new to the gluten free journey?
new to the gluten free journey?
Dysautonomia vs. POTS – a quick orientation
‘Dysautonomia’ is an umbrella term for disorders in which the autonomic nervous system (ANS) malfunctions, affecting heart rate, blood pressure, digestion, temperature regulation, and more.
POTS (Postural Orthostatic Tachycardia Syndrome) is one specific subtype within that umbrella, defined by an excessive increase in heart rate upon standing without a corresponding drop in blood pressure. In other words: all POTS is dysautonomia, but not all dysautonomia is POTS. We’ll use ‘POTS’ throughout this article, but when we cite studies that aggregate several autonomic disorders together, you’ll see the broader term ‘dysautonomia.’
Postural Orthostatic Tachycardia Syndrome is a form of dysautonomia defined by an increase in heart rate of ≥30 bpm (≥40 bpm in adolescents) within 10 minutes of standing, in the absence of orthostatic hypotension. Estimates suggest 1-3 million Americans, 80 % young women, struggle with POTS, which often goes undiagnosed for years.
Growing evidence suggests autoantibodies against nervous system receptors are present in 30-90 % of POTS cohorts, supporting an autoimmune hypothesis. Why is this important? Autoimmune disease has 5 categorical triggers:
Identifying and addressing these triggers should be a primary goal of anyone with POTS.
Traditional cardiology focuses on beta‑blockers, fludrocortisone, or midodrine for symptomatic relief. Functional medicine, by contrast, asks why the autonomic nervous system is misfiring: chronic infections, leaky‑gut‑driven autoimmunity, toxin exposure, nutrient deficits, and food reactions…especially gluten, as it is one of the most scientifically studied drivers of autoimmune disease.
| Study | Design | Key finding |
| Zha 2022 | Retrospective study, 20 POTS patients | All patients reported improvement in symptoms on a gluten free diet. Average improvement rating greater than 50%. |
| American JG 2014 | Double‑blind gluten challenge in gluten sensitive POTS patients | Re‑introducing gluten sharply exacerbated tachycardia and dizziness within 72 h. |
Bottom line: For many POTS patients, gluten is not just an innocent by‑stander, it is a driver of autonomic chaos.
If you have been diagnosed with POTS and want to confirm whether gluten may be contributing to your symptoms, the simplest and least invasive type of testing is HLA-DQ genetic analysis. This test identifies whether or not you have the genes that predispose you to gluten reactions.
Many people opt for celiac testing via blood and biopsy. Although this type of testing can be diagnostic for some, there is a high probability for these tests to yield false negative results. You can read our comprehensive review of the pitfalls of celiac testing here.
Some opt to perform an elimination diet to determine whether gluten free alleviates symptoms. If you are relying on this method, it is important to keep a symptom log and monitor for improvement. Also, it is important to understand that a short gluten free diet trial can be misleading, as it can take several months to clear gluten from your system.
Before we jump into the action steps, it helps to understand what tends to provoke POTS dysautonomia in the first place. Research points to a “multi‑hit” scenario:
These stressors funnel into three final common pathways: autoimmune reactions, oxidative/mitochondrial stress, and low blood volume. Together these set the stage for the hallmark racing heart and dizziness of POTS. Keeping these root causes in mind makes the following natural strategies far more intuitive.
| Step | Action | Why it works |
| 1 | Strict Gluten Elimination (including cross contamination, other grain based foods, and personal care products) | Removes antigenic trigger; allows gut and nerves to heal. |
| 2 | Support Blood Volume – Drink 2–3 L water + 3–5 g added sodium (unless hyper‑adrenergic POTS); use mineral‑rich electrolyte powders | More plasma volume = less tachycardia upon standing. |
| 3 | Mitochondrial Support – CoQ10 200 mg, magnesium glycinate 400–600 mg, B‑complex with methyl‑folate/B12, acetyl‑l‑carnitine 500 mg | Enhances ATP so baroreflex can keep BP stable. |
| 4 | Gut rehabilitation – Follow the No Grain No Pain diet. Consider digestive enzymes, probiotics, and L-glutamine supplementation. | Removes other POTS inciting foods. Supports natural gut barrier and digestibility of nutrients from food. |
| 5 | Gradual exercise – start with recumbent bike or rowing 5 – 10 min, progress 10 % weekly; incorporate resistance bands body weight calisthenics to tolerance. | Strengthens calf‑muscle pump; proven to lower resting HR in POTS. |
| 6 | Compression therapy – Consider the use of waist‑high compression stockings. | Prevents venous pooling. |
| 7 | Modulate co‑triggers – Address other food sensitivities, nutritional deficiencies, MCAS/histamine issues, and environmental toxin exposures (i.e. heavy metals and mold toxins) | Eliminates other known contributing factors to POTS. |
If going gluten free sounds overwhelming, don’t fret. Use the following resources to help you master the diet.
Several studies have identified autoantibodies in 30 – 90 % of people with POTS, suggesting that in many cases the syndrome has an autoimmune component. Ongoing clinical trials with intravenous immunoglobulin (IVIG) and immune‑adsorption therapies are exploring this link further, but gluten removal remains a low‑risk first step to calm immune over‑activity.
Unfortunately, even trace exposures – crumbs containing as little as 20 parts per million (ppm) can keep gluten antibodies elevated for months and perpetuate autonomic symptoms. A strict, gluten free diet is essential for full nerve recovery.
Many patients notice less light‑headedness and gastrointestinal (GI) pain within 2–6 weeks. Full autonomic recalibration, especially in long‑standing cases, can take 6-18 months as antibodies decline and blood‑volume homeostasis normalizes.
Yes, but make sure to choose third‑party‑tested, certified GF strains or make your own ferments (e.g., coconut‑milk yogurt, sauerkraut). Always verify that capsule excipients are wheat‑free.
Clinical anecdotes and small case series indicate that removing gluten can reduce histamine driven flares and improve vascular tone in joint hypermobility POTS. Because gluten can aggravate intestinal permeability, eliminating it often lessens the inflammatory burden on both connective tissue and mast cells.
If you suspect gluten is sabotaging your autonomic nervous system, or just need better nutritional guidance, schedule a consultation with Dr. Osborne to build a personalized game plan.
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The entire contents of this website are based upon the opinions of Peter Osborne, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Peter Osborne and his community. Peter Osborne encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.
