# POTS diet | Symptoms, Causes, Tests and Treatment | OSANG > In POTS patients, sufficient fluid (2-3 L/day) and salt (10-12 g/day) intake is the most basic non-drug treatment to secure intravascular volume and relieve symptoms whe… - Official page: https://osns.co.kr/en/encyclopedia/postural-tachycardia-diet - Organization: OSANG Neurosurgery ## Page content Autonomic Medicine ## POTS diet Dietary Management for Postural Tachycardia Syndrome The POTS diet is a diet and water management strategy aimed at maintaining blood volume, securing intravascular volume, and alleviating symptoms in patients with orthostatic tachycardia syndrome (POTS). ## At a glance In POTS patients, sufficient fluid (2-3 L/day) and salt (10-12 g/day) intake is the most basic non-drug treatment to secure intravascular volume and relieve symptoms when standing. Eating small, frequent meals, avoiding large, high-carbohydrate meals, and limiting alcohol and caffeine are recommended. If MCAS is present, a low-histamine diet may be of additional help. Dietary management is a key component of first-line treatment for all POTS patients. - 01Definition and Overview - 02hydration - 03salt intake - 04eating strategy - 05Special dietary considerations - 06electrolyte supplementation - 07Summary of Practice ## Definition and Overview Diet is a key non-pharmacological treatment that is equally important as drug treatment in the management of POTS (orthostatic tachycardia syndrome). In many POTS patients, intravascular volume is reported to be about 10-20% less than normal, and securing volume through sufficient water and salt intake is the basic strategy for alleviating symptoms when standing. The 2015 Heart Rhythm Society expert consensus also recommends increasing water and salt intake and controlling diet as the first non-drug treatment for POTS. ## hydration ### recommended amount Consumption of 2-3 L of water per day is recommended. This is water intake in the form of beverages, not the total amount including water in food. ### Fluid intake during acute symptoms When orthostatic symptoms are acutely worsened, drinking about 480 mL (about 2 cups) of water quickly (within 5 minutes) activates the sympathetic nerves through the osmopressor response and has the effect of increasing systolic blood pressure by about 20 mmHg. This effect lasts for about 20 to 30 minutes. ### Hydration Strategy - Drink 500 mL of water immediately after waking up in the morning to compensate for nighttime dehydration. - Drink evenly throughout the day and do not consume excessive amounts at once. - Caffeinated drinks (coffee, green tea) have a diuretic effect, so limit them to less than 200 mg (about 2 cups of coffee) per day. - Alcohol causes vasodilation and dehydration, so avoid it as much as possible. ## salt intake POTS patients are recommended to consume 10 to 12 g of salt (NaCl) (approximately 4 to 5 g of sodium) per day. This is approximately 2 to 2.5 times the recommended amount for a general healthy person (sodium 2 g/day). ### How to consume salt - Sprinkle extra salt when eating. - Take a salt tablet (1 g/tablet) with a meal. - Foods high in sodium: miso soup, kimchi, pickles, olives, pretzels - Oral rehydration solution (ORS): Replenishes sodium and water simultaneously. ### Precautions If you have kidney disease, heart failure, or high blood pressure, a high-salt diet may be contraindicated and you must consult your doctor. When salt intake increases, potassium intake also increases to maintain electrolyte balance. ## eating strategy ### small frequent meals Instead of three large meals a day, it is recommended to eat five to six small meals a day. Large meals cause splanchnic vasodilation, which worsens symptoms when standing up. ### Avoid eating large, high-carbohydrate meals Consuming large amounts of refined carbohydrates (white bread, white rice, sugar) promotes insulin secretion, and insulin affects sodium reabsorption and vasodilation, which can worsen postprandial symptoms. ### balanced nutrients - Protein: Include adequate protein at every meal to help stabilize blood sugar. - Complex carbohydrates: Choose foods with a low glycemic index (GI), such as brown rice, whole grains, and sweet potatoes. - Healthy fats: olive oil, nuts, avocado - Potassium: Supplement with bananas, potatoes, spinach, etc. ## Special dietary considerations ### low histamine diet In POTS patients with MCAS, a low-histamine diet may help relieve symptoms. High-histamine foods to avoid include: - Fermented foods: cheese (ripened), sausage, sauerkraut, kimchi (long-term fermentation) - Alcohol: especially red wine and beer - Processed meat: bacon, ham, salami - Certain seafood: tuna, mackerel (high histamine content) - Some fruits: strawberries, citrus fruits, tomatoes (promote histamine release) ### gluten free diet For POTS patients with celiac disease or non-celiac gluten sensitivity, eliminating gluten may help improve digestive and systemic symptoms. However, not all POTS patients need a gluten-free diet. ## electrolyte supplementation ### Oral rehydration solution (ORS) According to the World Health Organization (WHO), ORS contains approximately 75 mEq of sodium per liter of water. You can efficiently replenish water and sodium by using commercially available oral rehydration solutions or electrolyte powders. ### Limitations of Sports Drinks Commercially available sports drinks are high in sugar (approximately 6-8%) and lower in sodium than ORS, so they are often not optimal for POTS management purposes. It is effective to choose products that are low in sugar and high in sodium, or to prepare your own electrolyte solution. ## Summary of Practice - Drink 500 mL of water immediately after waking up - Aim for total water of 2-3 L and salt of 10-12 g per day. - Small, frequent meals (5-6 times/day), avoidance of large, high-carbohydrate meals - Limit alcohol and maintain an appropriate amount of caffeine - Use of electrolyte supplements - If MCAS is present, consider a low-histamine diet - Do not stand up immediately after eating ## Frequently asked questions ### Q01How much water should POTS patients drink per day? In general, it is recommended to consume 2 to 3 L of water per day. It is more effective to drink it evenly distributed throughout the day rather than drinking a large amount all at once. During acute symptoms, quickly drinking about 480 mL (about 2 cups) of water has the effect of increasing systolic blood pressure by about 20 mmHg through sympathetic nerve activation. ### Q02Doesn’t eating a lot of salt cause your blood pressure to rise? In POTS patients without high blood pressure, salt intake secures intravascular volume and relieves symptoms when standing. Since many POTS patients have a blood volume deficiency of about 10 to 20% compared to normal, salt intake of 10 to 12 g (approximately 4 to 5 g of sodium) per day is recommended. However, if you have kidney disease or heart failure, you need to consult a doctor. ### Q03Are there any foods to avoid in POTS? You should avoid or limit alcohol (which dilates blood vessels and causes dehydration), large amounts of carbohydrates (which concentrate blood into the digestive tract after a meal), and excessive caffeine (which has a diuretic effect and causes dehydration). If you have MCAS, be careful with high-histamine foods (fermented foods, aged cheese, processed meats). ### Q04Why do my symptoms get worse after eating? After a meal, internal blood vessels dilate and blood moves to the abdomen for digestion. People with POTS have insufficient reflexes to compensate, which reduces blood flow to the brain and worsens dizziness, tachycardia, and fatigue. It is helpful to eat small, frequent meals (5-6 times a day) and not stand up immediately after eating. ### Q05Do electrolyte drinks help? Electrolyte drinks (oral rehydration solutions) with adequate sodium content are more effective at retaining water in the body than plain water. Commercial sports drinks may be high in sugar and low in sodium, so it is recommended to check the sodium content or mix electrolyte powder in water before drinking. ## Related articles - Irritable Bowel Syndrome - sympathetic nervous system - Aging and autonomic nervous system - Autonomic dysfunction after stroke This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.