Does standing up sometimes feel like a small event? You get up from a chair or out of bed, and your heart starts racing, your head goes light, the room feels swimmy, and everything gets foggy. Maybe you feel shaky or sick to your stomach. Sit back down, and after a bit you feel okay again.

When this keeps happening, and your lab work keeps coming back “normal,” it’s easy to feel dismissed or a little crazy. You’re not. There may be a real pattern behind it. One name for that pattern is POTS — Postural Orthostatic Tachycardia Syndrome.

Let’s walk through it in plain language.

First, what do those big words mean?

The name sounds scary, but it just describes what happens:

• Postural — it has to do with your posture, meaning your position (like standing up).
• Orthostatic — a fancy word for standing upright.
• Tachycardia — a fast heart rate.
• Syndrome — a group of symptoms that tend to show up together.

Put it together and it means: when you stand up, your heart races and you feel awful.

Meet your body’s autopilot

Your body has an automatic control system that runs in the background. It manages your heartbeat, your blood pressure, your digestion, and more — all without you ever thinking about it. Doctors call it the autonomic nervous system. I like to call it your autopilot.

One of its jobs is to keep blood flowing up to your brain, even when gravity is pulling it down. Most of the time it does this perfectly, and you never notice.

So what goes wrong when you stand?

Here’s the thing. Every time you stand up, gravity pulls a big rush of blood down into your legs and belly. Normally your autopilot reacts in a split second — it squeezes those blood vessels and fine-tunes your heart so blood keeps moving up to your brain.

With POTS, that hand-off doesn’t go smoothly. Blood pools low in your body, less of it reaches your brain, and your heart speeds way up to try to catch up. That racing you feel is your heart working overtime to make up the difference.

Here’s the key idea: your heart isn’t broken. Your autopilot is overwhelmed. The signals just aren’t keeping up the way they should.

What POTS can look like

This is the confusing part. Because the problem is about blood flow and your autopilot, symptoms can show up all over — and they often come and go. Common ones include:

• When you stand: racing or pounding heart, dizziness, lightheadedness, feeling like you might faint (and sometimes actually fainting)
• Brain: brain fog, trouble focusing, headaches
• Whole body: deep fatigue, feeling wiped out, shakiness, weakness
• Gut: nausea, bloating, feeling off after meals
• Other clues: feeling worse in heat, worse in the morning, worse after standing in a line or a hot shower; legs that look blotchy or purple after standing a while

The tell-tale sign isn’t one symptom. It’s the pattern: things get worse when you’re upright and better when you sit or lie down, and it flares and settles.

Doctors often look for a big jump in heart rate soon after standing — around 30 beats a minute or more within about ten minutes — without the kind of blood-pressure drop that would fully explain it. (That’s part of why this needs a proper check, not a guess.)

Common triggers

Everyone’s list is a little different, but these are the usual suspects:

• Standing up quickly, or standing still for a long time (lines, showers, cooking)
• Heat — hot showers, hot weather, saunas
• Not drinking enough fluid (getting dehydrated)
• Big or heavy meals (blood rushes to your gut and away from the rest of you)
• Alcohol
• Long stretches of bed rest or sitting still — this actually makes POTS worse over time
• Getting sick — POTS often shows up after a viral illness, and many people first noticed it after a bad infection
• Hormone shifts
• Mornings (symptoms are often loudest early in the day)

The hormone connection (why this matters in perimenopause)

For many women, POTS symptoms shift with their monthly cycle. They’re often worse in the days right before and at the start of your period — the time when estrogen and progesterone dip the lowest. In the middle of your cycle, when those hormones are higher, your body tends to hold onto fluid a little better, and standing can feel easier.

Perimenopause is when those same hormones start swinging and dropping in a less predictable way. For some women, that up-and-down can make POTS symptoms feel more erratic or intense. Interestingly, some women find things settle down after menopause, once hormones level off — though everyone is different.

One honest note: the monthly-cycle link is well known, but the perimenopause and menopause part hasn’t been studied as much yet. So this is something we watch for in your own pattern, not a one-size-fits-all rule. If your symptoms seem to track with your hormones, that’s real — not in your head.

POTS vs. orthostatic hypotension (a quick but important difference)

People mix these two up, so let’s keep it simple. Both make you dizzy when you stand — but for different reasons.

• Orthostatic hypotension is mainly a pressure-drop problem. When you stand, your blood pressure falls too far, and that’s what makes you dizzy. Your heart rate may only rise a little.
• POTS is mainly a heart-racing problem. When you stand, your heart rate shoots up a lot to keep blood moving, and your blood pressure often doesn’t crash the same way.

Why this matters: they can feel alike, but the path forward isn’t identical, and telling them apart usually needs a simple standing test in the office (or a tilt-table test). The good news is that the foundation steps in this post — steady hydration, careful position changes, gradual movement — can help you feel steadier either way, while you get clear answers.

The functional (FDN) way I look at it: total load

In Functional Diagnostic Nutrition, we don’t chase one single villain. We look at your total load — everything stacking stress on your body at once.

POTS is a perfect example. One thing alone might be fine. But stack a hot morning + skipping your water + a big breakfast + a poor night’s sleep + a hormone shift + a stressful day, and now the bucket overflows. The dizzy, racing moment you feel when you stand is the overflow, not just the last thing you did.

So the goal isn’t to never stand up. The goal is to lower the total load so your autopilot has an easier time keeping up.

How I use the D.R.E.S.S. framework for POTS support

D.R.E.S.S. stands for Diet, Rest, Exercise, Stress reduction, and Supplementation. Here’s how it applies:

• Diet: Two pieces. First, smaller, steadier meals often sit better than big heavy ones, because a large meal pulls blood toward your gut. Second — and please be careful with this one — many people with POTS are told by their provider to drink more fluids and get more salt, to raise their blood volume. That can help a lot, but it is not right for everyone (it can be a problem with certain blood pressure, heart, or kidney conditions). So this is a “with your clinician” step, not a do-it-yourself tip.
• Rest: Sleep protects your nervous system, and POTS is a nervous-system issue at its core. Some people are also guided to raise the head of their bed a little. And pacing your day — instead of crashing and then over-doing it — keeps you steadier.
• Exercise: This one surprises people. Sitting still too much actually makes POTS worse, so movement matters — but it usually needs to start gentle and often reclined or seated (think recumbent bike, rowing, or swimming), then build up slowly over weeks. All-out upright workouts too early can backfire. Slow and steady wins, ideally with guidance.
• Stress reduction: Your autopilot is the same system that runs “stress” and “calm.” Calming it — slow breathing, time outside, gentle routines — directly supports the system that’s struggling. This is a big lever.
• Supplementation: Electrolytes come up a lot, and other supplements sometimes too — but these should be chosen with your licensed clinician, especially anything that changes your fluids, salt, or blood pressure.

Getting real answers (and when to get help now)

POTS is often missed or brushed off, and it usually takes a provider who knows what to look for. A simple standing test or a tilt-table test helps confirm it, and part of the job is ruling out other causes of a racing heart. That’s exactly why you shouldn’t try to sort a racing heart out on your own.

And one safety note I never skip: fainting is the risk that can hurt you fast. If you pass out and hit your head, faint and get injured, have chest pain or trouble breathing, or someone can’t be woken up — that is an emergency. Call for emergency help right away. A new or scary racing heart always deserves a medical check.

Where an FDN practitioner fits in (mild to severe)

I’m a Functional Diagnostic Nutrition Practitioner and a nurse. I don’t diagnose POTS or prescribe medicine — that’s your licensed provider’s job. What I do is work on the foundation underneath your symptoms: hydration habits, steady meals and blood sugar, sleep, gentle reconditioning, and stress support — so your body has an easier time. Here’s how that looks at different levels:

• Mild symptoms: This is often where lifestyle and root-cause work shines. We look at hydration, meals, heat, movement, sleep, and daily habits — the D.R.E.S.S. pieces — and many people feel real relief from these changes alone.
• Moderate symptoms: We do the same foundation work, and I help you stay steady and consistent — tracking triggers, spotting patterns, building simple routines — while you also work with your provider.
• Severe symptoms: Here I work with your medical team, never in place of it. Your provider leads the diagnosis, the medicine, and the plan. My job is to support the daily foundation alongside them, so every piece is pulling in the same direction.

No matter where you land, the goal is the same: fewer flares, a steadier system, and a simple plan built for your body — done safely, with the right people on your team.

Next step

If standing up shouldn’t be this hard, and “normal” labs haven’t given you answers, you don’t have to keep guessing. Visit MyHeart4Health.net to learn more or schedule a call, and we’ll look at your whole picture together.

Disclaimer: This content is for educational purposes only and is not medical advice. POTS is a medical condition that requires evaluation by a licensed provider. Fainting can cause injury — seek emergency care for a fall or injury, chest pain, trouble breathing, or someone who can’t be woken. A new or unexplained racing heart should always be checked by a clinician. Always work with your licensed healthcare provider for medical concerns, diagnoses, medications, or treatment decisions. Lab tests do not diagnose conditions; they may help identify patterns and support further investigation.