Foods to Avoid: What Foods Make POTS Worse?

October 19, 2025 •

4 min read

According to a 2021 POTS Expert Consensus Review, modifying diet can be a crucial step in managing symptoms for many with Postural Orthostatic Tachycardia Syndrome (POTS). Identifying what foods make POTS worse is a personalized process that can significantly improve daily well-being and reduce the frequency and severity of symptomatic flares.

Quick Summary

This guide provides a comprehensive overview of common dietary triggers for Postural Orthostatic Tachycardia Syndrome (POTS), including high-carbohydrate meals, alcohol, caffeine, and highly processed foods. It details why these items can exacerbate symptoms and offers guidance on alternatives and eating strategies to help manage the condition.

Key Points

High-Carbohydrate Meals: Large meals, especially those rich in refined carbs, can worsen symptoms by causing blood to pool in the gut, leading to dizziness and increased heart rate.
Alcohol: As a vasodilator and diuretic, alcohol can increase blood pooling, lower blood pressure, and cause dehydration, often exacerbating POTS symptoms.
Caffeine: For some, caffeine worsens tachycardia and dehydration, while others tolerate it well; individual response should be monitored under medical guidance.
Processed and High-Sugar Foods: These cause rapid blood sugar fluctuations that can lead to fatigue and brain fog, making symptoms worse.
Histamine and FODMAP Triggers: For those with MCAS or IBS comorbidities, foods high in histamine (e.g., aged cheese) or FODMAPs (e.g., onions, wheat) can trigger symptoms.
Hydration and Sodium: While avoiding certain foods is important, increasing fluid and sodium intake is a key management strategy for most POTS patients.

Common Dietary Triggers for POTS

For individuals with Postural Orthostatic Tachycardia Syndrome (POTS), certain foods and eating patterns can worsen symptoms such as dizziness, fatigue, and tachycardia. Understanding these triggers and their effects on the body can help in developing a personalized nutritional strategy.

Large, High-Carbohydrate Meals

One of the most frequently reported dietary triggers for POTS is a large meal, especially one high in refined carbohydrates. After consuming a large meal, the body directs a significant amount of blood to the digestive system to facilitate digestion. In a person with POTS, whose blood flow regulation is already compromised, this can lead to postprandial hypotension—a significant drop in blood pressure that diverts blood away from the brain and heart. This effect can cause increased dizziness, light-headedness, and a faster heart rate.

To mitigate this, it's recommended to shift from three large meals to smaller, more frequent meals throughout the day. Opting for balanced meals with protein and healthy fats alongside complex, low-glycemic carbohydrates can also help stabilize blood sugar and prevent dramatic shifts in blood flow.

Alcohol and Caffeine

Both alcohol and caffeine are common culprits for worsening POTS symptoms. Alcohol is a vasodilator, meaning it widens blood vessels, which can exacerbate blood pooling in the legs and lower blood pressure. It is also a diuretic, leading to dehydration, which further decreases blood volume and can trigger a flare-up. For these reasons, many POTS patients are advised to limit or completely avoid alcohol.

Caffeine can be a double-edged sword for people with POTS. While some report that it helps with alertness, for many, its stimulant and diuretic effects can worsen tachycardia, anxiety, and dehydration. Because individual tolerance varies widely, it is best to approach caffeine with caution and in consultation with a healthcare provider.

Processed and High-Sugar Foods

Highly processed foods and those high in refined sugars can be detrimental to managing POTS symptoms. These foods often contain additives, unhealthy fats, and excessive sugar, which cause rapid spikes and crashes in blood glucose. These fluctuations can increase fatigue, brain fog, and dizziness. Examples include:

Sweets and pastries
White bread and pasta
Sugary sodas and energy drinks
Packaged snacks and chips
Fast food and fried foods

Instead, a whole-foods-based diet rich in complex carbohydrates, lean protein, and healthy fats is recommended for more stable energy levels.

Foods High in Histamine or FODMAPs

For individuals with comorbidities like Mast Cell Activation Syndrome (MCAS) or Irritable Bowel Syndrome (IBS), certain foods high in histamine or FODMAPs can be problematic. Histamine is a compound that can trigger inflammatory responses, and some POTS patients are sensitive to high-histamine foods.

Similarly, FODMAPs are fermentable carbohydrates that can cause gastrointestinal distress, bloating, and diarrhea, which can exacerbate POTS symptoms by stressing the gut and nervous system.

Some high-histamine and high-FODMAP foods include:

High Histamine: Aged cheeses, cured meats, fermented foods, alcohol, and certain nuts.
High FODMAP: Onions, garlic, wheat, certain dairy products, and specific fruits like apples and pears.

Comparison Table: High-Carb vs. Balanced Meals for POTS


Feature	High-Carbohydrate Meal (e.g., large plate of white pasta)	Balanced Meal (e.g., grilled chicken with brown rice and vegetables)
Symptom Risk	High risk of postprandial hypotension, causing dizziness and tachycardia.	Lower risk of postprandial symptoms due to slower digestion.
Blood Sugar	Causes a rapid spike followed by a crash, leading to fatigue and brain fog.	Provides a steady release of energy, stabilizing blood sugar levels.
Digestive Effect	Can cause large amounts of blood to be diverted to the gut, decreasing overall circulation.	Promotes more balanced blood flow during digestion, preventing severe blood pooling.
Satiety	Can lead to feeling hungry again sooner due to blood sugar instability.	Keeps you feeling fuller for longer, supporting a smaller, more frequent meal pattern.
Nutrient Density	Often low in vital nutrients and fiber.	Rich in protein, fiber, and essential nutrients, supporting overall health.

Conclusion: Navigating Your Diet with POTS

Dietary management is a powerful tool for controlling Postural Orthostatic Tachycardia Syndrome symptoms, though it is not a cure. By being mindful of high-carbohydrate meals, alcohol, caffeine, and processed foods, individuals can significantly reduce their risk of triggering flares. Working with a healthcare provider or a registered dietitian is highly recommended for developing a personalized nutrition plan, especially if food sensitivities like gluten or high histamine foods are suspected. The key is to listen to your body, experiment with a balanced approach, and focus on smaller, more frequent meals rich in nutrients to support consistent energy and better blood pressure regulation.

For more detailed information, the nonprofit Standing Up to POTS offers extensive resources on nutritional strategies and managing POTS symptoms: Standing Up to POTS.

Frequently Asked Questions

Large meals, especially high-carbohydrate ones, can make POTS worse by diverting a large volume of blood to the digestive system, a process called splanchnic pooling. This can cause a drop in blood pressure, leading to lightheadedness, dizziness, and a rapid heart rate.

Yes, eating smaller, more frequent meals throughout the day can help prevent the dramatic blood flow shifts that occur after large meals. This strategy can lead to more stable blood pressure and fewer symptomatic episodes.

Caffeine's effect on POTS is highly individual. It acts as a stimulant and can increase heart rate, which is bad for many patients. However, some feel it improves alertness and blood pressure. It's best to discuss caffeine consumption with a doctor and monitor your personal reaction.

Alcohol acts as a diuretic, increasing fluid loss and causing dehydration, which reduces blood volume. It is also a vasodilator, causing blood vessels to widen and increasing blood pooling. Both effects can significantly worsen POTS symptoms like dizziness and tachycardia.

Not all POTS patients need to avoid high-histamine foods, but many with a comorbid condition called Mast Cell Activation Syndrome (MCAS) find a low-histamine diet helpful. Common high-histamine foods include aged cheeses, processed meats, and fermented items. If you suspect a sensitivity, discuss a low-histamine trial with your doctor.

Yes, highly processed foods are generally not recommended for POTS patients. They are often high in refined sugars and unhealthy fats, causing blood sugar instability and inflammation. A whole-foods diet supports more stable energy levels and overall better health management.

Some research suggests a higher prevalence of gluten intolerance and Celiac disease among POTS patients. Some individuals have reported reduced symptoms on a gluten-free diet. It is best to consult a healthcare professional before eliminating gluten to determine if it is right for you and to ensure adequate nutrition.