Living with POTS (Postural Orthostatic Tachycardic Syndrome)

What is it?

Postural Orthostatic Tachycardic Syndrome is a fancy way of saying that when you change positions (sitting to standing for example) your cardiovascular system cannot keep up with this change, so to get more blood up to your brain your heart speeds up (becomes tachycardic). Because of this reaction an individual may experience severe lightheadedness, dizziness, shortness of breath, and may even pass out (experience syncope). Other symptoms can include anxiety, chronic fatigue, angina, brain fog, alternating constipation and diarrhea, or abdominal bloating. POTS is not a disease, but is more a symptom, and many different medical conditions can cause POTS episodes. 

Types & Causes of POTS?

According to the Johns Hopkins Medical, the major causes of POTS are:

  • Neuropathic POTS – damage to small nerve fibers that regulate constriction of blood vessels in the abdomen and limbs. 
  • Hyperadrenergic POTS – elevated levels of norepinephrine. 
  • Hypovolemic POTS – decreased blood levels. 

POTS is more common among females than males, can be brought on or made worse by an acute viral infection and has been linked to the genetic connective tissue disorder known as Ehlers Danlos Syndrome; there are many forms of EDS, however the most common form of EDS is hypermobile EDS (hEDS) which is exactly how it sounds – the individual has hypermobile joints or may be known to be “double-jointed” or very flexible. 

POTS & Gastrointestinal Disorders

Those with POTS can tell you they feel worse in the heat, if they don’t eat enough salt, and after they eat! But why after eating? In a normal person, the blood flow to the mesenteric plexus (the major artery supplying blood to the digestive system) is increased by 300% postprandial (after eating). Individuals with POTS have an even LARGER increase in mesenteric blood supply which then causes the symptoms to worsen as the body tries to compensate even more for the lack of blood supply to the brain. POTS patients have also been found to have decreased gastric motility which may lead to nausea or early satiety after eating.

Living with POTS

Before I was diagnosed with POTS I always felt like I was crazy! I couldn’t understand why I was always tired, or that I was constantly anxious, jittery, I would get random bouts of dizziness and nausea. I remember as a child I would always get nauseous and have a stomach ache after lunch in school and my mom would have to come get me. After a while the teachers at my school told me I was just making it up to get out of schoolwork. I was always tired and had brain fog, but my teachers would just tell my parents that I wouldn’t pay attention in class. It wasn’t until I was in my 3rd year in medical school in my Cardiology class that we were talking about POTS. The more we covered POTS and the symptoms the more familiar it sounded – then when we got to the part where it is linked with EDS, it clicked in my brain as I had been told I had hEDS not too long before this class. I went to my cardiologist, discussed with them my concerns and asked them to perform a tilt test on me; I then went through the tilt test (which I’m not going to lie – it was not fun at all), and shortly after got diagnosed with POTS. My symptoms are definitely worse in the summer heat of Arizona – I get these waves of hot flashes, then I get extremely lightheaded and dizzy, followed by nausea, shortness of breath and palpitations. 

How Do I Treat My POTS

Once I got diagnosed with POTS and I knew the underlying cause for me was my EDS, I knew how to help treat the symptoms. Personally for me I have to make sure I eat a high salt diet to increase my blood volume. Getting nutrient IVs regularly has also improved my symptoms by supplying me with additional hydration especially in the summer months. Making sure to eat a well-balanced diet of protein, vegetables and complex carbohydrates. I also wear compression stockings especially when traveling to keep the blood from pooling in my legs. Weight training exercises have improved my muscle mass which also improves blood circulation throughout the body. I make sure to drink lots of fluids – at least 1/2 my body weight in ounces of water. Herbs! I utilize herbs to help support my adrenal glands, which in turn helps to support my POTS symptoms. Because my POTS is caused by hEDS, I will never truly be able to cure my POTS, but knowing the underlying cause I am able to support my body to decrease the symptoms. 

Again, because POTS is not a disease but is a symptom of an underlying condition, finding and treating the underlying cause is the first step to lessening the symptoms, or treating them altogether. Working with a Naturopathic Medical Doctor means they can help you find the underlying cause of your POTS, and from there they can work with you to help support you to get you feeling better!