Neuroscience Can Finally Solve The POTS Hydration Problem
Dr. Nathan Keiser
19,191 views
Download our Dysautonomia Protocol Roadmap: https://keiserclinic.com/roadmap/
Dr. Nathan Keiser talks about Electrolytes and POTS dysautonomia
The standard advice for POTS is drink more water and increase your salt. And in the short term, that's not unreasonable. Salt helps retain water, water expands blood volume, expanded blood volume overflows the system enough to temporarily push more blood to your brain. You get a window where you feel a little better, sometimes an hour, sometimes a couple. But then your kidneys figure it out, strip the excess, and you're back where you started, except now you're also peeing constantly and redistributing your potassium in ways that create new problems.
The deeper question nobody asks is whether this is actually a volume problem or a distribution problem. For most people with POTS, the blood is there. There's enough of it. The issue is that the reflexes responsible for squeezing it out of the venous reservoir in your abdomen and returning it to your heart aren't firing the way they should. The signal from brain to blood vessels has gone quiet. And no amount of water fixes a quiet signal. You can tell this is the case if you've been maximally hydrated and nothing changes when you stand, if you feel worse standing still than walking, if crossing your legs or squatting gives you instant relief, or if compression garments help more than you'd expect them to. All of those point to distribution, not supply.
The good news is these are reflexes, and reflexes are trainable. That's where the real work is. Hydration isn't the enemy, but it's a bridge, not a destination. Use it to keep yourself functional while you figure out why the system underneath isn't distributing on its own.
CHAPTERS
00:00 You're doing it right and it's still not working
01:46 Why salt and water loading makes theoretical sense
03:00 Absolute vs relative blood volume
04:26 blood flow is regional
06:00 The hydration continuum and the sweet spot
07:03 Salt loading: why it doesnt work
08:08 What that window teaches you about your problem
09:04 The splanchnic reservoir and standing
10:26 POTS and ME/CFS: 25% cerebral blood flow loss
11:29 Blood pooling is a feature, not a flaw
13:46 Cues that it's distribution, not supply
17:01 Compression: what it's actually doing
18:21 The 2021 consensus: 2-3 liters, 3-10 grams salt
19:55 Why more salt isnt always better
21:46 The reflex loop: sense, signal, constrict, stabilize
š The Keiser Clinic in Chelsea, Michigan
People travel from all over the world to seek care with us. We are the only neurological rehabilitation clinic that specializes in measuring and training the systems that regulate blood flow to the brain so you can restore function and escape the symptom management lifestyle.
Visit our website
š keiserclinic.com
šKeiser Clinic Patient Success Stories
https://keiserclinic.com/pages/keiser...
š¹ Our Pledge to You:
We know what it feels like to be on the other side of illness. Several of our doctors have been patients or caregivers themselves. They know what it feels like to be dismissed and sent home with no answers. When you become a patient at the Keiser Clinic, you have a care team of doctors who understand where you've been, and what it actually takes to get better.
20 Comments
I just canāt anymore. Iām on propranolol, my heart rate is stable but the REST of the symptoms make me miserable on the daily. Especially as someone with comorbidities(fibromyalgia, migraine disorders, epilepsy, gastroparesis, cspine osteoporosis arthritis ((with a syrinx down through t)), the pots)? Justā¦I just canāt anymore. I want to give up, lay down and refuse to stand back up.
So in this framework, a layer of structured water lines our vessels, called "exclusion zone" water, because it's a form of gel water that excludes any solutes. This creates a charge differential, which causes the blood to flow electrostatically. So the theory as to why POTS happens would be a collapse/loss of EZ water, and then upon standing, the blood cannot electrostatically return to the heart, causing a loss of flow that the heart tries to compensate for. This model also has a different explanation about cardiac function that's too complex for this comment, but is an important thing to understand if you are interested in this theory.
So the solution is not to drink more salt water, but to increase EZ water, and stop doing things that damage it. Keeping warm is the #1 priority, including drinking warm drinks and never anything cold. Then other things such as potassium and magnesium to build electrolytes, but not overdo the sodium ratio as commonly suggested. Infrared heat and light is also very helpful.
I have noticed a significant reduction in heart rate spikes, but I have only been doing it for a short period of time and I need to continue for at least 6 months in my opinion before I will be confident in the outcome.
It's very easy to call this quackery without actually looking into the science. There's a book by Gerard H. Pollack about it, or you can find some presentations on here for free. There's none about POTS that I am aware of, I'm piecing that part together myself. But I have been studying and researching this condition for over 20 years now, so I have a lot of background knowledge about the mainstream theories of Pentad Super Syndrome (the comorbidities of POTS which can all be logically connected with loss of EZ water). So I haven't just stumbled on this as my first idea to treat POTS. I'm almost 40, and this is the first time I have started to see any real improvement in my POTS and other syndromes.
I hope that you will investigate this with an open mind. Try to remember the first time someone told you the heart pumps blood around your body. Were you like me, and thought that was impossible? Well that's because it is...
Still having a hard time though. In fact I get dizzy a lot more often now.
I was diagnosed with POTS//MCAS/EDS and disautonomia in UT had to move unexpectedly to OR. Oregon wants to remove all my diagnoses and refuses to treat any of those.
Donāt come to OR if you have any health problems.
Edit to add: I do NOT need to urine often.
Neuroscience Can Finally Solve The POTS Hydration Problem
Dr. Nathan Keiser
19,191 views
Download our Dysautonomia Protocol Roadmap: https://keiserclinic.com/roadmap/
Dr. Nathan Keiser talks about Electrolytes and POTS dysautonomia
The standard advice for POTS is drink more water and increase your salt. And in the short term, that's not unreasonable. Salt helps retain water, water expands blood volume, expanded blood volume overflows the system enough to temporarily push more blood to your brain. You get a window where you feel a little better, sometimes an hour, sometimes a couple. But then your kidneys figure it out, strip the excess, and you're back where you started, except now you're also peeing constantly and redistributing your potassium in ways that create new problems.
The deeper question nobody asks is whether this is actually a volume problem or a distribution problem. For most people with POTS, the blood is there. There's enough of it. The issue is that the reflexes responsible for squeezing it out of the venous reservoir in your abdomen and returning it to your heart aren't firing the way they should. The signal from brain to blood vessels has gone quiet. And no amount of water fixes a quiet signal. You can tell this is the case if you've been maximally hydrated and nothing changes when you stand, if you feel worse standing still than walking, if crossing your legs or squatting gives you instant relief, or if compression garments help more than you'd expect them to. All of those point to distribution, not supply.
The good news is these are reflexes, and reflexes are trainable. That's where the real work is. Hydration isn't the enemy, but it's a bridge, not a destination. Use it to keep yourself functional while you figure out why the system underneath isn't distributing on its own.
CHAPTERS
00:00 You're doing it right and it's still not working
01:46 Why salt and water loading makes theoretical sense
03:00 Absolute vs relative blood volume
04:26 blood flow is regional
06:00 The hydration continuum and the sweet spot
07:03 Salt loading: why it doesnt work
08:08 What that window teaches you about your problem
09:04 The splanchnic reservoir and standing
10:26 POTS and ME/CFS: 25% cerebral blood flow loss
11:29 Blood pooling is a feature, not a flaw
13:46 Cues that it's distribution, not supply
17:01 Compression: what it's actually doing
18:21 The 2021 consensus: 2-3 liters, 3-10 grams salt
19:55 Why more salt isnt always better
21:46 The reflex loop: sense, signal, constrict, stabilize
š The Keiser Clinic in Chelsea, Michigan
People travel from all over the world to seek care with us. We are the only neurological rehabilitation clinic that specializes in measuring and training the systems that regulate blood flow to the brain so you can restore function and escape the symptom management lifestyle.
Visit our website
š keiserclinic.com
šKeiser Clinic Patient Success Stories
https://keiserclinic.com/pages/keiser...
š¹ Our Pledge to You:
We know what it feels like to be on the other side of illness. Several of our doctors have been patients or caregivers themselves. They know what it feels like to be dismissed and sent home with no answers. When you become a patient at the Keiser Clinic, you have a care team of doctors who understand where you've been, and what it actually takes to get better.