By Nicholas Tullo, MD
The Postural Tachycardia Syndrome, or “POTS,” is a complex constellation of symptoms that primarily affects young women. There are many different varieties of this syndrome, but patients suffer from “postural intolerance,” meaning they have difficulty whenever they are in an upright position for some time. There is now some evidence that the symptoms in POTS patients may be worsened by eating foods that contain gluten, a complex protein mainly found in wheat products.
Patients with POTS are often normal, healthy people who wake up one morning with debilitating symptoms. The symptoms include rapid palpitations due to an elevated heart rate, lightheadedness, “brain fog,” chronic fatigue, and at times chest pains, headaches, sweating problems, abdominal symptoms like nausea, bloating, diarrhea, constipation, and even an increased risk of fainting. Most of the symptoms improve if the person lies down. The symptoms are so severe that they have to take time off from school, have difficulty functioning at work, and they sometimes feel so poorly that they can’t even take a shower.
POTS is a type of “Dysautonomia,” because it primarily affects the autonomic nervous system, which include the reflexes that regulate heart rate, blood pressure, body temperature, sweating, and gastrointestinal activity. As a result, people have a hard time adapting to the forces of gravity because of excessive pooling of blood in the lower part of their body, and so standing up becomes very difficult because of these symptoms.
No one knows what causes POTS, but it can occur shortly after a serious infection (like influenza or mono) or after trauma, so some scientists believe it may be related to the immune system going haywire and affecting a person’s own autonomic nervous system. Other patients with POTS appear to have an underlying medical disorder – it is very commonly found in patients who exhibit joint hypermobility, suffer from Lupus or other rheumatological abnormalities, or who have multiple allergies, perhaps due to abnormal activity of histamine-containing white blood cells known as mast cells. Regardless of the cause of POTS, many patients have intolerable gastrointestinal (GI) symptoms that drive them to all sorts of specialists. Many POTS patients have been told that they have “gastroparesis” or abnormal stomach activity, irritable bowel syndrome, or gastro-esophageal reflux disease (GERD), but many are told that there’s nothing wrong with them. Some POTS patients are assumed to have anxiety or neurosis as the main cause of their disabling symptoms.
Since recent research suggests that POTS is autoimmune in nature, it is possible that these patients may be suffering from more than one autoimmune condition. According to a study published in the European Journal of Gastroenterology & Hepatology, there is a potential association with POTS and celiac disease or gluten sensitivity. In the study, researchers found that about 4% of people with POTS had celiac disease and self-reported gluten sensitivity, compared to only 1% of the general population. It also appears that over 50% of patients with celiac disease (extreme gluten sensitivity) can have evidence of autonomic problems. Because these two conditions may go hand-in-hand, some POTS specialists have started to advise their patients to avoid gluten and dairy-containing foods for a week or two to see if their POTS symptoms improve. If not, there is no harm done. However, if the GI symptoms resolve, even just partially, those dietary changes can help to restore a more normal level of health, functional ability, and happiness.
Dietary changes such as eating small, frequent meals, removing gluten and dairy, and decreasing carbohydrate-laden foods are often helpful to reduce symptoms in some POTS patients. Caffeine may help with the fatigue but might worsen palpitations in some POTS patients. Dietary recommendations should be individualized for each patient. There are a few specialists who care for POTS patients, and they are experienced in helping those patients live a more normal life. For more information on POTS, see the article on this website pertaining to the Postural Tachycardia Syndrome.
Feature image via Practical Neurology