Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia, meaning a disorder of the autonomic nervous system. This system controls automatic body functions such as heart rate, blood pressure, breathing, digestion, and temperature regulation.
In people with POTS, the autonomic nervous system does not respond properly when moving from lying down to standing. The heart rate increases abnormally fast, but the blood pressure does not rise quickly enough to keep blood flowing to the brain. This mismatch is a major reason people with POTS experience lightheadedness, dizziness, fatigue, palpitations, brain fog, and weakness.
Why POTS Happens: Common Subtypes
POTS can be difficult to diagnose, and there is no single cause. Researchers recognize several subtypes based on likely underlying mechanisms:
Neuropathic POTS
This occurs when small nerves—especially those in the legs and core—do not function properly. These nerves normally help blood vessels tighten when standing. When they fail, blood pools in the lower body instead of returning to the heart and brain.
Hyperadrenergic POTS
This form is driven by an overactive “fight-or-flight” response. The sympathetic nervous system releases excess adrenaline, leading to rapid heart rate, anxiety, tremors, and sometimes elevated blood pressure.
Hypovolemic POTS
In this subtype, total blood volume is low. With less circulating fluid, the body struggles to maintain adequate blood pressure when upright. Many patients have features of more than one subtype, which is why treatment often requires multiple strategies.
Treatment Strategies and Why They Help
Salt Intake
Salt helps the body retain fluid, which increases blood volume and improves blood pressure regulation when standing. This is especially important for people with hypovolemic and neuropathic POTS.
Ways to reach the goal safely:
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Adding salt to meals throughout the day
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Using electrolyte drinks to provide 3–5 grams of salt daily
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ZEROLyte: 1–2 packets daily (2.5 g salt per packet)
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Thorne Electrolyte Powder: 2–3 servings daily (1.25 g salt per serving)
Using high-quality salt free of plastic contamination is recommended. Brands such as Vera Salt and Redmond Real Salt are commonly used. Bone broth is another helpful option. It provides sodium, fluids, and protein, which supports blood volume and muscle strength. Heavy-metal–tested brands include Kettle & Fire, Fond, Wander Broth, Bare Bones, and Miller’s Bio Farm.
Compression Socks
Compression socks help prevent blood from pooling in the legs when standing. By gently squeezing the veins, they push blood back toward the heart and brain, reducing dizziness and fatigue. This is particularly helpful for neuropathic POTS.
Exercise and Lower-Body Strength Training
Deconditioning worsens POTS symptoms. Strengthening the muscles of the legs and core helps act as a “second heart,” pumping blood upward when standing. Starting with recumbent or seated exercises and gradually building strength improves circulation, autonomic regulation, and long-term symptom control.
Quality Sleep (Aim for 8 Hours)
Sleep is essential for nervous system repair and hormone regulation. Poor sleep worsens autonomic dysfunction, inflammation, and fatigue. Consistent, restorative sleep supports better heart rate and blood pressure regulation during the day.
Acupuncture, Mildfulness and Meditation
These therapies help calm the overactive sympathetic nervous system, especially in hyperadrenergic POTS. By promoting parasympathetic (rest-and-digest) activity, they may reduce palpitations, anxiety, and overall symptom severity.
Track and Discuss Symptoms With Your PCP
Symptoms such as constipation, diarrhea, bloating, migraines, and headaches are common in POTS and reflect autonomic involvement beyond heart rate and blood pressure. Tracking these changes helps guide treatment and identify triggers or progression.
Referral to a POTS-Trained Neurologist
If lifestyle and supportive measures do not adequately control symptoms, referral to a neurologist experienced in POTS is appropriate. Specialized evaluation can help clarify subtype, guide advanced treatment options, and rule out overlapping conditions.
Key Takeaway
POTS is a complex condition, but targeted lifestyle strategies can significantly improve quality of life. Increasing blood volume, supporting circulation, strengthening muscles, and calming the nervous system all work together to reduce symptoms and restore daily function.
