Postural Orthostatic Tachycardia Syndrome, commonly known as POTS, is a complex disorder of the autonomic nervous system. This system controls involuntary bodily functions, and in POTS, its regulation of heart rate and blood pressure is impaired. The condition is characterized by orthostatic intolerance, meaning symptoms worsen significantly upon standing, often involving a rapid increase in heart rate without a corresponding drop in blood pressure. To counteract the underlying physiological issues, increasing the daily intake of sodium is a widely recommended non-pharmacologic management strategy to alleviate these symptoms.
Why Sodium is Essential for POTS Management
People with POTS often experience hypovolemia (lower-than-normal blood volume). This reduced blood volume contributes to the body’s exaggerated response to gravity upon standing. When a patient stands up, blood pools in the lower extremities, and the brain registers a sudden deficit in blood return.
The body attempts to compensate for this reduced return by activating the sympathetic nervous system, causing the heart to beat excessively fast, a phenomenon called orthostatic tachycardia. Sodium helps the body retain water in the bloodstream, expanding plasma volume and increasing total blood volume. This volume expansion stabilizes blood pressure regulation. Increasing the circulating volume lessens the need for the heart to race upon standing, which can significantly reduce symptoms like lightheadedness and fatigue.
Determining Personalized Daily Sodium Targets
The sodium intake for POTS patients is higher than for the general population. While most healthy adults are advised to consume less than 2.3 grams of sodium daily, those with POTS often require a daily intake between 3 to 10 grams of sodium. This range is based on expert consensus and studies showing improved symptoms with high-sodium diets.
It is important to distinguish between sodium (Na) and common table salt (sodium chloride, NaCl). Sodium chloride is approximately 40% sodium by weight. To convert the amount of sodium listed on a food label to the equivalent amount of salt, multiply the sodium quantity by 2.5. For example, a goal of 10 grams of sodium is equivalent to approximately 25 grams of table salt.
The exact daily sodium target must be determined by a cardiologist or autonomic specialist. Factors influencing the target include the patient’s weight, the severity of orthostatic symptoms, and the presence of co-existing medical conditions. Patients with pre-existing hypertension or kidney dysfunction may require a cautious approach and a lower target amount. The specialist will start with a moderate increase and adjust the goal based on symptom improvement and regular monitoring.
Practical Strategies for Incorporating Extra Salt
Achieving a high daily sodium goal requires a consistent strategy, as it is difficult to meet these levels through typical diet alone. The most fundamental step is ensuring that the increased sodium intake is always paired with a substantial increase in fluid consumption, generally aiming for 2 to 3 liters of fluid daily. Sodium needs water to be effective in expanding blood volume, and without concurrent hydration, the high sodium intake will not achieve the desired therapeutic effect.
Maximizing dietary sources involves liberally salting foods, consuming high-sodium broths, and eating salty snacks like pickles and olives. Relying solely on processed, high-sodium foods is not advised, as a healthy diet remains important for overall wellness. High-sodium foods should be chosen healthily and used strategically throughout the day.
Many patients rely on salt supplements, such as sodium chloride tablets or capsules. These supplements provide a concentrated, measured dose of sodium useful for meeting the higher end of the daily goal. Some individuals prefer electrolyte beverages or commercially prepared oral rehydration solutions, which contain sodium alongside other electrolytes like potassium. These drinks are formulated to maximize the absorption of fluid and sodium in the gut, making them an effective method for blood volume expansion.
Monitoring and Safety Considerations
Since the sodium intake recommended for POTS patients is far above standard guidelines, regular monitoring by a healthcare provider is necessary to ensure safety. The high-sodium regimen is intended to increase blood volume, but this also carries the risk of adverse effects. Patients should watch for signs that their intake may be too high.
One common sign of excessive sodium is peripheral edema (swelling in the hands, feet, or lower legs). Persistent or newly developed high blood pressure (hypertension) requires immediate medical attention and a review of the sodium goal. Patients must check their blood pressure and heart rate, both lying down and standing, as directed by their physician. Routine follow-up appointments and blood tests are important to check kidney function and ensure the high sodium intake is not negatively impacting overall health.