A Functional Medicine Guide to POTS: Finding Balance and Vitality

Welcome back to our deep dive into Postural Orthostatic Tachycardia Syndrome (POTS), as part of our ‘Super Pentad’ series! In our last post, we explored what POTS is, how it’s diagnosed, and the benefits of working with a functional medicine provider. Today, we’re taking it a step further and focusing on the practical side of things: specific treatments and lifestyle changes that can make a real difference in managing POTS symptoms.

Remind me, what in the World is POTS?

Postural Orthostatic Tachycardia Syndrome = A type of Dysautonomia.

Translation: body positions (down/up) trigger heart racing. Dysfunction of the autonomic nervous system.

Types of POTS: Neuropathic, Hyperadrenergic, Hypovolemic

Diagnosis: NASA Lean Test, Tilt Table Test, Autonomic Reflex Testing (Quantitative sudomotor axon reflex test-QSART), Valsalva Maneuver

Let’s start with the basics. POTS is a condition that affects your autonomic nervous system, the part of your nervous system that controls things you don’t have to think about, like your heart rate and blood pressure. People with POTS experience a significant increase in heart rate when they move from lying down to standing up, which can lead to dizziness, lightheadedness, and even fainting. There can be a lot of correlating symptoms as well like swelling and color changes of extremities, temperature regulation issues, headaches, blurry vision, chronic fatigue, palpitations, nausea, tremor, anxiety, irritable bowel syndrome, shortness of breath, urinary frequency, palpitations, focus issues, etc. POTS is not constant. Patients often describe their symptoms in “flares.” One can go years, even decades without flares. Some may develop it, heal over time, and never experience it again. Others can have mild long-term symptoms that they do not consider “abnormal.” Dr. McCubbins didn’t realize she had POTS until her late 30s- yet she had symptoms her entire life. Knowledge is empowering- both for validation of one’s experience as well as knowing what we have for tools!!

Reading about POTS can be overwhelming. Don’t worry, we’re here to talk about how to tackle this beast with a functional medicine approach.

The Functional Medicine Approach: Holistic Healing

Functional medicine is ultimately looking for the root cause, instead of just treating symptoms. The approach considers the whole person, so if you are struggling with POTS, your functional provider will be assisting in finding balance in your body’s systems and addressing factors that might be contributing to your POTS symptoms. Here are some key areas functional medicine focuses on to help manage POTS:

1. Nutrition: Fuel Your Body Right

First off, let’s talk food. What you eat can have a huge impact on how you feel. Functional medicine practitioners often recommend:

Balanced Diet: Eating a variety of whole foods, including plenty of vegetables, lean proteins, and healthy fats.
Hydration: Drinking lots of water. Sometimes, therapeutic doses of salt can help, but it’s best to do this under the guidance of a healthcare professional.
Electrolytes: Incorporating electrolyte-rich foods or drinks can help maintain blood volume and prevent dehydration. Way more on this unsung hero later!

2. Lifestyle Tweaks: Small Changes, Big Impact

Lifestyle changes can be game-changers. Here’s how they may gently support someone with a POTS diagnosis:

Exercise: Gentle, regular exercise like recumbent biking, walking or swimming can improve circulation and strengthen your heart. Start slow and build up gradually. If severe, one may have exercise intolerance and “deconditioning” of the nervous system which may require sessions with a specialized physical therapist.
Compression: Wearing compression socks with activity, long periods of time sitting or standing can help prevent blood from pooling in your legs, which can reduce dizziness. Bonus points- compression extending up over the entire abdomen! Beware of socks that are too tight below the knee
Posture: Moving slowly when changing positions, especially when standing up, can help your body adjust. Proprioception (feeling your body in space) may be compromised, leading to individual being more injury-prone
Legs up! Putting your legs up a wall if you are dizzy or out of breath can help get blood that has pooled back into circulation

3. Stress Management: Chill Out for Better Health

Stress can make POTS symptoms worse. Finding ways to manage stress is crucial. Here are some suggestions:

Mindfulness and Meditation: Practices like yoga and meditation can help calm your nervous system.
Deep Breathing: Simple deep breathing exercises can be surprisingly effective in managing symptoms.
Adequate Sleep: Ensuring you get enough restful sleep can help your body repair and recover.
Vagus Nerve Support: The vagus nerve governs the autonomic nervous system and innervates the heart, lungs, gut, bladder, etc. Though antidepressants and sedative pharmaceuticals are pertinent and have their place for certain individuals with sympathetic dominance (fight or flight), it sure is nice to have more options when it comes to nurturing a parasympathetic state (rest & digest). Vibration seems to have a profound beneficial effect on the vagus nerve! Here are some easy tools to implement for vagus nerve support:
- Humming, singing
- Deep breathing
- Gargling
- Vagus nerve stimulation devices like Sensate or Truvaga
- Contrast Hydrotherapy…Cold plunges!

4. Supplements: Wholistic Approach

Sometimes, you might need a little extra help from supplements. Some that might be beneficial include:

Magnesium: Helps with muscle function and relaxation.
B Vitamins (B1, B5, B12): Support energy levels and nervous system health.
Choline and Huperzine A: Impact acetylcholine levels- a neurotransmitter that aids parasympathetic tone (rest & digest)
Omega-3 Fatty Acids: Reduce inflammation and support heart health.
Adaptogens: Herbs that support cortisol regulation (adrenal support)
Nervines: Herbs that support the nervous system like huperzine.

Always talk to your healthcare provider before starting any new supplements to ensure they’re right for you. Your Vytal Health doctor can recommend specific supplements available at our FullScript Dispensary. Prescription medications may be needed to manage POTS. These can include blood volume expanders, heart rate inhibitors, vasoconstrictors, or sympatholytics. Everyone presents a little differently which makes POTS management an individualized approach.

5. Digging Deeper: Identifying Underlying Issues

Functional medicine practitioners often look for underlying issues that might be contributing to POTS, such as:

Hormonal Imbalances:

Thyroid issues or adrenal fatigue can exacerbate symptoms. Females can often see an aggravation of POTS symptoms in their luteal phase, 1-2 weeks prior to menstruation. Dr. McCubbins is an expert in endocrinology and reproductive health (including fertility), which can be challenged when patient’s have dysautonomia. So, the autonomic nervous system greatly impacts hormone regulation. If the body is in a chronic state of sympathetic dominance (fight or flight), then cortisol demand can impede production of progesterone as well as thyroid efficiency.

Gut Health:

Since gut health is linked to overall health, addressing gut imbalances can improve symptoms. Because of that, dysautonomia can be the cause of Irritable Bowel Syndrome. Many gastroenterologists recognize this and either prescribe antidepressants or even vagus nerve stimulators for kids! (see more on this awesome tool below). IBS with constipation and/or diarrhea often present dysfunction of digestive motility and don’t break down food efficiently, leading to microbiome changes of the small and large intestine. Dr. McCubbins will often prescribe supplements to aid the breakdown process and conduct testing for specific types of overgrowth, treating as necessary.

Chronic Infections:

Sometimes, hidden infections can play a role. Dr. McCubbins has noticed a profound increase in POTS patients over the last 5 years as post-viral conditions often present with dysautonomia. Another thing to consider is that COVID-19 is not the first virus to present this way (think EBV/Mononucleosis), but we have learned a lot about patients who are more likely to develop POTS and how to support them more comprehensively.

Connective Tissue Disorders:

Patients with hypermobility spectrum disorder (HSD) and/or Ehlers Danlos Syndrome (EDS) are more likely (50%) to develop POTS, even in childhood. Equally, 50% of POTS patients are likely to have some form of hypermobility syndrome.

Neurodiversity:

In addition, patients with Autism, Tic Disorder (Tourette’s), PTSD, and/or ADHD (to name a few) are more likely to have dysautonomia/POTS. They are 50% more likely to also have hypermobility syndrome. Highly Sensitive People (HSP) are totally that- so sensitive to their environment and internal physiological signals, that they are more likely to have a stress/vagal response to non-threatening messages (like perfumes or textures). When the autonomic nervous system is overwhelmed from overstimulation.

Dr. McCubbins specializes in what is called the “Super Pentad Syndrome” which includes connective tissue disorders, dysautonomia, autoimmune conditions, digestive issues, and mast cell activation (histamine-related) syndrome.

Electrolytes: The Unsung Heroes for POTS

Now, let’s shine a spotlight on electrolytes, those tiny but mighty minerals that can make a world of difference for POTS patients. Electrolytes are essential for many bodily functions, including maintaining proper hydration, nerve function, and muscle contractions. Specifically, for POTS, they play a crucial role in helping your body manage blood volume and pressure. Here’s how to make sure you’re getting enough electrolytes:

Salt (Sodium): Sodium is often increased in a POTS-friendly diet. It helps your body retain water and maintain blood volume, which can prevent dizziness and fainting. Add a pinch of salt to your water or enjoy salty snacks, but always consult your healthcare provider to find the right balance for you.
Potassium: This electrolyte helps balance sodium levels and supports heart and muscle function. Bananas, orangeΩs, potatoes, and spinach are excellent sources.
Magnesium: Magnesium supports muscle and nerve function and can help prevent cramps and fatigue. Nuts, seeds, and leafy greens are rich in magnesium.
Calcium: Vital for muscle function and nerve signaling, calcium can be found in dairy products, fortified plant milk, and leafy greens.
Electrolyte Drinks: Sometimes, getting electrolytes from food alone isn’t enough. Electrolyte drinks or oral rehydration solutions can be very helpful, especially after exercise or on hot days when you sweat more. Look for options low in sugar and free from artificial additives. Dr. McCubbins loves Zerolyte by Trace Minerals or LMNT for high dose sodium powders and Buoy or Nuun for lower dose drops/tablets.

Wrapping Up: Your Path to Better Health

Remember, everyone’s journey with POTS is unique. What works wonders for one person might not be as effective for another. The key is to be patient, persistent, and proactive in finding what works best for you. Functional medicine offers a personalized approach that can help you uncover the root causes of your symptoms and find a path to better health. So, whether you’re trying a new dietary plan, incorporating mindfulness into your daily routine, or working with a functional medicine practitioner to dig deeper into underlying issues, know that you’re taking positive steps toward managing your POTS and reclaiming your vitality. If you are interested in working with a functional medicine practitioner who an help manage your POTS, reach out. We have providers across the country who can treat you from the comfort of your own home.