Many people suffer from what is termed dysautonomia. This is an umbrella term used to describe any disease or malfunctioning of the autonomic nervous system. Our nervous systems are comprised of different parts:

• a central nervous system (CNS),
• a peripheral nervous system (PNS)
• an autonomic nervous system (ANS).

The autonomic nervous system is the part of the system that’s responsible for master regulation of organ function and thus the control of the bodily functions that aren’t consciously directed, such as breathing, the heartbeat, temperature regulation, and the digestive processes.

Dysautonomia is a full body condition, affecting the malfunctioning of many or all of the organs under the body’s control. Due to multiorgan system involvement, patients often present with numerous, seemingly unrelated, maladies. Dysautonomia has this feature in common with MCAS. Patients are often consulting a variety of doctors, each specializing in a different organ system, none of whom view the symptom presentation as a whole-body system involvement.

Dysautonomia is quite common and can include conditions such as vasovagal syncope, sinus tachycardia, orthostatic hypotension, diabetic autonomic neuropathy, neurocardiogenic syncope (NCS), mitral valve prolapse dysautonomia, and postural orthostatic tachycardia syndrome (POTS), the subject of today’s essay.

Simply put, POTS is the body’s inability to make the necessary adjustments to counteract gravity when standing up.

Dysautonomia is often associated with other disease processes such as Lyme disease, primary biliary cirrhosis, multiple system atrophy (Shy-Drager syndrome), Ehlers-Danlos syndrome, and Marfan syndrome.

POTS isn’t a rare condition but often isn’t considered, understood, or accurately diagnosed by primary healthcare providers. Most doctors don’t routinely think about it or test for the condition in their offices. A missed diagnosis of POTS (as well as that of orthostatic hypotension) can have devastating consequences for an individual’s health issues and prospects of recovery. In fact, my experience is that without recognition and adequate treatment of this condition, very little can be achieved regarding recovery for those suffering from complex, chronic health issues, where POTS is frequently a dominant co-morbid condition that’s notoriously underdiagnosed. This condition is often accompanied by a high degree of functional disability, appearing under the radar and masquerading as many other health conditions, most commonly referred to as psychosomatic, a cruel diagnosis to assign to a person that has very real biological and physiological imbalances.

POTS was first described in the 1860s and initially named Civil War Syndrome and Effort Syndrome, among other names.[i] It was also often called neurasthenia. Prevalence is estimated to be at around 0.3 percent of the U.S. population, affecting around three million people. However, within the population with chronic, complex illness that present themselves at my clinic, the prevalence is much higher, approaching ten to twenty percent. The condition is most often diagnosed in younger females, with onset occurring between fifteen and forty-five years of age.[ii]

POTS is a complex condition that can drastically affect the day-to-day lives of those that suffer from it. POTS is a type of orthostatic intolerance, which means that it gets worse when people who have the condition are standing, or when they move from a lying or sitting position to a standing position.

The two broad classifications for POTS are for those individuals who have the condition all the time (non-positional), and those who have it only with positional changes.[iii]  

One of the main characteristics of the condition is that the main focus is on the sympathetic nervous system activation, which characterizes the disorder.[iv] In emergency rooms and primary care clinics, it’s one of the most common presentations of syncope and pre-syncope. This refers to the patient feeling faint, but not quite passing out.

POTS is often described as a clinical syndrome consisting of multiple heterogeneous disorders. In addition, there are several possible underlying pathophysiological processes underlying the condition, including partial sympathetic neuropathy, hyperadrenergic state, hypovolemia, mast cell activation, deconditioning, and immune-mediated.[v] Many clinical features may overlap, making it difficult to categorize exactly what aspects are activated at any particular time. The good news is that although POTS may be extremely unpleasant to live with, limiting many activities associated with daily living, POTS isn’t associated with mortality. Patients can make significant symptomatic improvements over time, once the condition has been diagnosed and treated appropriately.

In addition to POTS, there are other conditions of orthostatic intolerance, like orthostatic hypotension. These conditions are also frequently seen with other ‘invisible’ conditions, such as Ehlers-Danlos syndrome, chronic fatigue syndrome, migraine, fibromyalgia, autoimmune disorders, irritable bowel syndrome (IBS), food allergies, and mast cell activation syndrome (MCAS). Please see my other articles related to MCAS.

In this two-part series, I’ll be discussing the etiology of POTS, how it manifests in most people, the common comorbid conditions it’s often seen with, and how to diagnose and treat the condition.

In this first part you’ll learn:

• What POTS is and its signs, symptoms, and complications
• The difference between POTS, orthostatic hypotension, and sinus tachycardia syndrome
• How POTS often manifests alongside other conditions, like MCAS and CFS
• What we currently understand about the cause of POTS
• How POTS is diagnosed

What is POTS?

As I already mentioned, POTS is a type of orthostatic intolerance. This means that it gets worse when people with the condition are in a standing position or when they get up from a lying or seated position.

With POTS, the heart rate increases rapidly when standing, by at least an additional thirty beats per minute compared to sitting, or up to 120 beats per minute within ten minutes. Tachycardia is the medical term for an increased heart rate.[vi]

The strict criteria for making the diagnosis are as follows:

• Symptoms must be for greater than or equal to six months in the absence of offending medication (SNRIs) and a thorough workup must be undertaken to exclude other conditions that can mimic POTS, such as Addison’s Disease, vasovagal syncope, physical deconditioning
• Heart rate increase within ten minutes of standing that’s greater than or equal to thirty beats per minute for adults older than eighteen, sustained; greater than or equal to forty beats per minute for adolescents, aged eighteen or younger; or  greater than 120 beats per minute after eight minutes of standing
• No orthostatic hypotension, featuring a drop in blood pressure of 20 mm Hg systolic or 10 mm Hg diastolic within five minutes of standing
• Symptoms such as presyncope, dizziness, lightheadedness, palpitations, tremor, or nausea, any of which are exacerbated with standing and relieved when recumbent
• No other overt causes of orthostatic symptoms or tachycardia can be identified, including panic attacks, pain, exercise, caffeine consumption, medication effects, anemia, dehydration, hyperthyroidism
• Resolution or improvement of signs or symptoms with assuming a lying  or seated position
• Standing plasma norepinephrine greater than or equal to 600 pg/ml (greater than or equal to 3.5 nM)

The pathophysiology pf POTS is complex but it appears to revolve around three central mechanisms:

• A predilection for hypovolemia or low blood volume
• Partial autonomic neuropathy, causing damage to the autonomic nervous system
• A hyperadrenergic state, in which the stress neurotransmitters adrenaline and noradrenaline increase [vii]

For a diagnosis of POTS to be made, the increased pulse rate must be sustained for longer than ten minutes, sometimes noted to be increased for up to thirty minutes. Many people will have a transient increase in pulse rate within forty-five seconds of standing, but it isn’t sustained and is often associated with a transient drop of blood pressure, which indicates a variant of orthostatic hypotension. Many patients with POTS will also have orthostatic hypotension, especially if associated with hypovolemia. However, if the increased pulse rate is less than thirty beats from baseline and is only associated with a drop in blood pressure, then this isn’t considered to constitute a diagnosis of POTS. Furthermore, in order to consider a diagnosis of POTS, the symptoms must be chronic in nature. Many people will experience transient POTS-like symptoms such as with a viral infection, which often resolve in a few days. Sometimes POTS may even be accompanied by a small rise in systolic blood pressure.   

Tachycardia is thought to occur because of the pooling of blood below the heart. In response to this pooling, the body releases norepinephrine and epinephrine in order to constrict the peripheral blood vessels and send blood pumping throughout the body again. However, in POTS and other orthostatic conditions, the vessels don’t respond properly to this increase of epinephrine and norepinephrine, so the blood vessels don’t constrict and blood remains pooled below the heart.

However, in POTS specifically, the heart still has a normal reaction to the norepinephrine and epinephrine, although the peripheral vessels don’t constrict appropriately and so the heartbeat quickens.[viii] Patients with POTS will often have high upright levels of plasma norepinephrine, reflecting sympathetic nervous system activation. In addition, some patients may have a dramatic response to eating food, whereby they can experience debilitating fatigue postprandial. This occurs because in the process of digesting a meal, a large amount of blood is diverted away from other areas of the body to the gastrointestinal tract, depriving the brain and the peripheral mitochondria of blood flow and hence energy, in order to run the rest of the individual’s physiology.  

There are four types of POTS:[ix]

Neuropathic/vagal tone dysfunction

This type of POTS may be caused by nerve damage that interferes with the blood vessels’ ability to constrict, as well as resulting from poor parasympathetic vagal tone and low levels of the neurotransmitter acetylcholine.

Hyperadrenergic/sympathetic fight/flight overdrive

This is POTS that’s associated with high levels of sympathetic nervous system overdrive and the production of adrenaline and norepinephrine.

Hypovolemic

This type of POTS occurs as a result of low blood volume. This has often been found to be associated with physical deconditioning.[x] It can also be associated with significant upright GI symptoms.

Secondary

This type of POTS is caused by another disease, like diabetes or Lyme disease.

It’s also important to note that POTS doesn’t usually occur as a result of any physical malformations of the blood vessels or heart, but rather as a result of functional abnormalities.

POTS is most commonly seen in women between the ages of fifteen and forty-five years old, mostly during child bearing years, and is thought to be widely prevalent. However, the exact statistics regarding the prevalence of the condition in the United States and Canada aren’t known because it’s likely that many people with POTS are misdiagnosed or undiagnosed.[xi] A family history is reported in thirteen percent of patients.[xii]

Signs and symptoms

Some of the signs and symptoms of POTS include:[xiii]

• Increased heart rate when standing, particularly after ten minutes
• Lightheadedness, dizziness, or vertigo caused by a lack of blood flow to the brain as blood pools in the lower portion of the body. This can lead to nausea, vomiting, and even fainting.
• Excessive fatigue after standing or light activity, which may be extreme
• Exercise intolerance and/or post exertional fatigue
• Diminished concentration and brain ‘fog’ or mental clouding
• Noticeable heart palpitations or forceful heartbeats
• Headaches
• Sleep disturbances
• Feelings of anxiety and panic, but ones that aren’t mentally induced. This is a very important distinction to be aware of.
• Shortness of breath and chest pains
• Unsteadiness, shakiness, or tremulousness
• Clammy skin
• Facial flushing and acid reflux
• Dark, red-blue discolorations of the lower extremities that are cold to the touch, known as acrocyanosis. This feature is seen in up to fifty percent of patients.[xiv]
• The vast majority of POTS patients, greater than or equal to ninety percent, have at least one gastrointestinal symptom, with the most common being nausea, abdominal pain, and bloating.[xv] Nausea and vomiting may represent the more common upright GI symptom of POTS and may improve altogether in the supine position.[xvi]

These symptoms don’t typically occur when a person is sitting or lying down, but they can be triggered by standing, exercise, stressful events, or warm environments. Approximately a quarter of blood volume resides in the chest when in the supine position. Upon standing and due to the effects of gravity, there’s an immediate shift of 500 to 1000 ml of blood from the chest cavity to the vessels in the lower extremities, buttocks, and lower abdomen. This leads to impaired venous blood return to the heart, with a resultant drop in blood pressure. There’s also a ten to twenty-five percent shift of plasma volume out of the vasculature and into the interstitial tissue.

When you stand up, gravity causes blood flow to be pulled downwards. For someone with poor parasympathetic vagus nerve injury with low acetylcholine production, this shift decreases venous return to the heart. This in turn results in a transient decrease in both arterial pressure and cardiac filling, reduced blood flow to the head, and an increased pooling of blood in the lower part of the body.

One of the consequences of blood pooling in the venous system is that it struggles to fill the heart. If the system fails to do this, the heart tries to compensate by increasing its heart rate to keep up the cardiac output. However, it usually still fails because if the blood isn’t there to fill the heart, the cardiac output is still going to drop, no matter how fast the heart goes.

In a healthy person, the autonomic nervous system compensates for these hemodynamic changes by stimulating the sympathetic (fight/flight) nervous system to release adrenaline to vasoconstrict the peripheral blood vessels, speed up the heart rate, and suppress the parasympathetic (rest/digest) nervous system. This facilitates an increased return of blood flow to the heart to counteract the initial decline in blood pressure. If the dynamics are working properly, these compensatory changes result in negligible changes in systolic and diastolic blood pressures with a normal ten to twenty beats per minute increase in the pulse rate when standing and a 5 mm Hg increase in diastolic blood pressure.

However, as with POTS, if there are any abnormalities of the autonomic nervous system’s regulation of these hemodynamics, a resultant fall in blood pressure can occur, as well as the increased pulse rate as seen in POTS. 

The body then tries to compensate for that as best it can by revving up the sympathetic nervous system, secreting a significant amount of adrenaline and noradrenaline. The consequence of these adrenaline surges is a lot of anxiety, a racing heart, heart palpitations, and insomnia. These are the consequences of compensatory sympathetic overdrive.

As already mentioned, POTS symptoms may also be triggered after eating. This is because blood flow is redirected to the digestive tract, or if a person with POTS isn’t drinking enough fluid or getting enough salt in their diet.[xvii]

GI motility abnormalities appear to be a significant driver of POTS symptoms in both the orthostatic and the non-positional types of the condition. Many studies using combined 24-hour antroduodenal manometry (ADM), the study of stomach and small bowel motility, and TILT (TTT) table testing, have proven this association.[xviii] Even among patients whose gastric motility studies were normal at baseline, sixty-eight percent became abnormal during the TTT. Gastrointestinal symptoms of nausea/vomiting and abdominal pain were reproduced in eighty-nine percent of subjects during TTT. Vomiting was significantly more frequent in those with delayed gastric emptying, which is defined as greater than or equal to a ten percent retention of food in the stomach at four hours post ingestion. 

Interestingly, women with POTS often report that they feel better than ever when they’re pregnant. This is because there’s a natural increase in blood volume during pregnancy, which helps to ease their symptoms. However, women who aren’t pregnant may experience a worsening of their POTS symptoms when their menstrual cycle begins.[xix]

Symptoms may also be worsened by dehydration, exercise, alcohol intake, heat exposure, asthma, allergies, endometriosis and pelvic congestion syndrome in women, migraines, depression, anxiety, concussions, and sinusitis. However, there are many other conditions that aren’t listed here that may make the symptoms of POTS worse.[xx]

Complications

POTS may seem like a minor issue if you’ve never dealt with it before, but that’s actually far from the reality faced by those suffering from POTS. The condition can be profoundly impactful, severely interrupting the lives of people with POTS. Consider how your life would change if you couldn’t stand for more than ten minutes or spend any amount of time in hot weather. There would be no waiting in line, no walking your dog or walking around the block, no shopping, and no sports. Even attempting to take a vacation would be a significant challenge. Or what if merely eating a meal was enough to leave you fatigued for the rest of the day?[xxi]

For people with severe POTS, their quality of life can be seriously affected. In fact, some physicians have compared the level of disability accompanying POTS to that of chronic obstructive pulmonary disease (COPD), an obstructive airway disease that limits breathing and can deprive the body of oxygen. Additionally, some researchers have surmised that the quality of life of people with severe POTS is approximately the same as the quality of life of people with kidney failure who are on dialysis.[xxii]

POTS and other conditions

POTS and other conditions are often seen together in patients. Because POTS isn’t a disease itself, it doesn’t typically develop in the absence of any other diseases, conditions, or health factors. There’s always a causal factor, be it genetics, another condition or disease, or an illness or injury trigger.

POTS compared to orthostatic hypotension and sinus tachycardia syndrome

POTS isn’t the only orthostatic intolerance condition. Orthostatic hypotension and sinus tachycardia syndrome, while similar to POTS, are different conditions. Although these conditions are similar to POTS, with similar signs and symptoms, they’re not identical.

Orthostatic hypotension is characterized by a decline in blood pressure of more than 20 m (systolic) /10 (diastolic) mmHg while standing rather than an increase in heart rate.[xxiii] This condition usually results from autonomic failure and the changes are often far greater than those mentioned above, resulting in a temporarily loss of consciousness soon after standing.

Sinus tachycardia syndrome is when your body sends out electrical impulses that cause your heart to beat faster, typically at rest, but without cause. It’s normal for your body to send out these impulses in response to exercise, stress, or fever, but abnormal for these electrical signals to occur in the absence of these external triggers.[xxiv]

POTS and mast cell activation syndrome (MCAS)

In some people, POTS and mast cell activation syndrome are seen together. This is fairly common for people with hyperadrenergic POTS. These patients often exhibit severe flushing or redness during standing, along with an increased heart rate, diarrhea, abdominal cramping, and nausea.

Mast cells are a type of white cell representing one percent of the total white cell count. They’re found in all vascularized tissue throughout the body at the junction point of the host and the external environment at points of entry of a toxin or antigen. They’re particularly represented in the mucosal and the epithelial cells, such as those in the respiratory tract, the skin, and in the GI tract, particularly in the duodenum. These cells are involved in defending the host from incoming toxins of any kind.

MCAS is an abnormal activation of the mast cells, which when activated on mast cell receptors by triggers, of which there are many, degranulate and release into the extracellular matrix potent mediators of inflammation, anticoagulation, and vasodilatation such as histamine and tryptase, heparin, proteases, enzymes, prostaglandins, eicosanoids, cytokines, growth factors, and reactive oxygen species, otherwise known as ‘free radicals’. In many cases where histamine is involved, it can cause a response similar to an allergic reaction. In severe cases, people with MCAS are considered to be ‘allergic to everything’. Mast cells seem to degranulate more severely when a patient is upright with hypotension and tachycardia.[xxv]

In addition to all the standard POTS symptoms, those with MCAS may also have gastrointestinal symptoms. The following paragraph explains how MCAS can result in GI symptoms, skin reactions, hives, and angioedema, often seen as accompanying conditions with those suffering from POTS.

When the gastrointestinal tract is exposed to an antigen, its response is to increase fluid secretion, increase smooth muscle contraction, and increase peristalsis. Proteins derived from different plants and animals can act as antigens and activate the immune system in vulnerable subjects. The antigen (peptide) permeates through the epithelial layer of the mucosa of the gut and binds to IgE on mucosal mast cells. These peptides are presented to Th2 cells, and if there is an IgE antibody against the peptide present, it will cause activation of the mast cell resulting in an immune response. This causes mast cells to degranulate and release a variety of inflammatory mediators. These mediators increase vascular permeability, causing edema in the gut epithelium and smooth muscle contraction, which lead to vomiting and diarrhea. This type of reaction can occur in response to peptides found in certain medications. Food allergens can also cause skin reactions. Uptake from the gastrointestinal tract can introduce antigens into the blood, which are transported throughout the body where they bind to IgE on mast cells in the connective tissue in the deep layers of the skin. This results in urticarial reaction and angioedema. [xxvi]

Researchers are still studying how exactly POTS and MCAS interact with one another, along with whether one causes the other or if they might occur side-by-side in response to some other type of trigger, such as mitochondrial dysfunction. It’s been speculated that chronic exposure to prostaglandins and histamines affect the connective tissue and vasculature in the GI tract, resulting in conditions such as chronic constipation. Whenever a patient is seen with chronic GI symptoms, POTS, and MCAS, it’s imperative that the pathologist restain the GI tract biopsy specimens for CD 117 cells, which is a sure way to quantify the number of mast cells seen per high-power field in the biopsy specimen. If more than twenty mast cells are seen in a specimen stained in this way, it’s a clear indication that the person is suffering from MCAS. My blogs on MCAS provide a more detailed explanation regarding this. It has been referenced that an estimated nine percent of POTS patients have MCAS,[xxvii] although in my clinical experience it’s more like fifty percent. Avoiding certain food and gut bacterial antigen triggers can have a dramatic effect on reducing these symptoms. Please see the recent paper published by Dr. Afrin, with myself and others as co-authors, on the Consensus-2 criteria for the diagnosis of MCAS, entitled Diagnosis of mast cell activation syndrome: a global “consensus-2”[xxviii]

Formal diagnosis of MCAS requires fulfilling the major criteria, which is having characteristics of mast cell activation symptoms in two or more systems, along with one minor criteria.[xxix] Minor criteria include have more than twenty mast cells per high-powered field using the CD 117 immunohistochemical staining from a specimen collected from the second part of the duodenum, having an elevated number of mast cells mediators in the blood or urine, or document of improvement of symptoms with mast cell stabilizers.[xxx]

Other conditions often seen with POTS

In addition to MCAS, several other conditions may be present with POTS.

Chronic fatigue syndrome

POTS can lead to extreme fatigue, and people with POTS report poorer quality of sleep. CFS is commonly noted alongside POTS for these reasons. In fact, people who have been diagnosed with CFS and people who have been diagnosed with POTS tend to have similar symptoms when standing, leading some researchers to conclude that CFS may be part of the clinical presentation of POTS.[xxxi]

Ehlers-Danlos syndrome

Ehlers-Danlos syndromes are a group of inheritable connective tissue disorders characterized by joint hypermobility, skin hyperextensibility and tissue fragility with an incidence of 1 in 500. [xxxii] Joint Hypermobility Syndrome (JHS), synonymous with Ehlers-Danlos Hypermobile Type, formerly Type III (hEDS III), is the most commonly seen subset involving hypermobility of the musculoskeletal system and is associated with abnormal collagen formation and autonomic nervous systems abnormalities. Please see the paper entitled Neurovisceral phenotypes in the expression of psychiatric symptoms[xxxiii]for a table outlining the criteria for making diagnosis of JHS/EDSIII.

People with EDS often have symptoms of orthostatic intolerance, including POTS. Their symptoms can also be exacerbated by physical activity, eating, standing, and warm environments. According to one study, eighteen to twenty-five percent of POTS patients also meet the criteria for an EDS diagnosis, EDS-type III, characterized by hypermobility, is the most common condition that’s associated with POTS. The vast majority of hEDS patients also have gastrointestinal symptoms and if seen together with POTS, these symptoms are amplified. GI conditions such as irritable bowel syndrome (IBS), functional constipation, and GERD are prevalent in forty-eight, thirty-six, and seventy-eight percent respectively.[xxxiv]

There are various theories regarding why hEDS and the manifestation of GI symptoms, ranging from connective tissue abnormalities, lead to laxity increase in the GI tract with resultant mechanical dysfunction and altered motility. In addition, it’s known that neuronal development in the enteric nervous system is dependent on normal collagen formation.

Patients with concomitant POTS and hEDS were younger in age and had a higher prevalence of chronic fatigue syndrome, fibromyalgia, and depression. Symptoms such as functional dyspepsia, chronic nausea and vomiting syndrome, functional heartburn, dysphagia, fecal incontinence, and levator ani syndrome were all higher in the hEDS-POTS cohort.[xxxv]

Other conditions that have been associated with joint hypermobility include ADHD, anxiety, asthma, carpal tunnel syndrome, chiari malformation type I, chronic fatigue syndrome, chronic regional pain syndromes, Crohns disease, hiatus hernia, mitral valve prolapse, migraine, headaches, pelvic organ prolapse, rectal evacuatory dysfunction, and urinary stress incontinence.[xxxvi]

Median Arcuate Ligament syndrome (MALS). Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area, known as the median arcuate ligament, presses on the artery that sends blood to the upper abdomen. The artery is called the celiac artery. MALS can cause stomach pain in some people.[xxxvii]

Vasovagal syncope is a disorder characterized by sudden, sharp declines in blood pressure that lead to fainting episodes. Although POTS is primarily characterized by heart rate increases, people with POTS may also have vasovagal syncope or orthostatic hypotension, which can also lead to fainting.[xxxviii]

Fibromyalgia is a condition that’s characterized by muscle pain of an unknown cause. Like CFS, it’s commonly seen in people with orthostatic intolerance conditions, like POTS. Researchers theorize that POTS with fibromyalgia may be caused by neuroinflammation, which can occur after a triggering event like a viral infection.[xxxix]

Other conditions include migraine headaches, celiac disease and/or gluten sensitivity, gastroesophageal disease, and peptic ulcer disease. An ever-increasing number of COVID-19 patients are also now seen to have symptoms suggestive of POTS[xl]

Recently, a group of physicians have observed a strong relationship between Hypermobile Ehlers-Danlos Syndrome, Postural Orthostatic Tachycardia, and Mast Cell Activation syndrome, naming this as the triad of conditions. If further autoimmune conditions and gastric motility issues were noted, this has been referred to as a pentad of conditions. Dr Andrew Maxwell has an excellent PowerPoint describing these associated conditions.

Causes of POTS

POTS isn’t a disease itself, but rather a cluster of symptoms. It can be caused by any manner of other conditions, and may even be caused by genetics or trauma. Here are some of the many potential causes of POTS:[xli]

• Genetic factors
• Infection (most common) or other infectious illnesses – seen after Epstein-Barr virus, influenza and Borrelia burgdorferi infections[xlii]
• Physical trauma
• Autoimmune disorders, such as Type 1 diabetes
• Surgery
• Pregnancy
• Exposure to chemicals
• Degenerative neurological conditions, such as Parkinson’s disease and Multiple Systems Atrophy (MSA)
• Concussion or traumatic brain injuries
• Cervical spine deformities, such as cervical spine stenosis or Chiari malformation
• Vitamin B1 deficiency, known as beriberi, which is a treatable form of the condition

Some of the known diagnoses that may cause secondary POTS include heavy metal toxicity, amyloidosis, Sjogren syndrome, sarcoidosis, and lupus. Alcohol abuse may also increase a person’s risk of POTS, as well as a history of chemotherapy use.

Unfortunately, there’s still a great deal that we don’t understand about the pathophysiology of POTS and exactly what causes it.

Diagnosis

POTS is diagnosed by taking a thorough history, using a POTS questionnaire such as the Self-Report Orthostatic Grading Scale,[xliii] and by performing a physical examination during which orthostatic vital signs are recorded. POTS is often associated with hypermobility syndromes, so an examination using the Beighton Score is essential.

Specific diagnostic tests include a standing test or a tilt-table test with a 12 lead ECG.[xliv]

Standing Test

With a standing test, the patient lies down for a few minutes before their pulse and blood pressure are recorded with an electronic device, such as the Omron blood pressure machine. They then stand up and while not holding onto anything, and without talking or moving too much, their pulse and blood pressure are recorded at one, three, five, and ten minute intervals. Since POTS may be influenced by diurnal variations, with the morning being the most sensitive time of day, it may increase diagnostic accuracy if the readings are taken in the morning.

Tilt-table Test

A tilt-table test is considered to be the gold standard test for confirming the diagnosis. During this test, the patient is strapped standing up to a table and connected to monitoring equipment, which checks their vital signs at regular intervals. The patient rests while standing up for twenty minutes, before the table is then tilted to seventy degrees. Blood pressure and heart rate are monitored continuously and recorded at two, five, and ten minute intervals. The patient is kept in an upright position for forty minutes or until they faint.

The test is considered positive if the diagnostic criteria are met. Keeping the patient still on the table prevents fidgeting or any compensatory movements to which the patient may have grown accustomed to help ease their symptoms. Keeping them still enables the full magnitude of the patient’s symptoms to be assessed. The tilt-table test is most commonly used for people who experience frequent fainting episodes.

Each of these tests are brief when assessing POTS, taking only about ten to fifteen minutes. However, if other orthostatic syndromes are a possibility, these tests may take significantly longer. In the case of orthostatic hypotension, tests may take up to forty-five minutes.

People with POTS may also experience minor increases in blood pressure when standing. In addition, they will often have elevated blood levels of norepinephrine.[xlv]

Summary

There’s much more to POTS than meets the eye. It’s a complex condition characterized by an increased heart rate while standing, but it’s also associated with a number of other conditions and disorders. These include mast cell activation syndrome, chronic fatigue syndrome, Ehrler-Danlos syndrome, and fibromyalgia.

In this first part, we reviewed the definition of POTS, along with signs and symptoms, complications, associated conditions, and how to diagnose POTS. In Part Two, we’ll be reviewing how POTS is treated. It’s a multi-faceted treatment that may include diet changes, specialized compression clothing, strict exercise routines, pharmaceuticals, or indeed all of these.

In the meantime, please reach out to my office if you suspect POTS or if you need help managing your POTS. There’s no need to suffer in silence.

Please watch Dr. Andy Maxwell’s presentation.

[i] Fedorowski A. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. J Internal Med.2019: 285(4):352-366

[ii] Fedorowski A. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. J Internal Med.2019: 285(4):352-366

[iii] Tu Y. Abell T, Raj S, Mar P. Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome Neurogastroenterology & Motility 2020: \00e14031.

[iv] Raj S. The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis and Management. Indian Pacing Electrophys J 2006 April-Jun; 6 (2): 84-99.

[v] Arnold A, Ng J, Raj S., Postural tachycardia syndrome – Diagnosis, physiology, and prognosis. Autonomic Neuroscience: Basic and Clinical 215 (2018) 3-11

[vi] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[vii] Mar Pl, Raj SR. Postural orthostatic tachycardia syndrome: mechanisms and new therapies. Annu Rec\v Med. 2020; 71: 235-248

[viii] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[ix] Johns Hopkins Medicine. Postural orthostatic tachycardia syndrome (POTS). N.d. Accessed March 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots

[x] Ibid.

[xi] Cedars Sinai. Postural orthostatic tachycardia syndrome (POTS). N.d. Accessed March 2021. https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/postural-orthostatic-tachycardia-syndrome-pots.html

[xii] Ibid pg. 4

[xiii] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[xiv] Ibid pg. 4

[xv] DiBlaise JK, Harris LA, Goodman B. Postural Tachycardia Syndrome (POTS) and the GI Tract: a primer for the gastroenterologist. Am J Gastroenterol. 2028;113(10):1458-1467

[xvi] Tu Y. Abell T, Raj S, Mar P. Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome Neurogastroenterology & Motility 2020: \00e14031.

[xvii] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[xviii] Moak JP. Fabian RR, Clarke LC et al. Antroduodenal manometry is abnormal in children presenting with orthostatic intolerance and gastrointestinal symptoms. J Pediatric Gastroenterol Nutr. 2016:63 (3):329-335

[xix] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[xx] Cedars Sinai. Postural orthostatic tachycardia syndrome (POTS). N.d. Accessed March 2021. https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/postural-orthostatic-tachycardia-syndrome-pots.html

[xxi] Dysautonomia International. Postural orthostatic tachycardia syndrome. N.d. Accessed March 2021. http://www.dysautonomiainternational.org/page.php?ID=30

[xxii] Dysautonomia International. Postural orthostatic tachycardia syndrome. N.d. Accessed March 2021. http://www.dysautonomiainternational.org/page.php?ID=30

[xxiii] Arnold AC, Raj SR. Orthostatic Hypotension: A Practical Approach to Investigation and Management. Can J Cardiol. 2017;33(12):1725-1728. doi:10.1016/j.cjca.2017.05.007

[xxiv] Garland EM, Celedonio JE, Raj SR. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance. Curr Neurol Neurosci Rep. 2015;15(9):60. doi:10.1007/s11910-015-0583-8

[xxv] Tu Y. Abell T, Raj S, Mar P. Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome Neurogastroenterology & Motility 2020: \00e14031

[xxvi] https://www.frontiersin.org/articles/10.3389/fimmu.2015.00620/full

[xxvii] Shaw BH, Stiles LE, Bourne K, et al. The face of postural tachycardia syndrome- insights from a large cross-sectional community-based survey. J Intern Med. 2019; 286 (4): 438-448

[xxviii] https://www.degruyter.com/document/doi/10.1515/dx-2020-0005/html

[xxix] Tu Y. Abell T, Raj S, Mar P. Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome Neurogastroenterology & Motility 2020: \00e14031

[xxx] Weinstock LB, Pace LA,Rezaie A, Afrin LB, Molderings GJ. Mast cell activation syndrome: a primer for the gastroenterologist. Dig Dis Sci.2020

[xxxi] Garland EM, Celedonio JE, Raj SR. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance. Curr Neurol Neurosci Rep. 2015;15(9):60. doi:10.1007/s11910-015-0583-8

[xxxii] Tu Y. Abell T, Raj S, Mar P. Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome Neurogastroenterology & Motility 2020: \00e14031

[xxxiii] Eccles J, et al. Neurovisceral phenotypes in the expression of psychiatric symptoms. Frontiers in Neuroscience Feb 2025 Volume 9 Article 4 pg 1

[xxxiv] Ibid.

[xxxv] Ibid.

[xxxvi] bid.

[xxxvii] https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001

[xxxviii] Garland EM, Celedonio JE, Raj SR. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance. Curr Neurol Neurosci Rep. 2015;15(9):60. doi:10.1007/s11910-015-0583-8

[xxxix] Staud R. Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia. Curr Rheumatol Rep. 2008;10(6):463-466. doi:10.1007/s11926-008-0076-8

[xl] Blitshteyn S. Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after Covid

-19 infections: a case series of 20 patients. Immunologic Research 30^th March 2021

[xli] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[xlii] Eccles J, et al. Neurovisceral phenotypes in the expression of psychiatric symptoms. Frontiers in Neuroscience Feb 2025 Volume 9 Article 4 pg 1

[xliii] Self-Report Orthostatic Grading Scale Mayo Clin. Proc. 2005; 80 (3): 330-334

[xliv] Rowe P. General information brochure on orthostatic intolerance and its treatment. March 2014. Accessed March 2021. https://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

[xlv] Raj SR. The Postural Tachycardia Syndrome (POTS): pathophysiology, diagnosis & management. Indian Pacing Electrophysiol J. 2006;6(2):84-99. Published 2006 Apr 1.

Dr. Bruce Hoffman

Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.

hoffmancentre.flywheelsites.com

A recent controversy has emerged over the use of the gas stoves.  Gas stoves are present in roughly 1/3 of United States homes and it has been observed that there may be an increased risk of asthma in children and other respiratory health risks linked to indoor air pollution from these appliances. A study published in the Journal of Environmental Science and Technology in October 2022, found that gas stoves can emit low levels of methane, carbon monoxide, formaldehyde and benzene.  Two further lung irritant substances emitted from gas stoves are nitrogen dioxide and tiny airborne particles known as PM2.5 – both of which are lung irritants. Cooking of any kind produces some pollutants that are harmful if not properly handled. Applying heat to food produces particles — tiny particles (PM10, or particulate matter 10 micrometers in diameter), tinier particles (PM2.5, or 2.5 micrometers in diameter), and even tinier “ultrafine” particles (100 nanometers in diameter) — that can exacerbate respiratory problems.[i]

For a more in depth analysis of all of the indoor pollutants and the levels at which they produce health effects please see this VOX news article written by David Roberts.

In a further study published December in the International Journal of Environmental Research and Public Health, postulated that more than 12% of current childhood asthma cases in the U.S. can be linked to the use of gas stoves.

The controversy is made worse by the fact that these low levels can emit even when the stove is not in use. Given that people in the U.S. spend on average roughly 90 percent of their time indoors. With Covid -19, the average time spent indoors may be much higher.[ii] 

Thus, we do most of our breathing inside but very little attention or regulation standards govern indoor air quality. Outdoor air is the subject of massive legal and regulatory legal wranglings going back decades. The six common air pollutants covered by the U.S. Clean Air Act — ground-level ozone, particulate matter, carbon monoxide, lead, sulfur dioxide (SO2), and nitrogen dioxide (NO2) — have fallen an average of 74 percent since the Act was passed in 1970.

This is  a good thing, because a growing body of research suggests that those pollutants are even more harmful to humans, at lower exposures, than previously believed.

But the more ominous news is that the Environmental Protection Agency (EPA) warns that “studies of human exposure to air pollutants indicate that indoor levels of pollutants may be two to five times — and occasionally more than 100 times — higher than outdoor levels.”

Despite those risks, there are no federal standards or guidelines governing indoor pollution. A patchwork of state and local standards in the U.S. protects consumers, inadequately.[iii]

According to a David Roberts, four research and advocacy groups — the Rocky Mountain Institute, Mothers Out Front, Physicians for Social Responsibility, and the Sierra Club — released a literature review, assessing two decades worth of peer-reviewed studies. They find that “gas stoves may be exposing tens of millions of people to levels of air pollution in their homes that would be illegal outdoors under national air quality standards.” Like most issues involving health and environmental toxicants, the pro- lobbying groups, in this case the natural gas companies, have fought long and hard to fend off any regulatory standards being applied. 

The controversy of a gas cooking health hazards began almost 50 years ago when researchers in England and Scotland showed that 5000 children were linked to a positive correlation between gas cooking and asthma symptoms. Since then, a slew of new studies has been published.  

Use of a high-efficiency range hood that extracts indoor air contaminants and carries them outside appears to be of benefit. Opening windows may be of help and using a HEPA air filter ( which, if it extracts particles below 0.3 microns, will be of help in removing mold particles as well)  may also be of use. 

Environmentalists believe that switching to electric induction cooking is an important climate step. this is furthered by the awareness that there are cooking benefits to electric stoves- they allow you to cook faster.  Chefs have commented that making the switch to induction may help increase production and improved employee mental health because the kitchens are not as hot as when using gas stoves. 

It has been postulated by certain media outlets that U.S. federal regulators are considering a ban on gas stoves but the U.S. Consumer Product Safety Commission (CPSC) has commented that it is still figuring out the best way to tackle this issue. The CPSC are considering all approaches to regulation and has commented that any action would be a very lengthy process, implying that there are no eminent policy changes in the near future. It appears that the most likely move will be that, instead of having people physically remove gas stoves, the CPSC will require that new products comply with its regulations. This would mean that new homes be built with electric stoves or high-efficiency exhaust vents.[iv]

However, a very sensible article was written in Medscape by F. Perry Wilson Jan 24 2023[v] titled “The Gas Stove Debate Hinges on One Bad Word”. Here he points out the difference between association and causation. He makes the point, through deductive reasoning and math, that if all gas stoves were to be removed, there would very likely not be a reduction in the amount of asthma systems in children by 12%. The word “attributable” is the key word in his argument, bringing into focus the age-old conundrum of “association (or correlation), in studies, does not imply causation.”   There are a host of other factors that may be playing a role in the gas -stove/asthma debate, such as the economics and living conditions of those with gas stoves versus those without. There are multiple causes of asthma.

As always, an open mind is required when drawing conclusions about many studies that are published these days. There are too many factors that come into play when attempting to make up one’s mind about conclusions reached such as these. See my blog on evidence-based studies for further insights to the limitations of certain publications here.

[i] https://www.vox.com/energy-and-environment/2020/5/7/21247602/gas-stove-cooking-indoor-air-pollution-health-risks

[ii] Ibid

[iii] Ibid

[iv] Time Magazine Jan 30^th 2023.

[v] The Gas Stove Debate Hinges on One Bad Word (medscape.com)

Dr. Bruce Hoffman

Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.

hoffmancentre.flywheelsites.com

The damage electromagnetic fields (EMFs) can inflict on the human body is very real, and health organizations are only slowly realizing the extent of the problem. After all, electromagnetic and radiofrequency fields are everywhere these days, including in the office, at home, in the car, and wherever we take our cell phones. As a doctor, it’s so important to be aware of the symptoms caused by electromagnetic sensitivity, and what action can be taken to counteract the disease.

An electromagnetic field comprises energy created from electrical and magnetic energy emitted by electronic devices. The electrical current running through a device creates the magnetic field, and the electrical field is generated by the difference in voltage.

The planets and the solar system all have electromagnetic fields, as does the human body. Electromagnetic fields are a fact of life. However, due to advances in technology over the past thirty years, we’re now exposed to man-made EMFs on a daily basis for long periods from multiple sources. This is something that only happened occasionally in the past.

These two maps show the increase in electromagnetic pollution from 2004 (above) until 2022 (below) with a corresponding increase in 5G cell antenna, satellites, cell phone antennas, smart meters, smart appliances, and wearable smart devices.

The human body generates its own electromagnetic fields in relation to the heart, brain, and nervous system, so it isn’t that far-fetched to imagine that man-made EMFs can disrupt the health of sensitive individuals.

As many modern electronic devices can emit different frequencies of EMFs simultaneously, as practitioners we must take combined exposures into consideration when treating our patients.

Is Electrosmog Harming Our Health?

Electromagnetic fields, sometimes known as electrosmog, can have a severe impact on human health. While there’s considerable skepticism about the types of health effects caused by EMFs, there’s evidence that long-term exposure can contribute to diseases such as some forms of cancer, multiple sclerosis, and Alzheimer’s.

Much of the focus in legislation and guidelines regarding EMF exposure relates to excessive thermal effects, meaning the increased temperatures caused by absorption of electromagnetic energy. However, a rise in temperature isn’t the only way electromagnetic fields can affect the human body. This is largely unreported by political organizations and in the press. EMF regulations remain largely unchanged to reflect EMF dangers, but the tide is turning.

Recent guidelines on EMF exposure across the world include:

• The International Agency for Research on Cancer (IARC) recognized low-frequency magnetic fields as a possible cause of cancer in humans in 2002, making the same ruling on radio frequency radiation in 2011.
• The European Environment Agency has compared EMFs to other environmental carcinogens such as tobacco, benzene, and asbestos.
• The American Academy of Environmental Medicine (AAEN) drew attention to EMF exposure in 2012, urging doctors to reconsider electromagnetic exposure as an underlying cause of illness.
• In Belgium, the government banned the advertising of mobile phones to children under the age of seven in 2014. The specific absorption rate (SAR) of mobile phones also has to be published and all cell phone packaging must feature warnings that advise users to use a headset and minimize their exposure.
• In 2015, France decided to ban Wi-Fi in nurseries for children under the age of three. The government also mandated that at schools for children under the age of eleven, Wi-Fi should only be used when specifically needed for lessons.
• In September 2015, following the Paris Appeal Congress, the scientific committee published an international declaration, calling upon international and national organizations to recognize both electromagnetic hypersensitivity and multiple chemical sensitivity as diseases.

While government bodies and organizations are beginning to pay attention, we now need to be aware of the specific health risks related to electromagnetic fields.

Evidence of harm caused by EMFs

Electromagnetic fields can cause the following health conditions:

• EMFs have been known to cause breast cancer, along with brain tumors, and leukemia, particularly in young children. An existing condition of leukemia can actually be made worse by EMFs, while brain tumors are linked to cell phone use.
• EMFs can increase the prevalence of Alzheimer’s disease and other neurological defects, as well as worsen cognitive function. Radio frequency EMFs, such as those emitted by cell phones, can also affect the blood-brain barrier.
• The risks of infertility and stillbirthare increased for women living near a power line.
• Infertility in mencan be caused by proximity to a power line or by simply keeping a cell phone in a front pocket or attached to a belt.
• Increased blood pressure and cardiovascular strain.
• Damage to DNA and gene expression.
• In terms of depression, EMFs can alter a patient’s mood by activating his or her voltage-gated calcium channels, creating an imbalance of neurotransmitters and neuroendocrine hormones.
• EMFs can lead to the alteration of plasma membranes in cells. The activation of voltage-gated calcium channels also alters the structure of the membrane surrounding the cell, which may affect cell membrane permeability.
• The correlation between EMF exposure and amyotrophic lateral sclerosis (ALS) suggests that a confused immune system response and increased glutamate levels caused by EMF exposure may instigate ALS in susceptible individuals.
• EMFs are linked to increased blood sugar levels in diabetics and pre-diabetics. Dirty electricity can impede diabetics’ progress in managing their disease, potentially leading to them needing to use more insulin.
• Neurodevelopmental and neurobehavioral changes such as memory loss, learning difficulties, and attention and behavioral problems have been reported in numerous studies and are manifested in autism and attention-deficit hyperactivity disorders, where both epigenetic and genetic (DNA) damage are likely contributors. [iii]

For patients with electromagnetic hypersensitivity and mast cell activation syndrome (MCAS), any exposure to EMFs causes a systematic change in their body, leading to long-term illness. Researchers first noted skin-specific reactions, including skin and mucosa signs of itching and redness, flushing, pain, papules, and pustules in patients who were exposed to electronic screens and mobile phones in studies conducted back in the 1980s. They also noted symptoms in the same patients that were triggered in the heart and central nervous system. Further research in the early 2000s regarding electrical hypersensitivity noted headaches in about 85 per cent of cell phone users, with a significant number of subjects also reporting fatigue, dizziness, nausea, itching, redness, burning, and cognitive symptoms.

EMFs activate mast cells and increase histamine release, increasing the intracellular uptake of calcium across cell membranes.

In Sweden, Olle Johannson is leading the way with research into the effects of EMFs on mast cell physiology. Johannson describes a phenomenon called electromagnetic-hypersensitivity (EHS), where certain patients experience reactions to the full-body penetration of electrical and magnetic fields in their environment. Specifically, patient labeling of ‘environmental illness’ or ‘multiple chemical sensitivity’ are the strongest predictors of electro-hypersensitivity to EMFs. Whenever a patient presents with symptoms suggestive of mast cell activation syndrome, I immediately enquire about their exposures to electrical fields, magnetic fields, radiofrequency fields, and dirty electricity then have them answer the EMF sensitivity questionnaire.

All of these diseases and changes in the body are serious, but let’s focus on electromagnetic hypersensitivity, as this is an extremely modern disease that can often be mistaken for other conditions.

What is electromagnetic sensitivity?

Electromagnetic sensitivity, also known as electromagnetic hypersensitivity (EHS), is a physical intolerance to electromagnetic fields generated by power lines and power stations, electronic radio signals, and/or Wi-Fi. One patient with electromagnetic sensitivity may be more sensitive than another. Electromagnetic hypersensitivity exists on a spectrum dependent on individual susceptibility and the strength and duration of the EMF exposure. Individuals with this condition may have symptoms occurring from exposure to EMF radiation even below recommended reference levels and, when completely isolated from these fields, have complete remission of their symptoms. Although there’s still skepticism regarding the diagnosis of electromagnetic sensitivity, there are plenty of studies indicating that the condition exists. In modern society, it’s harder than ever to avoid electromagnetic fields. In fact, the sheer density of overlapping electromagnetic fields and radiation fields means that doctors are likely to be seeing increasing numbers of patients exhibiting the same symptoms.

When patients experience symptoms suggestive of EHS, this cluster of chronic inflammatory disorders still lacks validated pathogenic mechanisms, diagnostic biomarkers, and management guidelines. Many individuals get marginalized by their traditionally trained healthcare providers as having a psychogenic or somatization disorder. However, the research is continuing to advance and has provided several plausible mechanisms that explain how EMFs cause electromagnetic sensitivity, including:

• The interaction between EMFs and voltage-gated calcium channels
• Creation of free radicals or oxidative and peroxynitrate stress
• Deterioration of cellular proteins through formation of peroxynitrate, a marker of the sum total of free radical activity 
• Triggering of an inflammatory response due to neurotransmitter disturbance and cytokine induction
• Induction of the cell danger response (CDR), outlined in work by Robert Naviaux
• Induction of the mast cell activation syndrome (MCAS)

Of course, these issues are often interconnected. When a patient’s body is out of balance, many reactions can happen simultaneously.

EMF Exposure Symptoms

For a medical practitioner, one of the most fascinating aspects of the illness caused by electronic magnetic fields is that the symptoms seem so familiar. Our patients present with symptoms very similar to those found in patients with long-term chronic illness, particularly autoimmune disorders. In fact, many patients struggling with EMF exposure may have been misdiagnosed as suffering from chronic fatigue syndrome or multiple chemical sensitivity. Many patients have neurological symptoms such as numbness and tingling in various body parts suggestive of multiple sclerosis, but when an MRI is performed, the characteristic white matter lesions of multiple sclerosis are not evident

Electromagnetic hypersensitivity exposure symptoms are characterized by a broad range of nonspecific multiorgan symptoms suggestive of both acute and chronic inflammatory processes, involving skin, nervous system, respiratory, cardiovascular, musculoskeletal, and gastrointestinal systems. These symptoms may include:

• Headache or migraine
• Trouble sleeping or sleeping disorders
• Fatigue
• Brain fog or trouble concentrating
• Memory problems
• Nausea
• Burning or tingling sensations
• Weakness
• Stress and/or anxiety
• Irritability
• Digestive issues
• Decreased libido
• Dizziness
• Heart palpitations
• Aches and pains in joints and muscles
• Depression
• Photosensitivity
• Chronic skin issues, especially eczema/dermatitis

Not all symptoms are present at the same time. In addition, these symptoms can vary from one patient to another, as an individual’s genetics, state of health, and exposure to other environmental or immune stressors influence how EMF manifests in the body. In most cases, these symptoms are self-reported and there’s an absence of organ-specific pathological signs except skin manifestations, which are the most common.

Additional symptoms experienced by patients living near a cell phone tower include:

• Visual disruptions
• Hearing disruptions
• Loss of appetite
• Difficulty moving with loss of balance
• Vertigo
• General discomfort

Some patients may react to an EMF source over time, whereas others are so frequently affected by acute exposure that the symptoms and cause are easy to miss. I can’t stress enough how crucial it is to ask the right questions as part of a routine doctor visit, ensuring that no stone is left unturned. It’s important to note that some patients only react to specific sources of EMFs, such as smart meters or cell phones.

It’s also advisable to keep EMFs in mind when examining patients who don’t exhibit classic electromagnetic hypersensitivity symptoms. The new man-made pollution of EMFs hasn’t been studied in detail in terms of its adverse effects on the human body. There’s certainly an argument to consider the effects EMFs could have on non-sensitive individuals, increasing their levels of biological stress at a cellular level. If you’re treating a patient who’s sensitive to heavy metals, chemicals, perfumes, fragrances, and other toxins, it’s worthwhile to educate him or her on how to reduce EMF exposure.In fact, we could all benefit from reducing our exposure to electromagnetic fields wherever possible. Even though not all of us are sensitive, EMFs do increase our chances of developing symptoms and diseases related to increasing levels of oxidative, free radical damage to vital cells of our body.

In addition, keep in mind that other medical conditions may be linked to electromagnetic sensitivity, often meaning that your patient is suffering from a total toxin overload or immune dysfunction, with electromagnetic exposure being the “straw that breaks the camel’s back”, so to speak.

These conditions include:

• Gastrointestinal problems
• PTSD
• Mast cell activation syndrome (MCAS)
• Neurodegenerative disease, including Parkinson’s, Alzheimer’s, Huntington’s, and ALS
• Liver disease
• Food allergies
• Chronic Fatigue Syndrome (CFS)
• Autoimmune diseases, including lupus, Hashimoto’s, rheumatoid arthritis, and thyroid dysfunction
• Allergic skin reactions, such as eczema
• MTHFR genetic mutation
• Lyme disease
• Asthma, Diabetes, and Autism

You’ll have to connect the dots between your patient’s different ailments, because your patient often won’t be able to do so.

Sources of Electromagnetic exposure

Man-made electromagnetic fields can be loosely sorted into two types, namely power-based and wireless-based. Electricity EMFs are generated by any appliance or machine operating on alternating current (AC) power. Radiofrequency EMFs, also known as microwave frequency EMFs, are generated by communication devices and the cell tower network.

Sources of electrical electromagnetic fields (electricity)

Sources in the home are from such things as home appliances and lighting, including:

• Microwave ovens
• Computers
• Washers and dryers
• Radios
• Magnetic induction stove tops
• Video game consoles
• Energy efficient HVAC systems
• Air conditioning systems
• Portable heating systems
• Portable fans
• Air filtration systems
• CPAP machines
• Electric beds
• Portable air conditioning systems
• Grounding or earthing pads plugged into the third prong of an electrical outlet
• Compact fluorescent bulbs
• Other fluorescent lighting
• Bedside lamps
• Televisions
• Aquariums
• Hot tub, pool, and pond pumps

Places where the electricity enters the home are also sources, such as:

• The electrical main panel
• The sub-panels in your home
• Photovoltaic (solar) panels
• Improperly wired electrical cables within the walls

Other sources include:

• Smart Home systems
• Hybrid cars, with some models having high EMF levels, making it important to check the technical specifications before buying
• Electric car chargers
• Neighbors with photovoltaic (solar) panels

Sources at school and work include fluorescent lighting, especially compact fluorescent bulbs, as well as proximity to a variety of devices, such as:

• Slide projectors
• Overhead projectors
• The main body of computers on the floor
• Any power chargers, power strips, or where a large number of wires are plugged in
• Computers, printers, or any appliances that plug into the electrical wall plugs
• Separate hard drives
• Copiers and fax machines
• Electrical main panels, sub-panels, or switchgear rooms
• Large electrical systems, such as electric motors, generators, and electric cables
• Power tools, drills, welding tools, and induction motors, including sewing machines

 Public sources include proximity to:

• Power lines (above and underground)
• Transmission lines (above and underground)
• Transformers
• Pad-mounted ground transformers, such as the big green boxes labeled ‘high voltage’ that sit outside buildings
• Electrical substations
• Wind farms/solar power plants

Other public sources include:

• Electrical transportation systems, such as trains and light rail
• Electric and hybrid cars, with exposure varying widely
• Broadband over power lines (BPL)

BPL is a relatively new technology that uses the existing electrical power grid to transmit a radio frequency signal for internet access. BPL runs through all buildings with electrical wiring, exposing occupants to constant radio frequency, even if they aren’t signed up for the service.

Sources of radio frequency electromagnetic fields (wireless)

Sources in the home include:

• Routers
• Cell phones
• Cordless phones
• Phone base stations
• Pagers
• Microwave ovens
• Bluetooth
• Nextel phones
• IDEN phones, which constantly emit a strong radio frequency signal
• Smart thermostats, smoke detectors, TVs, fridges, microwaves, stoves, washer/dryers, lighting/automation systems
• Smart watches, fitness trackers
• Wireless air purifiers/fans
• Smart TVs

Wireless sources include:

• Networks
• Laptops
• PDAs
• Tablets
• Virtual assistant hubs
• Smart speakers
• Wireless baby monitors
• Any other wireless device
• Smart energy meters
• CPAP machines

Sources at school and work include wireless networks, phones, computers, and cell towers or antennae such as:

• Cell phones
• Pagers
• Cordless phones
• Phone base stations
• Bluetooth
• Laptops
• PDAs
• Synchronized clocks
• Alarm/security systems and school lockdown systems
• Tablets
• Wireless microphones
• Bluetooth peripherals, such as mice, keyboards, and printers
• Cell towers or antennae that are on-site or adjacent to the site
• Antennae on buildings next door or on the building above, which can radiate in the direction of a nearby building with glass windows, since the glass reflects the radio frequency toward the building.

Public sources include:

• Cell towers and cellular antennae
• Wireless networks from local businesses and retail spaces
• Wi-Fi hotspots and municipal systems
• WiMAX
• Broadcast towers (AM/FM/ digital TV)
• Radar from a nearby airports or military bases
• Electronic article surveillance systems (EAS) in the security gates that resemble flat white panels near store entrances
• Radio frequency identification and metal detector systems found in airports, stores, libraries, and hospitals

Faced with a list like the one above, many of your patients may feel that avoiding EMFs is impossible. However, there are ways to minimize exposure if your patient is struggling with electromagnetic sensitivity.

Diagnosing electromagnetic sensitivity

When diagnosing electromagnetic sensitivity, it’s crucial to rule out other illnesses, understanding that this illness can make other environmental and immune conditions worse. However, if your patient believes that they’re struggling with EMF exposure, it’s likely to be true. There are a number of ways to diagnose electromagnetic sensitivity.

Questionnaires

The first way is to complete a questionnaire and have it reviewed by a healthcare professional well-versed in the diagnosis of EHS. Please be forewarned that there won’t be many healthcare practitioners who will be vaguely interested, never mind well informed on this issue. However, it’s relevant to note that the International Classification of Diseases ICD-10 includes codes for RFR and other forms of non-ionizing radiation.

• EMF Symptom Questionnaire
• Hoffman Centre EMF and EHS Questionnaires

Take a full history of health problems and EMF exposure, using a functional medicine timeline:

• Ask the usual questions regarding past illnesses and exposure to environmental issues.          Assess the time and place regarding the appearance of symptoms, but also ask about chemical trauma, such as exposure to heavy metals, chlorinated hydrocarbons, and DDT pesticides.
• In addition, ask about electrical trauma, such as electrocution, being struck by lightning, or multiple shocks.
• Investigate any biotrauma in the form of parasites, fungal infections, or viral infections.
• Consider any past physical trauma to the central nervous system, such as spinal problems, accidents, or whiplash.
• Make sure that your questions also cover any autoimmune disorders.
• Examining your patient from a systemic perspective is key.

Ensure that you ask the patient the following questions:

• Do you own a cell phone?

• Do you use your cell phone for talking, keeping it next to your ear or using speakerphone, or for texting?
• Do you switch it off at night?
• If you own a cell phone, for how many hours do you use it in an average day?
• Where is your Wi-Fi router located and how close do you sit/sleep next to it?
• How many Wi-Fi networks does your device detect in your home?
• Are you in a condominium where you can detect all of your neighbor’s router Wi-Fi signals?
• Have you had a smart meter installed in your home recently?
• Do you have cordless phones and a cordless base station close to you, particularly at night when you sleep?
• Do you own an electric or hybrid car?
• Have you had a solar panel installed in your home recently?
• Has a new cell tower been installed near your home lately?

Look for the health issues listed above, but also watch for blood pressure problems, increased risk of infections, lack of coordination, urinary urgency, tinnitus, and a sensation of pressure in the head and ears.

The severity of electromagnetic sensitivity depends on the person and the type of exposure. Full body EMF exposure may create flu-like symptoms, whereas cell phone use may cause a slight headache.

Order tests and examine the patient

Begin with basic tests, including blood pressure and resting heart rate tests with an electronic device in the morning, while still in bed. Omron devices are quite adequate for this purpose. These levels may need to be monitored by the patient, possibly several times a day in different locations. Encourage patients to keep a journal of their symptoms and how they feel over the course of the week.

Have them do the ten-minute blood pressure and pulse test. Advise them to lie down for five minutes then take their blood pressure and pulse. They should then stand up and at one minute, three minutes, five minutes, and ten minutes they need to repeat the blood pressure and pulse readings without moving or talking. They need to note the difference between their highest and lowest pulse rates, as well as the difference between the highest and lowest systolic and diastolic blood pressures. Advise them that they should be concerned if their pulse rate changes more than thirty beats over this ten-minute time period and their systolic blood pressure falls more than twenty points. 

Blood work may include:

• ACTH and am cortisol
• Bilirubin and liver enzymes
• Blood count and differential blood count
• Creatinine
• High-sensitivity c-reactive protein (hs-CRP)
• Electrolytes
• Fasting blood glucose
• Ferritin
• Glutathione peroxidase (GPX)
• Reduced glutathione (GSHL)
• Glutathione S-transferase (GST)
• Cholesterol (LDL, HDL, triglycerides)
• 8-hydroxydeoxyguanosine- for DNA oxidation (rusting or degradation/inflammation)
• Lipid peroxidase – for lipid peroxidation ( “rusting or degradation/inflammation”)
• Malondialdehyde (MDA)
• Nitrotyrosine and peroxynitrate
• Prolactin
• Selenium, whole blood
• Zinc, whole blood
• Coenzyme Q10
• Magnesium, whole blood
• Vitamin D3
• Vitamin E
• Testosterone
• Immune cytokine factors: Interferon-gamma, interleukin-10, interleukin-17, interleukin-6, interleukin-8, Nuclear factor kappa b
• Folate profile using FIGLU or the folate panel with Health Diagnostics laboratory
• Methyl malonic acid – intracellular B 12
• TSH, Free T3 and free T4 and thyroid antibodies
• Tumor necrosis factor (Alpha, TNF-alpha)
• Histamine and diamine oxidase (DAO)
• MCAS markers – see my article on MCAS and blood work
• Interleukin-1
• Intracellular ATP
• Intracellular glutathione, glutathione transferase, glutathione peroxidase, superoxide dismutase, n-acetyl cysteine, Vitamin E, Coenzyme Q10, Vitamin D, measurements of antioxidant activity
• Vitamin B6
• Folate profile using FIGLU or the folate panel with Health Diagnostics laboratory
• Homocysteine – an indirect measure of adequate methylation, required for histamine degradation

Second-morning urine test to assess urinary catecholamines

• Adrenaline
• Dopamine
• Noradrenaline
• Noradrenaline/adrenaline ratio
• Serotonin

24-hour urine test

• Melatonin sulfate
• Urinary cortisol, cortione, DHEA
• Saliva test for 4-point cortisol  
• Test at 8 am, 12 noon, 6 pm, and 10 pm

Also consider the following:

• 24-hour blood pressure monitor
• 24-hour ECG heart rhythm diagnosis
• 24-hour heart rate variability (HRV), ruling out autonomous nervous system diagnosis
• Sleep EEG at home to indicate if sleep is disturbed

Urine test

• Provocation Heavy Metal test, depending on patient’s history, focusing in particular on mercury, lead, arsenic, aluminum, and cadmium
• Kryptopyrroles

When treating a family, it’s worth checking out individual susceptibility to electromagnetic sensitivity.

Most of the studies to date on EHS have been animal-based, but a human case-controlled study, published in 2014, Metabolic and Genetic Screening of Electromagnetic Hypersensitive Subjects as a Feasible Tool for Diagnostics and Intervention[i] demonstrated that sensitive individuals may have shared organic determinants of impaired detoxification of common physic-chemical stressors, altered cell membrane integrity, pro-inflammatory cytokine markers, and depleted antioxidant defenses.

The following drug metabolizing enzyme-gene polymorphisms and cell markers were studied and were shown to have altered functions in sensitive individuals:

• glutathione peroxidase,
• catalase
• superoxide dismutase
• catechol-O-methyltransferase
• Coenzyme Q10 oxidation increased rates
• Vitamin E
• Depletion of polyunsaturated fatty acids
• CYP 2C19 variants
• GSTT variants. Glutathione S-transferase (GST) is a family of important drug-metabolizing enzymes, conjugating endogenous and exogenous compounds. Genetic polymorphisms result in the inter-individual variability of GST activity in humans. In particular, human GSTT1 and GSTT2 null alleles are associated with toxicity and various cancers derived from chemicals. [ii]

Measure EMF exposure

It’s best to liaise with a building biologist who can visit the patient’s home or workplace and carry out the necessary checks for the different types of EMF exposures that are derived from electrical and wireless sources. Crucially, a building biologist can assess your patient’s current sleeping arrangements in relation to electronics located close to the head and trunk of the body. A professional building biologist can provide suggestions regarding how to reduce the EMF exposure as part of the measurement report.

For a building biologist in Calgary, contact Mitch Marchand of EMF Aware at 1-403-264-2970

For a building biologist in your area, contact the Building Biology

Limit EMF exposure and provide a diagnosis

Advice on how to limit EMF exposure is included in the section below. Diagnosis of your individual patient depends upon careful monitoring of the times, places, and circumstances of possible EMF exposure, as well as the changing or intensity of symptoms over time. The report from the building biologist can help you determine whether EMF exposure is likely to be the culprit. However, other potential causes need to be excluded before you reach a diagnosis of electromagnetic hypersensitivity or EMF-related health problems.

Treatment

Although the main focus should be on minimizing EMF exposure, it’s also beneficial for your patient if you work together to strengthen their immune systems, improve antioxidant defenses, reduce their total body burden of associated toxins, improve diet with macro and micronutrient adjustments, help them to sleep and reduce stress. After all, everything’s connected.

Focus on things such as:

• Counteracting any other environmental pollutants in the body, which may bring about illness due to mold, allergies, food allergies, or an immune system reaction to toxins
• Instigating a detox program to neutralize any heavy metals found as a result of the patient’s blood test
• Reducing oxidative or peroxynitrate stress through diet, healthy sleep, and exercise
• Easing any forms of gastrointestinal upset, such as food intolerance or leaky gut
• Treating inflammation and poor mitochondrial function through diet and vitamin supplements
• Encouraging patients to drink more water

A lifestyle or health coach may be able to help with these aspects of the patient’s recovery.

How to Combat Health Effects of EMFs and Limit EMF Exposure

Many of your patients may feel frustrated with the diagnosis of electromagnetic sensitivity because of the nature of modern life and the reality of working all day in an office or with other industrial machinery. Yet it’s important to stress to them that it’s possible to counteract their symptoms with careful behaviors.

The most important piece of advice you can give to any patient suffering from electromagnetic sensitivity is to move if they live near a power line and transformer, since these are such a powerful source of EMFs.

Close proximity to the following places can also be problematic for patients with electromagnetic sensitivity:

• Radio or digital TV broadcast stations
• Cell phone towers
• Police stations
• Fire stations
• Hospitals
• Airports
• Military bases
• Solar parks
• Wind turbines
• Electrical substations

Cell phone towers emit microwave radiation and can have a directional beam, but some emit in all directions. A broadcast station is problematic when it’s closer than 1.24 miles (2 km) and a direct line of sight usually leads to greater exposures. Proximity to emergency service facilities is a risk because the personnel use terrestrial trunked radio (TETRA) to communicate. Airports and military bases use radar and shortwave radio communications, in addition to other harmful technologies.

Ideally, your patient should consult a building biologist to learn more about the specific EMFs that may be radiating from inside their home, but may also be occuring externally.

Here are some general guidelines for your patients to follow after their diagnosis.

In the home

• Use a landline phone with a cord for your regular telephone, particularly for lengthy calls
• Avoid wearing a cell phone or PDA while the device is on, as the battery-switching EMF emissions are excessively high, along with the RF emissions
• Avoid using a cordless or cell phone while pregnant or while carrying an infant or toddler
• Avoid DECT or IDEN cordless phones, since the base is always on and transmitting and these phones emit a large, continuous source of RF compared to other cordless phones
• Stop using smartwatches (Apple) or fitness trackers such as Fitbit
• Keep printers turned off and unplugged from the wall socket, unless needed
• Reduce use of video game consoles or remove them entirely when not in use, disconnecting them from the wall
• Be aware that digital media players emit EMFs unless unplugged from the wall
• Smart TVs need to be unplugged as they constantly emit RF, although older models may have the option to turn off Wi-Fi or Bluetooth. For an excellent guide on different types of TVs and their emissions, visit https://emfacademy.com/do-tvs-emit-radiation-complete-guide/
• Avoid using wireless virtual assistants such as Amazon Echo and Alexa, Google Home, or any wireless Bluetooth sound system
• Energy efficient HVAC systems or other air conditioning systems may emit dirty electricity, so have this measured by the building biologist
• Remember that home alarm systems can emit microwave radiation and many alarm systems have a wireless capability
• Avoid using wireless baby monitors, or at least place them more than ten feet from a crib or bed
• Use a battery-powered clock by the bed and sleep with your head at least six feet from electrical sources
• In the bedroom, your body needs to be at least three feet from electrical sources
• Remove any metal slats and frames in beds and cribs and remove mattresses containing bedsprings, replacing them with a memory foam mattress
• Don’t use electric blankets
• At night, the bedroom needs to be electronic-free, so remove all computers, laptops, cell phones, or cordless phones and don’t charge devices in the bedroom
• Exposure to EMF before bedtime can interfere with melatonin production and the sleep cycle
• Don’t install a smart meter or any smart appliances in the home
• Wear turquoise or blue-blocker glasses for two hours before bed, as these induce melatonin production and reset the suprachiasmic nucleus, which is the master controller of your circadian clock.
• Avoid using a laptop on your lap, as the wireless card gives out a strong emission similar to a cell phone and it’s better to have the laptop on a table
• Replace Wi-Fi-enabled devices such as thermostats, fire alarms, doorbells, and cameras
• An electric vehicle charging station should be assessed by a building biologist
• Remove the microwave oven from the home
• Portable heating systems, fans, CPAP machines, and portable AC systems all need to be kept at arm’s length or further.

It’ is advisable that everyone limit their cell phone and cordless calls by frequency and duration. Children should never use cordless phones or cell phones at all, as the level of radiation penetration into the brain far exceeds that experienced by adults.[iv] 

If there’s a need to use a cordless phone or cell phone, use a wired headset. These types of headsets are best, but any type of cord that creates distance between a person’s head and the phone is helpful. Alternatively, use the speakerphone. Avoid using Bluetooth headsets at all costs, as these generate RFs. While it’s harder than ever for patients to avoid using wireless laptops and wireless routers these days, if possible, your patient should use a computer that’s plugged into a cable modem via LAN (Ethernet cable). Stress the importance of having a non-wireless router, as unfortunately most routers default to wireless even when the Wi-Fi isn’t being used. It’s also impossible to determine if the router is transmitting wirelessly.

In addition to the recommendations above regarding bedrooms, hire a building biologist to determine which circuits to turn off at night. An electrician can then install a cut-off switch so that when you turn off your lights at night in the bedroom, this also turns off all the electrical supply to the room. If a cut-off switch isn’t installed, all electrical devices in the bedroom must be unplugged from the wall socket every night.

A Christmas light timer can be employed to turn off all Wi-Fi access at night, although using wired internet through ethernet at home is the best option. If your use of Wi-Fi is unavoidable, only plug the router in when the Wi-Fi is in use and unplug the router during sleeping hours. Beacon signal, power output, and number of radios enabled can be configured to reduce the amount of exposure from wireless access points. Install the wireless access points as far as possible from occupied space, such as your desk, and never have the wireless access points located in a child’s bedroom. You must also always work at least ten feet away from where the Wi-Fi signal is generated.

Compact fluorescent bulbs may be better for the environment, but they can emit dirty power. To protect your health, switch to LED or incandescent light bulbs and remove any dimmer switches from the home. However, keep in mind that LED light bulbs can still be a concern, as they’re known to disturb melatonin production and affect sleep patterns.

Although also recommended as being good for the environment, solar panels can emit dirty electricity if they use a particular type of inverter to convert the electricity that’s generated. If a neighbor uses a solar panel, EMF can permeate the neighborhood. You should also ask your immediate neighbors to turn off their Wi-Fi routers at night and when not in use. When you see several different wireless networks available on your device, it’s important to remember that each individual signal is a RF stressor and can potentially interfere with your health.

All personal wireless devices, such as cell phones, tablets, or laptops, need to be kept one foot away from a person’s body. Keep your laptop on the table, use speakerphone or wired headphones when talking on the phone, and use airplane mode when carrying a cell phone in your pocket. In addition, ensure that you’re ten feet away from these devices when they’re charging. Bluetooth should also be turned off unless it’s in use.

As EMS increases sensitivity to other environmental toxins, it’s also important to ensure that the home is free of pollutants such as mold, toxins, and common household chemicals. Get a quality air purifier with a HEPA filter and keep it at least a foot away from you. Doctors, please note that you should follow protocol to ensure that your patient isn’t dealing with a secondary sensitivity.

While driving and out in public

• Don’t use a cell phone inside the car, on staircases, or in elevators, as the cell phone increases its EMF emissions up to 10,000-fold, even when locked away or on standby
• If it’s necessary to make phone calls inside the car while driving, get a built-in, hands-free car phone jack and have the antenna hook up outside the car
• Hybrid electric cars can increase sensitivity for some individuals
• Modern cars often include Bluetooth systems and Wi-Fi hotspots, which need to be turned off
• Avoid staying in hotels that have Wi-Fi hotspots or at airports, if you want to sleep well
• Avoid cafes and restaurants that have wireless hotspots, particularly if children are with you
• Avoid making multiple trips through the security gates in stores, and don’t let children play between their panels or linger near them
• Avoid non-crucial medical procedures during pregnancy, such as MRIs and extra ultrasounds, to avoid unnecessarily exposing your baby to strong electromagnetic fields

Don’t use cell phones in the car as it can be immediately dangerous, but also ramp up exposure to EMFs. In particular, avoid using cell phones when children are present, as RF levels can be incredibly high in the back seat while a phone is used in the front of the car. Turn off cell phones in the car and avoid returning or taking calls while driving, retrieving messages when you arrive at a safe spot. In addition, don’t use Bluetooth for hands-free, as this is also a source of EMFs. Try to select a cell phone with a low specific absorption rate or SAR value. Choose the lowest where possible, which you can learn more about with this handy guide.

At work and at school

• Try to restrict your child’s exposure to Wi-Fi in school by encouraging staff to change school policy. See Techsafeschools.org for more information.
• Work at least ten feet from the Wi-Fi source, but ideally use an ethernet cable at work
• Watch out for extension cords or power bars underneath desks and close to feet

Most of the precautions recommended for the home can also be used at work or school, although there may be some resistance from bosses, coworkers, teachers, and the school district authorities. However, there’s no reason to use Wi-Fi in the classroom if it’s not pertinent to the lesson.

Although it may be tempting to provide all these guidelines at once, many patients may feel overwhelmed by all the things they’re advised to remember. Introduce the guidelines gradually where possible, perhaps focusing on those related to the bedroom and the home to begin with, alongside those regarding personal and portable electronic devices. Remind your patients that this is a process, and that it takes time to improve electrosmog symptoms.

EMF Protection in the Home

There are several forms of EMF protection your patient can employ to minimize their exposure to electromagnetic fields. These include:

• Installing a cut-off switch in the bedroom, which minimizes your patient’s EMF exposure at night and improves sleep significantly
• Installing GS filters, which filter out the most dangerous levels of dirty electricity in the home. Only do this after having a building biologist check your home for wiring errors and current over your water lines.
• Painting inside or outside the house using RF-screening paint. which blocks most cell phone Wi-Fi and TETRA signals
• Lining windows with RF-reducing window film
• Using a RF-shielding canopy, which resemble mosquito nets and are easy to install, over the bed at night. These are very effective for those living in apartments and condos.
• Investing in meters that check magnetic field levels and RF levels
• Hardwire computer workspace where computers, laptops, and tablets are located
• Unplug WIFI printers, smart TVs, streaming media devices, such as Apple TV, Roku, or Chrome Cast, when not in use

As healthcare professionals, we need to be aware of man-made pollutants, particularly those that have been introduced without any consideration of the health risks. Cell phones, Wi-Fi hotspots, and electrical devices seem to be everywhere these days, and the number of patients with electromagnetic sensitivity is bound to increase over time. You’re uniquely qualified to advise patients on how to minimize their vulnerability to EMFs. Ultimately, EMF exposure is avoidable but with your help, your patients can see a real improvement in their health.

This is a summary of 4425 peer review EMF studies showing biological effects downloaded from the ORSAA database. Oceania Radiofrequency Scientific Advisory Association (ORSAA) is a not-for-profit organization composed of scientists and professionals from various academic disciplines who are investigating the scientific research that relates to the effects of artificial electromagnetic radiation (EMR) on humans, animals, and the environment. As the name indicates, ORSAA has a special focus on radiofrequency electromagnetic radiation (RF-EMR) that includes high frequency microwaves widely used for wireless communication and surveillance technologies. However, ORSAA’s interest in biological effects research extends to extremely low frequency (ELF) fields such as those utilized for domestic electrification or power frequencies.

Resources

• https://www.ncbi.nlm.nih.gov/pubmed/15475717
• https://books.google.co.uk/books?id=zVK3BgAAQBAJ&lpg=PR9&dq=Igor%20Belyaev%20biophysical%20mechanisms
• https://www.ncbi.nlm.nih.gov/pubmed/27454111
• https://www.ncbi.nlm.nih.gov/pubmed/24984538
• https://www.ncbi.nlm.nih.gov/pubmed/17556764
• https://www.ncbi.nlm.nih.gov/pubmed/22332889
• https://www.ncbi.nlm.nih.gov/pubmed/25738972
• https://www.ncbi.nlm.nih.gov/pubmed/15475717
• https://www.ncbi.nlm.nih.gov/pubmed/8960756
• https://www.ncbi.nlm.nih.gov/pubmed/26017559
• https://www.ncbi.nlm.nih.gov/pubmed/25505778
• https://www.ncbi.nlm.nih.gov/pubmed/22047463
• https://www.ncbi.nlm.nih.gov/pubmed/27648194
• https://www.ncbi.nlm.nih.gov/pubmed/21742742
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341445/
• https://www.ncbi.nlm.nih.gov/pubmed/10212373
• https://www.ncbi.nlm.nih.gov/pubmed/19264461
• https://www.ncbi.nlm.nih.gov/pubmed/26300312
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780531/
• https://www.ncbi.nlm.nih.gov/pubmed/29350413
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557071/
• https://www.ncbi.nlm.nih.gov/pubmed/26372109
• https://www.ncbi.nlm.nih.gov/pubmed/23802593
• https://www.ncbi.nlm.nih.gov/pubmed/27083321
• https://www.ncbi.nlm.nih.gov/pubmed/27454111
• https://www.ncbi.nlm.nih.gov/pubmed/21830213
• https://www.sciencedirect.com/science/article/pii/S1567724919302922
• https://pubmed.ncbi.nlm.nih.gov/19398310/
• https://www.ncbi.nlm.nih.gov/pubmed/17193782
• https://www.ncbi.nlm.nih.gov/pubmed/15031956
• https://www.ncbi.nlm.nih.gov/pubmed/26556835
• https://www.ncbi.nlm.nih.gov/pubmed/26372109
• https://www.ncbi.nlm.nih.gov/pubmed/24192494
• https://www.ncbi.nlm.nih.gov/pubmed/26300312
• https://www.ncbi.nlm.nih.gov/pubmed/26372109
• https://www.ncbi.nlm.nih.gov/pubmed/24192494
• https://www.rfsafe.com/sar-values-specific-absorption-rate-comparison-database/
• https://www.orsaa.org/

[i] Sage C., Burgio E., Electromagnetic Fields, Pulsed Radiofrequency Radiation, and Epigenetics: How Wireless Technologies May Affect Childhood Development. Child Development, XXX 2017, Vol 00, No 0, pages 1-8 

[ii] Mchiara De Luca et al., Metabolic and Genetic Screening of Electromagnetic Hypersensitive Subjects as a Feasible Tool for Diagnostics and Intervention Mediators of Inflammation Vol 201 Article ID 924184

[iii] https://pubmed.ncbi.nlm.nih.gov/30169019/

[iv] https://ehtrust.org/research-on-childrens-vulnerability-to-cell-phone-radio-frequency-radiation/

Dr. Bruce Hoffman

Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.

hoffmancentre.flywheelsites.com

Exercise

Hire a personal trainer to start you off with your new lifestyle.

Find exercises that you enjoy, wherever possible.

Workout on a daily basis. Remember, it’s a choice of lifestyle not a temporary solution to an immediate health issue.

Hydrate before you work out, with salt, water, and electrolytes. Drink half your body weight in pounds in ounces. For example, if you weigh 200 pounds, drink 100 ounces or 3 litres. If you’re educated regarding the deuterium-depleted water controversy, the proponents of this approach wouldn’t agree on consuming this amount of water that isn’t deuterium-depleted.

In addition, check your bioimpedance to assess your total body water content, as well as your intracellular and extracellular fluid content.

Salt is essential, especially if you have Postural Orthostatic Tachycardia Syndrome
(POTS). Use salt that’s rich in mineral diversity, such as New Earth Organics, Crucial 4 Icelandic Flake Salt, or Redman’s Real Salt. Salt prevents muscle cramps and headaches, increases cardiac output, improves endurance, and replaces some of the electrolytes that have been lost.

Aim for cardio three times per week and high-intensity interval training three times per week.

Walk for between thirty and sixty minutes per day. If you’re a dog owner, maintaining your pet’s exercise routine can really help!

Lift weights between three and five times per week, for approximately thirty to forty-five minutes per day.

To gain muscle mass, use heavier weights in your routines. For toning of existing muscle, do less weight, but more reps.

Don’t be consistently sleep deprived, since this increases your caloric intake the next day by as much as 440 calories.

Turn your bedroom into a sleep sanctuary. Enhance sleep by wearing glasses that block blue light after 6 pm. Limit your screen time with devices such as TVs or IPads, unplug your router, and turn off your cell phone.

Find the best sleep aids from any number of combinations, from materials such as melatonin, glycine, magnesium, inositol, Gaba, or CBD. There are many different possibilities.

Define your top values in life in a hierarchal fashion by asking yourself the questions
“what do I spend most of my time doing, what do I spend my money on, what do I talk about the most, what do my surroundings demonstrate what I love the most, how do I spend my energy and what energizes me the most, what do I think about the most, what inspires me the most?”

Most people have their highest values within one or two of the following seven areas.

• Career enhancement
• Knowledge and education
• Health and well-being
• Relationships and family
• Financial well-being
• Spiritual goals
• Social enhancement

Then compile a list of the top twenty benefits of daily exercise to your top one or two values columns.

If you can link all the benefits of exercise and a good meal plan to your highest values, it will be much easier for you to continue this change in lifestyle. i.e., ask yourself “by going to the gym and eating correctly every day, how will I be even more successful at what I most enjoy doing and what I love the most?”

You have to set your priorities and values, get up early to work out, link exercise and diet to your highest values, jettison low priority activities, such as endless Netflix and Instagram engagement, be honest with yourself, and don’t entertain a fantasy of achieving huge gains without significant effort. Nobody is going to do this for you and there’s no one to blame if you don’t achieve your intended results. This begins and ends with you and your effort.

Protein and food in general

Hire a nutritionist that’s highly skilled in providing an eight-day diet analysis using a cronometer in order to estimate where you may be macro or micronutrient deficient or over-fed, protein deficient, and whether you’re metabolically optimized.

In addition, ensure that your nutritionist is skilled in providing an anti-inflammatory approach and is knowledgeable regarding all the various food reaction subtypes. The list these days is rather long, but includes histamine, oxalates, salicylates, lectins, fodmaps, and sulfates, for example. For the most part, using a traditionally trained dietician following Canada’s Food Guide won’t help you to achieve the subtlety that’s often needed to attain your nutritional health goals.

Be quite prepared to analyze, through functional medicine laboratories, how metabolically repleted you are, the health of your cell membranes, and how functional your mitochondria and peroxisomes are in their specialized task of making both ATP and adequate fats for cell function. The biomarkers found in traditional laboratories are far from adequate when it comes down to analyzing these subtle variations.

Eat organic, whole, and nutritious food all of the time.

Don’t eat or snack after you slow down your activities for the day. Have supper no later than 6 pm and don’t snack at night. If you do, the calories contained in those snacks will immediately be deposited into storage, meaning into fat tissue.

Avoid snacking during the day, unless it’s part of your nutritional plan and you have hypoglycemic tendencies. If you’ve excluded sleep apnoea as the cause, use a Freestyle Libre blood glucose monitor if you suspect low blood sugars. This is particularly important if you wake up in the middle of the night with some or all of the following symptoms:

• Fast heartbeat
• Shaking
• Sweating
• Nervousness or anxiety
• Irritability or confusion
• Dizziness
• Hunger

Stop eating processed or packaged food.

Eat between 1 and 1.25 grams of protein per pound of lean body weight. This helps with hunger and weight loss.

A minimum of 30 to 50 grams of protein per meal is recommended, which means a minimum of six ounces of chicken, fish, or red meat. That’s for breakfast, lunch, and supper combined. In addition to essential fats, this will get you off the carbohydrate and sugar rollercoaster.

Substitute with a good quality animal protein powder, such as Designs for Health PurePaleo beef protein. Don’t substitute with a rice or pea protein, primarily due to contamination with heavy metals, glyphosate, and issues with histamine.

A lack of protein, as well as good quality essential fats, is the main reason why you lose muscle mass as you age. This also influences overeating and feeling hungry at the end of the day.

Eliminate all junk food and nutritiously-deficient food from your pantry and from your fridge. Don’t hesitate and simply throw it out!

Starting the day with a high carbohydrate and sugar-laden meal will spike your insulin and blood sugar levels and these will never quite settle down throughout the day. It won’t make any difference how ‘organic’ the meal is supposed to be, or if it was bought at a health food store. You’ll be playing catch-up all day, with feelings of hunger and cravings. Eating a protein-dense meal in the morning, after you’ve woken in a catabolic state, will help to regulate your blood sugar levels for twenty-four hours and prevent any further breakdown of muscle tissue for energy requirements.

Eat consciously. Food transformation to energy and information requires the cooperation of the vagus nerve, which is the main parasympathetic nerve in the body. Parasympathetic dominance enhances rest, relaxation, healing, and digestion.

• Eat in a quiet, settled, and comfortable environment.
• Never eat when you’re upset.
• Always sit down to eat.
• Eat only when you feel hungry.
• Minimize the consumption of ice-cold foods and beverages.
• Finish chewing and swallowing what’s in your mouth before taking another bite.
• Eat more slowly and at a comfortable pace, always remaining conscious of the process.
• Listen to your appetite, by digesting the previous meal before starting the next one.
• Don’t overeat, always leaving a third of your stomach empty to aid digestion.
• Eat freshly prepared foods. Lightly-cooked foods are preferable to raw or over-cooked food..
• Sit quietly for a few minutes after finishing your meal. Focus your attention on the sensations in your body.
• Go for a short walk after your meals to aid your digestion.

References

Read my blogs on Intermittent Fasting Part One and Part Two

Read my blog on the Ketogenic Diet

Read my blog on the Qualities of a Successful Patient

Read The Obesity Code and The Diabetes Code by Jason Fung

Read The Obesity Fix by James DiNicolantonio

Contact the Hoffman Centre for a consultation at www.hoffmancentre.com or Justine Stenger for a nutritional workup.

Dr. Bruce Hoffman

Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.

hoffmancentre.flywheelsites.com