When I was in my 20s, a major hospital in Charlotte told me I was the worst case of POTS they had ever seen. I could die at any minute. I should never work again, never drive again. I should just lay on the couch and never get up the rest of my life.
I said I’d find something to get me better.
That was more than 30 years ago. I’m still working. I still drive. I’ve been largely symptom-free for years. And every week I see patients who are exactly where I was: told there’s nothing that can be done, handed an antidepressant, sent home with normal labs and no real answers.
I know what POTS feels like from the inside, because I have it. I’ve been diagnosing and treating it for three decades. What follows is what I’ve found actually works, drawn from 30 years of patients and my own body.
What is POTS, and what does it actually do to you?
POTS stands for postural orthostatic tachycardia syndrome. It’s one type of a broader category called dysautonomia, which is when the autonomic nervous system stops working the way it should.
Your autonomic nervous system controls everything that happens in the background: heart rate, blood pressure, digestion, how you breathe while you sleep. You have two branches. The sympathetic fires when you’re under threat. The parasympathetic keeps things controlled, keeps it chilled. In POTS, those two stop working together the way they should.
Here’s what happens when you stand up. Normally, your blood pressure rises slightly to keep blood moving to your brain. In POTS, it falls. Your heart then races to compensate, trying to push enough blood upward. The result is dizziness, fatigue, nausea, a racing heart, shortness of breath. If it gets bad enough, you pass out.1 Mine was severe enough that I would pass out just walking across the room.
A lot of people with POTS end up lying down most of the day, because that’s the only time they feel okay. Many have gone years undiagnosed or misdiagnosed because of it. That’s physiology, not weakness.
Why I believe viruses are driving most of what we’re seeing
I was diagnosing POTS long before COVID existed. It’s not a new condition. What COVID did was confirm something I had suspected for years.
The research that came out after the pandemic matched what I was already seeing in clinic. Ormiston and colleagues documented that 2-14% of COVID-19 survivors go on to develop POTS, with 9-61% experiencing POTS-like symptoms within 6-8 months of infection.2 Blitshteyn and Whitelaw described new-onset POTS and other autonomic disorders in 20 patients following COVID-19, which lined up exactly with the pattern I had been watching for decades.3
Here’s how I think about it: stress brings out viruses. Chickenpox stays in your body for life and re-emerges as shingles when you’re run down. Other viruses behave the same way. When someone goes through pregnancy, a major trauma, sustained high stress, or a viral illness like COVID, that stress can reactivate viral load that was being kept quiet, and that’s when the autonomic system starts to misfire.
Autoimmune conditions, which are increasingly linked to viral triggers, are a recognized risk factor for dysautonomia.4 Knowing the root driver changes the treatment.
Why your doctor probably said it was anxiety
Standard bloodwork comes back normal with POTS. Every time. A metabolic panel, a CBC, a full cardiac workup, all clean. And when a woman comes in with a racing heart, dizziness, nausea, and shortness of breath, with nothing showing on her labs, the answer tends to be anxiety.
I’ve seen this hundreds of times. Patients who’ve been to four or five doctors, been given an SSRI, been told to manage their stress. An SSRI is a band-aid. It can buffer those symptoms, but it doesn’t change what’s actually happening. Sebastian and colleagues reviewed the POTS literature and identified this pattern specifically: tachycardia and air hunger are consistently attributed to anxiety before POTS is ever properly considered.5
I recognized POTS in patients partly because I had it myself. I knew exactly what that constellation of symptoms felt like from the inside. If you’ve been told it’s anxiety and something still feels physically wrong, I believe you. Your labs can be perfect and you can still have a real physiological problem.
What an actual POTS diagnosis looks like
I knew something was wrong long before anyone confirmed it on paper. And I knew the only way to get a real answer was a tilt table test, the one test that can actually reproduce what happens to your body when POTS is present.
The first cardiologist I went to refused to order it. He told me flat out: you don’t have this. I told him I wasn’t there for his opinion, I was there for the test. Cardiologists are the only ones who can order it, so I told him I’d go to the next guy if he didn’t. He ordered it.
I flatlined within five minutes of being tilted. Stopped breathing entirely. That’s what freaked them out.
The test works by tilting your body upright while heart rate and blood pressure are monitored continuously. A simpler bedside option also gives useful information: checking blood pressure and heart rate sitting, then standing. A heart rate increase of 30 beats per minute or more in the first 10 minutes of standing meets the basic diagnostic criteria.5
What frustrates me is what happens after the diagnosis. Most patients leave with a label and no plan. I’ve seen it over and over. That’s part of why I’m writing this.
POTS natural treatment: what the research actually says
I’ll be honest: the research base for POTS is more limited than most people realize. Most clinical guidance relies on expert consensus rather than large randomized trials.1 A 2025 systematic review of randomized trials found that while the overall evidence is still developing, certain non-pharmacological approaches have shown consistent benefit.6
Salt and water. This is the first thing I tell every POTS patient, and it has the most consistent support in the literature.1 The goal is expanding blood volume so that when you stand, there’s enough fluid available to maintain pressure to the brain. Everybody’s been told don’t eat salt. But if you have POTS and you’re avoiding sodium, you’re going to be hitting the floor. Salt helps you hold the fluid. Of everything I recommend, this moves the needle the most.
Horizontal exercise. Upright, high-intensity training can worsen symptoms during a flare. Swimming and recumbent biking work the cardiovascular system without the orthostatic stress of being fully upright. Structured conditioning built around those activities has shown real improvement in POTS symptoms over time.7
Compression stockings. Waist-high compression stockings reduce blood pooling in the lower extremities and help get blood flow up to the brain.1
A lot of the women I see are doing HIIT and intermittent fasting because they’ve been told it’s healthy and they’re trying to do right by their body. For a system that’s trying to recalibrate, those things can be too much. Pulling back on them is temporary, while we address what’s actually driving this.
What I do for POTS patients at Doctor’s Nutrition
I always start with labs. Not because POTS shows up in bloodwork, but because thyroid problems, low vitamin D, hormonal imbalances, all of those add extra physiological stress to a system that’s already struggling. Fixing them first reduces the load.
Olivir. The first thing I reach for with dysautonomia patients is Olivir, our olive leaf extract. It comes from the leaves of the olive tree. The active compound, oleuropein, has documented antiviral properties. My reasoning: if viral reactivation is driving the autonomic dysfunction, the viral load needs to be addressed directly.
There are no published clinical trials yet specifically for Olivir and POTS. But as the science advances, I am hopeful this approach will be validated. What I can tell you is what I’ve seen in 30 years of treating this condition and what I’ve lived in my own body. I’ve watched it help patients who had tried everything else. I take it myself. The results speak for themselves.
Olivir supports immune function rather than simply stimulating it, which makes it safe even for patients with autoimmune conditions. In my practice, I’ve used it in patients with organ transplants. The minimum dose for adults is 4 capsules a day. Most of my patients take about 6. I take 8 myself because my case was severe.
Preservative-free IV therapy. IV hydration has real consensus support for POTS.1 Increasing blood volume directly helps maintain blood pressure when you stand. At Doctor’s Nutrition, we do it preservative-free. Standard IV preparations routinely include preservatives, and for patients whose immune systems are already under stress, that chemical burden matters. Our nurse practitioner Angie Cowan has been focused on IV therapy for the last 8 years, and having that level of dedicated expertise alongside our normal supplement protocols is a real advantage for POTS patients. We can also add targeted intravenous nutrition to support nervous system and immune function.
Supplements for the neurological overlap. When anxiety symptoms are prominent, I look at taurine, phosphatidylserine, and 5-HTP. These can address the neurological component without an SSRI as the only option.
Every patient is different. The protocol I use with one POTS patient won’t be right for another, which is why the individual assessment always comes first.
Can POTS be cured?
Probably not in the way you’re hoping, and I won’t pretend otherwise. Dysautonomia is incompletely understood. The honest framing is management, not cure.
But real improvement is possible. I’m largely symptom-free. The goal I work toward with every POTS patient is function: being able to work, live, and do the things that matter without being floored by a walk across the room.
For younger patients especially, getting proper support early changes everything. I see a lot of teenage girls with POTS. The right clinical relationship, started early, can change the entire trajectory of how this condition plays out in their lives.
Frequently asked questions
What is POTS and what causes it?
POTS is a form of dysautonomia in which blood pressure drops on standing and heart rate spikes to compensate, producing dizziness, nausea, racing heart, and sometimes fainting. Viral triggers, autoimmune activity, hormonal changes, and significant stress are the most commonly identified contributing factors. COVID-19 substantially increased the recognized prevalence of the condition, though I was diagnosing and treating it long before the pandemic.
How is POTS diagnosed?
The gold standard is a tilt table test, where heart rate and blood pressure are monitored as the body is tilted upright. Bloodwork typically comes back normal, which is a major reason POTS gets missed or attributed to anxiety. A bedside blood pressure and heart rate check, sitting then standing, can also give useful clinical information.
Can POTS be managed without medication?
Many patients see significant improvement with non-pharmacological approaches. Increased sodium and fluid intake, compression stockings, horizontal exercise, and targeted supplementation can reduce the symptom burden meaningfully. A 2025 systematic review of randomized trials found that some non-pharmacological approaches showed benefit in controlled settings, though the overall evidence base is still developing.6 My clinical experience over 30 years matches that, and in many cases goes well beyond what the published research has caught up to.
What is Olivir and why do you use it for POTS?
Olivir is an olive leaf extract with documented antiviral properties. I use it because I believe viral reactivation is a significant driver of dysautonomia in many patients. I use it myself. There are no published POTS-specific trials yet, but as the science advances I am hopeful this approach will be validated. What I have in the meantime is 30 years of results in real patients.
Is IV therapy covered by insurance for POTS?
Insurance does not currently cover IV hydration therapy for POTS. We offer cash-pay options at Doctor’s Nutrition. For patients who respond well, regular sessions can maintain a meaningful improvement in quality of life. We use preservative-free preparations, which as far as I know makes us one of the few practices in this area doing so.
If you’ve been told there’s nothing that can be done
I heard that too. I don’t believe it, and I didn’t accept it for myself. I’m not going to ask you to accept it either.
At Doctor’s Nutrition, every consultation is free. You’ll walk out with a clearer picture of what may be driving your symptoms and what your options actually are. No pressure, no obligation.
Schedule your free consultation at Doctor’s Nutrition.
References
1. Raj, Satish R., Juan Carlos Guzman, Phillip Harvey, Ratika Richer, Max Schondorf, Colette Seifer, Nathalie Thibodeau-Jarry, and Robert Sheldon. “Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance.” Canadian Journal of Cardiology 36, no. 3 (2020): 357-372. PMID: 32145864. [DOI NEEDED — verify at onlinecjc.ca or PubMed]
2. Ormiston, Cameron K., Iwona Swiatkiewicz, and Pam R. Taub. “Postural Orthostatic Tachycardia Syndrome as a Sequela of COVID-19.” Heart Rhythm 19, no. 11 (2022): 1880-1889. DOI: 10.1016/j.hrthm.2022.07.014. PMID: 35853576.
3. Blitshteyn, Svetlana, and Sheryl Whitelaw. “Postural Orthostatic Tachycardia Syndrome (POTS) and Other Autonomic Disorders After COVID-19 Infection: A Case Series of 20 Patients.” Immunologic Research 69, no. 2 (2021): 205-211. DOI: 10.1007/s12026-021-09185-5. PMID: 33786700. Note: a published correction exists for this article.
4. Ghazal, Mohamad, Dina Akkawi, Isaac Fancher, Omowumi Oundo, Syed Tanzeem, Imama Sajjad, and Alexandros Briasoulis. “Pathophysiology and Management of Postural Orthostatic Tachycardia Syndrome (POTS): A Literature Review.” Current Problems in Cardiology 49 (2024): 102977. [DOI NEEDED — verify from ScienceDirect pii/S0146280624006121]
5. Sebastian, Sneha Annie, Christopher O. Co, Venkata Panthangi, Reena Jain, Andrew Ishak, Manan Shah, Abhijit Vasavada, and Inderbir Padda. “Postural Orthostatic Tachycardia Syndrome (POTS): An Update for Clinical Practice.” Current Problems in Cardiology 47, no. 8 (2022): 101384. DOI: 10.1016/j.cpcardiol.2022.101384. [DOI NEEDS FINAL VERIFICATION]
6. Kwok, Chun Shing, Stacey Lee, Matthew Hall, Tahir Qureshi, Gregory Y. H. Lip, Yoon K. Loke, Satish R. Raj, and Edward Holroyd. “The Evidence for Treatments for Postural Orthostatic Tachycardia Syndrome: A Systematic Review of Randomized Trials.” Trends in Cardiovascular Medicine 35, no. 8 (2025): 517-527. DOI: 10.1016/j.tcm.2025.07.001. [DOI NEEDS FINAL VERIFICATION]
7. Fu, Qi, and Benjamin D. Levine. “Exercise and Non-Pharmacological Treatment of POTS.” Autonomic Neuroscience 215 (2018): 20-27. DOI: 10.1016/j.autneu.2018.07.001.
Metabolic elements such as insulin Resistance and glucose dysregulation, mitochondrial dysfunction and energy metabolism, and gut microbiome changes likely interact with autonomic dysfunction rather than standing alone. For example, dysautonomia can impair blood flow to the gut/pancreas, affecting glucose handling, while metabolic stress could exacerbate autonomic symptoms. Metabolic components appear relevant in subsets of POTS patients—particularly involving glucose/insulin handling, gut hormones, and cellular energy production—but they are not universal or the main driver for everyone. One small study found Time-restricted eating/TRE improved heart rate response, quality of life, and mitochondrial ATP production markers in POTS patients.