Most people have felt dizzy, lightheaded, or even fainted once or twice in their life when standing up too quickly. But if you have POTS – Postural Orthostatic Tachycardia Syndrome, this experience is a daily struggle.

POTS can feel like your body’s internal elevator system is malfunctioning. Instead of smoothly transitioning between floors, it gets stuck on the ground floor. When you want to get up to higher floors — and stand up — your heart will race, your blood pressure will drop, and you will experience symptoms like light-headedness or you could even faint.

Living with POTS can be difficult and exhausting. You are not alone though. 1 to 3 million people struggle with this condition in the US alone.

What can you do about it? How can you improve your POTS symptoms? In this article, I will explore the ins and outs of POTS, and I will offer some simple tips to improve your symptoms and quality of life naturally. Buckle up, and let’s dive into the world of POTS!


spinning room

What Is POTS?

Dysautonomias are disorders that affect your autonomic nervous system (ANS). Your ANS is in charge of the automatic functions of your body. These automatic functions include breathing, heart rate, blood pressure, temperature regulation, digestion, and other areas. Health issues that affect your ANS can impact these bodily functions. (1).

Postural orthostatic tachycardia syndrome (POTS) is a type of dysautonomia. It is also a form of orthostatic intolerance (OI). Orthostasis simply means standing up and OI is essentially an intolerance to standing up. OI is characterized by an inability to tolerate an upright posture, causing an abnormally rapid heart rate (tachycardia) and other sudden symptoms ( like a drop in blood pressure) when standing up that disappear when lying down (2, 3, 4, 5).

If you have POTS, the blood often pools in the lower half of the body, so that there is not enough blood flow, oxygen or nutrients to the brain.  This can result in tachycardia, lightheadedness, dizziness, tunnel vision, hearing changes and even fainting when standing up. Other common effects on the brain include foggy thinking, attention issues, insomnia, mood disturbances and depression.  Fortunately, lying down or sitting down can quickly improve your symptoms. Unfortunately, avoiding being upright is challenging.

Dysautonomias and similar symptoms affect about 70 million people worldwide. Officially, POTS affects up to 3 million people in the US alone. However, since the COVID-19 pandemic, it seems that at least 6 million people are affected with POTS and POTS-like symptoms. This doesn’t account for undiagnosed cases (2, 3, 4, 5).


Other Types of Dysautonomias

Other forms of dysautonomias include orthostatic hypotension, autoimmune autonomic ganglionopathy, vasovagal syncope, inappropriate sinus tachycardia, pure autonomic failure, baroreflex failure, familial dysautonomia, and multiple system atrophy. This sounds like a laundry list of conditions and it is, with some of these being more common and others much more rare.  Orthostatic hypotension, for example, is fairly common and occurs when someone’s blood pressure drops upon standing, rather than having a heart rate spike. Inappropriate sinus tachycardia is a condition just like it sounds, the heart rate is fast at inappropriate times, not just upon standing.   Some dysautonomias are more localized. For example, reflex sympathetic dystrophy tends to cause pain in the arms or legs.  It used to be known as complex regional pain syndrome (CRPS), but now is more appropriately categorized as dysautonomia. Others, such as pure autonomic failure and multiple system atrophy, are more generalized (6, 7).

Some, such as dysautonomia affective Guillain-Barre syndrome, is more severe and sudden, but reversible. Forms, such as POTS, are more chronic and may worsen over time. Some dysautonomias occur as a symptom or consequence of other conditions, such as alcoholism or diabetes. At other times, it is the main condition. It may also occur alongside other conditions, such as dysautonomia symptoms in Parkinson’s disease and other degenerative neurological diseases (7).


woman with Symptoms of POTS

Symptoms of POTS

Symptoms of POTS may include:

  • Increased heart rate (from 30 beats increase/minute resting heart rate to 120 or over when standing or from 40 beats/ minute in someone ages 12-19)
  • Fainting
  • Fatigue
  • Weakness
  • Dizziness
  • Shaking
  • Sweating
  • Shortness of breath
  • Bloating, cramping, diarrhea, and other digestive symptoms
  • Sleep difficulties
  • Mood disturbances
  • Attention issues
  • Brain fog and difficulty thinking
  • Vision changes and tunnel vision



Risk Factors and Causes of POTS

POTS may affect anyone of all ages and genders. However, women during their reproductive years are at a much higher risk than others. About 75 – 80% of individuals with a POTS diagnosis are women between 15 and 50  (2, 3, 4, 5).

When it comes to the risk factors and causes of POTS, there is still so much we don’t fully understand. Ongoing research efforts are aimed at improving our understanding of this condition. Current research suggests that for some, POTS may be an inherited condition. Others suggest that it may be linked to prolonged inflammatory reactions, an injury, a degenerative disease, or another disease. In many cases, the first symptoms tend to appear after a viral illness, major surgery, pregnancy, giving birth, or trauma (2, 3, 6, 7, 8).

New research suggests that gut microbiome imbalance, mast cell activation issues, and mold may play a role in the development or symptoms of POTS. I find this fascinating and promising from a functional and integrative medicine standpoint. These are exactly the underlying root issues we tend to focus on in functional medicine, but also the ones that often get missed in conventional medicine practices.

In the next section, I want to explore these four underlying factors a bit further. I will also discuss how COVID-19 may play a role in some new POTS diagnoses.


Gut Health and POTS

Your gut and your brain are closely connected. Your gut health affects your brain health, but your brain also affects your gut microbiome and digestive function. It’s a two-way communication system (9). There is ongoing communication between your gut and your central nervous system through your ANS and vagus nerve (10).

Understanding this interconnection between your gut and nervous system may help to understand symptoms and health conditions that affect the ANS. If there is an imbalance in your gut microbiome and the enteric nervous system of your gut, it can create havoc in your ANS and lead to related issues (11). POTS symptoms are, of course, related to functions directed by your ANS. So it wouldn’t be surprising if gut-related ANS dysfunction may be triggering your symptoms of POTS.

Moreover, gut microbiome imbalance, small intestinal bacterial overgrowth (SIBO), and other gut infections can put a lot of stress on the body, which may result in an increase of norepinephrine from your sympathetic nervous system. Thus SIBO and other gut infections may increase your symptoms of POTS (12, 13, 14, 15). A small study done by Dr. Lenny Weinstock found that 69% of 35 patients with POTS also had SIBO (16). The connection between SIBO and POTS is not clear. But it seems logical to test for SIBO and possibly other gut infections to receive treatment.

Even if SIBO or other gut infections are not directly causing the symptoms of POTS, gut microbiome imbalances increase chronic inflammation and put an enormous toll on the body. They also affect brain and neurological health. Recovering from SIBO and improving the gut microbiome can create better overall health supporting your treatment plan for POTS.


Histamine, Mast Cells, and POTS

Other potential contributing factors for POTS are mast cell activation and histamine intolerance. Chronic inflammatory reactions related to mast cell activation and histamine intolerance may increase your risk and worsen your symptoms of POTS. Research suggests that mast cell activation syndrome (MCAS) and POTS are common double diagnoses (17).

An interesting fact is that your gut is full of histamine receptors. In a healthy body, this is not an issue, rather it’s a good thing. However, if you are dealing with gut microbiome imbalances and gastrointestinal issues, these may alter the expression of the histamine receptors in your gut (18).

Gut microbiome imbalance, gut inflammation, and leaky gut can increase the overgrowth of histamine-producing bacteria in your gut and contribute to histamine intolerance (19, 20).

It’s important to note that the symptoms of SIBO and histamine intolerance often overlap. SIBO may also lower the tolerance of dietary histamine and increase the risk of histamine intolerance (21, 22).

Let’s stop for a second here. SIBO and gut dysbiosis may increase the risk of histamine intolerance and MCAS. Patients commonly receive a double diagnosis of POTS and SIBO (16). This is just another way the state of your gut health may be contributing to your POTS. And it may be worth looking into SIBO, other gut health issues, histamine intolerance, and mast cell activation syndrome as potential contributing factors to POTS.


Mold and POTS

I’ve written several articles about mold and related health issues. It turns out that there may be a link between chronic mold exposure and POTS as well. Research suggests that chronic mold exposure may increase the risk of POTS and other chronic health issues, including chronic fatigue syndrome (CFS), complex regional pain syndrome (CRPS) which is now reflex sympathetic dystrophy, autoimmune conditions, and autoimmune dysautonomias (23, 24, 25).

Research suggests that mold toxicity may increase neurological symptoms, including balance issues, difficulties with coordination and walking straight with eyes closed, as well as other movement issues, and memory problems (26, 27). Since balance and coordination is a common struggle in POTS when standing, it’s possible that mold illness may further trigger these symptoms.

Other research has found that mold toxicity may affect the central and peripheral nervous system and cause arrhythmias (irregular heartbeat), along with other symptoms, such as pain, fatigue, and brain fog (28). Since people with POTS commonly experience irregular health beats, it is possible that mold toxicity may trigger POTS-related arrhythmias.

Fatigue is another common issue that patients with POTS experience. If you are experiencing fatigue from POTS and fatigue from chronic mold exposure, this combination may aggravate your symptoms further (29).


Chronic Infections and POTS

Chronic infections may also increase the risk of POTS. Epstein-Barr virus, influenza, and Borrelia burgdorferi infection may also increase the risk of POTS (30). Moreover, COVID-19 and long haul syndrome may also cause POTS or POTS-like symptoms. According to a 2022 review, somewhere between 4 and 14% of people develop POTS or POTS-like symptoms after recovering from COVID-19 (31).

COVID-19 may increase mast cell activation and related histamine release, pro-inflammatory chemical release, and inflammation (32, 33). As you already know, mast cell activation and mast cell dysfunction may increase the risk of POTS and similar dysautonomia symptoms.

COVID-19 may also lead to an increased risk of neurovascular coupling dysfunction, which may cause POTS-like symptoms (34, 35). It may also increase stress which can trigger POTS (36). Prolonged bed rest from COVID-19 may also increase POTS-like symptoms (37). Though research has found that the COVID-19 vaccine may also increase the risk of POTS, the risk of getting POTS from COVID-19 seems to be 5 times higher than from getting vaccinated (38).


POTS diagnosis

Diagnostic Definition of POTS

POTS is diagnosed when the patient has the symptoms above and meets the criteria, and other conditions are ruled out, such as orthostatic hypotension, acute dehydration, and blood loss. Orthostatic hypotension is a type of low blood pressure characterized by 20 mm Hg drop in systolic or a 10mm Hg drop in diastolic blood pressure within three minutes of standing up

The gold standard for POTS is a tilt table test, however, I have found that many specialists are hesitant to perform it and so a 10-minute standing test is another option.  If you can find a POTS-savvy cardiologist or neurologist, hopefully, you can have a tilt table test performed.  However, these tests are not always abnormal, so it can be frustrating. I use the clinical definition of an increase of heart rate more than 30 bpm ( or >40 bpm in a young person) within 10 minutes of moving from lying to standing. People can do this at home with a pulse ox or bp cuff. Here’s a handy sheet you can download and use to track your heart rate each minute after standing up!


woman drinking water after exercise

Recommendations for POTS

Here is what I recommend if you have POTS:

Improve Your Hydration and Support Electrolyte Balance

Water plays a critical role in your body, including supporting the transport of nutrients, delivering oxygen to the cells, and removing toxins. Hydration may also support your body in recovering from various health issues.

People with POTS tend to experience issues recirculating blood throughout their bodies when standing up (39). Improving stroke volume may be one way to improve this. Stroke volume refers to “volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction” (40). People with POTS generally experience a lower stroke volume due to a decrease in total blood volume and blood pooling in the lower extremities. Improving fluid, salt, and electrolyte intake is a great way to improve total blood volume and stroke volume.

For proper hydration, I recommend starting your day with 16 to 32 oz of water and drinking a glass about every hour throughout the day. To improve salt (sodium) and other electrolyte levels, I recommend supplementing electrolytes in your water (41, 42). I recommend  E-Lyte from Body Bio, salt tablets, or other non-sugar-based electrolyte mixes.

You can add pink Himalayan or Celtic sea salt to your water, ensuring 3 to 5 g of sodium in a day. Organic vegetable broth, chicken broth, and bone brother are also high in electrolytes and offer hydration, as long as these don’t bother you if you have histamine intolerance. Leafy greens and other vegetables are also rich in electrolytes. Kale, spinach, and collard greens are great for improving magnesium and calcium levels. Squash, sweet potatoes, and avocados are rich in potassium. Prickly pears, cherries, bananas, and mangos are great fruits to offer electrolyte support and hydration. Sometimes people find that they need even more minerals and so adding our Spring Center Mineral Support supplement may boost your levels and improve your symptoms.


Follow a Nutrient-Dense Diet

Along with proper hydration and supporting normal electrolyte levels, following a nutrient-dense diet may help to manage your POTS symptoms. Eating smaller, more frequent meals may help to reduce hypotension after meals (43, 44). Smaller meals can help to decrease the amount of blood needed to digest food, which helps to improve blood distribution throughout the body.

Following a nutrient-dense diet can also improve overall health, reduce blood sugar spikes and crashes, and support normal energy levels throughout the day. It helps to meet your micronutrient needs, including necessary electrolytes. Remove inflammatory foods, such as refined sugar and carbs, refined oils, food allergens and food sensitivities, and overly processed foods. Eat lots of greens, vegetables, herbs, spices, sprouts, fruits, grass-fed meat, pasture-raised poultry and eggs, and wild-caught fish. For healthy snacks, choose fruits, veggie sticks with hummus or nut butter dips, olives, pickles, nuts and seeds, and other healthy options. Don’t skip meals, and avoid over-eating.


Support Your Mast Cells and Reduce Histamine Intolerance

Since mast cell activation issues and histamine intolerance may play a role in increased POTS symptoms, I recommend supporting your mast cells and reducing histamine intolerance. Reduce common triggers of mast cell activation including allergens–both food and environmental–mold and mycotoxins, other toxins, chemicals, heavy metals, and infections.

Eat lots of quercetin-rich foods, including cranberries, blueberries, grapes, cherries, cruciferous vegetables, red onions, red leaf lettuce, cabbage, and peppers, and try Quercetin supplements to lower histamine naturally. Follow a low-histamine diet. Reduce your histamine bucket by lowering stress, sleeping enough, moving your body, and improving your lifestyle. To learn more about how to calm your mast cells and reduce histamine intolerance, check out my recommendations in this article.


Support Your Gut Health

Since gut microbiome imbalances and gut infections may increase symptoms of POTS, I recommend supporting your gut health. Eat plenty of prebiotic-rich foods to support the good bacteria in your gut. Unless you have histamine intolerance, eat lots of probiotic-rich fermented foods, including kimchi, sauerkraut, yogurt, and kefir. Take a daily probiotic supplement. Work with a functional medicine practitioner to address underlying gut infections or leaky gut syndrome.


Reduce Mold Exposure

Mold illness is another potential trigger for POTS symptoms. I recommend that you check your home for mold and get tested for mold illness. If your home is infected by mold, ideally, you want to move. If that’s not possible, you can take some measures to remove mold and reduce future mold exposure.


Move Your Body Regularly

Exercise is a great way to improve your body’s capacity to move blood from your heart (45). Unfortunately, physical deconditioning is a common issue in people living with POTS for a longer period of time. This leads to a smaller heart size over time, which reduces your body’s ability to pump blood and lowers cardiac output. This can increase the risk and severity of tachycardia, lightheadedness, nausea, and dizziness in POTS patients (46).

Fortunately, you can improve this by moving your body and exercising more. Only 20 minutes of aerobic exercise three times a week may improve your cardiovascular health (47). Swimming, cycling, rebounding, jogging, hiking, and rowing are great options for cardiovascular exercise. I recommend adding strength training to the mix as well, such as weight lifting, pilates, or Barre workouts. I recommend graduated exercise, which means that you gradually increase your activities, intensity, and range of motion to avoid injuries or other health issues.


Sleep Plenty and Reduce Your Stress Level

Improving your sleep and reducing your stress may also help to reduce your symptoms. Poor sleep may increase inflammation, blood sugar imbalances, stress, and cortisol secretion, which may worsen your symptoms. Poor sleep may also reduce your quality of life and your body’s ability to heal (48).

Chronically elevated cortisol levels from chronic stress can also seriously impact your body. It can increase chronic inflammation, lower immunity, negatively affect blood pressure, decrease digestive functions, and more. If you have POTS, you have an increased risk of stress, anxiety, and depression due to dealing with chronic health issues. However, stress itself can trigger and worsen your symptoms if you don’t pay attention (49, 50, 51).

I recommend reducing stress and improving your sleep. Practice breathwork, meditation, mindfulness, and guided relaxation. Try biofeedback. Considerjournaling. Avoid electronics, stress, heavy food, and alcohol in the evening. Opt for relaxing, offline activities instead, such as reading, art, listening to music, or taking a bath. Support your sleep with a supportive mattress, comfortable bedding and pillows, an eye mask, and blackout curtains.


Try a Compression Device

On average, when standing up, the gravitational force causes a displacement of approximately 700-900mL of blood from the upper body to the lower body in a typical person. People with POTS can experience venous pooling, where less blood returns to the upper body, and this leads to symptoms.

Using compression garments and other compression devices may help to reduce venous pooling, improve systolic blood pressure, increase cardiac output, and reduce tachycardia and other symptoms. This strategy was first used for post-spaceflight orthostatic intolerance in astronauts. Since then, it has been recommended to people with POTS to prevent or decrease symptoms (50).



Medication may be necessary if you have POTS or dysautonomias. Corlanor is one of my favorites, and most of my patients find it very helpful.  Most of the other medications recommended for dysautonomias, such as midodrine and florinef, work better for orthostatic intolerance.



Next Steps

Are you dealing with symptoms of POTS or other chronic health issues? We can help. If you want to improve your health, I welcome you to schedule a functional nutrition consultation with my nutritionist, Sarah. Visit our store for products.

And stay tuned for more information to help you uncover the root cause of your health issues, improve your nutrition, repair your body, and regain your health naturally.

You can learn about working with us at the Spring Center for individualized support here. You can schedule a nutrition consultation with Sarah here.