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Postural Orthostatic Tachycardia Syndrome


POTS is a medical condition plaguing many women. And more and more people, including men, seem to be affected.

Recently, I saw a 27-year-old woman named Sarah. As a busy, working mom with a newborn, she chalked up her fatigue, dizziness, and heart palpitations to the inevitable exhaustion of her demanding lifestyle.

Then something dramatic happened.  Sarah collapsed.

When she regained consciousness, Sarah found herself on the ground and with pain in her jaw, injured in the fall. After struggling to regain her footing, she realized that her health problem was more than just the result of a demanding lifestyle. Something was seriously wrong.

This would ultimately lead to a complex medical condition called Postural Orthostatic Tachycardia Syndrome, more widely referred to as POTS.

Does Sarah’s narrative resonate with you? Maybe you, too, have noticed a rapid heartbeat or lightheadedness upon standing. Perhaps you’ve felt an inexplicable sense of anxiety. You might be dealing with unexplained health symptoms. Like Sarah, you’ve likely dismissed these signs as mere byproducts of a hectic life.

Illustration of a young woman sitting in a chair feeling dizzy with a headache

Perhaps you’ve passed through the labyrinth of diagnostic tests only to be told that “everything looks fine.” You may have been met with a prescription pad offering symptomatic relief without addressing the root of your malaise.

Feeling unwell without an apparent reason can leave you in a maze of uncertainty, where every turn seems more perplexing than the last. It’s a daunting struggle, almost like you’re lost at sea, trying to make sense of your body’s obscure language. Adding to the torment, the very professionals meant to guide you through this healthcare labyrinth may brush off your concerns. This dismissive approach can further deepen the frustration and confusion, adding layers to an already challenging situation.

However, remember the power of your intuition. It’s your health compass, guiding you even when tests fail to reveal the root cause. Don’t let the complexity of conditions like POTS, or the nonchalance of others, silence your intuitive voice. Trust that if something feels off, it probably is. Your body whispers before it screams. Listening to it is a step towards better health.

Once diagnosed with POTS, You might find yourself grappling with questions like, “How serious is this?” or “What triggered this?” Such questions are not only valid but integral in navigating your health journey.

Indeed, it’s crucial to acknowledge that those grappling with POTS are far from isolated. Although POTS may often lurk unseen, scientific science has confirmed its notable presence within our communities. Two thousand twenty estimates point to 500,000 to 3,000,000 Americans, predominantly women of reproductive age, grappling with POTS. According to Dysautonomia International, this condition also touches the lives of approximately 1 in 100 teenagers.

Nevertheless, the actual breadth of POTS is probably far more expansive than these numbers imply. Many patients, unknowingly grappling with the condition, are lost in the abyss due to healthcare providers’ lack of awareness or understanding of POTS. This results in countless cases remaining undiagnosed and hidden beneath the surface.

Moreover, recent research underscores a concerning trend: COVID-19 and the associated vaccines have seemingly fueled a surge in POTS cases, amplifying the condition’s overall prevalence.

While the diagnosis of POTS might seem overwhelming, it doesn’t have to be an insurmountable obstacle in your life. In fact, with a focused and balanced approach that targets the root cause, you can effectively manage and potentially overcome this condition. Numerous individuals, just like Sarah, have found comfort and healing. They’ve charted a course toward holistic balance, directly addressing the foundations of this syndrome.

If Sarah’s story resonates with your experience, don’t let POTS control your narrative. With Natural Heart Doctor, you have access to tools that can guide you on your path toward health.

What is POTS?

To fully understand POTS, it’s important to distinguish between a disease and a syndrome. Most diseases have an identifiable cause and tend to impact a specific part of the body or system. Moreover, diseases tend to cause changes in the body that show up on diagnostic tests.

A syndrome, on the other hand, is classified by a cluster of symptoms. Oftentimes, syndromes are difficult to diagnose because they don’t always show the immediate cause.  Additionally, conventional testing often comes back relatively “normal.” The “S” in POTS stands for syndrome.

Someone with POTS experiences a number of symptoms that impact the autonomic nervous system (ANS). This is the system that controls automatic functions such as heartbeat, blood pressure, digestion, and even the temperature of your body.

The ANS has two key components: the sympathetic and parasympathetic systems. These two systems function as the body’s accelerator and brake, respectively. The sympathetic nervous system gears your body up for action, increasing heart rate and blood pressure. On the other hand, the parasympathetic system prompts relaxation, slowing the heart rate and facilitating digestion.

In an individual with POTS, there’s an imbalance in this finely tuned system. The sympathetic system—akin to the body’s gas pedal—becomes overactive, especially when transitioning from prone to seated to standing. As a result, the body experiences a dramatic increase in heart rate, a hallmark sign of POTS. However, the blood pressure doesn’t increase as it normally would. It’s like stepping on the gas pedal of a car without properly steering.

A Closer Look at POTS Subtypes

POTS is a complex and multifaceted condition, exhibiting itself in a myriad of ways. Yet, in its complexity, three primary types of POTS emerge. Intriguingly, all three share a common thread of nervous system involvement, reflecting the intricate interplay of bodily systems at work.

  • Neuropathic POTS

    In the case of neuropathic POTS, the fundamental issue lies in the malfunction or loss of nerve function, primarily in the lower extremities. Essentially, the nerves that are key in signaling blood vessels fail to operate correctly.

    Consequently, when we change postures, say, from sitting to standing, our blood vessels fail to receive the crucial directive to tighten, a process vital to sustaining an uninterrupted blood flow to our heart and brain. This miscommunication can trigger the dizzying and often debilitating symptoms of POTS.

  • Hyperadrenergic POTS

    Hyperadrenergic POTS is linked to a hyperactive sympathetic nervous system, our body’s own ‘fight or flight’ controller. This results in an excess of the stress hormone norepinephrine in the blood, especially noticeable when standing.

    A substantial portion of individuals with POTS, as many as 50 percent, grapple with this specific type. Symptoms can intensify under stress, reflecting the close connection between this form of POTS and the body’s stress response system.

  • Hypovolemic POTS

    Hypovolemic POTS is characterized by low blood volume. This shortage may occur due to various factors, such as bleeding, dehydration, or conditions like anemia. With less blood to pump, the heart struggles to maintain an adequate supply to the brain and vital organs when standing, leading to the hallmark POTS symptoms.

In understanding these three types of POTS, we see the condition’s complexity and diversity. This knowledge can help tailor treatments and approaches to manage and potentially overcome POTS, making it an essential aspect of the healing journey.

POTS and the Vagus Nerve: A Critical Connection

Aptly named after the Latin term for “wandering,” the vagus nerve is a central player in the body’s orchestration of balance and function. As the body’s longest nerve, it anchors the parasympathetic nervous system, which aims to keep our body in a balanced state. Its broad reach includes supervision of our heart rate, blood pressure, breathing, digestion, and even our relaxation response.

The vagus nerve begins in the brain and travels down the neck, just in front of the cervical vertebrae. This nerve may become compressed in some individuals, especially those with cervical instability or forward head posture.

This compression can impede the vagus nerve’s impulses, potentially contributing to conditions like POTS.

Vagus Nerve

When the communication from the vagus nerve is disrupted, the sympathetic nervous system—the body’s ‘fight or flight’ response—kicks in, leading to the classic POTS symptoms of increased heart rate (tachycardia), dizziness, and fatigue. Over time, a persistently activated sympathetic nervous system can provoke inflammation associated with dysautonomic conditions, including POTS.

Research has indicated that many individuals with POTS often have abnormalities related to their vagus nerve. Some studies suggest stimulating the vagus nerve can alleviate symptoms in POTS patients. These findings highlight this ‘wandering’ nerve’s critical role in POTS, offering potential pathways for understanding and managing this complex condition.

What Are the Symptoms of POTS?

Under normal circumstances, the body has an effective system to ensure adequate blood flow to the brain. When we stand up, although gravity naturally pulls blood towards our lower body, our blood vessels constrict, and the heart rate increases modestly. This response ensures that blood flow to the heart and brain remains consistent. However, in individuals with POTS, this mechanism malfunctions, leading to an excessive increase in heart rate and a series of symptoms that generally alleviate upon sitting or lying down.

When we examine the array of symptoms associated with POTS, the research identifies several that commonly occur:

WOman standing at counter feeling dizzy, wearing oximeter on her finger
  • Heart palpitations
  • Racing heart
  • Chest pain
  • Headache
  • Nervous, jittery, or anxious feeling
  • Nausea
  • Abdominal pain or bloating
  • Temperature dysregulation (feeling hot or cold)
  • Excessive or lack of sweating
  • Shortness of breath
  • Insomnia
  • Brain fog
  • Weakness
  • Bladder dysfunction
  • Tremors
  • Exercise intolerance

Decoding a POTS diagnosis

POTS presents a complex diagnostic challenge. Its signature marker is an abnormal increase in heart rate upon standing—a rise of more than 30 beats per minute or exceeding 120 beats per minute within ten minutes of standing. Yet, as noted in a 2021 study diagnosing POTS involves more than just observing a heart rate spike.

The criteria for diagnosing POTS, as per the study, are nuanced and multifaceted:

  • Heart Rate Increase: There should be a sustained increase of at least 30 beats per minute within ten minutes of standing for adults. For adolescents aged 12 to 19, this increment should be at least 40 beats per minute.
  • No Significant Blood Pressure Drop: Despite the heart rate increase, there should not be any substantial drop in blood pressure, also known as orthostatic hypotension.
  • Persistent Symptoms of Orthostatic Intolerance: These symptoms, which occur upon standing and alleviate when lying down, can include lightheadedness, heart palpitations, generalized weakness, and blurred vision. These symptoms should persist for at least three months.
  • Exclusion of Other Conditions: Finally, other potential causes of an elevated heart rate, such as anemia, fever, hyperthyroidism, or the use of certain drugs, must be ruled out to pinpoint POTS as the underlying culprit.

When diagnosing POTS, healthcare professionals must take a comprehensive patient history and perform a detailed physical exam, including orthostatic vital signs, at regular intervals after standing.

The gold standard for diagnosing POTS is a tilt table test, although I do not think this test is necessary in most cases. The non-invasive procedure observes the body’s response to changes in position. The patient is strapped to a table that tilts from horizontal to vertical, simulating standing up, while heart rate and blood pressure are continuously monitored. This test can reveal a characteristic sharp increase in heart rate upon tilting, a hallmark of POTS, contributing significantly to a precise diagnosis.

Traditional physicians often request a set of standard laboratory tests to rule out secondary causes when diagnosing POTS. Regrettably, in many cases, they overlook the most crucial diagnostic examinations.

Certain patients may also see benefits from wearable devices like a Holter monitor or a Zio Patch, which can identify abnormal heart rhythms such as inappropriate sinus tachycardia. It’s essential to pay close attention to any indicators of autonomic dysfunction, such as issues related to the gastrointestinal or urinary systems, irregular sweating patterns, and pervasive fatigue – aspects often underemphasized in conventional medical approaches.

What Causes POTS?

When handed a POTS diagnosis, you might find your doctor shrugging at the cause. They might discuss hormonal changes or infections, painting the origin of POTS with broad strokes. The fact is, POTS remains an elusive puzzle for conventional doctors, with pieces that often fall outside the standard medical gaze.

Emerging evidence points to a host of factors that traditional medical approaches may overlook. For instance, chronic stress and trauma don’t just leave emotional scars—they can provoke physiological responses that might fuel conditions like POTS.

Similarly, environmental factors, often underestimated, play a pivotal role. Exposure to heavy metals and environmental toxins, prevalent in our modern world, can disrupt the delicate balance of our internal systems.

Persistent exposure to mold has been linked to the onset of POTS. Molds, a type of fungi present in both indoor and outdoor environments, emit toxins called mycotoxins. These toxins enter the human body through the food we eat, breathing, or skin exposure. Once in our body, these mycotoxins release pro-inflammatory cytokines that can be extremely harmful.

This link was emphasized in a 2020 study, which revealed a high incidence of POTS among young people exposed to dampness and mold in their indoor environments such as homes or schools. In fact, POTS was identified in 64 percent of individuals subjected to such mold exposure.

Nutritional imbalances play a significant role in the onset of POTS. These deficiencies can hinder the nervous system’s functionality, unbalancing the body’s critical chemical processes and potentially instigating POTS symptoms. Moreover, diets rich in processed foods pose an elevated risk for POTS. The pesticides and chemicals present in such foods add to the body’s overall toxic load, potentially exacerbating POTS symptoms.

Cervical instability can be a significant factor in POTS, particularly by disrupting the optimal operation of the vagus nerve. This instability can cause irregularities in the electrical signals transmitted by the vagus nerve, potentially leading to the dysautonomic symptoms commonly associated with POTS.

Finally, research indicates a significant link between certain vaccinations and the onset of POTS. Emerging scientific findings suggest that vaccines such as Gardasil and those developed for COVID might play a role in triggering the condition.

In essence, the roots of POTS can weave through a complex web of genetic, immunological, environmental, and psychological factors. Deciphering this interplay is key to understanding, managing, and overcoming POTS.

How Conventional Medicine Treats POTS

Like many so-called ‘mystery illnesses, POTS leaves the medical world in a conundrum, struggling to pinpoint its root cause and, consequently, to devise effective treatments. Despite its prevalence and debilitating condition, conventional medicine has a long way to go in treating POTS effectively.

In the quest to manage POTS, many physicians prescribe a cocktail of medications. This lineup includes Fludrocortisone, Beta Blockers, Midodrine, Clonidine, Ivabradine, Benzodiazepines, and SSRIs, to name a few. However, it’s essential to know that there’s little scientific backing for the effectiveness of these medications in treating POTS. In fact, they may even exacerbate the condition.

Take beta blockers, for example. They are typically used to lower heart rate. However, many POTS patients already have normal resting heart rates, and some even exhibit low blood pressure. By using beta blockers, there’s a significant risk of dipping these already stable or low parameters further, possibly doing more harm than good.

Moreover, these medications aren’t side effect-free. They often add to the burden of the illness rather than alleviate it. It’s crucial to understand that medicating symptoms without addressing the root cause provides only temporary relief and may lead to long-term complications.

Doctors often advise POTS patients to pinpoint and steer clear of triggers. Exposure to heat, such as spending time in the hot sun, can be particularly troublesome for those with POTS. Consuming large meals, indulging in alcohol, and extended periods of standing are also potential triggers for some individuals.

Here’s a snapshot of conventional treatment strategies for POTS:

Increased Sodium Intake

Salt shaker and blood pressure gauge

POTS patients often combat lightheadedness by increasing their sodium intake, which can help enhance circulating blood volume. They may need up to three times more sodium than the standard daily recommendation.

Staying Hydrated

Mature woman drinking water to stay hydrated

For POTS patients, hydration plays a crucial role. Consuming 2-3 liters of fluids daily aids in maintaining adequate blood volume, thereby preventing lightheadedness and reducing symptoms associated with postural changes.

Compression Garments

These garments, including socks, leggings, and bike shorts, help propel blood into the deeper veins and prevent it from accumulating in the lower legs’ superficial veins.


Exercise, starting from gentle floor exercises and slowly progressing to upright activities, can significantly improve POTS symptoms.

A Cardiologist's Role in Navigating a Nervous System Disorder

Why would a cardiologist discuss a condition rooted in the nervous system? Because Postural Orthostatic Tachycardia Syndrome (POTS) doesn’t play by conventional rules. This complex disorder pivots on the autonomic nervous system but echoes throughout the body, notably impacting the heart.

Our bodies are a meshwork of interdependent systems, with the autonomic nervous system acting as a critical link between the heart and the brain. When standing up—a shift that usually goes unnoticed—the body seamlessly adjusts heart rate and blood pressure. But in POTS, this automatic adjustment stumbles, causing the heart rate to spike.

However, the fast heart rate associated with POTS is just one facet of this multifaceted syndrome. Symptoms sprawl across systems, presenting challenges that extend beyond neurology. Patients often grapple with heart palpitations and dizziness, conditions in a cardiologist’s wheelhouse.

Understanding and managing POTS requires an all-hands-on-deck approach. A cardiologist’s expertise is invaluable, shedding light on cardiovascular symptoms and their implications. The aim isn’t just to decode heart rate anomalies but to join forces with other specialists to navigate the complexity of POTS, ultimately offering a comprehensive path toward better health.

Next Steps

Understanding POTS is like decoding an intricate dance between the sympathetic and parasympathetic systems. It’s crucial to remember that everyone’s dance is unique—symptoms can vary widely from person to person, making POTS a condition that truly underscores the importance of personalized care and treatment.

Consider attending our POTS Recovery Course by Dr. Jack Wolfson, an authority in POTS at Natural Heart Doctor. This informative 4-part series provides a deep dive into the root causes of POTS and how to facilitate the body’s natural healing processes.

About Dr. Keith Smigiel NP, DC

Dr. Keith Smigiel

Dr. Keith Smigiel is a regenerative medicine physician and pain management specialist. He takes an integrative approach to medicine, focusing on customized solutions tailored to individual needs. Using advanced, non-surgical treatments, Dr. Smigiel stimulates your body’s ability to naturally heal itself.

Dr. Smigiel helps people suffering from conditions such as chronic pain and erectile dysfunction, to hair loss and weight gain. Combining treatments such as PRP Therapy, Ozone, Neural Prolotherapy, and IV Infusions with functional rehabilitation, he helps you look and feel better.

He heals the body, instead of just treating the symptoms!

With his professional qualifications as a certified family nurse practitioner, a doctor of chiropractic, and a fellow of the International Academy of Medical Acupuncture, Dr. Smigiel offers patients comprehensive care from a broad perspective of conventional and alternative medicine. He also has extensive experience in functional rehabilitation and chronic pain management.

Dr. Smigiel is married to Angela and has two children, Sophia and Larz. When he’s not busy helping patients, he enjoys hiking, mountain biking, motocross, and boating.

About Dr. James Kneller, M.D., Ph.D., FHRS

Dr. James Kneller, M.D., Ph.D., FHRS

Dr. James Kneller is one of the nation’s leading heart rhythm specialists. Dr. Kneller is certified by the American Board of Internal Medicine (ABIM) in Clinical Cardiac Electrophysiology, Cardiovascular Disease, and Internal Medicine.

As a Fellow of the Heart Rhythm Society (FHRS) and Certified Cardiac Device Specialist (CCDS), Kneller provides comprehensive patient care, combining best medical practice with invasive procedures using state-of-the-art technologies to treat heart rhythm disorders.

Beyond guideline-directed therapies, Kneller is passionate about optimized personal health. With a deep interest in complimentary alternative medicine (CAM), he strives to reduce the need for pharmaceuticals, invasive procedures, and exposure to harmful radiation. With Natural Heart Doctor, he strives to help each and every client to Live Well, Eat Well, and Think Well to attain their 100-year heart!

About Dr. Lauren Lattanza NMD, FACC

Dr. Lattanza Office Visit with Patient

As a Naturopathic Physician, I am trained to treat the whole person and get to the root cause of disease.

I went to Arizona State University where I graduated with a bachelor’s degree in psychology with a depth in physiology and minor in Spanish. After my undergraduate degree I was working on prerequisite classes towards medical school, which is when I came to learn that my values identified best with the principles of naturopathic medicine. I knew that I wanted to help patients identify the causes of disease and be able to offer treatments which would improve their health rather than simply treating symptoms.

I dedicated the next 4 years to the Southwest College of Naturopathic Medicine in Tempe, Arizona where I attained my Doctorate of Naturopathic Medicine. I served as Class President all 4 years, Board of Trustees – Student Trustee, spoke as the Club President for our branch of Toastmasters, and was voted by my peers and attending physicians to earn the Outstanding Leadership Award for the Class of 2020. Throughout medical school I took it upon myself to work alongside MDs, DOs, chiropractors, and functional medicine practitioners in addition to naturopathic physicians.

As a Spanish speaking student, I was able to volunteer with community clinics around Phoenix and provide free healthcare to low-income families. Due to this combined exposure, I came to find my passion in treating cardiometabolic and digestive disorders that are all too common, yet largely preventable. I took the opportunity to learn the broad spectrum of healthcare so I can ensure that I am able to provide my patients with the best options.

About Dr. Jack Wolfson DO, FACC

Dr. Wolfson Office Visit with Patient

Dr. Jack Wolfson is a board-certified cardiologist, Amazon best-selling author, husband, father, and the nation’s #1 Natural Heart Doctor.

For more than two decades, more than one million people have enjoyed the warmth, compassion, and transformational power of his natural heart health courses and events.

Dr. Wolfson is the founder of Natural Heart Doctor Scottsdale, his heart health practice in Arizona, and Natural Heart Doctor, an online resource center with natural health information. Doctors from across the globe reach out to Dr. Wolfson for training and education in holistic health practices.

He has been named one of America’s Top Functional Medicine Doctors and is a five-time winner of the Natural Choice Awards as a holistic M.D. Dr. Wolfson’s work has been covered by more than 100 media outlets, including NBC, CNN, and the Washington Post. His book “The Paleo Cardiologist: The Natural Way to Heart Health” was an Amazon #1 best-seller.

Dr. Wolfson and his wife Heather have four children and are committed to making the world a better place to live. They provide for those in need (including animals) and support natural health causes through their philanthropic efforts.


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Frequently Asked Questions

I’d like to receive an online second opinion from Natural Heart Doctor. What do I do next?

You can initiate a second opinion online through our website at any time. To begin, select the team member you’d like to speak with and open an account.

Click here for cardiologist Dr. Jack Wolfson.

Naturopathic Medical Doctor Dr. Lauren Lattanza. Get details.

Naturopathic Medical Doctor Dr. Tonia Rainier. Get details.

Click here for  Natural Heart Doctor Health Coach.

Alternatively, you can email health@naturalheartdoctor.com. A member of our care team will help guide you through the process of starting a second opinion.

What is the cost of a Natural Heart Doctor Online Second Opinion?

The cost for most second opinions varies by team member. This fee includes information collection, a phone or video consultation, a second opinion from a Natural Heart Doctor specialist and guidance throughout the process from your personal Care Team at Natural Heart Doctor.

Cardiologist Dr. Jack Wolfson’s Second Opinion Fee is $1500.

Holistic Physician’s Dr. Lauren Lattanza’s Second Opinion Fee is $250.

Naturopathic Physician Dr. Tonia Rainier’s Second Opinion Fee is $250.

Note: We apply the Online Second Opinion Call fee as a credit to any future consultations with Natural Heart Doctor, should you choose them.

Will my insurance cover the cost of a Natural Heart Doctor Online Second Opinion?

Most likely, no. Most health plans do not cover online second opinions or consultations. You are responsible for the cost of our second opinion. Natural Heart Doctor cannot file a claim with your insurance carrier, nor can we provide a procedure (CPT) code for this service.

What is the timeline to receive an online second opinion?

We do our best to schedule your second opinion as quickly as possible. Typically, it takes 5 to 7 business days after your information has been collected to receive your phone or video online second opinion.

What information do you need in advance of our call?

Our office will send you a short questionnaire to complete and return. We DO NOT need your complete medical records.

How many questions can I ask the expert during our call?

You may ask a maximum of five questions. This is to ensure that the expert has sufficient time to devote to each question. All questions must be finalized before your online meeting.

What should I expect to receive once my second opinion is complete?

You will receive a summary of our discussion along with our second opinion. The second opinion will be in written form. After you have reviewed the second opinion, a Natural Heart Doctor clinician will follow up with you by phone to address general medical questions about the information provided in the second opinion.

What if I have follow-up questions for the expert after I have reviewed my second opinion?

If you have a clarifying question about an expert’s response to one of the questions in your second opinion, and the Natural Heart Doctor clinician is unable to address it, then you may request a follow up session for an additional fee. 

Is my medical and payment information secure?

Natural Heart Doctor is strongly committed to protecting the privacy and security of all our patients. Our website meets all federal requirements for protecting personal health information under the Health Insurance Portability and Accountability Act (HIPAA). All financial transactions are processed by Natural Heart Doctor securely using industry standard payment processing tools.

I would rather visit Natural Heart Doctor for an in-person appointment. What should I do next?

If you would prefer an in-person appointment at Natural Heart Doctor instead of an online second opinion, please call (480) 535-6844 for details and scheduling.

Can I schedule a follow up appointment with the specialist who provided my online second opinion?

Yes, we’re happy to help you on an extended basis. Our clinician can discuss options with you when presenting our second opinion summary.