What is Postural Orthostatic Tachycardia Syndrome – or POTS?

By: Dr. Matt Lewis, D.C., DACBN, CFMP®

While there’s probably only a handful of Philadelphia Eagles fans living here in Tampa, Fla., the team’s 2018 Super Bowl-winning quarterback Nick Foles has certainly been highlighted in the news lately.

That’s because Foles and his wife, Tori, have brought public attention to a private issue within their family. Tori Foles was recently diagnosed with postural orthostatic tachycardia syndrome — better known as POTS — which is an often undetected and underdiagnosed chronic syndrome that causes an increased heartbeat, fatigue, dizziness, and fainting.

POTS patients like Tori Foles frequently find themselves at battle with gravity, which is why this disorder is often referred to as “the fainting disease.” The human heart normally beats 70 to 80 times per minute when we are at rest. That rate climbs another 10 to 15 beats per minute when standing up, then settles back down. But for people with postural orthostatic tachycardia syndrome, the heart rate often increases 30 to 50 beats per minute — or more — leading to the lightheadedness, dizziness and fainting that Tori Foles experienced.

(Image © Maria Hagsten Michelsen)

While the plight of those suffering POTS became more visible last month when Tori Foles took her case to news outlets and a CNN audience, many of us in healthcare — especially those of us who practice functional and integrative healthcare — are committed to raising awareness about the disorder, and the misconceptions and frequent poor diagnoses surrounding POTS.

Women and the Misdiagnosis of POTS

Between one and three million Americans suffer from postural orthostatic tachycardia syndrome, and 80 percent of them are young women — particularly those in their early teens — with the condition getting worse through the growing years. Because these women are younger and otherwise appear healthy when the disorder strikes, doctors often dismiss the physical prognosis, choosing instead to explore the mental.

Tori Foles recalls her doctor telling her that she was in perfect physical shape, and then asking her if, perhaps, she might be suffering from depression or anxiety. After insisting on further tests, the doctor took her vitals, where he discovered that her heart rate increased by about 40 beats per minute when she stood up.

“BINGO,” she wrote on her blog. “If your heart rate is increasing by more than 30 bpm upon standing, then there’s a good chance you have POTS and your autonomic nervous system is not regulating things properly. It took one minute to figure out. “It makes me mad just talking about it.”

The CNN story about POTS and Tori Foles cited a survey of 4,178 diagnosed POTS patients which revealed that more than 75 percent of them were told their symptoms were psychological. And one-fourth of those said they were treated for a mental disorder before they got an accurate diagnosis.

Understanding and Properly Diagnosing POTS

Among the amazing internal features within each of us is our autonomic nervous system, which consistently conducts involuntary functions such as breathing, blinking, and maintaining blood pressure. However, people diagnosed with POTS often suffer a glitch in that system, which can result in near-constant fatigue or dizziness.

I understand how frustrating an incorrect assessment of a serious condition can be. Here’s my take on a proper program of diagnosis for this oft-misread condition.

I begin with a thorough physical examination, where I assesses blood pressure and pulse while you’re in a seated or lying-down position, followed by standing up. What I’m looking for is abnormal changes, and I often find those changes with POTS patients who have low blood pressure, but have been told by their physician or nurse that they “have excellent blood pressure.” And yet, these patients claim they really don’t feel all that “excellent.”

Next, I test for lab indicators of autoimmunity, tick-borne illnesses, chronic inflammatory response syndromes, and adrenal markers, and I conduct a variety of other tests targeting the underlying cause. In addition to addressing and treating those hidden causes, your lifestyle habits are also explored. And if a patient has not been seen by a cardiologist, then the appropriate referral is made.

Treating POTS

Treatment is focused on improving symptoms and may include elimination of specific foods or exposure to certain environments. If there is a mast cell or histamine problem, allergies are taken into consideration and properly treated. Also under consideration where treatment is concerned — improvements to the response by the autonomic nervous system (this occurs by using natural medicines that can calm the noradrenaline surges coming from the brain and adrenal glands, balancing electrolytes, and modifying physical activity and exercise).

I also pay attention to infections that could be aggravating the autonomic nervous system and causing POTS.

Symptoms for POTS can show up following a viral illness, or a stressing event such as a pregnancy or major surgery. The condition might also develop as a result of cancer, multiple sclerosis, diabetes, or Lyme disease. In fact, in some cases, a cause is never discovered.

Conditions related to POTS

Other conditions may be related to postural orthostatic tachycardia syndrome? POTS UK is a member of the Specialized Healthcare Alliance — an independent organization made up of patient groups that campaign on behalf of patients with rare or complex medical problems. That organization claims other conditions can be tied in with POTS, including:

  • Chronic Fatigue Syndrome (CFS) — POTS is believed to affect up to half of patients diagnosed with CFS. In fact, it has been suggested that these two conditions are part of a group of ailments featuring similar causes.
  • Inappropriate Sinus Tachycardia (IST) — This is yet another condition with similar symptoms to POTS. Those sufferers experience a high heart rate when lying down, which accelerates with exertion or stress. Both conditions may share the same underlying causes, and treatment options are the same.
  • Mast Cell Activation Disorder —This condition should be considered if flushing or allergies are evident in the patient.
  • Autoimmune Conditions — Research in recent years demonstrates that auto-antibodies affecting the autonomic nervous system are more common in people with POTS. In fact, the treatment of underlying conditions can improve symptoms of POTS.

If anything covered in today’s blog post strikes a chord with you, seek medical attention from a licensed healthcare professional immediately.

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Disclaimer: The information in this blog post is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from Dr. Matt Lewis, D.C., DACBN, CFMP®, nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.
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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Florida. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.

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