Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia — a condition in which the autonomic nervous system (ANS) dysfunctions, sending the wrong signals to areas in the body which it controls— heart rate, blood pressure, digestion, temperature regulation, and more. With POTS, the hallmark feature is an abnormal increase in heart rate upon standing, often accompanied by lightheadedness, fainting, brain fog, and debilitating fatigue. But POTS is far more than a heart rate problem; it is a nervous system problem.

It is well recognized that MCAS, hEDS, and POTS — or at least some form of dysautonomia — form what doctors call the trifecta or "unholy trinity," feeding into each other. However, we respectfully disagree with the framing that MCAS and dysautonomia are secondary downstream effects that often require life-altering adjustments in order to manage them long-term. Both of these can be fully reversed. Similarly, hEDS, although a multi-genetic condition, has not yet identified the specific genetics that cause this multi-system connective tissue disorder. Thus, we can also consider it to have the potential for being symptom-free with correct care, routine, and, of course, consideration for the severity of each individual's condition.

POTS is completely reversible. The key is understanding what is driving the autonomic dysfunction in the first place. As with all dysautonomia, there are three main causes:

• Severe or chronic infection or illness — brain-driven
• TBI, concussion, or neck injury — structurally or functionally driven (primary), with brain involvement secondary
• Stress or trauma — brain-driven

Genetic components (such as those in hEDS) can also be a factor, but are rarely the main or prominent driver — though they are often misdiagnosed as such.

It is important to understand the difference between hyperadrenergic POTS and the more common hypovolemic/neuropathic POTS. Hyperadrenergic POTS is characterized by a significant surge of norepinephrine upon standing, causing a dramatic spike in blood pressure (not just heart rate), along with tremor, anxiety, and a feeling of adrenaline flooding the body. This form is often driven by sympathetic nervous system overactivation and can be linked to mast cell activation. The more common form — often called hypovolemic or neuropathic POTS — involves blood pooling in the legs due to poor vascular constriction, leading to low blood volume and a compensatory heart rate spike. Both forms are rooted in autonomic nervous system dysfunction, and both can be improved and reversed when the underlying drivers are addressed.

The conventional approach to POTS diagnosis and treatment is limited. A tilt table test is the standard diagnostic tool, but it only confirms that the heart rate increases upon a postural change — it tells you that POTS is happening, not why. This is why Dr. Kiser and the Kiser Clinic have become a gold standard for POTS evaluation. Their functional neurology approach goes far beyond the tilt table — evaluating the brain, the autonomic nervous system, the vagus nerve, structural cervical issues, and the neurological pathways that govern autonomic function. Through comprehensive neurological examination, oculomotor testing, balance and vestibular assessment, and functional brain mapping, the Kiser Clinic identifies the specific areas of brain and nervous system dysfunction driving each patient's POTS. This is the difference between being told "you have POTS, take a beta-blocker and drink more salt water" and actually understanding which part of the nervous system is misfiring and why.

The Kessler Institute is another leading institution heading and instructing functional neurological approaches to POTS and dysautonomia. Their work in neurorehabilitation and functional neurology has demonstrated that the brain's neuroplasticity — its ability to rewire and reorganize — can be harnessed to restore proper autonomic function. Through targeted neurological rehabilitation, vestibular therapy, oculomotor training, and cerebellar stimulation, they help retrain the brain to send proper signals to the autonomic nervous system. This approach treats POTS at its source — the brain and nervous system — rather than simply managing the downstream symptoms.

As Dr. Cathleen King, founder of Primal Trust, explains: "Chronic illness is often a nervous system stuck in threat physiology. Symptoms can become neural memory loops — not ongoing damage. When we rewire the brain and regulate the nervous system, the body can begin to heal." Because POTS is, by definition, an autonomic nervous system dysfunction, the nervous system is one of the main root causes — and addressing it is not optional. A body stuck in chronic fight-or-flight cannot regulate heart rate, blood pressure, or blood flow properly. The alarm keeps sounding, and the autonomic system stays dysregulated.

The same first vital steps apply here as with all forms of dysautonomia: start with nervous system retraining and brain rewiring. Programs like Primal Trust, neuro-somatic regulation, vagus nerve stimulation, and functional neurology can calm the threat physiology that keeps the autonomic nervous system stuck. For many POTS patients, starting here — before chasing every infection, supplement, or medication — has resulted in significant improvement, and in some cases, full resolution of the condition. This does not mean other drivers should be ignored; infections, structural issues, hEDS, MCAS, and toxicity may all need to be addressed. But the nervous system is the foundation upon which all other healing depends.

hEDS can certainly exacerbate POTS, since connective tissue laxity and increased joint flexibility in the cervical spine can lead to structural and neurological complications that directly impact autonomic function. The combination of hEDS and POTS is common, and addressing the structural cervical instability alongside nervous system retraining is often essential.

POTS is not a life sentence. It is an autonomic nervous system dysfunction — and the nervous system can be retrained. The same brain that learned to send the wrong signals can learn to send the right ones. You can find practitioners who understand the functional neurology and nervous system approach to POTS here.