POTS Protocol
POTS Is Real, Measurable, and Treatable
Health Atlas MD is an immunity and longevity medicine practice in Lakeway, Texas, led by Dr. Amin Mery, MD, who also leads Hill Country Allergy, Asthma and Immunology. The POTS Protocol is built for patients whose heart races the moment they stand up, who feel dizzy, foggy, or exhausted when upright, and who have been told their tests look essentially normal. At Health Atlas MD, POTS is understood as a convergence of overlapping biological mechanisms that can be identified and addressed simultaneously.
What Is POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome. When you move from lying to standing, your heart rate jumps abnormally because your nervous system is not regulating blood pressure and blood flow correctly in response to gravity. The diagnostic threshold is a heart rate increase of 30 or more beats per minute within 10 minutes of standing, with symptoms.
But POTS is not a single-mechanism condition. Most patients have at least three to five overlapping biological failures, and addressing only one produces incomplete results. Reduced blood volume (most POTS patients have 25 to 30% less plasma volume than healthy controls) means there is not enough circulating volume to maintain brain perfusion when blood pools in the legs on standing. Small fiber neuropathy means the tiny nerves that tell blood vessels to constrict when you stand up are damaged and cannot fire correctly. Mitochondrial dysfunction means the autonomic nerve fibers responsible for regulating blood pressure cannot sustain their continuous, high-energy firing demands. And in a significant subset of patients, MCAS co-occurs with POTS, where histamine release from mast cells causes vasodilation that makes an already impaired system significantly worse.
Who the POTS Protocol Is For
This protocol is built for patients who are dealing with one or more of the following:
- Heart rate spikes, dizziness, or near-fainting on standing, with tests that have not fully explained why
- Brain fog, fatigue, or difficulty functioning while upright that improves when lying down
- Post-COVID autonomic symptoms that began after a viral illness and have not fully resolved
- A known or suspected POTS diagnosis where treatment has been incomplete or symptomatic only
How the POTS Protocol Works
The baseline evaluation for this protocol looks at plasma volume markers, inflammatory burden, autonomic markers, small fiber neuropathy indicators, Vitamin D and B12 levels, and mast cell mediators where indicated. The non-pharmacological foundation, which includes salt loading, increased fluid intake, waist-high compression stockings, head-of-bed elevation, and recumbent exercise, begins from Day 1 and never stops. The supplement and IV protocol builds in three stages.
What the Protocol May Include: electrolyte support for plasma volume expansion throughout the day; magnesium glycinate for autonomic regulation and sleep; high-dose Thiamine for autonomic nerve energy metabolism; sublingual methylcobalamin B12 for myelin repair; quercetin for mast cell stabilization; and alpha lipoic acid, the most specifically evidence-backed antioxidant for small fiber neuropathy. As the protocol advances, injectable vitamins at the clinic deliver NAD IV, injectable B12, CoQ10, alpha lipoic acid, glutathione, and carnitine at therapeutic levels. Stage 3 adds peptides including MOTS-c for mitochondrial energy in autonomic nerve fibers, Selank for sympathetic nervous system overactivation, BPC-157 for gut-vagal axis repair, and TB4 for small fiber nerve regeneration and vascular endothelium repair.
Stage 1 (Pathway) establishes the non-pharmacological and supplement foundation that all further stages build on. Stage 2 (Roadmap) adds injectable delivery at the clinic for therapeutic-level nerve and mitochondrial support. Stage 3 (Atlas) is the complete protocol for complex presentations, including post-COVID POTS and the MCAS-POTS-hEDS triad.
Common Questions About
POTS Protocol
Why does salt help POTS?
In the general population, excess sodium can raise blood pressure in people whose kidneys retain too much of it. In POTS, the situation is different. Most patients have reduced plasma volume and impaired sodium retention, so adding sodium expands the circulating blood volume that gravity is pooling in the legs. For patients with normal cardiac and kidney function, therapeutic sodium loading is clinically appropriate and supported by published POTS guidelines.
What is the connection between MCAS and POTS?
Mast cells line blood vessel walls, and when they activate they release histamine, which dilates blood vessels. In POTS, blood vessels are already failing to constrict appropriately on standing. Any additional vasodilation from mast cell activation makes an already difficult situation significantly worse. This is why mast cell stabilization is a foundational POTS intervention for a significant proportion of patients.
Is POTS a permanent condition?
For post-viral POTS specifically, the prognosis is more optimistic than many patients are told. Published evidence supports meaningful improvement and, in many cases, full functional recovery over a 12 to 24 month timeline with appropriate management. The most important factors are a consistent non-pharmacological foundation, gradual heart-rate-guided exercise rehabilitation, and treatment of the underlying mechanisms driving autonomic dysfunction.
Take the First Step
Request Your Inflammation and Immunity Assessment
If you have been told your tests are normal while your symptoms are anything but, a more targeted evaluation may reveal what has been missed. Dr. Mery reviews each patient's full picture before any protocol begins.
Disclaimer
This page is for educational purposes only. It does not diagnose, treat, cure, or prevent any disease. All treatment is individualized and supervised by Dr. Amin Mery, MD. Peptide therapies are investigational and have not been FDA-evaluated for all indications described.
Entity Statement
Health Atlas MD is an immunity and longevity medicine practice led by Dr. Amin Mery, MD, who also leads Hill Country Allergy, Asthma and Immunology.