What is postural orthostatic tachycardia syndrome (POTS)?
Postural orthostatic tachycardia syndrome (POTS) is a common complex disorder of the autonomic nervous system, also known as dysautonomia
POTS is defined as a clinical syndrome marked by an excessive increase in heart rate (i.e. tachycardia) after switching from lying or sitting to standing posture.
What are the symptoms of postural orthostatic tachycardia syndrome (POTS)?
In addition to excessive increase in heart rate after standing:
- lightheadedness
- palpitations (fast heart beats)
- tremor
- generalized weakness
- blurred vision
- exercise intolerance
- fatigue
- brain fog
- gut symptoms, including nausea, abdominal pain, and bloating
What causes postural orthostatic tachycardia syndrome (POTS)?
Viral infections, including COVID-19, are an established trigger for POTS.
How is postural orthostatic tachycardia syndrome (POTS) treated?
Diet and lifestyle management is recommended as the first line of treatment for patients with POTS.
One of the mainstays of POTS treatment is the consumption of fluids and salt; although this is quite simple, compliance can be challenging.
Hydration
The main treatment options for POTS is the consumption of adequate fluids and salt. Although this is quite simple, compliance can be challenging.
Here are some top tips:
- Start to consume fluids early in the morning
- Consume fluids throughout the day
The 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome recommends considering the consumption of up to 2 to 3 L of water and 10 to 12 g of NaCl (salt) daily.
The Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome, published in 2020, recommended 10 g of salt via high-salt foods, salt sticks, and tablets, and at least 3 L of oral fluids.
Salt
Standard salt is composed to sodium chloride and has been associated with many health conditions. However, what about salt and POTS?
Sodium, salt and Postural orthostatic tachycardia syndrome (POTS)
Measuring sodium in the urine is a good method to assess the level of salt in the body. A 2012 study found that the level of sodium in the urine of children with POTS was significantly lower than that of children without POTS.
Then a 2017 study assessed the effect of IV saline drips and reported improvements in all areas, leading the researchers to conclude:
'Intermittent IV infusions of saline dramatically reduce symptoms and improve quality of life in patients suffering from POTS.'
A major issue with salt or sodium is that increased intake can cause harm to blood vessels and increases in blood pressure. However, a 2021 study reported that 6 of a high salt diet did not harm blood vessels.
A 2021 study published in the prestigious Journal of the American College of Cardiology assessed the effects of a low sodium diet compared to a high sodium diet in POTS. The high sodium diet reduced heart rate and norepinephrine but increase blood volume.
This study led a group of doctors of researchers to write that high sodium (salt) intake in patients with POTS is a Practice Worth Its Salt.
Gluten
Gluten is a protein naturally found in wheat, rye, barley, triticale (a cross between wheat and rye) and some types of oats.
Gluten and Postural orthostatic tachycardia syndrome (POTS)
A 2016 study from the Royal Hallamshire Hospital in Sheffield, England examined 3 groups:
- Group 1: confirmed POTS
- Group 2: 1,200 local subjects of whom, 12 had confirmed coeliac disease
- Group 3: healthy subjects
Among the group with POTS, coeliac disease was confirmed in 4%, 4 times higher than in the local population. In addition, 42% of those with POTS had self reported gluten sensitivity compared to 19% in the general population.
Following this initial research a 2022 study from the Buffalo School of Medicine and Biomedical Sciences examined the effect of a gluten free diet on POTS.
20 patients with POTS but without coeliac disease were included in a 4 week trial of a gluten free diet. POTS severity score (COMPASS-31) were 57.8 before the gluten free diet and reduced to 38.2 with the gluten free diet. The biggest improvement were in:
- Orthostatic intolerance
- Vasomotor symptoms like hot flushes
- Gut symptoms
In fact, 'all patients reported improved symptoms on gluten free diet' with an average self reported improvement of 50%!
If you feel you might have coeliac disease, speak to your healthcare provider(s) about getting screened medically.
Additional tips
Consumption patterns that are known to exacerbate POTS symptoms, such as dehydration, consumption of alcohol and caffeine, are best limited.
General nutrition recommendations for POTS can include eating small frequent meals and also consuming primarily lower glycemic carbohydrates (choosing wholegrain/wholemeal over refined varieties).
Conclusions
Both a gluten free diet and a higher salt diet are supported by some scientific. evidence. However, there are some limitations. Therefore, before removing gluten and/or adding salt, it is best to consult with a registered dietitian to ensure a safe diet which contains all essential elements.
For information on the best supplements, vitamins and nutraceuticals for Postural Orthostatic Tachycardia Syndrome (POTS), check out our dedicated blog here.
