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Nutrition Recommendations for POTS
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that can significantly affect quality of life. Although its management requires a multidisciplinary approach, nutrition interventions play an important role, particularly in improving orthostatic tolerance and reducing postprandial symptoms.
What is POTS?
POTS is characterized by an excessive increase in heart rate upon standing, defined as an increase of at least 30 beats per minute in adults (40 beats per minute in adolescents), without a significant drop in blood pressure. Common symptoms include palpitations, dizziness, fatigue, weakness, and difficulty focusing. These symptoms typically worsen when standing and improve when lying down. POTS primarily affects women of childbearing age. International estimates suggest that approximately 0.1% to 1% of the population is affected.
Three main POTS phenotypes are generally recognized, and they may overlap:
- Hypovolemic: Reduced circulating blood volume.
- Neuropathic: Impaired peripheral vasoconstriction, leading to blood pooling in the lower extremities
- Hyperadrenergic: Excessive activation of the sympathetic nervous system, often associated with elevated norepinephrine levels upon standing
Optimizing Fluid and Salt Intake
Hypovolemia is common in POTS and contributes to orthostatic intolerance. Importantly, it is not limited to patients specifically identified as having the hypovolemic phenotype. Reduced blood volume can occur across different POTS phenotypes. Therefore, in the absence of contraindications, optimizing fluid and salt intake is generally part of POTS management. Increasing salt intake may also benefit patients with hyperadrenergic POTS. A controlled study demonstrated that a high-sodium diet increased plasma volume while reducing orthostatic tachycardia and standing norepinephrine concentrations.
General recommendations suggest consuming 2 to 3 liters of fluids per day, with individual adjustments based on body weight, physical activity, sweating, and other fluid losses. For salt, a gradual increase may be considered, starting at approximately 5 to 6 grams per day. Canadian recommendations generally suggest a target of around 10 grams of salt per day, while some international guidelines recommend up to 12 grams. These recommendations should be individualized based on comorbidities and clinical response.
Author
Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.
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