Postural Orthostatic Tachycardia Syndrome (POTS)
Functional Medicine Gold Coast
wave functional health
Dr Matt le Roux
Postural Orthostatic Tachycardia Syndrome, commonly known as POTS, is a form of dysautonomia in which the autonomic nervous system fails to regulate heart rate and blood flow correctly when a person moves from lying or sitting to standing. Rather than blood vessels constricting and heart rate adjusting smoothly to maintain blood pressure, the heart rate rises sharply (often by 30 beats per minute or more within ten minutes of standing) while blood pressure may remain stable or drop. POTS is increasingly recognised as one of the more common autonomic disorders, particularly affecting women of reproductive age, and has seen growing diagnosis rates following viral illness, concussion, and periods of prolonged physical or psychological stress.
Understanding what is happening
POTS is Common, Not Normal
POTS affects a significant number of people, yet it is frequently misidentified as anxiety, deconditioning, or a psychosomatic presentation. The physiological reality is that the autonomic nervous system has lost its ability to regulate blood flow and heart rate appropriately in response to postural change.
Many people with POTS have spent years being told their symptoms are stress-related or that their investigations are normal. Standard testing is not designed to assess autonomic nervous system function in detail, which is why clinical HRV analysis and a thorough case history form the starting point of assessment at Wave.
POTS is a pattern of dysfunction with identifiable and often modifiable drivers. Identifying which drivers are present is what makes structured management possible.
Standing up should not feel
like a physical event.
Conditions We Support
A functional medicine perspective on POTS
POTS is not a single condition with a single cause. It is better understood as a pattern of autonomic dysfunction that can arise from several contributing pathways, often overlapping in the same person. At Wave Functional Health, assessment focuses on identifying which of these pathways are driving symptoms, rather than treating POTS as a fixed diagnosis with a single protocol.
HPA axis dysregulation
Chronic stress, whether physical, emotional, or physiological, can disrupt communication among the hypothalamus, pituitary, and adrenal glands, altering the body's capacity to regulate blood pressure and heart rate during postural changes.
Post-viral and post-concussion autonomic injury
Both viral illness and head injury are well documented triggers for the onset of POTS, likely through disruption of brainstem and autonomic regulatory centres. This pathway has become significantly more recognised following COVID-19.
Deconditioning and reduced blood volume
Extended periods of reduced activity, whether due to illness, injury, or lifestyle, can reduce blood volume and vascular tone, thereby amplifying orthostatic symptoms. Graded reconditioning is an important component of management once other drivers are addressed.
Gut and immune involvement
Mast cell activation and intestinal permeability are frequently present alongside POTS and may contribute to the inflammatory load affecting autonomic regulation. Gut assessment is often a relevant part of a complete POTS investigation.
Hormonal and blood volume factors
Fluctuations in oestrogen, low blood volume, and electrolyte imbalance can all influence symptom severity. This is one reason POTS disproportionately affects women of reproductive age and often fluctuates with the menstrual cycle.
Common Presentations
Contributing factors we investigate
Beneath the Surface
How Wave Functional Health approaches POTS
Assessment begins with a detailed case history and objective measurement of autonomic function using Heart Rate Variability analysis through the BioSign system. This provides an objective picture of sympathetic and parasympathetic balance — central to understanding how the autonomic nervous system is functioning day to day, not just in a single clinical snapshot.
Where indicated, further functional medicine testing is used to investigate underlying contributors including adrenal and HPA axis function, gut health markers, and inflammatory load.
This is a collaborative, root-cause approach designed to work alongside any existing medical management, not to replace it. If you have already received a POTS diagnosis from a cardiologist or neurologist, functional assessment adds a layer of investigation into what is maintaining the dysfunction.
Clinical HRV assessment
BioSign HRV analysis provides an objective baseline of autonomic nervous system function, sympathetic and parasympathetic balance, and adaptive reserve — essential context for structuring any autonomic rehabilitation programme.
Autonomic nervous system rehabilitation
HRV biofeedback and neurofeedback to support the nervous system in rebuilding flexible regulation between activation and rest — the capacity that is specifically impaired in POTS.
Frequency Specific Microcurrent
FSM to support nervous system and tissue recovery, particularly relevant in post-viral and post-concussion POTS where neuroinflammation and autonomic nerve pathway disruption are contributing factors.
Functional medicine investigation
Investigation and correction of underlying drivers including HPA axis dysfunction, gut health, inflammatory load, hormonal factors, and blood volume — addressing the physiology maintaining the autonomic dysfunction.
Graded reconditioning and practical guidance
Structured reconditioning where deconditioning is a contributing factor, alongside practical guidance on hydration, electrolyte balance, and nutrition to support blood volume and vascular tone.
Advance Testing
What we assess for POTS
← Scroll to see full table
| Assessment | What it reveals in a POTS presentation |
|---|---|
| HRV Analysis (BioSign) | Autonomic nervous system balance, sympathetic and parasympathetic activity, adaptive reserve, and orthostatic response — providing an objective functional picture that standard cardiovascular testing does not capture |
| DUTCH Complete Hormone Testing | Full cortisol curve across the day and night, adrenal function, and sex hormone balance — HPA axis dysregulation is a common contributing factor in POTS and is invisible to a single morning cortisol blood draw |
| Functional Blood Chemistry | Inflammatory markers, iron status, thyroid function, vitamin D, B12, electrolytes, and blood glucose regulation assessed at functional rather than disease thresholds — identifying nutrient and metabolic contributors |
| GI MAP Stool Analysis | Gut microbiome health, intestinal permeability, and inflammatory markers — mast cell activation and gut-immune dysregulation are frequently present alongside POTS and contribute to the overall inflammatory load |
| Organic Acids Testing | Mitochondrial energy production, neurotransmitter precursor status, and oxidative stress markers — particularly relevant in post-viral POTS where cellular energy production is commonly impaired |
| Neurofeedback Assessment | Where indicated, brain mapping to assess brainwave patterns associated with autonomic dysregulation — supporting targeted neurofeedback training to complement HRV biofeedback and physical rehabilitation |
Who This Is For
This approach may suit you if…
Frequently Asked Questions
What people ask about POTS care at Wave
No. POTS can produce symptoms that resemble anxiety, such as a racing heart and a sense of unease when standing, but it is a physiological disorder of autonomic regulation. The heart rate rise on standing in POTS is a measurable physiological event, not a psychological response.
Anxiety may be a consequence of living with POTS rather than its cause, and the two can coexist. Distinguishing between them requires appropriate clinical assessment rather than attributing autonomic symptoms to anxiety by default.
Many people with POTS benefit from a combination of lifestyle strategies, autonomic nervous system rehabilitation, and correction of underlying contributing factors. Some require medication as part of a broader management plan. The right approach depends on the individual case and should be guided by appropriate assessment.
Functional medicine assessment adds a layer of investigation into what is maintaining the autonomic dysfunction — addressing these drivers often supports improved function alongside or following medical management.
Common triggers include viral illness including COVID-19, concussion or head injury, pregnancy, surgery, and periods of significant physical or psychological stress. In some cases no clear single trigger is identified. The onset pattern is often an important part of identifying which pathways are most relevant to investigate.
Formal diagnosis typically involves orthostatic vital-sign testing — measuring heart rate and blood pressure lying, sitting, and standing — or a tilt-table test conducted by a medical practitioner such as a cardiologist or neurologist.
Clinical HRV analysis at Wave provides additional objective insight into autonomic nervous system function and helps identify the specific pattern of sympathetic and parasympathetic imbalance, which informs the management approach.
Many people see meaningful improvement with consistent, appropriately structured management, particularly when underlying contributing factors are identified and addressed. Recovery timelines vary from person to person depending on the duration of symptoms, the contributing drivers, and the individual's starting point.
Objective HRV monitoring throughout the management process provides measurable evidence of autonomic nervous system improvement over time, which can be valuable when progress feels slow subjectively.
Maybe it Might Be Something Else?
Standing up should not feel
like something to manage.
At Wave Functional Health we use clinical HRV analysis and functional medicine assessment to investigate the autonomic, inflammatory, and physiological drivers behind POTS — working alongside your existing medical team, not instead of them.
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