Postural orthostatic tachycardia syndrome (POTS) is a disorder of the circulatory system marked by an abnormal elevation in heart rate after standing or sitting. It is a type of orthostatic intolerance, an autonomic condition in which the body cannot adjust to gravity, leaving the individual feeling lightheaded or dizzy.
What Happens in POTS?
When a healthy person stands or sits up, gravity pulls blood to the hands, feet, and stomach region. The autonomic system then gets to work. The heart rate rises a bit, and blood vessels constrict to maintain blood flow to the vital organs and prevent blood pressure from falling. This is possible due to the release of epinephrine and norepinephrine.
This autonomic process does not happen in a POTS patient. Instead, blood flow to the brain is reduced, and heart rate increases to make up for the deficit. Some POTS cases cause reduced blood pressure on standing for more than three minutes (hypotension), while others cause elevated blood pressure on standing (hypertension).
Researchers do not precisely know the origins of POTS, and the symptoms may vary among individuals. Women are more likely than men to get POTS, and young people seem to report more cases. Some factors such as autoimmune conditions (celiac disease, Sjogren’s syndrome), mononucleosis, pregnancy, trauma, viral infections, severe illnesses, and surgery may increase POTS risk.
An estimated 500,000 people in the United States experience some form of POTS. Some people experience symptoms all their lives, while others report that their symptoms stop after two to five years. The symptoms of POTS vary in severity, with about a quarter of patients reporting symptoms so severe that it affects their daily lives.
A doctor will diagnose POTS by monitoring vital signs while asking the patient to lie down, stand, and sit. A tilt table test – strapping the patient to a table and observing changes while moving the table to different angles – may also be performed when diagnosing POTS. An electrocardiogram test may also be recommended for the diagnosis.
Most POTS cases respond positively to drugs, dietary adjustments, physical therapy, and other treatments.
Symptoms of POTS include:
- Lightheadedness or dizziness
- Fainting
- Heart palpitations
- Headaches
- Sleep disturbances
- Brain fog: difficulty concentrating or remembering things
- Excessive sweating
- Tremors
- Hand and feet paleness
- Severe fatigue
- Exercise intolerance
- Nausea and vomiting
Types of POTS
Neuropathic POTS:
Neuropathic POTS happens due to damage to the peripheral nerves leading to an inadequate blood supply to the vessels in the core body and legs.
Hyper-adrenergic POTS:
This is caused by overactivity of the sympathetic nervous system leading to higher levels of norepinephrine.
Hypovolemic POTS:
Having less than average blood volume can also lead to POTS.
The Relationship Between a Healthy Gut and POTS
Gut problems appear to be prevalent in people with POTS. Many patients report that their POTS symptoms become severe right after a meal. Studies also show a link between gut health and POTS cases.
The autonomic nervous system (ANS) is responsible for the body’s involuntary functions, including heart rate, respiration, digestion, blood pressure, circadian rhythm, and gut motility. The gut is regulated by the enteric nervous system (ENS), which is one of the divisions of the ANS. An imbalance in the section of the ENS that controls the gut can trigger autonomic disorders (dysautonomias) like POTS.
Autonomic conditions feed into each other. Thus, diseases like Epstein-Barr syndrome, Lupus, and Lymes disease may be associated with POTS. It is, therefore, necessary for POTS patients or people at risk of the condition to pay attention to their gut health. The most common gut issues that POTS patients have, according to one study, are heartburn, constipation, abdominal cramps, nausea, irregular bowel movements, and bloating.
How POTS Patients Can Care for Their Gut Health
- Avoiding processed foods, artificial sweeteners, alcoholic beverages, and reducing sugar intake that might feed harmful bacteria.
- Eating plenty of vegetables, fruits, protein, and dairy, which feed beneficial bacteria.
- Avoiding unnecessary use of substances that may alter microbial environments, such as antimicrobial soaps, antibiotic drugs, mouthwashes, and preservatives.
- Eating salty snacks like chicken broth, sardines, and nuts also feed beneficial gut bacteria.
- Engaging in intermittent fasting exercises. Staying away from food for some hours gives the gut time to do some self-cleaning.
- Chewing food thoroughly before swallowing, so the gut has only little bits to digest.
- Eating organic foods as much as possible. Some studies show that genetically modified foods may be detrimental to gut health.
- Taking probiotic supplements. Probiotics promote a healthy gut microbiome and are therefore beneficial in dealing with POTS. Members of StuffThatWorks, a crowdsourced and AI analyzed data platform, report that this approach is not often tried but shows some positive results in alleviating certain POTS symptoms.
Drug Treatment for POTS
A doctor may prescribe salt tablets, beta-blockers, corticosteroids, and a vasopressor for POTS treatment. Medical compression stockings that reduce symptoms by forcing blood up from the legs may be prescribed. Some patients may have to undergo cardiac rehab programs to recondition their health and improve symptoms.
The patient may have to learn how to monitor their vital signs themselves. This may involve getting a blood pressure monitor to observe pulse, heart rate, and blood pressure daily.
Other Ways of Treating POTS
Engaging in Physical Exercises:
Some special exercises may help POTS symptoms. Special isometric exercises where patients contract their muscles without moving their body to push blood back to the heart can help relieve symptoms.
Slowly changing positions from lying, sitting, standing, and walking helps the body adjust to the change. Slowing down whenever symptoms arise or returning to the previous position also helps. Counting the number of walking steps before the symptoms occur helps patients know their baseline as a reference point for managing symptoms.
Maintaining Sleep Hygiene:
Autonomic disorders can disrupt sleep patterns. Maintaining a consistent sleep schedule can help reduce symptoms. Bedroom temperature should be ambient. Daytime naps may affect sleep quality.
Patients should avoid the use of smart devices or television in bed. Sleeping at an angle can reduce symptoms and increase circulation fluid volume.
Summary
POTS is an autonomic condition that can affect a person’s daily routine. Fortunately, the disorder is manageable and may disappear with time. There is no one-size-fits-all treatment for the condition. Doctors evaluate symptoms and come up with an individualized treatment strategy. Research into POTS treatment is ongoing, although as per most conditions, having a clean diet and living a healthy lifestyle seems to play a major role in minimizing symptoms or even having them disappear completely.
