POTS in post-COVID dysautonomia in Belgium: sugar, tachycardia, and INTI ginger (NOT vascular) 2025

POTS in Belgium: a post-COVID disease on the rise

POTS (Postural Orthostatic Tachycardia Syndrome) is characterized by a heart rate increase of ≥30 beats/min within 10 minutes of standing, without orthostatic hypotension. In Belgium, POTS was relatively rare before 2020. Since the COVID-19 pandemic, the number of cases has significantly increased as part of the long-COVID spectrum.

POTS patients suffer from tachycardia upon standing, extreme fatigue, cognitive fog, exercise intolerance, positional ginger headaches, and sometimes syncope.

Mechanisms of post-COVID POTS and the role of sugar

1. Autonomic dysfunction and postprandial insulin

In POTS patients, the sympathetic nervous system is hypersensitive. A sugary meal or drink triggers high postprandial insulin → splanchnic vasodilation (intestines and liver receive more blood) → splanchnic blood pooling → reduced venous return to the heart → compensatory heart rate increase (tachycardia). This mechanism is particularly detrimental in POTS, where the ANS cannot efficiently correct the situation.

2. Endothelial NO and vasomotor function

POTS is associated with endothelial dysfunction (NO ↓), preventing blood vessels from normally adapting to posture through contraction/dilation. Chronic hyperglycemia via AGE → RAGE exacerbates this endothelial dysfunction. Result: uncontrolled orthostatic pooling, compensated by excessive tachycardia.

6-gingerol activates eNOS via PI3K/Akt → NO ↑ → improved vasomotor function → reduction in the amplitude of orthostatic tachycardia episodes.

3. NLRP3 and autonomic neuroinflammation post-COVID

SARS-CoV-2 induces persistent inflammation of the autonomic nervous system via:

• NLRP3 activation → IL-1β → neuroinflammation of sympathetic ganglia
• Anti-adrenergic receptor antibodies (β2-AR) → sympathetic dysfunction
• Post-COVID intestinal dysbiosis → LPS → NF-κB → vagal inflammation

6-gingerol inhibits NLRP3 and NF-κB — two key pathways of post-COVID autonomic neuroinflammation.

Dietary recommendations for POTS and beverages

💡 POTS tip: POTS patients generally need more salt (8–12g/day as prescribed) to increase plasma volume. Adding a pinch of salt to diluted INTI water is a particularly suitable combination.