lassesen 4:08 pm on December 14, 2020

Update on postural orthostatic tachycardia syndrome (POTS)

I have done prior posts on POTS (POTS Revisited) and been requested to check the latest research. Checking PUBMED statistics, we see there have been many papers in the last few years

From https://pubmed.ncbi.nlm.nih.gov/?term=+Postural+orthostatic+tachycardia+syndrome+&sort=pubdate&sort_order=asc

“The physiology underlying “brain fog” in the absence of orthostatic stress in postural tachycardia syndrome (POTS) remains poorly understood. … greater slowing in psychomotor speed and a greater increase in symptom scores at study completion in the patients with POTS, including increased difficulty with concentration. All other physiologic responses (blood pressure and end-tidal carbon dioxide) did not differ between groups after PCST ” [2020]
Restless legs syndrome is increased in postural orthostatic tachycardia syndrome [2020]
Dry Eye Syndrome and Sicca Complex are Commonly Found in Patients with Postural Orthostatic Tachycardia Syndrome [2020]
Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome [2020]
Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review [2020] “Postural orthostatic tachycardia syndrome has been recognized for decades, but treatment is largely based on anecdotal experience and expert opinion. Pharmacologic treatment is inconsistent and unstandardized. …There is a paucity [very few] of high-quality data about effectiveness of medication in the treatment of postural orthostatic tachycardia syndrome. “

Trying Citizen Science

We have 55 samples annotated with POTS and we recently added enzymes to the system. Time to go on a statistical fishing expedition… and we found some fish, all of them small one (i.e. too low production)

EnzymeName	POTS Average	No POTS Average	Test Statistic	Obs
crotonobetainyl-CoA reductase	174	1500	-5.31511	28
L-carnitine CoA-transferase	177	1381	-5.04204	31
D-apionate oxidoisomerase	573	1541	-4.57861	29
nitrite reductase (NO-forming)	5311	17941	-4.46254	51
5-aminopentanamidase	5900	16862	-4.31631	51
phosphatidyl-myo-inositol alpha-mannosyltransferase	5523	17379	-4.16094	50
cysteinylglycine-S-conjugate dipeptidase	5611	17868	-4.15823	48
polyphosphate—glucose phosphotransferase	5621	17638	-4.09764	48
8-oxo-dGDP phosphatase	5725	17788	-4.05173	47
8-oxo-(d)GTP phosphatase	5930	17351	-3.93432	48
lactocepin	1411	8104	-3.90514	50
formyl-CoA transferase	5998	17156	-3.84911	46
oxalyl-CoA decarboxylase	6234	18799	-3.80263	39
galactofuranosylgalactofuranosylrhamnosyl-N-acetylglucosaminyl-diphospho-decaprenol beta-1,5/1,6-galactofuranosyltransferase	5714	14910	-3.60734	50
lipid II isoglutaminyl synthase (glutamine-hydrolysing)	8292	22101	-3.5937	54
galactan exo-1,6-beta-galactobiohydrolase (non-reducing end)	6876	19457	-3.53129	35
N-acetylhexosamine 1-kinase	6876	19434	-3.52637	35
dehydrogluconokinase	6710	18931	-3.52007	36
Pup amidohydrolase	5718	15393	-3.51166	47
prokaryotic ubiquitin-like protein ligase	5718	15393	-3.51166	47
all-trans-retinol dehydrogenase (NAD+)	6484	17326	-3.47966	41
gamma-glutamyl hercynylcysteine S-oxide hydrolase	6876	19217	-3.47867	35
glucosyl-3-phosphoglycerate phosphatase	7804	18811	-3.474	50
isopenicillin-N epimerase	6367	17710	-3.44546	38
2-acetylphloroglucinol acetyltransferase	6295	15991	-3.43971	45
phosphatidylinositol dimannoside acyltransferase	8899	20502	-3.38033	50
dolichyl-phosphate-mannose—protein mannosyltransferase	8156	17812	-3.34246	54
sorbose reductase	6144	15938	-3.29349	41
tRNA (adenine57-N1/adenine58-N1)-methyltransferase	8093	18743	-3.26853	48
tRNA (adenine58-N1)-methyltransferase	8093	18743	-3.26853	48

This is actually a happy path because for too low, we can identify probiotics that produces these missing enzymes. Three bifidobacterium are at the top of the list. Custom Probiotics daily recommended dosage for these are 350-400 BCFU /day.

bacillus pumilus	8
bacillus simplex	2
bacillus velezensis	8
bifidobacterium adolescentis	26
bifidobacterium animalis subsp. lactis bb-12	26
bifidobacterium longum	26
clostridium beijerinckii	5
clostridium butyricum	5
enterococcus durans	1
enterococcus faecalis	1
lactobacillus acidophilus	4
lactobacillus helveticus	4
lactobacillus kefiri	2
lactobacillus paracasei	2
lactobacillus plantarum	1
lactobacillus rhamnosus (strain atcc 53103 / gg)	2
lactobacillus salivarius	2
lactococcus lactis	3
leuconostoc lactis	2
streptococcus thermophilus	3

Bottom Line

We have deduced which probiotics should help POTS (if taken in sufficient dosage) by using citizen science on the annotated-with-symptoms uploads, the KEGG Enzyme data and statistics. We may not know the why’s of these enzymes missing causing POTS, but we have some ideas of where to start looking for explanations. Until then, we at least know what to try.

There have been NO STUDIES using Bifidobacterium probiotics with POTS published.

Again consult with your medical professional first.

Cristian O. 12:14 pm on December 15, 2020

Hi,

A interesting thing to look into is thoracic outlet syndrome. My hypothesis is years of stress plus stress generated by microbiome disfunction and deconditioning from CFS + thick blood from genetics may give this in some people and thus POTS.

I do not negate the implications of the microbiome in POTS but MAYBE, a big maybe TOS is just a comorbidity generated by it ?

Article here:
https://www.researchgate.net/publication/341234629_Does_thoracic_outlet_syndrome_cause_cerebrovascular_hyperperfusion_Diagnostic_markers_for_occult_craniovascular_congestion?fbclid=IwAR0C2JOsbDyfiTBqUNRHhL-GxDdu0YF5HuE_jOX1hrWK2ad5b_U7wIdqGfo

Kind regards,
Cristian O.
lassesen 9:22 pm on December 15, 2020

No argument — the thing that the microbiome offers is citizen science (and with me being a data scientist, a sand box) where you can look for relationships and thus get treatment suggestions that no one has ever done a study on…. which are NOT random suggestion, but based on good data…

See this new page(https://www.microbiomeprescription.com/Library/Symptoms) for an example.
L 12:56 pm on December 16, 2020

The use of probiotics with POTS cases does not consider MCAS patients with POTS as many cannot tolerate or are flared by probiotics
- lassesen 8:56 pm on December 16, 2020
  
  Agreed. These are suggestions to be reviewed by your knowledgeable medical professional based on enzymes. Different probiotics produces different factors, like d-lactic acid, histamines etc which the medical professional needs to evaluate against your medical condition.
  
  There is a wide choice of probiotics to consider, a few produces almost all of the enzymes, thus a single probiotic strain is sufficient. When there are other factors, like histamine, the medical professional may need to piece together a mixture of the species to cover all of the enzyme deficiencies and avoid issues like MCAS.
Cristian O. 1:44 pm on December 17, 2020

Hi,

Can your blog next subject be MCAS and the Microbiome.

I found a group of patients in Romania with MCAS they do not believe there is a gut connection and only use H1 or H2 blockers with no positive outcome long term.

Can you share us your view from a pragmatic point of MCAS ?

Kind regards,
Cristian O.
lassesen 7:50 pm on December 17, 2020

See this post
https://cfsremission.com/2020/12/17/mast-cell-activation-syndrome-mcas-and-the-microbiome/
Learner1 10:09 am on December 18, 2020

POTS, in many cases, is autoimmune. This test finds autoantibodies linked to POTS.

“POTS – CFS/ME – CRPS – SFN – CellTrend Luckenwalde” https://www.celltrend.de/en/pots-cfs-me-crps/

It is unlikely probiotics will convince the body to not make these rogue antibodies. IVIG, Rituximab and LDN have been known to help, as well as substances like Huperzine A, pyridostigmine, fludricortisone, and salt.
lassesen 12:56 pm on December 18, 2020

Learner1 — the question is what causes the autoantibodies. If it is an enzyme imbalance then the RIGHT probiotic may help, as well as encouraging bacteria which increases the enzyme. What is the impact of Huperzine A, pyridostigmine, fludricortisone on the microbiome?

What I am advocating is a complimentary approach/analysis.