Foundational Treatments for POTS

Postural Orthostatic Tachycardia Syndrome (POTS) is a mystery illness that has gained a lot of attention recently. It is characterized by an increased heart rate when standing up, causing symptoms such as dizziness, lightheadedness, and fainting. As a medical doctor in central Virginia, I have seen many patients with POTS that have been referred to me.

One thing that I have noticed is that many physicians skip these foundational treatments and go straight to medications like Adderall for focus and attention, midodrine to increase blood pressure, or fludrocortisone to increase blood volume. In this blog post, we will discuss the four key foundations of POTS treatment that should be addressed first to help patients who suffer from POTS. In many cases, we can avoid prescription medications and their side effects by addressing these foundational areas.

Foundation #1: Electrolytes

People with POTS do not maintain adequate levels of sodium, magnesium, and trace minerals. While the current healthcare system focuses on sodium chloride, it often overlooks the magnesium, potassium, and other important minerals. Trace minerals are also important in treating POTS. Ideally, individuals with POTS should consume anywhere from two to four grams of trace minerals a day. Without enough of these minerals, patients will not experience relief from their POTS symptoms.

Foundation #2: Fluids

People with POTS need to drink more water. Clean water free of chemicals, chlorine, and pesticides is ideal. Mineral water that is rich in trace minerals is even better. Individuals with POTS should consume anywhere from 4-6 liters (or more) of water per day based on their symptoms, blood pressure, and other factors that their healthcare provider can help them with.

Foundation #3: Compression

Compression stockings, hose, or even wearing lycra like Spanx can help push the fluid from the tissues back into the veins and the central nervous system, thus helping with blood pressure. Compression can be really powerful for people with POTS and this alone can have a big impact for many patients.

Foundation #4: Exercise

Certain types of exercises that build up the muscles in the legs and calves can also help with the body’s regulatory systems. The Children’s Hospital of Philadelphia has had up to an 80% response rate using certain exercises alone.

Other Treatments

In addition to these foundations, there are also different modalities that can be used to treat POTS. These include medications, acupuncture, massage, IV therapies, mind-body medicine, and certain herbs. For those with mast cell issues, quercetin can be helpful, and basic histamine medications like Claritin and Pepcid can also be used. Low-dose naltrexone is another potential treatment option.

Starting with the Foundations in the Treatment of POTS

It is important to understand that POTS is not a standalone illness, but rather a result of underlying conditions. By addressing the four key foundations of treatment and the related illnesses, individuals with POTS can significantly improve their symptoms. I hope this series on POTS has been helpful!

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