Vitamin B1 (thiamine) and Postural orthostatic tachycardia syndrome (POTS)
A 2017 study from the Buffalo School of Medicine and Biomedical Sciences reported that low vitamin B1 (thiamine) levels were present in some people with POTS. Further, 25% of the people low in vitamin B 'experienced significant improvement of POTS after oral vitamin B1 supplementation'.
Vitamin B12 and Postural orthostatic tachycardia syndrome (POTS)
A 2014 study in the journal Pediatrics measured vitamin B12 levels in 125 children and teenagers reporting short-term loss of consciousness and 50 children and teenagers with no health issues. Vitamin B12 levels were significantly lower in the children with short-term loss of consciousness compared to children with no health issues. Of those with short-term loss of consciousness, some had POTS and some didn't and vitamin b12 levels were significantly lower in children with POTS compared to children with no POTS.
The researchers concluded:
'Vitamin B12 deficiency in patients with POTS may lead to nervous system dysfunction.'
Another study, this time from 2018 assessed 160 children for POTS symptoms. These children had the 'Head up tilt test' performed and 80 were positive; 80 were negative. Vitamin B12 levels were significantly lower in the positive group compared to the negative. In fact, vitamin B12 deficiency was found in over 82% of children with confirmed POTS.
A group of researchers from University of California San Diego published a case report on a middle aged lady with POTS, which didn't respond to medical therapy. However, this lady did improve with supplementation of B vitamins. This B vitamin research was published in the British Medical Journal (BMJ) Case Reports.
Vitamin C and Postural orthostatic tachycardia syndrome (POTS)
One issue in POTS is an issue with blood vessels whereby blood vessels can be too small. Small blood vessels means less blood flow and this may contribute to POTS. A group of researchers from New York Medical College in Valhalla conducted a small study to assess the effect of vitamin C in people with POTS.
At the start of the study, before administering vitamin C, responses were decreased in POTS, including:
- decreased blood delivery to the skin
- decreased blood output from the heart
- decreased blood flow in the arms and legs
Vitamin C increased these responses, including increasing blood output from the heart by 40%!
It is important to note that this trial used very high dose vitamin in the form of an IV drip. They used 60mg vitamin C per kilogram of body weight per minute for 20 minutes, followed by 20mg vitamin C per kilogram of body weight per minute for an hour. If we use me (Dr. Conor Kerley) as an example:
I'm 75kg so this protocol would mean 180,000mg of vitamin over an 80 minute IV infusion. In terms of food, this is the same as:2,570 medium oranges!!!
Nevertheless, this research suggests that antioxidants and vitamin C are important considerations for diet and supplements in those with POTS.
This vitamin C research was published in the American Journal of Physiology-Heart and Circulatory Physiology
Vitamin D and Postural orthostatic tachycardia syndrome (POTS)
One early study reported low levels of vitamin D in patients with POTS. Interestingly, low vitamin D levels were associated with more orthostatic intolerance. This vitamin D research was published in The Southern Medical Journal.
A group of researchers from Woodhull Medical Center in Brooklyn, New York published a case report on a 37 year old lady with confirmed POTS.
As part of the medical examinations, this lady was found to have normal vitamin D levels but low levels of calcitriol which is the hormone our body makes from vitamin D.
The doctors prescribed a small dose of calcitriol, which remember is a hormone and not available over the counter, only available as a controlled medication.
At this lady's next visit to the medical centre, 'she reported remarkable improvement in her palpitations and had been working full time for the past 4 months'.
Her heart rate was normal at 72 beats per minute and did not change when she was seated or standing. In addition, her calcitriol level was normal.
The authors suggest that calcitriol should be measures in POTS and if low levels are measured, calcitriol treatment should be started.
Although this research reported normal vitamin D levels and then used calcitriol (not standard vitamin D), for anyone with POTS it is worth getting both your vitamin D and calcitriol levels measured.
This vitamin D research was published in the British Medical Journal (BMJ) Case Reports.
Conclusions
There is a lack fo research around vitamins and nutraceuticals in POTS:
-Vitamin B1 rich foods include brown rice, legumes/beans, wholewheat bread etc.
-Vitamin B12 is cheap and easy to measure in blood and this is a sensible first step. Vitamin B12 is found in all animal foods and some fortified foods like soy milk. If vitamin B12 levels are low, a supplement may be needed.
-Vitamin C is found in fresh fruit and vegetables e.g. kiwi, strawberries, bell peppers etc.
- Like vitamin B12, vitamin D is cheap and easy to measure in blood and this is a sensible first step. In addition, a further test of calcitriol or 1,25 dihydroxyvitamin D (1,25D) may be advisable.
Nutrition, diet and Postural orthostatic tachycardia syndrome (POTS)
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