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What is POTS anyway?

Have you heard of POTS --  Postural Orthostatic Tachycardia Syndrome (POTS)?  It's a mix of factors that lead to a dramatic intolerance to orthostatic changes resulting in a rapid and unstable heart rate.  The condition can characterized by:

  • significant lightheadedness and sometimes fainting

  • fatigue

  • weakness 

  • visual changes

  • rapid heart rate

  • palpitations

  • tinnitus

  • headaches

  • tremulousness [tremors]

  • nausea

  • insomnia

Physiologically the heart struggles to deliver sufficient blood supply to the body/organs & as a result, small positional changes lead to a sustained increase in heart rate of greater than 30 beats/min (bpm) when a person goes from lying down to standing.  In scientific terms -- POTS patients have a low cardiac stroke volume which causes sinus tachycardia. 

• Experts have estimated that 500,000 to 3,000,000 Americans could be affected, and potentially 70 million world-wide.
• One study in China reported 6.8% of adolescents met clinical criteria for POTS
• POTS is a common neurocardiovascular disease, representing approximately 32.2% of all corresponding syncope [fainting] cases.
• POTS is one of the most common forms of autonomic dysfunction. 

POTS is more likely to happen during pregnancy, traumatic events, autoimmune disorders, chronic infections, chronic disease and neuroinflammatory conditions.  Approximately 15-20% of POTS patients have a pre-existing Auto-Immune disorder.

This is not a new or rare condition but we've certainly seen increased incidence post-pandemic.

• Recent reports indicate that 2%-14% of coronavirus disease 2019 (COVID-19) survivors develop POTS and 9%-61% experience POTS-like symptoms, such as tachycardia, orthostatic intolerance, fatigue, and cognitive impairment within 6-8 months of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

• Post–acute sequelae of SARS-CoV-2 syndrome,” “post–coronavirus disease 2019 (COVID-19) syndrome,” “long-haul COVID,” or “long COVID” and are usually defined as symptoms that persist for >4 weeks from acute illness.

POTS also comes in different flavours -

  • hyperadrenergic,

  • neuropathic,

  • hypovolemic,

  • immune-related [MCAS].

What we hear from these patients is --  "I can't stand up without feeling lightheaded", "I can't go for walks or exercise -- I feel I might faint", "I can't think straight", "I'm having more migraines than usual", "I can't sleep at night".


Unfortunately - 75-77% of POTS patients are misdiagnosed with a psychiatric disorder or told that they are simply anxious.  And we're not surprised by this -- because it looks a lot like chronic stress and happens alongside it.  But anxiety is usually an artifact of experiencing all the symptoms listed above and the underlying physiology of a heart that is simply struggling to keep up with the body's needs.  

When we see these patients we focus on better understanding the root cause so we can tailor treatments to address the factors contributing to POTS.  If you have POTS or suspect you might -- book in with a Naturopath at BeWell for a better work up and a plan of action. While you wait for your appointment -- start each day by having a glass of water before getting out of bed to increase blood volume. Adding electrolytes into your water may also help.

POTS is often present with other complaints and is an obstacle to cure for other conditions. For example, if an individual is also anemic and suffers from POTS, restoring iron levels will not likely help with their fatigue until the POTS is also addressed. Because it impacts blood supply, it has a profound effect on all systems in the body and requires attention and treatment first.

Don't suffer, it's not in your head. Come talk to one of our NDs today.


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