Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with POTS, 2023, Hanna Tufvesson et al

Abstract
Objectives. Postural orthostatic tachycardia syndrome (POTS) is characterized by cardiovascular autonomic dysfunction of unknown etiology with high a prevalence of gastrointestinal symptoms. The aim of the present study was to examine sociodemographic, lifestyle, and nutritional factors as well as inflammatory markers in patients with POTS.

Materials and Methods. Forty-three patients with POTS and 61 healthy controls completed questionnaires about sociodemographic factors, lifestyle habits, and gastrointestinal symptoms. Blood samples were analyzed for serum levels of cobalamins, folic acid, iron, total iron-binding capacity (TIBC), ferritin, sodium, potassium, magnesium, phosphorus, albumin, high-sensitive C-reactive protein (CRP), and 25-hydroxyvitamin D (25-OH vitamin D). Results. POTS patients were predominantly women with a lower education level and were more often working part-time, on sick leave, and living alone compared with healthy controls. They reported lower alcohol intake and physical activity levels than controls. The nutrient intake was in general similar in both groups, but POTS patients had a higher intake of different drinks and reported more gastrointestinal symptoms than controls. POTS was associated with higher CRP levels (β: 1.370; 95% CI: 0.004–2.737; ), lower albumin levels (β: -1.443; 95% CI: -2.648–(-0.238); ), and higher sodium levels (β: 1.392; 95% CI: 0.559–2.225; ). Abdominal pain () and intestinal symptoms’ influence on daily life () were negatively associated with albumin levels. Abdominal pain (), vomiting and nausea (), and intestinal symptoms’ influence on daily life () were associated with higher sodium levels. Serum levels representing iron and vitamin metabolism were equal between groups.

Conclusions. POTS is associated with poorer sociodemographic status, but malnutrition cannot explain POTS or related gastrointestinal symptoms. Higher CRP and lower albumin levels suggest low-grade inflammation as one possible etiological factor.

https://www.hindawi.com/journals/ans/2023/3992718/

 

I question whether POTS is actually even associated with lower social status. Forty-three pwPOTS is IMO not a large enough sample.

This is only n=1, but it is interesting that the POTS participants had GI issues. Prior to ME, and POTS I had IBS, and motility problems.

I wonder if eventually medical science will find that people with certain precursors such as GI and allergy issues, and who knows what else, might be at higher risk of developing ME. I've noted before on the forum that a ME expert told me IBS is known to preceed ME.

 

The conclusions are actually useful in underlining it isn't linked to nevermind caused by nutrition problems or 'behaviour' etc. So any arguments for those who might claim the 'below' 'association' was the other way around e.g. 'behaviours' or 'choices' underlay both should technically be put in their box by these two findings together?

It states 'associated with' lower sociodemographic status, but basically in the discussion seems to define/expand on that by saying 'less likely to complete education' etc. SO cart before horse issue. Anything to do with ME/CFS (and therefore likely POTS) has involved plunging people out of support and services for the last decade in most places - so 'treatment' has been directly, actively associated with decimating sociodemographic status almost directly by cutting them out of access to all these basic important things and rumours/inferences that affect the rest. Even if only a small % of those with POTS sample got caught up in that the decimation could be so extreme that averaged out it counts for a lot.

It sounds more like something that should be highlihgted to be 'controlled for' but also highlighted as a 'look what has been done to these people' on whatever cost-benefit and cost of not treating analyses there might be regarding the illness.

I looked that detail up because I saw in the abstract it saying 'assessed by questionnaire' and know this is Malmo/Skane (so no idea of the context there) but if it was UK then people don't assess their own class very well - or that concept of class interferes with sociodemographic in a very weird way. And that's even if you somehow found some method by which you could claim your selection of 43 was 'representative' of something vs the 61.

Basically sociodemographic is really hard to get accurate even when you use all the free school meals and Acorn and the like type of data because you've got so many loopholes in them drawing on postcodes to make averaged assumptions about all addresses, and averages of free school meals to make assumptions of all attendees at a particular school and so on.

 

Yes. What I took exception to really is the finding if it is one, that people with POTS have lower education levels.

PwME know from their own, or others' experience that their financial status drops. And, due to ME being well and thoroughly stigmatized, our circumstances are reduced in other areas of life as well. POTS is very debilitating, as many of us also know. The same reduction in status applies to this disease. However, I still question the finding of lower educational status.

It is interesting they found higher CRP, and lower albumin, that they indicate suggests low-grade inflammation. If memory serves low-grade inflammation has been suggested for ME as well.

 

Possible insomnia issues might play a role too.

 

Yup. All this means is that people fare worse if ill and already deprived. Which is universal and expected.

But I'm sure we could see hundreds more of studies like this asking impertinent questions without anyone clueing on just how utterly useless all of this.

 

Association does not mean causation. We do know that POTS is disabling, so it is not surprising that patients are unable to work therefore are in a more precarious financial position as general population.

Edit to add: same for schooling. If patients get POTS young enough, there are increased difficulties to attend university and get degrees, from the physical demands of getting there and sitting on hours long lectures, to the ability of studying and retaining information.

I think the authors are noting the impacts of living with POTS and the socio-demographic data, which is typically asked for any study, demonstrate that this is a disabling condition, importantly affecting predominantly women (they said that, right?)

 

I agree on the 'lower educational status' thing. It's another one of those where the real issue gets twisted.

Sadly in the census-type approach people go with 'what level of qualification have you achieved'. When we all know someone with a 1st in economics could be more well-educated and wickedly clever than someone who managed to wade their way up to a PhD with poor marks in a niche area. Or someone who was frankly brilliant in all subject at school, and indeed brilliant at anything they tried to learn, but because of ME and the lack of adjustments never picked up the qualification that reflect that knowledge and learning and ability.

I'd hate to think the term might get twisted to infer people are 'ill or less educated or knowledgeable', when it actually points to discrimination in the qualification-awarding/access end of things and really is reflecting a society that wouldn't let people access those parts to pick up the qualification that adequately reflected their education. ANd of course the snowball effect of that - as we all know, you get less leeway and less cushy jobs or onto courses that are a less good fit if you 'don't make the grades' and so on.

Exactly the sort of people who need education to be bending over backwards because if someone has ME and has a talent then being able to up their education in a way that fits their illness in order to increase chances of a role that can both fit their limitations but also mean they can offer something that is deemed useful within e.g. a few days from home is vital. But lots of them are set up to be more about 'wheedling out the ill by explicitly testing 'under pressure' 'because workplaces demand'...' so can be more about a survival programme as if that means 'the best'. The style of assessment will have a big bearing too in a way that isn't specific to knowledge (it took a pandemic for people who can 'sit upright in an uncomfortable chair and write fast with a pencil' in 2019 to not be advantaged - whatever the subject).

Whilst all the while telling themselves that as their marking schemes talking about critical thinking or whatever it can't really just be about whether you are lucky enough to not get ill if you try and do too much in a row without a break, so someone chucking in 4 mediocre essays looks more educated than getting ill after one decent one. I'd like to think that things have changed, and certainly that with skills-based stuff like coding or whatnot there could be room for 'at your own pace' learning and assessment to separate out that factor which probably is something that needs to be measured separately to 'education/knowledge/ability'.