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Stop P.O.T.S. (Postural Orthostatic Tachycardia Syndrome)

Stop P.O.T.S. (Postural Orthostatic Tachycardia Syndrome)
November 6, 2017 Dr. Patrick Nemechek and Jean Nemechek

Stop P.O.T.S. using The Nemechek Protocol Postural Orthostatic Tachycardia Syndrome, called “POTS”, is a relatively new and growing diagnostic label.

 

Individuals with POTS experience a very rapid increase in their heart rate when they stand up which is often accompanied by orthostatic symptoms of heart palpitations, altered balance, lightheadedness or dizziness, and syncope (passing out).

They may also suffer from non-orthostatic symptoms such as fatigue, headaches, neck tightness, impaired concentration or memory, gastrointestinal symptoms, impaired sleep quality, and anxiousness.

The rapid increase in the heart rate after standing is the unique characteristic of this condition and it predominantly occurs in young women of reproductive age, but it can also occur in young males.

 

People are not born with POTS, it often develops following an injury to the brain or to the autonomic nervous system.

The rapid heart rate symptoms typically come on quickly when the person stands up or is standing still. The injury may be a result of physical or emotional traumas, viral infections, the stress of surgery, vaccination, pregnancy, or autoimmune disorders.

The current diagnostic criteria for POTS is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, without a significant drop in measured blood pressure. Standing for 10 minutes is a very simple test for POTS but many patients are diagnosed by a cardiologist using a tilt-table test.

While POTS is diagnostically determined by an abnormal heart rate, it is also fairly common for POTS patents to have a noticeable drop in blood pressure upon standing.

But some POTS patients have no change in their blood pressure, or they may even experience an increase in their blood pressure, when they stand up. Those conflicting blood pressure readings can be confusing for people who do not understand the mechanics of what is malfunctioning with their body.

One important point to know is that POTS is not a discrete diagnosis, it is considered a “syndrome”. The medical use of the word “syndrome” implies a lack of a well-defined understanding of the disorder at hand.

In other words, there are probably a variety of issues causing the disorder. What has become clearer is that POTS is one form of autonomic nervous system dysfunction.

A second important point is that similar to all new syndromes, health professionals may tend to initially focus more on labels and sub-diagnosis than in finding practical answers in order to help the patients feel better. Fortunately for patients suffering from POTS, improvement or recovery from their underlying autonomic damage is now possible.

 

In order to understand how I begin to STOP POTS (a palindrome, as POTS spelled backwards is STOP), I will go back to the beginning to teach you about the nervous system problem and the autonomic answers.

The mechanical problems involved with POTS involve the dysfunction of the autonomic nervous system, which is the brain’s master control mechanism over the body. The autonomic nervous system is involved with the coordination and regulation of all organ function, blood pressure control, metabolism, hormone regulation, and inflammation.

Autonomic dysfunction is something that occurs when the nerves that carry the information from the brain and spinal cord to the heart, bladder, intestines, sweat glands, blood vessels, hormonal organs, and the immune system no longer work properly. Damage or disruption to autonomic function causes those bodily things to not function correctly and leads to a wide range of symptoms.

The autonomic nervous system controls our heart and adapts our blood pressure and pulse rate to changes in our posture and physical stress. Erratic heart rhythms, excessively high or low heart rates, and abnormal blood pressure readings are connected to autonomic nervous system dysfunction.

The autonomic nervous system has two main branches. We know them by the type of brain commands they carry such as the sympathetic (“fight or flight”) and the parasympathetic (“rest and digest”) branches. Both the sympathetic and parasympathetic branches feed into the heart and modulate the heart’s natural rhythm and contractility.

Our normal resting heart beat should be 60 to 70 beats per minute, and it is the parasympathetic branch that manages that rate. The parasympathetic branch makes the heartbeat go fast or slower, while the sympathetic branch is more involved with the strength of the heart’s contractions.

 

Five stages in autonomic dysfunction:

There are five stages in autonomic dysfunction and autonomic testing can reveal the subtle and progressive autonomic dysfunction as the brain becomes increasingly unable to modulate the heart. Parasympathetic dysfunction results in an increase of cardiac arrhythmias, and POTS is also related to weakening of the sympathetic branch in particular.

As parasympathetic function weakens the EKG portion of autonomic testing indicates whether the person has moved into atrial fibrillation (A-fib), atrial flutter, has low heart rate variability, or has progressed to a point where they are now at risk of sudden cardiac death (Cardiac Autonomic Neuropathy or CAN).

The unique feature of POTS, the rapid heart rate, is from the combined effects of poor regulation of the heart rate response to the inadequate generation of blood pressure and oxygen delivery upwards into the brain when the person is in the upright position.

The person suffering from the rapid heart rate symptom is having difficulty adapting their blood pressure and their pulse against the stress of gravity. The problem with the change in their posture is the letter “P” in POTS.

In other words, when someone stands up their body should compensate for gravity by delivering a perfectly timed increase of blood pressure and blood oxygen upward to their brain. When their autonomic nervous system branches work correctly, blood pressure and oxygen delivery occur normally, and there are no symptoms.

But when the autonomic nervous system is damaged and the sympathetic and parasympathetic branches no longer function correctly, the person may feel the rapid heart rates of POTS and experience swings in blood pressure.

The letter “O” (orthostatic) in POTS stands for their orthostatic intolerance, which is the development of symptoms when they move to an upright position or after sitting or standing up for an amount of time.

The other feature of POTS, the elevated heart rate, is a tachycardia response to the drop in the blood pressure upward to the brain. Tachycardia is the letter “T” in POTS. It is a hydraulic malfunction with one’s cerebral blood pressure regulation which makes their pulse go up very high.

In less severe cases of autonomic dysfunction (stages 1 -3) the person may just feel a head rush, get a little dizzy or lightheaded, or feel anxious when they stand upright or change their posture.

The functional damage to the autonomic nervous system that triggers POTS symptoms may be triggered by physical trauma to the brain (falls, concussions, bumps to the head), from emotional traumas that deeply impact the individual (death of a loved one, intense fear, bullying), or from prolonged inflammatory reactions that may result after a vaccination, surgery, or even from allergy testing or shots.

I have discovered a multifaceted formula for autonomic nervous system restoration that is so groundbreaking that I filed a patent application for The Nemechek Protocol™ for Autonomic Recovery (Patent Pending). The steps in my treatment program that can help STOP POTS begins by encouraging someone’s own stem cells and repair mechanisms to once again function.

This is not accomplished by injecting stem cells into someone because high levels of metabolic (chemical) inflammation is what prevented that person from making their own stem cells and from healing their initial injury to begin with.

Instead, it is done by suppressing the chronic inflammatory state within the body and brain which allows someone’s own stem cells to turn back on and perform their job of repairing cell damage.

 

The key to restoring our natural inflammation control mechanisms is through a global reduction of inflammation throughout the brain and body by using every scientific, nutritional, and bioelectric tool available.

It is the natural process of re-activating natural stem cell production that allows a person to begin healing their underlying autonomic nervous system injury. This is possible to do without long term medications in most individuals by down-regulating metabolic (chemical) inflammation through short term medications, a limited number of omega-3 nutrients for the brain, the elimination of omega-6 vegetable oils from the diet, by controlling bacterial overgrowths in the intestinal tract, and in some people by using bioelectric Vagus nerve stimulation.

Something as simple as a core shift in the diet to more omega-3 fatty acids (most easily accessible in fish oil) and the elimination of omega-6 fatty acids (vegetable oils) helps to create a healthier inflammatory environment in the body that restores the production of stem cells.

It has been my experience that a consistent change in these dietary chemicals in someone’s daily food is absolutely mandatory for achieving or maintaining autonomic nervous system health.

I have also seen the powerful effects of bioelectric medicine to the main nerve of the autonomic nervous system, which is the Vagus (or “vagal”) nerve. The Vagus nerve carries information from the organs to the brain, and it is instrumental in the regulation of inflammation in the autonomic nervous system.

While we typically think if we stimulate something we are turning something “on”, when it comes to the autonomic Vagus nerve this stimulation actually helps turns inflammation “off”.

The stimulation of the Vagus nerve is one additional tool to calm down the inflammation that is preventing the brain and nervous system from healing the underlying injury (concussion, trauma, inflammatory trauma) that is responsible for the symptoms of POTS.

When inflammation is lowered and cells naturally function again, the body is finally allowed to heal. When the autonomic nervous system improves or repairs and the two branches work together again in balance, the symptoms with the change in posture (the “P”) are relieved because the body can once again generate enough blood pressure and oxygen upward to the brain.

This improved blood pressure and oxygen delivery to the brain further resolves the orthostatic intolerance (the “O”) and the abnormal tachycardia response from the heart (the “T”). When the symptoms are gone, the syndrome is gone.

There are two other types of autonomic disorders with low brain oxygen features that a POTS patient may or may not experience. One is Vasovagal Syncope (VVS), another autonomic disorder causing low oxygen delivery to the brain but the main symptom of VVS is passing out when startled or stimulated (needle puncture from blood draw, sight of blood, a negative visual experience).

The other autonomic disorder causing low brain oxygen levels is neurogenic orthostatic hypotension. In the case of orthostatic hypotension, individuals have very low blood pressure readings at the arm and are frequently feeling faint or lightheaded.

There is no magic pill or quick fix when it comes to repairing the autonomic nervous system and individual results will always vary. The reversal of autonomic nervous system damage requires a sustained reduction in metabolic (chemical) inflammation in the patient for years.

 

Maintaining one’s recovery and healing from new autonomic injuries will require maintaining a lower, healthier inflammatory state in the body throughout their lifetime.

If you or a family member have been diagnosed with POTS or any of these other conditions causing low brain oxygen, the encouraging news is that these things are now reversible in some people. The key to recovery is to work to resolve the underlying sympathetic and parasympathetic dysfunction and to not just mask the symptoms.

At first glance POTS seems like just a cardiac issue but it actually involves the brain, the nervous system, the intestinal tract, the production of stem cells, inflammation, and the chemicals in someone’s diet.

Therefore, the reduction of brain inflammation, the reversal of intestinal bacterial overgrowth, and the electrical stimulation of the autonomic nervous system help reverses the underlying dysfunction and eliminates symptoms.

 

I am an internal medicine physician (D.O.) from UCLA and my Internal Medicine and Autonomic practice, Nemechek Autonomic Medicine, is in the greater Phoenix, Arizona area. My discovery is that autonomic nervous system improvement or repair is possible without using long term medications that only serve to stabilize symptoms.

Even when autonomic testing has identified the weakest pattern of stage 5 autonomic dysfunction (Cardiac Autonomic Neuropathy), I have facilitated improvement or recovery of this pattern in some of my patients. I have seen the recovery of CAN even in elderly patients, so the ability of the brain and body to repair throughout our lives and well into advanced age is amazing.

My wife and I recently published “The Nemechek Protocol™ for Autism and Developmental Delay” further explaining my discovery and my work with brain inflammation, bacterial overgrowth, and autonomic dysfunction in children with autism and other developmental disorders such as SPD, ADD and ADHD. The Nemechek Protocol™ for Autism and Developmental Delay is available at AutonomicRecovery.shop.

For additional information, you may call my office 623-208-4226.

This post is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship.

© 2017. Nemechek Consultative Medicine, Inc. All Rights Reserved.

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Chrissy R
Chrissy R

Is the protocol book for Autism the same one you would use for a adolescent patient with POTS?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes

Josie
Josie

Hi Dr Nemechek,
I have severe POTS and am bedridden . I’m saving up to have a skype consult with you from the UK, but wondered while I’m waiting if there’s anything I can get started with to help me get out of bed and more upright? Perhaps if I start omega 3 fish oils and eliminate all omega 6 oils? If so how much fish oil should I take? Thank you so so so much, Josie

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The protocol I developed for adults was later adapted for autism.

Reading our autism protocol book will outline the science and gives you the doses I recommend for adults. The dosing for aults with and without autism are the same.

You can purchase a copy at https://autonomicrecovery.shop

Donna
Donna

Hello Dr. Nemecheck,
My 14 year old daughter has just been diagnosed with Mast Cell Activation Syndrome and Vasovagal Syncope. I have MCAS as well. We live on the East Coast and both are unable to travel due to reactions. I started her on the oils, but she has a histamine reaction to the fish oil and the EVOO. Is there a way to have a digital visit with you without traveling across country?

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

I am sorry, we no longer provide Skype or phone sessions for U.S. residents.

I would like to add that the histamine reactions you are seeing are secondary to SIBO and not due to fish oil or olive oil per say.

Paula Barrows
Paula Barrows

Hello Dr Nemechek My seven year old granddaughter has been recently diagnosed with POTS using the tilt table test at the Great Ormond Street Hospital in London. She was diagnosed with Ehlers Danlos a number of years ago and has high functioning autsm. The cardiologist has prescribed a beta blocker, salt and fluids. She has not started the beta blocker yet, but we have been told that this drug will only take the edge off of the symptoms. She has a severe case of POTS and we have been warned that she could end up in a wheelchair. Since birth,… Read more »

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

Yes we can help.

She is crawling around the house because standing causes too much unpleasant lightheadedness when fully upright.

The propranolol might make this worse.

Start my protocol and set up a Skype visit.

Katia
Katia

I was tested positive for SIBO (methane dominant) 2 years ago and was treated with Rifaximin and Neomycin (they often substitute if with Flagyl). It is believed in Australia that only the combo of both can treat it properly. Now I am facing full-on POTS syndrome and going to follow your protocol. Would you say Rifaximin still works for methane SIBO? Thank you for your time and all the work you are doing.

Patrick Nemechek, D.O.
Patrick Nemechek, D.O.

The test is extremely inaccurate and I don’t use it.

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