Question about POTS which is postural orthostatic tachycardia syndrome. So my 13-year-old cousin was diagnosed with POTS after fainting 50, 5-0 times, for unknown reasons in the last six months. Every conventional test has come back normal. They’ve tested for a lot including brain scans, a 30-day Holter monitor. Her only symptom is this bout of lightheadedness and fainting. Outside of the episodes, she feels completely fine, high energy, low stress. Is there any insight on the functional medicine root cause of POTS or any treatment ideas? I’m working with her on improving her diet, which is pretty much the Standard American Diet right now. Otherwise, she is athletic, sleeps well, and tells me she isn’t stressed.

Dr. Amy Nett:  Yeah, so POTS is really a tricky one and I think there’s a lot more to be learned about it. The things I would think about, so I like that you’re working on diet because I would wonder if there’s like a nutritional deficiency issue, that would be one possibility, sometimes, rarely, a nutrient deficiency. The other thing is chronic inflammatory response syndrome or biotoxin related illness, but I would expect her to have some symptoms outside of these episodes, so that one seems a little bit less likely. The other thing to consider might be dental orthopedics and some jaw positioning can affect the autonomic nervous system pretty significantly, at least, based on input from some at this time, so that would be something also to look into. Oh, and then make sure she is not dehydrated. I’m guessing she’s not because she has been worked up pretty well, but sometimes when I have particularly athletic younger women who have these episodes, I do increase their fluid intake and maybe have them do an electrolyte solution with something like Designs for Health Electrolyte Synergy or you can get a lot of different electrolyte solutions, even just saltwater might be a good option. So CIRS, you know, if she has some other symptoms, otherwise I think it’s less likely. And let’s see, some additional information here, so she’s not dehydrated, has a good appetite. Okay. Then, yeah, think about maybe the dental orthopedics and see if there’s something to do with jaw alignment there. POTS is a pretty tricky one.