Postural Orthostatic Tachycardia Syndrome (POTS) is more than just being dizzy from getting up too fast! 

It is certainly one of those conditions where “you look normal.”  You know, the “invisible” condition that you constantly deal with but others can’t see.  This is a condition that causes brows to furrow or heads to tilt slightly to the side when you try to explain it.

But for those battling POTS day after day, it is anything but invisible.

Though often dismissed, Postural Orthostatic Tachycardia Syndrome (POTS) is a serious condition affecting blood flow.

It’s the unexpected black outs and subsequent face plants.  The anxiety and fear when the heart races at ridiculous speeds.  The frustration of doctors trying to medicate the symptoms, while having no answer to “why” you are suffering.

POTS most often manifests itself as lightheadedness, fainting, and an uncomfortable, rapid heart rate.  Typically, these symptoms are initiated by changes in posture (i.e. standing up from either sitting or lying down).  But its symptoms don’t always fit in neat, little boxes.

Dysautonomia

Being a form of dysautonomia, its symptoms can vary person-to-person.  As with most chronic conditions, POTS is the result of multiple out of balance systems.  Most notably:

• Autonomic Nervous System
• Central Nervous System
• Gastrointestinal System
• Mitochondrial-Energy System
• Neurohormonal System
• Immune System

Common POTS Symptoms:

• Dizziness
• Fatigue
• Heart palpitations
• Trouble concentrating
• Nausea
• Exercise intolerance
• Heat or cold intolerance

For many, it goes beyond a medical textbook definition.  POTS induces the “fight or flight” nervous system to ramp up when there is neither reason to fight nor flee. 

Therefore, unexplained sweating, or the inability to sweat, may occur.  Vision may become blurry.  Headaches may blindside you.  Shakiness and tremors may come and go.  Breathing may be difficult while sitting, and even more so while climbing stairs.

Three Categories of POTS:

• Neuropathic – Damage to small nerves create an inability to control blood flow from the abdomen and lower extremities.  This will cause issues in blood delivery to the brain and blood pooling in the legs.
  
• Hyperadrenergic – Unchecked, and unbalanced stress throws us into turmoil.  In this form, an overactive sympathetic stress response occurs via the adrenal glands.
  
• Secondary – This form is the result of damage caused by an underlying infection or condition such as diabetes, Lyme disease, alcoholism, chemotherapy, or autoimmune conditions.

Within all three classifications, we recognize the common thread of STRESS.  Whether from trauma or toxins and their resulting damage, overactive adrenals, or infection and pathology, it all comes down to stress and the body’s inability to adapt.

Outside of these groups, I have found there to be four main connections that create conditions conducive to POTS:

Lyme Disease & POTS

Lyme disease sits at the intersection of multiple microbial imbalances, toxins, and systems out of sync.  It is so much more than just a tick bite or a bacterial issue.

It is the condition of the biological terrain that ultimately determines the development of Lyme disease signs and symptoms.  The biological terrain is the water-based “soil” that surrounds and supports every cell, tissue, and microbe in our body.  The more we are stressed, burdened by toxins, and depleted of nutrients, the more hits our biological terrain sustains.  As its condition devolves, we are more likely to harbor bacteria that work against us rather than beneficial, supportive bacteria that help us.

The biological terrain houses our autonomic nervous system.  If our terrain is unhealthy, then our autonomic function suffers.  Lyme disease unleashes damage on the small fibers of our nervous system which can fire up dysautonomia.¹ Therefore, terrain issues usher in conditions like Lyme disease while also causing autonomic issues, like POTS.²

Brain Inflammation & POTS

Inflammation is the body’s natural response to activate healing from noxious stimuli.  But when our brain is under prolonged infection, injury, or toxicity, this natural response fuels degeneration and damage.

Increased permeability of the mitochondria, gut, and brain (i.e. “leaky mitochondria,” “leaky gut,” and “leaky brain”) are all dominoes, one knocking into the next.  These factors are linked in a health-stealing cascade of events in response to toxic thoughts, toxic substances, or toxic events/traumas.

Mitochondrial health is arguably the most important and influential factor in brain inflammation.  As our toxic load and stress burden (chemical, emotional, spiritual, et al) increase, our mitochondria are the first to suffer.  Mitochondrial dysfunction sets off neuroinflammation, and increased neuroinflammation begets more mitochondrial dysfunction.^3,4

Genetic/Epigenetic Connection to POTS

While practitioners do not consider POTS a genetic disorder, there are reports of the condition within family history. Additionally, POTS shares a genetic link with two other known genetic conditions.  It is not uncommon for those with POTS to also have Mast Cell Activation Syndrome (MCAS) and Ehlers-Danlos Syndrome (EDS).

Although often dismissed as an allergy issue, MCAS is much more complex than this.  Mast cells secrete histamine as well as 200 other chemicals in response to changes in our environment.  Imbalances in our body, or genetic makeup, can lead to mast cells causing symptoms of diarrhea, cramping, abdominal pain, flushing, trouble breathing, itching, lightheadedness, or brain fog.

Ehlers-Danlos Syndrome is an inherited condition of several types, causing changes to the integrity of connective tissue.  This is commonly associated with hypermobility of joints, which can lead to chronic pain and injuries.  Less known is its effect on blood vessels, leading to increased bruising or worse, the rupture of major blood vessels.

As DNA testing is now less expensive and more readily available, studies are beginning to show the genetic connection between these three syndromes.  One study shows the link between an elevated immune protein in the blood and a specific gene mutation.⁵ More research is necessary, but these studies are already providing much needed insight into these relatively unknown conditions.

Genetic variation can also play a part in a person’s predisposition to POTS.  The single nucleotide polymorphisms (SNPs or “snips”) of COMT and MAO are the most connected to POTS. 

COMT shares a connection because its snip deals with norepinephrine metabolism and will relate more to the hyperadrenergic type of POTS.  MAO connects to POTS via imbalanced histamine metabolism, like that of the previously outlined effects of MCAS.

Trauma & POTS

The stress of trauma, especially ongoing trauma, can have various devastating effects on the body.  Whether it is physical trauma, emotional trauma, or chemical trauma, there are no holds barred as to the type of trauma that can cause POTS to flare. 

Our autonomic nervous system constantly scans our environment for dangers.  Significant, untimely trauma causes imbalances in our autonomics.  Coupled with our limbic system, our nervous system remembers and reacts with “once bitten, twice shy.” The body is wired to avoid pain and to gravitate towards pleasure. 

When trauma persists, or initial trauma isn’t optimally resolved, the limbic and autonomic systems are relied upon too heavily resulting in dysautonomic conditions.  Since the heart is the seat of our spirit and how we process emotions, is it any wonder why deep-set trauma can affect the heart?

Examples of Trauma Connected to POTS^6-10:

• Traumatic Brain Injury
• Emotional Trauma/PTSD
• Surgery
• Vaccination
• Adverse childhood experiences

Other Connections to POTS:

• Hormones – namely estrogen and insulin.  Estrogen triggers mast cells in the brain and insulin resistance connects POTS to conditions like PCOS.
• Toxicity – especially heavy metals and the effect all toxins have on mitochondria and the brain
• Autoimmune – Examples: Crohn’s, Celiac, Sjogren’s, and Ulcerative Colitis
• Vitamin/Mineral Deficiencies – primarily electrolytes/trace minerals, but also vitamin E, thiamine, niacin, B6, and B12 to some extent
• Post-COVID– more studies are needed, but there is an emerging link from lingering symptoms of the viral infection being made to dysautonomia and increased cases of POTS.
• Pregnancy

How to Support POTS Naturally:

• Castor Oil Packs – are one of the best ways to calm the autonomic nerve in the comfort of your home.  Castor oil packs are anti-inflammatory, support healthy sleep and digestion, and can help with proper lymphatic flow.
• Cranial Electrotherapy Stimulation – Through gentle, low level electrical stimulation, cranial electrotherapy finesses brain function back to a state of calm and restores neurochemical balance.
• Nutrients – Minerals and electrolytes such as magnesium, sodium, and potassium are effective at establishing optimal blood volume and nerve function.  But sometimes electrolytes alone aren’t enough.  This is where Oral Rehydration Solutions can offer more effective ways for reestablishing, or maintaining balance via electrolytes and safe, specific carbohydrates.
• Heartmath – Heartmath is a research-heavy, and clinically proven, mind-body technique. This is one of the most successful ways to realign the rhythm between the brain and heart, previously disrupted by various stressors.
• Vagal Tone – Incorporating the nerve in charge of our “rest, digest, and repair” nervous system wields considerable leverage in calming the autonomic nervous system.  Humming, gargling, and coffee enemas are all safe, applicable ways to support your vagus nerve at home.

The above examples are all focused on maintaining your autonomic tone, which can be very helpful in overcoming POTS and reclaiming your life.  However, as with most complex conditions, POTS includes other facets that require a healing partnership with knowledgeable practitioners.

Are you interested in getting to the root cause of your POTS, or other dysautonmic condition? If you would like a team that understands your story, contact us at the Institute for Restorative Health for a complimentary consultation.

Reference:

1. Novak, Peter, et al. “Association of Small Fiber Neuropathy and Post Treatment Lyme Disease Syndrome.” Plos One, vol. 14, no. 2, 2019, doi:10.1371/journal.pone.0212222.
2. Kanjwal, Khalil, et al. “Postural Orthostatic Tachycardia Syndrome: A Rare Complication Following Electrical Injury.” Pacing and Clinical Electrophysiology, vol.33, no. 7, 2009, doi:10.1111/j.1540-8159.2009.02634.x.
3. Kanjwal, Khalil, et al. “Autonomic Dysfunction Presenting as Orthostatic Intolerance in Patients Suffering From Mitochondrial Cytopathy.” Clinical Cardiology, vol. 33, no. 10, 2010, pp. 626–629., doi:10.1002/clc.20805.
4. Li, De-Pei, et al. “Neural Mechanisms of Autonomic Dysfunction in Neurological Diseases.” Neural Plasticity, vol. 2017, 2017, pp. 1–2., doi:10.1155/2017/2050191.
5. Lyons, Jonathan J, et al. “Elevated Basal Serum Tryptase Identifies a Multisystem Disorder Associated with Increased TPSAB1 Copy Number.” Nature Genetics, vol. 48, no. 12, 2016, pp. 1564–1569., doi:10.1038/ng.3696.
6. Deepika, A., et al. “Demonstration of Subclinical Autonomic Dysfunction Following Severe Traumatic Brain Injury Using Serial Heart Rate Variability Monitoring.” Autonomic Neuroscience, vol. 192, 2015, p. 81., doi:10.1016/j.autneu.2015.07.088.
7. Meyer, Christian, et al. “POTS Following Traumatic Stress: Interacting Central and Intracardiac Neural Control?” Journal of Diabetes and Its Complications, vol. 29, no. 3, 2015, pp. 459–461., doi:10.1016/j.jdiacomp.2015.02.003.
8. Blitshteyn, Svetlana, and Jill Brook. “Postural Tachycardia Syndrome (POTS) with Anti-NMDA Receptor Antibodies after Human Papillomavirus Vaccination.” Immunologic Research, vol. 65, no. 1, 2016, pp. 282–284., doi:10.1007/s12026-016-8855-1.
9. Ryabkova, Varvara A., et al. “Neuroimmunology: What Role for Autoimmunity, Neuroinflammation, and Small Fiber Neuropathy in Fibromyalgia, Chronic Fatigue Syndrome, and Adverse Events after Human Papillomavirus Vaccination?” International Journal of Molecular Sciences, vol. 20, no. 20, 2019, p. 5164., doi:10.3390/ijms20205164.
10. Elbers, Jorina, et al. “Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation.” Children, vol. 4, no. 11, 2017, p. 98., doi:10.3390/children4110098.