Emerging Connections: POTS, MCAS, and Hypermobility – What You Need to Know

In recent years, research has unveiled an important connection between three chronic conditions that often go hand in hand: Postural Orthostatic Tachycardia Syndrome (POTS), Mast Cell Activation Syndrome (MCAS), and Hypermobility. Patients and healthcare providers alike have noticed patterns linking these conditions, yet many individuals remain undiagnosed or unaware of the overlapping symptoms. If you or a loved one struggle with these disorders, understanding the connection between them can be a game-changer in symptom management and treatment.

The Link Between POTS, MCAS, and Hypermobility

These three conditions frequently co-occur, leading experts to explore whether they share a common underlying cause:

• POTS is a form of dysautonomia that affects the autonomic nervous system, leading to symptoms like dizziness, rapid heart rate upon standing, fatigue, and exercise intolerance. (Learn more about POTS from Dysautonomia International)
• MCAS involves an abnormal activation of mast cells, which release excessive histamine and inflammatory mediators, causing issues like flushing, hives, digestive problems, and severe allergic-like reactions. (MCAS research overview from Mast Cell Disease Society)
• Hypermobility Spectrum Disorders (HSD) and Ehlers-Danlos Syndrome (EDS) affect connective tissues, leading to joint instability, chronic pain, gastrointestinal dysfunction, and skin fragility. (The Ehlers-Danlos Society provides more information on hypermobility)

Many people with one of these conditions often exhibit symptoms of the others, suggesting a potential shared mechanism, such as connective tissue dysfunction, immune system dysregulation, and autonomic nervous system impairment.

How These Conditions Overlap

1. POTS and Hypermobility

Individuals with hypermobility disorders, particularly those with hEDS (Hypermobile Ehlers-Danlos Syndrome), are at a higher risk of developing POTS. Weak connective tissues can affect blood vessels, making it harder for the body to regulate blood flow when changing positions. This results in pooling of blood in the lower extremities and a compensatory increase in heart rate, the hallmark symptom of POTS.

2. POTS and MCAS

MCAS and POTS frequently co-exist, with research suggesting that mast cell dysfunction may contribute to autonomic instability. Many POTS patients experience flushing, palpitations, brain fog, and gastrointestinal distress—symptoms commonly seen in MCAS due to histamine release. Some individuals find that antihistamines or mast cell stabilizers help alleviate their POTS symptoms, further reinforcing this connection.

3. MCAS and Hypermobility

Hypermobility and MCAS are often seen together, and many hypermobile individuals report allergic-like reactions, chronic pain, and food sensitivities. It is believed that unstable connective tissues might affect mast cell behavior, leading to increased activation and widespread inflammation.

Why This Connection Matters

Recognizing this POTS-MCAS-Hypermobility triad can lead to better, more comprehensive treatment approaches. Many patients with one condition may benefit from being screened for the others. Multidisciplinary care—including cardiologists, allergists, rheumatologists, and autonomic specialists—can help tailor treatment strategies that address all aspects of these interconnected conditions.

Managing Symptoms Across All Three Conditions

If you suspect you have a combination of these disorders, here are some key management strategies:

• Hydration & Electrolyte Replenishment: Since blood volume regulation is a challenge in POTS, Oral Rehydration Solutions (ORS) like NormaLyte can provide rapid hydration and improve symptoms.
• Mast Cell Stabilization: Antihistamines, cromolyn sodium, and low-histamine diets can help manage MCAS symptoms.
• Compression Garments & Exercise: Supportive clothing helps maintain blood circulation, and a gradual exercise regimen (such as recumbent biking) can improve POTS symptoms.
• Gastrointestinal Support: A low-FODMAP or mast-cell-friendly diet can reduce bloating, nausea, and food sensitivities common in all three conditions.
• Pain Management: Physical therapy, bracing, and targeted medications can help reduce hypermobility-related joint pain.

The Future of Research

While the link between POTS, MCAS, and Hypermobility is still being explored, ongoing studies continue to uncover shared pathways that could lead to improved treatments. Patients experiencing symptoms across these conditions should seek specialists who understand the complexity of these overlapping disorders.

By increasing awareness and advocating for a holistic, multi-system approach, we can pave the way for better care and improved quality of life for those navigating these chronic conditions.

Have You Noticed This Connection?

If you have been diagnosed with POTS, MCAS, or Hypermobility, we'd love to hear your experiences! Join the conversation in the comments below or share this blog to help spread awareness about this emerging health connection.