2026 Volume 2 Issue 1 Pages 330-337
Background: In adolescents with postural orthostatic tachycardia syndrome (POTS) and post-COVID-19 condition, altered nutritional metabolism and gut environment may be associated with persistent orthostatic intolerance, sleep disturbance, and cognitive symptoms.
Case: A 13-year-old boy with traits of autism spectrum disorder and attention-deficit/hyperactivity disorde r presented with daytime hypersomnolence, general fatigue, palpitations on standing, and brain fog. A stan ding test showed a heart-rate increase of +57 bpm, and POTS was diagnosed. Laboratory findings included ALT 9 U/L, BUN 8.1 mg/dL, ferritin 37.9 ng/mL, and 25-hydroxyvitamin D 23.2 ng/mL. He received iro n, B vitamins, fish oil, vitamins D/A/C, CoQ10, approximately 70% reduction of gluten/casein, morning li ght exposure, butyrate 600 mg/day, N-acetylcysteine 500 mg/day, alpha-lipoic acid 100 mg/day, zinc carno sine 16 mg/day, and magnesium 400 mg/day; in October, the heart-rate increase improved to +45 bpm and school attendance resumed. After COVID-19, symptoms relapsed; increased protein intake, vegetables/mu shrooms, dairy restriction, supplemental meals, curcumin 300 mg/day, and Kampo extract yokukansan 7.5 g/day were added, stabilizing sleep and enabling re-attendance.
Conclusion: In this single case, multimodal nutritional and lifestyle adjustments including gut-focused stra tegies may have been temporally associated with changes in autonomic symptoms and functional status.
