Introduction

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the autonomic nervous system (ANS), leading to significant challenges for those living with it.

Postural refers to the position of the body. Orthostatic refers to being in an upright position. Tachycardia refers to a heart rate higher than 100 beats per minute. Syndrome refers to a group of symptoms that happen together.

Postural Orthostatic Tachycardia Syndrome is particularly prevalent among individuals with other chronic illnesses but can exist on its own.

POTS can significantly affect the quality of life, with symptoms that interfere with daily activities. In some cases, POTS can lead to disability.

POTS and the Autonomic Nervous System Breakdown

POTS is a form of dysautonomia—a group of neurological disorders affecting the autonomic nervous system. The ANS, a branch of the peripheral nervous system, is responsible for regulating the body’s involuntary functions, such as:

● Heart rate
● Blood pressure
● Breathing
● Digestion
● Body temperature regulation
● Metabolism
● Pupil dilation
● And more

When someone has POTS, their heart rate increases by over 30 beats per minute when changing to an upright position, without the heart rate returning back to normal.

Their body has a hard time balancing blood vessel constriction and heart rate response.

Prevalence of POTS

POTS is estimated to affect approximately 0.2% of the general population (500,000 to 1,000,000 individuals), though some sources such as the Cleveland Clinic suggest the number may be as high as 1 to 3 million Americans. It is often misdiagnosed and misunderstood.

Disproportionately affecting women, it often begins between the ages of 15 and 25. POTS ranges in severity and symptoms. While some people are able to manage it through nutrition and lifestyle and live a relatively normal life, others require more interventions.

According to Dysautonomia International, about 25% of individuals with POTS are disabled and unable to work. Even those not classified as disabled often experience a significantly reduced quality of life—comparable to patients with congestive heart failure. Many find that symptoms fluctuate in response to a variety of factors.

POTS frequently co-occurs with other conditions, such as ME/CFS, lyme disease, celiac disease, lupus, fibromyalgia, MCAS, and more, creating a complex web of overlapping symptoms and challenges. This can make it difficult to know which condition the symptoms are stemming from.

Mechanisms and Symptoms

Dysautonomia, which POTS is a form of, arises from dysfunction in the autonomic nervous system. Since the ANS regulates numerous bodily functions, dysautonomia patients can have many different symptoms simultaneously.

Key symptoms of POTS include:

● Orthostatic intolerance (symptoms worsen upon standing or in an upright position)
● Tachycardia (abnormally fast heart rate)
● Lightheadedness or dizziness
● Shortness of breath
● Chest pain
● Headaches or migraines
● Tremors
● Nausea
● Brain fog
● Chronic fatigue
● Exercise intolerance
● Presyncope (feeling like you’re about to faint) or syncope (fainting)

A hallmark of POTS is impaired blood flow. Many patients experience “blood pooling” in their extremities, which reduces oxygen supply to the brain and exacerbates symptoms like brain fog and fatigue.

When even healthy individuals stand up, 10% to 15% of their blood settles in their abdomen, legs, and arms – causing less blood to reach the brain. This results in brief lightheadedness that most people don’t notice because their leg muscles immediately start pumping blood back up to their heart.

However, in people with POTS, the autonomic nervous system is dysfunctional, leading to more lightheadedness that may not easily go away. Due to this, people with POTS often have more adrenaline released from their body to compensate for less blood returning to the heart in an upright position.

The adrenaline helps the heart beat faster (causing the tachycardia). Due to various underlying causes, people with POTS have blood vessels that just don’t respond normally to this response.

Potential Root Causes

POTS often develops following acute stressors, such as viral illnesses, surgeries, injuries, or pregnancy. However, it is also associated with underlying factors like these listed below.

It is important to note that research is still evolving around POTS and dysautonomia in general, and we may not completely understand the condition. It is likely there are different combinations of underlying factors for each person including:

1. Mold Illness and Mycotoxins: Exposure to mold can trigger inflammation and disrupt the ANS. Addressing mold exposure and supporting detoxification pathways (e.g., liver and kidney function) can be key to recovery.

2. Pathogen Overgrowths and Gut Dysbiosis: Imbalances in the gut microbiome can lead to inflammation, immune dysregulation, and nutrient malabsorption, all of which exacerbate POTS symptoms. Stool testing (e.g., GI-MAP) can provide valuable insights into gut health.

3. Low Sex Hormones: Hormonal imbalances, particularly low progesterone, can contribute to symptoms like heart palpitations. Many women with POTS experience symptom fluctuations throughout their menstrual cycle.

4. HPA Axis Dysfunction: Chronic stress can lead to dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis. Supporting adrenal health through stress management, adaptogenic herbs, and proper nutrition can help break the cycle of depletion.

5. Histamine Intolerance: Histamine intolerance often coexists with POTS, contributing to symptoms like tachycardia and flushing. Gut health plays a significant role, as certain gut bacteria produce or degrade histamine.

6. Electrolyte and Mineral Imbalances: Electrolytes are vital for fluid balance and nervous system function. Hair tissue mineral analysis (HTMA) can uncover imbalances that might not appear on standard blood tests.

7. Genetics: Connective tissue disorders, such as Ehlers-Danlos Syndrome (EDS), are common in POTS patients. These disorders affect blood vessel elasticity, leading to blood pooling and other symptoms.

Is It Just Anxiety?

One common misconception is that POTS symptoms stem solely from anxiety. While there is overlap between autonomic dysfunction and anxiety symptoms, research shows that POTS patients do not have higher rates of anxiety disorders compared to the general population.

Symptoms like tachycardia and blood pooling are physiological rather than psychological in origin.

Approaches to Support Recovery

Addressing the root causes and managing symptoms is critical to improving the quality of life for POTS patients. Strategies include:

● Treating Underlying Causes: Identifying and addressing triggers like infections, mold exposure, or hormonal imbalances.
● Increasing Hydration: Electrolyte supplementation and higher fluid intake can help combat blood pooling and improve circulation.
● Blood Sugar Balance: many people with POTS find that symptoms worsen with high carbohydrate meals. This is due to increased blood flow heading to the digestive system, leaving less blood circulating elsewhere. Eating balanced meals with the right combination of fiber, protein, and fat to accompany complex carbs is usually recommended.
● Avoiding Extreme Heat: Heat can exacerbate symptoms by dilating blood vessels and worsening blood pooling.
● Using Compression Garments: These garments help improve blood flow and reduce blood pooling.
● Elevating the Head of the Bed: Raising the head of the bed by 4-6 inches can improve circulation during sleep.
● Exercise Reconditioning: With guidance from a specialist, a gradual exercise program can help rebuild tolerance to upright activities.
● Pharmaceuticals: Medications to retain sodium or manage other symptoms may be prescribed as needed.

Conclusion

POTS is a complex and often misunderstood condition that requires a multifaceted approach to management.

By identifying and addressing root causes, individuals can experience significant improvements in their symptoms and quality of life.

Functional diagnostic approaches, such as comprehensive testing and individualized protocols, offer hope for recovery and a path to better health.

To learn more about Kristin’s story and her services, please check out her website here.

You can find other ME/CFS related blogs here.

Sources:
Cleveland Clinic. (n.d.). Postural orthostatic tachycardia syndrome (POTS). Retrieved from
https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndromepots

Dysautonomia International. (n.d.). What is POTS? Retrieved from
https://www.dysautonomiainternational.org/page.php?ID=30

Raj, S. R., & Sheldon, R. S. (2020). Postural orthostatic tachycardia syndrome. Autonomic
Neuroscience: Basic and Clinical, 224, 102637. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC7046364/

Johns Hopkins Medicine. (n.d.). Postural orthostatic tachycardia syndrome (POTS). Retrieved
from https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardi
a-syndrome-pots