The Connection Between POTS and COVID: How Gut Damage & Inflammation Trigger Worsening Symptoms

Since 2020, a growing number of people have developed POTS (Postural Orthostatic Tachycardia Syndrome) after having COVID—many for the very first time. And for those who already lived with POTS, COVID often worsened symptoms dramatically: dizziness, fatigue, tachycardia, brain fog, digestive issues, and unpredictable flare-ups.

But why does COVID have such a strong connection to POTS?

And why does inflammation—especially gut inflammation—play such a big role?

This article breaks down the connection clearly and compassionately, so you can understand what’s happening inside your body and learn how to support your healing.

Why COVID Can Trigger (or Worsen) POTS

POTS has always been known to develop after viral infections like mono, flu, Epstein-Barr, and Lyme. COVID is no different—but the scale has been much larger.

Research suggests COVID can trigger POTS in five core ways:

1. Autonomic Nervous System Dysregulation

COVID can disrupt the autonomic nervous system (ANS)—the system responsible for:

• heart rate

• blood pressure

• digestion

• blood vessel constriction

• temperature regulation

If the ANS becomes inflamed or damaged, it struggles to keep the body stable when standing upright. This instability can lead to tachycardia, dizziness, fainting, and blood pooling—classic POTS symptoms.

2. Blood Vessel & Endothelial Damage

COVID affects the endothelium, the lining of blood vessels.

Healthy vessels tighten when you stand to keep blood from rushing to your legs.

Inflamed or damaged vessels?

They don’t tighten enough.

This leads to:

• poor circulation

• blood pooling

• low blood volume

• increased heart rate

All of which make POTS symptoms worse.

3. Persistent Systemic Inflammation

COVID is known to trigger long-lasting inflammation throughout the body—even in mild cases.

This chronic inflammation affects:

• blood volume

• cortisol balance

• digestion

• vascular function

• mitochondrial energy production

• immune function

Inflammation heightens nearly every hallmark POTS symptom.

4. Gut Disruption & Microbiome Damage (The Missing Link No One Talks About)

One of the most overlooked impacts of COVID is how aggressively it affects the gut.

The virus can weaken the gut lining, disrupt the microbiome, and trigger inflammation that spreads through the entire body.

A disrupted gut leads to:

• chronic inflammation

• histamine intolerance

• food sensitivities

• nutrient malabsorption

• worsened fatigue

• unstable blood sugar

Because your gut communicates directly with your nervous system, gut inflammation = nervous system dysregulation.

And dysregulation = POTS flares.

This is why after COVID, many people develop:

• new digestive issues

• IBS-like symptoms

• nausea

• bloating

• increased heart rate after meals

It all ties back to gut inflammation.

5. Autoimmune Activation

COVID may trigger autoimmune responses in certain people.

Some develop autoantibodies that attack receptors responsible for:

• blood pressure

• heart rate

• adrenaline response

This can mimic or intensify POTS.

How Gut Inflammation After COVID Makes POTS Symptoms Worse

This is the piece most people feel but don’t fully understand.

COVID can cause:

• increased intestinal permeability (“leaky gut”)

• microbiome imbalance

• low stomach acid

• vagus nerve irritation

• mast cell activation

• nutrient depletion

Each of these can worsen POTS in very direct, physical ways.

Gut Inflammation → Nervous System Overactivation

The gut and autonomic nervous system are directly connected by the vagus nerve.

When the gut becomes inflamed, the nervous system becomes overstimulated and unstable.

This can lead to:

• heart palpitations

• anxiety spikes

• digestive symptoms

• blood pressure swings

• dizziness

Many people report “anxiety” after COVID, but in many cases, it’s actually gut-driven nervous system dysregulation, not psychological anxiety.

Gut Damage → Malabsorption

COVID can reduce absorption of:

• iron

• B vitamins

• electrolytes

• magnesium

• sodium

• amino acids

Low nutrient absorption = worsening POTS symptoms.

Gut Disruption → Histamine Overload

COVID has been shown to increase mast cell activation in many people.

More histamine =

More tachycardia

More dizziness

More flushing

More stomach issues

More fatigue

Again—gut-driven.

Why POTS Symptoms Often Stay Worse for Months After COVID

Even after the virus leaves your body, the inflammation and gut disruption remain.

For many people, COVID was the trigger…

But lingering inflammation is what keeps symptoms going.

Think of it this way:

COVID lights the fire.

Persistent inflammation keeps the fire burning.

And the gut often becomes the “firewood.”

The good news?

Inflammation can be calmed, and the gut can heal.

How to Reduce Inflammation After COVID to Improve POTS Symptoms

Here are evidence-informed steps that help calm inflammation, strengthen the gut, and stabilize the autonomic nervous system.

1. Support the Gut First (Your Foundation for Nervous System Healing)

— Prioritize easy-to-digest, anti-inflammatory foods

Examples:

• warm meals

• soups and broths

• root vegetables

• cooked greens

• lean protein

• low-histamine fruits (blueberries, pears)

Avoiding ultra-processed foods gives your gut a chance to heal.

— Add gut-healing support

Many people benefit from:

• L-glutamine

• electrolytes

• probiotics (or spore-based, depending on tolerance)

• ginger or peppermint tea

• low-histamine eating

Healing the gut = reducing POTS flare severity.

2. Increase Electrolytes and Hydration

COVID increases fluid loss and reduces blood volume regulation.

Replenishing electrolytes:

• increases blood volume

• reduces dizziness

• reduces tachycardia

Daily goal for many POTS patients: 2–3 liters of fluids + 3,000–5,000 mg sodium, unless medically contraindicated.

3. Reduce Systemic Inflammation

Start with basics that support the immune response:

— Prioritize sleep

Healing cannot occur without restorative sleep.

— Reduce inflammatory triggers

These vary, but common ones include:

• gluten

• dairy

• alcohol

• seed oils

• refined sugar

— Gentle movement

Walking, stretching, or recumbent exercise improves lymph flow and reduces inflammatory load.

4. Strengthen the Nervous System

COVID often leaves the nervous system hypersensitive.

Helpful practices:

• slow deep breathing

• grounding techniques

• controlled cold exposure (gentle)

• vagus nerve exercises

• pacing your movement

This helps reduce adrenaline spikes and heart rate changes.

5. Support Mitochondrial Energy

Many post-COVID patients develop mitochondrial dysfunction.

Supportive approaches include:

• CoQ10

• B-vitamins

• Magnesium

• Omega-3s

• Gentle conditioning exercises

This reduces fatigue and improves stability.

The Hopeful Reality: You Can Feel Better

If your POTS symptoms changed after COVID, you’re not imagining it.

Your body has been through a tremendous inflammatory storm.

But inflammation can calm.

The gut can heal.

The nervous system can stabilize.

And POTS symptoms can improve with the right plan.