64 - Savita Sandhu on Diet and Hypermobility (Part 2) POTS & Diet

Key Points

• POTS (Postural Orthostatic Tachycardia Syndrome) is a form of dysautonomia, a dysfunction of the autonomic nervous system, commonly seen in hypermobile individuals.
• Dysautonomia involves an imbalance between the sympathetic ("fight or flight") and parasympathetic ("rest and digest") nervous systems, often leading hypermobile people to spend excessive time in a stressed sympathetic state.
• This sympathetic dominance significantly disrupts digestion, causing symptoms like low stomach acid, bloating, reflux, and impaired nutrient absorption, which can worsen overall health.
• Dietary management for POTS should consider smaller meals and addressing low stomach acid, but must be combined with therapies (e.g., breathing exercises, acupuncture) that promote parasympathetic relaxation to be effective.
• Individualized care with a qualified practitioner is essential due to the lack of extensive research and the highly variable presentation of symptoms.

Summary

This podcast episode from Hypermobility Happy Hour features dietitian Sivita Sandu discussing the relationship between hypermobility, POTS, and diet. POTS is explained as a type of dysautonomia, where the autonomic nervous system—regulating automatic functions like heart rate and digestion—becomes dysregulated. A key concept is the imbalance between the two branches of this system: the parasympathetic ("rest and digest") state and the sympathetic ("fight or flight") state. The discussion highlights that hypermobile individuals often experience a heightened and prolonged sympathetic response, not to immediate physical threats but to chronic stressors like inflammation or injury.

This persistent sympathetic activation has profound effects on gastrointestinal function. Blood flow and nervous system resources are diverted away from the gut, leading to reduced digestive secretions, including stomach acid and enzymes. Consequently, common issues arise such as nausea, bloating, reflux, and either slowed digestion (like gastroparesis) or overly rapid digestion (like dumping syndrome), all of which hinder nutrient absorption and overall wellness.

While dietary strategies are important, the conversation emphasizes that nutrition alone is insufficient if the nervous system remains in a stressed state. Recommendations include eating smaller meals to ease digestive burden and being mindful of symptoms indicating low stomach acid. However, equal or greater importance is placed on adjunct therapies that stimulate the vagus nerve and promote parasympathetic relaxation, such as specific breathing techniques, acupuncture, and even flotation tanks. The episode concludes by stressing the need for personalized care due to the complexity of symptoms and the current lack of robust research, underscoring that effective management of POTS and related gut issues requires a holistic approach addressing both diet and nervous system regulation.