Postural Orthostatic Tachycardia Syndrome (POTS) is a form of orthostatic intolerance characterized by an abnormally rapid heart rate (tachycardia) upon standing. It is a disorder of the autonomic nervous system, which regulates heart rate and digestion. Patients with POTS may experience a variety of symptoms, including brain fog, lightheadedness, tremors, blood pooling, gastrointestinal (GI) distress, and nausea. These symptoms can be exacerbated by simple activities such as eating, showering, or low-intensity exercise, making daily life challenging. While most POTS patients require both pharmacological and non-pharmacological treatments, diet is a crucial component in managing symptoms.
Understanding POTS and Its Symptoms
POTS causes a rapid increase in heart rate when moving from lying down or sitting to standing up. Other symptoms include sudden drops in blood pressure, dizziness, lightheadedness, and fainting. Anyone can get POTS, but it most commonly affects women between the ages of 15 and 50. Although symptoms generally improve as you age, changing your diet can also help you avoid getting dizzy and lightheaded more often.
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
Several factors can trigger or exacerbate POTS symptoms, including dehydration, low-salt diet, alcohol, prolonged standing, hot temperatures, strenuous exercise, stress or illness, certain medications, and large meals.
The Role of Diet in Managing POTS
Since there is no known cure for POTS, diet plays an important role in managing symptoms. Eating a diet that includes extra salt and staying adequately hydrated can help maintain blood volume and stabilize blood pressure. Certain dietary changes can improve gastrointestinal symptoms associated with POTS, such as delayed gastric emptying. Overall, people with POTS can better manage their condition by maintaining a healthy, well-balanced diet.
Read also: The Hoxsey Diet
General Dietary Guidelines for POTS
If you have POTS, doing things such as staying hydrated, getting plenty of salt, and eating small meals frequently throughout the day can help. You should try to consume naturally salty foods, electrolytes, high-fiber foods, complex carbs, and protein-rich foods while avoiding alcohol, processed foods, fatty foods, and artificial sweeteners.
Managing POTS symptoms through diet often involves increasing plasma and blood volume through high fluid and salt intake. This is especially beneficial for patients with blood pooling, hypovolemia, and hypotension. Other diet changes may involve managing blood glucose to avoid lightheadedness and supporting digestion to avoid bloating, diarrhea, and constipation.
Here are some general recommendations to help manage POTS symptoms:
Drink Plenty of Water: Increasing water intake to two to three liters per day is often recommended. The specific amount of fluids may vary for each person depending on their size and exercise routine. Staying hydrated should be a priority for patients with POTS, involving a combination of water and electrolytes. Track your daily fluid intake to ensure you are getting enough. Experts recommend 2-3 liters (68-101 ounces) of fluids daily. But be sure to check with a doctor if you have heart or kidney disease. Some tips to drink more water include:
- 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 workAnother tip: Drink 2 cups (480 milliliters) of cold liquid if you feel faint, as that may help boost your blood pressure and lower your heart rate.
Increase Salt Intake: Some patients may need to increase their salt intake to up to 10-12 grams per day (4000-4800 milligrams of sodium). Some patients may take salt tablets, if tolerated, to help reach this amount. For others, increasing the amount of salt you consume through naturally salty foods may help. Recommendations for how much salt people with POTS should aim to eat each day vary from 6-20 grams, which equals about 2.4-8 grams of sodium. Since this is well above the recommendation of the American Heart Association, check with a doctor first, especially if you have heart or kidney disease.
Read also: Walnut Keto Guide
Eat More Frequent, Smaller Meals: Eating smaller, more frequent meals can help stabilize your blood glucose. Low blood sugar may worsen POTS symptoms such as fatigue, dizziness, and lightheadedness. In addition to being consistent with your meals, it is important to eat a balance of lean protein, complex carbohydrates, and healthy fats with each meal to keep your blood sugar in control. Experts recommend five to six small meals a day.
Limit or Avoid Alcohol: Because alcohol often leads to dehydration, it almost always worsens symptoms of POTS and should be limited. Alcohol can lead to a variety of negative effects on the body. It increases fluid and electrolyte losses through urine, causing dehydration, and can inhibit your body from absorbing important vitamins and minerals. Some research suggests that alcohol may induce orthostatic hypotension and may be linked with syncopal (fainting or passing out) events.
Talk to Your Doctor About Caffeine: There is conflicting research on caffeine and POTS symptoms because individual responses to caffeine vary. Some people may experience lightheadedness and nervousness, increased tachycardia, and affected sleep. It is best to consult your doctor to determine if caffeine would help or hinder your treatment.
Keep Track of What Foods Trigger Symptoms: Certain foods may trigger symptoms in individuals with POTS. Caffeine and foods that are high in sugar are common triggers. Some patients with POTS also report worsened GI symptoms with gluten and dairy. Keep track of your food and symptoms in a food journal to help you identify links between specific foods and symptoms.
Watch Out for Gluten Intolerances: Some studies have suggested that following a gluten-free diet, whether you have celiac disease or not, may reduce GI symptoms associated with POTS. If you experience GI discomfort, eliminating gluten may be beneficial for you.
Read also: Weight Loss with Low-FODMAP
Watch Out for Symptoms of IBS: Symptoms of Irritable Bowel Syndrome (IBS) are commonly reported in patients with POTS. Patients may experience a wide array of GI symptoms such as nausea, vomiting, bloating, diarrhea, or constipation. To avoid GI discomfort, avoid your trigger foods and eat a balanced diet that includes adequate fiber and probiotics.
Best Foods to Eat with POTS
There are a variety of foods you can eat with POTS to help improve symptoms by keeping you hydrated, supporting your digestive system, and providing you with adequate energy.
Here are recommendations of specific foods you can incorporate daily:
- Naturally Salty Foods: Canned vegetables, pickles, olives, and some cheeses naturally contain higher amounts of salt. Some salty snack ideas include pickles, olives, salted nuts and seeds, popcorn, cheese, anchovies, smoked fish, and miso.
- Electrolyte Beverages: Electrolytes (such as sodium, potassium, and magnesium) are key to maintaining fluid balance. Electrolyte beverages will help your body retain fluids and stay hydrated. Sports drinks and electrolyte packets that are low in sugar are good options.
- Complex Carbs: Brown rice, quinoa, oats, sweet potatoes, and whole grain products are common sources of complex carbohydrates.
- High-Fiber Foods: Consuming beans, lentils, whole grains, and fresh fruit on a regular basis can help you consume adequate fiber.
- Foods with a lot of Potassium & Magnesium: Spinach, avocados, and bananas are all rich in both potassium and magnesium.
- Protein-Rich Foods: Lean beef, poultry, fish, and eggs are great sources of protein.
- Probiotic Foods: Food sources of probiotics include Greek yogurt, kimchi, kefir, sauerkraut, and tempeh.
- Foods with a lot of Antioxidants: Adding berries, artichokes, pecans, cherries, dark leafy greens, and apples to your daily diet will boost your antioxidant intake.
Foods to Avoid with POTS
Some foods may worsen symptoms that are associated with POTS, often foods and beverages that can cause drastic changes in blood sugar, GI distress, and dehydration.
Here is a list of foods that should be limited or avoided if you have POTS:
- Meals and Drinks with a lot of Simple Carbs: A rapid increase and decrease in blood sugar can cause feelings of shakiness, lightheadedness, fatigue, and nausea.
- Highly Processed Foods: Most highly processed foods often contain little-to-no nutrients and have been linked with different health conditions such as heart disease and obesity.
- High-Fat Meals: Meals higher in dietary fat take longer for your body to digest, which may cause you to feel drowsier after eating them.
- Artificial Sweeteners: Artificial sweeteners may promote harmful gut organisms and contribute to gut inflammation, glucose intolerance, and breakdown of the GI intestinal barrier, potentially worsening GI symptoms.
- Energy Drinks: Caffeine may be helpful to some patients with POTS but may exacerbate symptoms for others. It is best to avoid caffeine overall unless told otherwise by your physician.
- Alcohol: Because alcohol often leads to dehydration, it almost always worsens symptoms of POTS and should be limited.
Sample POTS Diet Plan
Here’s a sample POTS meal plan that includes around 2,000 calories and emphasizes the best POTS foods listed earlier. This is just a sample POTS meal plan and can be adjusted based on your personal preferences and tolerances. As with any diet plan, please consult with a healthcare provider or a registered dietitian to ensure it meets your specific dietary needs and health goals.
Breakfast: Overnight Oats
- 1/2 cup of oats (150 calories)
- 1 cup of almond milk (60 calories)
- 1 tablespoon chia seeds (70 calories)
- Topped with 1 sliced banana (105 calories) and a sprinkle of cinnamon
Morning Snack:
- A handful of raw, unsalted almonds (1 oz) (164 calories)
- 1 medium orange (62 calories)
Lunch: Quinoa Salad
- 1 cup of cooked quinoa (220 calories)
- A mix of colorful veggies: bell peppers, cucumber, cherry tomatoes (approx. 50 calories)
- 1/4 cup of chickpeas for extra protein and fiber (72 calories)
- A sprinkle of sea salt for added sodium and flavor
- Dressing: 1 tablespoon olive oil (120 calories) and lemon juice
Afternoon Snack:
- 1 cup of Greek yogurt, no added sugar (146 calories)
- 1/4 cup of blueberries (21 calories)
Dinner:
- 4 oz grilled chicken breast (184 calories)
- 1 cup of steamed spinach (41 calories)-a great source of magnesium and potassium
- 1/2 baked sweet potato (103 calories)-a good source of potassium and complex carbs
- Seasoned with herbs and a sprinkle of salt
Evening Snack:
- 1 slice of whole grain bread (69 calories)
- Topped with 1 tablespoon of natural almond butter (98 calories)
- Sprinkle of chia seeds (35 calories)
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, including 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.
- Choose smaller portions or consider sharing dishes to prevent exacerbating GI symptoms.
- Stay hydrated by drinking water throughout your meal, and limit your intake of alcohol, which can cause low blood pressure and dehydration.
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)
- Dysautonomia International (dysautonomiainternational.org)
- The Dysautonomia Project (thedysautonomiaproject.org)
- POTS UK (potsuk.org)
Working with a POTS Nutritionist
It’s important to note that no single diet will help all patients with POTS, as patients can experience a variety of symptoms and have different tolerances to certain foods. Working with a POTS nutritionist can help bring clarity to your own individual nutrition needs. A nutritionist can help guide you in reaching your nutrition goals in your everyday life, understand how to follow a higher sodium diet while avoiding potential nutrient deficiencies, and formulate an individualized plan to improve your symptoms and overall quality of life.
Other Lifestyle Changes That Can Help
Most people with POTS need a combination of diet changes, medication, and lifestyle changes to reduce their symptoms.
Below is a list of common lifestyle changes that may be beneficial to someone trying to manage POTS symptoms:
- Exercise Regularly: It is important to retrain the autonomic nervous system to allow for more exercise, which helps increase blood volume. Because POTS symptoms can worsen with exercise, exercise intensity should be slowly and carefully increased with expert supervision.
- Get Plenty of Sleep: It is important to get the general recommendation of a minimum of seven hours a night to help support energy levels and prevent fatigue throughout the day. Having a consistent bedtime and avoiding screen time before bed can help you get the quality sleep that you need.
- Consider Compression Garments: Wearing lower-body compression garments may help reduce excessive blood pooling in the legs and reduce heart rate.
- Avoid Prolonged Standing: Moving your lower half while standing may improve blood flow back to your heart.
- Elevate Your Head
Salty Meals and Snacks Recipes
Here are a few easy recipes and salty snack ideas for those of you who have been placed on a high salt diet. Please check with your doctor before significantly increasing your salt intake, as it is not appropriate for all forms of dysautonomia.
Soy Sauce Egg:
- Ingredients: egg, spinach, soy sauce
- Instructions: Coat pan with 2 Tbsp. so eggs don't stick. Saute spinach in 1 tbsp. soy sauce. Push to the side of the pan. Add egg whole to pan if you like sunny side up eggs, or scramble egg in a bowl and add to the pan if you prefer your eggs scrambled. While egg is cooking, add the other tbsp. of soy sauce right on top of it. Once egg is fully cooked, put spinach on the plate first, and then lay egg on top.
Spinach Quiche:
- Ingredients: pie crust, eggs, egg beaters, half and half, frozen spinach, baby spinach, cheeses, chopped onions, nutmeg, salt, pepper, french's onions, sour cream, thyme, lemon juice, garlic, sea salt
- Instructions: Preheat oven according to pie crust instructions. In a small bowl combine eggs and egg beaters with a 1/2 cup of half and half. Microwave and drain frozen spinach according to package, or wash and chop baby spinach and combine with egg and cream mixture. Add cheeses and chopped onions. Add nutmeg, salt, and pepper to taste. Pour mixture into pie crust. Sprinkle french's onions and extra cheese to the top of the quiche mixture. Bake for 40-45 minutes. Test with fork, if it comes out clean the quiche is ready! Add desired amount of sour cream to a small bowl. Sprinkle a good amount of thyme and stir. Add a few drops of lemon juice to thin out the sour cream a little, and stir well. Taste to control amount. Next, add garlic and sea salt to taste. To garnish: add lemon zest or a sprig of fresh thyme.
Salty Salad:
- Ingredients: produce, olive oil, toppings, sea salt
- Instructions: Wash all produce, dry and toss in a large salad bowl. Do not add oil until you are just about to serve. Drizzle a tablespoon or two of olive oil on the salad in your own serving bowl. Add as much salt as you can to your salad bowl, while still enjoying the taste. Add your favorite toppings.
Peanut Butter Noodles:
- Ingredients: Noodles, vegetables, peanut butter, soy sauce, sesame seeds
- Instructions: Boil your noodles according to package directions. Just before they are done, throw in your vegetables. You are trying to heat up the vegetable, but still leave a nice crunch. Drain water. When the noodles are still hot, add peanut butter and soy sauce to taste, and stir until it becomes a smooth well blended sauce. Sprinkle sesame seeds on top.
Simple Soup:
- Ingredients: Broth, coconut milk, vegetable, noodles
- Instructions: Prepare broth according to directions or make from scratch. If using optional coconut milk, add coconut milk to broth to achieve desired consistency. Chop vegetable into thin slices and add to soup. You want the veggies to warm, but stay crispy. Boil vegetable in soup for 3 minutes, turn down heat and add noodles.
One-Pan Recipes
- Prawn jambalaya
- Curried spring veggie pilaf
- One-pan cod & red shrimp
- Spiced lamb wraps
- One-pot chicken & rice
- One-pan beef stew with vegetable mash
- Tomato, pepper & bean one pot
- Curried cod
- Spinach, sweet potato & lentil dhal
- Prawn jalfrezi
- Chicken cacciatore one-pot with orzo
- Artichoke & aubergine rice
- Spanish rice with squid, prawn & fennel
- One-pan egg & veg brunch
- Prawn, fennel & rocket risotto
- Quick and easy fish stew
- Spicy meatballs with chilli black beans
- One-pot goulash pasta
- Vegan winter one-pan
- Poached hake in tomato, chilli & ginger broth
- Spring chicken paella
- Spanish rice & prawn one-pot