Natural Remedies For POTS

I’ve talked a few times recently about the massive increase in POTS cases we’ve seen (in our functional medicine telehealth clinic and in the general population) since 2020.

POTS, like all inflammatory and autoimmune conditions, exists on a spectrum, and can be triggered by a combination of different factors. No two cases are exactly the same. But that never means we should throw our hands up.

With so many people struggling to get a clear diagnosis or consistent support, I wanted to share with you the best natural remedies for POTS and how you can work them into your individual healing plan.

We’ll also explore what’s really going on in the body with POTS and how it connects to other chronic health conditions in ways you might not be aware of.

What Is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a kind of dysautonomia, meaning that it involves dysfunction of the autonomic nervous system (ANS), the system responsible for regulating involuntary processes like heart rate, blood pressure, digestion, temperature, and breathing.

The hallmark symptom of POTS is orthostatic intolerance, or an abnormally high heart rate upon standing. (1) But this condition can affect the whole body, and often interferes with daily life in multiple ways.

Symptoms of POTS may include: 

• Dizziness or lightheadedness
• Increased heart rate upon standing
• Heart palpitations or chest pain
• Extreme fatigue, especially in the morning
• Sleep disturbances
• Headaches
• Brain fog
• Exercise intolerance
• Shakiness or anxiety
• Visual disturbances
• Intolerances to heat or exercise
• Intolerance to prolonged standing

POTS has been linked to other underlying health conditions and imbalances, including other autoimmune conditions, Ehlers-Danlos syndrome (EDS), mast cell activation syndrome (MCAS), chronic fatigue syndrome, adrenal dysfunction, and irritable bowel syndrome (IBS). (2 - 4) I often see a strong histamine intolerance component as well.

What Causes POTS?

POTS is usually caused by multiple triggers and factors, as opposed to one single cause.

Common causes or triggers may include: 

• Viral or bacterial infections including COVID-19, Lyme disease, Epstein-Barr virus (EBV), or pneumonia (5)
• Micronutrient deficiencies, including magnesium, vitamin D, and/or B vitamins (6)
• Existing autoimmune conditions including Hashimoto’s, Sjögren’s, Celiac disease, or undiagnosed autoimmunity
• Mast cell activation, leading to histamine overload and systemic inflammation
• Connective tissue disorders including Ehlers-Danlos Syndrome (EDS)
• Toxin exposure including to mycotoxins from mold
• Chronic stress or unresolved trauma

There are also different subtypes of POTS with different physiological causes:

• Neuropathic POTS: Caused by nerve dysfunction in the hands and feet (5,6)
• Hyperadrenergic POTS: Caused by too-high volumes of norepinephrine in the blood (5,7)
• Hypovolemic POTS: Caused by reduced blood volume (5)

POTS and COVID-19

Does COVID cause POTS? The answer is a bit more nuanced, but there’s definitely a strong connection. A 2023 review found that between 2 and 14% of people who had recovered from a COVID-19 infection developed POTS within 6-8 months. (7) Given the global infection rates, this translates to millions of potential new POTS cases.

The COVID-POTS connection fits well into the “overflowing bucket” analogy we think about a lot in a functional medicine model of chronic illness. Stressors like gut imbalances, toxin exposure, or chronic stress may have built up over time, but a significant trigger (like COVID or another viral infection, or a traumatic event) causes the overflow of the bucket and brings the dysautonomic condition to the surface.

I wrote in more detail about the POTS and COVID connection here, including the potential roles played by both the virus and the vaccine.

Diagnosis of POTS

The test for POTS typically involves a 10-minute stand test, tilt-table test or both. While the practitioner changes your position, they’ll measure your blood pressure and heart rate. Increases of more than 30 beats per minute while standing indicate POTS. A decrease in blood pressure is also a clue. Other underlying causes and diseases should also be investigated.

There is no single, clear indicator that diagnoses POTS. Much of the evaluation process is focused on excluding other conditions that mimic POTS, or may exacerbate symptoms. Based on these forms of testing, decisions on treatment can be made.

Functional Medicine & Natural Remedies For POTS

Conventional treatments for POTS typically include salt tablets, compression garments (e.g. compression stockings or compression socks), and medications like midodrine or beta blockers.

These can help with symptom relief, but in functional medicine, we want to look for the root cause (why you’re experiencing symptoms) and address the imbalances driving your condition for true healing.

With that in mind, here are a few of the best options for approaching POTS holistically, factoring in the various components of the condition.

#1. Natural Nervous System Regulation

The autonomic nervous system needs to be supported in POTS cases. Generally speaking, we’re looking at a hyperactive sympathetic (fight or flight) response and an underactive parasympathetic (rest and digest) response. And remember that chronic stress and trauma are often underlying causes of POTS, so we need to work to address these as well. We can support nervous system regulation overall through:

• Vagal nerve stimulation: Techniques like humming, gargling, singing, and deep breathing can help tone the vagus nerve and promote parasympathetic activity. (8)
• Mind-body techniques: It’s essential to incorporate mindfulness and stress reduction techniques like meditation, deep breathing, or yoga to balance nervous system activity, reducing stress and overactivation of the sympathetic response.
• Herbal remedies: Adaptogenic herbs including ashwagandha and rhodiola can help to modulate the body’s stress response and promote a calm, balanced state in those whose systems are overactive. (9)

If you suspect that stress is playing a part in your symptoms, take a look at my article The Most Effective Ways To Manage & Reduce Stress In Your Life.

#2. Mast Cell Stabilization and Inflammation Reduction

Mast cell stabilization is an essential and often overlooked component of POTS recovery. Here are some of the best natural remedies to stabilize mast cells, support histamine regulation, and reduce systemic inflammation:

• Vitamin C: Vitamin C is a great natural mast cell stabilizer, providing antioxidant protection and reducing histamine release. (10)
• Quercetin: This flavonoid helps to stabilize mast cells and reduce inflammation. (11)
• Low histamine diet: Not everybody with POTS needs to follow a low histamine diet, but for those who are struggling to find what works, this can be a missing link. On a low histamine diet you’ll avoid histamine-rich foods including aged cheeses, aged meats, and fermented foods.

#3. Electrolyte Support and Blood Volume Optimization

Adequate electrolyte balance is foundational for POTS treatment. We need sufficient sodium, potassium, and magnesium for vascular tone and heart function, and low levels and/or dehydration can exacerbate POTS symptoms. To ensure optimal salt intake, hydration, and circulation, incorporate the following:

• Electrolyte supplementation: Supplemental electrolytes, including sodium, potassium, magnesium, and calcium, help stabilize blood pressure and reduce symptoms like dizziness and fatigue.
• Hydration protocols: Drinking 2-3 liters of water per day (you can add your electrolytes to your water!) can support blood volume and circulation, preventing blood pooling in the lower limbs and improving overall blood flow.

READ MORE: The 10 Most Hydrating Foods + Beverages 

#4. Supplemental Nutrients and Mitochondrial Support

Many patients with POTS experience energy depletion and mitochondrial dysfunction. Supplementing key nutrients can support overall recovery and energy production. Consider the following:

• Magnesium: This mineral is vital for cellular energy production and nervous system function, and can help relax muscles and support cardiovascular health.
• B vitamins: In particular, B1, B6, and B12 are crucial for nerve function and energy metabolism. Many individuals with POTS are deficient in these nutrients.
• CoQ10: This powerful antioxidant is one of the best ways to support mitochondrial function and energy production at the cellular level. (12)
• Glutathione: Glutathione is the body’s “master antioxidant”, and it may be depleted for those with POTS. Supplemental glutathione can help reduce oxidative stress and inflammation.

#5. Gut Healing for POTS

POTS patients often have gastrointestinal dysfunction, either as a contributing factor, an effect of nervous system dysfunction, or both. (13) Issues like dysbiosis, intestinal permeability (leaky gut), and gut infections can exacerbate systemic inflammation and immune dysregulation. Natural remedies to support gut health include:

• Probiotics: To help restore balance to the gut microbiome and reduce systemic inflammation.
• Gut-healing supplements: L-glutamine, slippery elm, and marshmallow root are a few great options to help heal the gut lining and improve gut permeability. (Try my Gut Feelings supplement blends to support both gut healing and healthy brain chemistry.)
• Anti-inflammatory herbs: Herbs like ginger and curcumin (turmeric) can help to soothe the digestive tract and reduce inflammation throughout the body. (14)

To learn more about what you can do for your gut microbiome, check out my Complete Functional Medicine Guide To Restoring Microbiome Health.

#6. Address Hidden Root Causes and Underlying Conditions

To truly heal from POTS, it’s essential to identify and address underlying triggers. This really comes down to specialized testing to help unlock what’s going on behind the scenes. Depending on an individual’s symptoms and health history, I might look into:

• Testing for inflammatory and autoimmune markers: Identifying antibodies can help us figure out what’s going on with the immune system.
• Mycotoxins and mold exposure: Mold and mycotoxins can trigger immune dysregulation and exacerbate POTS. In many cases, it’s worth testing for mold exposure in the environment as well as the presence of mycotoxins in the body (and then we can work to clear out both).
• Viral overload: We know that viral infections can trigger POTS. Supporting immune function and addressing viral load with natural antivirals like olive leaf extract and licorice root.

Additional Considerations

A few foundational notes, too. No matter what chronic condition you’re looking to heal from, I’m always going to recommend a solid foundation of an anti-inflammatory diet, regular exercise, stress management, and a healthy sleep routine.

Although exercise intolerance is associated with POTS, that doesn’t mean you should avoid it altogether. Instead, start slowly and consider horizontally-oriented forms of exercise, such as swimming or rowing. As you get used to it, you can consider different kinds of physical activity.

There are a few other considerations when it comes to avoiding triggers, especially in earlier stages of treatment while your system is still quite reactive.

Higher temperatures can worsen postural tachycardia syndrome. Therefore, you might want to consider what you can do to reduce your exposure to heat.

Alcohol can also affect your nervous system, and you may see an increase in POTS symptoms when you drink alcohol. Consider cutting alcohol out, decreasing your use, or saving it for special occasions.

Personalized Holistic Support For POTS

POTS is a complex, multi-system approach that requires a multifaceted approach. But by using a root-cause lens and focusing on natural remedies, many patients see significant improvements and healing.

If you’re dealing with orthostatic intolerance, chronic fatigue, and other symptoms of POTS, know that you don’t have to rely solely on conventional treatments to mask symptoms. With a comprehensive, natural approach, you can regain internal balance and improve your quality of life.

We work with POTS all the time at my functional medicine telehealth clinic. If you’d like our help with a personalized treatment plan, we’ll work alongside you the whole way.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.