The Missing Piece in POTS: Why Your Inner Ear Controls Your Heart Rate and Blood Pressure

So what causes POTS? Now, I think it's important to understand that there's a difference between what causes POTS and what keeps it going.

So for some people, right, we look at infections, COVID-19, vaccines, flu.

Other infections can trigger it.

You have people who come out of surgery and they now have POTS.

But just because something acts as a trigger doesn't mean that's the issue, right? Like you come out of surgery, it's not like you're still in surgery.

So you have to say, what got dysregulated? Same thing with infections.

Like if you're not acutely sick anymore, but you're still struggling, is it the fact that you still have something you have to remove from the body? Or is it the fact that it dysregulated something? Now, what a lot of people are really looking for is low blood volume is kind of the central mechanism that a lot of people really focus on.

And part of that is going to be due to blood pooling.

And I think this is partly due to the fact that a lot of the people leading different pots.

Research papers are cardiologists.

And so they're thinking about circulation because we do know in POTS, you're not getting enough blood flow back to the heart and you're also not getting enough blood flow to the brain.

So it does make sense that the right cardiologist would think about that.

Now, there's also thoughts beyond that.

Some people have neuropathy, so you can have nerve damage in this way.

Many of you, unfortunately, you have to fight to get this type of autonomic testing with biopsies and QSART testing, which is basically a sweat analysis test saying, okay, you know what, we put this stuff on you.

Do you have appropriate sweat or is there likely nerve issues? Mass cell activation syndrome is a big player here.

This can also lead to vasodilation and increase the POTS-related symptoms and your lack of function.

Autoimmunity is another thing.

Now, every single one of these is important.

Let's be very, very clear.

As much as I like the vestibular system, I would never, ever ignore mass cell activation syndrome when it's present.

That's what I call a sabotager.

it can ruin what you are trying to accomplish.

But it also doesn't mean you treat mast cell and all of a sudden your POTS goes away.

This is where having an integrative approach, as we'll talk about later, is critically important.

So what causes POTS? Now, I think it's important to understand that there's a difference between what causes POTS and what keeps it going.

So for some people, right, we look at infections, COVID-19, vaccines, flu.

Other infections can trigger it.

You have people who come out of surgery and they now have POTS.

But just because something acts as a trigger doesn't mean that's the issue, right? Like you come out of surgery, it's not like you're still in surgery.

So you have to say, what got dysregulated? Same thing with infections.

Like if you're not acutely sick anymore, but you're still struggling, is it the fact that you still have something you have to remove from the body? Or is it the fact that it dysregulated something? Now, what a lot of people are really looking for is low blood volume is kind of the central mechanism that a lot of people really focus on.

And part of that is going to be due to blood pooling.

And I think this is partly due to the fact that a lot of the people leading different pots.

Research papers are cardiologists.

And so they're thinking about circulation because we do know in POTS, you're not getting enough blood flow back to the heart and you're also not getting enough blood flow to the brain.

So it does make sense that the right cardiologist would think about that.

Now, there's also thoughts beyond that.

Some people have neuropathy, so you can have nerve damage in this way.

Many of you, unfortunately, you have to fight to get this type of autonomic testing with biopsies and QSART testing, which is basically a sweat analysis test saying, okay, you know what, we put this stuff on you.

Do you have appropriate sweat or is there likely nerve issues? Mass cell activation syndrome is a big player here.

This can also lead to vasodilation and increase the POTS-related symptoms and your lack of function.

Autoimmunity is another thing.

Now, every single one of these is important.

Let's be very, very clear.

As much as I like the vestibular system, I would never, ever ignore mass cell activation syndrome when it's present.

That's what I call a sabotager.

it can ruin what you are trying to accomplish.

But it also doesn't mean you treat mast cell and all of a sudden your POTS goes away.

This is where having an integrative approach, as we'll talk about later, is critically important.