Postural Orthostatic Tachycardia Syndrome (POTS) is a complex medical condition affecting the autonomic nervous system (ANS), the body’s involuntary control center for functions like heart rate, blood pressure, and digestion. This disorder results in an inability to properly regulate the cardiovascular system, particularly when moving from a lying to an upright position. While POTS is often triggered by events like a viral illness, surgery, or trauma, a growing body of evidence suggests that environmental exposures may also play a role in its development. Many people with this condition have reported a history of exposure to water-damaged buildings and mold.
Understanding Postural Orthostatic Tachycardia Syndrome (POTS)
POTS is medically classified as a form of dysautonomia, meaning it involves a malfunction of the autonomic nervous system. The defining feature of the syndrome is orthostatic intolerance, where symptoms worsen upon standing and are relieved by lying down. Diagnosis requires a sustained increase in heart rate of at least 30 beats per minute (bpm) within the first ten minutes of standing in adults, or 40 bpm for adolescents. This heart rate elevation must occur without a significant drop in blood pressure.
The gold standard for diagnosis is typically a tilt table test, which monitors heart rate and blood pressure as the patient moves from a horizontal to a vertical position. Symptoms associated with POTS are diverse, frequently including lightheadedness, chronic fatigue, exercise intolerance, and severe mental clouding often described as “brain fog.”
Mycotoxins and Inflammatory Triggers
The true inflammatory trigger in water-damaged buildings is often not the mold itself but the toxic substances it produces, known as mycotoxins. These are secondary metabolites created by certain mold species, such as Stachybotrys chartarum, and act as potent biological toxins. Exposure typically occurs through inhalation of aerosolized spores or fragments in the air, or through direct contact.
Two mycotoxins frequently implicated in systemic illness are Ochratoxin A and Trichothecenes. These compounds are neurotoxic and immunogenic, meaning they can directly harm the nervous system and provoke an immune response in the body. Mycotoxins can be detected in the bodies of those exposed.
How Mold Exposure May Lead to POTS Symptoms
The proposed link between mycotoxin exposure and the development of POTS symptoms centers on a cascade of inflammatory and immune reactions. Chronic exposure to these toxins can initiate a condition known as Chronic Inflammatory Response Syndrome (CIRS), a systemic illness characterized by ongoing inflammation and oxidative stress throughout the body. This persistent inflammation forms the foundation for the subsequent dysregulation of the autonomic nervous system.
Mycotoxins are neurotoxic agents that directly impact the nervous system, leading to neuroinflammation that affects the central and peripheral nervous systems. This disruption can impair the delicate control mechanisms that regulate heart rate and blood pressure. The toxins may also interfere with mitochondrial function, the cell’s energy powerhouse, further contributing to the widespread fatigue commonly seen in POTS patients.
A frequent comorbidity in mold-related illness is Mast Cell Activation Syndrome (MCAS), which is also seen in many POTS patients. Mast cells are immune cells that release chemical mediators, including histamine, when they are triggered. Mycotoxins can directly stimulate these mast cells, causing them to degranulate and release excessive amounts of inflammatory substances.
The resulting surge of histamine and other mediators can cause symptoms closely mimicking POTS, such as flushing, rapid heart rate, and gastrointestinal distress. This inflammatory signaling also involves crosstalk with specialized immune cells in the brain, called microglia, amplifying neuroinflammation and potentially compromising the integrity of the blood-brain barrier. Furthermore, mycotoxin exposure has been associated with the production of autoantibodies, which are antibodies that mistakenly target the body’s own tissues.
These autoantibodies may target receptors that control the constriction and dilation of blood vessels, directly interfering with the body’s ability to manage blood flow and contributing to the orthostatic intolerance characteristic of POTS.
Testing and Remediation Strategies
For individuals who suspect a connection between their environment and their symptoms, a multi-step approach begins with objective testing. Medical evaluation includes a specialized urine test to measure the presence of mycotoxin metabolites, indicating a body burden from mold exposure. Physicians also test for inflammatory biomarkers and autoantibodies to assess the systemic impact of the toxins.
Environmental investigation is equally important, as removing the source of exposure is the foundational step toward recovery. A thorough visual inspection of the home or workplace is the most reliable initial tool, often utilizing equipment like moisture meters to detect hidden water damage. If mold is found, professional remediation is necessary to prevent the spread of spores during cleanup.
Remediation requires fixing the underlying water issue, removing all contaminated materials, and using High-Efficiency Particulate Air (HEPA) vacuums to clean surrounding surfaces. Ongoing prevention involves controlling indoor humidity, ideally keeping it below 50 percent, and ensuring adequate ventilation. Addressing the underlying mycotoxin exposure through binders and detoxification support is necessary for sustained improvement.