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Postural orthostatic tachycardia syndrome — known more simply as POTS — is a condition that causes a rapid heart rate and dizziness upon standing.
The condition also causes several other symptoms like chronic fatigue, sleeping problems, and depression, all of which can negatively affect one’s quality of life.
Fortunately, making changes to your diet and lifestyle can help you better manage POTS and its associated symptoms.
This article explains how to manage POTS with your diet and provides a sample POTS diet menu.
What is POTS?
POTS is a condition that causes an abnormal increase in heart rate upon standing.
It causes orthostatic intolerance or symptoms of dizziness, lightheadedness, blurred vision, and less commonly, fainting (1).
- sleeping problems
- brain fog
- bladder dysfunction
These symptoms range from mild to severe, and in some people, they develop gradually over time, but for others, they occur after an acute stressor, like an illness, pregnancy, or surgery.
Along with rising, these symptoms can also be triggered by activities of daily living such as eating or showering and resolved by sitting or lying down.
POTS can affect anyone but it predominantly affects white females between 15 and 50 years old (1).
The exact cause of POTS remains unknown, but it’s thought to be caused by nerve damage, changes to the function or structure of the heart and blood vessels, or excessive heart stimulation (2).
Many people with POTS have coexisting conditions, including:
- small intestinal bacterial overgrowth (SIBO)
- irritable bowel syndrome (IBS)
- Ehlers-Danlos syndrome (EDS)
- polycystic ovarian syndrome (PCOS)
- rheumatoid arthritis
- celiac disease
- mast cell activation syndrome (MCAS)
- gastroesophageal reflux disease
It’s unclear whether POTS increases the risk of developing these conditions or if these conditions increase the risk of developing POTS.
More recently, coronavirus disease (COVID) has been suggested to be a trigger for POTS (3).
In either case, while there is no single best treatment for managing POTS that works for everyone, making changes to your diet may help.
The role of diet in POTS
Many people with POTS have decreased blood plasma volume.
Normally, in response to a low blood plasma volume, the body stimulates a series of reactions that trigger the kidneys to retain sodium.
Sodium is an essential mineral that affects the amount of fluid in your blood and around cells.
This increased sodium causes the body to retain water to increase blood volume and blood pressure.
However, this mechanism is thought to be defective in people with POTS.
People with POTS also tend to have excessive pooling of blood in their lower body due to dysregulation in blood flow, both at rest and in an upright position.
Consequently, this pooling of the blood in the lower body combined with an inability to maintain normal blood volume causes a rapid heart rate, dizziness, lightheadedness, and other symptoms of orthostatic intolerance upon standing.
Increasing sodium and fluid intake, however, can increase blood volume and reduce these symptoms.
Indeed, a study in 14 females with POTS showed that a high sodium intake (6,900 mg) compared with low sodium intake (230 mg) increased blood volume, and decreased heart rate, mental confusion, heart palpitations, lightheadedness, and headache severity after six days (4).
Although a high-sodium diet can damage the blood vessels and increase the risk of heart disease in some people, a high-sodium diet has not been shown to result in the same blood vessel damage in females with POTS after six days (5, 6).
However, the long-term effects of a high-sodium diet on blood vessel health in people with POTS is unknown.
Sodium and fluid recommendations for POTS
While the long-term effects of a high-sodium diet remain unknown in people with POTS, it can be useful, at least in the short term, and potentially in the long term under medical supervision for managing your symptoms.
Salt is about 40% sodium and 60% chloride by weight.
For reference, the Dietary Guidelines for Americans recommends limiting sodium to 2,300 mg — or 6 grams of salt — per day (8).
Sodium is abundant in foods that tend to be high in unhealthy fats and calories and lack important vitamins and minerals, such as snack items, processed meats, and fast food.
Therefore, you should aim to get most of your sodium from the salt shaker.
But even then, it can be difficult to reach the 4,600–6,900 mg sodium target with the salt shaker alone, especially if you consume a minimally processed diet.
This makes salt tablets a good option. One tablet provides one gram of salt.
You shouldn’t rely heavily on salt tablets but instead use them to supplement the sodium you get through your diet and from the salt shaker.
Foods to eat that are high in sodium to eat include:
- cottage cheese
- salted nuts
- fermented foods like sauerkraut
- canned seafood
- canned beans
- some soups
- vegetable juice
- broths and stocks
Along with sodium, increasing fluids can help increase blood volume.
Aim to drink at least eight, 8-ounce (240 mL) cups of water per day.
Salt tends to increase thirst so tracking your water intake may not be needed.
3-day POTS sample diet menu
Here’s a 3-day POTS sample diet menu that contains at least 4,600 mg of sodium each day:
- Breakfast: cheesy omelet, toast, and two sodium chloride tablets
- Lunch: burrito bowl
- Snack: 1 cup low-fat cottage cheese and peach slices
- Dinner: salmon patty made using canned salmon, roasted potatoes, and asparagus spears, all liberally salted
- Breakfast: scrambled eggs, liberally salted, and oatmeal topped with fruit
- Lunch: ruben sandwhich with saurkraut
- Snack: 1/4 cup of salted mixed nuts and string cheese
- Dinner: grilled chicken, baked sweet potato, and sauteed green beans, all liberally salted
- Breakfast: Greek yogurt parfait and two sodium chloride tablets
- Lunch: chicken salad with liberally salted hard-boiled eggs and roasted sunflower seeds
- Snack: 2 ounces of beef jerky and an apple
- Dinner: vegetable beef soup, liberally salted, and a dinner roll
POTS and gluten
Gastrointestinal symptoms like constipation, diarrhea, stomach pain or discomfort, and delayed stomach emptying tend to frequently occur in people with POTS (9).
Although these symptoms may be linked with POTS, they may also occur due to the presence of a coexisting condition commonly associated with POTS, like celiac disease.
Celiac disease is caused by an immune response to gluten, which causes inflammation and damage to the small intestine.
Surprisingly, eliminating gluten has been shown to improve symptoms, even in people with POTS who don’t have celiac disease.
In one study, women with POTS who followed a gluten-free diet for more than four weeks reported significant improvements in orthostatic intolerance and gastrointestinal symptoms (10).
All of the women from the study didn’t have celiac disease but they were diagnosed with other conditions commonly associated with POTS, including mast cell activation syndrome, Ehlers-Danlos syndrome, and irritable bowel syndrome.
While larger and longer trials are needed to determine whether eliminating gluten is truly beneficial for relieving symptoms associated with POTS before it can be recommended, this study suggests that some types of elimination diets may be useful, especially with certain coexisting conditions.
Exercise as a treatment option
People with POTS tend to have a smaller, less efficient heart and reduced blood volume compared with healthy people (11).
While POTS is rarely reversible, several reports have suggested that it can be cured with exercise training.
This is because exercise strengthens the heart and helps your body maintain normal blood volume (12).
In one study, people with POTS who participated in a three-month exercise training program all experienced improvements in their quality of life, and 52% of the people no longer met the diagnostic criteria for POTS (11).
The participants in this study also followed a high-sodium diet and consumed plenty of fluids.
In the beginning, choose an exercise that you can do without standing, such as using a rowing machine, riding a recumbent bike, or using seated strength training machines, such as the leg press, leg extension, chest press, and seated row.
Aim to do these exercises for 25–30 minutes, 3–4 times per week.
After a few months of training, slowly begin to incorporate upright exercises, such as riding an upright bicycle, walking on a treadmill, or jogging.
As you get stronger and more fit, increase the frequency or duration in which you exercise.
Stick with something that you can sustain long-term, as becoming sedentary for too long may trigger POTS symptoms.
The bottom line
POTS is a condition that causes a rapid heart rate, dizziness, and lightheadedness, especially upon standing.
Increasing your intake of sodium and fluids can help increase blood volume and alleviate POTS symptoms.
Aim to consume 4,600–6,900 mg of sodium and at least eight, 8-ounce cups of water per day. Liberally salting your foods and taking sodium chloride tablets as needed can help you meet this sodium range.
Exercise has also been shown to be an effective treatment, and in some instances, has been shown to eliminate all signs and symptoms.
Start with exercises that you can do in the seated position and then, after a few months, introduce exercises that you can do standing.