Healthcare professionals are increasingly encountering a perplexing condition known as Postural Orthostatic Tachycardia Syndrome (POTS), particularly in the context of the ongoing Long COVID-19 Syndrome. This intricate disorder manifests when individuals notice a sudden and sharp increase in their heart rate upon transitioning from a lying to a standing position.
The defining characteristic of POTS is a clinical syndrome marked by an elevated heart rate of more than 30 beats per minute (or more than 40 beats per minute in young people aged 12 to 19) upon standing, excluding the possibility of orthostatic hypotension – a drop in systolic blood pressure of greater than 20 mmHg.
Delving into the Mechanism
The human body has a remarkable ability to adapt to postural changes. When we stand up, gravity pulls blood towards the lower half of the body. In a healthy individual, the nervous system quickly responds, activating various mechanisms to ensure adequate blood flow to the brain. This includes the production of hormones that trigger vasoconstriction and a slight increase in heart rate, ultimately improving blood circulation to the vital organs.
However, in individuals with POTS, the blood vessels fail to respond adequately to the vasoconstriction signal. As a result, blood accumulates in the lower extremities, leading to insufficient blood supply to the brain. This triggers the nervous system to continue producing epinephrine and norepinephrine, further elevating the heart rate in an attempt to counteract the blood pooling.
Symptoms and Associated Conditions
Patients with POTS often experience a myriad of distressing symptoms, including palpitations, dizziness, fainting, fatigue, sleep disturbances, headaches, blurred vision, excessive sweating, anxiety, difficulty breathing or swallowing, nausea, and general weakness. These complaints can resemble those associated with anxiety disorders or depression, conditions that can coexist with POTS.
Interestingly, the prevailing belief is that in these cases, the anxiety or depression is a consequence of the POTS, rather than the other way around. This underscores the importance of accurate diagnosis and a comprehensive understanding of the underlying mechanisms.
The Emergence of POTS in the Context of Long COVID-19 Syndrome
As the medical community grapples with the long-term effects of the COVID-19 pandemic, a troubling pattern has emerged. POTS is now being recognized as a common manifestation of Long COVID-19 Syndrome, a condition characterized by the persistence of various symptoms weeks or even months after the initial infection.
The connection between POTS and Long COVID-19 Syndrome is rooted in the autonomic dysfunction that can result from the viral infection. The disruption in the coordination and cooperation of the body's organs can occur spontaneously, with changes in body position, or even with minor exertion – a hallmark of POTS.
Diagnostic Considerations
Diagnosing POTS requires a methodical approach. Clinicians must first rule out other potential causes of sinus tachycardia, such as hypovolemia, anemia, hyperthyroidism, pulmonary embolism, or pheochromocytoma. Once these alternative explanations have been eliminated, the diagnostic process can move forward.
The gold standard for confirming a POTS diagnosis is the tilt table test, which involves non-invasive hemodynamic monitoring while the patient is tilted to an upright position. However, this specialized test is only available in a limited number of medical centers. As an alternative, an active standing test of 10 minutes can also provide valuable insights.
Prognosis and Recovery
The long-term prognosis for individuals with POTS is not well-studied, but estimates suggest that approximately 50% of patients may experience spontaneous recovery within 1 to 3 years. This underscores the importance of early recognition, appropriate management, and ongoing monitoring to support the patient's well-being and facilitate the best possible outcome.
As the medical landscape continues to evolve, healthcare providers must remain vigilant and attuned to the emerging complexities of conditions like POTS, particularly in the context of the Long COVID-19 Syndrome. By enhancing our understanding and refining our diagnostic and treatment approaches, we can empower patients to navigate this challenging condition and ultimately improve their quality of life.
There is no cure for POTS
Indeed, there are no known cures for pots or other types of autonomic dystonia. Treatment is aimed at managing symptoms, through several types of interventions. Patients might be advised to raise the head of their beds. High-salt diets combined with up to two liters of non-caffeinated, non-alcoholic fluid per day can help maintain appropriate blood pressure. People with extreme forms of this condition might wear compressive garments to reduce the pooling of fluid in the legs.
THERAPY:
Non-drug treatment [HOLISTIC]
Any medications that can worsen POTS should be stopped, such as norepinephrine transport inhibitors (SNRIs, including venlafaxine and duloxetine). Furthermore, increasing blood volume with improved salt and fluid intake can help. Venous pooling can be reduced by wearing compression stockings. It is important that patients continue to make efforts to counteract d-conditioning.
Exercise is an important part of POTS treatment for several reasons. It improves heart function, so the tachycardic episodes may feel less extreme. It can help counterbalance negative feelings associated with this disorder, especially since it often affects young people. If POTS symptoms are extreme, patients might be counseled to choose exercises that allow them to be in a reclining position. These might include swimming, rowing, or using a recumbent bicycle.
Many people have POTS that is relatively mild and manageable with these lifestyle adjustments. However, medications for POTS may be necessary. These include drugs that impact heart rate, blood vessel dilation, and how the kidneys retain sodium.
Implications for Massage
Massage therapy has some benefits to offer people with POTS, if we can anticipate and make appropriate accommodations.
People with POTS may feel that their body is unreliable, and that they can’t depend on being able to do the things they need to do. Receiving massage therapy may help boost a person’s sense of inner strength and ability to cope with the challenges of living with this this condition.
People with POTS may feel that their body is unreliable, and that they can’t depend on being able to do the things they need to do. Receiving massage therapy may help boost a person’s sense of inner strength and ability to cope with the challenges of living with this this condition.
Exercise
Exercise is an important part of the treatment plan for most people with POTS. Tachycardia can be frightening, but experiencing that sensation in association with health and strength can help mitigate that fearful feeling. Experts suggest that manual therapies that promote the ability for people with POTS to exercise can be especially helpful.
Stretching
STRETCHING therefor is also of paramount importance, as stretching helps aid in removes stress hormones, toxins and other free radicals from the body, it helps stimulate blood circulation and even raise oxigination levels.
When we become "stressed" stress hormones, such as cortisol, are excreted into the body. When cortisol levels are high, the walls of the veins weaken. This weakening of the veins can make them more susceptible to venous disorders.
Chronic stress can cause higher levels of inflammation in the body that contribute to increases in plaque buildup in the arteries—and that can lead to such problems as coronary artery disease,” says Dr. Lampert. Coronary artery disease can lead to heart attack, abnormal heart rhythms, and heart failure.
Stretching is key to comfort!
Detox
As POTS is now being recognized as a common manifestation of Long COVID-19 Syndrome, a strict detox regiment is HIGHLY recommended.
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There is no single, recommended diet for people with POTS. But, since keeping blood pressure at the right level helps alleviate symptoms, dietary changes that raise blood pressure may help.
Here are 6 dietary tips for people with POTS:
1. Stay hydrated
Experts often recommend that people with POTS pay special attention to their fluid intake since the condition can make people more sensitive to dehydration. And staying hydrated helps blood flow to the head, which alleviates dizziness.
Studies show that drinking 16 ounces of water can raise your blood pressure by 30 mmHg within 5 minutes. Of course, the amount of water a person needs varies depending on their body size, activity level, and the weather conditions.
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2. Have some salt
Often, dietary recommendations wrongly advice to limit salt consumption. For people with POTS, getting higher amounts of salt can be beneficial, because it helps increase their blood pressure. In fact, increasing salt intake is often a first course of treatment for people with POTS.
Ask your healthcare provider what a good target is for you. They may recommend that you consume an extra 3 g to 10 g of salt per day. This is up to around 5 times more salt than the average person should consume (2,300 mg).
At Watapana Wellness, we highly recommend Celtic Sea Salt for best effect, or any other NATURAL/ ORGANIC Sea salt.
Here are some ways to consume more salt:
Eat nutrient-rich foods that contain salt, such as soup, canned beans, and nuts.
Sprinkle salt on foods like fruit, salads, and cottage cheese.
Add a pinch of salt to your water bottle.
Take salt tablets.
3. Have small, frequent meals
When you eat a big meal, the body diverts blood to help the digestion process. That can leave you feeling dizzy. Instead, eat around six small meals throughout the day to help ease POTS symptoms. Eating more frequently can also help increase your fluid intake.
4. Eat a variety of organic nutrients
Since POTS is often connected to digestive discomfort, increasing foods that support gut health can ease symptoms. These include:
Probiotics, or “good bacteria,” which are found in yogurt, kimchi, and other pickled vegetables
Prebiotics, or foods that feed healthy gut bacteria, like beans, chickpeas, and nuts
Fiber-rich foods, such as oats, flax seeds, and peaches
Antioxidants from eating a variety of fruits and vegetables
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5. Consume Cayenne pPEPPER daily and consistently
Cayenne pepper truly is one remarkeble herb.
Cayenne peper is noy to be mistaken with chili.They are not at all related. Chili comes from the chili family and Cayenne comes from the capsicum family.
Chilli is a irritant in the gastro-intestinal trackt. Sames goed for black pepper! Cayenne pepper however will heal a stomach ulcer. Cayenne is one of the best circulatory stimulants there is. Unlike caffeine or tobacco, it is not a nervous system stimulant. It is a BLOOD STIMULANT.
Take into consideration that the life of flesh lies within the blood. Cayenne pepper truly is a remarkable healer. Additionally, Cayenne pepper intensifies the actions of any other ingredient!
Capsaicin is found in cayenne pepper, which benefits your veins due to its anti-inflammatory and analgesic properties . A small dose, only half a teaspoon in a cup of water, can be taken to help manage pain and inflammation due to varicose veins.
6. supplement there where needed
Which bring us to:
The Best supplements for POTS
POTS patients often have low levels of vitamins and minerals due to their symptoms, and this can make their condition worse. Therefore, it is important to supplement their diet with the right vitamins and minerals. Here are some of the best vitamins for POTS:
Selenium
Selenium is a nutrient that the body needs to stay healthy. Selenium is important for reproduction, thyroid gland function, DNA production, and protecting the body from damage caused by free radicals and from infection.
Selenium plays an important role in the health of your immune system. This antioxidant helps lower oxidative stress in your body, which reduces inflammation and enhances immunity. Studies have demonstrated that increased blood levels of selenium are associated with enhanced immune response.
So selenium not only lowers inflammation markers but may also ease oxidative stress, a condition in which free radicals and antioxidants are unbalanced in the body leading to cellular damage. Oxidative damage is also associated with several chronic diseases, including cardiovascular disease (CVD).
Selenium is a nutrient that plays a key role in maintaining thyroid hormone metabolism and DNA synthesis and protecting the body from oxidative damage and infection.
Selenium deficiency symptoms can include: hair loss, reproductive issues, muscle weakness, fatigue, brain fog and thyroid dysfunction. Include selenium foods in your diet to help bring levels up.
Lastly, selenium may help balance microbial flora by making it more likely for positive bacteria to grow and less likely for potentially harmful bacteria to grow in their place.
A balanced gut microbiome is key for a healthy digestive system overall, which is why it's a vital part of gut health as well.
Side note:
People with autoimmune diseases such as multiple sclerosis, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and other should avoid taking selenium supplements. Always consult your physician, dietist/ nutritional expert if any kind of supplementtation is fit for you.
Vitamine E
Vitamin E is a nutrient that's important to vision, reproduction, and the health of your blood, brain and skin. Vitamin E also has antioxidant properties.
Vitamin B Complex
POTS patients may have low levels of vitamin B, which can affect their energy levels, mood, and cognitive function. A high-potency B-vitamin supplement like Banana Bag Oral Solution can provide the necessary B vitamins to help alleviate symptoms.
Vitamin C
Vitamin C is a powerful antioxidant that can help reduce inflammation and oxidative stress in the body. It can also help improve immune function and collagen synthesis, which is important for skin and connective tissue health.
Vitamin D
Vitamin D is essential for bone health, immune function, and muscle function. It can also help regulate blood pressure and improve cardiovascular health.
Magnesium
Magnesium is important for nerve function, muscle function, and bone health. It can also help regulate blood pressure and improve sleep quality.
Iron
Iron is essential for red blood cell production and oxygen transport in the body. Iron deficiency can lead to anemia, fatigue, and weakness.
Banana Bag Oral Solution and POTS
Banana Bag Oral Solution (BBOS) is a high-potency B-vitamin supplement that can provide the necessary vitamins and minerals for POTS patients. It is available in two flavors: Unsweetened Lemon-Lime and Sweet Orange. One single-use packet of the original Lemon-lime flavor contains: Sodium (410mg), Potassium (120mg), Chloride (780mg), Dextrose (3.7grams), Vitamin-C (750mg), and high dose B-Complex. It is easy to use by dissolving the contents of one packet into 8 to 16 ounces of water and drinking it over 15 minutes once daily as needed for dehydration and/or fatigue.
A clinical trial conducted at the University of New Mexico resulted in significant absorption of B-vitamins following a single dose of BBOS. Most importantly, there was statistically significant absorption of the B6 and B12. This study showed that BBOS was proven to restore the body back to normal hydration status following clinical dehydration.
Banana Bag Oral Solution is the oral alternative to intravenous dehydration and vitamin therapy for those who require more than what typical electrolyte solutions and sports drinks can offer. It is an effective solution for POTS patients who need to supplement their diet with the right vitamins and minerals to alleviate their symptoms.
Experts emphasize that supplements should not be used for POTS without consent of health care professionals.
To read more about supplementation, click the button below:
Foods that worsen POTS symptoms differ from person to person.
Because POTS is often associated with gastrointestinal concerns like diarrhea, foods high in FODMAPs — carbohydrates that are difficult to digest — can be irritating. So avoiding foods like wheat, certain dairy products, and onions may be beneficial for some people.
Limiting your intake of the following types of food can also SIGNIFICANTLY help protect the gut:
Ultra-processed foods
Vegetable oils
(Refined) sugar
Artificial sweeteners
People with POTS are also better off avoiding alcohol. Alcohol is a dehydrating neurotoxin and can impact your blood pressure and can increase dizziness.
Avoid caffeine:
Overall, the research around caffeine and POTS is mixed. While it may help some people, more research suggests avoiding it, as it can aggravate symptoms in certain people. Scientists emphasize that caffeine should not be used for POTS until other treatments have been exhausted.
For more information on why your should avoid caffeine, click the button below:
For more information on why REAL FOOD is of paramount importance, click the button below:
What Accommodations Might Be Needed?
If clients who have POTS worry about dizziness or faintness when they sit up or stand up, the prospect of receiving massage might not be especially attractive.
However, with a the proper (profesional) guidance and a few key accommodations, massage therapy can be just as safe, RESTORATIVE, and supportive for people with POTS as it is for the rest of the population.
In patients suspected of hypovolemia, it is recommended to drink more than 2 liters of water per day and to increase dietary salt intake to 10-12 grams per day, although blood pressure must of course be monitored.
To boost your water and help in overal alkalization click on the button below:
Pharmaceutical treatment [PHARMA]
Symptom treatment of sinus tachycardia can be done with low doses (10-20 mg) of propranolol. This reduces the heart rate acutely when standing. Higher doses are often less well tolerated.
The non-selective beta blockers are preferred because they block epinephrine-mediated beta-2 vasodilation. Other beta blockers have not been adequately studied.
Pyridostigmine, a cholinergic agonist that acts by inhibiting acetylcholinesterase, may increase parasymptatic autonomic tone and has a lower risk of hypertension compared to other medications. However, this drug can cause unpleasant side effects such as abdominal cramps, diarrhea and muscle cramps.
Ivabradine slows sinus rhythm without affecting blood pressure. In an open-label study, 60% of patients with POTS had symptomatic improvement. Ivabradine is preferably given concurrently with beta-blockers for long-term therapy.
Midodrine, which can be used in orthostatic hypotension, is also effective in reducing orthostatic tachycardia, but less effective than saline iv. Midodrine has only a short effect and must be given 3 times a day. It can only be given during the day because it can cause hypertension when a person is lying down, especially at higher doses.