POTS (postural orthostatic tachycardia syndrome) is commoner than we think. 1 in 3 people with a diagnosis of Chronic Fatigue Syndrome(CFS) or ME also have POTS. Similarly a large number of patients with Fibromyalgia probably also have POTS. In my practice, I have the privilege of managing the treatment of about 150 patients with POTS . I have found that lifestyle and behaviour change recommendations can be a very valuable and effective adjunct to pharmacotherapy in terms of both empowering the patient and helping improve overall quality of life.

The aim of the lifestyle modifications are five-fold:

To increase the amount of blood volume within the body

To minimise pooling of blood in the legs by compression or strengthening the leg muscles

To prevent further deconditioning

To minimise adrenaline surges

To correct any electrolyte, nutritional and hormonal deficiencies



Here are some of the lifestyle measures that I recommend to all my patients who have POTS . It goes without saying that you should always check with your own doctor if the following recommendations are suitable for you



Increase daily fluid intake to at least 3L of water a day. The fluid intake should be increased even more when fluid losses are higher such as during hot weather. I would also recommend drinking a couple of glasses of water first thing in the morning about 20-30 minutes before adopting an upright posture.

Minimise loss of fluid by avoiding diuretics, caffeine, alcohol, and sodas.

Increase daily sodium intake to 10-12g of sodium per day. This can be done by increasing salt intake by using more table salt on food but also by taking slow salt tablets. Salt will help retain more volume within the body. Without salt, all the extra water that is drunk will simply pass out in the urine.

Increased salt intake can be distasteful for some patients and i advise supplementing electrolytes (such as 2 sachets of Dioralyte/day in divided doses) to water.

Magnesium supplementation: It is estimated that 75% of the population is deficient in Magnesium. The Blood tests for magnesium are notoriously unreliable and therefore i usually recommend magnesium supplementation regardless of the blood test results. In terms of supplements, i advise my patients to avoid magnesium oxide but other commonly available magnesium supplements such Magnesium CItrate 200mg daily or magnesium taurate 125 mg bd work well.