POTS and COVID-19: Is It the Virus or the Vaccine?

In my functional medicine telehealth practice, I’m seeing more of the dysautonomic condition POTS than ever.

This once underrecognized condition has been making the news because of its connection to COVID. But there are still a lot of questions, and today I’m going to dig into them.

For example, if you’re experiencing dizziness, fatigue, brain fog, and headaches, is it long COVID, is it POTS, or is it both? What’s the connection between COVID-19 and POTS? Is it the virus or the vaccine that’s triggering dysautonomia?

What makes someone more likely to develop POTS after a COVID infection or vaccination? What kinds of tests can help? And what is the functional medicine approach to treatment? We’ll get into all of it.

And let me just address some of the controversy around this topic upfront.

I know a lot of people— including a lot of clinicians— who are afraid to question vaccine safety. But it’s important for us to look critically at what we’re putting into our bodies. Almost nothing is black and white— vaccinations can save lives and they may cause problems for some.

And if we can identify risk factors that might make someone more susceptible to reacting badly to a vaccine, we can take steps to mitigate that risk.

I have dedicated my life to helping people improve their health, and I wouldn’t be doing my job if I didn’t explore these questions head-on. With that in mind, let’s take a look at what we know.

An Overview of POTS

Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia, or a syndrome that affects the autonomic nervous system (ANS).

The ANS regulates the kinds of bodily functions that we don’t consciously control. This includes things like breathing, blood pressure, temperature regulation, heart rate, digestion, and sweating.

Dysautonomia occurs when something goes wrong within that system. In the case of POTS, the hallmark issue is orthostatic intolerance, or an abnormally high heart rate when standing up.

This can lead to sudden symptoms upon standing including lightheadedness or dizziness, a rapid heartbeat or palpitations, and in some cases fainting.

Symptoms of POTS may include: 

• Intolerance to standing
• Orthostatic intolerance (abnormally high heart rate when standing)
• Dizziness or lightheadedness
• Fatigue (often worse in the morning)
• General weakness
• Muscle pain
• Headaches
• Nausea, vomiting, or other digestive symptoms

POTS can affect anyone, but is seen most commonly in females between the ages of 15 and 50. The prevalence in the US is thought to have increased since the start of the COVID-19 pandemic.

There are several possible causes of POTS, and in most cases it’s likely a combination of different contributing factors. There are also certain risk factors that can make you more likely to develop POTS.

Causes of and risk factors for POTS include: 

• Viral or bacterial infections including Lyme disease, Epstein-Barr virus, pneumonia, or COVID
• Micronutrient deficiencies including vitamins E, B1, B3, B6, and B12
• Autoimmunity; an existing autoimmune condition including Hashimoto’s, Sjogren’s, or celiac disease
• Toxin exposure
• Chronic stress or history of trauma
• Variants in certain genes including NOS3 and ADRB2
• Dysfunction of the sympathetic branch of the autonomic nervous system (impaired fight or flight response)
• Mast cell dysfunction or disorder
• Connective tissue disorders including Ehlers-Danlos syndrome (EDS)

An Overview of Long COVID

Long COVID, which also goes by several other names including post-COVID syndrome, post-acute COVID syndrome, and long haul COVID, occurs when a person experiences ongoing or long term symptoms following a COVID-19 infection.

Symptoms can last for weeks or months (sometimes a year or longer). Often, these longer term effects are different from the initial COVID-19 symptoms.

Symptoms of long COVID may include: 

• Chronic fatigue
• Brain fog, memory issues, or difficulty concentrating
• Digestive symptoms
• Post-exertional malaise (excessive fatigue after activity or exercise)
• Tinnitus, vibrating sensation in body, or other neurological changes
• Shortness of breath or chest pain
• Joint and/or muscle pain; general feeling of discomfort
• Difficulty sleeping
• Rashes or skin issues
• Autonomic dysfunction, including POTS

LISTEN: Jedediah Bila: Overcoming Chronic Lyme, Long COVID + How To Ghost Your Cell Phone To Take Back Your Life | Dr. Will Cole 

POTS After COVID-19: What’s the Connection?

After a COVID infection, some people develop dysautonomia, which may include POTS. According to some estimates, up to 14% of people may develop POTS after COVID. (1)

And up to 61% may develop symptoms that could be attributable to POTS (even if there’s no POTS diagnosis), including orthostatic intolerance, dysautonomia, and fatigue. (1)

Post-COVID POTS symptoms typically start between 6 and 8 months after an active SARS-CoV-2 infection, but this can definitely vary. (2)

We know that POTS can be triggered by various different kinds of viral and bacterial infections, so it may not be surprising that the virus that causes COVID can be a trigger.

In the case of COVID, research has shown that both the virus and the vaccine can trigger POTS.

What Causes POTS After COVID?

There are several ideas about what may be happening in the body to trigger POTS following a COVID infection or vaccine. As with most kinds of chronic illness, there likely isn’t one right answer— the mechanism will look a little different for everyone.

Here are two of the primary theories behind the connection:

#1. Immune System Overreactivity & Autoimmunity

For some people, a COVID (or other) infection may lead to an uncontrolled immune response and excessive inflammation, known as a cytokine storm. (3) The vaccine may also trigger an outsized inflammatory reaction for some people.

This immune system reactivity can lead to (or exacerbate) autoimmunity, causing the immune system to attack the self. The body may create autoantibodies to the ANS, triggering autonomic nervous system dysfunction including POTS. (1)

#2. A Direct Attack On the Brain

In some cases, the virus that causes COVID may directly attack parts of the brain that are involved in autonomic nervous system function, including the hypothalamus and the pituitary gland. (4) The virus may also directly affect the cardiovascular system. (2)

COVID may also disrupt a mechanism called neurovascular coupling, which is involved in adjusting blood flow to the brain based on brain activity. (5) This can affect overall nervous system function, and may contribute to dysautonomia, including POTS.

Is It the Virus or the Vaccine?

The short answer is that both the COVID virus and the COVID vaccine have been shown to cause or trigger POTS for some people. (6)

Here’s a summary of what we know from the available research so far (which has several limitations): (7)

• Both the COVID virus and the COVID vaccine can trigger POTS.
• The virus is more likely to trigger POTS than the vaccine.
• The risk of developing POTS is higher 90 days after a COVID-19 vaccination compared with 90 days before vaccination. (2)
• Other types of vaccines, including the Gardasil vaccine for human papillomavirus (HPV), have also been linked to the development of POTS. (8)
• Those who are unvaccinated and do get a COVID infection are five times more likely to develop POTS after the infection than those who have been vaccinated. (2)

More research is being called for (and is underway) to help us better understand the connections between POTS, the COVID virus, and the COVID vaccine. (6)

Should You Get the Vaccine?

The COVID vaccine has been shown to help reduce the risk of severe symptoms, hospitalization, and death. And, for some people (especially those with underlying risk factors), it can trigger or exacerbate serious health problems. It’s not either/or, it’s both/and.

I’ve seen a lot of people dismissing the research on COVID vaccines triggering POTS because of the fact that the virus may trigger it more often. We need to continue to look at both.

Ultimately, I believe everyone should be able to decide for themselves whether or not they get a COVID vaccine.

Part of that decision process should likely involve finding out if you have any risk factors for an autoimmune reaction that could trigger POTS (see more on risk factors below).

You can work with a functional medicine practitioner to evaluate your risk profile and help support your body through whatever you choose to do.

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Risk Factors

Not everyone gets POTS after COVID.

So from a functional medicine perspective, the question we’re really looking to answer when we see something like post-COVID-19 POTS is: why was someone’s body so susceptible to having this kind of reaction to a viral infection or a vaccine? What kind of underlying imbalances may be present?

As I write about in my book The Inflammation Spectrum, inflammation and autoimmunity occur on a spectrum. Many people have these underlying issues without realizing it, and most conventional doctors don’t really pay attention to the warning signs until a substantial amount of damage has been done.

These are the kinds of risk factors that can make someone more susceptible to getting POTS after a COVID infection or vaccination.

Here’s a list of potential risk factors: 

• Being a female of reproductive age
• Autoimmunity or a known autoimmune and/or inflammatory condition
• Gut microbiome imbalance and/or increased intestinal permeability (leaky gut)
• Mast cell activation syndrome (MCAS) (9)
• Mold or toxin exposure (10)
• History of trauma and/or chronic or severe stress
• Hypermobile Ehler-Danlos syndrome (EDS)
• Underlying medical issues including diabetes or cardiovascular disease

Testing For Underlying Imbalances

If you or someone you know has developed POTS following a COVID infection or vaccine, one of the most important steps to take towards healing is identifying what kinds of underlying imbalances may have caused this reaction.

Untangling these root causes will help you heal holistically rather than just managing your symptoms.

Different kinds of tests that may help to identify underlying imbalances or triggers might include:

• Immune system profiling and testing for markers of inflammation and autoimmunity
• Micronutrient deficiency testing
• Gut microbiome analysis
• Food sensitivity testing
• Comprehensive hormone testing including cortisol
• Mycotoxin (mold toxin) testing

These are just a few of the kinds of tests we might recommend at our functional medicine telehealth clinic, depending on your individual case, symptoms, and health history.

Treatment Options For Post-COVID POTS

Conventional POTS treatment generally involves some combination of supplementation with salt tablets, getting lots of hydration, wearing compression stockings, elevated the head of the bed, and medication such as midodrine in some cases.

Beyond these interventions and treatments (many of which are helpful and necessary, like staying hydrated), in functional medicine we also want to go a bit deeper.

POTS is a complex, multifaceted condition, and requires a comprehensive, personalized, root-cause based approach, focusing on addressing underlying imbalances.

While this looks a little different for everyone, here are a few treatments and remedies you may find helpful. Of course, it’s best to speak with a trusted healthcare provider before making any changes.

• Follow an anti-inflammatory, immune supportive diet consisting of whole foods. Work on identifying any hidden dietary triggers that may be affecting your symptoms.
• Incorporate regular aerobic exercise into your routine. This has long been shown to be one of the most effective treatments for POTS. Just make sure to choose safe options (for example a stationary bike) and/or work with a practitioner if your orthostatic intolerance and/or dizziness interfere with exercise.
• Take plenty of time for rest, including nourishing sleep and mindfulness practices like breathing exercises and meditation to help calm the nervous and immune systems.
• Make sure to get adequate hydration and sufficient salt intake, especially if your blood pressure is low. Work with your practitioner to determine how much of each is best for you.
• Try eating more frequent, smaller meals in order to avoid big blood flow changes associated with digestion.
• Support energy production and reduce oxidative stress and inflammation with glutathione, the body’s master antioxidant (glutathione can be taken as a supplement).
• Replenish deficient nutrients. In the case of POTS, deficiencies often include vitamin D, vitamin E, and various B vitamins. Supplements and/or food sources can help to bring your energy back up.
• Reduce inflammation naturally with the powerful plant compound berberine (this is one of my go-to supports for immune function and digestive health, and you can find my own berberine supplement here).
• Address underlying gut health imbalances with probiotics and/or prebiotics.
• Try humming, gargling, and/or singing to stimulate the vagus nerve, which can help to regulate your stress response and relax an overstimulated body.
• Consider low dose naltrexone (LDN), a medication that can be used off-label to help modulate the immune system and reduce inflammation. This isn’t necessary for everyone, but can be very helpful for some when used short term.

READ NEXT: Boost Your Immune System + Fight Off Sickness With These 2 Superstar Vitamins | Dr. Will Cole 

A Final Word on COVID and POTS

The connections between COVID and POTS may seem overwhelming, but with the right understanding and approach, it’s possible to untangle the web and get your quality of life back.

Given the multifaceted nature of both long COVID and POTS, I would always recommend a bio-individualized approach that addresses your specific imbalances and helps to heal and restore your body’s natural functions.

We’ve worked with many COVID-related POTS cases at our functional medicine telehealth clinic. Please reach out if you would like to learn more.

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