Nutrition Diet: What drinks should you avoid with POTS?

For people with Postural Orthostatic Tachycardia Syndrome (POTS), insufficient blood volume often exacerbates symptoms. Understanding what drinks should you avoid with POTS is a crucial step towards better managing your condition by preventing dehydration and blood sugar fluctuations that can trigger dizziness, fatigue, and other effects.

Quick Summary

Individuals with POTS should avoid or limit beverages like alcohol, caffeine, and high-sugar drinks to help manage symptoms. These can worsen dehydration, increase heart rate instability, and cause blood sugar crashes. Prioritizing proper hydration with water and low-sugar electrolyte fluids is an important strategy.

Key Points

• Avoid Alcohol: Alcohol is a vasodilator and diuretic, worsening blood pooling and dehydration, which are major triggers for POTS symptoms like dizziness and low blood pressure.

• Limit High-Sugar Drinks: Sugary beverages can cause rapid blood sugar spikes and crashes, leading to increased fatigue and shakiness, a common issue for many with POTS.

• Approach Caffeine with Caution: The effect of caffeine varies greatly among individuals with POTS; it can trigger or worsen tachycardia and dehydration in some, while others may find it helps.

• Choose Low-Sugar Electrolytes: Opt for electrolyte drinks that are low in sugar to support fluid balance and increase blood volume without causing blood sugar instability.

• Prioritize Water and Salt: Proper hydration with at least 2-3 liters of water daily, combined with increased sodium intake, is crucial for managing low blood volume in most POTS patients.

• Consider Herbal Teas and Broth: Non-caffeinated herbal teas and high-sodium broths are excellent, soothing alternatives to help meet daily fluid and salt requirements.

Understanding the Impact of Beverages on POTS

Proper fluid intake is a cornerstone of managing Postural Orthostatic Tachycardia Syndrome (POTS), a condition caused by an autonomic nervous system malfunction. A key component of a POTS-friendly diet is increasing overall fluid intake to combat the low blood volume (hypovolemia) that often accompanies the condition. However, not all drinks are created equal. Some common beverages can actively worsen POTS symptoms by disrupting hydration, impacting heart rate, and causing blood sugar fluctuations. By understanding the specific effects of certain drinks, you can make more informed choices to improve your daily comfort and stability.

The Primary Culprits: What to Eliminate or Limit

For many with POTS, certain drinks act as triggers that can intensify symptoms. While personal tolerance can vary, medical experts and patient experience generally advise caution with the following:

• Alcohol: A known dehydrator and vasodilator, alcohol can cause blood vessels to widen, leading to increased blood pooling in the legs and a greater drop in blood pressure upon standing. For most with POTS, even small amounts can significantly worsen symptoms like lightheadedness and tachycardia. It also interferes with fluid balance and can increase sympathetic nervous system activity.
• High-Sugar Drinks: Beverages loaded with refined sugars, such as soda, sweetened coffees, and many juices, can cause a rapid spike and subsequent crash in blood glucose levels. This instability can exacerbate feelings of fatigue, lightheadedness, and shakiness. Digesting large amounts of simple carbohydrates can also divert blood flow to the gut, leaving less blood to circulate to the brain and heart.
• Energy Drinks: Often containing high doses of both caffeine and sugar, energy drinks are particularly problematic. The combination of a strong stimulant and a simple carbohydrate load can trigger tachycardia, worsen jitteriness, and cause severe blood sugar instability. Some studies even link energy drink overuse to the onset of POTS symptoms.
• Caffeine: The effect of caffeine on POTS patients is highly individual. As a stimulant, it can increase heart rate, which is already a core feature of the syndrome. It is also a mild diuretic, promoting fluid loss. Some people find it helpful for boosting blood pressure, while others experience worsened tachycardia, anxiety, and digestive issues. It is best to approach caffeine with caution and discuss it with a healthcare professional.
• Artificial Sweeteners: Some research suggests that certain artificial sweeteners found in diet sodas and other sugar-free products may negatively impact gut health and contribute to glucose intolerance. For those with gastrointestinal symptoms, these additives may worsen digestive discomfort and lead to energy fluctuations.

Comparison of POTS-Friendly vs. Problematic Drinks

Feature	Problematic Drinks	POTS-Friendly Drinks
Effect on Hydration	Dehydrating due to diuretic properties (alcohol, caffeine) or high sugar content.	Actively hydrating, helping to increase blood volume.
Effect on Heart Rate	Can increase tachycardia and palpitations (caffeine, alcohol).	Neutral or calming effect; does not trigger or worsen rapid heart rate.
Effect on Blood Pressure	Can cause a drop in blood pressure (alcohol) or destabilize it (caffeine).	Helps stabilize blood pressure, especially with added salt/electrolytes.
Effect on Blood Sugar	Causes spikes and crashes that lead to fatigue (high-sugar drinks).	Maintains stable blood sugar levels; avoids sudden energy drops.
Gut Health	Can cause irritation, inflammation, or digestive upset (artificial sweeteners, caffeine).	Soothing and often rich in electrolytes (herbal tea, broths, coconut water).

Smart Swaps and Better Hydration Choices

Given that staying well-hydrated is critical, finding palatable alternatives to potentially harmful beverages is important. These swaps focus on increasing blood volume without triggering negative symptoms:

• Water: The most basic and important fluid. Aim for 2-3 liters daily, and remember to sip frequently throughout the day rather than drinking large amounts at once. For some, adding a slice of lemon or cucumber can improve the taste and encourage more intake.
• Low-Sugar Electrolyte Drinks: These are specifically designed to replenish fluids and critical minerals like sodium and potassium, which are essential for POTS management. Look for low-sugar options or make your own with water, salt, and a flavor source like lemon juice.
• Coconut Water: A natural source of electrolytes, coconut water is often well-tolerated and can help with hydration. Just be mindful of the sugar content in certain brands.
• Herbal Tea: Non-caffeinated options like peppermint, chamomile, and ginger tea can be soothing and contribute to fluid intake. They can be consumed hot or iced and may help with digestive symptoms.
• Broth: High in sodium, broth is an excellent way to increase both fluid and salt intake, particularly on days when eating is difficult.
• Milk: For those without a dairy intolerance, milk and milk alternatives can be hydrating and a source of protein and fat, which slows down digestion.

Conclusion: Tailoring Your Hydration Strategy

While general dietary recommendations for POTS provide a helpful framework, the condition's heterogeneity means that individual responses can differ significantly. The primary goal is to prioritize adequate hydration to support blood volume, which helps to alleviate many of the debilitating symptoms of orthostatic intolerance. For many, this means strictly avoiding alcohol and high-sugar drinks, while treating caffeine with caution and evaluating personal tolerance. However, always consult a healthcare provider or a registered dietitian experienced with dysautonomia before making major dietary changes. They can help you create a personalized nutrition plan that best supports your unique needs, helping you make the right beverage choices for a better quality of life.

Visit Dysautonomia International for more information on managing POTS.

Frequently Asked Questions

Why is alcohol particularly bad for people with POTS?

Alcohol acts as both a diuretic and a vasodilator. As a diuretic, it increases fluid loss, leading to dehydration. As a vasodilator, it widens blood vessels, which promotes blood pooling in the legs. Both effects lower blood volume and pressure, which can significantly worsen POTS symptoms like dizziness and a rapid heart rate.

Why should I be cautious with caffeine if I have POTS?

Caffeine is a stimulant that can increase heart rate, potentially worsening the tachycardia characteristic of POTS. It is also a diuretic, which can contribute to dehydration. However, reactions vary, and some people with POTS find it improves their alertness. It's important to monitor your personal response and consult a doctor.

Do I need to avoid all sugary drinks?

For most people with POTS, it is best to limit or avoid drinks with high levels of refined sugar, such as soda and sweetened juices. These can cause rapid blood sugar fluctuations that trigger fatigue, lightheadedness, and shakiness. Opt for low-sugar alternatives or natural sources of energy if needed.

Are energy drinks safe for people with POTS?

No, energy drinks are generally not recommended for people with POTS. They typically contain high amounts of caffeine and sugar, creating a powerful combination of stimulants and blood sugar spikes that can severely aggravate POTS symptoms.

What kind of drinks should I have instead?

Focus on hydrating fluids like water, low-sugar electrolyte drinks, herbal teas, broths, and coconut water. These help increase blood volume and provide necessary electrolytes without the negative side effects of caffeine, alcohol, or high sugar content.

How does increasing fluid intake help my POTS symptoms?

Many people with POTS have low blood volume (hypovolemia). Consuming adequate fluids, especially in combination with increased salt intake, helps expand your blood volume. This can improve blood flow and reduce symptoms like dizziness and lightheadedness when you stand up.

Should I use artificial sweeteners with POTS?

Some individuals with POTS report worsened symptoms with artificial sweeteners, as they may negatively impact gut health and overall energy balance. If you have a sensitivity, it may be best to avoid them and opt for naturally sweetened or unsweetened drinks.