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Postural Orthostatic Tachycardia Syndrome, typically referred to as POTS, is a common disorder that impacts the autonomic nervous system. This part of the nervous system is responsible for controlling the bodily functions that we aren’t consciously aware of, like our heart rate, blood pressure, body temperature and digestion. Patients who suffer from POTS experience a range of symptoms including light-headedness, fatigue, heart palpitations and others. To treat these symptoms, POTS patients benefit from a multifaceted treatment plan including medications, physical therapy and specific diets. 

In this article, we’re exploring the close connection between POTS and nutrition. We’ll discuss the ideal POTS diet and the ‘why’ behind it, equipping you with important information to manage symptoms and improve your quality of life.

Understanding POTS

POTS is a condition that between one and three million Americans struggle with. Simply put, it’s a condition that results in an increased heart rate upon standing. However, the symptoms are often far more complex than that alone. POTS is a form of dysautonomia, a dysfunction in the autonomic nervous system. This part of the nervous system directs your heart rate, blood pressure, digestion and the rest of your body’s unconscious functions. Disruptions within the autonomic nervous system can lead to the hallmark symptoms of POTS, including orthostatic intolerance, dizziness and fatigue.

Under the umbrella of the POTS diagnosis are three subtypes characterized by varying underlying mechanisms and symptoms. These subtypes are known as hypovolemic, neuropathic and hyperadrenergic. While many symptoms and characteristics of POTS overlap from one subtype to another, there are a few key differences.

  • Hypovolemic: Patients with hypovolemic POTS have a lower amount of circulating blood in their bodies. This causes the heart to beat faster to provide the body’s vital organs with the blood supply needed to do their jobs. Without an adequate blood supply, these patients experience symptoms including generalized weakness and exercise intolerance.
  • Neuropathic: In cases of neuropathic POTS, patients have decreased nerve function, particularly in their legs. This decrease in nerve function leads to a decrease in the release of norepinephrine from the nerves in the legs. Since norepinephrine causes blood vessels to constrict, a decreased amount of this neurotransmitter can cause blood to pool in the feet and legs. This leads to symptoms like swollen legs or feet and a bluish-purple discoloration of the feet, called cyanosis.
  • Hyperadrenergic: The hyperadrenergic subtype of POTS is characterized primarily by increased levels of norepinephrine in the body. Norepinephrine plays a key role in the body’s ‘fight-or-flight’ response and increased levels lead to symptoms like heart ​​palpitations, anxiety and increased heart rate and blood pressure.

While these subtypes help to explain the mechanism behind POTS, another factor may also be at play. Patients with POTS often have increased autoantibodies and elevated levels of autoimmune markers, both of which are typically seen in patients with various autoimmune conditions such as lupus and Sjogren’s syndrome. 

Common Symptoms and Challenges

No matter the subtype, patients with POTS can present with a wide range of symptoms, all stemming from dysfunction within the autonomic nervous system. Common symptoms of POTS include:

  • Heart palpitations, or the feeling that your heart ‘skipped a beat’
  • Dizziness and lightheadedness
  • A general feeling of being unwell
  • Excessive fatigue
  • Nausea
  • Orthostatic intolerance
  • Brain fog
  • Gastrointestinal symptoms

Crafting a POTS-Friendly Diet

When creating a POTS-friendly diet, there is no one-size-fits-all approach. Dietary needs vary from person to person, so POTS patients should work closely with their healthcare providers or nutritionists to create a personalized plan. 

Finding the best diet for your needs is also an ongoing and adaptable process. You won’t experience change within a day, and you’ll need time to create a diet tailored to your unique symptoms and preferences. One easy starting place for making your diet a POTS-friendly one is to consume smaller, more frequent meals. This helps stabilize blood sugar levels and reduces the risk of dizziness and heart palpitations. Other key components of a POTS-friendly diet include portion control and a balanced nutrient intake.

However, there are certain types of food that are particularly beneficial and others that could cause further complications. Here are some of the key ones to look out for.

Best Foods to Eat for POTS

The right diet can play a pivotal role in both managing POTS symptoms and improving the quality of life for individuals living with this condition. Making the correct nutritional choices can have a profound impact on several aspects of POTS, including heart rate, blood pressure and overall well-being. Here’s a look at several types of foods and food groups that you should and should not consume.

Whole Grains

Whole grains such as quinoa, brown rice and oats, contain carbohydrates, fiber, vitamins and minerals that provide the body with a sustained form of energy. They break down slowly, maintaining energy over longer periods without causing blood sugar spikes. Unlike other forms of carbohydrates, whole grains provide sustained energy and are less likely to cause swings in blood sugar. 

Fiber-Rich Foods

Fiber-rich foods are also key in supporting digestive health. Soluble fiber, found in oats, apples and citruses, helps to promote nutrient absorption and soften the stool. Insoluble fiber, found in other whole grains, vegetables and nuts, prevents constipation and promotes regular bowel movements. 

Hydration and Electrolyte-Rich Foods

Maintaining adequate hydration and electrolyte balance is crucial for individuals with POTS, as it can significantly alleviate symptoms and contribute to overall well-being. Electrolytes, such as sodium, potassium and magnesium, play a pivotal role in nerve function, muscle contraction, and fluid balance.

Including electrolyte-rich foods like bananas, leafy greens and nuts in the diet, along with staying adequately hydrated, can aid in stabilizing blood pressure, mitigating symptoms and promoting overall cardiovascular health for those adopting a POTS-friendly diet.

For patients who struggle to drink enough fluid, using hydration reminders or a reusable water bottle can make a big difference. Water and herbal teas are excelling fluid sources that are well-tolerated by POTS patients. Hydrating foods like cucumbers, watermelon and other water-rich fruits and vegetables are also excellent additions to a POTS diet.

Supplements and Diuretics

In some cases, supplements may be needed to maintain electrolyte balance. Electrolyte supplements can help patients maintain their electrolyte levels when other strategies aren’t quite cutting it. However, it is important to only consume supplements under the guidance of a healthcare provider. Diuretics can also impact fluid and electrolyte balance, as they cause the body to create more urine. This decreases fluid volume and can have a notable impact on potassium levels. Thus, medical supervision is necessary when using diuretics. 

Some energy drinks include electrolytes like sodium and potassium. However, they do have their cons. Energy drinks contain high levels of caffeine, which is a diuretic. This can lead to dehydration and further electrolyte issues. Caffeine also increases your heart rate and may exacerbate POTS symptoms.

The Role of Salt

Adequate salt intake is vital for patients seeking a POTS-friendly diet. Sodium helps to increase blood volume by retaining fluids in the body and also helps to prevent drops in blood pressure. It even supports proper heart function. Try incorporating different sodium-rich foods, like condiments, cheese or cured meats during either meal or snack time.

Balancing Nutrients

POTS patients should focus on creating a well-balanced diet that includes all essential nutrients such as vitamins, minerals, proteins, carbohydrates and fats. In cases where certain nutrients may be lacking due to dietary restrictions, supplements can be a good way to reach nutrient goals. Throughout your dietary journey, be sure to maintain regular contact with your healthcare provider or nutritionist to ensure that your nutritional needs continue to be met.

Worst Foods to Eat for POTS (Avoid)

On the other hand, there are types of food that may be better to avoid when crafting a POTS-friendly diet. 

Be Aware of FODMAPs

While whole grains are a must in a POTS-friendly diet, FODMAPs, or fermentable carbohydrates, may cause more harm than good. FODMAPs are not well absorbed during digestion and may ferment in the gut. This can cause uncomfortable symptoms like abdominal pain, bloating and diarrhea. As the gut is closely connected with the autonomic nervous system, stress on the gut can also result in exacerbation of other POTS symptoms like fatigue and dizziness. 

To prevent these symptoms from compounding on one another, a FODMAP-aware diet may be beneficial. Foods that are considered to be FODMAPs include certain fruits like pears, certain vegetables like onions and garlic, dairy products and certain grains like wheat, barley and rye. Steering clear of these can significantly contribute to managing POTS symptoms and promoting overall well-being.

Consider Gluten-Free Options

Carbohydrates are the main source of power for every cell in the body. They fuel organs like your muscles and brain and are quickly converted into a usable source of energy, making them even more vital for POTS patients dealing with weakness and fatigue. 

While not all POTS patients have dietary restrictions, such as those related to celiac disease, some patients may find a gluten-free diet to be beneficial. People with POTS may also have undiagnosed celiac disease or gluten intolerance, as some of their symptoms overlap. With that in mind, gluten-free diets can be beneficial for some POTS patients. A gluten-free diet can help to reduce inflammation and alleviate gastrointestinal symptoms like bloating and constipation. 

Avoid Highly Processed Foods

Processed foods often contain excessive sodium, unhealthy fats, and artificial additives that can exacerbate symptoms associated with POTS. Opt for whole foods and check labels for hidden additives, excessive sodium content, artificial preservatives, and added sugars. 

Examples of highly processed foods to avoid include fast food, deli meats, crackers, surgery breakfast cereals and ready-made meals.

Avoiding these types of foods can help manage symptoms by reducing sodium intake, stabilizing blood sugar levels, and providing essential nutrients for better overall health and symptom control.

Improving Quality of Life

Making informed dietary choices can significantly enhance the quality of life and improve the overall sense of well-being for individuals living with POTS. These benefits include:

  • Reducing Symptom Burden: Following a POTS-friendly diet can significantly reduce the severity of POTS symptoms. By maintaining adequate fluid and electrolyte intake, eating smaller and more frequent meals and avoiding foods that cause GI distress, patients may experience fewer heart palpitations, reduced dizziness and improved cognitive function. 
  • Enhancing Energy Levels: A well-balanced diet with adequate carbohydrates, protein and fluid provides the body with sustained energy throughout the day. This is especially beneficial for POTS patients who struggle with fatigue. Consistent meal timing and nutrient-rich choices help to improve energy levels, minimizing ‘brain fog’ and making daily tasks more manageable. 
  • Empowering Patients: Making informed dietary decisions provides POTS patients with a greater sense of self-efficacy and control over their symptoms. As you begin to follow a POTS-friendly diet,  remember to view these dietary changes not as restrictions, but as tools for improving your quality of life. 

Final Thoughts

The symptoms of POTS can be incredibly burdensome, but opting for the right diet may help. Making the correct nutritional choices can help to minimize many of the characteristic symptoms of POTS and significantly improve quality of life. 

Use these tips as tools to better health and wellness and remember to consult a healthcare provider or nutritionist for personalized advice. If you’re seeking clarity on your journey to a POTS diagnosis, UCF Health Diagnostic Cardiology is here to help.