What are the symptoms of Postural Orthostatic Tachycardia Syndrome (POTS) with associated weight gain?

From the Guidelines

Weight gain can exacerbate Postural Orthostatic Tachycardia Syndrome (POTS) symptoms, and a comprehensive approach focusing on gradual weight loss, lifestyle modifications, and targeted therapies is essential to manage symptoms and improve quality of life. To address POTS symptoms with weight gain, consider the following strategies:

• Gradual, sustainable weight loss through a balanced diet rich in lean proteins, complex carbohydrates, and adequate hydration (2-3 liters of water daily with added electrolytes) 1
• Incorporate regular, reclined exercise like swimming or recumbent biking, starting with 10-15 minutes sessions and gradually increasing, as part of a formalized exercise program to support long-term cardiovascular health 1
• Compression garments (20-30 mmHg) can help manage blood pooling in the lower extremities 1
• Medications that may help include beta-blockers like propranolol (10-20mg twice daily) or midodrine (2.5-10mg three times daily) for blood pressure support, with propranolol potentially useful in those with coexisting anxiety or migraine 1
• Salt intake should be increased to 5-10g daily unless contraindicated, as part of a nonpharmacological intervention to address reduced plasma volume, along with elevation of the head of one’s bed and use of support stockings 1
• Avoid factors that contribute to dehydration, such as consumption of alcohol and/or caffeine, ingestion of large heavy meals, and excessive heat exposure 1

It is crucial to break the cycle of worsening symptoms, decreased activity, and further weight gain, as excess weight affects blood volume distribution and autonomic nervous system function, directly impacting orthostatic tolerance. A comprehensive approach, as outlined above, can help manage POTS symptoms and improve quality of life 1.

From the Research

POTS Symptoms with Weight Gain

• There is no direct evidence in the provided studies that links POTS symptoms with weight gain 2, 3, 4, 5, 6.
• The studies focus on the pathophysiology, diagnosis, and treatment of POTS, but do not specifically address the relationship between POTS symptoms and weight gain.
• However, some studies suggest that patients with POTS may experience gastrointestinal distress, which could potentially lead to changes in weight 3, 6.
• Additionally, some treatments for POTS, such as fludrocortisone, may cause weight gain as a side effect, but this is not directly related to the symptoms of POTS themselves 4, 5, 6.

Treatment and Management

• The treatment of POTS typically involves a combination of lifestyle modifications, such as increasing fluid and salt intake, and pharmacological interventions, such as beta-blockers and fludrocortisone 2, 3, 4, 5, 6.
• Some studies suggest that experimental therapies, such as ivabradine and midodrine, may also be effective in managing POTS symptoms 5, 6.
• However, the effectiveness of these treatments in patients with POTS and weight gain is not well established, and further research is needed to determine the best course of treatment for these patients.

Pathophysiology

• The pathophysiology of POTS is complex and multifaceted, involving a variety of mechanisms, including peripheral denervation, hypovolemia, and hyperadrenergic state 2, 3, 4, 5, 6.
• Some studies suggest that POTS may be related to immunological stressors, such as viral infections, which could potentially contribute to changes in weight 3, 6.
• However, the relationship between POTS pathophysiology and weight gain is not well understood, and further research is needed to determine the underlying mechanisms.