Tips for managing POTS


So I recently had a conversatio with an old friend who has been diagnosed with POTS (Postural Orthostatic Tachycardia Syndrome) since she had an opperation, so I thought I would do a summary of thigns that I've found help me with my sypmtoms. Keep in mind, some of these suggestions you'll need to try and do consistently as they can take time to have an effect, so don't give up straight away. 

Summary of what POTS is in non-medical terms

First I thought I would do a quick summary of what POTS is to make this post more comprehendable. POTS is where a part of the nervous system that regulates blood pressure, heart rate, breathing, and digestion becomes dysfunctional. Resulting from this is often fast heart rates, low blood pressure, and difficulty adapting these things to changes in posture. People with POTS can also develop digestive issues (which is another topic for another day), heart palpitations, nausea and fast breathing rates. However it’s most commonly known for dizzy-spells, light-headedness and fainting.

Having stretchy connective tissue (hypermobility) is strongly linked with POTS; the stretchy connective tissue that makes up the blood vessels can mean that it’s harder for the heart to pump blood as effectively through the body. Therefore the heart rate needs to be faster.

The best way to understand this is using the analogy of a hose. A normal hose that has a thick casing doesn’t expand outwards when water is pushed through it. Therefore, the only way for the water to go is forward.Imaging the hose was made of rubber, and could expand like a balloon. Pushing water into means that the water doesn’t just go straight forward, it also goes out to the side a bit as well, expanding the stretchy hose. Therefore to get the same amount of water out the end of the stretchy hose in the same time as the thick normal hose you would need to turn the tap on a lot harder (i.e. increase the heart rate). Sometimes even doing this, the water (blood) takes too long to the end of the hose (the upper body, heart and brain) which is what causes light-headedness and fainting.

I hope this made sense and didn’t confuse you more.

Anyway, here are my top tips for managing POTS:

1. Salt

This seems to be the most common one that everyone already knows. I have a little salt shaker which I take with me in my bag to add to my water, or I add it before I leave in the morning. I add just a few grinds so that the water tastes slightly salty, but nothing overpowering. I also take salt sachet’s with me in my purse for ‘emergencies’.

What salt does is increase your blood pressure temporarily, which is very beneficial for people with low blood pressure (i.e. people with POTS) as this temporary increase leaves you less likely to get light headed, dizzy or faint.

Side-note: despite common belief that ‘salt is bad’, it’s actually an essential electrolyte that the body needs to function properly. In society today, most of the health / dietary guidelines that I see are aimed at weight loss, and the management of common medical conditions like high blood pressure and high cholesterol. In these circumstances, because salt DOES raise your blood pressure temporarily, it is best to limit because for someone with already high blood pressure that temporary increase puts extra strain on the heart and cardiovascular system. However, if you’re not someone who has high blood pressure there’s no reason to avoid it (but also don’t over use it either..)


2. Electrolytes

Electrolytes (like salt, potassium and sodium) are essential to normal body functioning, and also essential in maintaining your blood volume and blood pressure. Drinking just plain water doesn’t replenish any electrolytes – you need to get them through food or an electrolyte drink (the fastest way to absorb and replenish them). Drinking water alone can actually dilute the body’s electrolyte balance, which causes the blood volume and pressure to lower (worsening POTS symptoms – dizziness, light headedness, fainting). Ever notice after an intense exercise session that your lips taste salty? This is because when we sweat, we don’t just lose water but we also sweat out electrolytes (like salt). This is why drinking electrolytes is important, as drinking plain water doesn’t replenish them.

Also, does anyone else notice that when they’re trying to rehydrate they have to pee a lot more? This is because rehydrating on water alone doesn’t actually stimulate water to be retained in the body, it just creates a more frequent water output (i.e. lots of toilet trips). Electrolytes, like salt (I’m sure everyone with POTS is sick of being told to have lots of salt), stimulate the body to retain water, and by doing this they increase the blood pressure. So it's also essential to maintain not just your fluid intake, but your electrolyte levels as well. 

Aqualyte is the best brand of electrolyte drinks I've found - if you order online you can use the code 'pots' (lower case) for a mini discount!

You don't necessarily have to buy electrolyte drinks, you can make some home-made drinks using a mix of lemons, limes, orange and ginger to make your own electrolyte replenishing juce (if you have the time) or eat electrolyte rich foods like banana. But if you're on the run then electrolyte drinks are really useful and effective. 

3. Compression

Wearing compression clothing helps to assist in the flow of blood from the legs back up (against gravity) to the heart and brain. For people with POTS, getting up from a lying down position to an upright one can mean that blood ‘pools’ in the lower limbs. The hear then has to work harder to pump it back up against gravity à hence the fast heart rate. If the blood isn’t pumped well enough up to the heart and brain then this is where the feelings of light-headedness or dizziness occur, which can lead to fainting because the brain doesn’t get enough oxygen from blood. This can happen to people even without POTS when they get up really fast. For people with POTS, this happens a lot more often. Also standing for a little while can cause the blood to ‘pool’ in the lower limbs, which again causes the feeling of faintness. What compression wear does is supports the blood vessels by compressing them (as the name suggests), which makes it easier for the heart to pump blood back up to the upper half of the body.

I’ve tried just two brands of compression wear – Bodyplus and Skins. I was so sceptical of them before I tried any, and it made such a difference to me I was so surprised. It’s definitely worth investing in some. It’s the leggings that I find make the biggest difference, rather than upper body compression wear. The good ones aren’t cheap, but are very effective and last a long time – I wore my skins to uni (I’m studying Physio so active-wear is everyday attire, haha) everyday for like 4 months of winter, and they’re still going strong. Here’s a link to the compression wear I’ve either tried or heard is good. If anyone has tried any others please let me know!!

Bodyplus: This brand is good for compression wear that can be worked into every day non-sporty outfits, but can also be used to exercise in. Really effective

Skins: - I have the A200 and they have lasted me a long time. I find them really comfortable, and fashionable (for active-wear) so don’t mind wearing them often. I don’t think they have as strong compression as bodyplus, but they’re still effective. It depends on what your needs are I guess.

2XU: - I’m told they have good compression wear, I haven’t tried them for myself though.

Cheaper options - Target: Target also has some compressive leggings – for a much cheaper price. However I’m assuming that these won’t be nearly as effective as the brands listed above. But they would do something, so if you need a cheaper option or find you don’t need that much compression then they might be a good pick.

I recommend going into a store and trying them on before buying. Remember they will feel a bit different to normal leggings / clothes, but you will get used to it. You'll know if they're too tight and uncomfortable. 

4. Get those calves & glutes pumping

I have a morning routine that takes 2 minutes (I do it while brushing my teeth). It involves 10 calf raises, 10 squats and repeat both x 3. If I’m feeling coordinated enough then I’ll also do some bicep curls (without weight) for 3 lots of 10 as well (difficult with a tooth brush though.. haha). Engaging these big muscle groups, especially in the legs helps to pump the blood back up from the lower limbs.

Activating muscles increases circulation in the body areas surrounding them. This is why doing these exercises helps increase circulation. It does this on a temporary basis, however if you continue to do this routine +/- some more strength training then it becomes a longer benefit.

If you find it hard to exercise standing up (it can be difficult for people with POTS), I’ve discovered plenty of exercises that can be done in a lying down position. A pilates reformer is fantastic for people with POTS to use, as you can add resistance and exericse but remain lying on your back. There are also exercises you can do like leg lifts or bridges lying down without equipment. And then there’s aerobic things like the recumbent bike which is good too. Exercise is VITAL in improving the strength of the muscles, which in turn helps to support the blood vessels to increase blood pressure and help pump blood back up to the heart. Exercise and improving muscle strength is the only long term solution to improving POTS symptoms  that I know of. 

5. Ginger

A weird one, but I find this helps settle the nausea that I get sometimes from being upright. I find the easiest way is to sip on ginger tea.


Those are the things that have helped me the most with my POTS symptoms. Hope this has been beneficial in some way to you, if you have any other suggestions I’d love to hear them.