Many of our patients come in with a POTS (postural orthostatic tachycardia syndrome) diagnosis. They’ve been told they have POTS and are given ways to manage the symptoms, along with some medications that may or may not help and sent on their way.
POTS describes a set of symptoms related to autonomic nervous dysfunction, including nausea, dizziness, increased heart rate, exercise intolerance and more1. Patients with the “partial dysautonomic” (PD) form don’t respond to gravity/postural changes well (moving between laying down and sitting up, standing for long periods of time, etc)2. Patients with the hyperadrenergic form discuss experiencing significant tremor, anxiety, and cold sweaty extremities while upright. With an estimated 1,000,000 and 3,000,000 Americans impacted4, and 25% of which are disabled and unable to work2, this diagnosis can be devastating for many of our patients.
There’s more hope than just managing POTS symptoms, though. Most often, the POTS symptoms are the tip of the iceberg, pointing to a root cause that can be addressed. We often find these things to be root causes behind POTS symptoms, and when treated, patients are able to live fully functional:
- Mycotoxin Exposure/Chronic Inflammatory Response Syndrome (CIRS)
- Lyme Disease and Co-infections
- Nutrient deficiencies, specifically Vitamin B124
- Other bacterial infections, including: Mycoplasma pneumoniae5
- Viral Infections, including: Epstein Barr virus (mononucleosis) and Hepatitis C4
- Food Allergies/Sensitivities4
- Celiac disease and other autoimmune diseases6,10
- Medications, including: Alpha receptor blockers, Beta blockers, Calcium channel blockers, Opiates, Monoamine oxidase inhibitors, Tricyclic antidepressants, Diuretics, Nitrates, and others1
- Some studies suggest that some genetic variants (polymorphisms) in the NOS3 and ADRB2 genes are associated with an increased risk of developing the condition.7
- Mast Cell Activation (episodic flushing and abnormal increases in urine methylhistamine, shortness of breath, headache, lightheadedness, and gastrointestinal symptoms).8
- Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility, skin texture abnormalities, and vascular and visceral dysfunctions.9
While we’re addressing the root cause, these tools and guidelines are helpful for our POTS patients:
- Start with hydration. Most patients require more than the “half your bodyweight in ounces per day” normal recommendation.
- Avoid sitting or standing for prolonged periods of time.
- Refrain from alcohol.
- Increasing nutritious salt intake. Using Himalayan or Celtic salt, both of which also happen to have added mineral content, to help support adrenal function. Many patients find some relief by adding roughly a teaspoon to a water bottle. We offer pink Himalayan sea salt in the office. All products can be shipped to you by reaching out to Sandy at [email protected]
- Quinton marine plasma. We prescribe this sea water source of active, ionic ocean minerals for many patients. It has been used by elite athletes to keep electrolyte balance, and was even used during WWI as a plasma replacement. It has been used to remineralize, restore homeostasis, balance pH, support cellular nutrition and detoxification, as well as many other beneficial uses.
- Pulsed Electro- Magnetic Frequency (PEMF) treatment. This treatment is something we offer many of our POTS patients (as well as others) because research has proven neurological, physiological, and psychological benefits with the use of PEMF. It is known to improve oxygenation of cells, reduce pain, promote healing, and improve energy.
- Licorice Root. This herbal supplement is used short-term for adrenal support and can sometimes be used as an alternative to Florinef, a steroid often prescribed in the treatment of adrenal dysfunction and POTS. All supplements can be ordered for shipment by emailing Sandy at [email protected]
- CoQ10. This is a fat-soluble vitamin-like substance that is also a powerful antioxidant. It is known to have powerful cardio-protective benefits.
- L-carnitine. This amino acid is critical for energy production in every cell in the body. It carries fat, in the form of fatty acids to the mitochondrial inner membrane where energy is produced through a process called Kreb’s cycle. Without L-carnitine, the normal burning of fat cannot take place and energy production is impaired. Biofeedback – EEG neurofeedback is our preferred choice. It is a method of retraining the brain to function more appropriately.
- Wear compression devices. Pooling of blood in the lower extremities is effectively addressed using 30 mm Hg of pressure with effective stockings.
- Stress reduction. Stress exacerbates symptom of POTS so we recommend use of daily relaxation techniques such as breathing exercises, prayer, meditation, gratitude journaling, yoga and tai chi.
- Slowly build up exercise tolerance. While it can be uncomfortable, increasing light activity helps with everything from lymph flow and detox to vascular tone. Qi Fu, MD, PhD, the first study-author and assistant professor of Internal Medicine and Cardiology at the University of Texas Southwestern Medical Center stated, “exercise training is superior to the beta blocker in restoring upright blood circulation, improving kidney function and dramatically improving quality of life.”
- Use care with temperature changes. While sauna is a great detox tool, POTS patients sometimes can’t tolerate the heat. Same goes for long, hot showers or baths.
- Defy gravity. Sometimes standing in public is inevitable but bringing your legs closer to your heart by doing things like squatting can help keep patients from passing out.
- Bulletproof Coffee. Coffee can construct the blood vessels enough to allow for standing. Because most coffee is mycotoxin-contaminated, we recommend mycotoxin-tested Bulletproof brand. (Give your brain a boost while you’re at it by adding a healthy fat to your coffee, like Bulletproof’s Brain Octane. Check out more on fat-added Bulletproof Coffee here. Patients with adrenal fatigue should use coffee sparingly. Caffeine can exacerbate POTS symptoms in some patients.
- Supplement with care. Some supplements, herbs and homeopathic remedies amplify POTS symptoms. We recommend introducing new supplements every 3 days (not all at once) so it’s obvious which is supplement is the culprit. Some patients have seen an exacerbation of symptoms happen with certain supplements, including GABA, hemp CBD oil and melatonin, but this varies by patient.
Ultimately, though, these tools aren’t fixes but instead ways to cope. At Vine, we look to find root causes and don’t stop with symptom diagnoses.
- Blair P. Grubb, Postural Tachycardia Syndrome. Circulation. 2008; 117: 2814-2817.
- Grubb BP, Kanjwal Y, Kosinski D. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol. 2006; 14: 108–112.
- Vincent S, Robertson D. Hyperadrenergic postural tachycardia syndrome. In: Robertson D, ed. Primer on the Autonomic Nervous System. San Diego, Calif: Elsevier Academic Press; 2004: 344–345.
- Oner T, Baris G, Vedide T, et al. Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents. Pediatrics. 2014; 133: Issue 1.
- National Institute of Health, Neurological Institute of Neurological Disorders and Stroke, Postural Tachycardia Syndrome Information Page.
- The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.
- Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161 (2011) 46-48.