Nervous System and Dysautonomia

Why it's often missed

Standard tests for the heart and brain often come back normal in dysautonomia, because the problem is in how these systems are regulated, not in their structure. The symptoms span the heart, gut, sleep, mood and energy, so they are often treated separately or put down to anxiety.

Dysautonomia is also often driven by something else. Mast cell activation, mold and mycotoxins, infections, joint hypermobility, blood sugar swings and hormonal changes can all keep the nervous system on alert. Treating only the heart rate or only the sleep problem usually isn't enough.

The nervous system also learns. After months or years of illness, the body can stay stuck in a threat response even after the original trigger is gone. That doesn't mean it's in your head. It means the nervous system itself needs treatment.

How I sequence treatment

My approach follows The Longevity Hierarchy™, a framework I developed for organizing care around what your body can tolerate right now. It has two aims: reduce the load your body is carrying, and expand its capacity to handle treatment. In the hierarchy, the autonomic nervous system is something I treat directly, because a regulated system can tolerate treatment that a dysregulated one can't.

In practice, that usually means:

1. Support circulation. For POTS, the basics make a large difference: more fluids and electrolytes, compression garments, changing position slowly, and avoiding triggers such as heat, alcohol and large high-carbohydrate meals. When these aren't enough, prescription medications can help, and for some patients a procedure such as a stellate ganglion block is an option.
2. Regulate the nervous system. Short daily practices such as slow breathing with a longer exhale, humming and orienting can help. For deeper patterns, I often recommend brain retraining (limbic system retraining), Depth Hypnosis, EMDR, somatic therapy or neurofeedback.
3. Restore sleep and rhythm. A consistent wake time, morning light, and a calm evening routine come first, with targeted sleep support when needed.
4. Dose movement carefully. Exercise helps, but too much too soon can cause a crash. For POTS, I often start with reclined exercise and build toward upright activity. For post-viral fatigue, rest and pacing come first.
5. Address the drivers. As you stabilize, we work on what's keeping your nervous system on alert, such as mast cell activation, mold, gut problems or hormones.

Tracking can help, but constant monitoring of symptoms, heart rate or sleep scores can itself keep the nervous system on alert. I aim for informed attention without hypervigilance. During a flare, I simplify your plan rather than add more to it.

Frequently asked questions

Do you treat POTS and dysautonomia for patients outside the Bay Area?

Yes. I see patients with POTS, dysautonomia, long COVID and chronic fatigue anywhere in California by video. I'm licensed in California, so patients need to be located in the state. If you live outside California, your own doctor can still get my guidance: clinicians can book a one-on-one case consult with me about your care, while they remain your treating physician.

Is POTS just anxiety?

No. POTS involves real changes in how your body regulates heart rate, blood pressure and blood flow. A racing heart and a sense of alarm can feel like anxiety, and stress can make symptoms worse, but treating the nervous system is not the same as saying it's all in your head.

Do you treat POTS with hypermobility or Ehlers-Danlos syndrome?

Yes. Joint hypermobility, including hypermobile Ehlers-Danlos syndrome, often occurs alongside POTS and mast cell activation. I coordinate physical therapy with hypermobility specialists, often using the Muldowney method, to build stability from the ground up, along with pelvic floor therapy when needed. If physical therapy isn't enough, imaging and a consult about regenerative therapies may be next steps.

Can long COVID cause POTS and fatigue?

Yes. POTS and lasting fatigue often begin after a viral illness, including COVID. In some people, mast cell activation is also involved. I look at the nervous system, mast cells, sleep, nutrients and other contributors together.

Should I exercise if I have POTS or chronic fatigue?

Usually yes, but carefully. With POTS, I often start with reclined exercise, such as a recumbent bike or rowing, and progress toward upright activity. With post-viral fatigue, overexertion can cause a crash, so we start with rest and pacing and build up gradually.

What is brain retraining?

Brain retraining (also called limbic system retraining) is a structured practice that helps the nervous system move out of a stuck threat response. It can be done with a coach or through self-guided programs such as Primal Trust, DNRS or the Gupta Program. I often recommend it for patients with chronic reactivity, mold or mast cell patterns, chronic fatigue, or flares triggered by stress. The patients who fully engage with it often see faster progress.