We need to define POTS, which is Postural Orthostatic Tachycardia Syndrome. Parsing the words, it literally means that with position changes you are susceptible to the heart racing, blood pressure changes, and the sensation that you may pass out. Why does this syndrome seem to be on the rise with the Mast Cell Activation? I postulate that it is related to the sheer amount and location of mast cells nearly everywhere in the body from the skin, tissue, nerve, and vascular areas. Histamine releases from the mast cells, but so do other cytokines, proteins, factors, and immune mediators. Histamine, itself, will dilate open the small vessels and in doing so, the blood pressure drops, then the heart must compensate and speed up to continue circulating to vital organs.
Both conditions have a slew of symptoms from the mast cell immune soldiers being stationed in so many places in the body. Not everyone connects the dots with the plethora of symptoms and may start to segregate out portions of the symptoms and farm them to specialists that help with those categories. It is no wonder that by the time I have seen a patient that I suspect with these conditions, they have seen multiple specialists, and they cannot keep up with the number of tests or treatments rendered. Most times, the patients are no further ahead, but now exhausted with an aggressive (and appropriate) work up.
Mast cell activation has risk factors including hormonal fluctuation, environmental irritants or smells, allergies, body, and emotional stress, and/or medications. In some cases, there is a mass production of mast cells in chronic infections or certain cancers. You can see how this may present as a medical mystery. Compare the risk factors of POTS to include illness, trauma, autoimmunity, alcohol, cancer, diabetes, Ehlers-Danlos Syndrome (plus more), and we can see quite an overlap. There are even more complicating factors since not all patients will have “orthostatic” symptoms since mast cells release other mediators. In such patients they may have other ghastly symptoms such as flushing, angioedema, airway reactions, vomiting, headaches, and diarrhea.
The medical community is advancing to understand more, but not all, factors relating these two phenomena. A good 1:1 cause and effect would be nice, but not probable. We can agree upon measuring mediators such as prostaglandin D2, histamine, tryptase, urine methylhistamine, but as I have learned, trying to catch this phenomenon is like trying to catch a thief on the run. In the budding world of functional genomics, we are getting closer to the intricate pathways in the cells that may determine how and when a mast cell gets activated.
In the meantime, what can be done with such complicated patients? For sure, we need to get down to whatever root causes are causing such stimulation. Look for the viruses, immune stimulation, stress, mental stress, lack of sleep, environmental toxins, internal and external allergies, acidity, or high sugar (yes, diabetes plays a role), and possible gut dysregulation that contributes or is a consequence from these factors.
My approach is to assess how severe the conditions are and how much involvement we may need from traditional medical specialists. Then we may try to work on vagal and energetic techniques to simply quiet and calm WHILE we start assessing the underpinnings and root causes. I may have to pull out compounds to balance the system and repolarize the mast cells. I believe in cleaning up the lifestyle will pay off in spades! Sometimes, I am needed for a brief period for the assessments while the patient can take matters in to his/her own hands once armed with the proper causality.
Do not get me wrong, these conditions can be quite uncomfortable and feel devastatingly terrible, but they usually are not life threatening. Debility is real when the condition is severe. Perhaps I am overly optimistic, but the body has many tools to help itself if given all the right input. Maybe someone will not be twenty years old again, but able to live a fulfilling life with manageable symptoms. We just need to get the right “diagnosis” and the body functioning better, hence the concept of “functional” medicine. Thankfully, there is much research underway regarding these symptoms. When there are multiple systems involved, there wind up being multiple specialists interested in fixing these perplexing conditions
