Electrolytes for POTS and Dysautonomia: A Comprehensive Guide

Title for blog: Electrolytes for POTS and Dysautonomia

Have you been wondering why electrolytes are recommended for people with Postural Orthostatic Tachycardia Syndrome (POTS), a type of dysautonomia?

 

You’re in the right place!

 

This article walks through how electrolytes can help people with POTS maintain good fluid balance and manage some symptoms. Let’s dive in!

Electrolytes and fluid balance

Electrolytes are minerals like sodium, chloride, potassium, calcium, and magnesium. They play a variety of roles in the body like transmitting nerve impulses and contracting muscles. Electrolytes also help maintain fluid balance in the body. Sodium, in particular, is important for fluid balance because it helps the body retain water.

 

Sodium and water like to stay together, so as sodium intake goes up, the amount of water that stays in the body goes up too. This helps to retain water and increases overall blood volume (what people with POTS usually want to get symptom relief!).

Electrolytes for POTS

Some research suggests that people with POTS may have issues with maintaining fluid balance in the body. This is because some people with POTS experience something called hypovolemia.

 

Hypovolemia is a medical condition where someone experiences low blood volume. In the case of POTS patients, hypovolemia can happen for a few reasons:

  • impaired function of the renin-angiotensin-aldosterone system
  • excessive fluid loss from diarrhea
  • poor fluid and electrolyte intake due to chronic nausea

 

How do electrolytes help POTS patients with hypovolemia?

 

Consuming electrolytes helps the body retain the water we drink, which helps keep blood volume higher. This means that electrolytes and good hydration can improve hypovolemia (low blood volume).

 

Graphic showing why POTS patients have fluid balance issues: RAAS system dysregulation, frequent nausea, and too much excretion

Do electrolytes help manage POTS symptoms?

Electrolytes can help manage POTS symptoms in some people by helping the body retain water which can increase blood volume and correct hypovolemia.

 

Electrolytes will help POTS patients whose symptoms are worse when blood volume is low. Because electrolytes (along with good hydration) correct hypovolemia, some POTS patients will see improvements in symptoms like dizziness, nausea, low blood pressure, and fatigue.

 

It is important to note that there are several different types of POTS (Neuropathic POTS, Hyperadrenergic POTS, Hypovolemic POTS, and Secondary POTS), some of which may not see improvement with electrolyte supplementation because low blood volume is not what is causing POTS symptoms.

Symptoms of Postural Orthostatic Tachycardia Syndrome:

  • Dizziness
  • Nausea
  • Lightheadedness
  • Fainting
  • Rapid heartbeat or breathing
  • Thirst
  • Fatigue
  • Weakness
  • Low blood pressure

Symptoms of Hypovolemia:

  • Dizziness
  • Lightheadedness
  • Fainting
  • Rapid heartbeat or breathing
  • Thirst
  • Fatigue
  • Weakness
  • Low blood pressure

Common POTS symptoms graphics: nausea, rapid heartbeat, rapid breathing, fatigue, weakness

 

How much water should POTS patients drink?

The Cleveland Clinic recommends that patients with POTS should aim for about 2-2.5 liters (about 8.5-10.5 cups) of fluids per day. Sports drinks, juice, teas, broths, and of course water, all count towards this goal.

 

Patients should always consult with their healthcare team for individualized fluid intake recommendations.

How much salt should POTS patients have?

The Cleveland Clinic recommends that people with POTS have about 3,000-10,000 milligrams of sodium per day. This is why POTS patients are often recommended to eat high-salt diets.

 

A few things to keep in mind here.

 

First, it’s easy to make the mistake of assuming that a certain amount of salt is equal to a certain amount of sodium! Salt is 50% sodium because it’s made up of 50% sodium and 50% chloride ions. So, 1 teaspoon of salt is technically half a teaspoon of sodium. For reference, there are about 2,325 milligrams of sodium per teaspoon of salt.

 

Additionally, the recommended range of sodium intake for people with POTS (3,000-10,000mg) is quite a large range. It will take experimentation and assistance from your medical team to see what amount within this range is best for you, personally.

 

Graphic showing how much salt is recommended for POTS patients: 3000-10000mg daily

Electrolytes for POTS and dysautonomia patients

There are a variety of electrolyte supplements available that may help POTS and dysautonomia patients increase their sodium intake. Picking an electrolyte drink or powder can feel confusing. How much sodium should they have? And should added sugar be avoided?

 

Here are my thoughts on these questions.

How to choose an electrolyte supplement

Look for a supplement with enough salt to help you get closer to the 3,000-10,000mg sodium per day recommendation. A good rule of thumb would be to look for one with at least 500mg of sodium per serving.

 

Additionally, decide whether or not to choose one with added sugar. If you are not dehydrated and eat enough food daily, added sugar is probably not necessary. However, if you are pretty dehydrated or have not been able to eat much food due to illness, picking a supplement with added sugar is probably a good idea since it can help maximize the hydration process.

 

Here are a few popular electrolyte supplements, as well as my thoughts on whether or not they are a good option for someone with POTS or dysautonomia.

LMNT for POTS

LMNT is a popular electrolyte powder for athletes and POTS patients alike.

 

Here are my thoughts on LMNT as a registered dietitian who specializes in working with patients with EDS and POTS:

  • Good amount of sodium: LMNT contains 1000mg of sodium, enough to make a meaningful contribution to the recommended 3,000-10,000mg daily for POTS patients
  • Low sugar: LMNT does not contain added sugar, which is a bonus for people who are trying to reduce their added sugar intake
  • Good flavor: Many people like the taste of LMNT electrolytes (myself included!), although it is quite salty!

 

I think LMNT is a good choice for POTS patients who need a little help with reaching their sodium intake goals. Since sugar is actually needed to optimize the hydration process, LMNT is not the best choice for someone who is severely dehydrated. But for most POTS patients, LMNT is a great way to get more sodium and water in on a daily basis.

Nuun for POTS

Nuun is a popular electrolyte tablet that’s sold at most major grocery stores and Target. It’s also one of the more affordable options.

 

Here are my thoughts on Nuun as a registered dietitian who specializes in working with patients with EDS and POTS:

  • Not enough sodium: Nuun contains 300mg of sodium per tablet. This is likely not enough sodium to help someone with POTS feel better or make a meaningful contribution to the 3,000-10,000mg sodium per day recommendation
  • Low sugar: Nuun contains only 1 gram of added sugar
  • Good flavor: Many people like the taste of the various flavors available

 

While very affordable and widely available, I do not think that Nuun has enough sodium per serving to help most people with POTS feel the benefits of an electrolyte supplement. If you’re looking to add flavor to water, this could be a good option, though.

Liquid IV for POTS

Liquid IV is a popular electrolyte supplement among athletes, healthcare workers, and POTS patients. It’s marketed as a “hydration multiplier” since it contains electrolytes and sugar, which enhance water absorption into the circulatory system.

 

Here are my thoughts on Liquid IV as a registered dietitian who specializes in working with patients with EDS and POTS:

  • Okay amount of sodium: Each serving of Liquid IV contains 500mg of sodium, which is more than some electrolyte supplements but not as much as others that are around the same price point
  • Contains sugar: Most Liquid IV products contain over 10 grams of added sugar. While most of us don’t need to worry about sugar’s role in the hydration process since our bodies can use the carbohydrates from the food we eat, added sugar can actually be helpful for someone who is severely dehydrated and/or has not been able to eat much food due to severe symptoms or illness.
  • Okay flavor: My patients tend to not love the taste of Liquid IV because most flavors are quite sweet

 

In my opinion, Liquid IV is best for someone who is dehydrated and hasn’t been able to eat regularly due to illness or severe symptoms like nausea and vomiting. It is fine to use regularly as well, as long as added sugar in other foods is kept to a minimum.

 

 

Conclusion

Electrolytes are minerals such as sodium, chloride, potassium, calcium, and magnesium, which help maintain fluid balance in the body. Sodium, in particular, is important for fluid balance because it helps the body retain water by balancing the water inside and outside of cells.

 

Electrolytes can help manage some symptoms of Postural Orthostatic Tachycardia Syndrome (POTS), a type of dysautonomia, by increasing blood volume and correcting hypovolemia, a medical condition where someone experiences low blood volume.

 

Consuming electrolytes helps the body retain the water we drink, which increases blood volume and corrects hypovolemia. However, it is important to note that there are different types of POTS and some may not see improvement with electrolyte supplementation.

 

There are a variety of electrolyte supplements available, but some might not have enough sodium to make that much of a difference for POTS patients.

 

When choosing an electrolyte supplement, pick one that gets you closer to the recommended 3,000-10,000mg sodium per day recommendation.

 

Interesting in working with a dietitian who specializes in helping patients with conditions like POTS and hypermobility? Join my EDS Nutrition group program.

 

If you are looking for more information on POTS and dysautonomia, I recommend visiting awarenessforpotsies.org, a non-profit created and run a fellow patient who is also a healthcare professional.

1 thought on “Electrolytes for POTS and Dysautonomia: A Comprehensive Guide”

  1. About electrolytes – if someone with dysautonomia (post covid) increases substantially the amount of sodium ingested, is there a corresponding amount that they should increase potassium? Is there a guiding ratio?
    Thanks!

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