Can Vitamin Toxicity Be Causing Your POTS?

So this is one that comes up and it's an interesting question — can B6 toxicity cause POTS? Let's do a little story on B6 so people know what we're talking about.

Pyridoxine. B6. B vitamin. Wonderful stuff. We need it, we need a good amount of it. But with toxicity, you can see that people can start to develop problems in the peripheral nerves primarily. And when that happens and you irritate the peripheral nerves, you get things that resemble neuropathies, right? So you get tingly, numb, pain sometimes, all sorts of things.

And in severe cases, we can start to see it affect more central things, or it can affect the autonomic nerves to the point where we start to develop autonomic problems.

Now — whether that comes to yield POTS or not is a question of severity and where it affects. And the second consideration is that sometimes that toxicity can worsen or exacerbate symptoms if you're already in the environment of autonomic dysfunction.

How Does It Happen?

The main way you get it is just by over-consuming. Sometimes there's a metabolic problem where you have a hard time clearing it out, and that can overwhelm the system as well. So just things to consider.

Is it possible? Yeah. Is it common? Not so much. But you can measure these things and be able to see where you're at, and then figure out — do we need to reduce the ingestion? Do we need to look into the metabolic pathways? Understand a little bit more there.

But I wouldn't say it's probably the leading cause of POTS in the world.

OK, So How Do You Start Moving Again with POTS?

This is a question we get a lot, and it's a tough one because there's a lot of different pieces to it, right? Someone asked how do you start walking when you have POTS, long COVID, balance issues, etc.

And I think the better frame of that question might be: how do we start increasing activity levels?

So I have a friend Mike — he's an airplane mechanic. And we talk about airplanes. I dream about airplanes. I'm too scared to fly them. He flies them but I'm too scared. I'm a wimp. But he talks about planes and working on them, and he says you have to run them. They don't do well if you don't run them. Using them helps keep them healthy.

And man, if that's not an obvious correlary to humans, I don't know what is.

We work better when we're being used. So maybe walking isn't quite on the table yet, right? That's the goal. That's where we're headed. But maybe that's not where we're starting from.

Take Gravity Out of the Equation

Here's the thing — if we can't get people to just stay upright and get blood in their head, then we probably don't want to exercise them while they're also trying to get blood in their head. Those are two things that are hard that we're not able to do, which is the reason we're not feeling well in the first place.

So if we take gravity out of the scenario and we let people lay down — where they don't have to solve that problem right now — but we let the system run, flush the fluids, get the muscles going, get your breathing up a little bit, get that under control, then sometimes that helps us get that machine going in a way where we can do more.

Can you lay down and cycle your legs for a minute? Can you lay down and do circles with your arms for 20 seconds? Then you just start where you can start.

Set the Goal Super Low

James Clear wrote a really good book, Atomic Habits, and what he talks about is not setting the goal so high that it feels hard to do every time. Like if I go in to work out and I say every day I'm going to do max deadlifts — I can't do that every day. I'm not going to be able to do 400 pounds every day. And so I'll lose, and that will affect my motivation.

But if you can say "I'm just going to lay down and I'm going to move my legs for 30 seconds" — you can do that pretty easily. Maybe you just have to say "I just have to pick my legs up one time." And as long as you pick your legs up one time, it counts.

And then you just see what you can do from there. The rest is all bonus, right? Where you make a living is in the bonus. Set the goal super low, something you can easily do every single day. Everything else is just upside.

What About a Hypoplastic Vertebral Artery?

Another question that comes up: is having a hypoplastic left vertebral artery relevant in POTS, or is it a normal anatomic variant?

The quick answer: it can be both.

So what does it mean? We've got two carotid arteries that come up the front and they kind of fuel the upper areas. And then the vertebral arteries come up by the vertebrae in the back and they make a little circle in the brain — they do more of the irrigation in the back part of the brain and the brainstem.

Now, it's not uncommon that when you actually look at the arterial systems in people through an MRA, you'll see they develop a little bit differently. Some of them will be really robust, really clear, really nice — beautiful highways. And sometimes you'll have them that just don't form real well. They don't actually transmit a lot of blood. And that's why we have this circle at the top — because sometimes it just doesn't work as well, so we have to use blood from one of the different segments to wrap around and fill one of the other ones.

With a hypoplastic artery, sometimes that can be problematic if we see a decrease in the overall flow rate. This is probably something that happens in development, right? And your brain as it's developing can start to adapt to that change in blood flow. For some people, they're totally fine — they can get enough blood coming through one of the other arteries, it makes up for the whole thing and they do great.

Other people, if the brain doesn't adapt to it as well, may be more prone to decreased flow with certain activities or certain head movements, and then we start to see symptoms.

The Head Turn Problem

Here's an example. If you've got a left hypoplastic vertebral artery — means you don't have enough blood coming up that side — you may rely on the right one more, right? So it's feeding both sides. Cool.

But sometimes we know that with a big head turn to the left, it can have the tendency to cause compression in that artery in the back. And if that right one in the posterior is the one feeding the whole thing, then you may be more susceptible to what's called bow hunter syndrome — a problem with that artery getting compressed — and then you're affecting the whole system.

So can it affect POTS? You might find that when that blood flow level drops, you try to compensate for it with a heart rate increase. That can be a normal response to that. Worth investigating, especially if we're looking at how different movements and positions might be affecting symptoms.

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