POTS, or postural orthostatic tachycardia syndrome, is a condition where your heart rate rises abnormally when you stand up, often bringing dizziness, fatigue, and a long list of other symptoms.
Something as simple as standing in the shower or waiting in line can trigger a wave of lightheadedness or a pounding heartbeat that derails the rest of the day.
The good news is that while there’s no one-size-fits-all fix, there are practical, everyday strategies that can meaningfully improve how you feel.
Because POTS symptoms and triggers vary so much from person to person, effective symptom management always has to be individualized.
Key Takeaways
- POTS symptom management usually combines hydration, sodium intake, gradual movement, and lifestyle changes rather than a single fix
- Identifying your personal triggers, through a symptom journal or careful observation, is one of the most effective early steps
- Physical strategies like compression garments and gradual position changes can reduce dizziness and support blood flow
- What works for symptom management varies by person, which is why an individualized treatment plan matters more than a generic checklist
- Addressing the root cause behind your POTS, not just the symptoms, is often what leads to lasting improvement
What Is POTS?
When someone with POTS moves from lying down to standing, their heart rate increases abnormally as the body tries to compensate for blood pooling in the legs. This happens because the autonomic nervous system isn’t properly regulating blood vessel tone, a pattern known as orthostatic intolerance.
POTS is a form of dysautonomia, meaning it reflects a broader dysfunction in how the nervous system regulates heart rate, blood pressure, and blood flow.
Because the underlying drivers differ from person to person, whether that’s nerve dysfunction, low blood volume, or an overactive sympathetic nervous system, management needs to be individualized rather than following a single standard protocol.
Common Symptoms of POTS
People with POTS often experience a wide range of symptoms, including:
- Rapid heartbeat
- Dizziness or lightheadedness
- Brain fog
- Fatigue
- Headaches
- Digestive issues
- Temperature intolerance
- Fainting or near-fainting
- Exercise intolerance
- Shakiness or anxiety-like sensations
Symptoms can fluctuate day to day, which is part of what makes living with POTS so unpredictable and exhausting to explain to others.
POTS Diagnosis
POTS is typically diagnosed by a physician who evaluates your heart rate and blood pressure while lying down and again after standing, often using a tilt table test to observe how your body responds to a change in position.
Diagnosis usually involves a detailed medical history, bloodwork to rule out other causes, and sometimes referral to a cardiologist or neurologist who specializes in autonomic disorders. Because POTS symptoms overlap with so many other conditions, getting an accurate diagnosis is often the first real step toward effective treatment.
Identify Your POTS Triggers
Common triggers include prolonged standing, heat, dehydration, large meals, alcohol, poor sleep, and illness or infection. Stress and hormonal fluctuations can also worsen symptoms for many people with POTS.
Keeping a simple POTS symptom journal, noting what you ate, how long you stood, the temperature, and how you felt, can help you spot patterns that aren’t obvious in the moment. This makes it much easier to build a treatment plan around what actually worsens your symptoms, rather than guessing.
Stay Hydrated and Support Blood Volume
Hydration matters in orthostatic intolerance because low blood volume makes it harder for your body to maintain blood pressure when you stand. Increasing fluid intake is one of the most consistent first steps in POTS treatment, and many patients benefit from electrolyte solutions when appropriate, since electrolytes help your body actually retain the fluid you’re drinking rather than losing it quickly.
Plain water alone may not be sufficient for some patients. Without adequate sodium, extra water can pass through the body without meaningfully increasing blood volume, which is why fluid strategies for POTS usually pair water with electrolytes rather than water alone. Always consult with your physician before doing this.
What About Salt for POTS?
Increasing sodium intake is a common strategy for supporting blood volume in POTS, since sodium helps the body retain fluid more effectively. This often means adding salty foods, electrolyte supplements, or sipping on salty broth throughout the day.
Sodium needs vary significantly from person to person, especially for those with certain heart or kidney conditions, so this should always be discussed with your provider before making significant changes.
How Your Diet Affects POTS Symptoms
Eating smaller, more frequent meals can help prevent the blood flow shift toward digestion that sometimes worsens POTS symptoms after large meals. Building balanced, nutrient-dense meals, with adequate protein, fiber, and complex carbohydrates, can also help prevent the blood sugar swings that tend to intensify fatigue and brain fog.
Are there foods you should avoid with POTS? Large, high-carbohydrate meals and alcohol can worsen symptoms for many people, and some patients find that excessive caffeine has a similar effect. Since tolerance varies widely, tracking your own response in your symptom journal is more useful than following a strict universal list.
Physical Strategies to Reduce POTS Symptoms
A few practical, physical strategies can meaningfully reduce day-to-day symptoms:
- Compression garments: Compression stockings or abdominal binders help support blood vessel tone in the legs and abdomen, reducing blood pooling and improving blood flow back to the heart
- Change positions gradually: Moving slowly from lying to sitting to standing, rather than standing up quickly, gives your nervous system more time to adjust
- Avoid prolonged standing: Shifting your weight, sitting when possible, or using a stool can prevent symptoms from building
- Manage heat exposure: Heat widens blood vessels and can worsen symptoms, so staying cool, avoiding hot showers, and being cautious in hot weather all help; some patients also find that cool water exercise, such as swimming or walking in a pool, is easier to tolerate than exercise on land
- Prioritize sleep and recovery: Consistent, quality sleep supports nervous system regulation and helps the body recover from the physical toll of symptom flares
Supplements and POTS?
Supplements should be based on individual needs rather than a generic list, since POTS involves so many overlapping systems.
Deficiencies such as iron or vitamin B12 are worth ruling out with bloodwork, since correcting an underlying deficiency can meaningfully improve fatigue.
Beyond that, supplement choices depend on your specific labs, symptoms, and any other conditions you’re managing, which is why you should always work through this with a provider rather than trial and error.
What to Do During a POTS Flare
If you suddenly feel dizzy or lightheaded, sit or lie down immediately, and elevate your legs if possible to help blood flow return to your heart. Crossing your legs while standing, tensing your leg and abdominal muscles, or gripping something firmly can also help in the moment while you find a place to rest. Sipping a salty drink or electrolyte solution can help if you’re able to. Consult your physician for the best strategies for your body.
Preventing future flare-ups often comes down to consistency: staying ahead of hydration and sodium needs, avoiding known triggers, and not waiting until you’re already lightheaded to sit down.
Treating the Root Cause of Your POTS
Symptom management strategies like hydration, compression, and pacing can make daily life more manageable, but they don’t always address why your nervous system became dysregulated in the first place. This is why individualized care matters so much in treating POTS.
Integrative medicine approaches look beyond heart rate alone, considering underlying triggers like a prior viral illness, autoimmune activity, or nervous system dysregulation that may be driving your specific case.
Rather than applying a standard protocol, this approach builds a treatment plan around what’s actually happening in your body, with the goal of improving function, not just controlling numbers.
Conclusion
Managing POTS symptoms day to day is possible, even without a guaranteed cure. Hydration, sodium, gradual movement, compression, and pacing can all reduce how often symptoms interfere with your life. But because POTS looks different for everyone, lasting improvement usually comes from combining practical symptom management with a treatment plan that addresses the underlying drivers behind your case.
If you’re managing POTS symptoms but still feel stuck, Dr. Melanie Stein specializes in individualized, root-cause care for complex conditions like POTS. Schedule a consultation to build a treatment plan designed around your body.
This blog post is for educational purposes only and isn’t medical advice. Every body is different, and what’s right for one person may not be right for you. Always talk with your own doctor or healthcare provider before making changes to your health, medications, or supplements.
References
- Dysautonomia International. 10 Facts Physicians Should Know About POTS. www.dysautonomiainternational.org/pdf/10FactsAboutPOTS.pdf
- Sheldon, R. S., et al. (2015). 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm
- Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience
- Raj, S. R. (2013). Postural tachycardia syndrome (POTS). Circulation
- Fedorowski, A. (2019). Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. Journal of Internal Medicine
- Vernino, S., et al. (2021). Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting. Autonomic Neuroscience
- National Institute of Neurological Disorders and Stroke (NINDS). Dysautonomia Information Page
