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Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic disturbance of the nervous system. It’s associated with an abnormal increase in heart rate after standing up from a seated or horizontal position (1). In Part 1 of this series, The 3 W’s of POTS, we dug deeper into the condition itself, why it occurs, who it affects, and the pathway to an accurate diagnosis. In part 2, we’ll be shifting our focus towards some of the best research-based therapy options for POTS and how to go about implementing them into your daily routine.

As a chronic and debilitating condition, hundreds and thousands of people are seeking the best therapy approach to help manage their symptoms. As a reminder, the most common POTS symptoms include an abnormal increase in heart rate (tachycardia), flushing episodes, light-headedness, nausea, headache, sleeping problems, brain fog, fainting, and dark blue legs. In terms of effectiveness, often times the most beneficial therapy options to treating such a condition are those that do not require prescription medication. Some of the most well-established methods to treating POTS include exercise, salt and water intake, diet, compression devices, and sleep.

Get more exercise

Exercise helps to improve your capacity to move blood from your heart to your body more efficiently. This is also known as cardiac output, which is the product of your heart rate, which is the number of heartbeats per minute (bpm), and your stroke volume, which is the volume of blood being pumped by your heart during every beat (2).

A common symptom for people living with POTS is known as physical deconditioning. Over longer periods of time, physical deconditioning can lead to a smaller heart size which limits your ability to pump blood throughout your body. For a healthy individual, having a smaller heart and reduced cardiac output wouldn’t play as big of a toll on their body when compared to someone who’s living with POTS. Based on the fact that blood pooling in the lower limbs is a common feature of the condition, having a smaller heart and lower cardiac output creates an even larger strain to the heart, leading to more severe episodes of tachycardia. In order for the body to circulate blood quickly, this overcompensation can lead to a variety of other symptoms such as light-headedness, dizziness, and nausea (3).

Fortunately, there’s a healthy way to manage this and it starts with exercise.

Numerous studies have reported exercise to be beneficial in alleviating POTS symptoms as well as playing a role in curing the condition entirely in some cases. For instance, one study including patients without significant fluctuations in blood pressure were trained over time to move from lying down position, to seated position, then to standing position during several exercises. Some of these exercises include swimming, cycling, and rowing. It was reported that any sort of aerobic exercise or accomplished three times a week for a minimum of 20 minutes produces cardiovascular improvements for those who can tolerate it (4).

Increase your fluid and salt intake

People with POTS generally have difficulties recirculating their blood throughout their bodies after standing up from a horizontal or seated position. Although an increased heart rate is a hallmark symptom of POTS, another piece of the puzzle to improve cardiac output is a higher stroke volume.

So how can we improve our stroke volume?

To elevate your stroke volume you need to increase your total blood volume. Typically in POTS patients, stroke volume is lower due to a reduced total blood volume. To help improve this, it’s recommended to increase both fluid and salt intake. This method of symptom management is shown to be particularly helpful in patients with blood pooling of the lower limbs and hypotension (low blood pressure). For the average adult, it’s recommended to have approximately 2 litres of water and 3-5g of sodium in a day (5). The same benefit is seen when supplementing electrolytes with your water. Consider this method when you begin to incorporate more exercise into your daily routine.

Consider your diet

In conjunction with increasing your water and salt intake, diet is another contributing factor in managing your POTS symptoms. Both the size and composition of your meals and snacks matter greatly throughout the day. In fact, eating smaller, more frequent meals has shown to reduce the severity of post-eating hypotension due to reducing the amount of blood that’s required to digest your food. This helps to ensure blood distribution throughout your body is optimized, and less pooling of blood in your lower abdomen blood.

Other ways to modify your diet include:

– Eating more fibre and complex carbohydrates to reduce spikes in blood sugar

– Preparing meals in advance to avoid having to consistently go to the grocery store and risk having low energy

– Avoid processed foods as they cause a decrease in your energy levels

– Maintain a balanced nutrition with a good amount of protein, fresh fruits and vegetables, and dairy

– Keep salty snacks on hand, such as pickles, olives, salted nuts, etc. if tolerated

– Don’t rely on the unhealthy salty snacks like chips and crackers

– Consider consulting with a specialist on specific dietary advice

Try out a compression device

As described previously, many different mechanisms may be causing poor constriction of blood vessels (vasoconstriction) in the lower limbs. Some theories pose it may be the result of neuropathy, lack of nitric oxide, or even the presence of viruses.

In the average person, gravity shifts about 700-900mL of blood from the central body into the lower body when standing up. Without the mechanisms in place for vasoconstriction, people who suffer from POTS often experience venous pooling. In the efforts to combat this, compression garments have been used as a countermeasure. This was first discovered for post-spaceflight orthostatic intolerance in astronauts and has now been introduced to POTS patients as an effective therapy method. This method reduces venous pooling while also increasing systolic blood pressure as well as cardiac output – ultimately preventing, or at the very least, limiting tachycardia from occurring (6).

What kind of compression is best?

Lower limb compression of the calf and thigh is shown to be advantageous, as well as abdominal compression. Leg compression alone is less effective treatment due to the majority of venous pooling in the large abdominal space.

Get enough sleep

Maintaining a proper sleep schedule is difficult for many of us. With a busy schedule, it’s often neglected. Unfortunately, this becomes even more of an issue for people with POTS syndrome due to the many symptoms that interfere with a good nights’ rest, including chest pain, sweating, restlessness, and a racing heart.

One of the best ways to do this is to maintain a more ‘typical’ sleep schedule by going to bed and waking up at the same time daily. This establishes a habit while also giving your mind and body the right amount of rest it needs to take on your daily tasks. Interestingly, even if you have a poor sleep quality, waking up at a regular time still helps you to feel better long term. In addition, excessive daytime napping can alter this regularly scheduled sleep time by causing less restful nights’ sleep.

Tips on achieving 7-10 hours of sleep every night:

– Avoid napping during the day to help you adhere to your nightly scheduled sleep hours

– Avoid watching television or use of phone/computer before bedtime

– Adjust the room temperature to make sure you’re the most comfortable throughout the night (cooler is often better)

Moving Forward

Postural orthostatic tachycardia syndrome is a relentless and frustrating condition affecting countless people world-wide. Many are turning to non-pharmaceutical treatments in the efforts to manage and ultimately treat their symptoms. The top therapeutic options include getting enough daily exercise, incorporating more salt and water into your diet, changing some important dietary habits, using compression devices, and getting enough sleep. It’s important to note, no one approach is right for everyone; instead, one option might be right for one person while a combination of several therapy methods may be better for others.

For more personalized guidance, request an integrative medicine consultation with Dr. John Gannage, MD

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