Salt and Electrolytes for POTS

Estimated reading time: 8 minutesI was officially diagnosed with Postural Orthostatic Tachycardia (POTS) after the pandemic.  Like many people, my moderate POTS symptoms that I had managed all my life became much worse post pandemic.

This led me to see a leading EDS cardiologist for investigation. He recommended daily electrolytes as one part of my management plan. There are so many different types and forms on offer now – it was really difficult to find one that suited me.

I have been asked many times by clients about what brand of electrolyte to purchase, and it is a frequent topic in our Zebra Club community. I asked Lorna Ryan, rNTP and leading EDS nutrition authority to share her views here on electrolytes for the EDS and HSD population.

This information is meant for general guidance only. Please consult with your healthcare providers who understand your specific medical history, conditions, and symptoms before making any health decisions.

Electrolytes and hydration

Electrolytes are chemical compounds with either a positive or negative (+/-) charge when dissolved in water. Essential electrolyte minerals include sodium, potassium, calcium, chloride, magnesium, and phosphorous & require water (H2O) to act as a carrier. Electrolytes are naturally abundant in dietary intake.

How do electrolytes work in the body? Essentially, electrolytes control chemical reactions & maintain the regulation of fluids inside and outside cells.

Specifically:

• Sodium (Na+) supports fluid balance, muscle contraction, nerve signaling
• Potassium (K+) supports nerve impulses, muscle function, heart rhythm
• Calcium (Ca2+) supports bone health, muscle function, nerve transmission
• Magnesium (Mg+) supports cell use of nutrients

Electrolyte balance is maintained within tight margins, mainly due to kidney function & hormone regulation. Increased perspiration (sweat), urination, vomiting, diarrhea, medications & some chronic health conditions lead to altered electrolyte and/or fluid balance.

Salt and Electrolytes may help POTS

Firstly, to preface this topic, we should consider research on salt intake for management in POTS is for the population with POTS. It is not specifically for individuals with EDS and POTS.

Therefore, when discussing salt intake for POTS it’s important (and my soap box!) that we consider the totality of implications in EDS – such as altered GI function, altered tissue laxity, venous insufficiency, and frequent urination.

Research suggests salt intake (or higher sodium intake) for POTS increases blood volume, therefore positively supporting symptoms such as dizziness, syncope, and palpitations (1).

Specifically, research finds high dietary sodium intake compared to low dietary sodium intake increases plasma volume whilst lowering standing plasma norepinephrine (2).

How may higher salt intake help POTS? Well, this depends on case by case presentation.

Some may experience increased sweating, where the loss of sodium is increased. Some may experience loose stools, where the loss of potassium is increased. Some may have kidneys involved where electrolyte balance is compromised.

So can we say salt helps POTS – not entirely. Can we say correct electrolyte balance may support POTS symptoms – yes.

Photo by Jason Tuinstra on Unsplash

How much salt do you need?

Intake of adequate salt depends on many factors for the individual with POTS & EDS.

Many differing daily salt intake guidelines exist for adults, depending on geographic regulations. A healthy adult requires only a relatively small amount to sodium daily to function well (approx. 200 – 500 mg). At time of electrolyte imbalance, increased daily dietary salt or occasional electrolyte supplementation may be helpful.

With health conditions such as POTS, maintaining a higher sodium diet or regular electrolyte supplementation may be beneficial. Increasing to 3,000-10,000mg salt daily for some may support symptom presentation. Exact intake cannot (and should not) be advised as a broad stroke suggestion.

Symptom presentation and co-occurring conditions, bowel habits,  and existing dietary & fluid intake must be considered in each case.

What is the difference between salt & sodium?

Salt, (also known as sodium chloride or NaCl) is made up of approximately 40% sodium and 60% chloride. Sodium is the pure chemical element.

Dietary salt occurs when sodium and chloride elements combine. Approx 1 gram of sodium = 2.5 grams of salt. (So if your provider recommends 8g of salt a day, that is 3.2g or 3200 mg of sodium)

But, salt/sodium is not the full picture. To be accurate in dietary considerations we should note potassium also. Potassium interplays with how the body uses sodium. Potassium works in the opposite way as salt.

It’s relevant, therefore to question if an increase in salt in the diet is needed or if a higher dietary potassium intake is needed. Ensuring sufficient dietary potassium is key.

We should consider calcium also. Too high dietary sodium intake leads to loss of calcium. Anyone with risk factors for bone health should seek advice on increased sodium intake.

Supplementing: Salt tablets or Electrolyte Powders

Firstly, we should ask; do you need to supplement?

Not everyone with POTS requires electrolyte supplementation. If there is a medical need for prescription salt tablets, that is discussion to have with an individual’s medical Doctor.

Beyond that, infrequently the topic of dietary sodium or fluid intake/loss is questioned before advice to supplement with electrolytes is given. Or for an individual self-purchase.

Before supplementing with electrolytes, we aim to review the quantity of dietary salt & fluid, matching this with factors such as physical presentation like sweating, bowel movements, cramps, etc. Then, an informed choice can be made between products.

What you should look for in a supplement?

First: Evidence, evidence, evidence! Your products need to be fully tested & regulated.

Second: A supplement that matches your needs; an oral rehydration solution is different than an electrolyte. Most oral rehydration preparations are based on the WHO oral rehydration solution (which you can make easily at home). These will be helpful in times of fluid loss due to acute illness/conditions (vomiting, excess sweating, diarrhea) where rehydrating is imperative.

If we’re looking for an electrolyte supplement to maintain improved daily electrolyte imbalance to support low blood volume & poor water retention in POTS, here’s what we should look for in a product:

• Sodium = 500mg sodium per serving.
• Potassium = 100mg sodium per serving.

If we’re looking to support the acute onset of symptoms associated with POTS in times of prolonged exercise or water loss in stool, then here’s what we should look for in a product:

• Sodium = 120-130mg per serving
• Potassium = 20 – 25mg per serving.

Third: Co-occurring conditions in EDS should be considered when discussing electrolytes for POTS (and this is too often overlooked!):

• On presentation of MCAS, the additive, flavorings & colorings will likely not be tolerated.
• On presentation of upper GI concerns, higher potassium levels in oral solutions may lead to stomach irritation.
• For those with swallowing concerns a volume of liquids or a capsule may be difficult.
• With the co-morbidity of Lipedema, the potential for altered tissue concentration of sodium should be considered.

Other ways to help with sodium intake and hydration

We can do much to improve dietary salt/sodium & fluid intake. And, no it’s not all about salty snacks! Many nutrient-dense foods naturally contain sodium, if one is consuming a balanced diet it is likely sufficient salt is being consumed.

To enhance intake we can look at foods such as;

• Blended capers & olives
• Roasted nuts & seeds with salt
• Canned beans
• Seafood from salt-rich oceans
• Pickled veggies
• Soy sauce

Other ways to help hydration: Drink mineral rich water (as opposed to fully filtered). Bulk drink 200ml fluids if not contraindicative for your health conditions and drink frequently during the day to suit your climate & activity.

You can increase the uptake of fluids by supporting absorption. Simple carbohydrates (glucose molecule) aid sodium & water absorption from the intestinal lumen. A few ways to do this:

• Consume milk
• Add a small quantity of fruit juice & pinch (1/8th teaspoon) of salt to 1L fluid
• Note more glucose (sugar) reduces the effect.

Is sugar necessary in electrolyte supplements?

Depending on the manufacturing process, molecule size, and ingredients, often yes. Glucose supports the absorption of sodium. But the quality required is small. Most sugar found in electrolyte products is formulated for taste.

What about Intravenous (IV) fluids for hydration in POTS?

Whilst many in POTS & EDS groups discuss IV fluids for the management of POTS, with some benefits reported, there is no robust research, clinical efficacy, or guidelines for regular IV fluid use in POTS – or EDS. Therefore this method is not advised.

IV fluid may be used in emergency medical situations such as surgery, excessive fluid loss (i.e., due to prolonged vomiting), or compromised oral intake of fluids (i.e., due to complex gastrointestinal disorders/swallow concerns). This is strictly under medical care.

For those with EDS, there are additional dangers associated with regular IV saline fluids. It should not be considered a management route to increasing hydration.

Comparison of Different Electrolyte Supplement Brands

Here is a side-by-side comparison of some of the popular electrolyte supplement brands available. None of these are endorsed by either Jeannie Di Bon or Lorna Ryan. Remember, it is always best to speak with your provider about how much sodium is needed for your particular symptoms.

When looking at supplements you may want to compare the amount of electrolytes per serving, the cost, taste, and any ingredients that may not suit you.

Since each has a different amount of sodium, we also include the cost per 500mg of sodium so you can compare prices more easily.

Vitassium Capsules (US/UK/Europe/Can/Mex/Aus/NZ)

Amount of sodium and potassium per serving: 250mg/capsule but a serving is 2 capsules for 500 mg sodium and 100mg potassium

Cost per serving: USD: $23.99 for 100 capsules which is $0.48 per serving, or the 200-count bottle for $39.99 which works out to $0.40 per serving

Price per 500mg: USD $0.48

Ingredients: Sodium chloride, potassium citrate, hypromellose (vegetable capsule), vegeterian stearic acid

Note: You can join the Vitassium Club which will give you 25% off in the US, and 20% UK, Europe, Australia, and more

Vitassium Fast Chews (US/UK/Europe/Can/Mex/Aus/NZ)

Per serving: 125mg Sodium, 25mg Potassium

Price per 500mg: USD $1.12

Cost per serving: USD: 60 tablets per bottle, $16.99 per bottle $0.28 (USD) per chew

Ingredients: Sodium citrate, potassium citrate, dextrates, dextrose, citric acid, stearic acid, natural fruit punch (orange, lemon, grapefruit) & raspberry flavors, crospovidone, silica, magnesium stearate, Reb A (stevia extract).

LMNT Powder (US/UK/Canada/Aus)

Per serving: 1000 mg, 200mg Potassium

Cost per serving: USD: (USD) $1.50 (one-time purchase) or $1.30 (subscribe and save)

Price per 500mg: USD $0.75

Ingredients: Salt (Sodium Chloride), Citric Acid, Magnesium Malate, Potassium Chloride, Natural flavors, Stevia leaf extract (with variations for flavors)

Note: LMNT has published its recipe for the unflavoured version which may be more cost-effective. They say “if you used magnesium malate, one serving weighs about 3.3 grams; if you used di-magnesium malate, one serving weighs about 3.15 grams.”:

• For one serving:
  • 2,500 mg sodium chloride (for 1,000 mg sodium)
  • 385 mg potassium chloride (for 200 mg potassium)
  • 390 mg magnesium malate OR 265 mg di-magnesium malate (for 60 mg magnesium)
• Or for 30 servings:
  • 75 grams sodium chloride
  • 11.5 grams potassium chloride
  • 11.7 grams magnesium malate OR 8 grams di-magnesium malate.

Liquid IV Powder (US, Australia, Canada, China, Mexico, Italy, and the UK)

Per serving: 510mg, around 380mg Potassium (varies by flavor)

Cost per serving: (USD) One-time purchase is $1.56 a stick and subscribe and save is $1.09 a stick for each package size (16, 32, 64 sticks)

Price per 500mg: USD $1.53

Ingredients: Cane Sugar, Dextrose, Citric Acid, Salt, Potassium Citrate, Sodium Citrate, Natural Flavors, Dipotassium Phosphate, Silicon Dioxide, Stevia Leaf Extract, Vitamin C, Vitamin B3, Vitamin B5 ,Vitamin B6, Vitamin B12

Buoy Drops (US, but ships internationally)

Per serving: 50mg per serving (1 short squeeze which is 1.5ml), 15mg Potassium per serving

Cost per serving: USD This works out to $0.33 (one time) or $0.28 (subscribe and save) per serving. Keep in mind that unlike the others 1 serving is only 50mg of sodium so the actual cost for the amount of sodium you are getting is much higher than the others – there is 200mg in one bottle (the equivalent of 2 packets of LMNT or 4 of liquid IV)

Price per 500mg: USD $3.30

Ingredients: They are not straightforward with ingredients, they say they have sea minerals (Sodium, Chloride, Potassium, Magnesium, 87 ionic trace minerals (proprietary blend) and B vitamin complex and antioxidants (the mention Acacia, Rosemary, Blood Orange, Star Anise)

Redmond ReLyte Hydration Powder

Per serving: 810 mg Sodium, 400mg Potassium

Cost per serving: These come in a tub and sachets. The tub works out to USD $0.75 (one time) or $0.64 (subscribe and save) per serving.

Price per 500mg: USD $0.46

Ingredients: Redmond Real Salt, essential electrolytes (sodium, potassium, chloride, calcium, magnesium), coconut water powder, non-GMO citric acid, and natural flavors, with stevia leaf extract. Note this contains COCONUT.

Bulk Unflavoured Electrolyte Powder (UK and Europe)

Per serving: “1034 mg sodium and 306mg potassium per serving (2 servings)” We are unclear if that means 517 mg sodium per serving due to the 2 servings inclusion.

Cost per serving:  Depending on the size of the bag ordered – £0.10/serving to £0.06/serving

Price per 500mg: £0.10

Ingredients: Sodium Chloride, Potassium Sulphate, Dicalcium Phosphate, Magnesium Oxide.

Sodii Powder (Australia)

Per serving: 1000mg sodium, 210 mg potassium

Cost per serving: Price will differ based on flavor and if you do sachet or tub. For a flavoured tub, this works out to AUD $2.23 per serving which decreases the more you buy they also have a bundle and save option.

Price per 500mg: AUD $1.12

Ingredients: This will vary by flavor, for example, grapefruit: Sodium chloride (Lake Deborah Salt, Western Australia), potassium chloride, magnesium gluconate, citric acid, tartaric acid, natural grapefruit flavor (contains grapefruit oil), silica, organic stevia.

This is not an exhaustive list, let us know in the comments if you have found a recipe or brand that works for you!

Interested in more on EDS and Nutrition? Check out this video where Lorna breaks down some common myths!

FAQ:

Why does salt help POTS?

Research suggests salt can help with POTS by increasing blood volume. This can help with symptoms like dizziness, fainting, and palpitations. It is best to speak with your providers about the amount you need based on your situation.

How much salt should I have with POTS?

For people with POTS, maintaining a high-sodium diet and supplementing with electrolytes can be helpful. Some recommend around 3,000-10,000mg a day, but this needs to be personalized to your symptoms and co-occurring conditions like digestive issues.