Postural Orthostatic Tachycardia Syndrome- Unraveling this Condition

In this episode I do a deep dive on POTS:

• What is POTS? Learn about Postural Orthostatic Tachycardia Syndrome, how it impacts the nervous system, and why it's on the rise—especially post-COVID.
• Symptoms & Diagnosis: Discover the key criteria for diagnosing POTS, how it differs from other forms of dysautonomia, and common symptoms like dizziness, fatigue, brain fog, and gut issues.
• Root Causes & Triggers: Understand the connection between POTS and factors like autoimmune conditions, concussions, long COVID, gut health, mast cell activation, and hormonal imbalances.
• Why Conventional Treatments Fall Short: Find out why simply taking salt tablets, wearing compression stockings, or using beta-blockers may not be enough—and what a more comprehensive approach looks like.
• A Functional Approach to POTS: Dr. Zimmerman breaks down a neurological and immune-based framework for evaluating and treating POTS, focusing on brain function, balance, gut health, and inflammation.

To learn more about POTS we have a blogpost on our clinic website: https://peakbrainandbody.com/dysautonomia-and-pots-why-you-have-dizziness-headaches-and-chronic-fatigue/

Transcript

hey everyone welcome to this week's live stream we are going to be talking about pots not pots and pans but we're talking about postural orthostatic tachycardia syndrome now pot syndrome has gone through the roof over the past few years it really wasn't even official diagnosis until because it was so common in those that suffered with COVID. So we're going to review what exactly is POTS, okay? Who does it impact? What are the symptoms? But most importantly, what do you need to do to get answers for this? Not only to get a diagnosis. I know so many of you are like, I just need that diagnosis. But what can you actually consider for treatment? So first thing we're going to do is We're going to go over some of the research on, Hey, who does it really even impact? So I'm gonna share my screen and we are going to review that. So here we go. All right. So when we look at this. This is from the narrative review of postural or the static type of cardio syndrome associated conditions and management. Okay. So US cardiology reviews. Now, first thing is who does it actually impact? So it's estimated upwards of three million Americans have POTS. Now it primarily impacts females five to one. Okay. So, eighty percent of those dealing with POTS syndrome are going to be females and not males. Now there are some diagnostic criteria. Now here's the diagnostic criteria, okay? So we are looking for a heart rate change of a thirty beats per minute or forty if they're under the age of nineteen. Now, or as it says, even a rate of one twenty that persists within ten minutes of standing. You also should have symptoms with it. Now what's important is that you shouldn't have blood pressure changes dropping too much. If you're having a blood pressure drop, then this is no longer POTS. This just falls in the category of dysautonomia. So before we go exactly into POTS a little bit more, we're going to break down POTS versus dysautonomia because a lot of people use these very interchangeably, but POTS and dysautonomia are not the same thing. Make sure you comment. If you've got any questions, let me know because this really is about you. That's why I'm doing it. So when we look at POTS, so Postural Orthostatic Tachycardia Syndrome, we said this impacts phenols. Eighty percent of those diagnosed are going to be phenols. Next, you need to have a heart rate change of thirty beats per minute when you go from laying we're sitting to standing, if you're an adult, but if you're a teenager, it needs to be forty beats per minute, okay? So, beats per minute teens, and then adult. And now there should not be a significant blood pressure change. If there's a significant blood pressure change, then you do not meet criteria for POF, okay? So obviously put no, BP changes. Okay. If you have big BP changes, then this is not POTS. This actually brings us into more of orthostatic hypotension or dysautomia. Now let's quickly break that down. So now let me understand. POTS impacts females, eighty percent. There should be heart rate changes of greater than thirty beats per minute if you're an adult, over forty if you're a teen, with no blood pressure changes. Dysautonomia is a bigger name. So dysautonomia. All right. So dysautonomia means dysfunction in the nervous system. Your nervous system isn't being regulated, specifically your autonomic nervous system. This controls blood flow, heart rate, you know, respirations, GI motility, stomach acid production, all of those through your autonomic nervous system. Pain sensations, temperature, oh, I'm hot, I'm cold. All of that is what it's going to cover. Now, not everybody, Everyone with dysautonomia will have POTS. It won't happen. It's just like if you drive a Honda. Not everyone who drives a Honda drives a Civic. But if you drive a Civic, it is a Honda. So dysautonomia and POTS, those go back and forth. But not all dysautonomias are POTS. So this is super important because some people come in, they're frustrated. I've got POTS. but you've got to meet diagnostic criteria to have POTS. Now that doesn't mean there's not overlapping between other types of dysautonomia and POTS because there absolutely is. So now that we've established this, females get it five to one. So, eighty percent of those diagnosed with POTS are going to be female. You need to have a heart rate change of greater than thirty beats per minute if you're an adult, greater than forty if you are a teenager, and you should not have a significant drop in blood pressure Okay. So, twenty on the systolic side and ten of diastolic when going from laying or sitting to standing. If that occurs, then once again, it's dysautonomia, not POTS. Now, what are the symptoms people are going to have with POTS? What are they? Now, we're going to go back to that research article that we referenced earlier. And what are the symptoms people are going to have? All right. Now, you're going to see that this impacts a lot of different things. It's not that, oh, well, I've got POTS and I can only have vascular related symptoms. No, you can have cardiovascular palpitations, fainting, feeling faint. Now, you don't have to faint to have POTS. That's not a criteria, but you could feel like it. Raynaud's, we see connective tissue disorders often in those that have POTS as well. Raynaud's is where basically it's cold and stuff your fingers will go purplish green you know look bruising shortness of breath get lots of gi issues with pots nausea bombing diarrhea bloating constipation so we'll see as we talk about this in the future there's a lot of overlap with irritable bowel syndrome and pots gi issues we get bladder dysfunction we have musculoskeletal weakness joint pain joint dislocation hypermobility yes we will talk about hypermobility and what it does in pots as well and then neurological we have a lot of different ones lightheadedness dizziness vertigo headaches blurry vision so much more endocrine now menstrual cycles can impact and then ultimately psychiatric we get adhd and anxiety are also very common in those that have pots so how many of you does this sound familiar like oh man, I've got a lot of those symptoms. Now you do not have to have all of them. Now, normally in my experience, I've heard a lot of people that have dental pox, they go from one provider to the next and they are really, really frustrated because, well, this doctor here, they're not taking me serious. They don't know what to do. And it's because each doctor, right? You're usually a specialist and they're looking at their part of the body they care about, right? So if they care about the brain, they're focused on the brain. If they care about the gut, they're focused on the gut. But What happens when your brain impacts your gut and your gut impacts your brain, but you're not really connecting the two. And so you're just trying to address one. What do you get? Well, you have frustration. Now, when we look at POTS, there are different subtypes of POTS. So I'm being clear on this. There are different subtypes of POTS. Now, we're going to look at this and then we'll ultimately go to different research article where you're able to continue this discussion so when we look at pots we've got primary pots secondary and then we've got associated disorders so we can have some due to norepinephrine elevations which is too much can measure through urine we also can have an autoimmune response that causes pots but then secondary where I'm going to spend more time Mass cell activation syndrome or histamine related? Yes, we will talk more about that. Also, we have neuropathic, so neurological dysfunction. We'll also talk about viral illnesses that can cause POTS. And then ultimately there's associated disorders. So who are these people that are likely to end up with POTS, right? We know it's females, but females with Ehlers-Danlos syndrome, okay, EDS. Now, these are those with joint hypermobility, okay? They can dislocate stuff. They can do stuff with their fingers and their joints that you're like, hey, you really shouldn't be able to do that. But yet they can. Chronic fatigue syndrome. Those who just have persistent issues with their heart rate. It's just always chugging north of a hundred. Brain injury. Now, when I say brain injury, this includes concussions. Don't say like, well, it wasn't a stroke. I didn't have a bleed because a concussion can give someone POTS. Also, migraines can give people POTS too, but POTS can also keep migraines going. So once again, if you've got questions, let me know because I am doing this for you. So we're going to go back. We're going to recap really quick. Okay. So we've talked multiple times now about who actually gets POTS, right? So we know it's your mouse. Now, what are the symptoms people are getting with POTS? We said cardiovascular, right? So we get fainting or lightheaded because once again, you do not have to faint. Okay. We've talked about gut issues right nausea diarrhea constipation bloating and so forth we've talked about neurological issues so focus dizziness blurry vision memory right so much more okay And really the list could keep going on and on and on. So there's a variety of symptoms people can experience with POTS. And it's important to realize that when you treat POTS, you need someone who can understand how to put it all together and not separate it out into little pieces because you're not getting the whole story. And those are the people that I get that come to my office. They've usually been given salt tablets. They may be using compression stockings, which is fantastic. It helps. because their heart rate's going up. They're being medicated usually with propranolol to get their heart rate down, but propranolol does come with side effects of brain fog, fatigue, and other stuff. So while they may not have as much of a tachycardia, they're often like, but I've got all these other side effects. So what do we really need to consider when we're looking at POTS? Once again, we're not focusing on the cardiovascular side aspect of POTS. So we're going to look at what are these subtypes of POTS? So this is from the Journal of the American College of Cardiology. We are looking at POTS subtypes. So we've got neuropathic POTS. We've got autoimmune. We've got hyperadrenergic. We've got mast cell activation disorder. Lots more people are talking about mast cell activation syndrome. But it's not just activation syndrome. It's anything that drives a mass cell response, which don't worry, we will talk about things like that. And then we have volume dysregulation. So some people do have issues with their heart where they are not pumping enough volume. Now, those are not the people that I see in my office. They've usually been through that route first and made sure it's good. The people I see are those who come in with the neurological-based side, autoimmune, and the mass cell side. Now, it's super important that we understand that there's a variety of different things that people are dealing with. And there's also different susceptibility. So it's like, well, but what caused my POTS to come on? Well, you could have had an infection. As we're going to look at, COVID is a really big insider of POTS. And it wasn't until COVID that POTS actually became an official diagnosis. Surgery, concussions, chronic pain, chronic migraines, headaches, and then bed rest. Now, ultimately, right, this causes a lot of issues. You get diminished activity because these people feel bad. That further diminished activity actually tends to make them do a little bit worse. So now you get issues cardiovascular-wise. and it you just see it's this perpetuating loop and cycle so let's step back now right and really work through this you can have pots and you can have co-existing conditions this is where so many people get the answers they're looking for is we have to break this down and we've got to go and do beyond what regular medicines do okay your cbcs all that stuff five ten dollar test I know we get to feel way more than that because when it goes through insurance but the cheap tests rarely give you a lot of good information what happens now if you've got pox but you also have underlying concussions or autoimmune or migraines overlapping What happens if you've got POTS and you have anemia because every time you have a menstrual cycle, you've got super heavy menses that last for four days, but you're not truly done with menses for seven days. And so you're in a constant state of anemia that breeds inflammation. As you can see, there's not one approach for POTS. There's not. There's not a magic bullet, a magic recipe that here's what it is. But I'm going to review with you what is a framework that I use to evaluate and actually process through POTS. So what does it look like? Here's the exact same thing, right? So when a patient comes in here, I meet with them. And if they come with POTS, I listen to them, see what they're going through. But then I'm going to review this exact same thing with them that I'm sharing with you. Because at the end of the day, knowledge is power. So here we go. Once again, right? The people I see, cardiovascular has already been done. We know there's not excess epinephrine being done. We're looking more at the neurological, okay? So POTS is a neurological issue. Let's just call it that, right? Because it is dysautonomia. When your nervous system is off, You get a variety of symptoms throughout the body, which we've talked about, from fatigue to headaches to joint pain to gut issues, dizziness, mood changes, and so much more. Now, if it's neurological, well, should we maybe evaluate brain function? Right? I mean, you feel the symptoms of your brain not functioning as well as it should. So how do we look at brain functions? Now, many of these people, they've had MRIs and they're frustrated because their MRIs keep coming back as, hey, your MRIs work. Well, what are MRIs for? MRIs are not for pots. MRIs are to say, did you have a bleed? Is there a tumor, right? Was there a fracture? Was there something more that we need to be concerned about? So don't be frustrated if you get an MRI or CT scan and it's completely normal because it's gone. maybe if you have chronic migraines you can see some changes in the mri but even then it's not predictable so don't be frustrated so we've got to understand how your brain's functioning next which don't worry we'll talk about how to evaluate brain function but the other side is immune system is really what we are going into I could also add in mitochondrial dysfunction because that would be very true as well but ultimately neurological function and then the immune system, right? It's not just the immune system, what's going on in the body, but what's happening in the body can impact the brain as well. So we've got to really understand this. So when we look at the neurological function, how do we evaluate this? Well, the eyes, the eyes are known as the windows into the health of the brain. So you need to have eye movements like that. Okay. So, for example, if you're looking at a finger like this, right, and you do it, let's just say you do it for ten seconds, you're up and down for ten seconds. You're like, whoa, that made me dizzy. Oh, man, that kind of made my eyes hurt. Give me some neck issues. Give me a headache. Guess what? You've got visual dysfunction that's going to give you issues because when your brain is not as healthy as it should be, which is the case with most pots, then chronic fatigue is not a mystery. Chronic fatigue is the expectation. your brain uses more energy than any other part of the body and your eyes are the secret energy trainer next we've got to look at balance also routinely off of the pots patients okay so about seventy percent of the patients I see when they come in and do their neurological testing they really struggle with their eyes and their balance and it's when we address this you figure out what's going on they do better because here's something that most no one talks about, is when you improve neurological function, you improve your eyes, your balance, you stimulate the brain appropriately, you actually better regulate the immune system. You reduce inflammation. So better function inhibits inflammation. Now, I've done this through a few different mechanisms, but a lot of people dealing with POTS and going down the rabbit hole, they all learn about vagus nerve output. Well, when your brain's healthy, you now get proper vagal nerve output, which goes down and it quiets down inflammation through the spleen and also through what it does in the immune system, okay? So that's one side. Reminder, if you've got questions, let me know. I'm doing this for you. And we're going to keep going on. So if you haven't, please follow me. and subscribe on the YouTube channel, as well as you can follow me on the Facebook, Instagram, wherever you're watching this as this will be live streamed to multiple areas. Next, the immune system. I really need you to take what I'm gonna say to heart next. Whatever controls the immune system controls the outcome. Once again, whatever controls the immune system controls the outcome. And what controls the immune system for one person may have a little to no impact for someone else. And this is where I love different support groups, but it also drives me a little nuts because people are like, oh, I'm dealing with this. But honestly, I've treated enough POTS patients and no two are the exact same. Yes, there's some overlapping triggers and things that are driving symptoms, but what's more important for one person may not be the most important for someone else. And the recipe that one person needs may not be the recipe someone else needs. So we know with the immune system, and we'll be in the COVID research, right? But we know infections. We know infections are meant to start pox, but also can keep your pox going. Next, we know gut, right? A lot of your immune system develops in the gut, and that plays a big role in helping to regulate your immune system, so gut-based issues. Next, we said mast cells. So I'm just gonna put mast or histamine. Because it could be mast cell activation syndrome, or it could be things that drive mast cell histamine responses. Even food allergies, environmental allergies, mold allergies, which I'm seeing a ton of, right, can drive these histamine responses. And it comes as no surprise because we know females are more likely to have POTS. We also know that we use more antibiotics than pretty much anyone else, which impacts the development of our immune system. As a result of all these exposures, the processed foods, we have more seasonal allergies, environmental allergies, food allergies than we've ever had at any other point in recorded history. And if the immune system is off, And it's been altered from the very beginning and it keeps getting pushed. Then it makes sense that we're gonna have more shoes mold now than we had in the past, more shoes with food that we had in the past. Right now, even stress, right? Can impact this lack of sleep. We said menstrual cycles. So there's a lot of different things that can drive this put in anemia. Put in blood sugar issues. Put in autoimmunity. Maybe you already had Hashimoto's thyroiditis. Maybe you already have rheumatoid arthritis. Maybe, right? What I didn't put up here was the vaccines. Vaccines can also trigger the immune system to misbehave, leading to POTS. So there's a lot of different things that can drive this. Now, I hope you're really getting a good picture of how we approach and we work through POTS. Because there's not one thing for everyone. There's just not. But there's a framework that when we look at the framework, it allows us to evaluate someone. But it's also important, as I mentioned, POTS really didn't become an official diagnosis until COVID. I've been helping people with POTS for over a decade. But once again, it was not in there. Before, all you had was a code for familial dysautonomia, and that was it. So why did they do it for COVID? Well, because lots of people with COVID were getting, well, POTS, and they were getting dysautonomia related symptoms. And they were like, oh crap, like what do we do now? So long COVID and postural orthostatic thyroid syndrome is dysautonomia to be blamed. So let's look at this one really quick. So when we look at this, right? There is a wide variety of things, okay? Ultimately, it looks at long COVID, right? The most common symptom, for example, with those in long COVID is fatigue. Now, there's many other things that people are dealing with. Here, they even call it post-COVID-XIX tachycardia syndrome because of what we're seeing with heart rate and everything else. But what's the mechanism? when we look here at the mechanism long covet ultimately can impact the heart and ultimately impact contractility how well it's getting stuff there and once again most people have had this rolled out by a cardiologist so you know your heart's healthy or you know it's not but the things that are routinely not looked at as thoroughly as they should be it's the inflammation autoimmune and then the neurological okay I'm not going to go into the other research but we know long covid due to its changes on the immune system can cause a brain injury yes it can cause a brain injury so we'll go here where it says neurotropism right so what does it say causing direct damage on nerves or indirect damage via a cytokine storm so cytokines are chemical signaling molecules Now, this can persist, okay? Ultimately causing damage within the brain. Next, we know inflammation and everything else can do it too. So once again, there's a lot of different things that drive this. I hope you're getting a lot out of this because there's, once again, POTS syndrome, it's going through the roof. It's every single week now I'm getting someone contacting my office They're dealing with POTS. They're not sure what to do. They've been the whole traditional medical route. They've seen cardiologists. They've seen neurology. Some of them have seen endocrinology or rheumatology. At best, they're given salt tablets told to wear compression stockings and are doing propranolol. But no one's really dove in. Once again, you have to look at the immune system. Are there chronic infections? What about gut issues? Yes, gut issues can be a side effect. But gut issues can drive POTS. Gut issues like IBS can predispose to POTS. Mass cell, histamine-based issues, stress, sleep, cycles, anemia, other autoimmune conditions. We talked about concussions early on. Concussions can increase the likelihood of getting POTS as well, which is why, because POTS, for most, right, you all have neurological-based issues. We need to look and see how the brain is functioning, connecting via eyes and balance. I'll tell you having done this work long enough if this is off and it's not addressed no one gets the results they really want and here's the key you don't know until you test people I have people who come in and like all right man sounds like this is going to be them this is going to be like eighty percent of their issue and that's gonna be twenty and then it's like nope I was wrong and good thing I tested because if not I would have brought someone down the wrong path and we can predict it Based upon the severity of dysfunction in these areas, hey, more likely you're going to do better. The less severity, the less likely. So we're humans. We're not robots, right? For one person, function could be ten percent, immunity could be ninety. For the other person, it could be flipped. Maybe it could be fifty-fifty. But I hope what you're getting from this is that there is no magic bullet when it comes to POTS. But there are answers. There are solutions to help people live a better life. And it comes through evaluating the body as a whole. Brain impacts the gut. Gut impacts the brain. Brain impacts your liver. Liver impacts your brain, right? Hormones, right? We just get through all of that stuff. The body does connect. So hope everyone found this useful. Once again, if you haven't, go please subscribe on the YouTube channel so you'll be notified of this. Also follow me on any other social media I post a lot of content okay these are the longer videos that I do but I also do shorter videos but I want to do the things that are most beneficial for you you know put your request in let me know really anything brain or that impacts the brain I'm game for doing because I want people to be empowered in their health we're sicker than we've been at any other point in time autoimmune diseases only keep going up neurodevelopmental disorders only keep going up neurodegenerative conditions only keep going up positive we've talked about only keeps going up and we need people to be informed they need to know what they can do so they know what questions to ask where to look for help so until next time I'm dr zimmerman I'm licensed both a chiropractor. I'm a diplomat in chiropractic neurology, as well as I'm a nurse practitioner. I specialize ultimately in connecting the body as a whole because, well, that's the way the body functions. It doesn't function in pieces. So thanks, everyone.