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Article summary:

• Postural Orthostatic Tachycardia Syndrome (POTS) is a confusing and troublesome condition with limited conventional treatment options.
• A substantial number of patients develop POTS after an infection.
• POTS is a type of autonomic nervous system malfunction (dysautonomia) that causes disturbed blood flow in the body.
• POTS affects one million to three million Americans, including one of every 100 teenagers.
• The condition is far more prevalent among women in their teens, twenties, and thirties. 
• Although people with POTS may look healthy on the outside, the condition can be so severe that it significantly limits their daily activities.
• POTS patients are often misdiagnosed with an anxiety disorder.
• You can test for POTS using a tilt table test or another diagnostic test that observes orthostatic intolerance.
• Lifestyle changes, including dietary adjustments and physical movement, can help to improve POTS.
• Further lifestyle considerations for POTS patients include avoiding potential triggers and examining sensitivities.
• POTS could be connected to mitochondrial dysfunction caused by mold exposure, Lyme disease, viral pathogens, or other chronic infections. As such, many individuals with POTS respond favorably to protocols designed to restore mitochondrial health.

Postural Orthostatic Tachycardia Syndrome (POTS) is a mystifying and challenging condition. It can confuse and frustrate patients and practitioners alike. While this disorder is being seen more and more frequently, it has many unknowns. Currently, there are no FDA-approved medications designed to treat it. The prescription drugs used to treat it are “off-label,” meaning they are not officially approved to treat POTS. The condition also lacks a set of universally established treatment guidelines. 

There are varying theories about what POTS is and what causes it. POTS could be connected to mitochondrial dysfunction caused by mold exposure, Lyme disease, viral pathogens, or other chronic infections. Indeed, a significant number of POTS patients develop the syndrome after an infection. As such, if you have POTS, you may respond favorably to protocols designed to restore mitochondrial health.

What is POTS?

POTS is a type of autonomic nervous system malfunction (dysautonomia) that can affect the blood flow throughout the body. This disturbed blood flow leads to orthostatic intolerance, meaning symptoms come on when standing up from a reclining position. You may relieve symptoms by sitting or lying back down. 

Stated simply, when you go from sitting or lying to standing, the blood has to travel further to get to the brain. When blood does not reach the brain quickly upon standing, you get light-headed and may even faint.  Then, the heart beats faster as it tries to pump more blood to the brain. (1) 

POTS and the Autonomic Nervous System

POTS is a form of dysautonomia. Dysautonomia refers to several different medical issues that cause the autonomic nervous system to malfunction. The autonomic nervous system controls the body’s involuntary actions and functions.

Since standing up requires that the body initiate an entire set of processes, this involves your autonomic nervous system. When you stand, gravity takes hold and causes a substantial amount of blood to drop down into the lower body. Then, the autonomic nervous system reflexes kick in, triggering specific actions that ensure the blood flows to the upper body as well. These actions include changes such as: (2)

• Blood vessel tone 
• Heart rate
• Muscle tone
• Pumping responses in the heart

If you have signs and symptoms of POTS, you should have your autonomic nervous system tested.

Who Does It Affect?

According to Dysautonomia International, POTS affects one million to three million Americans. That includes 1 in every 100 teenagers. Although this syndrome can affect anyone, it is far more prevalent among women in their teens, twenties, and thirties. It is most often seen in young women less than 35 years of age. Older people can have POTS as well. In these cases, orthostatic intolerance is typically secondary to another condition, such as diabetes. (3)

While POTS patients may look healthy on the outside, the syndrome can be significantly incapacitating. It leaves 25% disabled and unable to work. POTS may be so severe that it even limits normal day-to-day activities many people take for granted. (4)

POTS Signs and Symptoms

POTS is well-known for causing dizziness upon standing. Some may even faint when trying to stand. However, dizziness, fainting, and lightheadedness are just a few of the many symptoms POTS patients face every day. Symptoms include: (1)

• Abdominal pain
• Anxiety
• Bladder dysfunction
• Blurred vision
• Brain fog
• Chest discomfort or pain
• Chronic pain
• Coldness or pain in the extremities
• Dizziness
• Exercise intolerance
• Headaches
• Head or neck discomfort
• Heart palpitations and rapid heartbeat (tachycardia)
• Fainting
• Fatigue
• Gastrointestinal issues (bloating, constipation, cramps, diarrhea, and nausea)
• Insomnia and sleep disorders
• Lightheadedness
• Poor concentration
• Shortness of breath
• Sweating abnormalities
• Tremors
• Weakness

Additionally, people with POTS often have low blood volume (hypovolemia) and high levels of norepinephrine while standing. Norepinephrine is a naturally-occurring chemical that acts as a stress hormone and neurotransmitter. When the sympathetic nervous system activates during a stressful event, the body often releases norepinephrine into the blood. In excess, norepinephrine can contribute to your symptoms. (5)

For this reason, POTS patients are often misdiagnosed with anxiety, depression, panic attacks, or some other psychological disorder. Often, a misdiagnosis suggests that the individual has a mental, not physical, issue. (6)

Approximately half of POTS-affected people have a condition that impacts the nerves that activate sweat glands. Plus, some develop a reddish-purple color in their legs when they stand, likely due to blood pooling or poor circulation.

Diagnosing POTS

Typically, the diagnosis criteria for POTS is if the heart rate increases by 30 beats per minute (bpm) or exceeds 120 bpm within 10 minutes of standing up. For children and teens, an increase in 40 bpm is the new revised indicator. (3)

A variety of tests can diagnose POTS. The most common one is a tilt table test. In a tilt table test, you get strapped to a movable table that tilts to simulate standing up. Then, the examiner monitors any changes in your vital signs. Tilt tables aren’t available everywhere, though. Some medical practitioners diagnose POTS by observing changes in heart rate and blood pressure while the patient stands up from a reclining position. (7)

Treating POTS

If you have received a POTS diagnosis, some off-label prescription medications may help. But the bulk of improvement comes from lifestyle changes, such as dietary adjustments and physical activity. Gluten-free and high-sodium diet may help. You can also limit or eliminate the intake of specific foods and beverages. Research has found that along with diet, physical activity can help lessen POTS symptoms. (8)

Improving POTS with Dietary Changes

Diet and hydration are critical factors in a POTS treatment plan. Recommendations include:

• Avoid Alcohol 

Alcohol is dehydrating, so it can worsen symptoms for POTS patients. It can also lower blood pressure due to the dilation of the veins. As a result, you may consider avoiding alcohol or limiting your intake. (9)

• Decrease Carb Intake and Eat Smaller Meals

To lessen POTS symptoms, you may benefit from eating more frequent small meals. Some people with POTS report a worsening of symptoms after meals. Digesting food requires more blood flow to the organs involved. This can add stress for POTS patients since it decreased the amount of blood in circulation. Eating too fast may further compound this situation.

Additionally, meals with high carbohydrate content can lower your blood pressure. Low blood pressure can in turn heighten symptoms like dizziness, fainting, and weakness. But when you limit carbohydrate content in meals, your blood pressure remains at a higher level. If you often experience symptoms after eating, you may especially want to consider restricting carb intake. (10) 

• Examine Reactions to Caffeine

Caffeine can be helpful to some POTS patients but may be detrimental to others. Patients with a hyperadrenergic form of POTS already have higher levels of natural stimulants, so caffeine (a stimulant) may potentially worsen the situation. (9)

• Examine Sensitivities

Dairy: Many people with POTS have a sensitivity to lactose in milk. Some have a true allergy to milk protein as well. Reducing or eliminating dairy may offer benefits if this is the case for you. (11)

Gluten: You may want to consider also getting tested for celiac disease. Even if celiac disease is not an issue for you, gluten sensitivity may be a factor. There is no test for gluten sensitivity, so the best way to pinpoint it is to eat a gluten-free diet on a trial basis. Symptoms may improve within a short time of eliminating gluten, or it may take a few months to notice a benefit. Stick with it! Many, many people (not just those with POTS) experience improvements in their health when they avoid gluten. (12)

• Increase Fluid Intake

Part of a comprehensive POTS treatment strategy is increasing hydration. Higher water intake in general helps people tolerate standing for longer periods. It provides the same benefit in POTS patients. Proper hydration can lead to an improvement in your standing blood pressure and reduce standing heart rate. Fortunately, fluid intake isn’t limited to water. Boosting both water and electrolyte intake can increase your blood pressure and blood volume, as well as decrease heart palpitations. (13)

An often-heard general rule of thumb is to drink half your body weight in ounces daily. Strive to maintain clear urine as well. If you experience significant dizziness upon standing, drinking two glasses of water over a few minutes may relieve the symptoms.

• Increase Salt Intake

Researchers believe increasing salt intake can benefit people with POTS. Add more good salt (not table salt) to your diet. Examples of good salt include pink Himalayan salt and sea salt. These salts are not processed and have essential minerals that your body needs. You can also look for supplemental mineral tinctures that help provide these essential minerals and electrolytes. However, if you have kidney disease or cardiovascular concerns, you should consult with your medical practitioner beforehand. (8)

Improving Physical Deconditioning with Exercise

Physical inactivity and lack of use leads to physical deconditioning. Basically, normal body functions deteriorate from prolonged inactivity. Apart from harming general well-being, physical deconditioning can worsen POTS symptoms.

Since those with POTS have low exercise tolerance and difficulty standing upright, maintaining physical activity can be challenging. Yet, studies have shown that endurance exercise is an effective therapy in POTS. Physical training can lead to a significant improvement in POTS symptoms if maintained overtime. These include: (14, 15)

• Exercises that strengthen the abdomen and legs
• Reclined gentle movements, such as leg lifts, pillow squeezes, and stretching
• Reclined aerobic exercise, such as recumbent bicycling, rowing, and swimming
• Weight training to increase strength and tone

Further Lifestyle Considerations for POTS Patients

You may also benefit from other lifestyle modifications, including: (12, 16)

• Avoiding Prolonged Standing

Prolonged standing can exacerbate your symptoms. If standing is a must, you may benefit from moving your feet or the lower half of your body to ensure blood pumps back to the heart.

• Avoiding Triggers

Each POTS patient may see a worsening of symptoms from specific triggers. To help, you can figure out which activities and situations worsen your condition, then avoid those triggers. 

• Elevating the Head During Sleep

Elevating your head during sleep can help to recondition the body to withstand the orthostatic stress that occurs upon standing.

• Maintaining an Even Temperature 

Extremes in temperature, particularly heat, can worsen POTS symptoms. You should take steps to maintain an even temperature. 

Potential Causes of POTS

As mentioned, POTS episodes often begin after an infection, major surgery, pregnancy, or trauma. However, most experts agree that the condition likely has more than one cause. Some of these may include: (3, 17, 18, 19)

• Anemia
• Autoimmune conditions
• Chronic infection
• Diabetes and pre-diabetes
• Ehlers-Danlos syndrome (hypermobility syndrome)
• Epstein-Barr viral infection
• Gastric bypass surgery
• Hepatitis 
• Hypothalamic-pituitary-adrenal (HPA) axis dysfunction
• Lyme disease
• Mast cell activation disorders
• Mitochondrial disease and dysfunction
• Mold exposure
• Multiple sclerosis
• Mycoplasma pneumonia 
• Neuropathy
• Nitric oxide
• Reactive hypoglycemia
• Toxin buildup from chemotherapy, environmental sources, and heavy metals
• Vaccinations
• Vitamin deficiencies

POTS and Mitochondrial Support

When POTS becomes an issue, you can take steps to minimize any infection or other contributing factors. However, many of those issues take time to resolve. In the meantime, you may be in danger of fainting and need to take steps to avoid them.

Mitochondrial dysfunction is a significant contributor, although the connection isn’t fully understood. Researchers have found that cells isolated from POTS patients show mitochondrial impairment and dysfunction. As a result, methods to restore healthy and fully functional mitochondria may benefit you. (20) 

To help support your mitochondrial function, you can look for mitochondrial-supporting products. 

When it comes to addressing a complex health issue like POTS, it may feel overwhelming at times. Fortunately, you can take lifestyle steps to limit its impact on your life. But to fully address this issue, remember to look for root causes. Your body is made to live well — so something must be triggering your autonomic nervous system to malfunction. If you do not have a specific triggering trauma, a comprehensive detox protocol may be helpful to detox a variety of harmful substances. 

But most importantly, remember to take each day one at a time. Work to be a little better today than you were tomorrow. Celebrate the small victories and remind yourself, no matter what POTS throws your way, “I’m still standing!”

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