EP.377/ POTS and Dysautonomia 101

Podcast

1 Feb

Welcome to our continued series exploring the trifecta of POTS, MCAS and h-EDS/hypermobility, and today we are basically doing a little POTS 101.

Let’s get to it.

What is POTS

POTS is a condition caused by a dysfunction of the autonomic nervous system. The autonomic nervous system is the part of our nervous system which governs involuntary actions of the body that essentially keep us alive and we don’t have to think about in order for them to happen, such as breathing, heart beat, blood pressure regulation, blood sugar regulation, digestion and so on.

POTS is a type of dysautonomia (which is a spectrum of conditions and symptoms caused by this dysfunction of the autonomic nervous system) which causes a rapid increase in heart rate when going from sitting to standing. This change in heart rate is caused by pooling of blood in the lower body, which isn’t getting up to the heart and the brain like it normally should, resulting in the heart working harder to get the the blood moving. This reduced blood flow causes dizziness, breathlessness, feeling faint or fainting, palpitations and chest pain, and the change in heart rate can be measured.

Now, this might not sound like a big deal, but the symptoms of POTS aren’t fleeting and can affect the entire body because of the effects of this dysfunction autonomic nervous system and the poor blood flow. People with POTS tend to also experience:

Weakness and poor exercise or movement intolerance
Shakiness
Chronic fatigue
Brain fog
Sleep problems
Visual disturbances
Bladder issues such as frequency and urgency
Gut symptoms, which honestly is very far reaching but I often see a lot of nausea, vomiting and bloating at least in my demographic
Headaches and migraines
Swelling of the hands, feet, arms and legs as well as discomfort or pain
Excessive sweating
Blood sugar swings

The dysfunction of the autonomic nervous system and associated symptoms can result in every day activities feeling near on impossible for some people. Standing just to make dinner can cause significant symptoms, showering can cause fainting spells, walking can cause chest pain and shortness of breath. And I really am not exaggerating. For some of my most debilitated clients, just getting up to try and make food would wipe them out for the entire day, one client couldn’t wake up and get out of bed without nausea and vomiting for the first hour. Some of my most affected clients are often not able to leave their sofa or bed, let alone work, the condition can put their entire lives on hold.

However, form some, the symptoms are more moderate or mild, or can play up at times like around their period, which typically worsens symptoms. We can also go through phases of life when POTS is worse, or triggered by something going on for us whether that’s stress, or a physical issue like an infection.

POTS affects women more than men, and more often teens and young adults, though post-covid we are seeing diagnoses of people in their 30s-50s, as well.

Now, there are three subtypes of POTS to be aware of.

Hyperadrenergic PoTS

We touched upon this last time, but hyperadrenergic PoTS causes elevated levels of adrenaline as well as high blood pressure or wavering blood pressure, POTS UK state that 30-60% of POTS patients struggle with this subtype.

If you suffer with a lot of anxiety, especially the physical symptoms, and find yourself experiencing shakiness, a racing heart or palpitations, excessive sweating, waking in the night feeling anxious, etc. then it may be worth investigating hyperadrenergic POTS. These patients can also suffer with headaches and migraines, bladder frequency after standing or being upright, nausea or vomiting.

Neuropathic POTS

Your nerves play a vital role in the functioning of the autonomic nervous system, and in neuropathic POTS, nerve fibres that help support blood flow in the hands, arms, legs and feet are for a myriad of reasons, damaged. These fibres regulate the constriction of blood vessels, which helps push blood back up to the heart, but when these are damaged, the blood vessels are too wide, and upon standing or when standing, gravity pulls the blood down and blood pools in the legs, feet, hand, arms, and even the abdominal area.

Patients may often suffer with swelling in the extremities, loss of sweating in the extremities and blue or purple feet.

Hypovolemic PoTS

This subtype is caused by abnormally low blood levels, and amongst the usual POTS symptoms, prominent symptoms are often fatigue, weakness and exercise intolerance and in the worst cases, this would include walking.

What causes POTS

So, what causes POTS? I am going to do a deeper dive into the covid piece in another episode, but here are some of the most common causes, and symptoms will often show up after these events or illnesses:

As significant traumatic event
Physical stress such as surgery
A viral infection such as covid
Bacterial infection
And vaccines (and no I’m not anti-vaccine, this is a legitimate cause listed on POTS UK and it doesn’t mean all vaccines, but immunisation can be a possible trigger in some people).

Now we don’t quite know why these events cause POTS, the research is still being developed, but this are some of the notable triggers for POTS to develop, and after these triggers, it can develop slowly or come on suddenly.

Co-conditions

Again, I am going to do a deeper dive episode on this, but so you know of co-conditions to look for, common commodities include:

SIBO
Endometriosis
Hypermobility spectrum disorders
MCAS
h-EDS and EDS
Chronic Fatigue Syndrome
Fibromyalgia
IBS
Bladder conditions and problems
Autoimmune conditions including celiac disease
Anxiety
Migraines

According to recent research, the most common co-condition of hyperadrenergic PoTS is MCAS, and stabilising mast cells may improve POTS.

Okay, so I am going to wrap up here. I do have a number of episodes on POTS treatment, but I am going to do a very focused episode on POTS symptom triggers and management, and as I mentioned, I’ll do more on the covid connection, as well as the co-conditions, but this is sort of like an introduction with simple need to know POTS facts.

Now in the show notes, I have put references to the sites and research I used to gather this information, so you can do further reading there.

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