What is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a recognised disorder of the autonomic nervous system. This system controls heart rate, blood pressure and digestion. People with POTS experience an abnormal increase in heart rate when moving from lying or sitting to standing, without a large drop in blood pressure.

Typically, the heart rate rises by 30 beats per minute or more within 10 minutes of standing, and symptoms such as dizziness, fatigue, palpitations, blurred vision or “brain fog” can appear. It can affect both men and women, but is most common in women aged between their teens and mid-forties. Although POTS isn’t life-threatening, it can be debilitating if not properly recognised and managed.

Causes and Triggers

There isn’t one single cause for POTS. It usually develops when several factors come together to affect circulation or nerve control.

Possible causes and triggers include:

• After a viral illness such as glandular fever or COVID-19
• Following surgery, pregnancy or trauma
• Long-term bed rest or deconditioning
• Low blood volume (due to dehydration, bleeding, or salt deficiency)
• Autoimmune or connective-tissue conditions, such as hypermobility syndromes (e.g. Ehlers-Danlos)
• Hormonal changes, including after menopause

Medical Conditions Linked to POTS

POTS can also appear alongside other health problems such as:

• Chronic fatigue syndrome (CFS/ME)
• Mast cell activation disorders
• Migraine, fibromyalgia and irritable bowel syndrome (IBS)
• Thyroid or adrenal disorders
• Low iron or vitamin B12 levels

If these conditions are present, they may worsen or mimic POTS symptoms, so a careful medical assessment is important.

Medicines That May Worsen POTS Symptoms

Certain medications can contribute to rapid heart rate, low blood volume or changes in vascular tone.

Examples include:

• Stimulant medicines (used for ADHD or weight loss)
• Diuretics (fluid tablets) that lower circulating volume
• Antidepressants or blood-pressure tablets that affect autonomic control
• Excessive caffeine or energy drinks

Always review your medicines with your pharmacist or GP before making any changes.

Symptoms You Might Notice

POTS symptoms can vary from mild to severe, and may include:

• Rapid heartbeat or palpitations when standing
• Feeling light-headed or faint
• Extreme tiredness or weakness
• Brain fog and poor concentration
• Nausea, bloating or early fullness after meals
• Sensitivity to heat, especially after showers or in warm weather

Symptoms often improve when lying down and worsen when upright or after large meals.

How POTS Is Diagnosed

Diagnosis usually involves:

• Reviewing your symptom history
• Measuring heart rate and blood pressure when lying and standing (or using a tilt-table test)
• Excluding other medical causes such as anaemia, thyroid disease, heart conditions or dehydration

This is best done in collaboration with a GP, cardiologist or neurologist familiar with autonomic disorders.

Treatment and Management

There is no single cure for POTS, but most people improve with the right plan.

1. Lifestyle and physical measures

• Hydration: Aim for 2–3 litres of water daily.
• Salt intake: Your doctor may recommend increasing salt (sodium) intake to boost blood volume.
• Compression garments: Waist-high stockings can help reduce blood pooling in the legs. We recommend the Sigvaris range .
• Gentle exercise: Begin with seated or reclined activities (recumbent cycling, rowing, Pilates) and gradually build up.
• Avoid triggers: Limit long periods of standing, hot environments, and large heavy meals.

2. Medical management

Your doctor may consider specific prescription medicines if lifestyle changes aren’t enough. Options may include:

• Fludrocortisone – increases sodium and water retention to expand blood volume
• Midodrine – helps tighten blood vessels and improve circulation
• Beta-blockers or ivabradine – slow the heart rate to control tachycardia

These are often used “off-label” in Australia and require specialist oversight.

Nutrition, Vitamins and Foods That Help

Nutrition plays a vital role in managing POTS and supporting energy levels.

Helpful dietary approaches:

• Small, frequent meals instead of large heavy ones
• Adequate hydration and electrolytes (sodium, potassium, magnesium)
• Protein-rich and high-fibre foods to support blood sugar stability
• Iron, vitamin D and vitamin B12 supplementation if blood tests show deficiency
• Magnesium or B-complex supplements may help energy and nerve health.

Foods or substances to minimise:

• Alcohol (can cause dehydration and worsen symptoms)
• Excess caffeine or energy drinks
• Very high-fat or high-carbohydrate meals
• Hot spicy meals or saunas that trigger vasodilation

A dietitian with experience in autonomic or gastrointestinal conditions can create a personalised plan.

Living Well With POTS

Living with POTS takes patience, structure and support. Many people feel frustrated when symptoms are misunderstood or dismissed as anxiety. Knowing that POTS is a recognised medical condition and that recovery is possible, can be empowering.

At Lygon Everyday Chemist, our pharmacists can:

• Review your medicines for possible contributors to POTS symptoms
• Recommend supportive supplements or hydration aids
• Liaise with your GP or specialist for ongoing care

Simple, consistent changes - hydration, salt balance, gentle movement and nutrition can lead to steady improvement over time.

When to Seek Help

See your doctor if you experience frequent dizziness, rapid heartbeat or fainting on standing. Early diagnosis and multidisciplinary care can prevent unnecessary distress and improve recovery outcomes.

References

1. Healthdirect Australia. Postural Orthostatic Tachycardia Syndrome (POTS). 2024.

2. Australian POTS Foundation. Living with POTS & Treating POTS. 2024.

3. Cleveland Clinic. POTS – Causes, Symptoms, Diagnosis & Treatment. 2023.

4. Mayo Clinic. Postural Orthostatic Tachycardia Syndrome and Chronic Fatigue. 2023.

5. National Center for Biotechnology Information (NCBI). StatPearls: Postural Orthostatic Tachycardia Syndrome. 2023.

6. Garland EM et al. Effect of High Dietary Sodium Intake in POTS. Journal of the American Heart Association, 2021.

7. BioCeuticals Australia & Blackmores Institute – Nutritional Support for Autonomic and Circulatory Health, 2023.