Gluten-free diet in postural orthostatic tachycardia syndrome (POTS)

Abstract

Objectives Postural orthostatic tachycardia syndrome (POTS) is a chronic disorder of the autonomic nervous system that is associated with orthostatic intolerance (OI) and gastrointestinal (GI) symptoms. We aimed to determine if a gluten-free diet (GFD) may be an effective treatment in patients with POTS. Methods Patients with confirmed POTS and without celiac disease who followed GFD for 4 weeks retrospectively completed pre- and post- GFD COMPASS-31 questionnaires. Paired-samples t-tests were conducted to compare COMPASS-31 scores before and after adopting GFD. Results All 20 patients (all females, age 16–62 years (mean age 33)), had POTS symptoms for 1–30 years (mean 10.8, SD = 10.23 years). Eleven patients had co-morbid mast cell activation syndrome, and 8 had hypermobile Ehlers-Danlos syndrome. Pre-GFD COMPASS-31 scores (mean 57.8) were significantly higher than post-GFD scores (mean 38.2, t(19) = -8.92, p < 0.00001), with the largest improvement noted in the OI (p < 0.00001), vasomotor, (p = 0.0034), and GI (p = 0.0004) domains and with a mean reduction in total COMPASS-31 score by 33.9% after implementing GFD. All patients reported improved symptoms on GFD with mean self-assessed improvement of 50.5% (range 10-99%). Discussion GFD may be effective in reducing the symptom burden in patients with POTS, particularly in the OI, vasomotor, and GI symptom domains. Large prospective studies are necessary to confirm whether GFD is an effective long-term treatment option for patients.

Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of autonomic dysfunction in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

“…A gluten-free diet was demonstrated to be beneficial in some patients with POTS. 82 When considering dietary changes, the benefits of a particular diet need to be weighed against the risks, including vitamin or nutrition deficiencies. Diets may be individualized and targeted toward the patient's specific set of symptoms and food sensitivities.…”

“…Low‐histamine, gluten‐free, dairy‐free, low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) and plant‐based diets have been anecdotally reported to be beneficial. A gluten‐free diet was demonstrated to be beneficial in some patients with POTS 82 . When considering dietary changes, the benefits of a particular diet need to be weighed against the risks, including vitamin or nutrition deficiencies.…”

The Gut Microbiota and Short-Chain Fatty Acids Profile in Postural Orthostatic Tachycardia Syndrome

“…Our findings highlight the need to educate POTS patients more about lifestyle changes that can improve their symptoms. Lifestyle changes such as adopting a gluten-free diet, or a high salt diet reduce the symptom burden including gastrointestinal changes in patients with POTS ( Smith et al, 2021 ; Zha et al, 2022 ).…”

POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment

“…While there are no studies on the benefits of any particular diet in pregnant POTS patients, it’s been our experience that patients with POTS experience significant reduction in various autonomic symptoms with the implementation of a gluten-free diet. 48 This may present an effective and safe non-pharmacologic treatment strategy in pregnant women. A consultation with a dietician or nutritionist may be helpful to ensure that nutritional requirements are being met.…”