POTS (Postural Orthostatic Tachycardia Syndrome)
When standing up becomes the hardest thing you do.
Most people take it for granted that they can move from lying down to standing without consequence. For people with POTS, that simple act triggers a cascade of physiological responses that can leave them dizzy, breathless, heart-racing, and struggling to remain upright. On a bad day, it can mean not getting out of bed at all.
POTS (Postural Orthostatic Tachycardia Syndrome)
POTS is a form of dysautonomia, a dysfunction of the autonomic nervous system, which is the part of the nervous system responsible for regulating the body’s automatic functions. Heart rate, blood pressure, digestion, temperature regulation, breathing rate…all of these are managed without conscious effort in a healthy autonomic nervous system. In POTS, the regulation of heart rate and blood pressure in response to postural changes breaks down.
When a person with POTS stands up, blood pools in the lower body rather than being efficiently returned to the heart and brain. The heart responds by racing, trying to compensate. Heart rate increases of 30 beats per minute or more within ten minutes of standing is the diagnostic benchmark. The result is a constellation of symptoms that can include dizziness, lightheadedness, fainting or near-fainting, heart palpitations, brain fog, fatigue, headaches, nausea, tremors, and exercise intolerance.
POTS is more common than most people realize, and it disproportionately affects women and young people. It is also frequently found alongside MCAS and Ehlers-Danlos Syndrome, the combination sometimes called the trifecta, and managing all three together requires a particularly careful and layered approach.
Symptoms can include flushing, hives, itching, and skin reactions. Digestive disruption, including nausea, cramping, diarrhea, and reflux. Neurological symptoms including brain fog, headaches, and anxiety. Cardiovascular effects including heart palpitations and drops in blood pressure. Fatigue. Joint pain. Breathing difficulties. Reactions to foods, medications, fragrances, temperature changes, stress, and exercise. The triggers are individual. The picture is complex. And it shifts.
Why conventional medicine often falls short
POTS is underdiagnosed, in part because its symptoms overlap with anxiety, deconditioning, and other more commonly recognized conditions. Many people with POTS are told for years that their symptoms are psychological, or that they simply need to exercise more and drink more water, before anyone investigates the autonomic system.
For many people, the management of POTS is something they largely figure out themselves through research, community, and trial and error.
Even once diagnosed, conventional treatment options for POTS are limited. Increased fluid and salt intake, compression garments, and a graded exercise program are the standard starting points. Medications including fludrocortisone, midodrine, and beta-blockers are sometimes prescribed, with variable results and significant side effects in some people.
The underlying cause of POTS is not always identified, and treatment is largely symptomatic rather than addressing root causes. For many people, the management of POTS is something they largely figure out themselves through research, community, and trial and error.
The result is that many people with MCAS manage their condition largely on their own, through exhaustive research, trial and error, and the support of online communities of others navigating the same experience. If this sounds familiar, I want you to know that this research you have done is not a symptom of anxiety. It is a reasonable response to being underserved.
What herbal medicine and homeopathy offer
Herbal medicine approaches POTS through several interconnected pathways: supporting cardiovascular tone and function, regulating the autonomic nervous system, supporting adrenal health, and building overall resilience and capacity.
Adaptogenic herbs are central to POTS support. Adaptogens work by helping the body regulate its stress response and improve physiological resilience, which is directly relevant to the dysregulation at the heart of POTS.
This is one of the areas where modern homeopathy is especially valuable. Homeopathic preparations, particularly at higher potencies, are generally very well tolerated even by the most reactive systems. They can be introduced carefully and adjusted based on response, offering a way to begin supporting the body before moving into herbal interventions.
In terms of plant medicines, the focus for MCAS is on mast cell stabilization, histamine modulation, and nervous system support. Key approaches include:
Rhodiola rosea
One of the most researched adaptogens for fatigue, cognitive function, and stress resilience. Grown here in northern Alberta's climate. For people with POTS navigating profound fatigue and brain fog, rhodiola offers meaningful support.
Eleuthero (Siberian ginseng)
Supports adrenal function and overall adaptive capacity. Long history of use in conditions involving fatigue and autonomic dysfunction.
Hawthorn
One of herbal medicine's most valued cardiovascular herbs. Supports heart muscle function, improves circulation, and helps regulate heart rate over time. Gentle and well-evidenced for palpitations and cardiovascular instability.
…there are so many more herbs to support you lving with POTS also. We review all appropriate options with clients in our cilinal appointments.
Common support approaches
People with POTS have usually already discovered many of these approaches. This is the landscape of what is broadly known to help:
Increased fluid intake:
Drinking two to three litres of fluid per day, and sometimes up to four, helps to maintain blood volume, which is often low in POTS. Electrolyte-rich fluids are more effective than plain water alone.
Increased salt intake:
Sodium helps the body retain fluid and maintain blood volume. Current recommendations are to have an intake of 6 to 10g of additional salt each day. 6g is around one level teaspoon.
Compression garments:
Graduated compression stockings or tights, ideally waist-high, help to prevent blood pooling in the lower body and reduce the cardiovascular demand of standing. 20 to 40 mmHg is the recommended compression level.
Eating smaller, more frequent meals:
Large meals divert blood flow to the digestive system and can worsen POTS symptoms significantly. Smaller, more frequent meals reduce this postural demand on the circulation.
…and more in the full guide
Free resource
The Two Roots POTS Support Guide
A detailed, expanded guide to supporting your health with POTS, including all common approaches, herbal and nutritional supports, and practical strategies. Free to download.
POTS Support Guide.pdf
Expanded guide — free download
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What to expect working together
POTS is a condition where small, consistent gains accumulate into meaningful improvement over time. The initial consultation gives me a thorough picture of your symptom pattern, your current management strategies, any co-occurring conditions, and what you have already tried.
Because POTS is often found alongside MCAS, I pay particular attention to signs of mast cell involvement and adjust the protocol accordingly. Herbs that would otherwise be helpful may need to be introduced more carefully if reactivity is also part of your picture.
We begin with the preparatory phase before introducing cardiovascular and adaptogenic support. Most people working on POTS notice improvement in fatigue and cognitive clarity first, with cardiovascular stability following as the protocol develops over subsequent months.
For a full overview of how consultations work, including fees and the appointment process, visit the Services page.
For a full overview of how consultations work, including fees and the appointment process, visit the Services page.
Managing POTS is possible. You do not have to figure it out alone.
POTS is demanding, and the gap between what conventional medicine currently offers and what people actually need is real. Herbal medicine cannot cure dysautonomia, but it can meaningfully support the body’s regulatory systems, reduce symptom burden, and improve quality of life in ways that many people with POTS have not yet had access to.
If you are ready to explore what a more integrated approach might offer…I would be glad to hear from you.