The 5 POTS Myths Keeping You Sick (And What No One’s Telling You)

Myth #1: “It’s just anxiety.” Dr. Z breaks down why this misunderstanding leads to misdiagnosis, gaslighting, and years of unnecessary suffering.

Why drinking more water and pounding salt isn’t a real solution—and what’s actually driving your dizziness, fatigue, and tachycardia.

The shocking truth: Most POTS symptoms are neurological, not cardiovascular—and traditional testing completely misses it.

Why medications help some symptoms but never fix the root problem (and why you crash as soon as you stop them).

The biggest unlock: Your visual system, vestibular system, hormones, blood sugar, and immune health may be the hidden drivers your providers never checked.

Transcript

Five myths about POTS syndrome that keeps so many individuals stuck and unfortunately many believe it. So what are these five things that you should understand about POTS and are they actually true and what can you do about it? I'm Dr. Spencer Zimmerman. I'm one of a very few dual licensed nurse practitioners and doctor of chiropractic who uses a combined approach of functional medicine and functional neurology that has helped so many individuals get their lives back following a POTS diagnosis. So let's jump right in to these myths. So Here we go. Myth number one, POTS is just anxiety. How many of you have been diagnosed with anxiety and ultimately get sent to psychiatrists and counselors because, oh, you had anxiety before this. So, you know, it's likely that your heart rate and everything else is just anxiety. The thing is, when your nervous system is off, guess what? You can have anxiety. Now, this doesn't mean that maybe you don't have pre-existing anxiety. your anxiety can make things worse but to overly simplify and reduce it down and just blame everything on anxiety isn't really the right thing because we do know that with it being a neurological disorder when the autonomic nervous system is off having anxiety is an issue and that's where the confusion comes in is anxiety truly the cause or is anxiety also a side effect of it so let's not get too focused on the side effects and realize that pots and anxiety often can go hand in hand and it doesn't mean anxiety is the true cause Next myth, you just have to drink more water and take in more salt. This is one of the most common recommendations given in people, it's hydrate better, pound the salt, take your salt tablets. Well, while this may be important for some, it doesn't truly give people resolution or anything like that. People with POTS, they need more than just that, right? Yes, they may be told compression stockings or garments, but this is what's done in regular care which we're going to talk about why there's so much more than these generic recommendations that's needed now what does it actually look like to have pots well You may be fatigued, dizzy, lightheaded, weak, have headaches, brain fog. You may even have a little bit of swelling in your lower extremities. Now, the reason why POTS is often treated as a cardiovascular-based issue is because your heart rate is going up. Some people do have pulling in their lower extremity because, well, you're not able to pump blood back up efficiently. but this is not necessarily make it a cardiovascular issue there's a difference between cardiovascular symptoms or a manifestation as a cardiovascular issue but this all comes from the nervous system being off specifically a component known as the autonomic nervous system okay if it was as simple as what are five myths about pots that so many individuals believe and unfortunately because they believe it they will never get better so you're watching this because you believe there has to be a better way to get your life back following a pot's diagnosis so before we go on this who am i well i'm dr spencer zimmerman i am one of a few dual licensed nurse practitioners and doctor of chiropractic that focuses on POTS. And beyond that, when we look at the world of functional medicine and functional neurology, there are but a few of us in the entire United States who combine both approaches. You may find more who utilize just functional neurology or functional medicine as a standalone, but those that take an integrative approach, there's really just a few of us. So let's dive right into what are these myths. One, POTS is often blamed on anxiety, especially if you had preexisting anxiety before this started. This leads to you being misunderstood, gaslighted, and sent to counselors and psychiatrists, where you are then prescribed medications for anxiety, like ecitalopram, maybe you're even put on things like Xanax, Valium, and others. Well, the thing is, when you have POTS, with this being a neurological disorder, neurological dysfunction occurs, can actually manifest as anxiety as well so it's not always fair to say anxiety is everything maybe anxiety truly is part of your issue which we should acknowledge and should address but to overly simplify it down and just say well you know what this person has anxiety we just have to treat them as they're anxious that is gaslighting people at their finest especially when there truly can be underlying neurological issues within the autonomic nervous system that needs to be addressed next people who get diagnosed they're routinely told with traditional medicine you need to increase your salt intake you need to drink more and get your hydration better and that's pretty much it the thing is I have yet to see a patient where that's been sufficient. Maybe it's because I see people who don't get better, but I don't see anyone in Facebook groups or anywhere else who gets better with this approach. Now that's not saying it may not help with a little bit of your symptoms, but it is saying that POTS isn't so one dimensional or two dimensional that you increase your salt and your fluid and maybe do compression stockings that you truly get better. And unfortunately, traditional care is very focused on this and maybe a few medications, which we'll talk about. But that's not sufficient. So what does POTS actually look like? Now, there's a lot of different symptoms those with POTS are going to have because it is a multi-system and symptom syndrome. From chronic fatigue to brain fog to headaches to dizziness to gut-related issues to the immune system, respiratory, and so much more. Now, one of the systems that gets all the focus, though, is that of the cardiovascular system, right? You've got tachycardia. Your heart rate goes up greater than thirty beats per minute if you're an adult or greater than forty if you're an adolescent or child. When you go from laying to standing. Now, it's often blame on, oh, you don't have enough fluid volume or you've got blood pooling. And so let's treat it as a cardiovascular issue. But it's important to understand that most of that cardiovascular regulation is completely controlled by your nervous system. So if you don't have a healthy nervous system, that is off. Now, that's not saying you shouldn't have things rolled out, such as cardiovascular-based issues by a cardiologist to make sure you don't have a valvular defect, you don't have electrical activity-based issues truly causing it. Because if that's what's causing it, then you don't have POTS. That's actually what you have. So I'm completely for that being looked at. But when that's normal, then the blood pulling and all those things that people talk about That is a manifestation of nervous system dysfunction and not the true cause of your issue. So let's continue. Myth number three is that you are just going to outgrow your pots. You know, some people get pots and it just magically goes away. I get it. For some people, it is truly been there and then it goes away without you doing anything. Unfortunately, that's not fully true. There are people who continue to deal with POTS-related symptoms for years. Now, we still need to get a lot more research on this. Unfortunately, until COVID, when they made it an official diagnosis, there was some research, but still even now the research is going to lag behind and we're not going to have solid, good data for probably another ten to twenty years to really look at the longevity of this. But it can definitely impact people. And current medical treatment very much views it as, well, this is something you've just got. We kind of manage your symptoms the best we can. Well, what have I seen after doing this for over ten years, and especially the past five years, seeing way more POTS patients than I've seen before then? Most people can either get symptom-free or they can see a significant reduction in their symptoms to where it really doesn't impact their life in a meaningful way. Number four, who does it impact? Well, while females are the most frequently impacted gender by about eighty to eighty five percent, males are absolutely impacted. And if you look at the concussion research, it's almost fifty fifty. So is it truly all females and minimal? I think we still need more research to truly say that. And then females of any age can actually be impacted, too. We have teenagers, we have young adults, we have middle age and we have elderly. can all be diagnosed with pots and it can onset at that point in time so we shouldn't necessarily just say it's only this age group because guess what it can be of any age and unfortunately though depending on your age group things can be you know misdiagnosed you can be oh you know this age not as likely so unfortunately diagnoses are going to be missed Now, it should be noted that there's a lot of providers that don't even feel comfortable making a POTS diagnosis. I can't tell you how often in Facebook groups people are expressing frustrations because certain providers, like they're even their own primary care provider, will not make the diagnosis. The thing is, as we've stated, this wasn't even an official diagnosis until COVID. Yes, there were plenty of people who were told, hey, you've got POTS. But when you look at the medical diagnosis, so the ICD-X diagnosis, POTS did not exist. It was familial dysautonomia. It wasn't until about twenty twenty one that they officially put in. Maybe I was wrong. It's twenty twenty. Right. It's going to be one of the two. But that's when they officially put in the ICD-X diagnosis of postural orthostatic tachycardia syndrome. And because of that, there is a very big lag in diagnosis and education. So hopefully people get caught up on the education. But until now, you need to find people who truly have made this what they do. Myth number five is that you can just have to take medication and that's really all you can do. I wish I could say medication truly did it for my patients. It has it. Some people get no relief. Some people get twenty five to fifty percent relief when combined with hydration, compression stockings and salt sodium intake. Right. But it's not sufficient. Yes, you may be on metoprolol, propranolol, you may have ivermectin, mitodrine, and others in that arena, flutercortisone, right? Those are basically all the medications people use. The thing is, this doesn't do anything to truly address the underlying issues in the autonomic nervous system. And it's why... even if it does work for you you only feel good while you're on it the second you stop the medication you usually are going to lose everything now this is why it's so important that you get treatment that is tailored around your needs but not just your needs right because because needs is more symptomatic you need to have stuff that's really tailored around the underlying issues So what does this look like? Well, POTS is an autonomic nervous system issue. But the autonomic nervous system doesn't live in isolation. So very first, it's the health of your body impacts the health of your brain. So what's happening with your blood work? Now, I'm not talking about the twenty dollar lab panel that they do where they just look at your red blood cells, white blood cells, your blood sugar, your electrolytes and call it good. But what's your insulin doing? The amount of people I see with impaired insulin responses, especially above the age of twenty five, it's crazy. And if your insulin is off, that's going to impact you. If you have a diagnosis of polycystic ovarian syndrome, guess what? You're probably going to have issues with your insulin response as well. That's one of the reasons they give people metformin to help them to get pregnant and to deal with their PCOS because it's so well known. And despite it being well known, it's rarely talked about. So maybe we'll do a separate video on that. Thyroid issues. really big especially if your mom has thyroid issues it's probably autoimmune and autoimmunity especially with thyroid runs very in family the other autoimmune diseases not necessarily as much on that side hormones play a big role especially the amount of people who go through menses and every time they go through that oh everything just gets exponentially worse Now, the frustrating part is, is if you convince your provider to your hormone panel, it's going to come back as normal. So know that your hormone panel can come back as normal, but your hormones can actually be an issue. So what does it mean? Well, it means They're normal labs, but we still have to modulate your hormonal response because you just can't measure everything you need with labs. Next, it is very well known that if you have bad menstrual cycles, you're likely going to have anemia. Now, you can have okay menstrual cycles and still have anemia, but at the end of the day, if you do have anemia, your likelihood of having POTS does go up significantly because of what it does with delivering blood flow and oxygen and the size of your blood vessels gets impacted as well. And then lastly, there's a lot of people who have autoimmune markers who will end up with POTS. So it may either be a true cause or it may be something that coexists. But at the end of the day, they both need to be addressed and it can be so much more than just doing an ANA panel or looking at thyroid autoimmunity. Now, it's important to understand that even if your autoimmune markers come back as normal, there are some things we just can't yet check. We can't check for everything. So know that things are evolving. There's going to be more things that can be checked, but things are normal. It's just, hey, it's normal for what we can evaluate, and that's why there are many providers who will basically say, we're going to treat you as if you have autoimmunity because we understand the testing's not perfect. Now, that's the body side, right? Because we said the brain doesn't live in isolation. But what's happening within the nervous system? Yes, you've got your heart rate, your blood pressure metrics. Maybe you're even using things like an aura ring or other things that tells you, you know, here's your heart rate variability. But what do I find is exceptionally valuable for people who have POTS? It's not an MRI or CT scan that usually frustrates people because nothing frustrates people more with POTS than being told, hey, you're testing, you're imaging, your labs is normal. Well, what do we find is off in at least seventy five percent of patients? That is neurological testing to look at their function, specifically oculomotor function. So your visual processing, how would your eyes do when you perform a variety of tasks? This is routinely off. And if your visual system is off, guess what? That has to be treated because it will absolutely wreck your autonomic nervous system. Going along with that and one of the reasons it does it. that of your balance system specifically a part known as your vestibular system but when really a balance it's really is made up of your visual system your vestibular system and what's called your proprioceptive system which is going to be the information come from your joints and muscles a lot of attention gets paid to the neck in that arena but it's not just your neck it can be your hip your ankles your knees all of that feeds into your brain to help you with balance. And when all of those function appropriately, your brain does a much better job of regulating your heart rate and blood pressure when you do positional changes, movements on your feet for a period of time, and more. So I hope at this point you are seeing the benefits of taking a really combined approach. Because if you only focus on labs, but you have all this neurological stuff going on, i'll tell you you will not get the results you cut on the flip side if all you focus on is the neurological side but then you have all those things in your labs that's off you also will not see the best results so it really is about taking a combined integrative approach and that's what we do at peak brain and body that makes it very special now you may be wondering well that's great but what can i do at home well Physical exercise is one of those things it can make or break you in your ability to get better. Now this is very different than doing like cardiovascular rehabilitation from going to an actual clinic. I have people just start low and slow. Okay. Because a lot of people, if they do too much, if you try to treat pots, like it is just purely a musculoskeletal based issue from a physical therapy standpoint, I see people routinely get wrecked and ruined. Because they get pushed to do too much. Oh, just got to push through. Just got to push through. Just got to push through. And they get wrecked. They do too much. They feel horrible. They end up in a flare. So I'm a big fan of a recumbent bike. You're just going to sit there, do the bike for like three to five minutes, five times a day. You're not trying to accomplish any records, right? You're basically doing an eighty percent of what causes an increase of your symptoms. Once you can do that for a week straight, you will then increase. now recumbent bikes my favorite because guess what even if you pass out you're sitting on a recumbent bike so you're not likely to fall but it's exponentially better than a treadmill and especially for those who deal with issues with dizziness pretty bad it is way better than elliptical as well ellipticals are horrible for dizziness now outside of our incumbent bike you know resistance bands are great for many people using swimming is also good because with the changes in gravity being in a swimming pool your vestibular system also tolerates that better now obviously this is just one little thing it should be combined with nutrition sleep stress management and so much more now based upon all this information you should be in a much better place to be able to finally get answers and solutions to pots as we've covered myths but we've also covered the unique approach that we use here at peak brand and body in wesley chapel which is just outside of tampa to help people get better if you'd like a more in-depth guide of what we do and have it on paper Feel free to comment if you're watching this on Facebook or Instagram, POTS, and we will send a guide to you. And if you'd like to work with us one-on-one, you can always contact our clinic and we'd be happy to help you. Until next time, I'm Dr. Z and I'm known as The Brain Guy.