POTS Is a Diagnosis, Not an Explanation

A lot of people with POTS are told the same things:

“Drink more water.”

“Add electrolytes.”

“Wear compression socks.”

“Stand up slower.”

And while those strategies can absolutely help manage symptoms, they often do not explain WHY the body is struggling in the first place.

POTS (Postural Orthostatic Tachycardia Syndrome) is a condition where the nervous system has trouble regulating blood flow and heart rate when changing positions, especially when going from sitting to standing. Common symptoms can include dizziness, lightheadedness, rapid heart rate, fatigue, brain fog, nausea, anxiety-like symptoms, and exercise intolerance.

What I wish more people understood is that POTS is often not just a “heart rate problem.”

In many cases, there is an underlying neurological component.

POTS is commonly diagnosed using a tilt table test, where clinicians monitor what happens to your heart rate and blood pressure when your body changes positions. Typically, they are looking for a significant increase in heart rate upon standing without a major drop in blood pressure. While this can help confirm that your symptoms are real and that your autonomic nervous system is struggling, it still does not explain WHY it is happening. In my opinion, a diagnosis without understanding the root cause only gets us halfway there. The real question is what underlying system is driving the dysfunction in the first place.

One of the biggest patterns I see clinically is vestibular dysfunction. Your vestibular system helps regulate balance, spatial awareness, eye movements, autonomic function, and even blood pressure regulation. If the brain is not processing vestibular information properly, the autonomic nervous system can become extremely dysregulated.

This is why some people develop POTS symptoms after:

• Concussions

• Whiplash injuries

• Viral illnesses

• Long periods of stress on the nervous system

The gut can also play a major role. Inflammation, histamine issues, microbiome imbalances, and poor vagal regulation can all influence autonomic function and keep the nervous system stuck in a dysregulated state.

EDS can absolutely increase susceptibility in some individuals because connective tissue laxity may make it harder for the vascular system to regulate blood flow efficiently. But not everyone with EDS develops POTS, and not everyone with POTS has EDS.

This is why specificity matters.

Two people can both have “POTS” but for completely different reasons.

One person may have a vestibular-driven issue after a concussion. Another may have a gut-driven inflammatory issue after a virus. Another may have a combination of both.

When we stop only managing symptoms and start identifying the systems driving the dysfunction, real change can happen.

I’ve seen many patients improve dramatically once the root cause is addressed appropriately.

There are answers.There is hope. But we have to stop treating every POTS patient exactly the same.