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Natural Treatment for POTS

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Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an increased heart rate when moving from lying down to standing up. Estimated to affect more than 500,000 patients in the United States, POTS commonly affects women ages 15 to 50. Most POTS patients are between 15 and 25, with symptoms first appearing during the teenage years.

In addition to lightheadedness and dizziness when standing up quickly, common symptoms include chronic fatigue, headache, digestive problems, trouble sleeping, heart palpitations, tremors, anxiety, depression, and vision changes.1Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed October 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK541074

Causes of Postural Orthostatic Tachycardia Syndrome

Misdiagnosis is common as POTS symptoms look very similar to other health conditions, including hypermobile Ehlers–Danlos syndrome, mast cell activation syndrome, and chronic fatigue syndrome (CFS). To further confuse matters, many people with POTS have co-existing health conditions. Research shows that about 20% of POTS patients also have fibromyalgia, CFS, and asthma. About 25% have Ehlers–Danlos syndrome, 30% have irritable bowel syndrome, and up to 40% experience migraines.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828

Although no single clear cause exists, scientists agree POTS involves many bodily systems. Several different types of POTS have been identified, with common overlap.

Woman holds head to control dizziness

In neuropathic POTS, nerve damage can prevent proper blood flow, making the heart work harder to stabilize blood pressure. In hyperadrenergic  POTS (estimated to affect 30% to 60% of POTS patients), norepinephrine doesn’t move properly through the body. Norepinephrine is a hormone and neurotransmitter that supports the body’s fight-or-flight response. A norepinephrine blockage is often reported in POTS patients taking tricyclic antidepressants or serotonin and norepinephrine reuptake inhibitors. These medications are commonly prescribed for POTS symptoms: difficulty concentrating, anxiety, and depression. In hypovolemic POTS (which affects about 70% of people with POTS), red blood cells or blood plasma levels are low, possibly due to dysfunction in the renin-angiotensin-aldosterone axis.1Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed October 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK541074 The renin-angiotensin-aldosterone axis controls blood volume, blood pressure, and electrolyte balance.3Fountain JH, Kaur J, Lappin SL. Physiology, renin angiotensin system. In: StatPearls. StatPearls Publishing; 2023. Accessed October 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK470410

Autoimmune Conditions

Autoimmune conditions are a strong potential cause of POTS. In autoimmune conditions like rheumatoid arthritis and lupus, the body mistakes its cells for those of an invader (like a bacteria or virus) and attacks itself. Autoimmune diseases primarily affect women and may be triggered by viral infections. POTS tests have detected chemicals associated with Hashimoto’s thyroiditis and chronic inflammation (also seen with autoimmune conditions).1Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed October 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK541074

Research shows that POTS patients and their close relatives have a higher-than-expected prevalence of autoimmune disorders, including celiac disease, Hashimoto’s thyroiditis, Sjögren’s syndrome, and systemic lupus erythematosus.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828

Genetics

Up to 14% of POTS patients have a family member with POTS; 31% have a family member with orthostatic intolerance (feeling dizzy with increased heart rate when standing); 20% have a family member with joint hypermobility; and 45% have a family member with autoimmune disease. Some people with POTS may have a specific variation in a gene that protects the cardiovascular system and regulates blood pressure.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828

Viral Infections

Chronic infections commonly linked to POTS include the Epstein–Barr virus, pneumonia, and (you guessed it) COVID–19. Up to 50% of people with POTS had a previous viral infection, which can lead to significant symptoms suddenly appearing soon after an illness or the slow progression of POTS symptoms over time.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828

Research shows that up to 14% of COVID–19 survivors develop POTS. Worse still, as many as 61% may experience POTS–like symptoms including rapid heartbeat, fatigue, and cognitive impairment within six to eight months of COVID infection. COVID infections may trigger an autoimmune response, damage the autonomic nervous system (which controls unconscious tasks like breathing and digesting), and even affect the central nervous system (brain, spinal cord, and nerves).4Ormiston CK, Świątkiewicz I, Taub PR. Postural orthostatic tachycardia syndrome as a sequela of COVID-19. Heart Rhythm. 2022;19(11):1880-1889. https://doi.org/10.1016/j.hrthm.2022.07.014

Lifestyle Changes for POTS

Woman balances in tree pose atop rock overlooking water

Experts note that a multipronged, nonpharmacologic approach to POTS should come before medication. There are currently no medications approved by the Food and Drug Administration or Health Canada for POTS treatment. More important, there is little evidence that medicine is effective in reducing POTS symptoms,2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828 and research shows patients find non-drug therapies more helpful.3Lei LY, Chew DS, Sheldon RS, Raj SR. Evaluating and managing postural tachycardia syndrome. Cleve Clin J Med. 2019;86(5):333-344. https://doi.org/10.3949/ccjm.86a.18002

There’s good news for people with POTS: One to two years following treatment, most patients no longer meet diagnostic criteria. Research points to the importance of a trusting, long-term relationship between patients and their healthcare teams to reduce the physical, psychological, and functional impairments common with POTS.1Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed October 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK541074 When addressing the root causes of this complex condition, diet and lifestyle management are typically the first line of treatment.4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

Be Aware of Your Body Posture

Feeling dizzy or lightheaded and experiencing a rapid heartbeat when standing are the hallmark symptoms of POTS. Reduce this unpleasant feeling and the risk of fainting by getting up slowly, moving your head carefully, and avoiding prolonged standing. Keep hot baths and showers to a minimum, as heat may worsen symptoms. Consider using a shower chair to prevent falls.

Get Moving

Exercise shows great promise for POTS relief, but with certain precautions. People with POTS tend to experience chronic fatigue and other symptoms that may complicate a regular exercise routine. Starting slow, with the right kinds of movement, may help prevent overexertion and fatigue.

Man jogs slowly on treadmill at gym

Research has demonstrated success for POTS patients who start with low-intensity exercise that doesn’t involve standing up (such as rowing, swimming, or using a recumbent bike). Activity should gradually increase over three months, with upright exercise included in the later stages. After three months, POTS patients have shown increased oxygen intake, a stronger heart, and more blood volume. In one exercise training study, more than 50% of patients were free of symptoms and no longer met POTS criteria. Benefits continue for patients who keep exercising.1Zhao S, Tran VH. Postural Orthostatic Tachycardia Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed October 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK541074

Combining aerobic exercise (30 minutes, four days a week) and leg resistance training may also improve symptoms. Although the first six weeks may be challenging, persistence (under a doctor’s supervision) reaps results.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828

It can take four to six weeks of regular exercise to see benefits. To help maintain the habit, try working out every other day for at least 30 minutes, and include aerobic exercise and resistance training (engaging the thigh muscles in particular). Ultimately, exercise is a treatment, not a cure. Without regular exercise, benefits quickly disappear.3Lei LY, Chew DS, Sheldon RS, Raj SR. Evaluating and managing postural tachycardia syndrome. Cleve Clin J Med. 2019;86(5):333-344. https://doi.org/10.3949/ccjm.86a.18002

Reduce Stress and Improve Sleep

Woman sleeps soundly with eye mask

When patients are diagnosed with POTS, they may experience stress, a sense of loss or trauma, or fear for their safety or well-being, especially if they have additional health conditions.

Engaging in regular exercise will naturally reduce stress. Mindfulness practices such as deep breathing, meditation, yoga, qigong, and Tai Chi gently work your body and nourish your nervous system to encourage deeper healing.

Getting proper sleep is another way to reduce stress. Stay well rested by creating a calming bedtime routine, getting up at the same time every day (even on weekends), and avoiding screens at least one hour before bed. Raising the head of the bed about 6 to 10 inches makes it easier for POTS patients to get out of bed in the morning without dizziness.5Dystautonomia International. Lifestyle Adaptations for POTS. Accessed December 18, 2023. http://www.dysautonomiainternational.org/page.php?ID=44

Maintain a Consistent Body Temperature

People with POTS tend to have a difficult time regulating their body temperature, with heat often exacerbating symptoms. Avoid long stretches in the sun and hot environments (such as saunas). As cooling down helps reduce symptoms upon standing, try misting yourself with cold water, carry a portable fan, or use a cooling vest.4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

Try Compression Garments

Compression garments prevent blood from pooling in the legs and feet. Garments covering the calf, thigh, and abdomen have proven helpful. Try waist-high compression stockings or an abdominal binder with 20–40 mmHg compression. Experiment with different brands to avoid bruising or digestive issues and overheating, which may worsen symptoms.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828

Avoid Certain Medications

Some POTS medications may make certain symptoms worse. Researchers advise doctors to stop medicines that decrease blood volume or directly increase heart rate.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828 Medicines that reduce blood volume can lead the body to compensate by increasing heart rate.3Lei LY, Chew DS, Sheldon RS, Raj SR. Evaluating and managing postural tachycardia syndrome. Cleve Clin J Med. 2019;86(5):333-344. https://doi.org/10.3949/ccjm.86a.18002

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Dietary Changes for POTS

Increase Fluids and Salt Intake

Assorted bowls of olives on table with herbs

More salt and water increases blood volume, which can reduce a rapid heartbeat upon standing.3Lei LY, Chew DS, Sheldon RS, Raj SR. Evaluating and managing postural tachycardia syndrome. Cleve Clin J Med. 2019;86(5):333-344. https://doi.org/10.3949/ccjm.86a.18002 Research recommends that people with POTS drink 2 to 3 liters of water daily and gradually work up to 8 to 10 daily grams of salt. Start drinking water as early as possible, even before getting out of bed. If drinking enough becomes challenging, try using an app or setting reminders on your phone.

Healthy, salty snacks such as olives and nuts are one way to increase dietary sodium. An alternative to increasing salt through diet is slow-release salt tablets, which may prevent the nausea of ingesting too much salt at once.

Ten grams of salt roughly equals 2 teaspoons. If you’re concerned about upping your salt intake, consider the results of a 2021 study, the largest trial demonstrating sodium’s effect on POTS. Patients who ate a high-salt diet had a lower heart rate, lower norepinephrine levels upon standing, and increased blood volume.4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

Eat Smaller Meals and Reduce High-Sugar Carbs

Because many POTS patients also experience digestive issues, experts recommend small, frequent meals, incorporating lower-sugar carbs, to keep blood sugar stable and prevent blood pressure dips following a meal. Opt for easy-to-digest foods like soups, stews, and pureed meals to further improve digestion.4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

Avoid Energy Drinks and Alcohol

Energy drinks and alcohol may trigger POTS symptoms. These beverages may cause dehydration, which tends to worsen symptoms.2Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting – part 1. Auton Neurosci. 2021;235:102828. https://doi.org/10.1016/j.autneu.2021.102828 Caffeine is helpful for some patients but exacerbates nervousness and dizziness in others.

Get Food Sensitivity Testing

With digestive issues common among POTS patients, food sensitivities may be a factor. Common culprits include gluten, dairy, and eggs.

Research indicates that people with POTS are four times more likely to have celiac disease (an autoimmune condition where eating gluten can damage the small intestine) than others.4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

POTS patients without celiac disease may also benefit from a gluten-free diet, pointing to the possible role of gluten sensitivity. In a 2023 study, people who had POTS (but not celiac disease) who ate a gluten-free diet for four weeks reported improved digestive issues and fewer symptoms upon standing.6Zha K, Brook J, McLaughlin A, Blitshteyn S. Gluten-free diet in postural orthostatic tachycardia syndrome (POTS). Chronic Illn. 2023;19(2):409-417. https://doi.org/10.1177/17423953221076984

Vitamins, Minerals, and Nutrients for POTS

More than 90% of POTS patients report one or more digestive symptoms, including nausea, abdominal pain, and bloating. People with additional conditions (especially hypermobile Ehlers–Danlos syndrome, hypermobility spectrum disorder, or mast cell activation syndrome) typically experience more digestive symptoms.4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

People with digestive disorders tend to avoid foods that cause digestive pain. They may be deficient in certain vitamins, minerals, and nutrients because of absorption problems. Doctor-recommended supplements help ensure POTS patients get enough iron, essential fatty acids, and vitamins A, E, K, and B12.

Because the risk of celiac disease is four times higher among POTS patients than in the general public, deficiencies in folate, zinc, magnesium, and vitamin D are also a concern.

Recent research notes a potential link between POTS and eating disorders, particularly in teens. Studies show nearly 74% of teens with POTS restrict their eating, with more than 10% reporting a prior eating disorder diagnosis (significantly higher than the national average).4Harris CI. COVID-19 increases the prevalence of Postural Orthostatic Tachycardia Syndrome: what nutrition and dietetics practitioners need to know. J Acad Nutr Diet. 2022;122(9):1600-1605. https://doi.org/10.1016/j.jand.2022.06.002

In addition to addressing deficiencies, several nutrients may improve symptoms. Magnesium, with its muscle-relaxing effects, may slow a rapid heartbeat. CoQ10 is well known for protecting the cardiovascular system, while L-carnitine can help increase energy and reduce fatigue. Melatonin, known as the sleep hormone, also shows promise for POTS patients, significantly reducing elevated heart rate upon standing.7Green EA, Black BK, Biaggioni I, et al. Melatonin reduces tachycardia in postural tachycardia syndrome: a randomized, crossover trial. Cardiovasc Ther. 2014;32(3):105-112. https://doi.org/10.1111/1755-5922.12067

Footnotes

This article is provided by

The Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform healthcare in America by increasing both public awareness of natural medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing healthcare systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:

  • Education – Reveal the unique benefits and outcomes of evidence-based natural medicine
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