Struggling with POTS (Postural Orthostatic Tachycardia Syndrome)? Functional medicine physician Dr. Alison shares her personal POTS recovery story and comprehensive treatment strategies.
Topics covered:
✓ POTS symptoms, diagnosis & subtypes (hypovolemic, neuropathic, hyperadrenergic)
✓ Long COVID and viral-induced POTS
✓ Why doctors dismiss POTS as anxiety
✓ Root causes: EBV, MCAS, dysautonomia, autoimmunity
✓ Compression socks & garments for POTS
✓ FL-41 glasses for light sensitivity
✓ Heart rate monitoring & wearables (Oura, Apple Watch, Visible)
✓ Hydration & electrolyte strategies
✓ Nervous system support & vagal toning
✓ Iron deficiency in POTS
✓ Beta-blockers vs. functional medicine approaches
✓ POTS and chronic illness management
Perfect for POTS patients, long-haulers, chronic illness warriors, and anyone seeking functional medicine solutions beyond standard care.
Learn more: www.LittleBlackBagMedicine.com
Listen here:
Transcript:
Welcome back to Functional Wellness with Dr. Alison – medicine for the body, heart, and soul. I’m Dr. Alison DiBarto Goggin, and today we’re talking about Living Well With POTS: Tools, Tech, and Truth.
POTS is a complex issue. It’s extremely frustrating and debilitating to live with, and honestly, it’s one of those conditions where the medical system often fails people. I want to give you what I’ve seen working with my patients over the years, share my own personal experience with it, and I’m genuinely interested in hearing what works for you too. So please, reach out on Instagram or leave a comment and let me know what’s helped you manage POTS because this is one of those conditions where we learn so much from each other’s experiences.
2. PERSONAL STORY
My personal story with POTS is relatively straightforward compared to what many of you are dealing with, but I think it’s a good example of what your average person experiencing this issue goes through.
Over the winter of 2024-2025, I got absolutely hammered by infections. First COVID, then the flu – and I’m not exaggerating when I say about five times – and then Epstein-Barr decided to reactivate and come along for the ride. It was a perfect storm of viral chaos in my body.
I had all the classic long-hauler symptoms. I developed new asthma and needed my first inhaler ever at this stage of my life, which was surreal. The crushing fatigue where even thinking felt exhausting. Muscle and joint pain that made everything hurt. And then came the new symptom I wasn’t expecting: POTS.
Mine was clearly viral-induced, and I had the classic presentation – heart rate jumping from 90 to 150 beats per minute just because I turned over in bed, or stood up, or did something completely mundane that should not cause your heart to race like you’re running a marathon. I wasn’t able to walk more than a few feet before I needed to sit down and take a break. Just getting from my bedroom to the kitchen felt like climbing a mountain.
It was incredibly taxing on my entire life. I’m a physician, I have patients who need me, I have a family, and suddenly I couldn’t function. I ended up needing beta-blockers just to work and get through basic daily activities.
So I started researching, as I do, and I heard about nicotine patches helping with long-haulers. Now, I had already done extensive research on nicotine for a previous podcast episode – I’ll link that in the show notes because I go into the physiology and the why behind nicotine’s effects on the nervous system. But I want to be very clear: this is my personal story, not medical advice. I’m sharing what I tried on myself as an informed physician who understood the risks and mechanisms.
I started using 7mg nicotine patches daily. The first weekend was absolutely brutal – all of my symptoms flared like crazy. My heart rate was all over the place, my energy was nonexistent, everything felt worse. I literally laid on the couch and played video games, trying to never move because any movement made everything worse.
But after that first week, I started to see some progress. Small improvements at first – maybe I could walk to the kitchen without my heart exploding. After five weeks, my long-hauler symptoms were completely resolved, including the crazy heart rate changes. My POTS was gone.
Now, I’m sharing this because I want you to understand something important: nicotine is not a cure for POTS. What worked for me worked because we addressed my root cause, which was a viral issue triggering dysfunction in my nervous system. The nicotine helped modulate the inflammatory response and supported the cholinergic pathways that were disrupted by the viral infections. Your root cause might be completely different, which is why we need to figure out what’s driving YOUR POTS specifically.
3. WHAT IS POTS
So let’s talk about what POTS actually is, because understanding this will help you advocate for yourself and make sense of what’s happening in your body.
POTS stands for Postural Orthostatic Tachycardia Syndrome. Let’s break that down: “postural” means related to your body position, “orthostatic” means related to standing upright, and “tachycardia” means fast heart rate. Put it together and you get: a syndrome where changing your posture or position causes abnormal changes in your blood pressure and heart rate.
What does this look like in real life? Your heart rate elevates significantly – we’re talking an increase of 30 beats per minute or more within 10 minutes of standing, or a heart rate that goes above 120 beats per minute when you stand – and this causes a cascade of symptoms: lightheadedness, dizziness, nausea, chest pain, palpitations, brain fog, fatigue, weakness, and sometimes even fainting.
But POTS isn’t just about standing up. Many people also experience issues with fluorescent lighting – you walk into a grocery store or Target and suddenly feel dizzy, overstimulated, nauseous, like the lights are physically assaulting your nervous system. You might have difficulty breathing, that sensation of air hunger where you can’t quite catch your breath even though your lungs are working fine. Some people lose consciousness, which is terrifying and dangerous.
Technically, the gold standard for diagnosing POTS is something called a tilt table test. This is where you lie flat on a special table that monitors your heart rate, blood pressure, and sometimes other vital signs. Then they tilt the table upright to about 70 degrees and watch what happens to your body over 10 to 45 minutes. They’re looking for that significant heart rate increase without a corresponding drop in blood pressure, which would indicate a different condition. It’s not a fun test – many people feel absolutely terrible during it – but it gives objective data that can be hard to argue with.
The current standard medical treatment is beta-blockers, which slow down your heart rate and can help manage symptoms. But here’s the thing – beta-blockers are symptom management, not root cause treatment. They can be incredibly helpful and life-saving for some people, and I’m not anti-medication by any means. But they’re not addressing why your body is doing this in the first place.
Now, POTS isn’t just one thing. There are several subtypes, and understanding which type you have is crucial for effective treatment:
Hypovolemic POTS is characterized by low blood volume. Your body literally doesn’t have enough fluid circulating, so when you stand up, there’s not enough blood getting to your brain and upper body. This type often responds well to increasing salt and fluid intake, compression garments, and addressing whatever is causing the low blood volume in the first place.
Neuropathic POTS is characterized by a decrease in sympathetic nervous system function, particularly in the legs. This is often associated with small fiber neuropathy, where the tiny nerve fibers that help regulate blood vessel constriction aren’t working properly. When you stand up, the blood vessels in your legs don’t constrict the way they should to push blood back up to your heart and brain, so blood pools in your lower body. This type is sometimes treated with medications like midodrine or acetylcholinesterase inhibitors like pyridostigmine, which help improve the nerve signaling.
Hyperadrenergic POTS is characterized by an overactive sympathetic nervous system. Your body is producing too much norepinephrine – one of your main stress hormones and neurotransmitters. Technically, this is defined as plasma norepinephrine levels greater than 600 picograms per milliliter and a systolic blood pressure rise of more than 10 points when standing for 10 minutes. People with this type often feel wired, anxious, jittery, and may have more pronounced symptoms with stress or certain foods. This is the type most commonly treated with beta-blockers because we’re trying to calm down that overactive sympathetic response.
Some people have a combination of these types, which makes treatment more complex but not impossible.
4. THE MEDICAL SYSTEM EXPERIENCE
So what usually happens when you suspect you have POTS? Let me walk you through the typical experience, because I hear this story over and over from my patients, and it’s frustrating and demoralizing.
Usually, you’ll be referred to a cardiologist. From what I’ve heard from my patients, you wait a few months to be seen while you’re suffering and trying to function despite feeling absolutely terrible. Then you finally get your appointment, and you go in hoping for help, hoping someone will believe you and figure out what’s wrong.
And then one of a few things happens:
Sometimes they don’t believe you. They look at your EKG, maybe do an echocardiogram, everything looks “normal” on the tests they run, and they tell you it’s anxiety. They might even suggest you see a therapist instead of treating this as a physical condition. This is especially common for women, and it’s medical gaslighting at its finest.
Or, if you’re lucky, they do believe you. They recognize the pattern, maybe they’ve seen POTS before. But then they tell you it’s a nervous system disorder, it’s dysautonomia, and you need to see a dysautonomia specialist. Except those specialists barely exist. There are maybe a handful in the entire country who actually specialize in dysautonomia, and they’re booked out for a year or more.
So you’re left with a diagnosis, maybe a prescription for beta-blockers or midodrine or increased salt intake, and these medications might help or they might not help, but you’re still suffering. You’re still unable to live your life the way you want to. You can’t exercise, you can’t stand for long periods, you can’t do basic activities without planning for rest breaks. It’s a horrible process.
Now, there are some amazing cardiologists out there who are really trying to help, who understand POTS, who will work with you to find solutions. But there aren’t enough of them, and there isn’t enough research funding going into POTS to give doctors the tools they need to help you effectively.
One thing that can help: bringing data. If you have a wearable device like an Apple Watch, Oura Ring, Whoop band, or any fitness tracker that monitors your heart rate, screenshot or download your data showing those heart rate spikes. Bring it to your appointment. Sometimes seeing objective data makes doctors take it more seriously. Maybe they’ll order the tilt table test, maybe they’ll try different medications, but at least you’re giving them something concrete to work with.
5. ROOT CAUSES
So let’s talk about root causes, because this is where functional medicine really shines. We’re not just asking “how do we manage these symptoms?” We’re asking “why is this happening in the first place, and what can we do to address the underlying dysfunction?”
It definitely depends on the type of POTS you have:
If you have hypovolemic POTS – low blood volume – we need to look at hydration, salt intake, movement patterns, and your digestion, particularly large intestine absorption of water. Your large intestine’s main job is to absorb water and minerals and house your microbiome. If you’re not holding onto hydration despite drinking plenty of water, there may be issues here. There could be bacterial overgrowths like SIBO or IMO, infections, inflammation, or motility problems that impact how your body absorbs and retains water. This tends to be pretty straightforward to work on once we identify what’s going on.
With neuropathic and hyperadrenergic POTS, there are many potential root causes. You might have several of them or just one driving factor. Let me walk through the main ones:
First: Dysautonomia. This is dysfunction of your autonomic nervous system, which controls all the automatic functions of your body – heart rate, blood pressure, digestion, temperature regulation, everything you don’t consciously think about. We need to support and retrain this system, which we’ll talk about in the treatment section.
Second: Viral infections. This is what happened to me. Viruses like Epstein-Barr, COVID, influenza, and others can disrupt your nervous system function and trigger inflammatory responses that lead to POTS. Even after the active infection clears, viral particles and inflammatory signals can persist and continue causing dysfunction. This is incredibly common with long COVID but can happen with any significant viral infection.
Third: Mast Cell Activation Syndrome, or MCAS. This is extremely commonly associated with POTS, and they often co-trigger each other. I wouldn’t say that MCAS causes POTS or vice versa, but they frequently occur together because both involve dysregulation of your nervous system and immune system. When your mast cells are overreactive, releasing histamine and other inflammatory mediators, this can absolutely affect your autonomic nervous system and contribute to POTS symptoms.
Fourth: Ehlers-Danlos Syndrome and connective tissue disorders. If your connective tissue is more lax or fragile, your blood vessels don’t constrict and dilate as effectively, which can lead to blood pooling and POTS symptoms.
Fifth: Autoimmune conditions. We know that autoimmune antibodies can target components of the autonomic nervous system, leading to dysfunction. This has been documented in conditions like autoimmune autonomic ganglionopathy.
Sixth: Nutritional deficiencies, particularly B vitamins, iron, and magnesium, which are crucial for nervous system function and red blood cell production.
Seventh: Deconditioning. Sometimes POTS develops after prolonged bed rest or illness when your cardiovascular system loses its conditioning. This is tricky because exercise can trigger POTS symptoms, but appropriate reconditioning can also help improve them. It’s a delicate balance.
The key is figuring out which of these factors are at play for YOU specifically, because that determines what treatments will actually work.
6. FUNCTIONAL SUPPORT OPTIONS
Now, let’s talk about how we support your nervous system, hydration, and overall system so you can actually function. I want to say this upfront: if medication is helping you, that’s wonderful. There is absolutely no reason to jump off of it and risk making things worse. You can work on your health and POTS alongside the medications. This is not an either-or situation.
Let me walk through the functional medicine options by category:
LIGHTING AND SENSORY SUPPORT
This is my new intrigue, and I’m so excited to share this with you because it can make such a practical difference in daily life.
You’re probably struggling with grocery shopping, going into fluorescent-lit places, feeling dizzy, overstimulated, and just weird. I know I do. The good news is there are glasses specifically designed to help with this.
Look for FL-41 lens options. These are rose-tinted lenses that filter out the specific wavelengths of fluorescent lighting that trigger symptoms. You can get them from:
- TheraSpecs (these are specifically designed for light sensitivity)
- Axon Optics (another company specializing in FL-41 lenses)
- Zenni Optical (much more budget-friendly option)
You can usually get them as regular glasses, clip-ons that go over your existing glasses, or fit-over styles. They come in both prescription and non-prescription options depending on what you need.
If FL-41 isn’t strong enough for your sensitivity, there’s a brand called Avulux that makes even stronger lenses specifically for severe fluorescent and light sensitivity.
For screen-heavy evenings, consider getting a separate pair of amber or orange-tinted glasses. These help filter blue light and can support your nervous system’s ability to wind down in the evening.
HYDRATION SUPPORT
This is absolutely crucial for all types of POTS, but especially hypovolemic POTS.
IV hydration can be a game-changer. You have several options for accessing this:
- Urgent care centers can often provide IV fluids, especially if you explain you have POTS
- Infusion clinics, which may require a prescription from your doctor
- IV therapy spas or nurse practitioner offices that offer this service (though this can be expensive if insurance doesn’t cover it)
For daily hydration support:
- Hydration drinks like Liquid IV, LMNT, or Ultima Replenisher that provide electrolytes, not just water
- Increasing salt intake – yes, really. Most POTS patients need significantly more salt than the average person. We’re talking 6,000 to 10,000 milligrams of sodium per day. Talk to your doctor about what’s appropriate for you, especially if you have any kidney issues or high blood pressure.
Now, here’s where the large intestine comes in. Your colon’s main job is to absorb water and minerals and be the home for your microbiome. If you’re not retaining hydration well despite drinking all the water and taking in salt, there may be issues with your gut.
We can do a comprehensive stool test to look for bacterial overgrowths, parasites, inflammatory markers, or other specific issues affecting absorption. Based on what we find, treatment might include:
- Probiotics to support healthy bacterial balance
- Antimicrobial herbs or medications to address overgrowths
- Fiber or binders to support proper intestinal function and reduce endotoxin load
- Digestive enzymes to improve overall gut function
There’s a lot of personalized work to be done here, so I don’t want to spend too much time on specifics because it really depends on what’s going on in YOUR gut. But I want to bring this to your awareness because it’s often overlooked.
VIRAL SUPPORT
If your POTS is viral-related, you have several options.
Nicotine patches – specifically the 7mg patches – can help modulate the inflammatory response and support cholinergic pathways. Again, this is based on my personal experience and emerging research, not standard medical advice. Work with a knowledgeable practitioner if you’re considering this approach.
There are also enzymes that have antiviral and anti-inflammatory properties:
- Monolaurin (derived from coconut)
- Nattokinase (from fermented soybeans)
- Serratiopeptidase (proteolytic enzyme)
- Lumbrokinase (from earthworms, sounds gross but very effective)
Important note: if you also have autoimmunity, you want to avoid immune stimulators that push you toward either Th1 or Th2 dominance. The enzymes I mentioned are all immune-neutral, meaning they support your body’s natural processes without pushing your immune system in one direction or another. This is crucial because we don’t want to inadvertently trigger an autoimmune flare while treating your POTS.
COMPRESSION WEAR
Compression socks and garments can be incredibly helpful because they prevent blood from pooling in your lower extremities when you stand.
There are so many options out there. My personal favorites are toeless compression socks – I wore these during all of my hospital clinical rotations. They’re more comfortable than full-coverage socks and you can still wear your regular shoes.
You want medical-grade compression, typically 20-30 mmHg for POTS. Some people need higher compression like 30-40 mmHg, but start lower and work your way up because high compression can be uncomfortable if you’re not used to it.
Beyond socks, there are more structured supports:
- Compression stockings that go thigh-high or waist-high
- Abdominal binders that provide compression around your core
- Full compression garments
Many people find that compression helps not just with POTS symptoms but also with pain management and lymphatic flow.
WEARABLES AND TRACKING
This can be so important because these devices tell you everything about your heart rate variability, when your heart rate is starting to spike and you need to rest, what activities are causing overexertion or overtraining. And yes, overtraining for someone with POTS can mean just folding laundry. Maybe you need to do that sitting down rather than standing up and bending over the couch or bed.
Visible is a patient favorite of mine – it’s an app paired with any wearable that helps you track your symptoms and learn your limits. But you can also use any watch or ring that you prefer – Apple Watch, Oura Ring, Whoop, Fitbit, Garmin, whatever works for you and tracks heart rate continuously.
There’s a new option called Lumia Health earrings, which are designed to track blood flow to your head by monitoring perfusion in your earlobe. In theory, this could be valuable for POTS since blood flow to the brain is exactly what we’re concerned about. However, I’m not entirely convinced this is the best approach yet. They’re quite expensive, the accuracy hasn’t been thoroughly validated in independent studies, and I question whether the external ear is the best measurement site. We know that cold extremities – including ears – can be influenced by food sensitivities, thyroid function, and other factors that might affect the reading. So I’d say wait on this technology until we have more data, unless you have the budget to experiment and are curious about the data.
IRON AND ANEMIA
This is one of my top places to look when someone has POTS. Iron deficiency, even without frank anemia, can significantly worsen POTS symptoms because your body needs iron to transport oxygen effectively.
Get your iron panel checked – not just hemoglobin, but ferritin (your iron stores), serum iron, TIBC (total iron binding capacity), and transferrin saturation. For POTS patients, I like to see ferritin above 50, ideally closer to 80-100, even though the “normal” range goes much lower.
If you’re low, you’ll need to supplement. Iron supplementation can be tricky because it can cause constipation and stomach upset. I often recommend:
- Taking iron with vitamin C to enhance absorption
- Trying different forms – some people tolerate ferrous bisglycinate better than ferrous sulfate
- Taking it on an empty stomach if you can tolerate it, or with food if you can’t
- Avoiding taking it with coffee, tea, or calcium, which all inhibit iron absorption
DYSAUTONOMIA SUPPORT
This is about retraining and supporting your autonomic nervous system, and there are several approaches:
Craniosacral therapy can be incredibly helpful. This is a gentle manual therapy that works with the nervous system through very light touch, primarily on the head, spine, and sacrum. Find a massage therapist, physical therapist, or chiropractor who specializes in this technique. It’s subtle but can have profound effects on nervous system regulation.
The Safe and Sound Protocol and vagal toning exercises. You mentioned salamander exercises – these are actually part of a broader set of exercises developed by Dr. Stephen Porges based on Polyvagal Theory. They use eye movements, head movements, and specific physical positions to activate and strengthen the vagal pathways that help regulate your autonomic nervous system. There are YouTube videos demonstrating these, or you can work with a practitioner trained in this approach.
Breathing exercises and HRV training. Simple diaphragmatic breathing, box breathing (inhale for 4, hold for 4, exhale for 4, hold for 4), and extended exhale breathing (inhale for 4, exhale for 6 or 8) all stimulate the vagus nerve and shift your nervous system toward parasympathetic (rest and digest) function. You can also use HRV biofeedback apps to train your system over time.
Vestibular rehabilitation. This is physical therapy specifically designed to retrain your balance and vestibular system, which is often disrupted in POTS. These exercises combine eye movements, head movements, and balance challenges to strengthen the connection between your inner ear, vision, and nervous system.
I also give my patients my personalized neurobalance program that combines concussion physical therapy protocols with breathing exercises and gradual reconditioning. This helps target the brain and nervous system to reduce overstimulation while also strengthening the brain so that stimulation becomes less overwhelming over time.
7. CONCLUSION
Overall, there are many supports you can use for POTS, and knowing what type you have is the most important first step. We talked about a lot of different options today, and I don’t want you to feel overwhelmed like you need to do everything at once.
Start with one or two interventions that feel most accessible or relevant to your situation. Maybe that’s compression socks and increasing your salt intake. Maybe it’s getting those FL-41 glasses and trying craniosacral therapy. Maybe it’s addressing the viral component or testing your iron levels.
See what combinations work best for you, and remember that everyone will be a little different. What works amazingly for one person might not help another, and that’s okay. Keep trying, keep tracking, keep advocating for yourself.
One more important thing: when you have flares, look back over the last three days, not just what you did that day. Our nervous system and body don’t always react immediately. Sometimes there’s a delayed response – you overdo it on Monday, feel okay Tuesday, and crash on Wednesday. So when you’re trying to figure out your triggers, think about the bigger picture.
And if you’re looking for personalized care, if you’re tired of trying to figure this out on your own and you want someone to do a deep dive into your labs, your health history, and make the right plan specifically for you, you can schedule with me. We’ll look at everything comprehensively and create a roadmap that actually makes sense for your body and your life.
Thanks so much for listening. If this episode was helpful, please subscribe, share it with someone who’s struggling with POTS, and tune in next week for more functional wellness. Take care of yourself, and remember – you’re not broken, your body is trying to protect you. We just need to figure out from what.