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POTS and Dysautonomia
POTS is the autonomic nervous system struggling to regulate blood flow on standing. We look at blood volume, brainstem regulation, inflammation, and triggers upstream.
What you may be noticing
You stand up and your heart races. The room greys at the edges. Showers, heat, and long lines feel impossible. You feel tired yet wired, foggy, and short of breath, and your hands and feet turn cold or purple. Some days you plan your life around where you can sit down.
Why it is rarely one thing
POTS is a regulation problem before it is a heart problem. Every time you stand, a substantial volume of blood shifts toward your lower body, and your brainstem must read that change, tighten blood vessels, and adjust the heart within seconds. In POTS, that reflex underperforms, so the heart races to compensate.
I see this as a neuro-autonomic integration skill. Your brainstem, cerebellum, vestibular system, and the nerves in your legs all feed the reflex, and each can be retrained. The deeper question is why it changed. Common upstream triggers include viral illness, concussion, mold exposure, mast cell activation, autoimmunity, connective tissue laxity, and prolonged deconditioning.
Patterns we look for
- Autonomic balance and vagal tone, including brainstem regulation of heart rate and vessel tone.
- Low blood volume, sodium handling, and mineral status.
- Small fiber neuropathy affecting the nerves that tighten blood vessels.
- Mast cell activation and histamine load, which dilate vessels and drive flushing and flares.
- Mold and biotoxin exposure, which often travel with mast cell patterns.
- Autoimmune patterns, including antibodies under active research in POTS (a working hypothesis, not yet a routine diagnostic standard).
- Post-viral inflammation and neuroinflammation.
- Hypermobility and connective tissue patterns.
- Iron, ferritin, and thyroid status, read as TSH, free T4, and free T3 together.
- Cerebellar and vestibular input, which help the brain predict posture changes.
How I evaluate it
Your comprehensive functional neurological exam includes heart rate and blood pressure from lying to standing, pupil responses, eye movements, vestibular testing, and balance under different conditions. These show how well your brainstem integrates posture, vision, and circulation.
Functional labs may include iron and ferritin, a metabolic panel with electrolytes, a full thyroid panel, vitamin B12, inflammatory markers, histamine and mast cell markers, autoimmune screening, and, when history suggests it, mycotoxin or infection testing. If you faint with injury, have chest pain, or have palpitations with fainting, see a cardiologist first. This work supports alongside that care.
How we address it
The order matters. Your nervous system is stabilized before any detoxification, histamine load is calmed before metabolic work, and drainage opens before anything aggressive.
- Stabilize volume and circulation with hydration, electrolytes and minerals on waking, compression, and slow position changes.
- Build the autonomic foundation lying down: diaphragmatic breathing with a long exhale, isometric handgrip holds, and calf and heel pumping to support venous return.
- Identify and calm triggers: mast cells, mold, infections, and inflammatory foods.
- Integrate eye movement, vestibular, and cerebellar rehabilitation seated first, then standing, then balance and gait, progressing only when each stage feels easy and steady.
- Grow upright endurance gradually with short daily morning and evening routines and a fuller weekly session.
Daily consistency trains the nervous system, and weekly depth accelerates change. Regulation can be rebuilt, and step by step the system finds its rhythm again.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.