5 Ways To Treat Postural Orthostatic Tachycardia Syndrome (POTS) Naturally
Postural Orthostatic Tachycardia Syndrome or “POTS” was once classified as a rare “syndrome” but in reality, its incidence rate is increasing each year since 2004. Unfortunately, there aren’t very many answers when it comes to POTS in your traditional primary care or neurology clinic, though many of the known root causes and mechanisms are well known.
In fact, a quick search reveals most of the aggravating factors though very few patients or doctors put enough emphasis on the treating the root causes of POTS.
What it is and Who Gets It?
POTS most often effects individuals when going from seated to standing, which is termed orthostatic intolerance. The primary symptoms of an orthostatic intolerance is lightheadedness, fainting, and an uncomfortable, rapid increase in heartbeat. The rapid increase of heartbeat being one of the key features that differentiates mild orthostatic intolerance from the more debilitating POTS.
3 Common Causes of POTS
There are 3 commonly diagnosed causes of POTS with 1 being the predominant form that I have seen to be most common.
- Neuropathic POTS – Neuropathic POTS occur due to loss of nerve function in the body. In a situation like diabetes that has peripheral neuropathy, due to the death of the nerves, the body may not respond properly to changes as you stand or move. This is a less common mechanism.
- Low Blood Volume POTS – This obviously occurs as one has low blood volume due to lack of hydration or loss of blood. Hydrating with some water or electrolyte mix should be one of the first steps you try before calling a doctor.
- Hyperadrenergic POTS – This is indicated by an overactive sympathetic nervous system. This is the most common presentation that I see in my office. There are many nuances to this presentation as once the nervous system is overstimulated, you can have a variety of seemingly unrelated symptoms, but because the nervous system has effects on every organ in the body, many body systems will start to perform sub optimally. Essentially all organs in the body perform best when they are in a “relaxed” rather than “hyper” state.
POTS is a female dominant condition effecting far more females than males.
What Causes Postural Orthostatic Tachycardia Syndrome?
As with most conditions, traditional medicine gives us great insight into the “risk factors” of POTS. Risk factors essentially mean things that possibly cause POTS onset. So if we go to our medical textbooks, here is what we see as “risk factors”:
Mononucleosis or Epstein-Barr
Those with celiac or (gluten sensitivity)
Autoimmune conditions (Sjogrens, Hashimoto’s, Lupus, etc.)
Endocrine problems (aka hormonal imbalances)
Blood sugar dysregulation
If you look at this list and open your mind a little, you will see nearly all the root causes of POTS which then delineates a treatment plan from the natural medicine and functional medicine paradigm.
Stealth and Hidden Infection
Any infection can put significant stress on the immune system as well as dramatically increase inflammation in order to address the infection. The problem is that most individuals recognize infection only if you have a noticeable cold or flu. The reality is that if you suffer from fatigue, digestive problems, skin conditions or chronic inflammation, you likely have a “stealth” infection. These “stealth” infections are at the root of many chronic conditions that I see in my office daily. With regards to POTS and infection, have you ever had a cold and noticed your brain felt off and when you stood up you got very dizzy? Dizziness and illness are almost always associated. In POTS, should always be addressed and treated. We have great success with all-natural herbal treatments.
Food Sensitivity & POTS
With food sensitivities, when the body reacts it releases histamine. When the body encounters large amounts of histamine, it uses the adrenal glands to produce epinephrine (aka adrenaline). Epinephrine is a stimulant to the nervous system. This adrenaline helps to counter act the histamine that is being released due to food sensitivities. If you are consistently exposed to a food or chemical that you are sensitive to and histamine is constantly being released, then the adrenals are constantly having to release adrenaline. This causes a dysregulation of the adrenal glands and thus leads to symptoms of POTS. The mechanism of how this works is relatively straight forward as a system that is constantly releasing epinephrine would be in a functionally hyperadrenergic state, which as I mentioned is the most common presentation that I see.
Autoimmune Disease and Postural Orthostatic Tachycardia Syndrome
Autoimmune conditions are marked by an overactive immune system that often begins to attack your own host cells. As far as functional medicine goes, it is widely accepted that two major factors namely food sensitivities and chronic infection contribute significantly to autoimmune conditions. What I find clinically most important is finding an autoimmune marker that is elevated on a lab such as elevated ANA, any elevated thyroid antibodies, elevated CRP, elevated CCP, RF positive or elevated ESR. Once we have found a significant inflammatory or immune marker our efforts to revers POTS go hand in hand with reversing the autoimmune disease. As one gets better the other will continue to improve.
Hormones and Postural Orthostatic Tachycardia Syndrome
As we have already discussed how the adrenal glands can be significantly taxed due to food sensitivities, it is critical to mention that the adrenal glands also produce androgens or sex hormones, primarily DHEA and testosterone. Because females are much more effected by POTS than males, I would like to discuss the adrenals and female hormones for a second. Androgens such as DHEA and testosterone play significant roles in libido and arousal. As women go through significant hormonal changes each month, the adrenal glands have to be unburdened to keep up. As women go through menopause, many are reaching for hormone replacement therapy though the adrenal glands should be doing most of the work through the transition and thereafter.
The adrenal glands are capable and should produce progesterone, but when stress loads are high, much of the progesterone is converted to the stress and anti-inflammatory chemical cortisol. Cortisol demand is high when blood sugar is imbalanced. The adrenals release another hormone known as aldosterone. The role of aldosterone is to aid in the conservation of sodium, secretion of potassium, water retention and to stabilize blood pressure.
The real secret to all of the adrenal hormones is that any stress will create high demand and thus alter its hormonal output. If you drink coffee (or energy drinks) if you have a stressful job, marriage, life, or just enjoy being a stress case, these can all contribute to adrenal/hormone dysfunction leading to POTS in severe cases.
Your Heart and POTS
While you could have a heart problem related to your POTS symptoms, this is more of a male presentation than a female presentation. I am always looking for exertional fatigue that may be associated with the POTS which can indicate concern for the heart. If you suspect you may have a heart condition, I always recommend you see your cardiologist and get anything significant ruled out and then return to the natural way of treating POTS.
5 Natural Treatments For Stubborn POTS
- Stress is the #1 cause of adrenal dysfunction. Taking an adrenal supplement is not going to be enough to cure your POTS if your lifestyle or life are significant. In fact, it is rare that I use an adrenal supplement anymore because in 2019 and beyond, external influences are so great that they don’t hardly help anyone at all.
- Figure out your food sensitivity. I either recommend you come see me in my office to determine your exact food sensitivity or you need to avoid ALL marks on any food allergy test you may already have. As far as food sensitivity tests, anything that shows up from low to high must be avoided to restore health. The easier way to narrow it down is to see someone trained in my methods or similar.
- Address your infections. My most popular infection treatments come from AMG Naturals though I use over 40 herbs to combat infection in my office. Some infections only take days to eradicate while other can take a few months.
- Make your autoimmune markers disappear! While most doctors feel that autoimmune markers never go away, I believe that they should be used to tell you whether the treatment has been effective or not. Realize you aren’t going to find many people saying this, its highly controversial, but my clinical experience says that we should be able to get most people’s markers down, especially if you have Hashimoto’s antibodies like TPO or TGB.
- Balance Your Hormones. As POTS is a female dominant condition, if you are pre-menopause, then you need to look at ovarian and uterine health. Fixing any indications of hormonal imbalance, losing any weigh that is necessary and addressing estrogen dominance is key to recovering from POTS.
While POTS often seems like a medical mystery, we know some of the exact root causes. The main problem with POTS treatment is simply that conventional medicine does not currently have many treatments for the root causes. By addressing the root causes I have seen numerous cases of POTS improve significantly or completely be put into remission.
2. Menstrual Cycle Affects Renal-Adrenal and Hemodynamic Responses During Prolonged Standing in the Postural Orthostatic Tachycardia SyndromeQi Fu , Tiffany B. VanGundy , Shigeki Shibata , Richard J. Auchus , Gordon H. Williams , and Benjamin D. Levine