By LCWNS Team
What is the Relationship Between POTS and Eating Disorders?
When you get out of bed in the morning, you probably are not thinking about regulating your heart rate and blood pressure as you transition from laying down to standing. This is because the part of the nervous system responsible for controlling these automatic functions responds as it should to account for the effects of gravity on blood flow1. With Postural Orthostatic Tachycardia, or POTS, however, positional changes trigger abnormal and prolonged increases in heart rate (by >30 BPM in adults or by >40 BPM in those under 18 years old)2 in an effort to return adequate blood to the brain2. Individuals with the condition often experience fatigue, dizziness, palpitations, or fainting1; blood pressure should remain unaffected3. While POTS cannot be “cured,” adequate hydration and implementing specific dietary changes can be useful in managing symptoms.
The cardiac complications of eating disorders are well-established. Both POTS and eating disorders can impact orthostatic tolerance. Eating disorders, such as anorexia nervosa and bulimia nervosa, put the heart at greater risk due to inadequate nutrition and electrolyte disturbances4. Additionally, vital signs like heart rate and blood pressure are sensitive to changes in energy intake, hydration, and physical and emotional stress5. As such, individuals with anorexia typically present with sinus bradycardia (heart rate <60 BPM) and decreased blood pressure/orthostatic hypotension3; individuals with bulimia are at increased risk for cardiac arrythmias due to the impact of purging on electrolyte and fluid balance5.
Due to the impact of malnutrition on the cardiovascular system, it can be difficult to discern whether cardiac abnormalities/symptoms are due to the eating disorder or autonomic dysfunction, as in POTS. Relatedly, autonomic nervous system dysfunction may increase one’s risk of sudden death from anorexia5. For these reasons, physicians should not diagnose POTS if someone currently has an eating disorder2, 5. Unlike POTS, cardiac effects secondary to anorexia and bulimia typically resolve once eating habits, weight, and compensatory behaviors stabilize5.
Additionally, POTS and eating disorders share mutual risk factors, with white, female, adolescents/young adults comprising much of the affected populations6. Other associations include dietary restriction and/or history of an eating disorder in those with POTS7. The former alone can increase the likelihood of developing an eating disorder. Besides the cardiac symptoms previously mentioned, gastrointestinal complaints are common in POTS as with eating disorders. These include nausea, bloating, and abdominal pain7.
Individuals with eating disorders and/or POTS can benefit from medical nutrition therapy. The registered dietitian plays a crucial role in the management of both as diet can be used as a means of mitigating symptoms3. Stay tuned for our next blog, where we will discuss tricks and tools for treating POTS and related disorders.
References
[1] POTS: Causes, symptoms, diagnosis & treatment. Cleveland Clinic. (2022, September 9). https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots
[2] Quesnel, D. A., Cooper, M., Fernandez-del-Valle, M., Reilly, A., & Calogero, R. M. (2023). Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review. Journal of Eating Disorders, 11(1). https://doi.org/10.1186/s40337-022-00685-9
[3] Postural orthostatic tachycardia syndrome (POTS). Johns Hopkins Medicine. (n.d.). http://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots
[4] Rittenhouse, M. (2021, October 29). Cardiovascular complications of eating disorders. Eating Disorder Hope. http://www.eatingdisorderhope.com/long-term-effects-health/cardiovascular-complications
[5] Friars, D., Walsh, O., & McNicholas, F. (2023). Assessment and management of cardiovascular complications in eating disorders. Journal of Eating Disorders, 11(1). https://doi.org/10.1186/s40337-022-00724-5
[6] Benjamin, J., Sim, L., Owens, M. T., Schwichtenberg, A., Harrison, T., & Harbeck-Weber, C. (2020). Postural orthostatic tachycardia syndrome and disordered eating: Clarifying the overlap. Journal of Developmental & Behavioral Pediatrics, 42(4), 291–298. https://doi.org/10.1097/dbp.0000000000000886
[7] Harris, C. I. (2022). COVID-19 increases the prevalence of postural orthostatic tachycardia syndrome: What nutrition and dietetics practitioners need to know. Journal of the Academy of Nutrition and Dietetics, 122(9), 1600–1605. https://doi.org/10.1016/j.jand.2022.06.002
