for the appropriate treatments, therapies or management tools for any which are uncovered, including genetic and microbiome analyses.
REBUILDING THE NERVOUS SYSTEM AND REGENERATING NEURAL CONNECTIONS
Now for the very good news. Since we now understand that PD is principally a problem with the Nervous System, it is entirely possible that we can pro-actively prevent further degeneration, and even regain what we've already lost, because Vagal Tone can always be improved, neurons regenerated, neural pathways re-written, and senses retrained.
I would go much further than this, as in pursuing these solution strategies, I can honestly say I am now, in many ways, better than I ever was before PD. Indeed, when I am the "on" state, I can actually move in ways I never could before, I am much more flexible and fluid, and have increased ranges of motion. I also have much better awareness of my own body and extremities and balance sense (proprioception), much better understanding of what my body is telling me (interoception), much better eyesight, including peripherial vision and appreciation for color, much better listening skills, including a profoundly increased appreciation for the nuances in music, and so forth.
Below are just a few things we can all do to help ourselves.
Start stimulating the Smart VN and Cranial Nerves on a daily basis, in order to re-strenthen Vagal Tone. I am collating simple and quick methods for doing this here: THE VAGUS NERVE AND PARKINSON'S DISEASE and THE CRANIAL NERVES AND PARKINSON'S DISEASE.
Engage with movement therapies to regain range of motion. A major point which is often totally missed in "exercise for Parkinson's" is that this must be done mindfully - both the body and brain have to be simultaneously fully focused on the therapy. Watching the TV while on an exercise machine will not work! We have to really feel, and be present to the sensations in our bodies, in order to rebuild the NS. Therapies which involve rotating or tilting the head, moving the arms and legs across the body (breaking symmetry) and core rotation are the most important.
Engage with sensory therapies, such as Neurological Music Therapy, aromatherapy, color and light therapy and eye exercises, in order to re-strengthen the Cranial Nerves through stimulation of their sensing functions.
Use vibration therapies to mindfully stimulate the hands and feet, in order to rebuild awareness and sense of the extremities.
Practice making facial expressions in front of a mirror, especially smiling - don't underestimate the importance of a "cheesy grin" , waggling the eyebrows and twitching the nose!
Practice using the vocal chords, whistling and humming, and especially singing.
Practice making eye contact with other people.
Ensure plenty of long cuddling sessions with loved ones.
Practice breathing exercises, in particular breathing awareness techniques - mindfully observing our own breathing, without judgement or effort.
Eat mindfully, try to experience the taste as fully as possible, and chew each mouthful well.
Basically, try to practice and fully experience as many as possible of all the functions which the Smart Vagal System and Cranial Nerves are designed to do, as often as possible. As we've said, there are no quick fixes for this condition, but there are definitely things we can to do continually reverse the symptoms over time and, I believe, to recover our health over the long term.