POTS - POSSIBLE SOLUTIONS
Updated: 2 days ago
(Postural orthostatic tachycardia syndrome)
POTS can be very difficult to diagnose due to so many symptoms. This often leads patients to try many doctors. I was in the ER many times, and even they didn't put it together. It used to consume me and affect how I lived each day. Even my last cardiologist didn't recognize I had POTS, despite my horrible symptoms and repeated visits.
I used to get some scary low blood pressure drops. I get confused, dizzy and act like I had been drinking. The room spins and I get blurred vision when I stand up. I took many failed medications, but eventually I found solutions to keep my electrolytes balanced and my blood pressure up to 100/60. I've managed well for years. My diet and how much I sweat change my needs.
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
Want to learn what POTS is, the signs, and what can cause it? Read my POTS CAUSES AND SYMPTOMS post:
Where I have a recommended product, the link to buy it is right under that product. Sign up here first for the Fullscript discount (25% off):
ELECTROLYTES
- I must use a quality electrolyte drink every single day or I have major issues. I need more in hot weather, and I make sure to increase on sauna days. I use one right before the sauna to help prevent an electrolyte imbalance.
- I've tried many products. Many work and many do not, and I'm always testing new ones. Skip cheap, low-sodium versions.
- These companies also respond with compassion when I ask them to donate products for raffles in our groups.
Learn more and find products here:
- My doctor taught me to stick to electrolytes with under 200 mg of potassium per serving. ALWAYS ask your doctor before adding potassium.
- I prefer unflavored electrolytes when possible because of my MCAS.
Redmond Re-Lyte (capsules or drink mix) - my favorite for quality and taste, with an unflavored option
Buy here (Redmond Re-Lyte: electrolyte capsules or drink mix; discount applies automatically, or use code RISEABOVE):
Jigsaw Health Adrenal Cocktail (capsules or powder) - an old favorite. The capsules have 380 mg of potassium per 6 capsules, so I split them up through the day.
Buy here (Jigsaw Health Adrenal Cocktail capsules: vitamin C, sea salt and potassium bicarbonate; 380 mg potassium per serving, ALWAYS ask your doctor before adding potassium):
Buy here (Jigsaw Health Adrenal Cocktail powder: vitamin C, sea salt and potassium bicarbonate; 380 mg potassium per serving, ALWAYS ask your doctor before adding potassium):
Quinton Hypertonic (unflavored seawater) - I learned about it from my Lyme doctor
Buy here (Quicksilver Scientific Original Quinton Hypertonic ampoules: seawater):
MAKE YOUR OWN COPYCAT ELECTROLYTES TO SAVE
My recipe is in my Adrenal Cocktail and Electrolytes Recipes post.
Learn more and find products here:
ORS ELECTROLYTES
- When my POTS was severe, I used ORS (oral rehydration solution) packets for 2 years. Now I use an ORS in extreme situations or during a big flare, to try to avoid needing an IV.
- The closest option I've found on Fullscript is BUBS Naturals Hydrate electrolyte drink mix. It's not a true ORS, but it's close. It has 200 mg potassium per packet, right at my limit.
- Learn what an ORS is and how to make your own in my Electrolytes post (linked above).
Buy here (BUBS Naturals Hydrate, Mixed Berry: sodium, potassium and magnesium; 200 mg potassium per packet, ALWAYS ask your doctor before adding potassium):
Buy here (BUBS Naturals Hydrate, Lemon: sodium, potassium and magnesium; 200 mg potassium per packet, ALWAYS ask your doctor before adding potassium):
SALT
- My cardiologist stressed that I keep up on my salt. He says his POTS patients need 4,000 to 6,000 milligrams of sodium a day, and some need even more.
- A clean diet gets around 2,000 to 3,000 mg total, so I add about 3,000 mg of sodium. The better my diet, the less sodium I get, so I have to adjust.
- Cleveland Clinic suggests raising sodium to between 3,000 and 10,000 mg a day for POTS. PoTS UK suggests 6 to 10 grams of extra salt a day for adults (6 grams is about one level teaspoon).
- Salt needs are different for everyone. If you have heart or kidney disease or high blood pressure, talk with your doctor first.
Redmond Real Salt - in my opinion the best quality and taste. They did a giveaway in my group, so they're also compassionate.
Buy here (Redmond Real Salt shaker: unrefined salt; use code RISEABOVE):
FLUIDS
- PoTS UK advises adults to drink about 2 to 3 liters of fluid a day. Cleveland Clinic and Johns Hopkins say about 2 to 2.5 liters.
- Spread your fluids out through the day.
COMPRESSION
- I was told to wear knee-high compression socks, and I had to wear them every day for a year.
- PoTS UK says waist-high compression gives the most benefit, and a small 2021 study found legs plus belly worked better than legs alone. I didn't personally need waist-high.
- PoTS UK notes the recommended pressure for POTS is 23 to 32 mmHg at the ankle.
WHEN YOU FEEL FAINT
- Lie down and raise your legs if you can, or sit down (PoTS UK).
- Cross your legs while standing, rock up and down on your toes, clench your buttocks, stomach muscles and fists.
- Avoid standing or sitting still for long. PoTS UK says fidgeting is the key.
GENTLE MOVEMENT
- Seated and lying-down exercise is usually easier with POTS, like a recumbent bike, a rowing machine or swimming (PoTS UK, Dysautonomia International).
- Start low and go slow. Build up based on how you feel, not a strict plan (Johns Hopkins).
- If you also have ME/CFS or post-exertional crashes, PoTS UK says graded exercise therapy is not recommended. Listen to your body.
AVOID TRIGGERS
- Heat, like hot showers, hot baths or hot days. (I still use my sauna with electrolytes first, but heat makes POTS worse for many people.)
- Alcohol.
- Large, heavy meals high in sugar and white flour. Smaller meals can help.
- Standing still for a long time, and getting up too fast.
- Menstrual periods can make symptoms worse too. See my Menstrual Cycles and POTS post:
SLEEP WITH THE HEAD OF YOUR BED RAISED
- Cleveland Clinic suggests raising the head of your bed six to 10 inches.
A NOTE ON CLEAN DIETS
- A doctor once asked me if I eat many packaged or processed foods. She explained that people with chronic health conditions tend to eat cleaner than most, which means healthier choices, but also less salt more times than not.
- She said most people are watching their salt, but with POTS you need more. A healthy diet can actually make POTS worse, so sodium adjustments must be made.
IV SALINE
- My favorite cardiologist, Dr. Sanjay Gupta, a consultant cardiologist at York Teaching Hospital in York, UK, says weekly IV saline has been transformative for most of his POTS patients. He's such a kind man and has taken the time to talk with me several times.
- I sent his saline video to my cardiologist and actually got insurance coverage.
- Please know PoTS UK says there isn't good research yet showing regular IV fluids work better than drinking more, and IV lines carry risks like infection and clots. This is a decision to make with your doctor.
Dr. Gupta's IV saline article:
His website:
WHAT DR. TANIA DEMPSEY SHARES
- Dr. Dempsey sees POTS symptoms in at least half of her Lyme patients. She feels that if Lyme is the root cause, treating the infection may help these symptoms improve.
- She suggests at least 8 to 10 glasses of water a day and salt intake up to 8 to 10 grams a day.
- She finds compression stockings that go up to the waist helpful, and recumbent exercise, like a recumbent bike or rower, easier to tolerate.
- Mast cell activation syndrome (MCAS) is a big contributor for many of her Lyme patients with POTS. She often starts with antihistamines, and mentions quercetin, luteolin and vitamin C for mast cell support, adding one at a time.
- She says there are no specific supplements that directly treat POTS, and she has started using IVIG for POTS in her practice.
- She describes POTS as treatable, controllable and potentially reversible with the right help.
Learn more and find products here:
MEDICATIONS YOUR DOCTOR MAY TALK ABOUT
- Medications often used for POTS include beta blockers, ivabradine, midodrine, fludrocortisone and pyridostigmine (Dysautonomia International). No medication is officially approved just for POTS, but doctors may prescribe some to help with symptoms (Cleveland Clinic).
- Low-dose naltrexone (LDN): in a small 2023 Cleveland Clinic case series, 3 of 6 patients said their POTS improved, but there's little evidence yet.
POTS EDUCATION, TESTING AND MORE
- To keep this post focused on what helps, my education, testing and menstrual cycle info now have their own posts. Every POTS post is in my POTS Directory, linked at the bottom of this post.
FREE POTS AND DYSAUTONOMIA MANUAL
If you want to slowly get stronger without crashing, the free ATLAS manual from the Cohen Center for Recovery from Complex Chronic Illness at Mount Sinai may help. It was written by Dr. Valerie Iovine Rogers, PT, DPT, for patients, caregivers and doctors. It walks through supports like fluids, compression and positioning, a daily breathing routine, tracking your symptoms, pacing, and moving through gentle phases of activity at your own speed. Bring it to your doctor or physical therapist so you can work through it together.
BEFORE YOU START
- Read the warning on each bottle.
- ALWAYS ask your doctor before adding potassium. Jigsaw Adrenal Cocktail has 380 mg of potassium per serving, and BUBS Hydrate has 200 mg per packet.
- Salt needs are different for everyone. If you have heart or kidney disease or high blood pressure, talk with your doctor first.
MY EXPERIENCE
I've managed my POTS well for years by keeping my electrolytes balanced and my blood pressure up to 100/60. I use a quality electrolyte drink every single day, add about 3,000 mg of sodium, and adjust for heat, sauna days and my diet. When my POTS was severe, I used ORS packets for 2 years, and I wore knee-high compression socks every day for a year. I sent Dr. Gupta's saline video to my cardiologist and actually got insurance coverage.
RELATED POSTS
POTS / DYSAUTONOMIA EDUCATION
POTS DIRECTORY
SOURCES
Dr. Tania Dempsey, Lyme and POTS (2023)
PoTS UK, Diet and fluids (2023)
PoTS UK, Compression clothing (2023)
PoTS UK, Preventing fainting (2024)
PoTS UK, Exercise (2024)
PoTS UK, IV fluids (2023)
Cleveland Clinic, POTS (2026)
Johns Hopkins Medicine, POTS (2026)
Dysautonomia International, POTS treatment essentials (no date shown)
Dr. Sanjay Gupta, York, IV saline for POTS (2022)
Cureus, LDN in POTS (2023)
Mount Sinai Cohen Center, ATLAS manual (2026)
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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