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POTS & Hydration: should I be using electrolytes?

Postural Orthostatic Tachycardia Syndrome (POTS) commonly coexists with hypermobility - and the importance of staying hydrated is one of the first things you'll hear when diagnosed.

But what does this look like, and should you be taking electrolyte supplements?

What is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of dysautonomia – a condition where our nervous system leans towards being in ‘fight flight’ sympathetic mode rather than rest & digest’ parasympathetic mode’. It is very common in people with hypermobility and is characterised by normal heart rate and blood pressure when laying down, but a sharp increase in heart rate (more than 30bpm) and often drop in blood pressure on standing.

The 2022 Malmo POTS Symptoms Score (Spahic et al) neatly sums up some of the key symptom areas that bug patients.

Other specific POTS experiences can include:

  • Brain fog

  • Poor digestion with fast or slow gut motility

  • Light and noise sensitivity

  • Anxiety

  • Blood pooling in hands and feet

  • Sweating

  • An improvement of symptoms when lying horizontal

  • Nausea, especially in the morning or between meals

Why does POTS happen in hypermobility?

Let me start by sharing Dr Andrew Maxwell's keynote presentation at the 2022 Australian POTS Foundation Conference, kindly made available to the public for free.

Hypermobility makes our connective tissue too stretchy. Connective tissue forms a key component of blood vessel structure, and hypermobility can result in our vessels not being able to maintain proper blood pressure, and results in blood pooling towards the lower part of the body.

Blood pooling is detected by the kidneys, which then responds by releasing sodium, and therefore water, out of the body via urine. However this only drops blood pressure further and worsens POTS symptoms.

Mast cell and histamine symptoms also commonly co-exist with hypermobility and POTS. Histamine can cause our blood vessels to temporarily dilate (become larger) and also activates the nervous system, worsening POTS symptoms.

Chronic pain and feeling dysregulated in our nervous system can also worsen POTS symptoms, as our body is generally more sensitive to stress hormones.

Hydration for POTS

For most people with POTS, making sure we're hydrated helps significantly. However in some cases, your doctor or cardiologist may advise reducing fluid and salt - however this is usually more for uncommon yet overlapping conditions like intercranial hypertension or Meniere's. Check with your healthcare team before making any changes to fluid and hydration.

For a general healthy population, it's recommended to have roughly 30-35mL fluid per kilogram body weight (as per Queensland Health NEMO guidelines). Fluid is generally defined as any water and liquids that aren't caffeinated or high sugar.

This is a good place to start if you're not currently meeting your target here. If you're already consuming this much, try to add a bit more.

Sodium, electrolytes and carbohydrate

Our body is best able to absorb and hold onto fluids when also consumed with sodium and a small amount of carbohydrates.

Sodium is a type of electrolyte found in table salt ('sodium chloride'). For most people with POTS, common prescribed sodium targets can range between an additional 4,000mg – 10,000mg on top of what you have in your ‘normal diet’.

To put this in perspective, half a teaspoon of table salt has ~1000mg sodium.

Because increasing salt intake this much can be challenging, electrolyte drinks can be a great convenient way to get in salt and fluids. However there is a big difference between electrolyte supplements.

Most supermarket effervescent electrolyte tablets only contain ~150mg per tablet, whereas other more specialised ones contain 1000mg sodium per serve. Others are marketed at sugar free, while others again have more than 25 grams of sugar per serve.

So what should I be looking for?!

Firstly, check in with your health team. But this is what I generally look for in an electrolyte:

  • 500mg sodium per serve (or the ability to take multiple sachets/tablets)

  • <5g sugar per serve - too much can cause blood sugar crashes and worsening of symptoms (unless when exercising, in some cases)

  • Check the fillers, flavours and colours and avoid products that you react to. As a rule of thumb, avoid artificial colours and flavours

It's a good idea to also work with an exercise health professional and/or monitor your heart rate using a smartwarch to figure out how much added sodium and fluid benefit you and to keep an eye on progress.

As always, reach out or book a discovery call online if you're interested in troubleshooting lifestyle strategies for POTS symptoms.



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