Understanding Postural Orthostatic Tachycardia Syndrome (POTS)
What Is POTS?
Postural Orthostatic Tachycardia Syndrome, or POTS, is a condition that affects the autonomic nervous system, leading to a rapid increase in heart rate and symptoms like dizziness or lightheadedness when standing up. It disrupts automatic body functions we don’t think about, such as heart rate, blood pressure, temperature regulation, and sweating. Understanding POTS is essential, as it can significantly impact daily life and often goes undiagnosed for years. As stated in a 2019 report from the Journal of the Academy of Nutrition and Dietetics, an estimated 1 to 3 million people in the U.S. have been diagnosed with POTS.
According to Johns Hopkins Medicine, when a person stands up, gravity causes blood to move to the lower part of the body. Normally, the nervous system responds by tightening blood vessels and slightly increasing heart rate to maintain steady blood flow to the brain. In individuals with POTS, this response doesn’t work as well as blood isn’t efficiently pushed back upward, which can reduce blood flow to the brain. This can lead to symptoms like dizziness, brain fog, fatigue, and more. In an effort to compensate, the body releases stress hormones, which further increase heart rate and can trigger sensations like shakiness, chest discomfort, or a racing heartbeat.
Common Symptoms
Symptoms of POTS can look different from person to person, but common experiences include:
- Lightheadedness
- Dizziness
- Fainting
- Shakiness
- Nausea or vomiting
- Headaches
- Excessive sweating
- Brain fog
- Severe fatigue
Several factors can make these symptoms worse. These may include warm environments like hot showers, saunas, or being outdoors on a hot day; lack of physical activity; skipping meals, which can negatively impact electrolyte balance; prolonged standing or walking; and certain infections. Understanding your triggers can be helpful for managing symptoms and improving day-to-day functioning.
Causes and Risk Factors
The exact cause of Postural Orthostatic Tachycardia Syndrome is still not fully understood. Research is ongoing to uncover why POTS develops and why it presents so differently from person to person. It’s important to note that POTS is not a disease, but rather a syndrome, a group of symptoms that tend to occur together.
There are several subtypes of POTS, each potentially linked to different underlying factors:
- Hyperadrenergic POTS – related to an overactive sympathetic nervous system
- Hypovolemic POTS – associated with low blood volume
- Neuropathic POTS – caused by nerve damage that affects how blood vessels constrict, particularly in the limbs and abdomen
Because POTS affects the autonomic nervous system and can stem from multiple sources, pinpointing the exact cause in an individual can be difficult. In many cases, a definitive underlying cause may never be identified, which makes personalized treatment and symptom management essential.
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What Are the Risk Factors for Developing POTS?
Several factors may increase the risk of developing Postural Orthostatic Tachycardia Syndrome (POTS), though no single cause has been confirmed.
Genetics and Gender
While genetics is believed to play a role, no specific gene has been linked to the majority of POTS cases. POTS is far more common in women (about 80% of diagnosed cases), though men can be affected as well. The reason for this gender difference is still unclear, but hormonal factors may contribute.
Physical Deconditioning
Prolonged inactivity or extended bed rest can lead to physical deconditioning, which weakens the circulatory system. This can increase the likelihood of developing orthostatic intolerance and POTS symptoms such as dizziness, rapid heart rate, and fatigue upon standing.
Underlying Medical Conditions
Certain health conditions may predispose individuals to POTS, including:
- Ehlers-Danlos syndrome and other connective tissue disorders
- Mast cell activation syndrome (MCAS)
- Autoimmune disorders like lupus or Sjögren’s syndrome
- Chronic Fatigue Syndrome (CFS/ME)
- Diabetes
- Infectious diseases such as Lyme disease and mononucleosis
- Traumatic brain injuries (TBI)
These conditions may contribute to the development or worsening of POTS symptoms by affecting the autonomic nervous system or immune response.
Understanding POTS Diagnosis and Testing Method
Because POTS is still not widely recognized or understood by many healthcare providers, and there’s no single lab test to confirm it, diagnosis can often be delayed. This means that many people live with symptoms for years before receiving an accurate diagnosis. Understanding POTS is essential to improving awareness, timely diagnosis, and proper care.
To be diagnosed with POTS, symptoms of orthostatic intolerance, which include lightheadness or rapid heartbeat upon standing, typically need to be present for at least three to six months. However, one of the main tools doctors use for diagnosis is checking orthostatic vital signs, which involves comparing heart rate and blood pressure while lying down and again after standing up. This helps identify the abnormal heart rate response that characterizes POTS.
POTS & Nutrition
Nutrition can play a key role in helping patients manage their symptoms. For example, individuals with Hypovolemic POTS often benefit from increasing their salt and fluid intake to help boost blood volume. However, it’s important to make these changes under the guidance of a doctor and dietitian, especially if other health conditions like high blood pressure or kidney issues are also present.
Patients are also encouraged to eat several smaller meals throughout the day rather than two or three large ones, since large meals can worsen POTS symptoms by causing the body to divert more blood to digestion.
People with POTS often experience other digestive issues like IBS, celiac disease, food allergies or intolerances, vitamin deficiencies, and symptoms such as nausea and vomiting, which can reduce appetite. Because of this, personalized support from a registered dietitian is essential to address these challenges effectively.
POTS & Eating Disorders
In 2021, the Journal of Developmental & Behavioral Pediatrics published a study that looked at the connection between Postural Orthostatic Tachycardia Syndrome and eating disorders, revealing that many individuals with POTS also experience disordered eating patterns. In fact, nearly 75% of participants reported restricted eating, and over half shared that they had experienced weight loss. Many also noted food sensitivities or allergies, often linked to Mast Cell Activation Syndrome (MCAS), a common comorbidity of POTS. Further research is necessary to deepen our understanding of how disordered eating and POTS are connected. This knowledge could enhance screening methods, improve diagnosis, and help develop personalized treatments for patients managing both conditions.
How We Can Help
We understand the unique challenges faced by individuals with POTS and eating disorders. Our team provides compassionate, personalized support that addresses both physical symptoms and nutritional needs. Through careful assessment and tailored guidance, we work alongside patients to improve symptom management, ensure proper nutrition, and support overall well-being. To learn more about our approach or to schedule a consultation, contact us today.
