POTS is a disorder of the autonomic nervous system, controlling involuntary bodily functions like heart rate and blood pressure. It is characterized by an abnormal increase in heart rate—usually 30 beats per minute or more—when moving from lying to standing. For people with POTS, an intense desire for salty foods is a common symptom. This craving is a direct biological signal attempting to manage a core physiological problem related to blood volume regulation.
The Physiological Mechanism Behind Sodium Cravings
The intense desire for salt in many people with POTS is a response to chronic hypovolemia, or abnormally low blood volume. When standing, gravity causes blood to pool in the lower extremities, and the autonomic nervous system fails to properly constrict blood vessels. This results in decreased blood volume returning to the heart and brain, triggering tachycardia as the heart tries to compensate.
Sodium is the primary determinant of fluid volume, and the body’s attempt to increase plasma volume drives the salt craving. Consuming sodium allows the body to retain more water in the bloodstream, acting as a volume expander. This increased blood volume helps normalize circulation and reduce orthostatic symptoms like dizziness, lightheadedness, and fatigue.
Volume regulation is managed by the renin-angiotensin-aldosterone system (RAAS). Many POTS patients exhibit the “renin-aldosterone paradox”: Aldosterone signals the kidneys to retain sodium and water, but levels are often inappropriately low despite low blood volume. This failure leaves the body volume-depleted. The salt craving acts as a behavioral compensation mechanism, correcting the deficit the hormonal system fails to address.
Medical Guidelines for Salt and Fluid Intake
Medical management for many POTS patients involves increasing both sodium and fluid intake to expand plasma volume. Standard dietary recommendations limit sodium intake to under 2,300 milligrams per day, but this is often reversed for individuals with POTS. Clinical guidelines suggest an intake of 3,000 to 10,000 milligrams of sodium daily, depending on symptom severity and individual response.
Increased sodium intake must be paired with increased fluid consumption. Sodium draws water into the bloodstream through osmosis; without sufficient fluid, high salt intake is ineffective and can cause dehydration. Healthcare providers recommend drinking 2 to 4 liters of fluid daily, often suggesting that a portion should be electrolyte-rich.
For the high-sodium regimen to be safe and effective, patients must consult with a physician to determine specific needs, especially if they have co-existing conditions like hypertension or kidney issues. The goal is to find the optimal balance that manages symptoms without causing side effects such as excessive fluid retention or edema. Monitoring blood pressure and heart rate is a standard part of this plan.
Practical Ways to Incorporate Extra Sodium
Achieving the high sodium goals requires a deliberate effort beyond simply salting meals. One straightforward method is incorporating high-sodium foods into the daily diet, moving away from low-sodium habits. Convenient food sources include heavily salted broths or bouillon, canned soups, pickles, olives, and salted nuts.
Supplementing the diet with salt tablets or capsules is often the most efficient way to meet high numerical targets. Products designed as electrolyte supplements can provide a concentrated and measurable dose of sodium. However, taking salt supplements must always be done under the supervision of a healthcare provider to ensure correct dosing and monitor for adverse effects.
Another practical strategy involves utilizing electrolyte-rich beverages, which deliver both sodium and fluid simultaneously. These include commercial sports drinks, specialized oral rehydration solutions, or homemade mixtures. Spreading the intake throughout the day is more effective than consuming a large amount all at once, as it maintains a more stable blood volume. Some people consume an electrolyte solution immediately upon waking to pre-load the circulatory system.