Postural Orthostatic Tachycardia Syndrome (POTS) is a condition affecting millions, characterized by an abnormal increase in heart rate upon standing, often accompanied by a myriad of debilitating symptoms. These may include dizziness, syncope, fatigue, anxiety, headaches, nausea, impaired gastric motility, and abdominal bloating. While the exact cause of POTS remains elusive, experts believe it may arise from neuropathic, hyperadrenergic, or hypovolemic triggers. It falls under the umbrella of dysautonomia, a group of conditions that disrupt the autonomic nervous system's normal functions, which control unconscious bodily processes like heart rate, blood pressure, body temperature, and digestion.
This article explores the intricate relationship between POTS and nutrition, offering practical dietary recommendations to manage symptoms and improve overall well-being.
Understanding POTS Subtypes
Within the POTS diagnosis, there are three subtypes, each with distinct underlying mechanisms and symptoms:
- Hypovolemic POTS: Characterized by a lower amount of circulating blood, compelling the heart to beat faster to meet the body's needs.
- Neuropathic POTS: Marked by decreased nerve function, especially in the legs, leading to reduced norepinephrine release, causing blood to pool in the lower extremities.
- Hyperadrenergic POTS: Defined by elevated levels of norepinephrine in the body.
Diagnosing POTS
Diagnosing POTS can be challenging due to its diverse symptoms. A tilt table test is often used, where heart rate, rhythm, and blood pressure are monitored as the patient is positioned at different angles. Alternatively, the Active Stand Test measures blood pressure and heart rate changes when transitioning from a supine to an upright position at specific intervals. The NASA 10-Minute Lean Test is also being investigated as a similar diagnostic tool. Additional tests, such as blood and urine analyses, autonomic nervous system assessments, and cardiac testing, may also be conducted.
The Pivotal Role of Nutrition in Managing POTS
The nutritional status of individuals with POTS can vary greatly due to the wide range of symptoms experienced. Gastrointestinal issues and insufficient hydration are two major barriers to consistent nutritional intake, potentially leading to deficiencies in both macronutrients and micronutrients.
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 of fluids each day.
- Increase Salt Intake: Consuming more salt can help retain fluid and increase blood volume. While recommendations vary, slowly adding up to 10 grams of salt to your diet each day can help improve low blood pressure upon standing.
- Eat Small, Frequent Meals: Smaller, more frequent meals can reduce symptoms of lightheadedness and dizziness upon standing and avoid GI upset.
- 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.
- 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.
Specific Dietary Recommendations
Hydration: The Cornerstone of POTS Management
Adequate hydration is crucial for improving POTS symptoms, with recommendations ranging from 2 to 3 liters of fluid per day, exceeding the average needs. Water and non-caffeinated beverages should form the bulk of this intake, while some caffeinated drinks can be included in moderation. For individuals struggling to maintain hydration, intravenous supplementation or oral rehydration solutions may be necessary.
- Strategies for Increasing Fluid Intake:
- 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 nearby.
- Drinking one glass of water per hour at work.
- Drinking 2 cups (480 milliliters) of cold liquid if you feel faint.
Sodium Intake: Balancing Blood Volume
Increased salt intake is often necessary to balance blood volume and alleviate POTS symptoms. Recommendations typically range from 6 to 10 grams per day, significantly higher than standard dietary guidelines. Added salt and certain processed foods can help achieve this goal, with broth, soups, and canned vegetables being preferable to cured meats. Sodium chloride tablets or oral rehydration solutions can be used if supplemental sodium is needed. One gram of table salt contains approximately .393 grams (393 milligrams) of sodium. That means that five grams of salt contains approximately 1.965 grams (1965 milligrams) of sodium.
- Salty Snack Ideas:
- Pickles
- Olives
- Salted nuts and seeds
- Popcorn
- Cheese
- Anchovies
- Smoked fish
- Miso
- Sauces such as cheese or gravy
Meal Size and Timing: Optimizing Gastric Motility
Given that over half of individuals with POTS experience changes in gastric motility, adjusting meal patterns is often beneficial. Instead of three main meals, a regimen of 4 to 6 smaller meals throughout the day is recommended. While some fluids can be taken with meals, the majority should be consumed between meals to prevent early satiety.
Vitamins and Minerals: Addressing Potential Deficiencies
Severe POTS symptoms that disrupt normal oral intake and digestion may necessitate vitamin and mineral supplementation.
Read also: Understanding Cushing's and Weight
Whole Grains: Sustained Energy
Whole grains, such as quinoa, brown rice, and oats, provide sustained energy due to their complex carbohydrates, fiber, vitamins, and minerals. They break down slowly, preventing blood sugar spikes.
Fiber-Rich Foods: Supporting Digestive Health
Fiber is crucial for digestive health, with soluble fiber (found in oats, apples, and citrus fruits) promoting nutrient absorption and stool softening.
Electrolyte-Rich Foods: Maintaining Balance
Electrolytes like potassium, magnesium, and calcium are vital for nerve and muscle function. Foods rich in electrolytes, such as bananas, leafy greens, and nuts, can help stabilize blood pressure and alleviate 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 like cucumbers, celery, lettuce, watermelon, and oranges.
- High-sodium foods such as pickles, olives, pretzels, cheese, anchovies, and salted nuts.
- Protein-rich foods including chicken, turkey, fish, eggs, beans, legumes, and tofu.
- Complex carbohydrates like oatmeal, whole wheat bread, brown rice, farro, and quinoa.
- Probiotic-containing foods such as yogurt, kefir, sauerkraut, kimchi, miso, and sourdough.
Foods to Limit or Avoid
Certain foods can exacerbate POTS symptoms and should be limited or avoided:
Read also: Nutrition for Sjögren's
Caffeine and Alcohol
Caffeine and alcohol can both exacerbate symptoms of POTS. 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 dehydrates the body and can lower blood pressure, worsening symptoms like lightheadedness and fainting in people with POTS.
High-Sugar Foods and Refined Carbs
If you have gastrointestinal issues from POTS, reducing your consumption of high-sugar foods and refined carbohydrates can help alleviate symptoms. Too much sugar can disrupt gut bacteria, potentially leading to GI symptoms like diarrhea. Examples of high-sugar foods and refined carbohydrates 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. Here are some processed and high-fat foods to limit:
- 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.
FODMAPs: Navigating Fermentable Carbohydrates
FODMAPs, or fermentable carbohydrates, may cause more harm than good for some individuals with POTS. These carbohydrates are not well absorbed during digestion and may ferment in the gut, leading to uncomfortable symptoms like abdominal pain, bloating, and diarrhea. A FODMAP-aware diet may be beneficial. Foods that are considered to be FODMAPs include certain fruits like pears, certain vegetables like onions and garlic, dairy products, and certain grains like wheat, barley, and rye.
Gluten: Considering Sensitivity
While not all POTS patients have dietary restrictions, such as those related to celiac disease, some may find a gluten-free diet beneficial, as POTS symptoms can overlap with those of celiac disease or gluten intolerance.
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.
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.
The Benefits of a POTS-Friendly Diet
Adhering to a POTS-friendly diet can yield significant benefits:
- Reduced Symptom Burden: Minimizing the severity of POTS symptoms.
- Enhanced Energy Levels: Providing sustained energy throughout the day with balanced nutrients.
- Empowering Patients: Granting a greater sense of control over symptoms.
Additional Strategies for Managing POTS
Beyond dietary modifications, several other non-pharmacological treatments and lifestyle adaptations can help manage POTS symptoms:
- Elevating the Head During Sleep: Raising the head of the bed slightly can help recondition the body to orthostatic stress and alleviate acid reflux.
- Compression Support: Compression hose and abdominal binders can reduce peripheral venous pooling and hypotension.
- Counter-Maneuvers: Tensing leg muscles or crossing legs while standing can reduce symptoms.
- Avoiding Prolonged Standing: Flexing and squeezing feet, leg, and gluteus maximus muscles, or shifting weight while standing can improve blood flow.
- Maintaining an Even Temperature: Using air conditioning, cooling vests, and other strategies to avoid temperature extremes.
The Importance of Professional Guidance
Creating a POTS-friendly diet is not a one-size-fits-all approach. Individualized diet modifications are crucial to minimize specific symptoms. Consulting a healthcare provider or registered dietitian is essential for personalized advice and guidance. A dietitian can evaluate your current nutritional needs and collaborate with you to identify specific food triggers. They can then create a personalized POTS meal plan to help manage and reduce your symptoms.
Navigating Restaurant Meals with POTS
Dining out can be challenging with POTS, but these tips can help:
- Choose restaurants offering healthy, balanced meals.
- Request extra salt on the side.
- Opt for smaller portions or shared dishes.
- Stay hydrated and limit alcohol.
Additional POTS Resources
Access to accurate information and support is crucial for managing POTS:
- National Institute of Neurological Disorders and Stroke (ninds.nih.gov)
- Dysautonomia International (dysautonomiainternational.org)
- The Dysautonomia Project (thedysautonomiaproject.org)
- POTS UK (potsuk.org)
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