Hydration and Electrolytes for POTS - What Actually Helps?

If you have POTS, you may have heard some version of: “Just drink more water and eat more salt.”

And while hydration and sodium really can be important tools for managing Postural Orthostatic Tachycardia Syndrome (POTS), the reality is a little more complicated. You can drink water all day and still feel dizzy. You can buy an electrolyte packet that says “hydration” on the front and discover it contains very little sodium. You might feel significantly better with increased sodium, while someone else with POTS needs a more individualized approach because of their blood pressure, medications, kidney function, gastrointestinal symptoms, etc.

So, what does hydration for POTS actually look like?

Let’s break down why fluids and sodium matter, how much people with POTS may need, what to look for in an electrolyte drink, and how to make hydration more manageable when chronic illness already takes up plenty of your brain space.

What is POTS?

Postural Orthostatic Tachycardia Syndrome, or POTS, is a form of orthostatic intolerance involving an abnormal increase in heart rate when a person moves into an upright position.

Symptoms can include:

• Dizziness or lightheadedness

• Racing heart or heart palpitations

• Fainting or feeling like you might faint

• Fatigue

• Brain fog

• Headaches

• Shakiness

• Nausea

• Shortness of breath

• Exercise intolerance

• GI symptoms such as bloating or nausea

POTS can have several contributing mechanisms. Some people experience low circulating blood volume, while others have significant blood pooling, autonomic nervous system dysfunction, excessive sympathetic nervous system activity, or a combination of factors. This is why hydration gets so much attention in POTS treatment.

Why does hydration matter for POTS?

When you stand up, gravity naturally pulls some blood toward your legs and abdomen. Normally, your autonomic nervous system responds by tightening blood vessels and making other tiny adjustments so enough blood continues circulating back toward your heart and brain.

With POTS, that system doesn’t always compensate effectively. Blood may pool in the lower body, circulating volume may be lower, and the heart may speed up in an attempt to keep blood moving.

Increasing fluid intake can help support circulating blood volume. For people whose POTS includes low blood volume, increasing both fluids and sodium may help expand plasma volume and improve the body’s response to standing.

This is why plain water isn’t always the entire answer for hydration.

Why sodium is so important for POTS

Sodium helps the body retain fluid. If you substantially increase your water intake without consuming enough sodium to go along with it, you may not get the same blood-volume-supporting benefit you’re hoping for.

Research in people with POTS has found that a higher-sodium diet can increase plasma volume while decreasing standing heart rate and standing norepinephrine compared with a low-sodium diet.

In other words, the salt recommendation isn’t arbitrary. For many people with POTS, sodium is being used therapeutically to support blood volume and circulation.

Salt and sodium are not the same thing

This distinction gets confusing very quickly.

Salt is sodium chloride. Sodium is only one component of salt.

For example, 1 teaspoon of table salt contains roughly 2,300 mg of sodium.

So if one resource recommends a certain number of grams of salt and another recommends a certain number of milligrams of sodium, you can’t compare those numbers directly. That matters quite a bit when you’re trying to figure out whether your electrolyte drink is actually helping you meet your prescribed sodium goal.

How much water should you drink with POTS?

There is no single hydration prescription that works for every person with POTS. Clinical recommendations commonly fall around 2 to 3 liters of fluid per day, although individual needs can vary.

Your actual needs can depend on things like:

• Your body size

• How much you sweat

• Climate and heat exposure

• Physical activity

• Diarrhea or vomiting

• Medications

• Kidney function

• Blood pressure

• Other cardiovascular conditions

• Pregnancy or lactation

• Your specific POTS presentation

And more fluid isn’t automatically better. Drinking excessive amounts of plain water can become counterproductive and, in extreme circumstances, can contribute to dangerously low blood sodium.

How much sodium do you need with POTS?

This is one of the most confusing POTS nutrition questions because recommendations vary between organizations, clinicians, and individual patients.

Cleveland Clinic notes that some people with POTS may be advised to consume approximately 3,000 to 10,000 mg of sodium per day. The Heart Rhythm Society consensus statement has also discussed intake of approximately 10 to 12 grams of salt per day, which is roughly 4,000 to 5,000 mg of sodium. That’s significantly more sodium than is typically recommended to the general population.

This is important:

A POTS diagnosis isn’t automatically a prescription to start eating the highest sodium amount you can tolerate.

Your target should ideally be individualized with your physician, cardiologist, autonomic specialist, or dietitian. Higher sodium intake may require additional caution or may not be appropriate for some people with conditions such as kidney disease, heart failure, certain types of hypertension, or other medical concerns.

Do you actually need electrolytes for POTS?

Not necessarily in packet form. You need fluid and the appropriate amount of electrolytes, particularly sodium, but those electrolytes can come from beverages, food, salt added to meals, oral rehydration solutions, electrolyte supplements, or some combination of these.

Electrolyte drinks are often useful simply because they make it easier to get sodium and fluid at the same time.

They can also be helpful for people who:

• Have difficulty eating enough salty foods

• Struggle with early satiety

• Have nausea in the morning

• Sweat heavily

• Have difficulty remembering to drink throughout the day

• Experience symptom flares in hot weather

• Need an easier option on low-energy days

• Have GI symptoms that make large meals difficult

Convenience can be important when you’re managing a chronic illness.

What are the best electrolytes for POTS?

There isn’t one universally “best” electrolyte drink for POTS.

And this is where marketing can get a little sneaky. A product can call itself an electrolyte drink while containing relatively little sodium. That might be perfectly adequate for someone drinking it after a casual workout but less useful for someone trying to meet a therapeutic sodium target for POTS. Instead of picking an electrolyte based on the prettiest packet, read the nutrition label.

When comparing electrolyte drinks for POTS, look at:

1. Sodium per serving

Compare the sodium in one serving with the sodium goal your healthcare team has recommended. A drink with 50 mg of sodium and one with 1,000 mg of sodium are technically both “electrolyte drinks,” but they serve very different purposes.

2. How much water it is mixed with

A high-sodium electrolyte mixed into 16 ounces of water and a lower-sodium electrolyte mixed into 32 ounces will contribute differently to your overall hydration plan.

Think about both sides of the equation:

How much fluid am I getting?

and

How much sodium am I getting with it?

3. Carbohydrate

Sugar-free is not automatically better. Some oral rehydration solutions intentionally contain glucose because glucose and sodium are absorbed together through sodium-glucose cotransport in the intestine, which facilitates water absorption.

This is why a true oral rehydration solution, or ORS, is different from simply adding flavored minerals to water. If you prefer a sugar-free electrolyte and it works well for you, that’s completely fine. But there’s no need to fear an electrolyte drink simply because it contains carbohydrate.

4. GI tolerance

The “perfect” electrolyte formula isn’t useful if drinking it gives you diarrhea, reflux, bloating, or nausea.

Some people are sensitive to:

• Sugar alcohols

• Large amounts of magnesium

• Certain artificial sweeteners

• Acidic flavorings

• Large carbohydrate loads

• Very concentrated beverages

You may need to experiment with concentration, serving size, temperature, flavor, or brand to find something your GI system tolerates.

5. Sensory preferences & taste

If the electrolyte drink you bought tastes like salty ocean water to you, chances are you’re not going to consistently drink it. A slightly less “optimal” product that you reliably consume can be far more useful than the theoretically perfect electrolyte collecting dust in your pantry.

What is an Oral Rehydration Solution?

An oral rehydration solution (ORS) is a specific combination of water, sodium, glucose and other electrolytes designed to enhance fluid absorption.

The sodium and glucose aren’t randomly paired together. The intestine contains transporters that absorb sodium and glucose together, and water follows along with that absorption process.

There is also some POTS-specific research here. In a small study of children and young adults with POTS, oral rehydration solution improved short-term orthostatic tolerance and cerebral blood flow measures during orthostatic stress.

That doesn’t mean everyone with POTS needs a medical-grade ORS every day. But it helps explain why, for some people, water plus an appropriate electrolyte solution feels noticeably different from water alone.

Can you get enough sodium from food?

Absolutely, electrolyte packets aren’t mandatory. Depending on your sodium goal, incorporating salty foods throughout the day may make it much easier to meet your needs without trying to choke down increasingly salty beverages.

Options might include:

• Soups and broths

• Pretzels

• Crackers

• Salted nuts

• Pickles

• Olives

• Cheese

• Cottage cheese

• Salted popcorn

• Deli meats

• Salted rice or potatoes

• Sauces and condiments

• Soy sauce or tamari

• Adding salt to meals and snacks

There is no nutritional gold star for getting your sodium from the most conventionally “healthy” food possible. If pretzels are an easy way for you to get sodium and carbohydrates when you’re nauseous and exhausted, pretzels are doing something useful.

A simple POTS hydration strategy

Instead of waiting until 4 p.m. to realize you’ve had half a cup of coffee and approximately three sips of water, it can help to try to attach hydration to things already happening in your day.

For example:

When you wake up:
Keep an electrolyte drink or water near your bed and begin hydrating before or around the time you get upright.

With breakfast:
Include fluid plus a source of sodium.

Mid-morning:
Refill your water bottle or make another electrolyte drink.

With lunch:
Include another beverage and intentionally salt your meal if that’s part of your treatment plan.

Afternoon:
Use a snack as another opportunity for both fluid and sodium.

Evening:
Check in with your overall intake rather than trying to catch up by drinking an enormous amount of water right before bed.

The bigger goal is to spread hydration and sodium throughout the day so you aren’t constantly trying to rescue yourself from a hydration deficit.

What if drinking a lot at once makes me nauseous?

This is common, especially when POTS overlaps with GI symptoms, early satiety, gastroparesis, reflux, Ehlers-Danlos syndrome, or other chronic conditions. You don’t necessarily need to drink a giant bottle of water in one sitting.

You could experiment with:

• Smaller amounts more frequently

• Sipping instead of chugging

• Drinking more between meals if fluids make you overly full

• Trying colder or room-temperature drinks

• Using a straw if it helps you drink more easily

• Trying different electrolyte concentrations

• Using salty foods alongside smaller amounts of fluid

• Beginning hydration earlier in the day instead of playing catch-up later

Hydration strategies should work with your body, not become another daily task you’re failing at.

Why does POTS feel worse in the morning?

Many people with POTS find mornings especially difficult. This is mainly because you’ve gone several hours overnight without drinking, and prolonged lying down changes how the body regulates fluid. Once you sit or stand, your cardiovascular system suddenly has to compensate for gravity again.

For some people, having fluid and sodium available first thing in the morning can make that transition more manageable.

You might keep:

• A prepared electrolyte bottle

• Shelf-stable electrolyte packets

• Water

• A salty snack

next to your bed or somewhere easily accessible in the morning.

Removing steps is a legitimate nutrition strategy, especially when dizziness, fatigue, pain, or nausea make multi-step routines difficult.

POTS hydration during hot weather, exercise and illness

Your baseline hydration needs may not be your hydration needs every single day. Heat is a common POTS trigger because it can widen blood vessels and make blood pooling more pronounced. Illness and strenuous exercise can also worsen symptoms.

You may need a different hydration plan during:

• Hot summer days

• Travel

• Fever

• Vomiting or diarrhea

• Increased sweating

• Exercise

• Long periods of standing

• Menstruation

• A POTS flare

This is one reason I often prefer thinking about hydration as a range and a toolkit, rather than one exact number you have to hit every day.

What if you have POTS and an eating disorder or history of disordered eating?

POTS recommendations can get complicated when you also have an eating disorder history.

Tracking exact ounces of fluid, milligrams of sodium, calories, carbohydrate grams, or food intake can quickly become another avenue for rigidity or compulsive monitoring. You don’t necessarily need to track everything forever.

A dietitian familiar with both eating disorders and chronic illness can help translate medical recommendations into something more flexible, such as:

• A certain number of electrolyte bottles each day

• Including a salty food at meals and snacks

• Keeping reliable hydration options in several locations

• Using visual rather than numerical hydration cues

• Creating minimum hydration supports for difficult days

• Identifying foods and drinks that work with sensory and GI needs

The goal is to support your POTS without creating another set of food rules.

A note about nutrition with POTS

Hydration is important, but nutrition care for POTS shouldn’t stop at electrolytes. People living with POTS may also be dealing with nausea, early fullness, diarrhea, constipation, reflux, fatigue, headaches, sensory differences, limited energy for cooking, food intolerances, or overlapping conditions such as hypermobile Ehlers-Danlos syndrome (hEDS).

Sometimes a nutrition plan for someone with POTS might help answer these questions:

How do we get enough food into you when standing in the kitchen makes you dizzy?

What can you eat when nausea is making everything sound terrible?

How can we increase fluids and sodium without making your stomach miserable?

What do we keep next to your bed for difficult mornings?

What are your backup foods when you have absolutely no energy to cook?

When should you talk with your healthcare provider?

Talk with your healthcare team before significantly increasing sodium or electrolyte supplements, especially if you have:

• High blood pressure

• Kidney disease

• Heart disease or heart failure

• Significant swelling or fluid retention

• Abnormal sodium or potassium levels

• Medications that affect blood pressure, sodium, potassium or fluid balance

POTS treatment is individualized, and hydration is only one component. New or severe symptoms such as fainting with injury, severe chest pain, significant shortness of breath, confusion, or other concerning cardiovascular or neurological symptoms also warrant medical evaluation rather than simply increasing electrolytes.

The bottom line on hydration and electrolytes for POTS

For many people with POTS, increasing fluid and sodium is an important part of symptom management.

But you may also need to consider:

• How much fluid you’re actually drinking

• How much sodium you’ve been advised to consume

• Whether your electrolyte drink contains enough sodium to meaningfully contribute

• Whether an oral rehydration solution is useful

• How you tolerate different drinks

• How you’ll remember to hydrate consistently

• Whether nausea or early satiety makes large amounts of fluid difficult

• How your needs change with heat, illness and activity

• How to incorporate hydration without making food and nutrition feel even more rigid

The goal is to find a hydration and nutrition routine that helps you feel more supported in your actual life.

Looking for nutrition support for POTS?

At In Good Company Nutrition, nutrition counseling is weight-inclusive, practical, and designed around the reality of living in a human body, including bodies dealing with chronic illness, neurodivergence, GI symptoms, disordered eating, and complicated relationships with food.

If POTS, dysautonomia, EDS, early satiety, nausea, or executive dysfunction are making feeding and hydrating yourself feel like a full-time job, nutrition counseling can help you build strategies that are individualized to your body instead of handing you another list of rules to follow.

In Good Company Nutrition offers virtual nutrition counseling for adults in Pennsylvania, Maryland, Virginia, and Delaware.

This article is for educational purposes and isn't a substitute for individualized medical care. Fluid and sodium recommendations for POTS should be personalized with your healthcare team.