Health
What is POTS, the disease affecting Olympic swimmer Katie Ledecky?
After nearly a decade of keeping it under wraps, Olympic medalist Katie Ledecky has shared her POTS diagnosis with the world.
The athlete, who has won 14 Olympic medals for swimming, the most of any female Olympian, said she has POTS (postural orthostatic tachycardia syndrome).
In “Just Add Water: My Swimming Life,” Ledecky’s new memoir, which was published by Simon & Schuster in June, she wrote that the disease can cause “dizziness, fainting and exhaustion.”
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Here’s more.
What is POTS?
POTS is a disturbance in the autonomic nervous system, which controls some of the normal regulatory functions of the body, according to Dr. Blair Grubb, a cardiologist and expert on POTS at The University of Toledo College of Medicine and Life Sciences.
Katie Ledecky competes in the swimming 400m Freestyle Women Heats during the Paris 2024 Olympic Games at La Defense Arena on July 27, 2024. After nearly a decade of keeping it under wraps, Ledecky has shared her POTS diagnosis with the world. (Getty Images)
“When the person stands, gravity will try to displace downward roughly 20% to 30% of the body’s blood volume,” he told Fox News Digital.
In response to this displacement, the brain tells the heart to beat faster and more forcibly, and tells the blood vessels in the lower half of the body to tighten, or constrict, to three times the level they were previously, the doctor said.
“This allows for accumulation of much more blood than normal in the lower half of the body,” Grubb said.
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As more blood is displaced downward, the brain gets less and less oxygen.
Ledecky discussed this effect in her book. She wrote, “I pool blood in the vessels below my heart when I stand. My body then releases extra norepinephrine or epinephrine, which adds additional stressors on my heart, making it beat faster.”
What causes the condition?
Individuals with a genetic trait called Ehlers-Danlos syndrome (also known as joint hypermobility syndrome) appear to be more susceptible to developing this condition, according to Grubb.
“However, POTS is frequently triggered by a viral infection, such as Epstein-Barr virus or COVID-19,” he told Fox News Digital.
Katie Ledecky reacts after competing in the swimming 400m Freestyle Women Heats during the Paris 2024 Olympic Games at La Defense Arena on July 27, 2024. (Getty Images)
One of these infections can trigger an autoimmune response, in which the body’s immune system attacks itself and produces antibodies that interfere with the ability of blood vessels to tighten, the doctor said.
POTS can also occur on its own, without any obvious triggers.
Symptoms of POTS
A POTS patient’s symptoms will depend on how much blood is displaced downward, experts say.
“It can vary from mild cases where your heart races and you get a little dizzy upon standing, all the way to presenting as a disabling condition, disallowing patients from being upright,” Valerie Iovine, PT, a physical therapist at Strive Physical Therapy in Philadelphia, told Fox News Digital.
“It can also change over the course of life, but can also change day to day or week to week.”
“When the person stands, gravity will try to displace downward roughly 20% to 30% of the body’s blood volume.”
The disorder’s name — postural orthostatic tachycardia syndrome — literally translates to “when you become more upright, your heart races,” noted Iovine, who treats many patients with POTS and also has the disorder herself.
“The heart will flutter in an attempt to properly oxygenate the brain,” she said.
Symptoms can include “disabling fatigue, exercise intolerance, heat intolerance, palpitations, lightheadedness, dizziness, fainting and brain fog,” a doctor said. (iStock)
“But in addition to the dizziness, headaches, passing out or near passing out, many with this disorder don’t realize that it can account for other issues, like temperature dysregulation, blood pressure dysregulation and GI dysfunction.”
In more extreme cases, patients may have difficulty thinking, concentrating or remembering — sometimes called brain fog, according to Grubb.
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People may also experience blurred vision, black spots in their visual field, tunnel vision and headache.
“Even greater displacement of blood can cause the individual to lose consciousness,” Grubb said.
Treatments and therapies
The primary treatment for POTS is increasing water and salt intake, Grubb said.
“It is also important to recondition the patient through exercise, building the strength in their lower extremities,” he said.
Some medications, such as midodrine and droxidopa — known as vasoconstrictors — can work to tighten blood vessels and increase blood return to the heart, according to Grubb.
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Still other drugs, such as fludrocortisone or desmopressin, work by increasing the volume of fluids available for the heart to pump.
“Medications such as pyridostigmine facilitate nerve transmission and help the nervous system work more effectively to maintain normal vascular function,” Grubb added.
The disease can often cause a flu-like feeling after exercise, something called post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE). (iStock)
Many often use the term “exercise intolerance” when describing symptoms of POTS, but Iovine said that “poorly prescribed and dosed exercise” is the problem.
“Exercise is the best management for POTS,” she said.
“I would argue that for these patients, movement is medicine.”
In her book, Ledecky noted that swimming can be an effective treatment for POTS, writing that “reclined aerobic exercise, such as swimming, and strengthening your core, can provide relief.”
“For these patients, movement is medicine.”
Seeking care from a cardiologist and a physical therapist is essential, according to Iovine.
The cardiologist can help to get vital signs like heart rate and blood pressure under control, she said, while a knowledgeable physical therapist can help to manage symptoms and increase upright tolerance.
“Things like proper hydration, extra electrolytes, and being able to keep cool can also help manage symptoms,” an expert advised. (iStock)
“Things like proper hydration, extra electrolytes, and being able to keep cool can also help manage symptoms,” Iovine advised.
“The heat will make the blood vessels expand, making it harder to get the blood up the head against gravity,” she said.
How POTS impacts athletes
“POTS can be a challenge for anyone — from people with complicated pre-existing conditions, all the way to the top athletes, like Katie Ledecky,” Iovine told Fox News Digital.
The disease can often cause a flu-like feeling after exercise, something called post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE).
“This is when the autonomic nervous system can have a reflexive reaction to stress or exercise, either making existing symptoms worse or creating a new host of issues in people with POTS,” Iovine said.
“This can pose an issue in the sense of rigorous exercise for an Olympic athlete — or in other cases, exertion may be as simple as getting out of bed and walking to the kitchen.”
While there is no cure for POTS, many patients are able to manage their symptoms and return to their daily activities with the help of a care team. (iStock)
POTS causes a “dynamic disability,” Iovine noted.
“One day, it may allow you to swim like an Olympic athlete, and other days, [it will] have you stuck in bed or even in a wheelchair.”
POTS is particularly challenging in athletic activities that involve frequent “start and stop” activities, such as basketball, volleyball, soccer and field hockey, added Grubb.
‘A real illness’
Both experts emphasized that POTS is a “real illness.”
“People who were previously quite healthy develop severe limitations and disabilities,” Grubb said.
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“They can experience disabling fatigue, exercise intolerance, heat intolerance, palpitations, lightheadedness, dizziness, fainting and brain fog.”
Iovine said that due to the “invisibility” of the disease combined with the high heart rate and variability of presentations, it is often dismissed as a function of mental health.
“One day, it may allow you to swim like an Olympic athlete, and other days, have you stuck in bed or even in a wheelchair.”
“Patients are often turned away from proper care, made to believe it is all in their heads,” she said.
“POTS is a very real condition, and the good news is that there are very real management strategies as well,” Iovine went on.
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While there is no cure for POTS, many patients are able to manage their symptoms and return to their daily activities.
Added Iovine, “Build up your care team and your confidence to advocate for your health and keep to your regimented routines for management.”
Health
Brain Health Challenge: Try a Brain Teaser
Welcome back! For Day 4 of the challenge, let’s do a short and fun activity based around a concept called cognitive reserve.
Decades of research show that people who have more years of education, more cognitively demanding jobs or more mentally stimulating hobbies all tend to have a reduced risk of cognitive impairment as they get older.
Experts think this is partly thanks to cognitive reserve: Basically, the more brain power you’ve built up over the years, the more you can stand to lose before you experience impairment. Researchers still don’t agree on how to measure cognitive reserve, but one theory is that better connections between different brain regions corresponds with more cognitive reserve.
To build up these connections, you need to stimulate your brain, said Dr. Joel Salinas, a neurologist at NYU Langone Health and the founder and chief medical officer of the telehealth platform Isaac Health. To do that, try an activity that is “challenging enough that it requires some effort but not so challenging that you don’t want to do it anymore,” he said.
Speaking a second language has been shown to be good for cognition, as has playing a musical instrument, visiting a museum and doing handicrafts like knitting or quilting. Reading is considered a mentally stimulating hobby, and experts say you’ll get an even bigger benefit if you join a book club to make it social. Listen to a podcast to learn something new, or, better yet, attend a lecture in person at a local college or community center, said Dr. Zaldy Tan, the director of the Memory and Healthy Aging Program at Cedars-Sinai. That adds a social component, plus the extra challenge of having to navigate your way there, he said.
A few studies have found that playing board games like chess can be good for your brain; the same goes for doing crossword puzzles. It’s possible that other types of puzzles, like those you find in brain teaser books or from New York Times Games, can also offer a cognitive benefit.
But there’s a catch: To get the best brain workout, the activity should not only be challenging but also new. If you do “Wordle every day, it’s like well, then you’re very, very good at Wordle, and the Wordle part of your brain has grown to be fantastic,” said Dr. Linda Selwa, a clinical professor of neurology at the University of Michigan Medical School. “But the rest of your mind might still need work.”
So play a game you’re not used to playing, Dr. Selwa said. “The novelty seems to be what’s driving brain remodeling and growth.”
Today, we want you to push yourself out of your cognitive comfort zone. Check out an online lecture or visit a museum with your challenge partner. Or try your hand at a new game, below. Share what novel thing you did today in the comments, and I’ll see you tomorrow for Day 5.
Health
Popular intermittent fasting diets may not deliver the health benefits many expect
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Time-restricted eating has gained popularity in recent years, but a recent study suggests that intermittent fasting — while effective for weight loss — might not live up to the hype in terms of wider benefits.
The small German study found that participants who were placed on two different time-restricted eating schedules lost weight, but experienced no improvement in blood glucose, blood pressure, cholesterol or other key cardiometabolic markers.
The participants included 31 overweight or obese women. One group ate between 8 a.m. and 4 p.m. and the other group ate between 1 p.m. and 9 p.m. for a two-week period, while maintaining their typical caloric intake, according to a press release.
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The findings, which were published in the journal Science Translational Medicine, suggest that the widely touted cardiometabolic benefits of intermittent fasting may be a result of eating fewer calories rather than meal timing, the researchers say.
The participants also showed a shift in their circadian rhythms (sleep/wake cycles) when they were placed on the time-restricted eating schedules, but the associated health impacts are not known.
A recent study suggests that intermittent fasting — while effective for weight loss — might not live up to the hype in terms of wider benefits. (iStock)
The study did have some limitations. Some researchers have cast doubt on the significance of the study due to its small size.
“It is severely underpowered to detect any difference, considering how gentle the intervention is,” Dr. Dr. Jason Fung, a Canadian physician, author and researcher, told Fox News Digital. He also noted that the participants were fasting for 16 hours a day instead of the normal 12 to 14 hours.
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Lauren Harris-Pincus, a registered dietitian nutritionist in New Jersey, agreed that the findings could be due to the fact that there was no intentional caloric restriction, and reiterated that the sample size is “quite small.”
“As a registered dietitian, I only recommend time-restricted eating when it is carefully planned and shifted earlier within the day,” Harris-Pincus, who was not involved in the study, told Fox News Digital.
One group in the study ate between 8 a.m. and 4 p.m. and the other group ate between 1 p.m. and 9 p.m. for a two-week period, while maintaining their typical caloric intake. (iStock)
“Only one in 10 Americans consumes the recommended number of fruits and veggies, and 93% miss the mark on fiber goals. Restricting an eating window necessitates more careful meal planning to ensure adequate intake of macro- and micronutrients.”
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The expert also cautioned that skipping breakfast to enable a later eating window may result in lower intake of the “nutrients of concern” in the American diet, including calcium, potassium, fiber and vitamin D.
Looking ahead, the researchers said more studies are needed to explore the effects of time-restricted eating over longer time periods. It also remains to be seen how the combination of caloric restriction and time-restricted eating may affect outcomes. Future research could also explore how different populations may respond.
“I only recommend time-restricted eating when it is carefully planned and shifted earlier within the day.”
Dr. Daryl Gioffre, a gut health specialist and celebrity nutritionist in New York, noted that the study didn’t account for critical factors like chronic stress, sleep quality, medications, hormone status and baseline metabolic health.
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“All of these can significantly blunt fat loss and cardiometabolic improvements,” Gioffre, who also was not involved in the research, told Fox News Digital.
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“Cortisol, the body’s primary stress hormone, is naturally highest in the morning, which overlaps with one of the fasting windows studied,” he went on. “If stress is elevated, cortisol alone can block fat burning, disrupt blood sugar regulation, and mask cardiovascular improvements, regardless of calorie intake or eating window.”
Growing research shows intermittent fasting — when done correctly and sustained over time — can improve insulin regulation, reduce inflammation, support fat loss and contribute to better cardiovascular health, an expert said. (iStock)
Gioffre did agree, however, that growing research shows intermittent fasting — when done correctly and sustained over time — can improve insulin regulation, reduce inflammation, support fat loss and contribute to better cardiovascular health.
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“These are outcomes that simply cannot be captured in a short, stress-blind study like this,” he added.
Fox News Digital reached out to the researchers for comment.
Health
Brain Health Challenge: Workouts to Strengthen Your Brain
Today, you’re going to do perhaps the single best thing for your brain.
When I asked neurologists about their top behaviors for brain health, they all stressed the importance of physical activity.
“Exercise is top, No. 1, when we’re thinking about the biggest bang for your buck,” said Dr. Gregg Day, a neurologist at the Mayo Clinic.
Numerous studies have shown that people who exercise regularly tend to perform better on attention, memory and executive functioning tests. There can be a small cognitive boost immediately after a workout, and the effects are sustained if people exercise consistently. And while staying active can’t guarantee you won’t develop dementia, over the long term, it is associated with a lower risk of it.
Researchers think that moving your muscles benefits your brain in part because of special signaling molecules called exerkines. During and after a workout, your muscles, fat and other organs release these molecules into the bloodstream, some of which make their way up to the brain. There, those exerkines go to work, helping to facilitate the growth of new connections between neurons, the repair of brain cells and, possibly, the birth of new neurons.
Exercise also appears to improve blood flow in the brain. That ramps up the delivery of good things to brain cells, like oxygen, glucose and those amazing exerkines. And it helps remove more bad things, namely toxic proteins, like amyloid, that can build up and damage brain cells, increasing the risk for Alzheimer’s.
All of the changes brought on by exercise are “essentially allowing your brain to age more slowly than if you’re physically inactive,” said Kirk Erickson, the chair of neuroscience at the AdventHealth Research Institute.
The benefits are particularly pronounced in the hippocampus, a region critical for learning and memory. In older adults, the hippocampus shrinks 1 to 2 percent a year, and it is one of the main areas affected by Alzheimer’s. Researchers think physical activity helps to offset some of that loss.
The best exercise you can do for your brain is the one you’ll do consistently, so find something that you enjoy and that fits easily into your life.
Walking is one option; two neurologists I spoke to said they got their exercise in by walking at least part of the way to their offices. Recent research suggests that just a few thousand steps a day can reduce the risk of dementia. It’s important to get your heart rate up, though, so “walk as though you’re trying to get somewhere on time,” said Dr. Linda Selwa, a clinical professor of neurology at the University of Michigan Medical School.
Or you could try swimming, cycling, Pilates, weight lifting, yoga, pickleball, dancing, gardening — any type of physical exertion can be beneficial.
If the thought of working out feels like a drag, try pairing it with something else you enjoy doing, like listening to an audiobook. This is a trick that Katherine Milkman, a professor who studies habits at The Wharton School of the University of Pennsylvania, calls “temptation bundling.”
For Day 3, we’re asking you to spend at least 20 minutes exercising for your brain. Go for a walk with your accountability partner if they’re nearby. (If not, call them and do a walk-and-talk.) Or let us find you a new workout to try, using the tool below. As usual, we can all meet in the comments to catch up and check in.
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