Postural Orthostatic Tachycardia Syndrome, called “P.O.T.S.,” is a relatively new and growing diagnostic label. Let’s take a look at this diagnosis and how to stop P.O.T.S.
What is P.O.T.S.?
Individuals with P.O.T.S. experience a rapid increase in their heart rate when they stand up, often accompanied by low blood pressure symptoms. These symptoms include heart palpitations, altered balance, fatigue, general anxiety, headaches, neck tightness, impaired concentration or memory, lightheadedness or dizziness, and syncope (passing out).
They may also suffer from non-orthostatic symptoms such as chest pain or tightness, air hunger, constipation, heartburn, IBS, insomnia, painful menstrual cramps, and premenstrual syndrome.
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. Still, it can also occur in young males.
How Does P.O.T.S. Develop?
People are not born with P.O.T.S. It often develops following an injury to the brain or autonomic nervous system.
Most people who experience an injury to their autonomic nervous system will experience symptoms from low blood pressure symptoms to their brain. This is referred to as orthostatic intolerance. Persons diagnosed with P.O.T.S. have two particular injuries. The first is orthostatic intolerance, and the second is damage to the normal compensatory heart rate increase when standing. When someone with an intact autonomic nervous system stands, their heart rate will often increase by ten beats per minute to compensate for the downward pressure of gravity.
When someone with only orthostatic intolerance stands up, their heart rate may go up 20-30 beats per minute. The increase in heart rate is a compensatory mechanism by the nervous system to maintain proper blood pressure within the brain. But when someone with P.O.T.S. stands up, the normal heart rate compensatory increase mechanism is damaged, so the heart rate skyrockets with increases of 40-80 beats per minute.
The rapid heart rate symptoms typically occur quickly when the person stands up or stands still. The injury causing the blood pressure regulation and compensatory heart rate increase often results from physical or emotional traumas, or surges in inflammatory stress from COVID, surgical stress, vaccinations, pregnancy, or fractures of large bones.
How is P.O.T.S. Diagnosed?
The current diagnostic criteria for P.O.T.S. is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first ten minutes of standing, without a significant drop in measured blood pressure. Standing for ten minutes is a very simple test for P.O.T.S., but many patients are diagnosed by a cardiologist using a tilt-table test.
While an abnormal heart rate diagnostically determines P.O.T.S., it is also reasonably common for P.O.T.S. patients to notice a drop in blood pressure upon standing. But some P.O.T.S. 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 the body.
One crucial 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. In other words, there are probably various issues causing the disorder. What has become more evident is that P.O.T.S. is one form of autonomic nervous system dysfunction.
The second important point is that similar to all new syndromes, health professionals may tend to focus more on labels than finding practical answers to help patients feel better. Fortunately for patients suffering from P.O.T.S., improvement or recovery from their underlying autonomic damage is now possible.
The Nervous System Problem
To understand how I begin to stop P.O.T.S. (a palindrome, as P.O.T.S. spelled backward 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 P.O.T.S. involve the dysfunction of the autonomic nervous system, which is the brain’s master control mechanism over the body. The autonomic nervous system coordinates and regulates all organ functions, blood pressure control, metabolism, hormone regulation, and inflammation.
Autonomic dysfunction 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 not to 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. The sympathetic and parasympathetic branches feed into the heart and modulate the heart’s natural rhythm and contractility.
Our normal resting heartbeat should be 60 to 70 beats per minute; the parasympathetic branch 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.
Stages of Autonomic Dysfunction
There are five stages in autonomic dysfunction, and autonomic testing can reveal subtle and progressive autonomic dysfunction as the brain becomes increasingly unable to modulate the heart. Parasympathetic dysfunction results in an increase in cardiac arrhythmias, and P.O.T.S. is also related to the 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 P.O.T.S., 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 upright.
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 P.O.T.S.
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 usually occur, and no symptoms occur.
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 P.O.T.S. and experience swings in blood pressure.
The letter “O” (orthostatic) in P.O.T.S. stands for 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 P.O.T.S., 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 P.O.T.S. It is a hydraulic malfunction with one’s cerebral blood pressure regulation, making their pulse very high.
In less severe cases of autonomic dysfunction (stages 1 -3), the person may feel a head rush, get a little dizzy or lightheaded, or feel anxious when standing upright or changing their posture.
The functional damage to the autonomic nervous system that triggers P.O.T.S. symptoms may be triggered by physical trauma to the brain (falls, concussions, bumps to the head), emotional traumas that profoundly 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.
How to STOP P.O.T.S.
I have discovered an approach that allows the autonomic nervous system to repair itself. Referred to as The Nemechek Protocol, my approach reduces the chronic inflammation within the body and brain, allowing the brain’s natural repair and rejuvenation mechanisms to function more appropriately. It is a natural process that allows a person to begin repairing the 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 vagus nerve stimulation.
A Shift in Diet
Something as simple as a shift in the diet to more omega-3 fatty acids (most easily accessible in fish oil) and a reduction of inflammation-promoting omega-6 fatty acids (vegetable oils) helps to create a healthier inflammatory environment in the body that improves the brain’s capacity to repair itself. 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 on the central nerve of the autonomic nervous system, which is the Vagus (or “vagal”) nerve. The vagus nerve carries information from the organs to the brain, which is instrumental in regulating 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.” Stimulating the vagus nerve is one additional tool to calm down the inflammation that prevents the brain and nervous system from healing the underlying injury (physical and emotional trauma, inflammatory stress) responsible for the symptoms of P.O.T.S.
When inflammation lowers and cells naturally function again, the body finally heals. When the autonomic nervous system improves or repairs, the two branches work together again in balance. Then, the symptoms with the change in posture (the “P”) dissipate 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 (the “S”) is gone.
There are two other types of autonomic disorders with low brain oxygen features that a P.O.T.S. patient may or may not experience. One is Vasovagal Syncope (VVS), another autonomic disorder causing low oxygen delivery to the brain. Still, the main symptom of VVS is passing out when startled or stimulated (needle puncture from a 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 in the arm and frequently feel faint or lightheaded.
There is no magic pill or quick fix for repairing the autonomic nervous system; individual results will always vary. Reversing autonomic nervous system damage requires a sustained reduction in the patient’s metabolic (chemical) inflammation for years. Maintaining recovery and healing from new autonomic injuries will require maintaining a lower, healthier inflammatory state in the body throughout their lifetime.
A Little Encouragement
If you or a family member have been diagnosed with P.O.T.S. or any of these other conditions causing low brain oxygen, the encouraging news is that these things are reversible. The key to recovery is to work to resolve the underlying sympathetic and parasympathetic dysfunction and not just mask the symptoms.
At first glance, P.O.T.S. seems like just a cardiac issue. However, it actually involves the brain, the nervous system, the intestinal tract, the production of stem cells, inflammation, and the chemicals in a person’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 eliminate symptoms.