Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system. Individuals with POTS often experience an excessive increase in heart rate upon standing, leading to symptoms like lightheadedness and fatigue. For most patients, maintaining adequate blood volume is a primary strategy for managing this condition, which requires high daily fluid and salt intake.
Why Fluid Intake is Critical for POTS
Many people with POTS have hypovolemia, meaning they have a lower-than-normal volume of blood plasma circulating. This reduced blood volume contributes significantly to POTS symptoms. When standing, gravity pulls the limited blood supply downward, and the body struggles to maintain blood flow to the brain. The heart compensates by beating faster, resulting in orthostatic tachycardia. Increasing fluid intake directly addresses this issue by expanding plasma volume. This improved volume reduces the severity of orthostatic symptoms, such as dizziness, brain fog, and excessive heart rate upon changing position.
Establishing Daily Fluid Goals
Specialists commonly recommend a substantially higher fluid intake for POTS patients compared to the general population. The typical baseline target is 2 to 4 liters (approximately 68 to 135 ounces) of fluids daily, depending on individual factors and symptom severity. This includes water and other non-alcoholic, non-caffeinated beverages, which are less likely to worsen symptoms or promote fluid loss. The body absorbs fluids more effectively when intake is spread throughout the day, rather than consumed in large amounts at once. Drinking in small, frequent amounts prevents the renal system from being overwhelmed and ensures consistent hydration. Using a marked water bottle or a tracking app can help monitor daily progress toward maintaining a steady state of hyper-hydration. Working with a healthcare provider to find the specific volume that best controls your symptoms is the most effective approach.
The Essential Role of Sodium and Electrolytes
While a high fluid intake is necessary, drinking large amounts of plain water alone can be counterproductive for POTS. Excessive water can dilute the body’s sodium levels, a condition known as hyponatremia, which can worsen symptoms. Sodium is the primary electrolyte that helps the body retain extra fluid, maximizing blood volume expansion. Therefore, fluid intake must be paired with a significantly increased sodium intake to ensure fluid retention. The daily sodium recommendation for many POTS patients often ranges from 3,000 to 10,000 milligrams (mg) per day, far exceeding standard dietary guidelines. This increased sodium intake is crucial for drawing water into the bloodstream and keeping it there, counteracting hypovolemia.
Achieving High Sodium Goals
Effective ways to achieve this high sodium goal include using salt tablets or capsules, which provide a concentrated dose of sodium chloride. Electrolyte drink mixes or oral rehydration solutions (ORS) are also beneficial, as they provide sodium along with other electrolytes like potassium and magnesium. Incorporating high-sodium foods like broths, bouillon, pickles, and salted nuts into the diet further supports the necessary sodium level.
Practical Strategies for Consistent Hydration
Integrating a high-volume fluid plan requires consistent strategies. One effective habit is to front-load hydration by drinking a significant bolus of fluid, such as 16 ounces of an electrolyte solution, before rising in the morning. This boosts blood volume before the orthostatic stress of standing. Situational adjustments are necessary for symptom control. Proactively increase fluid and salt consumption during high heat, exercise, or illness involving fever, vomiting, or diarrhea. If you feel faint or dizzy, quickly drinking one to two glasses of cool fluid may help elevate blood pressure and lower heart rate. To make the large daily volume manageable, consider varying the temperature or flavor of your fluids. Chilled or iced drinks are often easier to consume in volume, and adding flavorings or using electrolyte mixes can improve palatability.