Impact of POTS Disease (Postural Orthostatic Tachycardia Syndrome) on Adrenal Fatigue

By: Dr. Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH


Read Part 1

POTS Disease and Adrenal Fatigue Syndrome

POTS disease and Adrenal FatigueAdrenal Fatigue Syndrome (AFS) is a neuroendocrine condition induced by stress that can be physical or emotional. There are four stages, with symptoms ranging from mild to severe. Fatigue is the hallmark symptom, and can be incapacitating. Symptoms of advanced AFS include reactive hypoglycemia, heart palpitations, lightheadedness or dizziness on arising, insomnia, fatigue, salt craving, brain fog, and low blood pressure. The presence of Postural Orthostatic Tachycardia Syndrome or POTS disease can further complicate the individual’s health.

When the body perceives a threat to survival, it releases anti-stress hormones, including cortisol, norepinephrine, and epinephrine. If external stressors are not removed, continued release leads to a body chronically overloaded with norepinephrine in what is known as sympathetic overtone. In other words, the body is bathed in a sea of norepinephrine in order to keep the brain on high alert and the heart ready to run away or face danger. Sufferers of advanced AFS are therefore often in a constant alarm state as part of the body’s automatic response to stress.

While norepinephrine’s purpose is to ensure our survival, there are unintended negative consequences when produced in large quantities over time. The cardiovascular system is particularly at risk.

A quick comparison with the most cardiovascular related symptoms of POTS disease mentioned earlier shows many commonalities with advanced stages of AFS. Both tie to and are largely the result of excessive norepinephrine. Specifically, hyperadrenergic POTS disease is associated with elevated levels of norepinephrine, and so is advanced AFS; where chronic stress triggers excessive outpouring of norepinephrine as part of the hypothalamic-pituitary-adrenal (HPA) axis activation stress response.

Norepinephrine Overload

Excessive norepinephrine in the brain acts as a potent stimulatory neurotransmitter. It puts the brain in a state of high alert and keeps us mentally sharp on the look-out for danger. We feel wired, unable to relax. Sleep is a low priority in such a situation as far as the body is concerned. Falling asleep is a challenge unless physically exhausted. Many require sleep aids and even medications just to fall asleep. After a few hours of rest, the body automatically awakens, and is unable to fall asleep again. Sometimes this is also accompanied by heart palpitations. During the day, a sense of nervousness and anxiety may be present.

Norepinephrine also acts outside the brain as it travels as a hormone to the heart, increasing the heart rate as well as the force of the heartbeat. A pounding heart rate is largely the result of excessive norepinephrine.

Constant overload of norepinephrine, sympathetic overtone, can contribute or lead to hyperadrenergic POTS mentioned earlier, with symptoms mimicking it on a subclinical or clinical basis.

Epinephrine Overload

Epinephrine overload is a cause of POTS disease and Adrenal FatigueIn the case of advanced AFS, there is an additional aggravating factor of hormonal overload, and it has to do with epinephrine, norepinephrine’s chemical daughter. Epinephrine is the strongest of all emergency hormones. It is similar in action to norepinephrine, but much more potent. It is responsible for the flight-or-fight response and is the body’s hormone of last resort when dealing with stress. When the body’s norepinephrine level is high, part of it is automatically converted to epinephrine, leading to a higher epinephrine level. Epinephrine also acts on the cardiovascular system as norepinephrine, but stronger. The negative effects of epinephrine on the cardiovascular system are compounded.

Furthermore, in cases of severe stress, a branch of the autonomic nervous system called the adrenomedullary hormonal system is activated. Epinephrine is released directly from inside the adrenal glands in an area called the adrenal medulla when this system is activated.

Epinephrine is called the body’s hormone of last resort for good reason. It is the most powerful hormone in the body in terms of potency, and has no opposing hormones once released. Epinephrine released from the adrenal medulla travels to the heart and leads to a fast heart rate in order to deliver more blood to the brain. It works along-side norepinephrine, but is more powerful. Reactive sympathetic response is the term we use to describe a body bathed in a sea of epinephrine with its negative side effects.

It comes as no surprise that those in advanced stages of AFS often have symptoms mimicking POTS disease. Unfortunately, this is seldom recognized.

Typical Case History

Ellen is a 35-year-old adrenal fatigue sufferer in advanced stages. She has been struggling with fatigue and lethargy for about ten years, and has been under the care of seven doctors over this time. It started with a stressful workload and relationship problems. Her fatigue was mild at first, but gradually worsened. In the past few years, she began to experience lightheadedness on arising along with a fast heart rate, as well as salt cravings and low blood pressure at rest. She used to be a very active person but now spends much of her free time resting. She is barely able to hang on to her job, and feels that it is in jeopardy because of frequent absenteeism in recent years. When she is severely stressed, she feels palpitations and a fast heart rate, even at rest. These symptoms are accompanied by anxiety, headache, shortness of breath, and hypoglycemia. She goes on numerous visits to the emergency room as a result. Cardiac workup is invariably normal and she is sent home with anti-anxiety agents. She saw an endocrinologist who ordered a tilt table test but the result was inconclusive. All other laboratory tests are normal. Her fatigue continues to worsen with time, and energy crashes are more prominent and frequent. Her doctor also gave her an ACTH test that showed unremarkable levels. She was told her adrenal glands are normal.

POTS disease and feeling dizzyEllen’s quality of life is severely restricted. She does not have the energy for regular exercise or dance. She has to get up slowly in order not to feel dizzy. She is easily startled with loud sounds. She cannot tolerate long exposure to direct sunlight, and she gets dehydrated easily. During the day, she feels anxious, and at night, wired and tired. Falling asleep can take an hour or more. She is dependent on sleep medicine to fall asleep, however, she wakes up in the middle of the night unable to go back to sleep. She gets up in the morning feeling lethargic and unrefreshed.

Her doctor told her she is borderline POTS disease and wants to start her on medication. She wants to pursue a more natural solution to her problem.

Natural Recovery Principals of POTS Disease

Any astute clinician must consider AFS as a secondary cause of POTS disease if the history of the patient has an indication or history of physical or emotional stress. This includes a history of excessive exercise, infection, surgery, accident, overwork, relocation, divorce, or relationship problems. Frequent visits to the emergency room complaining of chest pain, palpitations and anxiety but accompanied by negative cardiac workup in a setting of stress is a classic alert.

Treatment for POTS disease by conventional medicine could help alleviate some of the symptoms. For long-term recovery, the focus should be on removing the underlying stressors and healing the adrenals. Once the adrenals are healed, symptoms of POTS disease automatically and spontaneously resolve. It can happen in a short time.

One should be careful not to begin heart rate suppression medication too early. Such a move could potentially force the heart to seek alternative electrical conduction pathways over time that can create a deeper set of problems while the underlying cause is being masked. One should also avoid anti-anxiety agents and antidepressants unless they are for temporary use, as these also tend to mask underlying problems.

Recovery Tips for Early Adrenal Fatigue and POTS Disease Symptoms

If your AFS is mild (stages 1 and 2) and you have symptoms of POTS disease that are not debilitating or prevent you from carrying out your active daily living, you can consider vitamin C, the B vitamin pantothenate, the amino acid l-tyrosine, licorice, maca, green tea, ginseng, ashwagandha, and adrenal gland extracts. They support healthy adrenal function, strengthen blood vessel constriction, and increase heart function. Because many of these are stimulatory in nature, always pay attention to the delivery system to ensure bioavailability and avoid over-dosage. Side effects include jitters, addiction, cramps, brain fog, and tremors. This is especially true if the dosage does not match the body’s need.

Recovery Tips for Advanced AFS and POTS Disease

Vitamin C can help both POTS disease and Adrenal FatigueThose with advanced AFS (stages 3 and beyond) and symptoms of POTS disease that are troublesome to the degree of interfering with normal living should not embark on any nutritional supplement program without careful consideration and a master recovery plan in place. One should proceed with extreme caution because a body with advanced AFS is thus far most likely in a state of hypersensitivity by the time POTS disease, either clinically or subclinically, is present. They are also at risk of paradoxical reactions and a low threshold for adrenal crashes. Their extracellular matrix is often congested, and the liver overburdened. Energy level is very low. Attempts to stimulate the adrenals and cardiovascular system using supplements that may have worked in earlier stages of AFS may backfire. Even a small amount of these vitamins, such as vitamin C or B, ashwagandha, rhodiola, maca, licorice, and glandulars can make POTS disease worse and trigger adrenal crashes.

Consider the following:

  • Gentle macro nutrition to match the body’s dietary needs and physical condition should be encouraged, with easy to digest soups and broths as part of the diet.
  • Avoid gluten, dairy, wheat and corn, as these are harder to digest and can lead to inflammatory reactions that trigger POTS disease.
  • Symptoms of irritable bowel should be addressed and stabilized with enzymes, probiotics etc. so that food assimilation from the gut is optimized.
  • A special form of breathing called Adrenal Breathing Exercise, as compared to regular breathing or deep breathing should be encouraged. Doing so enhances the parasympathetic tone to reduce the sympathetic tone, with acetylcholine replacing norepinephrine as neurotransmitter, and creates a sense of calmness. Heart rate normalizes and blood pressure stabilizes as a result.
  • Avoid antibiotics if possible as they can upset the internal flora and thus the pH of the body.
  • Avoid aggressive detoxification approaches such as chelation, liver flushes, cleanses, fasting, hyperthermia treatment, hot yoga, acupuncture and the like as they can aggravate extracellular matrix congestion and trigger POTS disease.
  • Mild and gentle liver support such as liposomal glutathione should be considered, along with fermented herbs such as milk thistle and others that have excellent bio delivery systems. Care must be taken to titrate the proper amount at the right time. Incorrect dosing and delivery systems are common mistakes and can make matters worse.
  • Take time to decongest the extracellular matrix first to stabilize the body’s internal biosphere.
  • Do use medication if there are no other choices and the body fails to respond.

Summary

POTS disease can be a very serious condition. Symptoms tend to occur in those in advanced stages of AFS when the body is flooded in a sea of norepinephrine and epinephrine. Frequent visits to the emergency room with complaints of heart palpitations amidst a negative cardiac workup are the norm.

AFS is perhaps the most commonly overlooked secondary cause of hyperadrenergic POTS disease. Quickly beginning a comprehensive adrenal fatigue recovery plan should be the priority. A recovery plan is required for long-term success to prevent POTS disease from recurring.

As the adrenals heal, one should notice that the frequency and intensity of POTS disease subsides. This can happen in a short time, especially for those who are young and have good rebound capabilities.

If you think that you are in, or have symptoms of POTS disease and suffer from Adrenal Fatigue Syndrome, recovery needs to be personalized. An improper approach to recovery can complicate, deter, or even exacerbate your current state.

Read Part 1

© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

POTS disease

DrLam.com
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Lately I have become aware that I have POTS. After standing for 10 minutes, my heart rate went from a resting rate of 70 to 150-160. Now that I have been doing your adrenal breathing exercises for two months, my heart rate only goes up 30-40 beats from resting, whether I am just standing or walking while shopping. This is a great improvement for me and I expect to reach my goal of being cured of the POTS symptoms.




36 Comments

  • Suraiya Hemani says:

    I have been diagnosed with adrenal fatigue and a morning cortisol level of 11.95mmol/L. I’ve been on glandular supplements twice a day for nearly 4 weeks which have helped a little with energy levels. However, I’m still experiencing lots of bouts of shortness of breath which is debilitating and energy crashes. Please could advice me as this condition has started about 12 years ago. Many thanks

  • Sasha says:

    Interesting article… I have pots, likely hyper pots of some variety (while I respond well to salt and fluid HR wise, I have all the symptoms of hyper pots- Florinef has helped my HR but caused weight gain and hypertension even at rest now).
    I also have narcolepsy and Ehlers danos. I’d been on adderall for several years for the narcolepsy stuff (only time I have hard time sleeping is when I get really potsy)and was feeling.. off. Read about dopamine depletion so I tried taking L-Tyrosine on my days off from adderall and instead of it waking me up, I’d sleep hard and couldn’t wake up. Esp when taken with my B-complex/iron supplement.. couldn’t find any Info for why this might have occurred…
    except for your blip about it possibly causing a paradoxical reaction…
    interesting…
    why does it do that in some advanced cases btw?

    • Dr.Lam says:

      You need a personalized program. Substituting stimulatory amino acids for Adderall can backfire on you. Be very careful. We deal with cases like this every day, so what you reported is not unusual. But everyone is different. If you need more help, call my office.

      Dr. Lam

  • Lisa says:

    Hi Dr Lam
    I did your questionnaire and scored 15. I have POTS but I believe its Hyperadrenergic. I also feel I am late stage adrenal fatigue too. Your website has given me a lot of valuable information. I am based in the UK so unfortunately cannot come to see you. What kind of Dr do you think I need? Would it be a Naturopath or is this something my GP could treat? Or someone completely different?

    Thank you x

    • Dr.Lam says:

      The problem when you have POTS and AFS is that the wrong approach can make you worse. Most conventional doctors have little idea on the holistic approach. We have a telephone coaching program and have many from UK. You can call my office for more detail.

      Dr.Lam

  • Jennifer says:

    I have a 20 year old daughter diagnosed with POTS and EDS. And. A 32 year old son with EDS.
    Please tell me how can we become your patients
    We’re are you located at?
    Please send me all contact information

  • Mark Anchors says:

    Hi Dr. Lam,
    I am a 33 year old male, who has been battling Lyme related illness for the last two years. I as well as my doctors believe that I have gotten rid of the Lyme, but now I am dealing with the fallout of treatment. Since my immune system took a real beating, I now suffer from an extreme case of candida and parasites. My salivary cortisol is low as well as my urine levels on the Dutch Hormone panel. Whenever I take nutritional supplements, glandulars or adaptogens I experience what I consider serious crashes, hyperventilation, crying, extreme anxiety, elevated heart rate. I’m in a severe state of dizziness all day long, I cant concentrate, my vision is severely blurred and I cry for no reason constantly. I’ve been hospitalized 3 times in the last month with heart attack like symptoms, palpatations, chest pain etc., but all the cardiac workup comes back normal. I’m suspecting extreme adrenal exhaustion at the very least, and what sounds like POTS at this point. I feel like I’m stuck between a rock and a hard place because my parasitic infection is worsening rapidly, but my adrenals can’t even handle normal day to day stress. I don’t know where to turn anymore. Even the doctors I’m working with who acknowledge there’s a problem don’t seem to know how to address it properly. I feel like you might be my last hope at this point. Any advice would be greatly appreciated.

  • Julie says:

    Hi, I have been having shortness of breath, especially in an upright position (sometimes sitting, always standing and walking). I am 33 and this has caused debilitation for me. I have a young child and am unable to keep up. Initially, I thought my symptoms came when I was cleaning up broken glass and thought I had inhaled some glass. During my visit with my pulmonologist, she discovered that I could have POTS. Do you think that POTS is the more likely explanation of my shortness of breath? Or do you think it could be from inhaling something like a sliver of glass? I have hopes that it is POTS because it seems treatable. Right now, I am planning to change my diet – eating soups as you mentioned. Is there anything else you recommend? Thank you.

    • Dr.Lam says:

      POTS is a very specific diagnosis that requires a tilt table test. Normal sensitivity or allergic response is unrelated. There are many reasons for POTS and its subclinical manifestation, with AFS being one potential association.

      Dr Lam

  • Catherine Clark says:

    How can I find out how to properly do the Adrenal breathing exercise?

  • Danielle says:

    I was dx with pots and ms 5/2016 not sure what caused what or if the 2 are even related it all started 2 years ago with my stomach after I would eat my pulse would start to race I would get real hot and faint feeling went to several doctors several test all came back normal given medication for acid reflux long story short non of the pots medication work I’m very sensitive to any medications including some vitamins could this really be pots or af I seem to get better at night pulse comes down and I feel better I need a treatment plan that works…..please advice

    • Dr.Lam says:

      When your body is so sensitive, you need to find someone who can tie in AFS and POTS like issue together so the complete picture emerges. Without a comprehensive plan, efforts , even heroic, will fail. If you cannot find someone, you can call my office. We deal with problems like you have everyday so nothing unusual on the surface so far.

      Dr Lam

  • Karen Feck says:

    I am a 38 year old female diagnosed with POTS in March after a positive tilt table test. I have been steadily getting worse since my pregnancy in 1999. I was diagnosed previously with PVCs, anxiety, and extremely low serum ferritin. I also have elevated thyroid peroxidase antibodies but my thyroid numbers are normal. I’ve had mountains of blood work all normal. I’m currently on ferrous sulfate and metoprolol. I have a disability case pending. I’m dizzy, exhausted, and presyncope 24/7 with no relief. I’m very discouraged and do t know what else to try.

  • Valerie Law says:

    HI Dr. Lam, I have been diagnosed with POTS since April. I am taking Florinef and Midon, which have now controlled the heart rate. Which I rising to 160 on standing. What I am experiencing on a daily basis is dizziness. When I go into a shopping centre, my eyes go all blurry and after a few minutes I Feel sick and dizzy, and feel I am about to fall and have to leave. Initially we thought it was my high heart rate was causing this but now it’s down and I still feel this way. then we questioned the meds, but on further research I have found and you have also mentioned problems with vision. Is there anything , anything at all to help with this. I find it so debilitating and need someone with me when I am going outside.
    I would be most greatful for your help on this. Thank you.

    • Dr.Lam says:

      POTS can be controlled to a certain extend with medicine as what you are on now. This is ncessaary ,but also the drugs can mask the underlying root cause if you fail to look into that. Dizzyiness can be a sign of such underlying unresolved issue, and is the body’s way to force you to reckon with it. Conventional medicine may not see the connection or the clue, and thus it is written off and you are abandoned,but do not give up your search for answers. They are there if you look close enough and persistent enough. Lab test are not helpful. The best way is by thorough history that factor in the rest of your body in terms of what is going on systematically. Remember that POTS itself can often be a symptom and not the root problem. This is the first step we take in our nutritional coaching program with many who come to us with similar issues.

      Dr Lam

  • Laurie says:

    Hello Dr. Lam,
    First a little background on me. I was diagnosed with Ischemic Colitis in Oct of 2012. I didn’t want the surgery that might leave me with “the bag”. I chose to hope my body would heal with minimal medical intervention. I continued to have bowel issues such as pain and very watery stools but continued to choose this over surgery. I had noticed my energy level decreasing but was still able to maintain a normal life…working full time, being a fun grandma who goes to the park, goes fishing and teaches the grandkids how to cook.. guess I should say I am 50 yrs young. On Jan 31st this year I was diagnosed with perforated diverticulitis, every attempt to avoid surgery was made but on Mar 25th emergent surgery was performed which has left me with a temp ostomy. Although not what I wanted, I accepted what was necessary to resume my life. However I don’t have the energy to resume my life. Other then the last couple weeks, before my perforated diverticulitis diagnosis, I have never been so exhausted as I am now, yet sleeping is so hard to accomplish. I learned yesterday that I have a nodule/tumor (depending on which dr I talk to) on my left adrenal gland. Today I learned it was found in Oct of 2012 but not sure if any change to date. Yesterday my GI Dr’s nurse told me the “tumor” was the cause of my lack of energy, nausea etc…and my thought process was okay, at least I know what’s wrong. Today my surgeon said no the nodule is not it. My GI nurse said to insist on a biopsy, my surgeon said not needed. What questions should I ask to ensure an issue with my adrenal gland is evaluated? I just want some help to get me back…..Hope this makes sense and thank you for your time.

  • Amy says:

    My saliva test completed in February. 2016 indicted elevated cortisol for yhe first 2 readings and norml cortisol for the last two readings. I eas given an adaptogen but felt jittery because of the ginsing. I eas also given Adrenalcam which was to help with sleep; it didn’t help. I was also given supplements with high doses of various B vitamins but felt weak on those. I felt better after stopping yhe B vitamins but I am starting to feel weak again. I also have Hashimotos and am on Levothyoxine and GTA forter (T3) I recently had some bad heartburn that put me in the hospital because I thought it was a heart attack. I am currently having chest pains that come and go. I had a nuclear stress test done in March which did not show anything. I am a 48 year old female. With high cortisol in morning and normal at night- is this adrenal fatigue?

    • Dr.Lam says:

      High cortisol in the morning and normal at night is a typical presentation of AFS in certain stages. If you read my book, you will see. The fact that you are also on thyroid support, is worrisome. Overstimulation can happen , and compounds such as vitamin B can trigger symptoms you mention in a body such as yours. Chest pain can be structural or due to autonomic nervous system on overdrive. It is good to have it checked out. Chances are it will be normal, which further points to AFS.

      Dr Lam

  • Robert says:

    this was probably the most helpful artical yet….to have read thank you i am 27 yrs old after my mom passed away 4 months ago didnt take long hell broke lose….i got sick with strep….put on antibiotics…[still wondering if the antibiotics was a mistake] and since then adrenal slowly getting bad from anxiety stress panic attacks….i have high cortisol and adrenaline ….month ago developed POTS….its gotten slightly better….idk if from less stress or eating more hopefully less stress….i cannot deal with heat nor do more than walking long i think my blood pressure gets high sometime…….i hate this badly…..its hard to tell if adrenals bad from stress or maybe my GI tract is messed up im going to a gastreotologist and a cardiologist maybe a rhumetologist it never ends for opinins and the doctor field is kind of not great this stuff they tend to treat the symptoms not the root cause….sometime i get chest pains not bad pains but i notice it annyoing comes n goes…..i once went to e.r and the ekg showed rhythms of people who are gonna have a heart attack but my heart tests were fine blood and x-ray i guess that is refered to as “broken heart sydrome”….yea that is weird….my palmar lines have increased and probably will keep increasing i use to have not that many lines on my palm of hands no alot n weird designs….my hands r blochy when hanging down sometime when cold i can see my vessels in my palms alot more look nasty…..fatigue list goes on n on….im just trying to figure out the way this works is it from stress from a few months ago when i was ALOT heavily stressed which i am not as much now…..with de-stressing techniques n stuff….or did the antibiotics mess my stomach up i need a root cause…..i even have 2 bad teeth in the back need dental work cavity its like everything im lookin at for a root cause i have to try everything cuz i dont know….its maddening….im going with the gut and dental tooken care of first…..im wondering about gettin a tooth pulled with pots….if i had to just one at a time im concered about that right now im taking!!!

    Real Vitamin C….250mg with bioflavnoids [only take 1 pill so 125]
    magnesium triple complex swanson brand [400mg]
    b12 meth form…..5000mg to 10000mg depends
    probotic 50 billion raw garden

    been experiementing with the diotomaceous earth also a candida herbal complex im gonna finish up
    then do a liver kidney tea cleanse!! i was on a b-complex vitamin i stop cuz it made me get num hands n feet sometime and pin needle feeling at night went away once stopped heard that could be too much thiamine this is such a roller coaster for me this stuff has my mind so messed up and outlook on life i just hope for better some day im ok somedays just bad mental state

    i figure i definetly dont

    • Robert says:

      i also quit sugar out of my diet….i think that has done something not sure…..sugar is bad for candida and adrenals….along with caffiene also another reason i suspect stomach issues as a possibility besides dental issue after i had strep and antibiotics messed me up i went to mexico and ate tons of good food lots of spicy foods on a 23 day trip….spicy and sugary foods very spicy i think bad on stomach after antibiotics between gut or the two bad teeth ive been gargling with oregano oil after each meal and ordered black walnut powder till i see a dentist still curious if i should with POTS i need to ask a cardiologist

    • Dr.Lam says:

      When the body is in a state of alert, the sympatathic nervous system is activated. A host of reactions may surface, including POTS like symptoms and others that will be very confusing. you should be careful with too much methlated products as they tend to be stimuatory. talk to your doctor. when you are quite weak, also be careful with trying things out as your body may get weaker if it is not tolerated . Even the right thing done at the wrong time can be wrong. oral health has a lot of tie in to cardiac and systemic health, so it is good that you get your oral health taken care of. Navigating through all this is not easy for someone who is not experienced. Do find a doctor is best. I know it is not easy, but dont give up.

  • J. Newland says:

    I’m 60. I was diagnosed with POTS 5 yrs ago. I went thru a trauma and I have also since been diagnosed with Lyme. I feel like I shake so much and have adrenal surges. I can’t seem to handle any stress at all now. I was improving somewhat in late 2014/early 2015 and then due to extreme stress I relapsed and became even more ill. Several questions, can extreme stress from a bad marriage induce symptoms, how can I finish tapering of a benzodiazapine and heal my adrenals at the same time, and can benzos cause pots? Thank you. I so want to reclaim some part of my life.

    • Dr.Lam says:

      Stress can trigger a host of response from the body that includes POTS and AFS. If the underlying issues are not fully resolved and mistakes made then relapses can occur. Click 7 Adrenal Fatigue Recovery Mistakes for more information. Benzo withdraw and tapering is highly personalized. some people can get off rather quickly , but others can take years. Many factors are involved. Generally speaking, the stronger the adrenals, the easier it is to get off. Always consult your doctor when it comes to medications and take your time to do it.

  • Ms Ally Houlli says:

    Dear Dr Lam,

    Thank you for this excellent article. I wonder if you can help me as my life is getting worse and worse. I was diagnosed with POTS last year after confirmation via Tilt Table Test. However, I was suffering the symptoms for the previous two years to that where no one understood what was going on. It was only after I had such a high level of tachycardia and was subsequently taken to hospital that POTS was diagnosed and confirmed.
    Since diagnosis my body is getting worse- I am drinking large volumes of water, I have a Vegan diet, I do not touch any medication and am on a probiotic and B vit supplement.
    I also have started to develop varicose veins and I seem to be getting hypergylcemic attacks because if I don’t eat for a while, or I eat certain foods- I get shaky, breathless and incredibly lethargic with a pounding heart.
    I need to find a way to address this as I am a recent Psychology graduate going onto the grad entry to Medicine MBBS program and I don’t know how I can manage with this condition.
    You caution to use any nutritional and supplementary measures for those who have advanced POTS- please would you consider explaining a program for me to start following for recovery? I am willing to pay if that is required.
    Many thanks for your time,
    Ally,
    28, London.

    • Dr.Lam says:

      You are quite young to have these issues, and unfortunately, conventional medicine is not on the alert enough to see the AFS connection. Call my office and I will talk to you first and explain to you and see where you stand and we will go from there. That is the simplest and fastest.

  • Catherine Lund says:

    I have been diagnosed with POTS (severe adrenaline driven) at the Mayo Clinic 8 years ago. I’m 59 Years old women and recently had a thumb joint replacement. I feel my adrenaline much more severe. Can’t sleep and feel horrible. I’m currently taking venlafaxine, beta blocker, methylphenidate , levoxyl, levothroxine. Drink salt water wear compression. I have constant brain fog, tired, hot flashes, nausea, headache and sweating.

    • Dr.Lam says:

      The conventional therapy for POTS is geared towards suppressing symptoms of fast heart rate, and increase metabolic stimulation if your thyroid function is low. If it works, you should be well. If you are not finding improvement, your body may be telling you to try different approaches. POTS like and low thyorid like symptoms are common in advance AFS. Do pay attention as if you miss the connection, you may get worse with your heroic effort. Click Adrenal Fatigue versus Hypothyroidism for more information. The good news is that if this the case, then resolving the underlying problem usually brings a body back to normal balance.

      Brain fog is a seperate matter. Click Brain Fog for more information.

      Dr Lam

  • LUCY says:

    If someone is on antidepressants can they still be treated for advanced asf, or do they have to come off the medication?

  • Manju says:

    How do I know if I am stage 1, 2, 3 or 4 of AF? I can relate to the symptoms of POTS.