PoTS: Understanding why dizziness doesn’t go away in teenage girls and young women (part 1)

Do you get dizzy episodes, heart palpitations, trembling, or weakness when you stand up? These are a few of the symptoms of Postural Orthostatic Tachycardia Syndrome (PoTS – the acronym uses a ‘little o’) which more people are becoming aware of. PoTS can be a debilitating medical condition that affects many people.

A much more noticeable number of cases are found among teenage girls and young women. Women often notice that symptoms of PoTS are worse around the time of their menstrual periods. Symptoms can also be more noticeable during the perimenopause and then lessen after the menopause.

This syndrome is characterised by an abnormal heart rate increase when a person moves from a lying down to a standing-up position. In this blog I will look at key symptoms of PoTS and I share some of the key reasons why someone might experience these PoTS symptoms and how the immune system, hormones, genetics, the environment, nutrition and the gut microbiome can all play a role.

Each word within the Postural Orthostatic Tachycardia Syndrome full name has an important meaning:

  • Postural: How you hold yourself and the position of your body.
  • Orthostatic: A form of low blood pressure caused by blood vessels failing to constrict when you stand up.
  • Tachycardia: This is when the heart rate goes over 100 beats per minute.
  • Syndrome: A cluster of symptoms that can happen together.

The medical diagnostic criteria are generally:

  • The patient must have experience PoTS-type symptoms over a period of at least 3 months.
  • There is a persistent increase in the heart rate of 30 beats per minute (40 bpm if under 19 years old).
  • The symptoms must develop within 10 minutes of standing up.
  • The symptoms are experienced in the upright position (which is usually when standing) and are generally relieved by lying down.

It can be formally diagnosed through a cardiologist well-versed in PoTS and dysautonomia, using either a 10-minute standing test or a head-up tilt table test.

Also see Part 2 of this blog, where you will find many dietary, exercise and lifestyle changes that you can weave into your daily routine to help manage some of the symptoms as well as some supplements that may help.

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Symptoms of PoTS

PoTS can lead to a wide array of different symptoms, often very debilitating, making it quite challenging to diagnose. These symptoms may include:

  • Heart palpitations: A rapid heartbeat, often felt when standing up.
  • Dizziness or syncope: Feeling lightheaded or even fainting upon standing.
  • Fatigue: Chronic tiredness, unrelated to physical exertion.
  • Brain fog: Difficulty with concentration and memory.
  • Digestive issues: Nausea, diarrhoea, or constipation.
  • Sweating irregularities: Either excessive sweating or lack of sweating.

Many of the symptoms cross over with symptoms of anxiety and these very real physical symptoms can be perceived as solely stress-induced, rather than being cardiovascular in nature. This is why it is important to seek out a full assessment through a cardiologist who understands PoTS.

They key triggers of PoTS symptoms

The exact cause of PoTS remains elusive, and there can be a number of factors involved, which means the prognosis is not clear cut. However, there is increasing evidence pointing to certain triggers:

Viral infections
The onset of PoTS may be precipitated by the contraction of a virus. Viruses that are well known to be associated with PoTS include Epstein-Barr Virus (Glandular Fever) and Covid-19. These viruses can trigger an immune response that inadvertently affects the autonomic nervous system, leading to PoTS and this can happen whilst the virus is active in the body or during the few weeks afterwards. Many people have associated their onset of PoTS symptoms as occurring alongside a wider set of Long Covid symptoms.

Some research has pointed this onset of post-viral PoTS being a misdirected immune response or autoimmune activity and many people with PoTS also co-currently test positive for anti-nuclear antibodies (ANA) or other autoimmune antibodies such as thyroid antibodies or rheumatoid arthritis related antibodies.

Hormonal changes, particularly those during adolescence and young adulthood, may contribute to the onset of PoTS. Natural changes in hormone levels during a woman’s menstrual cycle might also exacerbate symptoms and this is why symptoms can wax and wane over the month, depending on where you are in your cycle. Typically increased lightheadedness occurs during the days leading up to a period and can peak during menstruation. By supporting the underlying hormone balance, especially during the luteal phase (the second half of your cycle between ovulation and your period), PoTS symptoms can usually be better controlled.

While not fully understood, there may well be a genetic component, where a family history of PoTS or associated disorders increases the risk. A family history of blood pressure variations, hypermobility or hyperflexible joints, Ehlers Danlos Syndrome, dysautonomia, syncope (fainting or dizziness), chronic fatigue and fibromyalgia all have links with the propensity to another family member developing PoTS.

Environmental sensitivities to household chemicals and bath or skin care products as well as pesticide exposure from fields being sprayed can trigger some of the PoTS symptoms. Often the person reacts to multiple chemicals.

This multiple chemical sensitivity can lead to reactions such as nausea, dizziness, headache, upper respiratory discomfort, runny eyes, chest and throat pain, nausea, fatigue, lack of concentration, memory difficulties, depression, anxiety, mood disruption. These chemicals may be found in household detergents, plastics, glues and pesticides as well as some synthetic and natural fragrances in household cleaners, candles and air fresheners.

Living in a house with high levels of mould can also exacerbate and bring on these symptoms as moulds can emit mycotoxins. Mycotoxins can perturb both the immune system and the neurological system as well as upregulate allergy symptoms and mast cells which in turn can lead to chronic inflammation throughout the body and the symptoms associated with PoTS.

Nutrient shortfalls
When iron levels are low you may feel faint and dizzy, this is because one of the key actions of iron is to transport oxygen around the body and brain via the blood. Vitamin B1 and B12 levels are key for both neurological function and energy production and even quite small shortfalls can lead to some of the symptoms of PoTS. Having enough Vitamin D stores is also important and low Vitamin D has been associated with more severe PoTS symptoms. It is also important to consume enough Vitamin C from the diet, as very low vitamin C levels are associated with symptoms of orthostatic hypotension.

Gut trouble
Research has started to look at the connection between the balance of bacteria in our gut microbiome and PoTS-type symptoms. This has been identified partly because many people with PoTS also experience chronic gut issues to include slow motility, constipation, gut pain, bloating and gas.

Overgrowth of bacteria in the small intestine (SIBO) is also a common comorbidity that come along with each other and are found in people experiencing PoTS symptoms. Bloating, abdominal distension, gut pain or discomfort, diarrhea, and weakness as well as anxiety, fatigue and weakness are symptoms of SIBO.

The link between gut health and SIBO is emerging research, but worth considering if gut symptoms also feature.

Round up

PoTS symptoms of dizziness, feeling lightheaded, tiredness and suffering brain fog can all feel overwhelming and can prevent you from enjoying life. Now you know what PoTS is, and the reasons behind why you may have it, remember to read Part 2 on how to manage the symptoms better through diet, lifestyle and exercise, as well as supplements.

My team of practitioners are experienced in managing the symptoms that come along with PoTS. Please get in touch with us if you want to investigate the root triggers of your PoTS symptoms and this can be done through laboratory testing such as blood tests for viral load and autoimmunity as well as other laboratory testing for genetics, mycotoxins and the gut microbiome then be in touch. Just click on the CLINIC tab above.

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