Upright by Peem Lorvidhaya MD: Review & Summary

Summary of Upright

Dr. Peem Lorvidhaya’s Upright addresses dysautonomia including Postural Orthostatic Tachycardia Syndrome (POTS), vasovagal syncope, and Inappropriate Sinus Tachycardia (IST). Writing from a mechanism-first, clinical perspective, Lorvidhaya reframes these complex conditions not as structural heart defects or psychological anxiety, but as miscalibrations of autonomic nervous system regulation. The book introduces the “Five Levers Model” volume, venous return, cardiovascular conditioning, autonomic tone, and heart rate control to help readers systematically improve standing tolerance and daily function.

Key Lessons from Upright

• Focus on Mechanics, Not Labels: Symptoms often stem from faulty reflex loops rather than damaged organs, meaning normal test results do not invalidate severe physiological distress.
• Prioritize Structural Foundations: Long-term recovery relies on incremental lifestyle adjustments, such as front-loaded fluid intake, targeted sodium loading, waist-high compression, and recumbent-first exercise protocols like the Dallas/Levine model.
• Single-Variable Experimentation: Modifying one treatment variable at a time over two-week windows isolates what actually improves individual physiological function.

Best Quotes from Upright

• “Nobody should have to audition to be believed.”
• “Dysautonomia reflects real physiology. The fact that a standard workup looks ‘normal’ doesn’t mean you are normal; it means the standard workup wasn’t designed to catch this.”
• “A setback is not square one.”

Who Should Read Upright?

This book is essential reading for individuals experiencing post-viral fatigue, orthostatic intolerance, or unexplained racing heart rates who have struggled to find clarity through standard diagnostic workups. It is equally valuable for caregivers seeking to understand non-visible physical limitations, as well as primary care clinicians looking for a practical framework to explain dysautonomia physiology to patients.

Is Upright Worth It?

Yes, Upright is exceptionally practical and empowering. By cutting through confusing medical jargon with vivid analogies and actionable medical insights, Lorvidhaya provides a clear roadmap for navigating complex health challenges without offering false promises.

Final Verdict

Upright is an indispensable guide for taking control of autonomic health. It successfully bridges the gap between clinical expertise and patient self-advocacy, making it a highly recommended resource for managing POTS and dysautonomia.

Amazon link: https://www.amazon.com/Upright-Cardiologists-Guide-Living-Dysautonomias/dp/B0H6CJN6KX