I love finding answers to this question. I have had a lot of mammograms this year due to treatment for breast precancer (and I have one tomorrow), and the breath control and posture holding I have learned in karate makes it easy peasy to get good images. I like to wear my karate t-shirts to appointments/treatments for morale as well.

How has your karate training made your everyday life easier/better in some way?

This came across my Google Scholar alerts and I am intrigued. I have long had issues with a sort of rapid-onset hangriness that I initially believed to be due to reactive hypoglycemia, but I do not appear to experience actual blood sugar lows.

Sadly paywalled, but if and when I have the chance to read it, I will try to add a summary/my thoughts.

Abstract

Panic disorder, menopausal vasomotor symptoms, migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and postural orthostatic tachycardia syndrome (POTS) share a convergent physiological signature—episodic sympathoadrenal activation and catecholamine surges—yet no shared mechanistic trigger has been clearly identified. We propose Hypoglycemic Flash as a potential shared trigger: a rapid decline in blood glucose concentration that activates the sympathoadrenal system independently of the absolute glucose nadir, occurring within the lower physiological range and thus undetected by conventional hypoglycemia criteria. This hypothesis is grounded in established glucose sensing physiology: hypothalamic glucose-sensing neurons respond to changes in glucose as well as to its absolute concentration, and animal studies indicate that the rate of fall determines which central catecholaminergic pathways are recruited. Human clamp studies indicate that systemic counterregulatory hormone release is governed principally by the absolute glucose level, and we therefore locate rate sensitivity in the central noradrenergic arm rather than in peripheral hormone output. Even current continuous glucose monitoring technology—reporting at 1–5 min intervals with signal smoothing and a physiological interstitial lag—would be expected to resolve events of this brevity poorly, which may help explain why glucose has been considered irrelevant in these conditions. Refined carbohydrates, physical inactivity and sleep deprivation act on insulin sensitivity or on the postprandial glucose response, and we propose that they thereby increase Hypoglycemic Flash frequency. Dietary intervention has been reported to reduce symptoms in menopausal vasomotor symptoms and in migraine; for exercise and sleep optimization symptom-level evidence is not yet available. If confirmed, Hypoglycemic Flash represents a testable, mechanistically grounded target for prevention via glycemic stabilization.

https://www.sciencedirect.com/science/article/abs/pii/S0306987726002549

So, I have mild hypermobility, and I have POTS, and when I was still doing cardiac rehab, we avoided postures that were on all fours because it bothered my wrists and, to a lesser extent, knees. I also struggled with my hands hurting from hanging from a bar even though I could hold up my weight and do things like knee raises and scapular pullups.

Now, I am not a petite person, but is it possible that these aren't very tolerable moreso because of the hypermobility than the amount of weight?

If so, is there anything that helps you tolerate these things better?

So, today I took my first ever hip-hop dance class ("beginner groovin'"). It was an hour long and I kept up all class and did not need to take extra breaks. And I had a blast!

I've been wanting to do this for a long time. At the end of last year, I was starting sumo classes in addition to karate, but then wasn't able to continue sumo due to my treatment for DCIS and the heavy contact while my chest area is still inflamed (this can persist for 6 months after radiation?). So, dancing it is!

I was checking my Garmin data and apparently my heart rate peaked at 140, which for my age is just slightly into Zone 4, which feels about right. I was working pretty hard!

I did crash after for a couple hours, but am fine now.

Hi folks,

I train Meibukan Goju-ryu and we have a fairly high hikite. I have a tendency for my elbow to wing out slightly on one side, and I am just wondering what kinds of stretching/etc. you folks do to increase mobility and prevent this.

Bonus points if you can tell me which muscles tend to be the restricting factors in a good hikite!

I haven't read this article yet from May 2026, but just came across it. If I get the chance, I'll have a look and pull ut some highlights.

https://onlinelibrary.wiley.com/doi/10.1111/joim.70104

Abstract

Background

Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance that primarily affects female patients. There are scarce data evaluating the long-term outcomes in POTS.

Objectives

This study sought to evaluate the long-term impacts of POTS over multiple decades in adult patients.

Methods

Past research participants at the VUMC Autonomic Dysfunction Center Research Unit (symptomatic ≥10 years) were recruited to participate in the study. A custom survey was administered at one time point. Participants were grouped as IMPROVED or NOT IMPROVED based on symptom course over time. Continuous data are reported as median (25th, 75th).

Results

Patients with POTS (n = 44; 98% female) were included in the analysis (62% response rate). Patient age at the time of survey was 48 (38, 54) years, with 23 (15, 27) years from POTS symptom onset, and 17 (12, 24) years from POTS diagnosis. Since diagnosis, symptoms completely resolved in 2%, improved in 46%, worsened in 25%, were unchanged in 11%, and demonstrated a variable symptom course in 16%. Patients who were NOT IMPROVED were more likely than those IMPROVED to have neuropathy, gastroparesis, and overactive bladder symptoms.

Conclusions

In a cohort of adult patients with POTS who received care at a national referral center for autonomic disorders, almost half reported their POTS symptoms as improved 10 or more years after symptom onset. Most patients with POTS experienced ongoing symptoms for many years after diagnosis.

I recently tried to order the Wakewater bundles from Costco, and they were completely out of stock, so I contacted Wakewater to ask why. This is what they told me:

>Unfortunately, as Costco works with vendors on a rotational basis, our rotation ended a while ago. The only way to bring us back is to communicate with your local Costco! We are hoping to be back soon!

So, if you like their products and want to have access to them through Costco, please drop Costco an e-mail and let them know!

I had posted this to r/POTS, but in my Googling I discovered an old post in this sub discussing this phenomenon, so I thought I'd try here too. I have hyperadrenergic POTS, by the way.

-----------------------------------------

I used to have episodes all the time where I would get sick after eating and get sweaty, flushed, and jittery, have palpitations, and then a rising feeling that I was about to explode from both ends (horrible stomach cramps and nausea) that only alleviated when I was able to get rid of the offending contents of my stomach. My stomach would subsequently feel quite raw after that for a few days, probably often because I kept making the same mistake due to not knowing why it was happening.

Over time I narrowed this down to a fructan intolerance (onions, garlic, sunchokes, and also wheat but to a lesser extent) and have been largely able to eliminate these episodes for years through being cautious about the amount of these foods that I ate at one sitting.

Last night I made the mistake that I haven't in a long time, eating a bunch of dried coconut (not on my known list of triggers) after a reasonable, usually unproblematic amount of onions (on my known list of triggers). I have better tools to monitor this now, and my HR was in the 90's and 100's and I was pushing close to hypertensive crisis levels of blood pressure. It was very uncomfortable until I went to the bathroom a few times and my stomach settled down.

I know exactly what I did wrong (please don't suggest alternate explanations); I'm just wondering whether anyone else experiences this, whether you know why these adrenergic episodes happen, and whether you have any tips beyond stringent avoidance, should I accidentally have another episode?

Just curious if anyone's been through a course of radiation therapy and how that impacted your POTS, especially with respect to fatigue?

We caught some precancer of the breast (DCIS), which was surgically removed, and then I had a short course (9 days) of radiation that finished on Friday, no chemo. I feel like I am not experiencing much radiation fatigue now, but maybe my POTS is flaring a bit after the fact and just wondering what other folks experienced.

This article is paywalled, unfortunately, but here is the abstract and I will try to pull out some main points.

Abstract

Postural orthostatic tachycardia syndrome (POTS) as conventionally defined is a chronic condition (typically >3 months duration) incorporating reproducible symptoms of orthostatic intolerance (including dizziness/lightheadedness, and near-syncope) in the absence of orthostatic hypotension (i.e., absence of a sustained systolic blood pressure drop >20mmHg with upright posture). More recently, however, the ‘POTS’ landscape as applied by many clinicians has broadened; the term ‘POTS’ has become increasingly used to categorize a multisystem disorder the underlying etiologies of which remain unclear but may include autonomic dysfunction and/or autoimmune disorders; as such the clinical picture has evolved to encompass a wide range of non-cardiovascular symptoms such as persistent exertional intolerance, fatigue, ‘brain fog’, thermo-regulatory disorders, and various gastrointestinal symptoms including gastroparesis and certain food intolerance reactions. Thus, while cardiovascular disorders may be the principal manifestation of presumed ‘POTS’ in many patients, disturbances in a variety of body systems may dominate the clinical presentation in others. This communication, derived from a diverse group of practitioners who care for the wide range of patients often referred for ‘suspected POTS’, offer the view that optimizing diagnostic evaluation and subsequent care of these individuals necessitates a broad range of clinical skills; in essence involvement of a ‘village’ of dedicated multi-talented care providers.

https://www.amjmed.com/article/S0002-9343(26)00447-X/abstract

What they are essentially proposing is 3 categorizations:

1. Classic POTS for folks who clearly meet the diagnostic criteria, with "reproducible symptomatic orthostatic tachycardia" for at least 3 months. This is a group for which "as a rule, the cause is unknown; the initial causative ‘agent’ likely occurred at some point in the past and was unrecognized." In other words, it's idiopathic. We "often need long-term care."
2. POTS-mimic for folks who have "reproducible hemodynamic features similar to 'classic POTS"" but a "presumptive identifiable systemic cause that should be addressed." They go on to add that "These patients seem to have a higher probability of partial or complete recovery compared to idiopathic/classic POTS."
3. Not-POTS for folks who sort of vaguely resemble the symptom burden of POTS, but don't have the "expected hemodynamic features of POTS."

I think this is quite interesting, and a lot of this explains the quite varied experiences people report with management and recovery. There are lot of folks in category 2 who come back and report being "cured" and give false hope to folks in category 1.

They do not say which category they believe Long COVID falls under, but they engage with the inconvenient realities of Long COVID here:

>Among non-hospitalized, highly symptomatic long COVID patients evaluated at a median of 12 months post-infection by head-up tilt and active stand testing, 31% met presently utilized POTS criteria — but a nearly equivalent proportion, 27%, presented with an identical symptom constellation without satisfying any currently accepted heart rate or blood pressure criteria. These findings are diagnostically inconvenient but scientifically important, raising the question of the symptom burden in ‘suspected POTS’ patients often being decoupled from a primary cardiovascular disturbance.

There is also a discussion of the guidelines for interpretation of the heart rate and how long it needs to sustain, as well as how often those results need to be repeated, but no conclusions are drawn.

----------------------

Now, this is just me editorializing, but I've caught a lot of smoke over time for insisting that POTS is largely a circulatory/cardiovascular/hemodynamic disorder in the face of folks insistent that it is primarily a form of dysautonomia.

Between this article and this other one I previously posted, it appears that my views are much more consistent with the direction that POTS researchers are going, renarrowing the definition to "approximately encompass the original phenotype described by Schondorf and Low," where cardiovascular symptoms predominate.

https://www.reddit.com/r/POTS/comments/1shyk2z/new_research_article_postural_orthostatic/

----------------------

Edited to add the tables, which are actually one of the most interesting parts of the article; I missed them on my first read and then didn't have the energy to format them yesterday.

Table 1: POTS-mimics Due to Underlying Conditions

1. Deconditioning
   a. Prolonged bedrest
   b. Prolonged inactivity

2. Autoimmune Diseases

3. Neurologic Disorders
   a. Small fiber neuropathy

4. Hyperthyroidism

5. Adrenal insufficiency

6. MAST cell activation disorder

Table 2: Not POTS Conditions But May Resemble POTS

1. Acute or chronic inflammatory diseases such as
   a. Rheumatologic disease (e.g., rheumatoid arthritis, infectious arthritis)
   b. Connective tissue disease (e.g., Ehlers-Danlos syndrome)
   c. Bowel disease (e.g., ulcerative colitis or Crohn's),

2. Recognized autoimmune disorders such as
   a. Systemic lupus erythematosus,
   b. Psoriasis,
   c. Others

3. Neurologic disorders
   a. Guillain-Barre
   b. Acute or chronic neuropathies (including Diabetes)
   c. Multiple Sclerosis

4. Hematologic conditions leading to anemia
   a. Blood loss
   b. Iron deficiency
   c. Others

5. Volume depletion
   a. Endocrine
   b. Renal
   c. inadequate intake

6. Neoplastic disorders leading to volume depletion
   a. SIADH
   b. Certain chemotherapeutic regimens

7. Iatrogenic conditions
   a. Excessive diuresis,
   b. Excessive dialysis,
   c Stimulant prescriptions (e.g., ADHD)

8. Drug abuse (e.g., cocaine, amphetamines, etc.)

9. Myalgic Encephalopathy/ Chronic Fatigue Syndrome

I just had my first four days of radiation therapy (we caught some DCIS on a screening mammogram, so best case scenario), and I think I am starting to experience the fatigue already, but it feels qualitatively different from what I experience due to POTS or anemia. I feel fine -- good even! -- and do not experience any if the cerebral hypoperfusion symptoms, but I am moving slow and my muscles seem to wear out a lot faster on exertion.

I was just curious if anyone else had experienced radiation therapy and how the fatigue from that compared to your usual POTS fatigue and, if you experience anemia, that too?

Hi folks,

I recently had a lumpectomy and margin revision for DCIS -- I'm a bit over a month post the last surgery -- and I just had a question about how I can expect this to heal.

The incision was done around the top of the areola, and the tissue dents inwards, so there's a skin crease/crevice along the healing/scarring incision. My concern is keeping the area clean so as to prevent skin infection, and so I'm wondering if I can expect this to fill in/flatten over time.

I was poking around in the Pope's encyclical today on AI, and jumped to the section on "The limit, the heart and the grandeur of the human person" and found the intro really beautiful.

>Our relationship with life seems to be in crisis today. Everything that appears as a “limit” — incapacity, illness, old age, suffering, vulnerability — tends to be seen primarily as a defect to be corrected, rather than as a reality through which our humanity matures and opens itself to relationship. And yet we must remember that humanity flourishes not despite limitations, but often through them.

I recommend reading on, and just skip lightly over the Christianity-specific parts if that's not your jam.

https://www.vatican.va/content/leo-xiv/en/encyclicals/documents/20260515-magnifica-humanitas.html#grandeur_of_the_human_person

NB: I was raised in the Catholic faith, but I am best described as an apatheist -- I don't care whether God exists or not or whether you believe in God or not. I'm struck by his arguments from a philosophical perspective.

Hi folks,

I just wanted to ask those of you with uterine fibroids if you feel like POTS flares subsequently flare your fibroids?

I don't have a lot of data points and didn't keep good notes, but it feels like significant fibroid flares have now, at least a couple times, followed closely on the heels of POTS flares (of a few days or more in duration) after I've managed to start pulling myself out of them.

It's very not great, because then I get anemic from the bleeds and that makes my POTS feel worse and harder to manage.

Hi folks,

My fibroid flares are becoming more frequent and less controllable with meds. I plan to discuss possible embolization with my doctors, but I will be undergoing radiation therapy soon for DCIS, and, well, one thing at a time!

I was just hoping to get your best tips for recovering from anemia, as it's a lot to deal with on top of having POTS. I am trying to keep my blood volume up so my body fills it with new red blood cells, and taking iron, folic acid, and B12, but I am wondering what else folks recommend for recovery.

Just like many folks here dislike the term "POTSies," I am no fan of the term "bedrotting." It just feels so disparaging.

So I am wondering what other terms folks have heard used for this sort of rest. I use "horizontal time" for briefer periods, but there's no reason it couldn't be used for longer stints.

I've been having a rough couple of days trying to figure out the source of a flare I'm having, and it occurs to me I might have overdone the hydration/sodium; it can be hard to tell sometimes whether the high BP originates from that or hyperadrenergic stuff or some of both.

I recently replaced my fitness watch and we have a scale that hooks into that system too, and that got me to wondering if weighing myself more often would help me home in on the right amount of hydration for me.

Anyone else doing this successfully? Tips? Caveats?