What is POTS (Postural Orthostatic Tachycardia Syndrome)?
Updated: Sep 26, 2022
POSTURAL - Your body position.
ORTHOSTATIC - Relating to an upright or standing posture.
TACHYCARDIA - An abnormally elevated heart rate.
SYNDROME - A condition characterized by a set of associated symptoms.
POTS is a blood volume and circulation problem often resulting in light-headedness, sweating, and even fainting. Due to low blood volume, those with POTS will have excessively high circulating adrenaline to push the little blood they have through the body. This high adrenaline for circulation flow is what causes tachycardia upon standing. POTS is often accompanied by other handicapping health conditions and many are often bed-ridden due to extreme fatigue.
POTS & Dysautonomia
POTS falls under the dysautonomia category. Dysautonomia is when an individual has dysregulation of the autonomic nervous system. Dysautonomia and POTS can go on for years with no relief if the individual is not following a proper healing protocol.
Understanding the Nervous System
The nervous system is broken up into several sub-sections. In dysautonomia and POTS, the autonomic nervous system is compromised the most and needs the most healing.
What is the Autonomic Nervous System (ANS)?
The Autonomic Nervous System can be divided into three sections.
The Parasympathetic Nervous system (Also known as Rest and Digest response)
The Sympathetic Nervous system (Also known as the Fight or Flight response)
The Enteric Nervous system (Also known as the second brain, in the gut)
Parasympathetic Nervous system (Rest & Digest)
This is what happens to your body in a relaxed state. The body has a hard time doing these things for those with POTS.
Blood vessels that go to the gut dilate. This adds more blood flow to your gut which helps you digest properly. In POTS, digestion is usually not good due to this problem.
Decreases blood pressure and heart rate. In POTS, the heart rate and blood pressure are constantly elevated. The body will not lower either of these because a slower heart rate will slow down the blood moving through the body (and the blood pressure) which would cause poor blood flow to your limbs. Your body keeps this blood flow elevated so your limbs keep functioning and do not die.
Stimulates salivary gland secretion. In those with POTS salivation is often reduced or turned off, which leads to the salivary enzymes not breaking down food properly, ending with poorly digested food.
Speeds up peristalsis (increases the speed of your food moving through your digestive tract). Those with POTS often experience a slowing or impairment of digestion. Constipation and diarrhea are common.
Sympathetic Nervous System (Fight or flight)
This is what happens to your body in a stressed state. Those with POTS are often in this state too much and therapy should help them come out of this state.
Diverts blood flow away from the gastro-intestinal (GI) tract and skin via vasoconstriction (constriction of blood vessels)
Inhibits digestion and peristalsis (Movement of food via contractions throughout the digestive system
Increases heart rate and Blood flow to skeletal muscles and the lungs is enhanced through circulating epinephrine (adrenalin)
Dilates pupils and relaxes the ciliary muscles allowing more light to enter the eye and enhances far vision
Provides vasodilation of the coronary arteries (Opening up of blood vessels around the heart)
Enteric Nervous System
It is capable of acting independently of the sympathetic and parasympathetic nervous systems, although it may be influenced by them
The secretion of gastrointestinal hormones (Secretin and gastrin) which aid in digestion and absorption
The motor neurons in the enteric nervous system are responsible for coordinating peristalsis, rhythmic muscle contractions that move material along the digestive tract.
Enteric neurons can regulate the vomiting reflex, which is particularly critical in those cases in which vomiting arises as a side-effect of medical treatments, including chemotherapies.
Why does the autonomic nervous system matter to me?
Individuals with POTS have an unbalanced autonomic nervous system with too much sympathetic nervous system activation (1). Many areas of the body that the sympathetic nervous system stimulates as seen below will correlate extremely closely to the symptoms you are experiencing.
A POTS diagnosis will be given by a doctor if the patient has the following symptoms:
Heart rate increase ≥30 bpm within 10 min of
upright posture in adults. Heart rate increase
of ≥40 bpm within 10 min is required in adolescents
age 12–19 years.
The following tests are used to measure the change in heart rate
The active stand test
Head-up tilt table (HUT)***
A sustained elevated heart rate upon standing.
In this case, blood pressure should drop significantly upon standing. This doesn't happen in those with POTS. Blood pressure should drop ≥ 20/10 mm Hg.
Experiencing POTS symptoms (see above) upon standing up.
Or, "Orthostatic intolerance" symptoms for ≥6 months.
Standing plasma norepinephrine levels greater than or equal to 600 pg/mL (>3.5nM)
Do this in a lab or with a doctor. This is a measure of how much adrenalin your body is producing.
Absence of overt causes for sinus tachycardia such
as acute environmental stimuli, dietary influences, other medical conditions, and medications.
Dark red or blue hands and feet (acrocyanosis) from poor circulation and oxygen delivery to the hands and feet.
As you go through your recovery journey, you can use these diagnostic criteria as checkpoints to resolving POTS. (2,3,4,5,6,7,8,9,10)
***The Head-up tilt table (HUT) test is not the best way to measure a POTS diagnosis. With a HUT test, you lie down on a table and the table slowly raises you right-side up, as if you were going from laying down to standing. This test is not effective because in everyday life we get up by putting our feet on the ground and using our leg muscles to stand up. Blood rushes to the leg muscles when you use them. This blood rushing is what causes the usual drop in blood pressure. If you do not use your legs to stand then you will not have the same blood pressure change and will falsify the test results. Doing this test will reduce the heart rate increase and may cause your doctor to not diagnose you with POTS.
Solution: Ask the doctor to do the same test with you lying down and then standing up using your own leg muscles.
Prognosis - The course and development of POTS
Data suggest that many POTS patients may see some improvement over time following diagnosis and appropriate treatment. Those who develop POTS in their early to mid-teens during a period of rapid growth are more likely to see complete symptom resolution in two to five years. Unfortunately in various research and follow-up studies, some individuals do not recover, and some even worsen with time. The hyperadrenergic type of POTS may require lifelong therapy and should be closely followed by a specialized practitioner.
Many POTS treatments do not include lifestyle and dietary changes to target the potential underlying causes of your POTS symptoms. (11,12)
How can Cress Dietetics help me with POTS?
Cress Dietetics can help anyone with POTS get to the root cause of their condition and fast-track their healing through diet and lifestyle therapies. Benefits of working with Cress Dietetics:
Intake meetings where your entire health & well-being are taken into consideration.
You will receive an individualized nutrition protocol to address your symptoms.
You will receive a lifestyle optimization program to improve your quality of life.
Medication suggestions to help your healing.
A realistic healing timeline is given to you to monitor your progress.
Weekly, bi-weekly, and monthly check-in options are available.
If you or someone you know has POTS, either reach out to Cress Dietetics or book an appointment directly on the scheduling page.
Next upcoming post: The cause of POTS
Sympathetic activation is associated with increased IL-6, but not CRP in the absence of obesity: lessons from postural tachycardia syndrome and obesity - PMC (nih.gov)
Postural Tachycardia Syndrome | Circulation (ahajournals.org)
The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management - PMC (nih.gov)
Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome - PubMed (nih.gov)
POSTURAL TACHYCARDIA IN CHILDREN AND ADOLESCENTS – WHAT IS ABNORMAL? - PMC (nih.gov)
Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome - PubMed (nih.gov)
Postural Orthostatic Tachycardia Syndrome: Prevalence, Pathophysiology, and Management - PubMed (nih.gov)
Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review - PMC (nih.gov)
The biochemical assessment of sympathoadrenal activity in man | SpringerLink
Diagnosing Postural Tachycardia Syndrome: Comparison of Tilt Test versus Standing Hemodynamics - PMC (nih.gov)
Postural orthostatic tachycardia syndrome - PubMed (nih.gov)
Postural Tachycardia Syndrome | Circulation (ahajournals.org)