POTS & Intestinal Problems:
For many of the POTS kids at the PPRC, eating is a primary issue due to intense stomach pain. Why? POTS causes terrible GI symptoms including extreme (and unceasing) nausea, slow food motility (food does not move through the digestive track in a timely fashion), constipation or diarrhea, poor absorption of nutrients, pain and cramping, and gastroparesis (paralyzation of the intestines). Again, why all this? It’s a blood flow issue due a broken autonomic nervous system because of POTS. The blood vessels and nerves that are supposed to get blood to the digestive track are broken and don’t work correctly. It becomes a vicious cycle. Nausea = not eating (or only eating certain things … for example, at one point our son would only eat 3 things). Not eating (or limited eating) = poor nutrition, weight loss, & disordered eating.
This is the typical cycle for POTS kids: they stop or slow down eating due to bad GI issues. As they get less nutrition, their GI issues act up more. And not taking in proper calories and nutrition causes … guess what? More POTS-like symptoms! Increase heart rate, poor blood flow, stomach pain, & fatigue. So what do the kids do? They lie down, get more deconditioned, and feel even worse. As this cycle continues over time, many of the patient’s POTS symptoms can become magnified (or new symptoms may appear) due to the effects of malnutrition, starvation, and deconditioning.
What they are finding at the Mayo is that food is the answer. The approach that they take? EAT! And eat some more. Not eating, or eating a restricted diet, becomes another “pain behavior”. The way you train your brain (create new neuropathways) and tell your body to deal with food is to fill yourself with food. (And the deep breathing helps too.) Proper teenage eating is “normal” teenage eating. They do not put the kids on a limited “Gastroparesis Diet” because they can’t make the new neuropathways in their brain on a limited diet. They are finding at Mayo that the kids with POTS are experiencing huge improvements with their GI issues when they just start eating normally again. Even if it’s awful for them at first. They are telling their bodies to stop the cycle. Not that eating clears up POTS. Not that easy. But, eating clears up the POTS-like symptoms that get added on top of POTS due to starvation & malnutrition.
Example of the Effects of Starvation:
During the lecture on nutrition at the PPRC, we were given an example of a study done in the 1940s on the effects of starvation, dieting, and malnutrition called the Minnesota Starvation Study.
The study was led by one of the world’s most renowned scientists, Ancel Benjamin Keys, Ph.D., popularly known for inventing K-rations that kept our soldiers alive during World War II.
In the 1940s, when starvation was widespread throughout war-torn Europe, little was known about the effects of human starvation or how to best refeed people who’d suffered from such deprivations. Dr. Keys led the first scientific study of calorie restrictions for the War Department. The researchers wanted to understand the medical needs facing millions of starving war victims and how best to renourish and rehabilitate them to health after the war.
The 40 young male participants were carefully selected among hundreds of volunteers for being especially psychologically and socially well-adjusted, good-humored, motivated, well-educated, active and healthy. They were put on calorie-restrictive diets of about 1,600 calorie/day, meant to reflect that experienced in war-torn regions, for 3 months. They dieted to lose 2.5 pounds a week to lose 25% of their natural body weight. The calories were more generous than many weight loss diets prescribe today!
During the 3-month nutritional rehabilitation period after the diet, the men were randomly assigned to various nutritional regimens, with differing levels of calories, proteins and vitamins. The men lived at the lab and everything they ate and did was closely monitored, as was their health with a battery of tests. Daily exercise was walking about 3 miles a day.
As the men lost weight, their physical endurance dropped by half, their strength about 10%, and their reflexes became sluggish — with the men initially the most fit showing the greatest deterioration. The men’s resting metabolic rates declined by 40%, their heart volume shrank about 20%, their pulses slowed, and their body temperatures dropped. They complained of feeling cold, tired and hungry; having trouble concentrating; of impaired judgment and comprehension; dizzy spells; visual disturbances; ringing in their ears; tingling and numbing of their extremities; stomach aches, body aches and headaches; trouble sleeping; hair thinning; and their skin growing dry and thin. They had every physical indication of accelerated aging.
But the psychological changes that were brought on by dieting, even among these robust men with only moderate calorie restrictions, were the most profound and unexpected. So much so that Dr. Keys called it “semistarvation neurosis.” The men became nervous, anxious, apathetic, withdrawn, impatient, self-critical with distorted body images and even feeling overweight, moody, emotional and depressed. A few even mutilated themselves, one chopping off three fingers in stress. They lost their ambition and feelings of adequacy, and their cultural and academic interests narrowed. They neglected their appearance, became loners and their social and family relationships suffered. They lost their senses of humor, love and compassion. Instead, they became obsessed with food, thinking, talking and reading about it constantly; developed weird eating rituals; began hoarding things; consumed vast amounts of coffee and tea; and chewed gum incessantly (as many as 40 packages a day). Binge eating episodes also became a problem as some of the men were unable to continue to restrict their eating in their hunger.
The last part of the Minnesota Starvation Study revealed perhaps the most important effects. When the men were allowed to eat ad libitum again, they had insatiable appetites, yet never felt full. Even five months later, some continued to have dysfunctional eating, although most were finally regaining some normalization of their eating. As they regained their weights, their suppressed metabolism and energy levels returned, although even three months after ending the diet none of the men had yet regained their former physical capacity.
While it seemed the men were “overeating,” Dr. Keys discovered that their bodies actually needed inordinate amount of calories for their tissues to be rebuilt. In other words, they weren’t really “overeating,” it was a biological, normal effect of hunger and weight loss. The men regained their original weights plus 10%. The regained weight was disproportionally fat, and their lean body mass recovered much more slowly. With unlimited food and unrestricted eating, their weights plateaued and finally, about 9 months later, most had naturally returned to their initial weights without trying — giving scientists one of the first demonstrations that each body has a natural, genetic set point, whether it be fat or thin.
In the end, once they had regained all their weight, almost all of the physical & psychological symptoms eventually disappeared. The answer was FOOD.