POTS and Dehydration

Introduction

Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic condition that affects the autonomic nervous system, leading to a significant increase in heart rate when standing. Symptoms include dizziness, fatigue, brain fog, and fainting, which can severely impact daily life. Dehydration is a critical factor that can exacerbate these symptoms. For individuals with POTS, staying hydrated isn’t just about overall health—it’s a cornerstone of effective symptom management.

Why Hydration Matters in POTS

Hydration is essential in managing POTS symptoms due to the condition’s link to hypovolemia (reduced blood volume). Adequate fluid intake helps expand blood volume, which stabilizes heart rate and improves orthostatic tolerance. Dehydration can worsen the hallmark symptoms of POTS, such as tachycardia and lightheadedness, making it more challenging for patients to function.

Research has shown that even mild dehydration can exacerbate symptoms like dizziness and fatigue. In severe cases, dehydration can lead to fainting, complicating an already complex condition. Hydration, therefore, becomes a non-negotiable part of daily management for those with POTS.

How Dehydration Affects POTS Patients

Dehydration impacts several physiological processes that are already compromised in POTS:

• Blood Volume Reduction: Dehydration decreases circulating blood volume, impairing the body’s ability to maintain blood pressure and leading to orthostatic intolerance.
• Electrolyte Imbalance: Loss of electrolytes like sodium and potassium disrupts the nervous system's ability to regulate heart rate and blood pressure.
• Increased Tachycardia: Dehydration prompts the body to compensate by increasing heart rate, worsening one of POTS’ primary symptoms.

These effects can create a vicious cycle, where dehydration exacerbates POTS symptoms, leading to further physical and emotional stress.

Recognizing Dehydration in POTS

Dehydration symptoms can overlap with POTS, making it crucial to differentiate between the two. Signs of dehydration include:

• Increased thirst
• Dark or concentrated urine
• Dry mouth or skin
• Worsening fatigue, dizziness, or brain fog

POTS patients often experience these symptoms regularly, so maintaining vigilance about hydration status is key.

Strategies to Stay Hydrated

Here are actionable strategies for POTS patients to manage hydration effectively:

1. Set a Hydration Goal
   Aim for 2–4 liters of fluids daily, depending on activity level, climate, and individual needs. Work with your healthcare provider to find your "magic number."
2. Incorporate Electrolytes
   Use oral rehydration solutions (ORS) that include sodium, potassium, and magnesium. Electrolytes help retain water and support blood volume. Products like Liquid I.V. or homemade electrolyte drinks are popular options.
3. Spread Out Fluid Intake
   Consuming fluids in small, frequent amounts throughout the day improves absorption and minimizes the risk of overwhelming the kidneys.
4. Increase Sodium Intake
   Sodium helps the body retain fluids and expand blood volume. Patients with POTS are often advised to consume 3–5 grams of salt per day (or more), depending on their specific form of POTS.
5. Use Strategic Hydration
   Drink fluids before known triggers such as standing, prolonged physical activity, or exposure to heat. Studies have shown that drinking 16 ounces of water can improve orthostatic tolerance significantly.
6. IV Fluids in an emergency
   For severe cases of dehydration or during flare-ups, intravenous (IV) saline therapy may be recommended. Many patients report feeling much better after IV fluids are administered in the ER, but an ER visit is a very expensive and inconsistent method of treating POTS. Some POTS patients report significant symptom relief with regular IV hydration, but long term use of IV fluids creates additional complications including increasee risk of infection so itshould be discussed carefully with your doctor after exhausting all other options.

Foods and Drinks to Boost Hydration

Hydration goes beyond just water. Certain foods and beverages can help:

• Hydrating Foods: Watermelon, cucumber, lettuce, zucchini, and chia seeds (soaked for optimal hydration).
• Electrolyte Drinks: Coconut water, diluted sports drinks, or homemade solutions with water, salt, and a natural sweetener.
• Broths: Bone broth or vegetable broths are hydrating and rich in sodium.
• Salted Snacks: Pickle juice and salted nuts can help replenish sodium levels.

Avoid beverages that promote dehydration, such as alcohol, sugary drinks, and high-caffeine beverages, unless tolerated.

The Role of Oral Rehydration Solutions (ORS)

Oral Rehydration Solutions (ORS) have been shown to improve orthostatic tolerance in POTS patients. Unlike plain water, ORS contain a scientifically balanced mix of electrolytes and glucose, which enhances fluid absorption and stabilizes blood volume. Research indicates that ORS can be as effective as IV saline in certain cases, making it a convenient option for many patients.

Learn more about oral rehydration solutions and electrolyte supplements in this guide (click here).

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Beyond Hydration: Lifestyle Adjustments for POTS

Hydration is vital, but there are more strategies including lifestyle adjustments that can help manage POTS:

• Compression Garments: Compression socks or abdominal binders can help reduce blood pooling in the lower extremities.
• Physical Therapy: Gradual reconditioning exercises can improve circulation and orthostatic tolerance.
• Dietary Adjustments: Focus on nutrient-rich, anti-inflammatory foods to support overall health.

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Conclusion

For individuals with POTS, hydration isn’t just a daily habit—it’s a medical necessity. By prioritizing fluid intake, incorporating electrolytes, and using strategies tailored to their unique needs, patients can improve their quality of life and reduce the burden of symptoms. Always consult a healthcare provider to customize a hydration plan that works best for you.

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References

• Claydon, V. E., and R. Hainsworth. "Salt Supplementation Improves Orthostatic Cerebral and Peripheral Vascular Control in Patients with Syncope." Hypertension, vol. 43, no. 4, 2004, pp. 809–813. Hypertension (Dallas, Tex. : 1979), https://doi.org/10.1161/01.HYP.0000122269.05049.e7. Available at: https://pubmed.ncbi.nlm.nih.gov/14981050/.
• Ganesh, R., Bonnes, S. L. R., and DiBaise, J. K. "Postural Tachycardia Syndrome: Nutrition Implications." Nutrition in Clinical Practice: Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 35, no. 5, 2020, pp. 818–825. https://doi.org/10.1002/ncp.10564. Available at: https://pubmed.ncbi.nlm.nih.gov/32809263/.
• Kalman, D. S., et al. "Comparison of Coconut Water and a Carbohydrate-Electrolyte Sport Drink on Measures of Hydration and Physical Performance in Exercise-Trained Men." Journal of the International Society of Sports Nutrition, vol. 9, no. 1, 2012, pp. 1. https://doi.org/10.1186/1550-2783-9-1. Available at: https://jissn.biomedcentral.com/articles/10.1186/1550-2783-9-1.
• Medow, Marvin S., et al. "The Benefits of Oral Rehydration on Orthostatic Intolerance in Children with Postural Tachycardia Syndrome." Journal of Pediatrics, vol. 214, 2019, pp. 96–102. https://doi.org/10.1016/j.jpeds.2019.07.041. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0022347619308935.
• Raj, S. R., et al. "Neuronal and Hormonal Perturbations in Postural Tachycardia Syndrome." Frontiers in Physiology, vol. 5, 15 June 2014, Sec. Integrative Physiology. https://doi.org/10.3389/fphys.2014.00220. Available at: https://www.frontiersin.org/articles/10.3389/fphys.2014.00220/full.
• Williams, E. L., et al. "Salt Supplementation in the Management of Orthostatic Intolerance: Vasovagal Syncope and Postural Orthostatic Tachycardia Syndrome." Autonomic Neuroscience: Basic and Clinical, vol. 237, 2022, p. 102906. https://doi.org/10.1016/j.autneu.2021.102906. Available at: https://www.autonomicneuroscience.com/article/S1566-0702(21)00136-3/fulltext.
• "The POTS (Postural Tachycardia Syndrome) Epidemic: Hydration and Nutrition Issues." Practical Gastroenterology, June 2019. Available at: https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2019/06/POTS-June-2019.pdf.

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