Postural Orthostatic Tachycardia Syndrome (POTS)
More people than I care to remember over the years have suffered with POTS, especially those with Ehlers-Danlos syndrome. Simple interventions I have used with clients over the years has seen many clients return back to work and increased their standards of living. Let’s take a look at POTs, its mechanism and give you something to take away, use and hopefully help yourself.
What is Postural Orthostatic Tachycardia Syndrome ?
Postural Orthostatic Tachycardia Syndrome (POTS) is an abnormality in the functioning of the autonomic (involuntary) nervous system which affects many different people. However, it is most common in girls and women aged 15 to 50, with a higher prevalence in those who suffer from Ehlers Danlos syndrome. It causes a range of symptoms that occur within a few minutes of sitting up or standing. Some people have mild symptoms, while others find the condition affects their quality of life hugely and has caused many an EDSer to become housebound.
Typical symptoms of PoTS include:
- dizziness or lightheadedness
- heart palpitations
- shaking and sweating
- weakness and fatigue
- poor sleep
- chest pain
- feeling sick
- shortness of breath
Out of all of the many studies focusing on POTS, no single modality of treatment has been found to be effective for all, although some drugs have been found to help but no studies have been done into the long term. Truth be told, there is a huge correlation between POTS and the medication and treatments currently being used. Take Beta Blockers for example, the side effects from them when compared to the symptoms of POTS are near identical.
What causes Postural Orthostatic Tachycardia Syndrome ?
When you stand up, approximately 500ml of blood drops into the abdominal cavity and limbs by gravity, blood vessels quickly narrow and your heart rate increases slightly in a bid to maintain blood flow to the heart and brain keeping you conscious. Now unfortunately, this brilliant automatic function you need not even think about does not working correctly in those with POTS, resulting in an excessive rise in heart rate, increased norepinephrine in the blood and altered blood flow to the brain.
There has been a noted correlation between those with POTS and those who received the HPV vaccinations in adolescence. One study of 35 women aged 23.3 ± 7.1 years found that twenty-five had a high level of physical activity before vaccination and irregular periods were reported by all patients not on treatment with oral contraception. Serum bilirubin was below the lower detection limit in 17 patients. Twenty-one of the referred patients fulfilled the criteria for a diagnosis of POTS (60%, 95%CI 43-77%). All patients had orthostatic intolerance, 94% nausea, 82% chronic headache, 82% fatigue, 77% cognitive dysfunction, 72% segmental dystonia, 68% neuropathic pain. https://www.ncbi.nlm.nih.gov/pubmed/25882168
A further study by the European Medicines Agency (EMA) announced that a task force found no causality between the vaccination and two sets of chronic symptom syndromes in girls and young women. Although some clinicians and scientists say the EMA report is “not valid” and is marred by conflict of interest and reliance on already published data and are calling for an independent study of the association. Perhaps even more notably, Denmark has announced that it is conducting its own independent investigation. More than 1300 girls and young women with such symptoms have been referred to five specialist centers in the country.
It was Denmark that requested the recent review by the EMA into the safety of HPV vaccines. That review, which began in July, focused in particular at reports of complex regional pain syndrome (CRPS), a chronic pain condition affecting the limbs, and postural orthostatic tachycardia syndrome (POTS), a condition in which the heart rate increases abnormally after sitting or standing up, causing symptoms such as dizziness and fainting, as well as headache, chest pain, and weakness.
Respect the body
If you have worked with me or know me personally then you will know I am not a huge advocate for drugs. Most do not take into account how adaptive the body really is, which has lead us to a society where we think we are much smarter than body and instead of working with the body to heal itself, we try to force it to our will and change its physiology. The body has evolved over millions of years to get through the winter without a flu shot. It can grow human beings in 9 months, certain organs can regenerate and it is constantly working to keep you in constant balance. If your arteries become clogged it will increase you blood pressure, if you are walking down the street and you brain does receive enough oxygen it will make you unconscious to get your head lower down to make it easier to get oxygen. It is a truly beautiful and efficient machine that is built to keep you alive and everything it does is an adaptive response for this. However we have a society that is using something as foolish as using 120/80 bench mark for blood pressure. Blood pressure is yet another adaptation of the body. Running around for 10 minutes will almost certainly see a raise in your blood pressure. Instead of asking questions to understand why certain people have high blood pressure everyone is grouped into this ridiculous 120/80 model regardless of individual life choices, physiology and mental health, further pushing this hedonistic medical system.
The standard treatment for POTS
The standard treatments for POTS are Drugs such are;-
Beta Blockers – Beta-blockers are a large class of drugs that block the effects of epinephrine and norepinephrine in beta receptors in your body. Some common beta-blockers are atenolol, propanolol, toprol and metoprolol. Generally speaking, they are used to help prevent tachycardia. They also reduce the activity of the sympathetic nervous system, which can help some POTS patients. Yet again when we take into account that there is a reason Epinephrine is high, shutting off the body’s natural stress system is foolish.
Selective Serotonin Reuptake Inhibitor (SSRI) – Serotonin has been found to play a part in the control of both heart rate and blood pressure. SSRI’s increase nerve stimulation and connection of the standing vasoconstriction reflex reducing blood pooling and reducing Orthostatic intolerance. SSRIs also ease depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters. This on the outside looks to be a very good methods to controlling POTS, that is until you remember that in actual fact 90% of serotonin is made in the brain and these antidepressants have show to increase the risk of suicide, despite being prescribed for it. This is known as a “paradoxical reaction” wherein a specific medication that was intended to treat one symptom, actually ends up producing it in a greater magnitude. Benzodiazepines, common psychoactive drugs used to relax muscles and quiet convulsions, are prone to producing the exact opposite effects. Antibiotics as well, which have been in greater circulation in recent years, have been known to produce the “Eagle effect” — a phenomenon named after Harry Eagle, the physician who first noticed that when bacteria are exposed to antibiotics for a long enough time, their population rates not only stabilize; they increase. The drugs Prozac actually causes the brain to shut down its own production of serotonin, thereby causing a paradoxical effect or opposite effect on the level of serotonin. I go back to my comment on the body’s adaptability and tendency to remains within a specific hormonal range, environmentally dependant.
Fludrocortisone- prevents the release of substances in the body that cause inflammation. It is used to treat conditions in which the body does not produce enough of its own steroids, such as Addison’s disease, and salt-losing adrenogenital syndromeand which has been noted to decrease an individuals potassium which plays a critical role in many metabolic cell function. https://www.ncbi.nlm.nih.gov/pubmed/17616536
The problem with these approaches are that they are still trying to manipulate the body instead of working with it to correct the underlying issues. Introducing Beta Blockers will reduce the heart rate, which will reduce oxygen to the brain, which in turn, will force our bodies to adapt and increase blood pressure again to ensure our brain receives enough oxygen. People will end up increasing medication to keep up with the body’s adaptability. The side effects from BETA blockers are known to be:-
- Cold hands.
- Upset stomach.
- Shortness of breath.
Which are almost identical to the symptoms of POTS. It is completely insane that we are living in a society that still treats symptoms and not causes. Anything that reduces blood flow to the brain is a completely ridiculous idea and an even worse modality of treatment. There are mountains of examples out there of this contradictory medical system in action. Take the fact that we have known since 1985 that NSAID’s (non steroidal anti inflammatory drugs) indirectly inhibit the creation of new cartilage and ultimately speed up its destruction, are associated with progressive formation of bone cysts and bone thinning. Yet despite knowing this, 20-30% of the elderly population in the western world and probably a higher percentage of chronic pain sufferers are on these medications. Inflammation is your body’s healing mechanism, if you stop that you will temporarily get rid of the pain of the inflammation, but your body will not heal itself.
What you can do
By far the smartest thing you can do when it comes to POTS is to listen to your body. We know POTS is a problem with decreased blood volume and the autonomic nervous system. If someone is dizzy when they stand up we have to ask why.
Water– Used in every single cell and every single chemical reaction that takes in place in your body, Increasing your water increases your blood pressure aiding with recovery from POTS as your body does not have to make your heart pump as fast to get oxygen to the brain. A study carried out in 1999 looked into one of the ways this actually worked (Jordan et al). It was found that it stimulated the sympathetic nervous system and raised the level of the neurotransmitter norepinephrine, helping to maintain blood pressure.
Increase Salt– Eating salt raises the amount of sodium in your bloodstream , reducing the ability of your kidneys to remove the water. The result is a higher blood pressure due to the extra volume. It is important to note that your average table salt is highly processed to remove all impurities. Impurities which just so happen to be essential minerals. The majority of what is left is sodium chloride and then additives such as Aluminum hydroxide are used. I would urge anyone reading this to swap to an alternative like Himalayan salt. Himalayan salt is around 85% sodium chloride and has 85 trace minerals. These minerals help your body balance your PH, remove toxin, regulate water content, help absorb nutrients and prevents muscle cramping and is not chemically changed.
Exercises– Individuals with POTS tend to be those with chronic pain conditions EDS, Fibromyalgia, etc and because of this exercise can be difficult. As someone who has had many EDS client over the years, I talk from experience. I’ve had clients who would dislocate their hips in their sleep Olympic weightlifting in 8 weeks, Fibromyalgia clients returning back to work after 15 years and many more examples. Exercise is a huge physical stressor and about 80% of those with chronic pain do not have enough immune/nervous system conditioning to be able to exercise without ending up in bed for the next few days. The very idea of exercise is flawed and should not even exist. No other animal on the planet puts aside the man made construct such as time to dedicate it to movement. We are designed for movement all day every day and it is an important part of keeping the lymphatic system healthy, seeing as it doesn’t have a pump, moving with help move it and keep your body fighting infections. Those in chronic pain to need to re-learn how to walk properly using the correct structures. I have seen over the years that those with abnormal gait (walking) have the worst fatigue and POTS. All mechanical dysfunctions need to be fixed and those with chronic pain need to be able to move pain free first! before they can exercise. Exercise training has been proven to expand blood and plasma volume, it increases cardiac muscle mass and heart size and plays a huge part in rehabilitation for those with POTS. If your heart is stronger it will not need to work as hard to pump blood and oxygen to your brain.
Sort your nervous system out– If we know that part of the cause of POTS is nervous system dysfunction, sort it out. Book in with a corrective chiropractor or osteopath and let them assess you and treat your nervous system accordingly.
Nearly everything above is absolutely free, requires no fancy equipment and respects the intelligence of the body allowing itself to heal. Like I said earlier…. For some strange reason we seem to think we are far smarter than our bodies when in fact it is just not true. In this day and age of science we still haven’t figured out that the body does everything for a reason. We have children with osteoporosis, teenagers with POTS and 20 yr olds with rheumatoid arthritis. It is true that we are living longer, but we are definitely not living BETTER.
But for those of you reading, please take advantage of the age we live in today and do your own independent research. Everything discussed that has been proven to help with POTS is free. So imagine if we started prescribing exercise, salt and water, promoting all these things, things that are free and don’t make anyone money, I’m certain we would see a decline.