If you’ve been living with POTS for years, you’ve likely already had to increase your daily sodium intake. While regular guidelines recommend less than 2.3g (2,300mg) of sodium in your diet daily^[1], people with POTS are generally recommended to increase their sodium intake to anywhere between 3-10g (3,000mg to 10,000mg) of sodium daily^[2][3]. 

The reason for this is relatively straightforward. POTS is associated with a reduction in your blood volume. Low blood volume is, in turn, associated with conditions like hypotension, hypovolemia, and blood pooling. 

Increasing your dietary salt intake can help increase blood volume. Studies have long shown salt can help decrease symptoms in adults with orthostatic symptoms^[4] – that is, feeling lightheaded and dizzy when you stand after sitting or lying down. The 1996 study showed  not only do salt supplements increase orthostatic tolerance, they also increase plasma volume in patients with the condition.  

However, while there has been ample evidence of the effectiveness of salt and sodium in managing symptoms associated with POTS, these studies have, until recently, not focused on POTS patients in particular. 

A 2021 study^[5] published in the Journal of the American College of Cardiology changed that, and focused the study on POTS patients. Titled “Effect of High Dietary Sodium Intake in Patients With Postural Tachycardia Syndrome,” this study looks at the effects of both high-and low-sodium diets specifically on people living with POTS. 

Understanding the Study

Conducted by researchers at Vanderbilt Autonomic Dysfunction Center, the study involved 14 people diagnosed with POTS and 13 control subjects who did not have POTS, all between the ages of 23 and 49. 

These participants were randomly divided into two groups and assigned a low sodium diet with 10 mEq of sodium per day or a high sodium diet with 300 mEq of sodium daily. They were asked to follow this diet for 6 days, following which researchers measured their:

• Standing and supine heart rates
• Blood pressure
• Serum aldosterone: A test that measures levels of the hormone aldosterone in your blood or urine^[6]. People with POTS have low aldosterone.^[7]
• Plasma renin activity: Plasma renin activity plays a major role in regulating blood pressure, thirst, and urine output. People with POTS have reduced renin activity^[8].
• Blood volume
• Plasma norepinephrine and epinephrine: Epinephrine and norepinephrine play an important role in determining your blood pressure, heart rate, and blood sugar levels^[9]. People with POTS have elevated levels of these hormones ^[10]. 

Participants were also given a standing test, which allowed researchers to assess the “hemodynamic and chemical responses to increased central hypovolemia.” Following the standing test, participants were also asked to report the severity of other common POTS symptoms they would otherwise experience, including mental confusion, shortness of breath, blurred vision, and palpitations. 

After these levels were measured, participants were given a break of one month, after which the groups were reversed for a further 6 days. Researchers measured the above-mentioned levels once more, this time after participants had reversed their diet (going from low to high sodium and vice versa). 

Participants who had POTS experienced lower heart rates on a high sodium diet. Additionally, blood and plasma volume increased, and norepinephrine levels decreased.  

Furthermore, participants reported slightly lower self-reported symptoms following a high sodium diet as compared to a low sodium one. While these differences were not deemed statistically significant by researchers, it does indicate a high sodium diet for as little as 6 days can improve your symptoms.

At the same time, it should be noted a high sodium diet is not a cure for POTS. Even those on a high-sodium diet continued to experience and exhibit common POTS symptoms when compared to the control subjects who had not been diagnosed with POTS. 

So…What Does This Mean for You?

If you’ve been living with POTS for some time and have already increased your dietary sodium intake, you’re likely shaking your head and asking, “what else is new?” 

The main conclusion of the study is an increase in sodium intake can help manage and improve some POTS symptoms – but it is not a cure. Furthermore, it is also not the only POTS management strategy out there. 

This conclusion is nothing new for those of you who have lived with POTS for years. You have likely incorporated a high sodium diet into your life along with other lifestyle changes, such as^[11]:

• Increasing your fluid intake
• Eating smaller meals
• Eating fewer carbohydrates
• Consuming more lean protein
• Elevating your head while you sleep
• Wearing compression garments, such as socks, tights, and hose

However, while anecdotal evidence is important, it is not as effective as clinical studies that show provable and repeatable results. Some medical professionals may be hesitant to advise certain treatment avenues, including increasing dietary salt intake, and research will often sway them in ways that anecdotes would not. 

Additionally, more research into POTS is always a good thing. Long time POTS sufferers are always looking for new and more effective solutions. This study may also spur further research into POTS and further research interest from pharmaceuticals. 

Increasing Your Dietary Salt Intake

Wondering how to increase your dietary salt intake? 

Increase the amount of salt you add to your food or eat saltier foods, such as soups, pickles, and soy sauce. However, many find dietary changes unpalatable, especially as they have already adjusted their dietary patterns, as explained above. 

Consider salt pills. Salt pills are a convenient and economical way to increase your sodium (and potassium!) intake without changing the salt content of your meals. If you’re interested in trying salt tablets, one easy option is to try Klaralyte tablets.  

Klaralyte tablets contain 250 mg of sodium and 50 mg of potassium per tablet, providing you with a quick and easy sodium boost as needed. Simply swallow the tablet with water, and you’re good to go! You can take 2 Klaralyte capsules with water 2-5 times a day, you will be able to meet your additional sodium needs with these tablets alone.

Consult your doctor before adding salt tablets to your diet (or making any major dietary changes). They’ll be able to advise you if the change is necessary and can help, and will also advise you on what your daily salt intake should be, taking into account all the details of your condition.

Conclusion:

While previous research indicated the effectiveness of increased dietary sodium in combating and managing POTS symptoms, a 2021 study has shown a high-sodium diet has significant benefits for POTS patients in particular. 

However, increased sodium intake is not a magic bullet, it should be paired with other lifestyle changes for effective POTS management. When adjusting your sodium intake, consult a doctor first – they will advise you on what your new recommended daily sodium intake should be. 

A convenient and economical way to increase your sodium intake without adjusting your diet preferences is to opt for salt tablets like Klaralyte. These are easy to take, and you don’t have to worry about eating saltier foods.

Cited Sources:

[1] https://www.cdc.gov/salt/index.htm 
[2] https://myheart.net/pots-syndrome/diet/ 
[3] https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots 
[4] https://heart.bmj.com/content/75/2/134.long 
[5] https://www.sciencedirect.com/science/article/pii/S0735109721006306 
[6] https://medlineplus.gov/lab-tests/aldosterone-test/ 
[7] https://pubmed.ncbi.nlm.nih.gov/15781744 
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511483/ 
[9] https://www.medicalnewstoday.com/articles/325485 
[10] https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots 
[11] http://www.dysautonomiainternational.org/page.php?ID=44