The Lyme & POTS Connection

Do you experience dizziness upon standing, fatigue, nausea, a racing heart rate, or difficulty concentrating?

You might be one of the millions affected by postural orthostatic tachycardia syndrome (POTS). Surprisingly, POTS isn't as rare as previously thought, particularly among those with chronic Lyme disease. It's not just Lyme; there's an overlap of symptoms with other chronic illnesses like chronic fatigue syndrome, fibromyalgia, mast cell activation syndrome, and even long COVID.

Why is that?

POTS can effect people after having both bacterial and viral illness suggesting that there are other microbes beyond Borellia (Lyme) at play, affecting communication throughout the body.

So, what exactly is POTS and how can you improve your quality of life while managing its symptoms?

Let's talk about that.

POTS, short for postural orthostatic tachycardia syndrome, falls under dysautonomia, which encompasses various conditions affecting the autonomic nervous system (ANS). This part of the nervous system is responsible for controlling the automatic functions of the body, including blood pressure, rate of respiration, digestion, and more. In POTS, symptoms arise due to inadequate blood circulation. It's not just a cardiac issue; it's about how blood flows throughout the body, especially when changing positions.

To better understand, let’s look at a breakdown of the acronym POTS:

Postural: Refers to the position of your body

Orthostatic: Pertains to being in an upright position

Tachycardia: Refers the increase in heart rate

Syndrome: Consists of a combination of symptoms, which often occur together

Under normal circumstances, your heart rate and blood pressure work in tandem to maintain sufficient blood flow throughout your body, regardless of your body’s position. But people with POTS have orthostatic intolerance issues, meaning symptoms arise when they move from lying down to an upright position. They might feel dizzy, faint, or experience an increase in heart rate.

There are different subtypes of POTS, each with its unique features.

For instance:

Partial dysautonomic or neuropathic POTS: Nerve damage affects blood vessel constriction, leading to blood pooling in the lower body.

Hyperadrenergic POTS: The sympathetic nervous system goes into overdrive, increasing stress hormones.

Hypovolemic POTS: Low blood volume triggers symptoms.

Secondary POTS: Underlying illnesses like Lyme disease can damage nerves, affecting blood flow.

Common Symptoms

While not exhaustive, here is a list of some of the most common symptoms of POTS.

Heart palpitations

Dizziness, particularly with positional changes

Fatigue

Difficulty concentrating

Abdominal pain

Nausea

Exercise intolerance

Intolerance to hot or cold temperature

Sleep issues

Beyond those, additional symptoms someone with POTS might have include:

Brain fog

Memory issues

Lightheadedness

Noticeable heartbeats, heart palpitations, or changes in heart rate

Chest pain

Shortness of breath

Flu-like symptoms

Headache

Blurry vision

Profuse sweating

Body aches and pains

Flushed skin

Shakiness or tremors

Anxiety

Gastrointestinal distress such as diarrhea or constipation

Testing & Diagnosis

While many conventional doctors aren’t as familiar with POTS, it is common for Lyme Specialists to seeing in their Lyme positive patients. While diagnosing POTS can be challenging, there are tests like the standing test, tilt table test, small fiber biopsy, and blood work can provide insight.

The standing test

This test measures the resting blood pressure and heart rate first with the patient lying flat on the exam table, then with the patient sitting for up to 10 minutes, and finally with the patient standing up for 10 minutes. Those positive for POTS will have an increase in their heart rate of 30 beats per minute or more when they stand.

Tilt table test

This test can help figure out whether your symptoms are due to changes in your heart rate or blood pressure. You’ll lie on a table, and the table will be tilted upright at different angles while your heart rate, blood pressure, and oxygen levels are monitored for changes.

A small fiber biopsy

In this minimally invasive procedure, skin is typically numbed using an injection of the anesthetic, Lidocaine, and then your healthcare provider uses a tool known as a punch to obtain a skin sample. The sample will be viewed under a microscope to evaluate the small sensory nerve fibers in the skin. Those positive for POTS commonly have damaged nerve fibers resulting in the dysregulation of the autonomic nervous system.

Blood work

Blood work is useful to rule out other illnesses that have symptoms similar to those of POTS, such as autoimmune conditions and other potential causes.

Treatment Options

Like many chronic health conditions, there is no one-size-fits-all approach to treating POTS, but identifying the underlying factors and triggers, such as Lyme disease and co-infections, should be top of mind. From there, medication, herbals, and lifestyle modifications can be considered.

Herbal therapy

Balancing hormones and supporting the autonomic nervous system can be quick beneficial for those with POTS. This can be done through herbal therapy. While not everyone will respond successfully, it’s a good place to start before considering medication, as herbals work with the body and are supportive in its natural recovery.

Consider adaptogens such as the following:

Licorice: Restores and supports adrenal function.

Rhodiola: Supports cardiovascular function and immune health and protects the brain and nervous system.

Eleuthero: Assists with contractions of the blood vessels.

Ashwagandha: Balances the HPA axis in the brain, the control center for hormone regulation.

Any of these herbals can be ordered from Fullscript.

Lifestyle modifications

Adjusting your lifestyle can go a long way with POTS symptoms.

Avoid dehydration. Drink at least 8-10 glasses of water a day, and take in up to 8-10 grams of sea salt a day. For those who don’t want to put salt in their water, salt tablets can be purchased.

Wear compression stockings. They improve blood flow in the lower extremities, enhancing circulation throughout the body.

Keep your stress levels in check. Putting yourself in fight or flight can worsen symptoms.

Participate in the right kind of exercise. Choose something that allows you to sit or lay to start, to monitor how your body responds. Many people with POTS and other chronic illnesses have exercise intolerance so increasing exercise should be done slowly and at a pace your body finds comfortable. Pilates is a form of exercise that can be done in a lying or seated position to improve strength, and it can be modified to minimize the worsening of your symptoms.

Incorporate an antiinflammatory diet. Strive to reduce environmental toxins in your food and beverages, and limit processed foods and refined carbohydrates. Ideally, eating organic as much as possible and keeping your total carb count low, will be helpful. Both my Personalized Paleo program and Kleaner Keto program would be helpful here.

Medication

While POTS and Lyme can be life-altering, I prefer to keep medication as a last resort. Many people find that herbals, removing their environmental and dietary triggers, and mindset work does wonders to keep their symptoms in check.

Source: Rawlsmd.com