Postural Orthostatic Tachycardia Syndrome (POTS) is a condition affecting the autonomic nervous system, which controls involuntary bodily functions such as heart rate and blood pressure. POTS is characterized by a rapid increase in heart rate upon standing, often accompanied by symptoms like dizziness, lightheadedness, fatigue, and gastrointestinal issues. While there is no cure for POTS, dietary modifications can play a significant role in managing symptoms and improving overall quality of life. This article explores dietary strategies and recommendations for individuals with POTS, drawing upon available research and expert opinions.
Understanding POTS and Its Symptoms
POTS is a disorder of the autonomic nervous system that causes a rapid increase in heart rate when moving from a lying down to a standing position. While anyone can develop POTS, it most commonly affects women between the ages of 15 and 50. It causes a variety of symptoms, including gastrointestinal issues, and can significantly impact daily life.
Common Symptoms of POTS
Symptoms of POTS may include:
- Rapid heartbeat upon standing
- Low blood pressure
- Dizziness or lightheadedness
- Fatigue
- Shakiness
- Brain fog
- Headaches
- Gastrointestinal (GI) issues, such as delayed gastric emptying, heartburn, nausea, vomiting, diarrhea, and constipation
Factors That Can Trigger or Exacerbate POTS Symptoms
Several factors can trigger or worsen POTS symptoms, including:
- Dehydration
- Low-salt diet
- Alcohol
- Prolonged standing
- Hot temperatures, including a hot shower or bath
- Strenuous exercise
- Stress or illness
- Certain medications
- Large meals
- Menstruation
- Pregnancy
- Trauma
- Viral illness
- Major surgery
The Impact of Diet on POTS
Diet plays a crucial role in managing POTS symptoms, as there is no known cure. A diet that includes adequate salt and fluids can help maintain blood volume and stabilize blood pressure. Additionally, certain dietary changes can improve gastrointestinal symptoms associated with POTS, such as delayed gastric emptying. By maintaining a healthy, well-balanced diet, people with POTS can better manage their condition.
Read also: Diet and Ogilvie Syndrome
General Dietary Guidelines for POTS
Following specific dietary guidelines can help manage POTS symptoms. Here are some general recommendations to consider:
Increase fluid intake: Staying well-hydrated can help increase blood volume and reduce symptoms of POTS. Aim for at least 2-3 liters (68-101 ounces) of fluids each day. Consider strategies such as:
- Drinking as soon as you wake up
- Using a water-tracking app
- Drinking a glass of water before each meal
- Replacing other drinks with water
- Keeping a reusable water bottle near you
- Drinking one glass of water per hour at work
- Drinking 2 cups (480 milliliters) of cold liquid if you feel faint
Increase salt intake: Consuming more salt can help retain fluid and increase blood volume. Recommendations vary, but slowly adding up to 6-20 grams of salt (2.4-8 grams of sodium) to your diet each day can help improve low blood pressure upon standing. However, it's essential to check with a doctor first, especially if you have heart or kidney disease, as this is well above the recommendation of the American Heart Association.
Eat small, frequent meals: Smaller, more frequent meals can reduce symptoms of lightheadedness and dizziness upon standing and avoid GI upset. Experts recommend five to six small meals a day.
Focus on nutrients: Eating a well-balanced diet that emphasizes fruits, vegetables, whole grains, and lean proteins can help alleviate the gastrointestinal symptoms associated with POTS.
Read also: Understanding Cushing's and Weight
Avoid alcohol: It's recommended to limit or avoid alcohol if you have POTS. Alcohol can dehydrate the body and affect blood pressure, potentially worsening symptoms.
Foods to Include in a POTS Diet
When managing POTS symptoms, including the right foods in your diet can help. Here are some beneficial foods to include in a POTS diet:
- Water-rich fruits and vegetables: Cucumbers, celery, lettuce, watermelon, and oranges.
- High-sodium foods: Pickles, olives, pretzels, cheese, anchovies, salted nuts and seeds, popcorn, smoked fish, and miso. Sauces such as cheese or gravy can also contribute to sodium intake.
- Protein-rich foods: Chicken, turkey, fish, eggs, beans, legumes, and tofu.
- Complex carbohydrates: Oatmeal, whole wheat bread, brown rice, farro, and quinoa.
- Probiotic-containing foods: Yogurt, kefir, sauerkraut, kimchi, miso, and sourdough.
Foods to Avoid or Limit in a POTS Diet
Certain foods can make POTS symptoms worse. Here is a list of foods that should be limited or avoided if you have POTS:
- Caffeine: Caffeinated beverages like coffee, tea, and energy drinks can raise heart rate and cause dehydration by increasing urine production. This can potentially worsen symptoms like dizziness, lightheadedness, and fatigue. Caffeine can also aggravate gastrointestinal issues such as diarrhea and heartburn.
- Alcohol: Alcohol dehydrates the body and can lower blood pressure, worsening symptoms like lightheadedness and fainting in people with POTS.
- High-sugar foods and refined carbohydrates: Reducing consumption of high-sugar foods and refined carbohydrates can help alleviate gastrointestinal symptoms. Too much sugar can disrupt gut bacteria, potentially leading to GI symptoms like diarrhea. Examples include white bread, pasta, and rice; pastries and donuts; desserts such as cookies, cakes, and ice cream; candies and chocolate; soda, sweetened coffee drinks, and other sugar-sweetened beverages.
- Processed and high-fat foods: Processed foods are typically packed with added sugars and unhealthy fats, which can trigger gastrointestinal issues. High-fat options like fried foods, fast food, and processed meats such as bacon and sausage are particularly problematic for those with POTS. These foods can worsen symptoms like delayed gastric emptying, heartburn, nausea, constipation, and diarrhea. Examples include fried foods like French fries, fried chicken, and Chinese takeout; fast foods such as burgers, chicken nuggets, and pizza; processed meats including bacon, sausage, and hot dogs; snack foods like potato chips and packaged cookies; bakery items such as donuts, cakes, and pastries.
- Specific Triggers for Individuals: Triggers for POTS symptoms can vary widely among individuals, particularly regarding gastrointestinal issues. Some people with POTS find relief by avoiding or reducing their intake of specific foods or food groups such as gluten, dairy, FODMAPs, and other foods that can irritate the digestive system. Keeping a detailed food diary can be invaluable in identifying these individual triggers and making personalized dietary adjustments to better manage your condition. A gluten-free or low FODMAP diet might also help with certain symptoms.
Sample Meal Plan for POTS
Here's a sample POTS meal plan that includes six small meals and snacks, a minimum of 64 fluid ounces of water throughout the day, and incorporates salty foods:
- Breakfast: Oatmeal with fresh berries, chopped salted almonds, and a dollop of plain Greek yogurt. Drink 8 ounces of decaffeinated coffee, decaffeinated tea, or herbal tea.
- Snack: Smoothie made with kefir, natural salted peanut butter, frozen mixed berries, and fresh baby spinach. Drink 8 ounces of water.
- Lunch: Turkey sandwich made with whole wheat bread, deli turkey slices, cheddar cheese, avocado, and lettuce. Drink 16 ounces of water.
- Snack: Hummus with celery and salted pretzels. Drink 8 ounces of water.
- Dinner: Grilled salmon marinated in soy sauce, sautéed bok choy, and quinoa cooked in chicken stock and seasoned with salt. Drink 16 ounces of water.
- Snack: Apple slices with natural salted peanut butter. Drink 8 ounces of water.
This meal plan includes a mix of lean protein, complex carbs, healthy fats, salty foods, and hydrating foods to help manage POTS symptoms. Adjust portions and foods based on your preferences and dietary needs.
Read also: Nutrition for Sjögren's
Tips for Eating Out with POTS
Navigating restaurant meals can be challenging when managing POTS symptoms. Here are some helpful tips to make dining out easier and more enjoyable:
- Choose restaurants that offer healthy, balanced meals. Look for options that include lean proteins, whole grains, and vegetables to support your nutritional needs.
- Request extra salt on the side. To help reduce symptoms of low blood pressure, ask for additional salt to add to your meal.
- Avoid large meals. Choose smaller portions or consider sharing dishes to prevent exacerbating GI symptoms.
- Stay hydrated and avoid alcohol. Keep hydrated by drinking water throughout your meal. Additionally, limit your intake of alcohol, which can cause low blood pressure and dehydration.
Additional Non-Pharmacological Treatments and Lifestyle Adaptations for POTS
There are a number of non-pharmacological treatments and lifestyle adaptations that may help POTS patients reduce and cope with their symptoms.
- Increase Fluid and Salt Intake: It is often recommended to increase both fluid and salt intake in order to increase blood volume, which is typically low in POTS patients. Except for the hyperadrenergic subtype of POTS, a fluid intake of approximately two liters and an intake of three to five grams of salt is typically recommended per day.
- Elevate Head During Sleep: It is recommended to slightly elevate the patient's head during sleep. This is done in order to help (re)condition the patient's body to orthostatic stress, and this can also help patients that may be experiencing gastric motility problems that result in acid reflux or G.E.R.D. The best way to do this is to raise the head of the bed with a few bricks or large books. A wedge pillow is not very helpful for this.
- Compression Support Hose and Abdominal Binders: Compression support hose and abdominal binders can be helpful for some POTS patients by lessening the peripheral venous pooling and hypotension. The most effective compression hose are 30 mm Hg of ankle counter pressure and go waist high.
- Exercise: Exercise should be considered an essential part of treatment for almost all POTS patients. Studies show that reclined aerobic exercise, such as swimming, rowing and recumbent bicycling, has the best results. Strengthening your core and leg muscles is also helpful.
- Counter-Maneuvers: Counter-maneuvers such as tensing the leg muscles or crossing your legs while standing have been shown to reduce symptoms of postural stress, cerebral perfusion, and oxygenation.
- Avoid Prolonged Standing: It is important to avoid prolonged standing as standing precipitates a worsening of POTS symptoms in most patients. If you must stand for a long time, try flexing and squeezing your feet, leg and gluteus maxiumus muscles, or shifting your weight from one foot to the other. The more you can move your lower half while standing, the better your blood will pump back to your heart.
- Maintain an Even Temperature: It is important for POTS patients to maintain an even temperature as extremes, particularly heat, can exacerbate symptoms. Air conditioning, body cooling vests, sun shirts, handheld misters/personal fans, hats, layers in case of temperature fluctuation, and quick drying clothing and sheets can all be helpful in maintaining an even temperature.
Additional POTS Resources
When managing POTS, having access to accurate information and community support is crucial. Here are some recommended resources to learn more about POTS and connect with others:
- National Institute of Neurological Disorders and Stroke (ninds.nih.gov): Provides health information on POTS from the National Institutes of Health.
- Dysautonomia International (dysautonomiainternational.org): Offers comprehensive information, research updates, and support networks for individuals with POTS and other forms of dysautonomia.
- The Dysautonomia Project (thedysautonomiaproject.org): A book and other resources to support individuals with dysautonomia, including POTS.
- POTS UK (potsuk.org): Provides resources, support groups, and advocacy efforts specifically for those affected by POTS in the United Kingdom.
Conclusion
Postural orthostatic tachycardia syndrome (POTS) is an autonomic nervous system disorder characterized by a rapid heart rate and lowered blood pressure upon standing. It may also be accompanied by gastrointestinal symptoms. Managing POTS involves making lifestyle adjustments, including dietary changes, to ease symptoms.
While there isn’t a specific POTS diet, focus on staying hydrated, managing salt intake, and eating a balanced diet of nutrient-rich foods to help you effectively manage your symptoms. Including water-rich fruits and vegetables, salty foods, lean proteins, whole grains, and probiotic-rich options can help you maintain blood volume, stabilize blood pressure, and relieve gastrointestinal discomfort. To manage symptoms effectively, it's important to also limit common triggers like caffeine, alcohol, sugary foods, refined carbs, and processed or high-fat foods.
By working closely with a healthcare provider or dietitian, individuals with POTS can improve their quality of life and better manage their condition through their diet. Making informed dietary choices can significantly enhance the quality of life and improve the overall sense of well-being for individuals living with POTS. The right diet can play a pivotal role in both managing POTS symptoms and improving the quality of life for individuals living with this condition.
tags: #postural #orthostatic #tachycardia #syndrome #diet