Cortisol, POTS & COVID-19: Is this behind brain fog, bloating & cramps?

Content reviewed by Donna Gates
Written by Body Ecology on November 11th, 2020

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Postural orthostatic tachycardia syndrome (POTS) has been described in a growing number of people infected with SARS-CoV2 who survived infection but who remain sick for weeks or months afterward.

Although recognized since 1940, POTS is considered a circulation problem and tends to affect young women, which may be why it has received so little attention from the medical establishment.

Since young people are not expected to have circulation problems, they may go undiagnosed for years. Instead, they often receive a diagnosis of an anxiety disorder.

While most POTS patients are younger women, males who develop the condition tend to have experienced a recent viral or bacterial infection.

The syndrome is characterized by a rapid increase in heart rate of more than 30 beats per minute to more than 120 beats per minute when the person goes from lying or sitting down to standing up.

This can happen immediately or within 5 to 10 minutes after changing positions.

There is also a dizzying array of seemingly unrelated symptoms

These symptoms linked to POTS include:

  • Fatigue and extreme exhaustion
  • Intense sweating
  • Lightheadedness
  • Mental clouding/brain fog
  • Nausea and/or vomiting
  • Palpitations
  • Syncope (fainting)
  • Tremor

The fatigue associated with POTS can present as extreme exhaustion that wipes a person out for days at a time, along with intense anxiety and mental fatigue.

There are two categories of POTS:

  1. 1. Primary POTS is where the syndrome occurs without a known underlying condition.
  2. 2. Secondary POTS is the result of a chronic condition, such as diabetes mellitus, a connective tissue disorder, or sarcoidosis.

Interestingly, while most POTS patients are younger women, males who develop the condition tend to have experienced a recent viral or bacterial infection.

Whether primary or secondary, POTS is, in essence, a cluster of symptoms caused by a loss of the body’s ability to properly regulate blood pressure and blood flow when standing from sitting or lying down, or from lying down to sitting in some cases. This is an orthostatic intolerance due to dysautonomia. This means an autonomic nervous system is out of balance.

The autonomic nervous system (ANS) controls your heartbeat, breathing, and the peristaltic movement of your digestive tract. Issues with the heart, blood pressure, and breathing and loss of bladder control are just some examples of problems with your ANS.

It makes sense, then, that a circulatory problem with an inability to make sure blood flows up to your head, rather than pooling in your feet, could lead to you feeling faint and to actually fainting. But why the other symptoms? While there’s no exact answer, there are a couple of potential explanations.

One explanation might be that the body, upon experiencing this dysregulation, “freaks out” and activates the flight-or-fight system.

Because this can happen several times a day, or even several times an hour, the body develops a hair-trigger for stress. In short, the adaptive and helpful mechanism that would allow you to run from a tiger goes into overdrive at the slightest stimulus, such as suddenly sitting upright.

Unsurprisingly, given all the stress in their lives today, children with POTS may have persistently high cortisol levels, just like adults.1

The second explanation is that the system that malfunctions and leads to POTS — the autonomic nervous system (ANS) — governs a whole host of functions other than heart rate and blood pressure. The ANS splits into two branches: the sympathetic and the parasympathetic nervous system (SNS and PNS).

Dopamine, norepinephrine, epinephrine (AKA adrenaline), and acetylcholine regulate it, and it controls:

  • Bladder function
  • Body temperature
  • Digestion
  • Sweating
  • The fight-or-flight response to stress

As we mentioned above, a dysfunction of the ANS is referred to as dysautonomia, and POTS is a type of dysautonomia. So, it may be that COVID-19, in some people, causes wide-ranging damage to the ANS, leading to the symptoms of POTS in some and a seemingly unrelated array of symptoms in others.

It’s understandable that a person might not connect brain fog and dizziness to gastrointestinal problems, such as bloating, cramps, and diarrhea. (These can all be symptoms of POTS and dysautonomia.) But the common thread all these symptoms have is a connection to “neurohormone dysregulation,” including dysregulation of cortisol, adrenaline, and dopamine.

A better understanding of the effects of chronic stress, such as dysregulation of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and the interaction of stress with our genes, our lifestyle, and psychosocial factors, is clearly needed. Proper diagnosis of long haulers, including those suffering with POTS and other forms of dysautonomia, is essential to enable appropriate treatment.

Have questions about improving your immunity? The Body Ecology Diet has answers.

Stress & socioeconomics: Why recovery may be harder for essential workers

The awful irony, of course, is that chronic stress is extremely common in individuals who are at the greatest risk of infection. Who would that be? Certainly, healthcare assistants and other frontline healthcare workers, factory workers, and those in retail, restaurant, and other low-paid and insecure types of employment.

Add in a nutrient-deficient, high-carb diet, substandard living conditions, looming or current unemployment, and a healthcare system that seems to offer no solutions, and you have the perfect recipe for chronic stress and poorer outcomes when exposed to COVID-19.

Isolated seniors are also at risk of chronic stress and elevated cortisol, as well as a greater risk of serious outcomes from COVID-19 infection. Indeed, loneliness and social isolation are even more common this year and have long been linked to depression and cardiovascular disease in older adults, with cortisol thought to play a part in those connections.2,3

Dehydroepiandrosterone (DHEA) is another hormone that may influence persistent symptoms of COVID-19, especially in older adults. We’ll look at DHEA and COVID-19 in another article in this series, after we discuss the many ways to manage cortisol levels naturally.

In the meantime, right now is a great opportunity to take a closer look at the factors you can control.

As Hans Selye said, “It’s not stress that kills us; it’s our reaction to it.”4 A nutrient-rich diet and probiotic foods strengthen the body and mind.

There are many immune-supporting supplements as well. One of our favorites is our probiotic “power shots” — InnergyBiotic, CocoBiotic, and BeetBiotic. The diversity in these probiotic liquids can only be matched with fermented vegetables. And diversity is key to a hardy microbiome, which is 75 percent of your immune system.5

Body Ecology Principles like Acid/Alkaline, Cleansing, Food Combining, and especially Uniqueness are built to support healthy, day-to-day living. A gut-smart, gene-smart approach to eating for the last thirty years, it’s a time-tested, tried-and-true lifestyle with balanced nutrition that can help optimize your health.6


  1. 1. Lin J, Zhao H, Shen J, Jiao F. Salivary Cortisol Levels Predict Therapeutic Response to a Sleep-Promoting Method in Children with Postural Tachycardia Syndrome. J Pediatr. 2017 Dec;191:91-95.e1. doi: 10.1016/j.jpeds.2017.08.039. Epub 2017 Oct 13. PMID: 29037796.
  2. 2. Ahmad Jabri, Ankur Kalra, Ashish Kumar, Anas Alameh, Shubham Adroja, Hanad Bashir, Amy S. Nowacki, Rohan Shah, Shameer Khubber, Anmar Kanaa’N, David P. Hedrick, Khaled M. Sleik, Neil Mehta, Mina K. Chung, Umesh N. Khot, Samir R. Kapadia, Rishi Puri, Grant W. Reed. Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic. JAMA Network Open, 2020; 3 (7): e2014780 DOI: 10.1001/jamanetworkopen.2020.14780.
  3. 3. National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663external icon.
  4. 4. Wagner GP, Erkenbrack EM, Love AC. Stress-Induced Evolutionary Innovation: A Mechanism for the Origin of Cell Types. Bioessays. 2019;41(4):e1800188. doi:10.1002/bies.201800188.
  5. 5. Castro G. A., Arntzen C. J.Immunophysiology of the gut: a research frontier for integrative studies of the common mucosal immune system. Am. J. Physiol.265Gastrointest. Liver Physiol. 281993G599G610.
  6. 6. Sears B. Anti-inflammatory Diets. J Am Coll Nutr. 2015;34 Suppl 1:14-21. doi: 10.1080/07315724.2015.1080105. PMID: 26400429.


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