What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

Feeling lightheaded, shaky, or faint when you stand up isn’t normal and may signify an imbalance within the autonomic nervous system known as postural orthostatic tachycardia syndrome, or POTS.

POTS is a chronic disorder characterized by a dysfunction in the regulation of the circulatory system in response to gravity’s effects on the body.

Discover common signs and causes of POTS and learn about the practical strategies to help manage symptoms naturally.

What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome, commonly referred to as POTS, is an autonomic nervous system disorder characterized by an abnormal increase in heart rate when transitioning from a seated or lying position to a standing position. 

Typically, the autonomic nervous system regulates heart rate and blood vessel constriction to maintain stable blood flow regardless of the body’s movement or position. 

However, in those with POTS, the nervous system is unable to effectively regulate blood pressure, which allows blood to pool in the legs, triggering a rapid increase in heart rate.

POTS is a widespread health issue, affecting approximately one to three million Americans. Although it can occur in men, orthostatic intolerance is most commonly seen in teenagers and women between the ages of 15 and 50.

Watch the video below to learn more about the hidden deficiency linked to POTS.

Symptoms of POTS

POTS can develop gradually or suddenly, and symptoms can appear immediately upon standing or a few minutes after changing to an upright position.

POTS symptoms can vary from person to person, but often include:

• An increased heart rate or heart palpitations
• Brain fog
• Chest pain
• Dizziness
• Excessive sweating
• Fainting
• Fatigue
• Headaches
• Nausea or feeling sick
• Nervousness or anxiety
• Pallor or purple discoloration of hands and feet
• Shortness of breath

Many POTS patients notice fast symptom relief when lying down. This position improves venous return, increases blood flow to the brain, and reduces gravity-related strain on the autonomic nervous system.

Causes and risk factors

While the exact cause of POTS isn’t fully understood, it’s considered a complex condition with multiple contributing mechanisms. 

Researchers have identified three primary subtypes: 

• Neuropathic POTS
• Hyperadrenergic POTS
• Hypovolemic POTS

Neuropathic POTS occurs when the small peripheral nerves that control blood vessel constriction are damaged, allowing blood to pool in the lower body.

Hyperadrenergic POTS is characterized by an overactive sympathetic nervous system, which is the body’s fight or flight system. This can result in norepinephrine and adrenaline surges that rapidly increase heart rate, anxiety, and other stress responses. 

Hypovolemic POTS is linked to low blood volume, which means there isn’t enough blood to sustain stable blood flow and circulation when standing up.

Some healthcare providers theorize that POTS is an autoimmune disease, as it frequently develops after viral infections, significant stress, surgery, or trauma. POTS can be associated with other autoimmune or inflammatory conditions such as Hashimoto’s thyroiditis, Sjögren’s syndrome, and lupus.

Risk factors for the development of POTS include:

• Sedentary lifestyle
• Being female
• Chronic stress
• Neurological conditions
• Recent illness

Additionally, nutritional deficiencies have been identified as significant risk factors for POTS. 

A study published in Neurological Research reported a higher prevalence of deficiencies in vitamin B1 (thiamine), vitamin B12, vitamin D, and iron among individuals with POTS compared to healthy controls. 

“B vitamins, particularly vitamin B1, are key players in autonomic nervous system function,” explains Dr. Berg. “Thiamine supports nerve energy metabolism and communication between the brain, heart, and blood vessels, which explains why deficiencies may contribute to POTS symptoms.”

Common triggers

Several dietary, lifestyle, and environmental factors can trigger or worsen POTS symptoms by placing additional strain on the nervous and cardiovascular systems.

A high-carbohydrate diet may exacerbate POTS by increasing the body’s demand for B vitamins, such as thiamine, contributing to or worsening deficiencies that act as risk factors for autonomic dysfunction.

Prolonged standing, heat exposure, and strenuous activity may also aggravate POTS symptoms by promoting blood pooling in the lower extremities, reducing cerebral flow, and causing blood vessel dilation, all of which further impair blood pressure and heart rate regulation.

Additionally, significant hormonal fluctuations, such as those occurring during menstruation, puberty, or pregnancy, can temporarily trigger or worsen POTS symptoms by altering vascular tone, fluid balance, blood volume, and autonomic regulation and signalling.

Natural tips for managing POTS

Because POTS is associated with nutrient deficiencies, correcting nutritional gaps with targeted dietary and lifestyle changes may help manage symptom severity and reduce its impact on daily life.

Here are four natural strategies to help manage POTS.

1. Increase foods rich in vitamin B1

B vitamins, especially vitamin B1, play a critical role in maintaining nervous system signaling, mitochondrial energy production, and autonomic regulation. 

In individuals with POTS, low thiamine status may worsen symptoms such as fatigue, lightheadedness, and impaired cardiovascular regulation due to increased strain on the nervous system. 

Emphasizing foods naturally rich in vitamin B1, such as sunflower seeds, pork, beef, and organ meats, is a simple way to boost nutrient intake and reduce the risk of subclinical deficiencies that may exacerbate POTS.

2. Support electrolyte balance and hydration

For individuals with hypovolemic POTS, maintaining optimal hydration and increasing dietary sodium intake from sea salt or pink Himalayan salt can help expand blood volume, promote circulation, and reduce the risk of blood pooling in the lower body.

Research published in the Journal of the American College of Cardiology found that “In POTS, a high salt diet reduced upright heart rate and orthostatic tachycardia compared with a low salt diet. Total blood volume and plasma volume increased, and standing norepinephrine decreased.”

3. Support gut health 

Maintaining a healthy gut promotes efficient digestion and nutrient absorption, crucial for reducing the risk of vitamin and mineral deficiencies that can worsen POTS symptoms. 

Damage to the intestinal lining or imbalances in gut bacteria, known as dysbiosis, can impair nutrient absorption and place additional strain on the nervous system. 

A study published in Neurogastroenterology & Motility reported that up to 80 percent of POTS patients experience gastrointestinal symptoms such as reflux, nausea, abdominal pain, and bloating associated with dysbiosis.

Limiting foods that contribute to a leaky gut, such as refined sugars and carbohydrates, while prioritizing bone broth, fermented foods, and low-carb, fiber-rich vegetables, supports gut lining integrity and microbial diversity.

4. Maintain optimal vitamin D levels 

Vitamin D supports immune regulation, vascular function, and neuromuscular signaling, all of which are involved in maintaining autonomic nervous system stability.

Vitamin D deficiency is a common co-occurrence in individuals with POTS and may exacerbate symptoms such as fatigue, dizziness, weakness, and exercise intolerance. 

A study published in Expert Opinion on Investigational Drugs reported that more than 50 percent of POTS patients exhibited insufficient or deficient vitamin D levels.

Regular sun exposure and consumption of vitamin D-rich foods, such as wild-caught fish, egg yolks, cod livers with the oil, and organ meats, can support balanced levels and help promote overall autonomic and cardiovascular function.

When to talk to your doctor

If you experience frequent dizziness, fainting, a rapid heart rate upon standing, or other signs of POTS, contact your healthcare provider for evaluation. 

Diagnosing POTS typically involves reviewing your symptom history and performing a physical exam to assess vital signs in different positions. 

The tilt table test (TTT) is considered the gold standard for diagnosis. During this test, an individual is secured to a table that moves from a horizontal to an upright position while their heart rate and blood pressure are closely monitored. 

To treat POTS, healthcare providers typically focus on managing symptoms and improving quality of life. This often includes medications to support blood volume, vascular tone, or heart rate. 

However, your doctor may also help formulate a natural program to manage symptoms without medication by incorporating lifestyle changes, a balanced diet, and gradual exercise.

FAQ

Sources

1. https://pubmed.ncbi.nlm.nih.gov/28531358/ 
2. https://pubmed.ncbi.nlm.nih.gov/33926653/ 
3. https://onlinelibrary.wiley.com/doi/10.1111/
4. https://www.ahajournals.org/doi/10.1161/circoutcomes.8.suppl_2.121