Do you find you are dizzy, nauseous and exhausted when you stand up too quickly? These symptoms could be a sign that you are suffering from Postural Orthostatic Tachycardia Syndrome (PoTS).

In my first blog on PoTS (read it here),  I discussed exactly what this syndrome is and some of the factors that cause it. PoTS is a condition that responds really well to interventions, so in this second blog I take a look at the things you can do to manage your symptoms. These include key dietary and lifestyle changes, along with which nutrients you should be prioritising. Let’s dive in.

What you can do today to alleviate PoTS symptoms

We’ve found that clients in our clinic notice a big difference in their day-to-day symptoms when they start incorporating these little steps. There may look like a lot, but please build in as many as possible. Start with the ones that you can easily incorporate into your daily life first.

• Up your fluids – Aim to drink 3 litres per day of fluids. Filtered water or highly mineralised water is a good choice. Herbal teas or warm water with lemon juice and ginger can be helpful. Highly mineralised sparkling water with a pinch of salt, a drizzle of maple syrup and a big squeeze of lemon juice or lime juice makes a good emergency electrolyte drink.
• Increase sodium – aim to consume at least a 1/2 teaspoon (2g) a day over the day. Ideally use a mineral salt such as pink Himalayan salt or Celtic salt which contain trace minerals in addition to the sodium and help with electrolyte balance. You can also try sea salt. Healthy and beneficial salty snacks include miso soup, vegetable broth, pickles, olives, salted fish like roll mops, sardines or anchovies, and nuts. Don’t over-rely on crisps, chips and crackers for salt.
• Electrolytes are key – sometimes sodium is not the only mineral shortfall, and a better balance of sodium, potassium and magnesium makes you feel much better. There are now plenty of tasty electrolyte supplements in either liquid form or that dissolve in liquid which are sugar-free and artificial sugar-free. Sometimes these need to be taken twice daily when the PoTS symptoms are significant.
• Eat small and frequent meals – these are often better tolerated and reduce PoTS symptoms. Always have protein and fat with every meal or snack. This can look like pairing an apple with peanut butter, crunchy veg sticks with hummus, and seeded oatcakes with cream cheese.
• Balance blood glucose – a diet with high fibre vegetables and complex carbohydrates as well as high levels of protein and healthy fats can help reduce blood glucose (sugar) spikes and lessen PoTS symptoms. Cooking from scratch and avoiding ultra-processed convenience foods can help with this.
• Optimise sleep – try to maintain a typical sleep schedule. Most people need 7 to 10 hours sleep at night. Go to bed consistently at a certain time and set a consistent time to wake up. The best sleep hygiene and good rest comes from staying consistent with a sleep schedule every day. Even if you have had a poor night of sleep, try to get up at a regular time. Excessive daytime napping may make night-time sleep less restful. Avoid excessive television viewing or use of tablet/smartphone/computer in bed. Make sure the temperature is ideal in your bedroom to help you get proper rest. 
• Raise your head at night – raise the head of your bed 6-10 inches to help alleviate PoTS symptoms. The entire bed must be at an angle. Raising the head of the bed will reduce urine formation overnight and increase fluid volume in the circulation in the morning. This may help you to wake up more easily.
• Get out of bed slowly – when you get out of bed transition slowly. Gradually go from lying to sitting on the edge of the bed. Stay there for several minutes, allowing the body to naturally adjust to the change in position. Once standing, pause and wait before walking to allow blood pressure to adjust again. If you feel lightheaded at any point, wait for a few minutes in that position to see if it resolves. If not, then return to the prior position as your body isn’t adjusting properly. SLOWLY is the key.
• Exercise and physical activity – these are fundamental to managing PoTS and fatigue. Isometric exercises involve contracting muscles without actually moving your body. Isometrics squeeze the muscle and push the blood back toward the heart. They are simple to do and can be done lying in bed or seated in a comfortable chair. It’s a good idea to do these in bed before getting up to prepare your body for sitting and standing. Simple yoga poses as well as a focus on breathing correctly may well help reduce PoTS symptoms.
  Also try and begin a modest walking program. Count how many steps you can do without inducing any symptoms. This step count is your initial baseline. Start with walking once a day at this step count and go a little further in time, distance or by adding steps. If you feel good, add a second walk in the day. A simple strategy for counting steps is to do 100-300 steps per awakening hour during the day. Fitness trackers can monitor steps and distance easily. Every week or every few weeks add more steps to your daily total. Stay within 80% of your energy capacity.

Six key nutrients that can help with PoTS symptoms

If you are experiencing PoTS symptoms it is vital that you reassess your nutrient intake. The following nutrients are key for supporting people with PoTS and make a great start when setting out down the nutritional supplement route:

1. Vitamin C – when taken alongside salt or electrolytes, this can help with the weakness/dizziness. This can be from some freshly squeezed lemon, lime or orange juice, a piece of fruit, some parsley or some raw red pepper. You can take a scoop of ascorbic acid in water when needed, and some people benefit from as much as 4,000mg vitamin C daily to help stabilise their PoTS symptoms.
2. Mighty magnesium – magnesium is essential for hundreds of physiological functions, including muscle and nerve function. It may help with the muscle weakness and fatigue commonly experienced by PoTS sufferers. Magnesium supplements or a diet rich in magnesium-containing foods like dark chocolate, nuts, spinach and whole grains may be beneficial.
3. Try B vitamins – B vitamins, including B12, B6 and folic acid are crucial for energy metabolism and nervous system health. Supplementation with B vitamins can support overall vitality, potentially mitigating some of the fatigue and cognitive issues associated with PoTS. A subset of PoTS patients have a subclinical vitamin B1 (thiamine) deficiency which can manifest in symptoms of blood pressure and blood glucose irregularities, nausea and fatigue.
4. Keep an eye on iron – PoTS, fainting and syncope can sometimes occur due to low iron levels and anaemia, and so it is important to optimise iron levels and ensure ferritin levels are at least 70. This is because iron helps to transport oxygen through the blood stream.
5. Vitamin D – many people with PoTS are also low in vitamin D and since this nutrient is so important for the immune system and defence against viruses, this should be optimised. You can get vitamin D through sunshine exposure, as well as vitamin D rich foods like oily fish and grass-fed meat and via supplements on grey and rainy days as well as during the winter months.
6. Think quercetin – quercetin is a flavonoid with anti-inflammatory and antioxidant properties. It might have potential benefits for PoTS patients by reducing inflammation, improving blood flow, and potentially stabilizing the symptoms of this disorder. Sources of quercetin include apples, berries and onions; and supplements are also available.

Round up

There are many things you can do to manage your symptoms of PoTS, please don’t suffer in silence. Make as many of these suggested changes as you can manage and remember that every little step can make quite a difference to day-to-day symptoms.

My team are very experienced in helping clients with symptoms of PoTS to understand how they can best support their health going forward. We would love to hear from you if you’d like to find out more. Click on the CLINIC tab above to book an appointment.

References

• Reversible postural orthostatic tachycardia syndrome
• The Epidemic of Orthostatic Tachycardia and Orthostatic Intolerancev
• Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting – Part 1
• Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management  
• Nutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes
• Towards more evidenced-based therapies for postural tachycardia syndrome and other updates on recent autonomic research
• Comparison of curative effect and serum electrolytes between different oral rehydration salts in treatment of neurally mediated syncope children
• Oral rehydration salts: an effective choice for the treatment of children with vasovagal syncope
• Duration of treatment with oral rehydration salts for vasovagal syncope in children and adolescents
• Occupational Therapy Interventions for Clients with Ehlers-Danlos Syndrome (EDS) in the Presence of Postural Orthostatic Tachycardia Syndrome (POTS)
• Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar
• Vascular dysfunction of postural tachycardia syndrome in children  
• Cardiovascular exercise as a treatment of postural orthostatic tachycardia syndrome: A pragmatic treatment trial
• Ascorbate improves circulation in postural tachycardia syndrome
• What is the role of ascorbic acid in norepinephrine synthesis and orthostatic hypotension?
• A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension
• Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents
• Vitamin B1 deficiency in patients with postural tachycardia syndrome (POTS)
• Low iron storage and mild anemia in postural tachycardia syndrome in adolescents
• Significance of serum iron in the differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children
• Serum Vitamin D Levels in Children and Adolescents with Vasovagal Syncope, Syncope Due to Orthostatic Hypotension, and Cardiac Syncope
• Association of vitamin D deficiency with severity of symptoms in children with vasovagal syncope
• Association between vitamin D deficiency and vasovagal syncope: A systematic review and meta-analysis
• Vitamin D Deficiency and Vasovagal Syncope in Children and Adolescents
• COVID-19 Increases the Prevalence of Postural Orthostatic Tachycardia Syndrome: What Nutrition and Dietetics Practitioners Need to Know
• Focus on the high therapeutic potentials of quercetin and its derivatives
• Quercetin protects endothelial function from inflammation induced by localized disturbed flow by inhibiting NRP2 -VEGFC complex