Top 3 Lifestyle Changes to Treat POTS
You recently got diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS)... you finally have the confirmation that no you’re not crazy, no your symptoms aren’t “all in your head”, and no you are not all alone in this.
But where do you go from here? Navigating daily life with POTS can feel daunting. Debilitating symptoms, unpredictable flares, and daily obstacles can leave you feeling isolated and discouraged. However, exploring lifestyle strategies can significantly improve your symptoms and help you do more throughout your day. In my occupational therapy practice, I help individuals struggling with POTS, dysautonomia, and related conditions implement lifestyle-based changes so they can achieve their goals.
This article will outline the top 3 lifestyle strategies I recommend for treating your POTS symptoms without medication: increasing fluids, increasing sodium, and using compression garments. Of course there are more tips, but you have to start somewhere and starting with these basic building blocks can make a significant difference in how you feel every day.
#1: Increase Fluids
Did your doctor recommend that you increase your fluid and sodium levels to help manage your POTS symptoms? This is one of the first lifestyle changes I recommend to my clients!
Why it helps:
In certain forms of POTS, hypovolemia, or reduced blood volume, is a primary factor contributing to symptoms such as dizziness, nearly passing out (presyncope), rapid heart beat, fatigue, and more. Dehydration can also be an exacerbating factor that worsens symptoms and leads to flare ups.
What to do:
In general, attempt to increase your fluid intake (includes water, herbal teas, etc) to approximately 100 oz or 3 liters per day.
Make the habit stick:
Sip on water throughout the day
Keep glasses of water or water bottles in different areas of your house, in your car, etc. so you have fluids easily accessible
Explore ways to make drinking water more fun and rewarding for your brain, such as:
Time marked water bottles or glow smart water bottles
Apps like Plant Nanny
#2 Increase sodium
Alongside increasing your fluids, it is important in POTS to increase your daily sodium intake significantly. In my practice, I find that many people are drinking tons of water, but they are often not getting enough salt to really see the symptom management benefits.
Why it helps:
Sodium helps you retain water, so increasing sodium is essential for helping all of that fluid you are taking in actually help your body. Increased fluid plus sodium increases blood volume which makes it easier for your body to regulate your heart rate. This can reduce autonomic symptoms and help you feel better throughout the day.
What to do:
General recommendations for POTS are to increase your salt intake to 8-12 grams per day. However, salt does not equal sodium and most food and electrolyte products list sodium content (stick with me for the mental math…) You want to aim to consume 3,000 - 4,600mg of sodium per day.
The average American consumes approximately 3-4 grams of salt per day, so this lifestyle change can be a big adjustment. I recommend using a variety of strategies to increase sodium:
Electrolyte Supplements - Adding electrolyte powders to your drink can be a great way to boost your fluid and sodium intake. Some of my favorite brands:
LMNT recharge packets have ~1000mg of Sodium
Nuun “sport hydration” tablets have ~300mg of Sodium
LiquidIV packets have ~500mg of Sodium
Sodium Capsules/Chews - These can be a convenient way to increase your baseline daily sodium intake.
Electrolyte fast acting chews - These gummies are great to keep in your backpack or purse. The sodium is absorbed faster making it a good choice to manage symptoms or respond to a flare quickly.
Dietary changes
Sprinkle salt onto fruits or veggies (grapefruit, cucumbers, watermelon, etc.)
Identify fresh foods with higher sodium intake (pickles, olives, cheeses, etc.)
Identify canned/prepared foods with higher sodium levels and have some on hand, particularly for days when you might have less energy for meal prep (for example: canned soup)
Make the habit stick:
Decide on a preferred combination of drinks, capsules, and dietary changes
Make at least a part of your sodium intake “automatic”, for example, getting 1500mg of sodium through capsules daily
Find ways to visualize your salt intake (for example: mini salt shakers)
Prepare servings of salty snacks in advance
Keep electrolyte powers, capsules, or chews on hand
#3 Use compression
Compression garments are specially designed clothing items in the form of socks, sleeves, stockings, or abdominal binders which provide consistent and graded pressure to the body. Compression is your new best friend if you have POTS!
Why it helps:
In POTS, it is common to have difficulties with circulation and blood pooling in the legs and feet which can contribute to symptoms like brain fog, fatigue and lightheadedness. Compression strategies help to passively move blood towards your heart and head. By improving venous return, your heart will not have to compensate (e.g. beat rapidly) as much. This means less symptoms overall and improved endurance during activities you love to do!
What to do:
The type and style of compression that you use makes a difference. I recommend prioritizing:
Garments offering at least 20-30 mmhg of compression
Compression at the waist and abdomen (explore an abdominal binder and/or waist high compression leggings)
A 2021 study of POTS patients found that abdominal compression (binder combined with waist high leggings) reduced heart rate by 17 bpm and a 2018 study found that using only an abdominal binder was more effective than only leg compression (e.g. knee high socks)
Make the habit stick:
Keep compression garments easily accessible - for example, keep a pair of socks or an abdominal binder by your bed to put on first thing in the morning
Have a range of compression items for different outfits and scenarios for example nude calf sleeves for an evening out vs waist high compression when exercising
It can feel overwhelming to receive a POTS diagnosis and start the process of looking for answers and support. With persistence, self-compassion, the right support and community, you can improve your symptoms and get back to doing the things you love. These 3 lifestyle changes are a great place to begin.
While these strategies can seem simple, they are not always easy to consistently implement in your life. That’s where lifestyle-focused occupational therapy can be a huge support! My practice specializes in supporting people with POTS and other chronic conditions implement long lasting lifestyle change to feel better and design a life they love. Schedule a free consultation call to ask me any questions and figure out how our work could support you.