POTS: Causes, Symptoms & Support Strategies
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition for which there is little information and a lack of understanding, including by most doctors. POTS impacts millions of people around the world (1). Individuals suffering with this syndrome are often confused and frustrated because of the difficulty in receiving proper diagnosis and treatment.
Pharmaceutical drugs are often prescribed by doctors in the treatment of POTS. Unfortunately, these drugs have unwanted and sometimes dangerous side effects. Fortunately, there are many dietary and lifestyle strategies that can improve it. This article will discuss POTS, including its causes, pharmacological treatments, and the twelve natural support strategies to improve it.
What is POTS?
POTS is a form of dysautonomia that affects blood flow throughout the body (2). Dysautonomia refers to a range of diseases that affect the autonomic nervous system. POTS was known by different names until 1993 when a team of Mayo Clinic researchers coined its official nomenclature.
With this syndrome, a person will have an increased heart rate and dizziness or lightheadedness when standing. Technically, an individual has POTS if, within 10 minutes of standing, their heart rate increases by 30 beats per minute or their heart rate is greater than 120 beats per minute. The common method of diagnosing this syndrome is called the table tilt test. This is where a person is laid down on a table, strapped in, and their heart rate is monitored as they are transitioned from a lying to upright position.
In addition to dizziness, a person with POTS may have low blood pressure and low blood volume, and high levels of norepinephrine upon standing. In some cases, individuals faint when trying to stand.
How POTS Affects the Body
About half of POTS patients have a small fiber neuropathy that impacts their sub motor nerves (1). Other symptoms include chest pains, heart palpitations, shortness of breath, headaches, chronic pain, exercise intolerance, fatigue, insomnia, brain fog, sweating abnormalities, and weakness. Nausea, abdominal pain, bladder dysfunction, and tremors are also possible symptoms.
POTS has been classified in various ways, such as “primary” or “secondary” and “high flow” or “low flow”. Using the classifications primary or secondary, younger adults and children mostly likely have the primary classification.
Older individuals usually have it secondary to another condition such as diabetes, this would be considered the secondary form. Describing POTS as high flow or low flow is based upon the flow of blood in the individual’s lower limbs. POTS can also be described based on its prominent characteristics such as neuropathic, hyper-adrenergic, and low blood volume.
What are the Causes of POTS?
POTS was originally thought to be caused by anxiety because many of the physical symptoms overlap with the symptoms of anxiety. However, researchers now understand that it is caused by a malfunction in the autonomic nervous system.
It can be very difficult to determine the underlying cause, however there are many diseases and conditions that are known to cause or be associated with POTS.
Some of the potential causes include mast cell disorders, mitochondrial diseases, autoimmune disorders, and viruses such as Epstein Barr or Lyme Disease. It is also associated with conditions such as hypothalamic-pituitary-adrenal (HPA) axis dysfunction, anemia, diabetes, multiple sclerosis, vaccinations, and reactive hypoglycemia
Anyone can be affected, but it is far more prevalent among women between the ages of 15 and 50. This condition is especially common with new mothers due to the stress of the birth process and the subsequent lack of rest from taking care of the baby.
Pharmaceutical Interventions for POTS
There are several medications that are used to treat POTS such as SSRIs and benzodiazepines (Xanax and Klonopin) which are anti-anxiety drugs. Beta blockers are sometimes used to reduce heart rate. Clonidine, a drug that controls some of the nerve responses from the brain, is used to control heart rate and blood pressure.
There are many other drugs that are used as well. However, there are numerous unwanted and sometimes dangerous side effects with the use of these drugs, which can become somewhat unpredictable when multiple drugs are taken at once.
Natural Support Strategies
Many individuals with POTS find relief with dietary and lifestyle strategies. These strategies are safe and effective without risky side effects.
While these strategies are not FDA approved to prevent, mitigate, treat or cure POTS they are part of living a healthy lifestyle. I encourage you to work with a natural health practitioner to integrate these strategies in the best way possible.
Optimal Hydration
Water has many important roles in the functioning of the body such as improving oxygen delivery to cells, transporting nutrients, flushing toxins, and supporting the body’s natural healing processes. Optimal daily hydration is one of the top strategies for improving health and assisting the body in healing.
You should consume clean, filtered water throughout the day, preferably between meals, to hydrate the body. It is important to consume at least one half of your body weight in ounces of water every day. For example, a 130-pound individual should consume a minimum of 65 ounces of water per day.
130 pounds / 2 = 65 ounces
A helpful strategy for optimal hydration is to super hydrate first thing in the morning by drinking 16-32 oz. of water when you wake. It is best to drink away from meals so that the water will not dilute your stomach acid which is necessary for digestion.
Adding fresh lemon or lime juice to your water is a fantastic strategy. Lemons and limes are naturally rich in vitamin C, citrus bioflavonoids, and key electrolytes such as potassium and magnesium. The combination of vitamin C and bioflavonoids has numerous health benefits including enhancing the oxygenation of tissues (3).
Healing Diet
A healing diet includes whole, unprocessed foods and aims to eliminate processed foods. It is important to consume a variety of low carbohydrate, low glycemic, colorful vegetables and fruits. Low glycemic fruits include lemons and limes, grapefruit, berries, and granny smith apples. Use herbs in abundance and consume fermented foods and tonics. Choose grass-fed, pasture-raised, wild-caught meats and fish, rather than grain-fed, farmed, conventionally-raised meats and fish.
Healthy fats are a very important part of a healing diet. Healthy fats are found in coconut, olives, avocados, and their oils and in grass-fed butter and ghee. Omega-3 fatty acids and conjugated linoleic acid (CLA) found in wild caught salmon and grass-fed beef and dairy are fats with many health benefits. These healthy fats are an efficient source of fuel for the body to combat inflammation and support brain function.
You should remove refined sugars and grains that increase blood glucose levels, upregulate inflammation, and create extra acidity in the tissues. It is also critical to avoid unhealthy fats such as trans fats and highly processed oils. They are extremely damaging to the body.
Blood Sugar Stability
It is important to have stable blood sugar levels to improve POTS. Processed foods, carbohydrates, and sugars cause blood sugar instability. Unstable blood sugar increases inflammation, causes hormonal imbalances, and negatively impacts our health and vitality.
To balance and stabilize blood sugar levels, you should eat a healing meal every 3-4 hours. The top foods for blood sugar stability are healthy fats like coconut, avocados, olives and olive oil, grass-fed butter, and pasture-raised eggs. Herbs and spices such as turmeric and cinnamon, along with apple cider vinegar and lemons and limes are excellent for balancing blood sugar levels.
Green tea and organic coffee are the best beverages to help stabilize blood sugar. If you are easily stimulated or react unfavorably to coffee, then use your best judgement to avoid it in your healing journey.
Prioritize Sleep
Restorative sleep is an important strategy for improving POTS and having overall optimal functioning. Ongoing sleep deficiencies have been linked to increased risk of heart disease, kidney disease, high blood pressure, diabetes, stroke, and obesity. Sleep is imperative for our immune and digestive systems to function properly.
Our bodies have sleep cycles that control how we wake in the morning and fall asleep at night. When this natural rhythm is disrupted, there are many negative health consequences. Poor sleep causes blood sugar imbalances, increases inflammation, and increases cortisol secretion, which may contribute to the worsening of POTS symptoms.
Magnesium is an important micronutrient that plans a critical role in stress and sleep. Magnesium helps balance blood sugar and relieve physical tension, both of which are related to stress and impaired sleep.
Magnesium helps regulate melatonin and GABA levels in the brain. Both melatonin and GABA are necessary for sleep. Supplementing with magnesium, may help the brain signal the body for sleep.
Other strategies for better sleep are getting sunlight during the day (especially first thing in the morning), avoiding artificial light, blacking out your room with blackout curtains or using a sleep mask, and forming healthy sleep habits.
Healthy sleep habits include turning off electronics, having good hygiene practices, light stretching, practicing gratitude, journaling and prayer time, and spending time with family. It is also important to be smart about caffeine intake by using it early in the day in small quantities and cycling on and off caffeine.
Proper Movement
Healthy movement patterns are important for improving POTS. Exercise helps to improve circulation in the cardiovascular and lymphatic systems and improves antioxidant production of the body.
It is important to avoid overtraining. Instead, incorporate low-intensity movement into your daily schedule. Great low-intensity exercises to incorporate are walking, yoga, light weightlifting, light bicycle riding, and dancing.
For added benefits, be sure to get your bare feet on the ground to absorb beneficial electrons from the earth. Grounding has been shown to provide anti-inflammatory and anxiety relieving benefits.
Trace Minerals and Electrolytes
Having adequate amounts of trace minerals and electrolytes in the diet is essential for improving POTS. Trace minerals are micronutrients that are necessary for health but only in trace amounts. Trace minerals include iron, copper, iodine, fluoride, chromium, manganese, molybdenum, selenium, and zinc. Marginal or severe trace element imbalances are considered risk factors for several diseases (4).
A balance of different electrolytes is also vital for healthy functioning of the body. Common electrolytes include sodium, potassium, calcium, magnesium, chloride, and phosphate.
To maintain proper electrolyte balance in the body, add natural salt (pink Himalayan or grey Celtic) to water. Increasing salt consumption to 3,000 mg to 10,000 mg per day is recommended for optimal intake. Drinking diluted organic vegetable or chicken broth is also helpful due to the high mineral content in broths.
Stress Reduction
Chronically elevated cortisol wreaks havoc on the body (5). Increased stress hormones tax the adrenal glands, lower immunity, decrease digestive functions, cause fatigue, and affect blood pressure. It is critical to take steps to reduce stress and lower elevated cortisol levels daily.
Following the healing diet and balancing your blood sugar levels are two effective strategies for reducing stress on the body. Other powerful techniques are grounding, deep breathing exercises, sunlight exposure, gratitude practices, Epsom salt baths, and dry brushing. Practice these stress reduction strategies daily to enhance the body’s healing capabilities.
Improve Bowel Motility
It is important to have regular bowel movements to improve POTS. We should be moving our bowels two to three times a day as our body naturally eliminates what it has consumed within 12-24 hours after eating.
Regular bowel motility is important because defecation removes toxins from our bodies. When we are constipated and there is difficulty emptying the bowels, the digested food putrefies and becomes a breeding ground for bad microbes. These bad microbes produce toxins which lead to inflammation.
Consuming an anti-inflammatory diet with plenty of fiber will improve bowel motility. Good fiber sources are chia and flax seeds. Using bone broths, fermented foods, and probiotics will also help improve bowel motility.
Blood Sugar Support Multivitamin/Mineral Supplements
High quality, bioavailable multivitamin and mineral supplements supply the body with optimal amounts of easily absorbable trace minerals and B vitamins. These minerals and vitamins are critical for supporting healthy blood sugar levels which can improve POTS.
Chromium is an excellent nutrient for balancing blood sugar. Chromium increases the production of the glucose transport molecule GLUT-4 (6). Chromium activates GLUT-4 to metabolize glucose for energy and lower circulating blood sugar. The minimum recommended dosage of chromium for balancing blood sugar is 125-250 mcg.
Magnesium helps to improve blood sugar signaling patterns and protects the blood-brain barrier. The best magnesium and B vitamin rich foods include dark green leafy veggies, avocados, grass-fed animal products, raw cacao and pumpkin seeds.
You can also do Epsom salt baths to support your magnesium levels. It would also be wise to supplement with a good magnesium and B complex supplement. Look for magnesium L-threonate which is the best form of magnesium for crossing the blood brain barrier.
When it comes to B vitamins, it is best to look for one with pre-activated forms such as methyl-folate, methyl-cobalamin (B12), Pyridoxal-5-Phosphate form of B6, and Riboflavin-5-phosphate form of vitamin B2. The methyl groups are in the active form and will be better utilized by the body.
Adaptogenic Herbs
When the body is under chronic stress, the HPA axis is altered and is unable to effectively produce enough adrenal hormones and metabolic energy to meet the body’s demands. To produce sufficient amounts of adrenal hormones and metabolic energy, the body needs key nutrients such as CoQ10, Alpha Lipoic acid, N-Acetyl Cysteine, and Acetyl-L-Carnitine, vitamins B5, B6 and C, magnesium, and trace minerals.
Adaptogenic herbs can also be very helpful in regulating the body’s stress response and improving POTS. Adaptogenic herbs can reduce and stabilize stress hormone levels by enhancing the body’s ability to adapt to stress.
Some of the best adaptogenic herbs are panax ginseng, rhodiola, holy basil, ashwagandha, reishi mushroom, eleuthero, banaba leaf, lemon balm, schisandra and cordyceps. These all act to support the body’s ability to effectively adapt to stress and supports stable energy and blood sugar levels.
Deep Breathing
One of the most important aspects of mental and physical health and wellbeing is breathing. Oxygenation of tissues through breathing is essential for all human performance, energy, and function. Deep breathing is an effective strategy for improving POTS.
Deep, mindful breathing has abundant health benefits. It helps lower blood pressure, release tension, relax the mind and body, relieve pain, and massage the organs. It also helps strengthen the lungs, detoxify the body, improve digestion, increase muscle and improve posture.
Most people take short, chest breaths which reduce your body’s ability to effectively oxygenate. Instead, you should take deep, diaphragmatic (or abdominal) breaths. Diaphragmatic breathing is necessary to move oxygen-rich air into the base of the lungs which has three times as many blood vessels for respiratory exchange as the upper lung area. This optimizes the body’s natural ability to pump fluid and nutrients to the heart and soft tissue structures around the spine.
Deep breathing activates the parasympathetic nervous system which is responsible for rest, digestion, relation, and growth and development. Deep breathing also releases calming stress hormones and decreases heart rate and blood pressure.
To practice deep abdominal breathing, try the following:
- Be aware of your breath.
- Roll your shoulders back and slightly tip your head back.
- Put your hand about an inch away from your navel.
- As you take a deep inhalation, your navel should expand out and hit your hand.
- As you exhale your abdomen should sink back in.
Chiropractic Care
There are numerous health benefits to chiropractic care. Chiropractic care helps to reduce stress on the body by improving the balance between the sympathetic and parasympathetic nervous systems (7). The parasympathetic nervous system is responsible for rest, digestion, relaxation, growth and development. The sympathetic nervous system is responsible for activating the adrenal glands, the fight or flight response, and protection and survival.
Increased chemical and emotional stress on the body causes subluxation. Subluxation is the mechanical compression and irritation of spinal joints and nerves. Subluxation causes imbalances in the central nervous system between the sympathetic and parasympathetic systems. Chiropractic care can remove upper cervical subluxations and restore proper structural and neurological function to the spine and nervous system.
Chiropractic care includes specific chiropractic adjustments to release pressure on the brain stem and certain exercises to maintain this correction and improve posture.
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Conclusion
POTS is a condition characterized by increased heart rate and dizziness upon standing. POTS is caused by a malfunction in the autonomic nervous system. There are many possible underlying causes and conditions associated with POTS including HPA axis dysregulation, autoimmune disorders, viruses, and reactive hypoglycemia.
Strategies to improve POTS naturally include optimal hydration with electrolytes, a healing diet, blood sugar stability, and improving bowel movements. Using nutrients to support and stabilize blood sugar and provide trace minerals along with adaptogenic herbs can be helpful. Regular chiropractic care, optimal sleep, and proper movement, along with stress reduction techniques and deep breathing exercises, can also improve POTS.
If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. On our website, we offer long-distance functional health coaching programs. For further support with your health goals, just reach out—our fantastic coaches are here to support your journey.
Sources for this Article Include
1. Postural Orthostatic Tachycardia Syndrome, Dysautonomia International; Link here
2. POTS: Explained by Doctors & Patients, MyHeart.net; Link here
3. Russo A, Acquaviva R, et al., Bioflavonoids as antiradicals, antioxidants and DNA cleavage protectors, 2000; 16(2): 91-8, PMID: 10917564
4. Mertz W, The essential trace elements. 1981 Sep 18; 213(4514): 1332-8, PMID: 7022654
5. How stress influences disease: Study reveals inflammation as the culprit, Science Daily, April 2, 1012; Link here
6. Chen G, Liu P, et al., Chromium activates glucose transporter 4 trafficking and enhances insulin-stimulated glucose transport in 3T3-L1 adipocytes via a cholesterol-dependent mechanism, 2006 Apr; 20(4): 857-70. PMID: 16339278
7. Hardy K, Pollard H, The organization of the stress response, and its relevance to chiropractors: a commentary, 2006 Oct. 14:25, PMID: 1629015
I’m trying to buy some more this brain calm magnesium from you and the phone number on the package is no good .
Wondering if anyone is experiencing these symptoms shortly after eating keto:
rear base of neck tension, turns into headache, fatigue, brain fog. Lasts about an hour. Blood sugar is normal, and I hydrate. Put salt in my water with lemon throughout day, and also take calcium at night. Possible POTS? Any thoughts?
Interesting Cory, are you just starting out? Could be a temporary adaptation effect. Could also be related to stress, caffeine, etc.
Since june 2017 i have been experiencing fast heart rate that starts at a particular time of the day and last for about 5-6hours if I don’t take the prescribed medication (propanolol 40mg/day), tight/heavy feeling in the head and face, ringing of the ears, dizziness in the form of loss of balance when standing and walking, short of breath feeling, racing heart beat on standing and moving even when active, recently ectopic beats repeatedly for about 20nins, interrupted sleep and most times fast heart beat when I lay down and I often wake up with racing heart beat which subsides after 10mins of sitting up. I have had 24 hours and 7days holter monitor test, echocardiography, numerous ECGs, cardiac catheterization and blood tests and all the results showed a very healthy heart. The doctors are not sure what it is , they thought of panic attacks and anxiety and i have been on propanolol 40mg/daily for the fast heart beats which has been helpful but the others symptoms are still there especially the dizziness. I have recently told my doctor about POTS and I have been booked to be seen. Can anyone relate and what can I do?
You can try the strategies above Divine!
“You should remove refined sugars and grains that increase blood glucose levels, upregulate inflammation, and create extra acidity in the tissues.” Is wheat/gluten one of the grains that can cause these issues?
The Ehler’s Danlos Syndrome specialist who diagnosed me has an extensive dietary recommendation to follow, including cutting out gluten, soy, high fructose corn syrup, and milk and limiting carbs, natural sugars, etc.
I have hEDS, POTS with low blood pressure, Gastroparesis, GERD, and am on blood thinners for life due to DVT/PE. I also likely have MCAS, per EDS specialist. All of these diets are contradictory and make it difficult to follow recommendations. For example, you recommend turmeric, which can affect blood thinners… Obviously the things that are more doable, like increasing water and salt/electrolytes I’m already doing.
Also, do you know if being gluten free will cause any further autonomic nervous system testing results (ie sweat test and neuropathy test) to be “normal?” Thank you for your time!
I am not sure about those tests but avoiding common food allergens like grains, sugar, dairy, soy, and processed carbs are definitely a good idea in your case Chris!
Hi- I believe my mom has been suffering from POTS, as she has many of the symptoms mentioned. And Thank you for your information.But She has a severe reaction that lasts up to hours. She experiences heat flushing in her upper chest and head. And uses ice packs to help, as she is miserable. I don’t see this symptom mentioned in your article. Can this still be POTS?
That sounds like acid reflux. Acid reflux can trigger a POTS reaction. Here is a helpful article: https://drjockers.com/beat-acid-reflux-naturally/
I’ve had heat flushing in head, chest and traveling throughout my body. Very strange with tingling. Mine didn’t last as long. Seems triggered by position for me typically with my neck and upper back. Research vaso Vagal nerve compression or reaction as a possible cause. Problems with nerves can cause a warm or hot feeling. May be blood flow restriction also.
Are these vitamins safe for a 14 year old / 100 lb child suffering from POTS?
Yes they are. But be sure to only use the dosage on the bottle and start with one at a time to make sure he is tolerating it well before adding another.
I was recently diagnosed with tachy/bradycardia. I was treated for the bradycardia with a Medtronic pacemaker. The doctors attempted to treat my tachycardia with beta blockers but without success. I’m now suffering from POTS. Are you able to tell me how I can treat this problem since these doctors aren’t sure what to do with me?
So sorry to hear this! Be sure to follow the recommendations in this article and find a really good functional health practitioner to work with. Here is a helpful article: https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
My daughter was recently diagnosed with POTS. One of the scariest symptoms she experiences when she is having a flare is that there isn’t enough blood flow to her brain, causing her to pass out over and over. In addition, when this happens, she becomes dehydrated despite drinking copious amounts of water and electrolytes and consuming lots of salt. Is there any way to remedy this?
So sorry to hear this! Be sure to follow everything discussed in the article and work with a functional health practitioner to customize a specific plan. https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
I have been having a variety of symptoms including light headedness, syncope, headaches, premature ventricular contractions, possible enlarged heart, stomach pain/nausea, IBSD, gluten intolerance, generalized anxiety disorder, as well as iron deficient anemia. My doctors cannot seem to find a cause for everything that is going on with me. I have my PCP, Cardiologist, Hematologist, and Gastroenterologist. I am tired of going to the doctors, and not really getting much help. I am scheduled for a nuclear stress test and an echocardiogram. However, after trying to do my own research it seems like a lot of my symptoms look like POTS. Should I address this with my doctors. Thank you.
Sorry to hear this Katie! Yes I would be sure to address this with your doctor.
Thank you for writing this article. It’s very helpful. I’m currently undergoing tests to see if I have POTs or something else. Both my heart rate and blood pressure are perfectly normal while sitting and then rise when I stand (possibly hyperadrenergic). I keep reading about increasing salt intake to help with POTS. Is this recommended for hyperadrenergic POTS?
Yes it is very helpful Kristi to get the electrolytes you need to create more stability in your HPA Axis.
The author correctly states that you should avoid coffee with POTS but then says that green tea and organic coffee are ok? Both contain caffeine which is a vasodilator and bad for people with POTS! Good article but please be consistent in the advice given.
Hey Jeff, There are different classifications of POTS and various underlying causes. Green tea and organic coffee are great for stabilizing blood sugar and help some individuals! However, everyone reacts differently to foods and if these foods cause an unfavorable reaction they should absolutely be avoided. I hope that helps clarify!
Hi. For the past 4 years or so, I have been experiencing these symptoms on and off. I feel like I might be dealing with either low iron or hypoglycemia, too, but never have gotten a blood test for them. I am currently 21 and for the past 2 years, I have done keto on and off, but never following your meal plan to a “t”. In the past 2 weeks, from doing a bone broth and steamed veggie Candida Cleanse into a Clean Keto diet (started your Keto 30 Day meal plan), I have been experience dizziness and a headache with blackout splotches in my eyes almost every single time I stand up. A throbbing headache onsets in my temples and a slight pressure going down my neck to under my left collar bone almost every time. Do you know why this could be happening? Maybe from detoxing? Or an iron deficiency?
When I wasn’t doing Keto, and was eating bad, anytime I had a large intake of gluten and sugar, I would get dizzy, shake, and weak as well. That does not happen on Keto though. I am just still experiencing the POTS symptoms when standing up.
Very sorry to hear this Brittany!! I would highly recommend working with a functional health practitioner to customize a specific plan to help you. Here is a helpful article https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
Is the some kind a detox cleanse that can help with POTS?
Hey Susie, everyone is unique so there isn’t a one size fits all detox cleanse for POTS. I would suggest following the strategies in this article and if you are still struggling, finding a functional health coach to personalize a health plan for you. Here is a helpful article on finding the right coach for you. https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
I have seen where some people with POTS seen a great improvement of symptoms after starting Thiamine supplementation. Is there any reason to have blood tests to check Thiamine levels (blood and/or serum) or just try the supplement and see if there is an improvement? Any thoughts or insights on this would be super helpful!
This is a great question. You can just do a trial and see if you notice improvement within a week or 2. The most bioactive form of Thiamine is benfotiamine here: https://amzn.to/3Q2jbqd