Q: What dietary recommendations (including sodium and fluid) are effective for the treatment of adults with postural orthostatic tachycardia syndrome (POTS), including POTS as a complication post-COVID-19 syndrome (long COVID)?
Last Updated: 2023-07-27
Key Practice Point
#1
Recommendation
Postural orthostatic tachycardia syndrome (POTS) has been reported as a postinfectious complication of COVID-19. Diet is recommended as a first-line treatment for POTS.
For the management of POTS, fair evidence suggests beneficial effects from:
- Increasing sodium intake to 10-12 g salt/day spread throughout the day as added salt or salt tablets. It is recommended to consult with the medical team regarding sodium goals, especially for those with co-morbidities (e.g. hypertension, renal disease).
Limited evidence suggests the following dietary recommendations can improve or stabilize POTS symptoms:
- Consume 2-3 L water/day (starting fluids early in the morning before rising).
- Avoid alcohol, caffeine and dehydration.
- Consume small, frequent meals and lower glycemic carbohydrates.
- Higher reported rates of the following conditions in individuals with POTS suggest screening and treating for the following: digestive symptoms (including irritable bowel syndrome), celiac disease, eating disorders and nutrient deficiencies (including iron-deficiency anemia).
Evidence Summary
Recommendations are based on empirical evidence reported in guidelines and narrative reviews
Grade of Evidence C, except for the salt recommendation, which was based on a randomized crossover study that found that a high sodium compared to a low sodium diet (6.9 versus 230 mg/day) was helpful in improving POTS but did not completely normalize symptoms
Grade of Evidence B.
Remarks
Postural orthostatic tachycardia syndrome (also known as dysautonomia) is a chronic disorder of the autonomic nervous system that is characterized by an increase in heart rate on standing. Symptoms include lightheadedness, palpitations, mental clouding (brain fog), headache, nausea, blurred vision, sleep disturbances, fatigue and gastrointestinal pain. Viral infections have been identified as a trigger for POTS and POTS has been reported as a postinfectious complication after COVID-19. No medications are approved for treating POTS.
10 g salt/NaCl (~2 tsp) = 3940 mg (171 mmol) sodium; 12 g salt = 4720 mg (206 mmol) sodium.
Increasing sodium intake can increase plasma and blood volume, which can improve tachycardia/orthostatic intolerance on standing.
Current Contributors
Dawna Royall - Author
Elaine Anderson - Reviewer
Shée Lillejord - Reviewer, Topic Advisor